Dog park bowling. Even after falling victim to this new urban sport, I could joke about it. Only after the second round of complications did the wisecrack turn stale.
Late November 2017, I was watching my dog play with another, a shaggy white critter who looked like Muffin, my very first dog from third grade. Muffin had mysteriously disappeared after a short time. The dogs I was constantly bringing home always disappeared without explanation sooner or later, and I was determined to have keepers when I grew up. My college graduation present, the only thing I asked for, was an Irish setter puppy named Fergus who lived to be 16 and set the pattern for my adult life.
Now, four dogs later, I was laughing at the latest. Ginger was a young, exuberant shepherd/retriever mix rescued from California’s Central Valley and brought to the San Francisco Society for the Prevention of Cruelty to Animals for the express purpose of finding a sucker like me. We called her the Moose. Sixty-plus pounds of energy, she was tearing after the Muffin dog, much to my delight.
I looked away for a moment, and when I looked back, it was too late. Ginger roared into my left leg, smashing the tibia, fibula, and medial malleolus. Later, everyone assumed my leg broke from the fall, but I actually stood like a stork on the good leg, then crumpled to the soft ground. I was a ten pin pickup in dog park bowling, done in by my own pooch.
Everything went as well as it could at first. The other dog walkers jumped in, corralling the beasts and calling 911. Two of them ran to the somewhat obscure entrances to flag down the paramedics and guide them in. Another called my partner, Iris, and I caught her just about to walk out the door. “I have a broken leg! Come and get Ginger!” I wailed.
Adrenaline is a wonderful thing. I felt hardly any pain and knew the leg was broken only by visual clues: thigh pointing one way, shin another, shoe looking like it belonged on a rag doll. I didn’t learn about the ankle break until the x-rays came back.
The paramedics were accompanied by a physician from Stanford who trains paramedics, so everything went by the book. Who knew that shoving cardboard under your leg and securing it with wrapping tape is the standard of care? It worked.
Iris arrived to collect Ginger, throwing herself down to give me a kiss, as the EMTs prepared to hoist me onto a gurney. One of the dog walkers offered to add Ginger to his pack, an opportunity we later pursued. Next-door neighbor Gail agreed to watch her for the day. Two friends who had taken the Moose in during our recent trip to New York offered to keep her for a week. Arrangements were falling into place.
As I rode in the rescue vehicle to the hospital, one paramedic shared the team’s relief at my injury. The only information they had been given was “trauma at the dog park,” and imaginations ran wild with vicious dogs, blood, and scattered limbs. My garden variety broken bones seemed like nothing.
By the time Iris caught up to me in the emergency room, I was on pain meds with leg somewhat straightened, x-rays completed. The surgeon, Dr. K, came by with news about the ankle break and plans for surgery later that day. The medical personnel were all competent and sympathetic. As bad as the incident was, all seemed to be going smoothly.
And so it went for two nights in the hospital after surgery, which resulted in many metal pieces inserted to stabilize my breaks. I started joking that a few small gardening tools might be found in my shin. Pain wasn’t a problem, and my spirits were high enough.
The first major challenge was getting home up our 30 steps. My short session with physical therapy in the hospital was mostly useless, as I was so weak and dizzy I could hardly make it to the practice stairs, much less go up them. Fortunately, I had already undergone two hip replacement surgeries, followed each time by a week in rehab, and was well coached in the stair-climbing technique necessary to conquer the second floor on one leg, a rail, and a crutch.
This time rehab wasn’t an option. In the ER, I had overheard a depressing series of conversations between the medical and social work staff and a patient behind the curtain, an elderly woman living alone who was being sent home, even though she had no one lined up to care for her. The only available rehab beds were as far away as San Jose or Sacramento. In the years since my hip surgeries, the hospital had canceled contracts with convenient local facilities. No way was I going 100 miles from home.
Bella the discharge planner presented me with two options: a wheelchair taxi that would cost $75 and deposit me at the foot of the steps, and a free ambulance with service to actually carry me up. I freaked out at the idea of being hauled, all 180 pounds, on a gurney around our curving faux marble steps, picturing a slip and me whizzing down like a bobsled. I asked, couldn’t the ambulance people drive me there and just help me up without the bobsled? No, it was a package deal.
Iris, a retired nurse well versed in such things, wasn’t there for the decision and told me that there’s no bobsled; they carry you up in a chair. Too late. I had already chosen the more expensive, less complete service. During the ride home, Iris and I noticed Biblical quotes stenciled all over the walls of the cab. Sure enough, as soon as I lurched out of the wheelchair and onto my crutches, the two-person taxi crew enveloped the hard-boiled atheists in extended hugs and uttered prayerful blessings on our heads. Perhaps a Divine Escalator was about to appear! But the crew with the heavenly connections abandoned us, and the stairs refused to flow upward.
