Doc Ernie's Blog

Cycling 2009 ends with an epic adventure

Ernie Franz — Tue, 05 Jan 2010 14:10:12 -0800

Well, now that we are officially into the 2010 cycling season (sort of anyway - waiting for the roads to dry, a bit of sun and temps above 45F), thought it was finally time to give a brief recap on the adventures of 2009. Overall it was a great season with roughly 2500 miles logged on the road.

As for what has now become my standard season ending ride, the goal was once again to complete 100 miles at the Dam2Dam Mike Utley Foundation bike ride the last weekend in September. A fund raiser for spinal cord research and for other such beneficial projects to help those with SCI find life and hope once again.

My amazing wife Gwen, and faithful physical therapist Keith Heinzelman, were in attendance. Our plans changed however the night before the ride when Gwen, carrying all my bags of gear with her vision blocked, sprained her foot on the curb at the Wenatchee Holiday Inn. This shortened her ride for the next day due to swelling and pain with weight bearing....she was to miss out then on the adventure Keith and I were to have!

In 2008, and recorded in this blog as well, I was able to complete 100 miles. This year the course was altered by a tragic accident which closed the Beebe bridge, a normal part of the 100 mile route. The bridge was structurally damaged by an apple semi-truck about a month before the bicycle ride. Sadly two people lost their lives as the cab tore through the railing and plunged into the river below.

With the bridge sagging and in need of vital repairs, the route had to be changed. This resulted in our facing a significant climb which began just 30 miles into the route. Though only 5.3 miles in length, the average gradient was over 8% with several sections over 12% - gaining 2200 feet in those few miles.

For the entire climb my HR was between 170-185 for 1hr 20min. If I was not an incomplete quad, it would have been a challenge - but this was in a real sense hors categorie for me. With prayers for strength and thinking of all the people supporting us, Keith and I did eventually make it over the climb to get to the flatter 60 mile long section - - we briefly thought much of the day's work was done......

But found at the top of the climb we had now winds reported steady at 30-35 mph with gusts to 40! An all too brief 5 mile tailwind section was completely enjoyed (no pedaling required to coast along at 30+ mph), followed by somewhat manageable crosswinds (that meant leaning hard into the wind to somehow just stay on the road) for 15 miles, but then turning a corner we faced 40+ miles of full-on increasing headwinds!!

Keith and I rode into this unrelenting wind with our best effort at 4-5 mph for perhaps 90 minutes, HR around 160 for the effort, and it was all we could do to stay upright! There was simply no way to even take a hand off the bars to grab a sip of water, as it would have resulted in a fall. We were using every available muscle group just to respond to the winds and not be blown off the bike. In a sympathetic act of kindness one of the support vehicles began motor-pacing us and attempted to block some of the wind for over 5 miles, which helped Keith and I to get another 1 mph of speed. The wind was so strong that on downhill sections we could hit almost 6-7 mph! When we finally realized it was 3:30pm (stopping to look at a watch) and that we had 38 more miles to ride, most of it still into the wind (at that pace possibly 7+ more hours on the bike as Keith reminded me) - we came to our senses and abandoned Plan A.

A purely "guy thing" had happened up to that point. As it turned out in our eventual debriefing of the ride, Keith was so ready to get off the bike and into the support vehicle - but he did not want to suggest that because after all, he was by far the stronger of the two of us, and how could he admit that to a quad who seemingly was determined to finish the ride? As for me, I had badly wanted to get a ride in the support vehicle, but assumed there was no way Keith would let me give up after we had made is this far! A communication gap, finally closed by the reality of the pace and number of miles left to ride into the gale.

So the last two riders on the course got a support vehicle ride to where Keith and I could meet up with Gwen. Now off the windswept plains of eastern Washington, along the Columbia river, the 3 of us rode back the last 10 miles to the finish in much calmer conditions - as we chased Gwen who paced us home.

At the end of the day Keith and I had cycled 70 miles altogether. Gwen cycling and excelling at being a patient, prayerful and understanding wife. Some final statistics for this 51 year old incomplete quad from the day: Riding time 6hrs 7 min, 70 miles, average speed 11.4mph, maximum speed 39.7 mph; average heart rate for the ride 151 beats/minute, maximum HR 186. So my HR was over 160 bpm for 39% of the ride, or for 2hrs 21 min. That's a few calories burned and certainly an epic adventure!

Two weeks later, with Gwen's encouragement, I made up for some of my "missed miles" by riding 44 miles roundtrip to a scheduled doctor's appointment. He and his office staff seemed to get a kick out of that. So for now I am once again indoors with group fitness spinning classes, until the drier slightly warmer weather appears. This changed life is not easy, but it still is very rewarding, challenging and exciting. I'll try to write more soon.....Thanks for reading.

Blog Orientation Essentials

Ernie Franz — Thu, 30 Jul 2009 15:20:23 -0800

This entry serves to give a quick orientation to recommended reading and audio/video links to those who might be visiting here for the first time. I have listed things below in a chronological order so that you may understand where I have come from, up until this point in time. You can get to those sections/links by clicking on the highlighted words. The first two entries are articles I have written from within the blog itself. Following that are a series of video and audio links.

As for reading within this site I would recommend starting with The Trauma section, which will give you the details of my injury August 23, 2004 - including x-rays, the car, and initial recovery.

You may then read more about my recovery and rehabilitation via two articles in this section entitled Recovery, which also includes the statement I made to the fellow that hit me, prior to his sentencing.

At the one year anniversary of getting swatted I was fortunate to be able to finish the ride home by cycling past the spot of injury and making it safely back to homebase. That story is nicely told in a 2 part video Bicycle Blues in the Key of E (be sure to watch it in HQ): Part I & Part II.

Last fall I was asked to be the lead-off speaker at the Spine Symposium Conference - Improving Outcomes in Spinal Injury, held at the University of Washington/Harborview. My 8 minute talk follows brief introductory comments by Dr. Jens Chapman, host of the symposium. I think you will find the segment interesting. Follow this link, then you will need to click on your choice of media player and speed connection to view the lecture. My talk starts at about 2min 35sec into the program.

Late Spring 2009 I particpated in a local Ride of Silence, an event now held across the US, which is ridden in memory of those cyclists killed or injured by automobiles. Our local newpaper presented this nicely done video segment of the ride.

