Defining Moment The Road That Chose Me The effects of a bicycle accident were immediate and lasting. By Marc Duyck, PTA, MEd | August 2015 Listen to 'Defining Moment' The bike ride was nothing out of the ordinary. It was a typical dusk on a typically wet January day in Oregon, with dark falling. But then, suddenly, the truck in front of me made a U-turn, causing me to swerve out of its way. The vehicle's lights blinded me. In the next moment my entire life changed. I hit the aluminum road barricade, tumbling head- and face-first. My head snapped backward in contrecoup whiplash. I was lying on the ground in my own blood, with a badly lacerated nose, lip, and chin. Adrenalin nevertheless propelled me up and home on my blood-spattered bicycle. From there, my spouse drove me to a level-one trauma hospital. It felt as if a very heavy object had struck my neck, which was largely numb yet also radiated pain. After extensive imaging and testing, physicians determined that the accident had left me with a spinal cord concussion, 5 broken cervical vertebrae, and the loss of 40% of my nose. For the initial 48 hours, I was completely dependent on others. The sudden role reversal—from provider of health care to helpless recipient of services—was surreal. I felt demoralized and humbled. The first month definitely was the most difficult. I underwent 4 facial reconstruction surgeries, and my orthopedic surgeon determined that my neck fractures would take up to a year to fully heal. The hard cervical collar, I was told, must remain on my neck around the clock for 3 months. While I understood the need for bone callus to form, I naively had assumed that I'd mend faster than most people do—given my low body-mass index for my age (47), a highly nutritious diet that was low in sugar, and a healthy lifestyle that exceeded the recommendations of the Centers for Disease Control and the American Heart Association for aerobic and muscle strengthening activity. I had to learn, however, to embrace the collar and accept my circumstances. It took me some time to adjust to my new road. Gradually, I learned to accept the goodness and kindness offered to me. I learned to say yes to the daily visitors and care providers who helped me with such things as housework and bill paying. My self-awareness and spirituality deepened as I strove to be as patient with myself as I always had been with the individuals I'd served, and the students I'd taught, in my roles as a physical therapist assistant and a PTA educator. My spirits were buoyed by my dean, program coordinators, and students, who frequently visited and, once I returned to teaching, honored me with a faculty recognition award. Thirty days post-injury, I started intensifying my workouts, with 60 minutes of daily cardio exercise and an additional 30 minutes of strengthening even as I adhered to strict spine precautions. My facial surgeon said I was healing faster than normal. My facial scars were flattening and becoming less pronounced. At 9 weeks post-injury my spine orthopedist took new X-rays. The news was great! Strong bone calluses were forming on the fracture sites. Even spinous processes that had not been expected to heal were mending beautifully on C4-C6. My vertebral body on C7 was stable. I graduated from the hard collar to a soft one. I finally could shave my neck and get a decent haircut. I received the okay to exercise at a higher intensity. I began doing water aerobics in deep water, a program in which I had led patients in the past. None of it was easy. My body was deconditioned. I was stunned by how difficult it was to work out at 15 or 16 on a Rating of Perceived Exertion scale of 20. But I cannot say enough about my company's commitment to my healing. The chief executive officer, Mike Billings, PT, MS, CEEAA, met with me personally during this period. Thirteen weeks after my injury, X-rays showed solid callous formation. My remaining movement restrictions were lifted. I got the go-ahead to begin weaning myself off the soft collar by adding 1 collarless hour every 2 days. My therapist, Scott Beadnell, PT, DPT, took an eclectic approach to my rehabilitation that included manual therapy, job-specific strengthening, proprioceptive cervical strengthening, and upper-quadrant stretching. Scott and I discussed evidence-based practice and the "why" behind the range-of-motion norms and goals he had set for my cervical mobility—80 degrees rotation, 60-70 degrees extension, and 45 degrees side-bending. Those numbers were consistent with those proposed in the widely used textbook Joint Range of Motion and Muscle Length Testing. Scott based the goals he established for me on my needs as a PTA in an outpatient and skilled-therapy geriatric setting who needed to drive himself safely to work and back. I've been asked how this experience has changed me. For 1 thing, I've learned that it's okay to cry. It's not a sign of weakness; it's 1 of the 5 stages of grief described by Swiss psychiatrist Elizabeth Kubler-Ross. On a physical level, I lost part of my face. On a psychological and emotional level, I lost my self-identify as someone who required no assistance in activities of daily living. I now can readily and viscerally identify with patients whose independence has been lost, temporarily or permanently, in a way that I could not before my accident. I have gained perspective and empathy that will make me a better PTA and a better person. The International Classification of Function, Disability, and Health (ICF) became very personal for me as I underwent my surgeries and rehabilitation. My preexisting familiarity with the ICF model helped me understand the factors behind my inability, for a time, to lift any weight, turn my head, or squat without significant dizziness and fear of falling. The experience gave me great insight into the many ways in which loss of function may differ among people, and what the various manifestations and implications of that loss might be. At this writing I'm continuing intensive physical therapy and planning to return to work soon, albeit on a limited basis at first. My neck mobility and overall strength have improved dramatically. I can only express my deepest gratitude to those inside and outside our profession who continue to support me as I embrace the road that chose me, and as I prepare to share my newfound knowledge with the patients I serve. Marc Duyck, PTA, MEd, is employed by Infinity Rehab at Mary's Woods at Marylhurst, a continuing care retirement community in Lake Oswego, Oregon. He also is an instructor in the PTA education program at Lane Community College in Eugene.