Friend Sylvie had agreed to meet the wheelchair cab and arrived in time to get her hug and blessing. She formed the other slice of the human sandwich that would guard my progress. Two women in their seventies, both much smaller than I am, were going to help me climb Mt. 26th Street. My good leg felt like cooked spaghetti as I put all my weight on the crutch and rail and hopped up, dragging the booted broken leg behind. The first step felt about three feet high, but I got the hang of it and humped up to the first landing, where we all rested. The second flight was harder, as I was exhausted and plants on the stairs obstructed the rail, but we made it.
Prior to what one old East Coast friend waggishly referred to as the “Ginger snap,” I had been feeling fit and trim. Always a jock, I got most of my exercise into and past middle age walking and bicycling. When I was laid off from my full-time medical editing job in 2009 and wobbled to retirement with part-time freelance gigs for the next several years, my regular bike commute faded and I gained some weight. Getting Ginger as a rambunctious yearling in 2016 meant long walks, often up San Francisco’s steep hills, and I shed about 20 pounds with little effort.
I was a healthy 68-year-old on the fateful day in November, basically a dream patient, with no diabetes, allergies, or sleep apnea and no medications stronger than baby aspirin. I felt for patients whose concomitant conditions made their care more difficult. One daunting complication was my size. Whenever I stood up during my entire medical journey, hospital staff would comment that I was tall, often with a quaver that meant “Please don’t fall on me!” Iris and Sylvie were no doubt thinking something along those lines on our journey up the stairs.
Once home, I was able to enjoy the benefits of community. San Francisco is rapidly gentrifying, and my friends and I all know many people who have been forced to move. My weeks marooned at the top of the stairs brought home the importance of being able to stay in one place. Iris and I are the lucky tenants of a rent-controlled apartment we’ve lived in for over 20 years, in a walkable neighborhood where we’ve gotten to know everybody. Being active in several social justice campaigns added to the circle of friends we had accumulated through work and other contacts. The most heartening aspect of my medical trials was the response from this wide network. For the first month I was home, we had to cook maybe two or three dinners from scratch. The rest were casseroles, soups, restaurant deliveries, and other contributions. With the food came company, and the odd result of being homebound was that I socialized more than usual.
Life may seem to stop during an emergency, but the outside world wasn’t revolving around my problems. I came home on a Friday, and that very Monday had a long-standing appointment to deal with. Several students from Kings College, London, were coming all the way to San Francisco to learn about the streetscape project on Cesar Chavez Street that I had worked on. They had seen Susie Smith’s short documentary about it, People Live Here. We had a date to discuss the project and its implications for gentrification. I had planned to walk with them along the corridor and point out important changes, allies such as the Day Labor Program, and landmarks like schools and public housing. That plan was out the window, but I couldn’t just stiff these kids who had traveled such a distance. So they came to me, trooping up the 30 steps and settling in for a lively discussion. I had handouts for them and enjoyed the back and forth, but the scene was surreal. Me with my leg propped on pillows, still loopy from pain meds, surrounded by these young ’uns from abroad, a heartwarming mix of men and women, some of South Asian descent, a few very pale looking, one woman in a headscarf, all serious and intense. They charmed the hell out of me, but, less than a week out of the trauma and surgery, I was a dishrag when they left.
Ginger was still away with friends when I came home, but she soon returned, and her daily walks became a focus. Gail, a retired project manager, drew up a spreadsheet with four daily time slots. Mark, the professional dog walker who knew Ginger from the park, added her to his pack three mornings a week, taking care of the exercise slot for those days. Sylvie’s own dog had died recently, and she filled in the other two weekday long walks. Weekends, various friends stepped up. The three short pee ’n’ poop walks were a scramble of friends and neighbors, mostly Gail, plus Iris, whose back injuries as a nurse were always a threat to bring her down if she had to wrestle with the dog too much.
About two months in, late January, I became able to put weight down on the affected leg and gradually worked up to using one crutch, then just a cane. Home health physical therapy worked me over with practice on the stairs, and I was able to move on to outpatient PT. Toward the end of February, I felt up to walking Ginger alone, just around the corner for a quick pit stop at first. I was terrified that she would see a cat or raccoon and yank me off my feet, but through March, I grew stronger and gained confidence. Complication number one was not on the agenda.
On April Fools’ Day, I took the Moose for her early morning stroll to the park two blocks away. A young woman with a sweet German shepherd puppy asked if they could play, and I made the mistake of my life by saying yes. We dropped the leashes, and they frolicked for a few seconds before Ginger spotted a half-eaten burrito. She started wolfing it down, the other dog came over to inquire, and Big G let out a snarl.