In July 2009, Dave Beck of local NPR station, KUOW at 94.9 FM, contacted me for an interview about recovery from trauma, and to discuss life changes that occur after illness or trauma. Though I certainly wish that what occured to me, now almost 5 years ago, never had happened - I can say for certain that my life has changed, and in many ways for the better since the injury. Certainly not in a financial sense, but in my relationships, my faith, in the way I now approach life, the opportunities I have teaching medical students, and in working with those who have experienced trauma and loss. You may listen to that 20 minute interview here, which is also available as a podcast.

Thank you for following along on this journey! I pray you will find some material of encouragment to yourself or others. Be well....

Spine Symposium talk on UW-TV

Ernie Franz — Wed, 06 May 2009 23:05:01 -0800

In October of 2008 I was honored to serve as the lead-off speaker at the Improving Outcomes in Spinal Injury conference, which was organized by Jens Chapman, MD of Harborview Medical Center. Dr. Chapman is both a friend and my physician. He is following me for spinal stenosis in my lumbar spine, a condition inherited, yet also accelerated in its advancement due to my injuries in 2004.

After Jens gives a brief overview of the day, I provide a brief 8 minute presentation of my injuries and my perspective on how outcomes can be improved in spinal injury care. That talk may be found on UWTV via this link. You will then need to select your media player of choice and connection speed. At that point a video stream of the presentation should open up for you.

Thanks for watching!

Ernie

Inspiration from various sources

Ernie Franz — Sat, 17 Jan 2009 18:45:27 -0800

What follows are a variety of quotations and comments from various sources which have inspired me and helped me in the recovery process. My intent is to keep adding verses and quotes to this section as I come across new material that in turn my inspire you in your own personal journey.

"Faith does not operate in the realm of the possible. There is no glory for God in that which is humanly possible. Faith begins where man's power ends." - George Muller

"Faith is not an instinct. It certainly is not a feeling - feelings don't help much when you're in the lion's den or hanging on a wooden cross. Faith is not inferred from the happy way things work. It is an act of will, a choice, based on the unbreakable Word of God who cannot lie, and who showed us what love and obedience and sacrifice mean, in the person of Jesus Christ." - Elisabeth Elliot

I command you, be strong and courageous! Do not be afraid or discouraged. For the Lord your God is with you wherever you go. Joshua 1:9

"God's people have no assurances that the dark experiences of life will be held at bay, much less that God will provide some sort of running commentary on the meaning of each day's allotment of confusion, boredom, pain, or achievement. It is no great matter where we are, provided we see that the Lord has placed us there, and that He is with us." - John Newton

I love the Lord, for he heard my voice; he heard my cry for mercy. Because he turned his ear to me, I will call on him as long as I live. The cords of death entangled me, the anguish of the grave came upon me; I was overcome by trouble and sorrow. Then I called on the name of the Lord: "O Lord, save me!" The Lord is gracious and righteous; our God is full of compassion. The Lord protects the simplehearted; when I was in great need, he saved me. Be at rest once more, O my soul, for the Lord has been good to you. For you, O Lord, have delivered my soul from death, my eyes from tears, my feet from stumbling, that I may walk before the Lord in the land of the living. from Psalm 116

"Faith is to believe what we do not see, and the reward of this faith is to see what we believe." - St. Augustine

YouTube Video Links

Ernie Franz — Sat, 17 Jan 2009 17:12:19 -0800

Three videos have recently been uploaded to YouTube which tell various parts of this ongoing story. The first two are due to the wonderful work of Kevin Lynch, who in 2005 put together a movie for our local Bainbridge Film Festival featuring my recovery and my "finishing the ride home" on the one year anniversary of being struck. Bicycling past the spot of injury, this time with a police escort, 20 or so close friends, 3 other ER docs, and a US Congressman - among others. The movie is entitled Bicycle Blues in the key of E. Part I via this link, and Part II here. Be sure to enable the "watch in high quality" or HD setting below the screen to your right. Kevin Lynch is a master spin class instructor on Bainbridge Island when he is not flying about the globe competing in and/or filming professional triathlons.

The other video was done for the Kitsap Sun newspaper group with support from MADD; it chronicles the effects of alcohol and driving and the lives of those impacted in our community. There are three parts to this video, with my interview taking place here in Part II.

I believe these videos will give you a deeper sense of what I have gone through, and also will help you understand a bit more of my character and the key supportive roles so many have played in my recovery process. Enjoy, and thanks for watching....

100 Miles! Cycling update fall 2008

Ernie Franz — Sat, 22 Nov 2008 15:28:37 -0800

First, an apology…..
I am sorry that it has been so long since my last update. I am obviously not a blogger who is into bringing you each tidbit of news or accomplishment achieved in my life.
Yet there are a few very important physical goals that have been able to achieve since my last update in June.

During the dry season here I was able to average 100 to 120 miles per week bicycling on the road. Total miles on my Moots titanium hybrid are now 2500 in the past 15 months. Now that the rainy season is upon us, I am back indoors in group spinning classes 3 to 4 days per week. Dry roads and temps above 43 degrees F keep me outdoors and on the road.

Now to the reporting of two fantastic goals accomplished this cycling season....

I can now ride the entire Chilly Hilly bicycle route, 33 miles and 2500 feet of elevation gain – and do not have to get off to walk any sections. Long hills are okay, yet the steeper the gradient the more difficult it becomes. Riding the ~ 18 percent gradient up to Battle Point Park is the most difficult, fortunately it is only a short section of steep road before leveling off. My heart rate is typically 185 on that climb, not too bad for a 50 year old pump.

On September 27th 2008 I was able to complete my major training goal for the season.
I bicycled 100 miles in the Wenatchee, WA area on the Dam2Dam ride for the Mike Utley Foundation to raise funds for spinal cord injury research. The actual stats were 102 miles in 7 hours 10 minutes on the bike, average speed 14.1 mph, total elevation gain ~ 3250 feet, average heart rate 144 bpm.
I was supported by my wife Gwen, who rode 60 miles (only her third time on the bike all summer), Keith Heinzelman (my amazing physical therapist) and good friend Tom Crane who both rode the whole route with me.
Honestly, it is still hard to comprehend and believe that a C5 incomplete quad can complete a 100 mile bicycle ride in one day, riding on a two-wheeled bike. The more people I meet with spinal cord injuries, the more fortunate and blessed I realize I truly am.