I decided it was time to go and picked up her leash. The grass was wet and the ground on a slope. When Ginger resisted, down I went, sticking out my arm to break the fall. Again, I didn’t feel pain, but I could tell by the wavy contour of my right arm and wrist that it was broken. I couldn’t believe it. The young woman came over and helped haul me up, obviously upset at the turn of events. I asked her to tie Ginger to the fence and limped home, my cane hand useless. Day laborers who asked if they could help agreed to keep an eye on the Moose for a few minutes.
For a second time, poor Iris heard me wail as I came up the steps, this time “My arm’s broken! We have to get rid of the dog!” She called Gail to deal with Ginger and off we went to the ER. The whole way there, we went back and forth about the dog. I just couldn’t face another three months of hiring dog walkers, imposing on friends and neighbors, and feeling vulnerable. We both felt our hearts breaking, and tears flowed in the taxi.
It being a Sunday, I got x-rays and a temporary cast with orders to come back the next day when the experts could finish the job of setting my arm. The ER doc and nurses trotted out the most amazing tool to straighten out my arm in the meantime. An IV pole dangled several little mesh cylinders that worked like the finger toys children use. You put your finger in, and it gets stuck when you try to pull it out. Finger traps in the ER followed the same principle, and my arm was left to hang after all five fingers were inserted into the cylinders. Who needs high tech? The toylike finger traps did the trick well enough for me to be sent home.
Iris and I were relieved to learn that I wouldn’t need surgery, but nothing I had undergone in my leg repair hurt as much as the bone setting manipulations the physician assistant performed the next day under fluoroscopy. She got the radius and ulna bones, which had slid one piece under another like the tectonic plates that cause California’s earthquakes, almost aligned for the hand expert orthopedic doctor who came in for the kill. He gathered my hand in his, placed his foot on my bicep, and yanked. The bones popped into place, and cast number two was quickly wrapped around my arm and wrist from past the elbow to fingers. One week later, I would get new x-rays and another cast, and two weeks after that a final, slightly shorter, cast. Total time when I could do nothing but waggle my fingertips, six weeks.
Meanwhile, on that Sunday after returning from the ER, we did take Ginger back to the SPCA and surrendered her for adoption. It was a sad day for me and even harder for Iris, who felt like we were abandoning the dog we had taken in and planned to live with until she died. We had always had a dog, and all of them had made it together with us to a natural death helped along at the very final moment. Each good-bye was heart-wrenching, but we knew we had given these dogs a loving home through their last days. Getting acupuncture for Fergus and chemotherapy for Lefty, scooping Spokes off the floor when she could no longer get up, buying a harness to help Kelsey on the stairs when her legs started to give out—every dog had some sad issue toward the end, but we were always there for them, and their deaths lacked the sting of giving up on Ginger.
We knew at least that such a magnificent beast would be adopted quickly. Sure enough, the Moose’s picture went up on the SPCA website on Monday and was gone by Friday. Iris and I had tortured ourselves during that week, checking the site several times a day.
After surrendering Ginger, I focused on continuing rehab for my limping leg and coping with an immobile arm. Even though I broke my dominant right arm, the main problem wasn’t that I had to use my left hand for everything; it was that I had only one hand instead of two. I couldn’t tie my shoes, put on my watch, floss, or use the rail down the stairs. So I went down the stairs backwards with the rail in my left hand, Iris put on my shoes and watch for me every morning (I could wrestle them off), and I used brush picks on my teeth. The arm felt less serious than the leg somehow because at least I could get around.
The combination of injuries, however, brought embarrassment at being so accident-prone. Sylvie took one look and said “Now what?” When I returned in a cast to the laundromat to help Iris wrangle the towels and undies, the manager did a double take, “I thought it was your leg.” I joked to all that I expected a piano to fall from the sky and maybe it would be a good idea not to stand too close. The old blues “Born Under a Bad Sign” became my new theme song. But I figured exercises and time would cure all.
I was unprepared for complication number two.
Some time in early May, a clear blister appeared on my affected leg, just below the knee. It wasn’t red or painful, just there. Iris and I had typically different responses. She, of Russian Jewish immigrant descent, expects to find a Cossack or Nazi behind every bush, and her worst-case scenario mentality insisted that this cystlike obtrusion was bad news. I, on the other hand, of old American WASP smugness, thought it was nothing. We went back and forth about what to do. Iris: Don’t you think you should write Dr. K? Fran: I don’t want to bug him. Iris: I don’t like the looks of this. Fran: La la la la la.