Here are a few photos from the ride. First with my wife, then with Keith and Tom at the finish, and finally with Mike Utley.
Thanks for reading!

Cycling update May 2008

Ernie Franz — Tue, 03 Jun 2008 17:04:03 -0800

Time to bring you up to speed with my latest cycling adventures since riding Chilly Hilly in late February 2008. Basically it has been a very very wet end to winter and splash into spring. No signs yet of global warming here in the Pacific NW. Thank goodness too for spinning classes, which I have been able to attend 2-3 times/week. Basically, if it is dry and above 45 degrees F, I hope to be out on my bike; especially now that I am finished at the University of Washington medical school until next January.

I have been able now to log a total of over 1100 miles on my Moots since I received it around August 2007, not too bad considering the weather, and that I hardly rode outside from October till late February. I am most often out on my own, cell phone in pocket, flashing tail light, helmet mirror - praying for no flat tires. Given the hilly nature of Bainbridge Island I am slowly adding post-SCI previously unconquered hills to my list of those I have now scaled. Not checking them off with quite the significance of Bainbridge resident Ed Viesturs, the first American to climb the 14 mountains in the world higher than 8,000 meters, but nonetheless rewarding, and too involving risk - not knowing if I may stall and topple in the midst of a climb. While I am gradually increasing the degree of difficulty, I think Toe Jam Hill with its 22 - 24 percent gradient is forever safe from my aspirations.

Most of my rides are 18-25 miles, but I have recently been increasing my mileage as I have found my endurance is improving. This past month I traveled to Moab, Utah to ride my Moots on the roads - while my friends and son, Daniel, rode classic Moab mountain bike routes such as Porcupine Rim and Flat Pass. I managed to put in 110 miles in 3 days, one day 45 miles, which was easier than expected and not as exhausting as it would have been even 6 months ago. This has caused me to dream of attempting 100 miles in one day for the Mike Utley Dam2Dam fundraiser on September 27th this year.

My cycling goals for this year will be to:

Increase mileage
Improve strength and hill climbing
Complete 100 miles in an effort to raise funds for SCI research thru the Mike Utley Foundation on September 27, 2008. This link will allow you to donate funds in my name directly to the Mike Utley Foundation - I would be deeply honored to ride for you, and raise money for this cause that will benefit the 11 - 13,000 new spinal cord injuries per year in this country, and which will help others living with SCI, such as myself and all those less fortunate than I.

I have found that my stability is improving on the bike, also that the left leg clonus (non-painful repetitive spasms & twitching) I had gotten while pedaling (especially when fatigued) is now almost gone! It seems the more pedal revolutions I do with my legs, the more they are acting "normal". Still I do not feel them well, and have never experienced a sense of muscle burning or fatigue in my legs themselves - only getting overall body fatigue when I am spent.

Nonetheless, much to be thankful for! Still waiting to find if there are other quads or paras who are able to ride an upright two wheeled bicycle. With my stability slowly improving I have decided it is time to shed my "training wheels". I have been using TUFO tubular tires - the Diamond D28, which are 700 x 28 mm, with a max psi of 90. Yet, I am set to make the switch to the TUFO Elite Ride 700 x 25 mm tires with a 145 psi rating and smooth center tread. This should decrease my rolling resistance and increase my speed. I will keep you posted....in the meantime, think seriously of investigating the Utley Foundation website and donating. Thanks!!

The way it is....

Ernie Franz — Fri, 18 Apr 2008 10:47:14 -0800

This section is really intended for those with spinal cord injuries. "Constitutional truths" in this case has absolutely nothing to do with what our forefathers generated over 200 years ago, nor anything pertaining to our countries politically misguided adventures or upcoming election.

Instead it speaks to catheters, suppositories, and how to best avoid UTI's. These are a part of routine life those of us with SCI deal with, and others perhaps are inquisitive about. The content that follows is really meant for those who have some dysfunction in elimation processes in hopes you may find a helpful hint or two.

As I have written previously, every person with an incomplete spinal cord injury is going to experience different abilities or functional changes in elimination processes, both in bowel and bladder function. What follows is information about what has worked for this physician/patient.

I underwent urodynamic studies in January 2005. While I can still say I don't feel much below my clavicles, I still had a sense that testing was being done somehow as I managed to have a significant vagal (aka fainting, or falling out) episode while 3 catheters were indwelling in 2 orifices below my umbilicus. Fortunately as I fell from standing the alert nurse ran across the room and caught me just as I had fallen backwards onto the exam table. I'll spare you any more details of the testing. Basically the study showed I maintain high bladder pressures, even after voiding. That I can only void about half of what is in my bladder. Net conclusion = self-catheterization was necessary once per day to get my collecting system some time at zero pressure and spare my kidneys long term damage. Being the non-compliant doctor, it only took me 9 months to begin this daily routine. I think I still just wanted to be/thought I might be "normal" again someday (whatever "normal" is).

So since late fall 2005 I do self catheterize once per day, usually right before bedtime so that I get a bit more uninterrupted sleep before my small capacity bladder begs for a urinal. I can say with certainty, that this is not a big deal at all. I used to think it was, or that I'd never get used to it, but it is not a problem and would encourage anyone who has to do this not to hesitate, nor to fear it. Yes, the first few times take some getting used to, and for me resulted in a couple of lightheaded episodes (enough that I wore my exercise heart rate monitor just to make sure my rate wasn't going too low - it wasn't); but shortly after that it became routine, a basic part of my life that really is no bother at all.

As for avoiding UTI's or urinary tract infections. I have had several of these, but so far this routine is working well for me. I use Lo-Fric Primo catheters which have the attached sterile water pouch. I take 1000mg of Vitamin C over the course of the morning/early afternoon, and 2 tablets of Cranberry concentrate at 400mg each tablet at bedtime. This has kept my urine acidic enough, and prevented all UTI's since being consistent with this regimen.

While a few with SCI will have regular bowel action, I do not, and require suppository use. Without that, despite adequate fiber, fluids, visualization... nothing will happen even after 3 days of no suppository use. This is not a "sponsored" endorsement, but this doctor recommends The Magic Bullet - quick acting, effective and so forth. All credit is due my wife for her creation of the new word "suppositate", which is defined as the reflective, thoughtful time one has whilst awaiting the action of said inserted medication. Safe to say, The Magic Bullet does significantly reduce your suppositation time.

A time to laugh - Act 2

Ernie Franz — Mon, 07 Apr 2008 07:55:30 -0800

I ended up with enough entries in my first write, so decided to split them into two sections of more readable snippets. Enjoy (or at least you will see, as many have noted before, I do have a warped sense of humor)....

Thank goodness for a resourceful wife! In my early days at Harborview, long before I had any arm movement at all, I had to be fed by family, friends or occasionally by Harborview staff when available. On one such occasion I found myself alone with my l lunch tray before me, yet no way to call for nursing or other such help, as I could not even operate a call button or switch. Gwen had realized that no one would be there to assist me that day, so she called the Virginia Mason ER to ask if one of the ER techs could break away from VM to travel the 5 blocks to Harborview to feed me lunch. As luck would have it, one was available as the ER was not busy (aka quiet - a word we NEVER say in the ER itself). So unexpected by me, in comes my co-worker from VM dressed in VM ER work attire, informing me he was sent by my wife Gwen to feed me lunch at Harborview, before returning to work duty in the ER at VM.

I have already mentioned a bit of my bicycling endeavors, still the first recumbent training ride was the most humorous with Keith and I going down twice to the asphalt (now with a bit more details). Again at this early point in my recovery I could not rollover, stand or walk without significant assistance. The first low speed tumble came as we cycled uphill as Keith downshifted only to have the chain derail and fall off. He put his feet out to keep us upright, mine too weak to assist. Then reaching behind and underneath himself he tried with one hand to get the chain back onto a smaller chainring. So here we were on an uphill rise with Keith struggling to balance the weight of us and the tandem, brakes on with one hand so we don't roll backwards, the other hand trying to re-engage the chain behind and underneath him. Myself entertained watching him juggle all this as we slowly began to roll over to our left, Keith struggling with all his might to keep us upright, landing close to the yellow midline of the road. I landed face down as softly as one can land on asphalt, immediately laughing at the situation, Keith was not so entertained. After untangling himself from the bike, he had to roll me face up and get me out of the middle of the road. A couple of passing motorists came to our aid, Keith getting the bike pointed back downhill with me on it, and away we went.

The second spill, which followed the first by perhaps 20 minutes, found us headed up a steep pitch on High School Road, the same road I was originally hit on in 2004. On this occasion my cleated foot came off the pedal causing us to immediately loose all momentum and fall to our right, myself landing twisted against the curb. While lying prone on the street before Keith could sit me upright, an alarmed motorist remarked that I appeared to be seriously injured. I assured her those injuries were from an earlier bicycle accident, and that I would be fine this time. At that point another motorist informed us that on his scanner he had heard the medics dispatched to the scene. My response was that we needed to get away from the scene as quickly as possible; I was not yet ready to see the medics again. So Keith got me upright with my gait belt, we crossed the street to point downhill, myself holding onto mailboxes for stability, we then got on the tandem and rode away from the area to avoid the medics. Little did I know by then we were actually being followed by the chief of police in his unmarked car as we rode into Keith's open garage. Though the officer later told me he was baffled by the sudden closure of the garage door, he figured we must not be hurt and the medics were called off.

A time to laugh - Act 1

Ernie Franz — Wed, 02 Apr 2008 22:38:07 -0800

In this section, hopefully you may find a few good laughs from my experiences. As said in Proverbs - a good word brings health to the bones. Beyond even a good word, laughter just deeply feels so right.

In early November 2004, I was to be transported from the rehab facility in Silverdale to Seattle to see my spine surgeon. If my neck and arms were found to be stable enough, I could qualify to be transferred back to Harborview for additional rehab. I had thought we would take the ferry to Seattle, but it was not to be. The ambulance transfer crew arrived late for my pickup with plans to drive around through Tacoma and up I-5 thinking it would save time. We had to hustle to make the appointment, and heading north on I-5 across from Boeing Field in the HOV lane at 60+mph we had a left rear tire blowout! The driver maintained control, but alas there was no shoulder. So we parked it in the HOV lane and called for another ambulance as there was no possible way to change the wheel; the tread had somehow caught the rear bumper pulling it into the wheel rim. All this time I am facing backwards, watching the rapid traffic come up from behind, thinking we were at risk for being rear-ended in the HOV lane and on a curve with limited sight distance. Visions of my legs which were close to the rear window being thrashed in a collision seemed possible, with myself having no way to move them out of harms way. 30+ minutes later another rig arrived, the back doors popped open and one of the attendant rescuers was an off-duty ER tech that I worked with at Virginia Mason! So timing my move with traffic, I was moved in the HOV lane of I-5 on a wheeled gurney from one ambulance to another. In fact making it to my appointment only a few minutes late.

While there have been many episodes of bowel and bladder dysfunction, a few are perhaps worth mentioning, others not fit for publication. Briefly, though everyone with a spinal cord injury has different levels of ability to control bodily functions, I was able to begin re-learn at least bladder control while on Harborview Rehab. Given my lack of mobility this meant lying in bed using a urinal. One particular day while lying on my hospital bed getting dressed, my nurse left me ONLY with the urinal and a small washcloth (yes, like 6x6 inches), and not a stitch of clothing on. While awaiting the nurse's return, without warning my mother-in-law pulled back the curtain and walked in simultaneously announcing her surprise visit finding me there with only my bit of a fig leaf in place.

Though I went home wearing Depends, my control was gradually getting better. Yet even to date I get very little warning of the impending fullness of my bladder, that urgency striking suddenly, so quickly I often have only minutes before risking incontinence. Though by then I had graduated from Depends, in the summer of 2005 on a hot day Gwen and I were headed over the North Cascades Highway to Winthrop for a bit of a getaway. The iced Latte I had consumed before the long stretch of mountain pass road suddenly hit my bladder, and I told Gwen that we must find a place to stop ASAP. We both figured there would be a gas station or restaurant along the way as we were getting close to Winthrop. But nothing appeared. Our peace of the day, time together and the amazing beauty of the mountains now replaced by one thought - empty that bladder. There were not even any indiscreet places to pull off for me to mark a tree or other object. Finally, myself now in a full sweat with lap belt off to avoid any extra pressure, a side road appeared, though admittedly it was a little too late. Gwen pulled quickly down the gravel road getting out of sight of the highway and I finished relieving myself amongst the shrubbery. Oh what relief!! As we pulled out from the side road back onto the North Cascades Highway we both saw the road sign, we had turned down Dripping Spring Road - and that is just what I had experienced.