Finally, as the growth took on the appearance of a miniature volcano and an appointment with the physician assistant to have my cast removed drew near, I wrote to Dr. K, and he directed the PA to check it out. By appointment time, the volcano had erupted and oozed a little blood and pus, then deflated. The PA give it a mighty squeeze and announced, “Your leg just spit out a stitch.” He seemed unconcerned, though five months-plus was an unusually long lag time for a stitch abscess to develop. After a few more weeks of hot compresses, oral antibiotics, packing, and poking, the volcano continued to ooze, and Dr. K decided the best move was new surgery to take out all the hardware: rod, screws, and gardening tools.
Back to the hospital in early June, the surgery itself was uneventful, and I had two nights there to recover. Because I couldn’t use my broken right hand for support, I encountered another inspired medical device, the platform walker. This involved a slot for my forearm on the right side of a conventional walker, so I could safely get around post-surgery. It turned out that I could put weight on the affected leg anyway, but the platform walker was reassuring, especially as my heart rate went bazoozy the first few times I tried to stand up.
This time, Bella the discharge magician didn’t even ask me; she just went ahead and ordered the ambulance with carry-up chair. It took four strong workers to haul me up. I waved to neighbors as we wound around the bends, feeling like Queen Victoria addressing her subjects. “Where are the elephants?” Iris and I asked.
I had one night at home, filled with relief that the surgery was over. Bella had arranged for a platform walker, which was waiting for us. The company had sent the wrong arm, but we were able to jerry-rig it to the correct side, and I was feeling fine. The next day, Dr. K called. Cultures he had taken during the surgery were positive for Staphylococcus aureus, and I had to return to the hospital NOW for intravenous antibiotics.
Earlier, Dr. K had impressed upon me the seriousness of his concerns about the volcano. You could have osteomyelitis, he said. You could lose your leg. Now, it seemed this possibility was at hand. Could a moment’s inattention at the dog park in November really be leading to amputation months later? It was with sinking hearts that Iris and I went back to the hospital. At least this time, we weren’t blubbering in the cab about giving up our dog. But a sense of doom pervaded.
My luck in medical care continued, however. Just at my lowest moment, back in the hospital facing a six-week course of IV antibiotics at home, in walked the infectious diseases expert, Dr. H, a veteran of San Francisco General Hospital’s famed AIDS treatment model and a personal friend of a nurse whom Iris and I had known for years. We recognized each other and commented on the small world. He reassured me that osteomyelitis was curable and the course in front of me would work. I was flooded with relief and called Iris, who had gone home for the evening. She emailed our mutual friend, who immediately texted Dr. H to “take care of Fran!” He told us later that this communication thread took all of five minutes from leaving my room.
I was also relieved when the nurse who installed the PICC (peripherally inserted central catheter) line that was threaded through my arm and toward my heart, creating the port where my daily infusions would go, walked us through the process we would follow at home. Iris had done these infusions when she worked in a hospital, but many years had passed since then, and she was greatly reassured to have refresher training. We figured out our home logistics and planned our lives for the next six weeks around the timing of the infusions.
From counting the days in December and January until I could put weight on my leg, through counting the days in April and May until I could get my cast off, I graduated to counting the days in June and July until the IV infusions would end.
When I start to feel sorry for myself, I remember how lucky I’ve been to have insurance, good healthcare, and an unbeatable medical pro partner. Iris once worked in a public health supportive housing environment, helping people with multiple issues: mental, substance, and physical. One client would butter her up by calling her “Angel Nurse Iris.” I always thought this was hilarious and would use the term to tease. Now I use it in earnest.
Comparing my woes with immigrants having their children stolen from them by my own government or Rohingya refugees or migrants on boats in the Mediterranean made me feel silly whenever I was tempted to complain. I would think, please, no earthquake until I’m better. But when that earthquake comes, there will always be a lot of people who aren’t “better.”
As I regained mobility at various times, I would return to public transportation for trips I had typically taken by bicycle. Or if I had ridden the bus, I would head for the back. Now, able to use only one leg or only one arm, I had to ride in the front, desperate to get one of the seats supposedly reserved for seniors and people with disabilities. One bus line runs past the county hospital, and the crushing misery surrounding me in those front seats could be overwhelming. But at the same time, the determination shown by people whose lives were always like this, not just temporarily, was inspiring. San Francisco can be a mean city, and I had experienced the kinder side of it, through my medical providers, friends, and neighbors.
As I enter my ninth month since the Ginger snap and month five since saying good-bye to the Moose, I wonder where that damn dog is. She may no longer even live in San Francisco, but I still look for her on the streets and in the parks and imagine a tearful greeting if we ever do cross paths. I hope her new people have strong bones, a nearby ER, and an angel nurse.