Since we are on the topic of water, I will relate my first swimming pool experience. Weekly, Harborview rehab patients have the opportunity to travel to a community pool for therapy. My first such episode involved getting from the wheelchair into the water by either a chair power assisted device, or via walking down steps to the water. This was at a point in my rehab when I could not walk, and had not yet tried steps. Yet my confident energetic African American therapy assistant was sure he could handle the steps with me and my 139 pound frame. He was after all still a buff muscular ex-athlete. The plan was to stand from the wheelchair arm in arm and face to face with Mike as he would support/carry me as he backed down the pool steps, I moving forward upright in his arms. Problem was, I could not feel my feet, and my nylon pressure stockings were still on. Once I hit the water and those tile steps, my feet and legs were sliding every which way; I had no control over them, nor could I even see where they were. Yet I felt like, and Mike's face confirmed, we were on the edge of losing all control. Desperate, I was looking for something, anything to grab onto - and all I could see were Mike's disappointing short and tightly curled chest hairs. His strength and ability saved the day, but I'll never forget the loss of control I felt and the overwhelming desire to grasp at something, anything to achieve stability - with the only option being those black, short, curly African American chest hairs. Mike and I had a good laugh over that.

Quotations

Ernie Franz — Tue, 01 Apr 2008 17:30:42 -0800

“Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.” Isaac Asimov

Shaking your head? Here are my honest unvarnished impressions. Although I nearly suffered a traumatic death, which in the ER we all have imagined as a horrible way to die, I can say from experience when you don't see it coming, and it strikes in an instant as John Donne remarked - it may not be all that bad a way to pass from this world. Yet as a survivor of a sudden change, an alteration to worse, I have found it is the transition that is indeed most troublesome. In my case, thankfully, it was a transition back to finding life, a life that is again (mostly) pleasant!

To follow this are quotes from all sources, on a variety of topics, presented hereafter without any additional comments...

"Life is getting up one more time than you've been knocked down." John Wayne

"There are two ways of spreading light: to be the candle or the mirror that reflects it." Edith Wharton

"There is only one thing that I dread: Not to be worthy of my sufferings." Fyodor Dostoevsky

“The only reason some people get lost in thought is because it’s unfamiliar territory.” Paul Fix, actor

"I am not what I ought to be. I am not what I want to be. I am not what I hope to be. But still, I am not what I used to be. And by the grace of God, I am what I am." John Newton (1725-1807)

"Kind words produce their own image in men's souls; and what a beautiful image it is. They soothe and quiet and comfort the hearer. They shame him out of his sour, morose, unkind feelings. We have not yet begun to use kind words in such abundance as they ought to be used." Blaise Pascal

"I found myself at peace with God, and rejoiced in hope of loving Christ. My temper for the rest of the day was mistrust of my own great, but before unknown weakness. I saw that by faith I stood; by the continual support of faith, which kept me from falling, though of myself I am ever sinking into sin. I want to be still sensible of my own weakness...yet confident of Christ's protection." Charles Wesley

"My son, oftentimes a man vehemently struggleth for somewhat he desireth, and when he hath arrived at it, he beginneth to be of another mind; for man's affections do not long continue fixed on one object, but rather do urge him from one thing to another." Thomas a` Kempis

"God hath thus ordered it, that we may learn to bear one another's burdens; for no man is without fault...no man is sufficient of himself; no man is wise enough of himself; but we ought to bear with one another, comfort one another, help, instruct, and admonish one another. Occasions of adversity best discover how great virtue or strength each one hath. For occasions do not make a man frail, but they show what he is." Thomas a` Kempis

"What is it, therefore, to believe in him? It is in believing to love, in believing to delight, in believing to walk towards him, and be incorporated amongst the limbs or members of his body." St. Augustine

"It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and a corruption such as you now meet, if at all, only in a nightmare. All day long we are, in some degree, helping each other to one or other of these destinations. It is in the light of these overwhelming possibilities, it is with the awe and the circumspection proper to them, that we should conduct all our dealings with one another, all friendships, all loves, all play, all politics. There are no ordinary people. You have never talked to a mere mortal. Nations, cultures, arts, civilization--these are all mortal, and their life is to ours as the life of a gnat. But it is immortals whom we joke with, work with, marry, snub, and exploit--immortal horrors or everlasting splendors. This does not mean that we are to be perpetually solemn. We must play. But our merriment must be of that kind (and, indeed, it is the merriest kind) which exists between people who have, from the outset, taken each other seriously. Next to the Blessed Sacrament itself, your neighbor is the holiest object presented to your senses." C. S. Lewis

"Science without religion is lame, religion without science is blind." Albert Einstein

"The great use of life is to spend it on something that will outlast it." James T. Adams

More to come...time now to read and discover more to share.

Cycling Fun inside Harborview!

Ernie Franz — Tue, 01 Apr 2008 16:52:16 -0800

In the late fall of 2007 the Harborview Rehab floor hosted an Adaptive Cycling Seminar. Through a donation made in my name, I was able to help fund the seminar. There were recumbent four wheeled tandems, various makes of three wheeled bikes, and options of foot or hand driven mechanisms. Although this was primarily set up for those who might be riding hand cycles, I did also bring my Moots and seized the opportunity to bicycle down the halls of Harborview. The very halls where I had pulled myself around in a wheelchair using my feet in 2004.

Being a C5 incomplete quad, in addition to my bilateral radial nerve injuries, I do not have the arm/hand strength to either pilot a wheelchair, or a hand cycle; whether on 2, 3 or 4 wheels. So in my particular case strangely, the only option for me is to ride an upright bicycle and pedal with my feet.

My intent was not, and is not now, to encourage those so injured to ride an upright two wheeled bicycle. Every person who is disabled who desires to bicycle will have very different requirements that will determine what is best and safest for them to be riding. Some will do better on various two or three wheeled bi/tri-cycles that are powered by arms or legs depending on your functional level. Others may need a 4 wheeled tandem setup. If you are interested and so motivated, investigate with your PT and/or local adaptive cycling retailers.

Here then are a few pictures from that day at Harborview - enjoy!

Current Bicycling status

Ernie Franz — Fri, 28 Mar 2008 09:18:35 -0800

Well, perhaps you are thinking this all seems too easy, or why did it take him so long to just advance to cycling on his own. You will have to believe me, it was not easy, though I had plenty of motivation to succeed, my spinal cord injury and general lack of balance and strength meant several falls were inevitable. Though Keith and I finished Chilly Hilly 2006 without incident, soon after that I was to experience quite a number of low speed falls. Being however an "experienced" cyclist, I always managed to land on my left (non-drivetrain) side, protecting my bike, yet causing a couple of left hip & elbow bruises along with a few head bangs.

To start on the bike required me to be pointing downhill, problem is though, we live at the bottom of a hill. So I would walk a bit up the hill, supported by another person I would aim downhill and away I went...briefly, because within 40 yards or so I had to make a U-turn and head back uphill before I ran out of road. This sort of worked, yet several hard falls over the course of a few attempts, made me realize I needed to devise some other method. I was also quickly getting tired of going down on my 14.8 lb. Davidson, so I began looking for an even more stable ride that could take some falls.

Briefly, I can tell you I thoroughly researched shifting and braking systems, frame design, cockpit/handlebar alternatives, wheel, tire and gear/drivetrain options. Though I tried a few of these systems out, even putting together one bicycle that just did not quite work for me, I finally settled on a frame design and controls that worked for my specific weaknesses.

While in the process of figuring out a more suitable bicycle, I had a "simple" ground level indoor fall while we were vacationing near Yellowstone National Park. This required left hand surgery once back in Seattle, followed by more hand specific rehab. The net effect was less functional use and strength of my left hand, particularly thumb and index fingers; which made it even harder to brake and shift my Campy Record equipped Davidson. Not to mention, loss of piano lessons and any progression of function I had found to that date.

In the spring of 2007 I placed an order for a custom Moots bicycle. This was then built up and delivered to me by Classic Cycle on Bainbridge Island. I was involved a bit in the frame design, then also hand picked all components, this time with success! At the heart, a cyclocross frame the Psychlo-X YBB, built to take more than a few hits. Curved and sloping top tube to allow ample standover height for weak legs; built-in rear suspension that keeps me stable over road bumps and ruts. GripShift shifters which I can operate with both hands; V-brakes which have excellent stopping power and require less lever movement to activate than road brakes. A carbon fiber wheelset to keep rotating weight as light as possible, with TUFO diamond tread 700 x 28c tires at 90psi and plenty of sealant in the tires to prevent flats. Compact 50/34 crankset with 11 x 32 rear cassette, which gives me a gear ratio I can get over most hills, AND most importantly allows me to avoid using a triple chainring!! Weight under 18 pounds.

While I was awaiting the building and arrival of my Moots, Keith Heinzelman, my PT, and I had time to prepare; the goal was to teach me how to ride completely independently without assistance. If the following description may be helpful to some of you, Keith and I have thought about shooting a brief video of this. Basically the pushing off and mounting the saddle motion had to be dissected into pieces I could learn, then put together to be able to ride away. (Note: I found early on, I must use clipless pedals and cleats due to barely feeling my feet, particularly having very little idea of where my left foot is in space. If anyone is interested I can give details as to how I chose a pedal/cleat system after trialing several of them.)

For learning this motion, we went to the High School grass sports fields. Straddling the bike, hind end not on the saddle, two hands on the bars, one foot clipped in, I repeatedly only tried to push off with one foot over and over. For me, left foot clipped in at 9 o'clock position ready to push down, right foot on the ground ready to push off. Only attempting to get enough motion to travel a few feet through the grass. No attempt was made yet to pedal or ride, only repeating the motion over and over of pushing off with the one foot on the ground, and pushing down with the left clipped in. After perhaps 30 attempts I had learned to travel further and further with each push off.

Next, was combining the push off with placing my rear on the seat. No attempts yet to pedal circles. It was push off to get momentum, then lift the hind end a bit forward to clear the saddle nose, before sliding back to sit on the saddle. All the time in the grass field. Repetition was the key, each time the movements became easier and more coordinated.

Now it was time to combine them all, and after a few attempts I was able to ride away, adding the last part of clipping my right foot into the pedal. A few more times on the grass and we transitioned to the HS track rubberized surface. Wow! Hardly any rolling resistance compared to thick grass, and immediately I could push off and ride away! Moments later Keith and I were on the asphalt roads and I was good to go!

Soon afterward the Moots was delivered, and the setup turned out to be perfect! That was in late summer 2007, and within 8 weeks I had almost 600 miles on the bike. My only fall to date being an attempt to do again a very low speed U-turn. I have finally learned that if I am to turn around, simply stop, walk the bike around to face the new direction, push off and I'm on my way.

The last weekend in September is the Mike Utley Dam2Dam bicycle ride which raises money for spinal cord research. Mike himself is quite a personality, a C6-7 level quadriplegic, injured as a Detroit Lion in a pro football game in 1991. Our whole family signed up for the ride, which offers routes with various mileage. Even my trustworthy PT Keith Heinzelman showed up for the ride (which is about 150 miles from our home). Total family mileage for the 5 of us that day was over 260 miles! Keith, Evan, Gwen and I each riding a bit extra to get to 100km, or 62 miles! My goal for 2008 will be to get to 100 miles for the day. Here's a photo of most of us with Mike (missing middle son Daniel who was sound asleep in the car after riding 50 miles).

So that just about brings you up to date with my cycling adventures. I did ride Chilly Hilly this year 2008 on my Moots with son Daniel; thankfully the day was dry and warm enough. I plan to continue in group spinning classes usually 3 days per week, schedule permitting. I get on the road as often as I can when it is dry and above 45 degrees, often riding alone with my helmet mirror, rear flashing light, and cell phone in my jersey pocket. If I were to suffer a flat, it will mean using the cell phone. Clinchers or tubular tires, either way, a flat will end my ride that day as I do not have the hand strength to change a flat. So far, I am very happy with my TUFO tubulars and the sealant.

Independent Cycling - a dream realized

Ernie Franz — Thu, 27 Mar 2008 20:19:44 -0800

By early summer 2005 I began thinking with my wife and PT what we could do for the one year anniversary of my trauma. Soon a plan was hatched that involved my bicycling past the scene of the crime on the day of the life changing trauma, this time to make it home! Problem was, I had not yet ridden a two wheeled bicycle on my own. By late July, it was time to give it a try.

Keith Heinzelman, my PT, and Kelly Campo, another PT whom had known me for a long time, came over to our house to figure out how we could get me on my mountain bike. We were unsure how my balance would be, what my leg strength would be like, how braking and shifting would work. On that memorable day I kept my gait belt on so Keith could run alongside me and remain attached somewhat to me, as a father would with his child, as I attempted to balance and pedal.

Well, as you can see from this gleeful smile on my face, the plan worked!! That is Keith running behind me, after I had told him "I think you can let go". I had Kelly, my other PT friend, snap the picture and catch me as I headed for the grass. Just like a kid, it did not take too long to gain some confidence and desire to take it to the next level. Keith and I spent the next several weekends preparing for the ride home on August 23rd; mostly figuring out how to start and stop and shift. My main problem was starting; I found I had to have a person beside me supporting me, one foot on the pedal, hind end on the seat, and a bit of a push helped too.

So on August 23rd, 2005, one year to the date post-injury, accompanied by my son Evan and about 20 friends on bicycles including local shop owners, Bill Davidson, Congressman Jay Inslee, PT's Keith & Kelly, three ER docs, and one other member of the "flying cyclists' club", Chris Stanley (both of us hit and tossed by cars) - with a Bainbridge Island police escort, we all bicycled past the spot I was hit, and completed the short 3 mile trip home to our house. The event documented on video and will be etched in my mind forever. We arrived home on that beautiful day to celebrate life, a new life - not a life I ever anticipated, but life all the same. Root Beer Floats were shared by all. A tradition we continue to this day on every 8.23.

Emotionally it was okay, no tears or sorrow, more thanks to our Lord for allowing me to live, to recover, and not to have been hit with a brain injury in the course of events. I often think that if I did in fact suffer any brain injury, it must have been to that area of my brain which would normally be responsible for generating PTSD, or post-traumatic stress disorder, as I seem to not have no evidence of that most thankfully.

Physically it was a challenging ride, though my mountain bike had low gears, my strength was lacking and there were a few good size hills to get over. At the top of High School road my heart rate was 197, a bit on the high side! Yet from there it was mostly downhill heading home.

The next big cycling boost came in December of 2005 with the delivery of my Bill Davidson road bike. Bill had poured over every detail of the bike; having the chainstays and lugs undergo extra machining to take off excess titanium where it was not needed structurally. The finished bike weighed in at 14.8 pounds, pedals included! A carbon and titanium featherweight with Campagnolo Record, Zero Gravity brakes and Reynolds carbon fiber wheelset. Here it is:

Given the time of year I received the bike, it had indoor privileges (as you can see from the pictures) for some time before I had a chance to take it on the road. In the meantime I kept spinning in indoor group classes, or on my own in the garage, to stay in some sort of condition. Though I had only a little actual "seat time" in preparation for Chilly Hilly 2006, Keith and I were able to complete the ride in dry but chilly conditions on my new Davidson. Cycling though was still in many ways sketchy for me, particularly in starting. I just did not have the ability yet to push off and ride away on my own power. I always needed another person to stabilize me for my starts, and still had to be seated, one foot clipped in, the other with a pointed toe touch, while Keith supported me on one side. This all worked better if I was pointed downhill too! Problem is, there are lots of hills here, and not all of them point downhill !

Next to follow, how Keith taught me how to bicycle completely unassisted.

Cycling advancements & Chilly Hilly 2005

Ernie Franz — Tue, 25 Mar 2008 20:37:55 -0800

Two and one-half months after my discharge from the Harborview Rehab floor, Keith Heinzelman and I set out to ride the Chilly Hilly 2005. With a huge amount of emotional and physical support we were accompanied by friends, family, church members, Seattle Symphony members, Bill Davidson framebuilder from Elliott Bay Bicycles, and Josh Golden my PT from the Harborview Rehab floor.

The day was a bit foggy and cool, but it was dry! Off we went....

To spare you the details... we made it! Nearly 33 miles and roughly 2500 feet of climbing. The ride really went well with no major problems, thanks to the support of Jon Green and Rachael Swerdlow of the Seattle Symphony who jumped off their tandem to run along side us and push us over the steepest pitch. Others helped too, cheering support or riding ahead to be ready at the last few hills to give us an assist. In the end it was hard to fit back the tears of joy and happiness - having reclaimed a bit of life. Many thanks go out to Keith Heinzelman, my PT, who dared to dream of this and yet had discovered the carrot to hold out for me what was to become a key to my rehab.

What next? Soon afterwards Keith would have me on an upright spinning bicycle in his office. Yet my arms were so weak from my SCI and radial nerve injuries that after 5 minutes I would beg Keith to let me off the bike. Without a trace of sympathy he immediately stuffed a large Pilates Ball between my chest and the handlebars, so that the weight of my upper body was supported by the ball. This became my spinning routine, slowly extending the time till my arms failed and the fit ball needed to be placed. This was all training for eventual upright standard tandem riding with Keith, and gym group fitness spinning classes that Gwen and I could do together.

In the meantime Bill Davidson framebuilder began drawing up plans for a road bike; one that he designed with input from both Keith and I regarding equipment, wheels, and frame dimensions. His goal was to make it superlight, stable and functional for my disabilities - particularly considering my poor hand function. Now all I had to do was to learn how to ride a bicycle again alone, this time two wheels and on my own power. That story is up next....

Life Update #3 - Legislative action

Ernie Franz — Sat, 22 Mar 2008 20:40:55 -0800

In January of 2008 I was asked by my friend and Harborview trauma surgeon Jerry Jurkovich, MD to be present with he and US Senator Patty Murray as she introduced her proposed Trauma Bill to the press and local TV stations. It was certainly an honor to be asked to be a part of this effort, which will begin to help fund uncompensated trauma care. This growing financial crisis for many critical "safety net" institutions, such now as Grady Hospital in Atlanta, has resulted in 20 US trauma centers closing since 2000. Though efforts are being made to keep Grady, and other such institutions open, I believe some radical changes will soon be necessary in the way we deliver and pay for health care.

At the press conference during which Dr. Jurkovich and Senator Murray spoke, I was asked to share my personal experience as a physician/patient and to relate just how vital it is to each of us that centers like Harborview remain financial viable and open. As I found out, you simply do not know when you too will need the services of your nearest trauma center.

Thankfully Harborview is not in a financial crisis mode as best I know. Yet allow yourself to imagine for a brief time just what life in the NW would be like if Harborview had to close. That would mean not a single level I trauma center between Alaska, Montana, Idaho and Washington. Either critically injured patients would need to be taken care of as best as possible locally, or moved to trauma centers in Oregon or California. In my case I would have been sent south to such facilities, out of reach with family, friends, church and others who were so very vital to my recovery process.

Though it may seem impossible that such an institution like Harborview would someday face closure, once you read the Grady Hospital story you can begin to see how it all could unravel. Without outside funding from the state or federal government, or with only minimal funding at best, an institution must depend more and more on those with insurance. Trauma is a disease of those generally under age 35, in fact the leading killer of those under that age. With nearly 50 million uninsured in the US, and trauma striking most often at an age when those injured are least likely to have insurance, one can begin to see the economic burden placed not only on those injured, but also upon the facilities that care for them. Yet in an institution like Grady with 33% of patients having no insurance and only 8% having private insurance (generally the best payor), eventually things begin to fail. Costs must be controlled, which impacts staffing levels, equipment repair and purchase; working conditions deteriorate, staff including physicians become disenchanted and look for jobs elsewhere with better support, staffing, equipment and pay. Once the exodus begins, it only seems a matter of time before closure will come and another hole in the safety net appears with no clear means to repair it at all.

That said, I would urge you to read more on this subject, beyond even the NY Times article I have linked to. Certainly I support Senator Murray's Trauma Bill, yet this too may only be a brief stopgap or respite for many trauma centers who have otherwise entered the cycle leading to insolvency already. I don't know the long term solution, beyond perhaps national healthcare.

I welcome your thoughts.

First steps to getting back on the bike

Ernie Franz — Thu, 20 Mar 2008 21:44:02 -0800

Bicycling has been in my blood ever since I was a kid, but I became more serious about it in my college days at Indiana University, home of the Little 500 annual bicycle race and the fantastic movie Breaking Away, filmed while I attended IU. Although I never came close to finishing on a podium, I did dabble in both mountain bike and road racing from time to time during my Emergency Medicine career. When I was struck in 2004, beyond commuting by bicycle, I had been doing frequent training rides and a bit of racing; logging around 4000 miles in the twelve months prior to my injury.

When asked by a counselor while laying nearly paralyzed in my hospital bed what I loved about cycling, I remember saying it was feeling the wind in my face, the tension of the crankarms pulling on the chain, the sound and feel of the road underneath me, all the while spinning with my heart rate around 160-165. Speed. Efficiency. It just all felt so right, a sweet spot in a complex life, a break from the chaos of the ER, a sort of Chariots of Fire experience, such that when I rode I felt God's pleasure.

What follows then is the story of how I came to get back on the bike....

My first attempt at turning some crankarms 6 weeks after injury did not go so well. I was in my wheelchair with my feet velcro'd to some free spinning (that is no resistance) cranks. After a few minutes of satisfaction, my feet slipped off the pedals twisting one of my ankles. Though barely feeling my feet, this precipitated a moderate episode of Autonomic Dysreflexia which can occur with painful stimulus below the level of one's spinal cord injury - with myself feeling immediately dizzy, faint, and sweaty such that I needed to be laid down. I did not try spinning or turning cranks after that until my discharge home some 6-8 weeks later.

Once home in mid-December 2004, my physical therapist worked with me on a recumbent trainer in his office. One in which my heart rate and cadence could be monitored, my watt output measured and various programed training profiles set to challenge me. Initially I did this 5 days per week, traveling each time to Keith Heinzelman's office to work on the Sci-Fit trainer. Since I do not feel my feet very well, and particularly do not know their position (lack of proprioception), it was immediately obvious that I needed to use clipless pedals with cleats on the Sci-Fit. This worked beautifully! I could focus on spinning circles, not just mashing out watts. Improving watt output and some evidence of potential for fitness, lead my PT to consider getting me onto a bike.

I will never forget the day Keith asked me how I might feel about getting back on a bike. He had checked into us borrowing a recumbent tandem from one of the Washington state ferry boat captains who ever so kindly made his custom 'bent available to us. So beginning in early January 2005 we began riding together on the recumbent, Keith and I. I was the stoker with responsibility to provide some power over hills; Keith steering, shifting, braking and providing most of the wattage. That first ride for the two of us already written about in the section covering The Trauma, did include two low speed spills with no injuries, many laughs from me, and a few quietly muttered expletives from Keith. Yet we persisted, each outing gaining strength and confidence such that we signed up for the Chilly Hilly, 33 miles, 2500 feet of climbing on the last Sunday of February 2005. More on that next....

Life Update #2 - Legislative action

Ernie Franz — Tue, 11 Mar 2008 19:35:25 -0800

Although update #1 reflects my most current "work" related volunteer activities, I have also been involved in a few legislative actions which will be touched on here and in another post to follow. The information below is specifically in regard to Washington state's Crime Victim's Compensation program; the post to follow this will be in regards to US Senator Patty Murray's Trauma Bill.

As a crime victim myself, I qualified under Washington state law to receive some compensation for lost wages, to help cover out-of-pocket hospital expenses and to compensate me for the gap in my disability policy before coverage began.

In order for the victim to receive funds after the person who caused the injuries has been convicted of a crime, the victim must apply and meet several criteria as well as stay in touch with the CVC (Crime Victim's Compensation) program on an ongoing and regular basis. The CVC program is to be a payor of last resort, and from what I understand they primarily seek to cover unpaid medical expenses and generally soften the economic hardship that comes after an injury.

Given my immediate and long-term loss in wages, and to help cover unpaid medical costs, I did qualify to receive funds in 2005. I was given $11,508 by the CVC program which was very helpful to our family. Yet within a year I was forced to pay back 2/3 of that amount to the state after I received compensation from my insurance company for injuries sustained via my UIM (Under-Insured Motorist) coverage. Regrettably, the way in which the state of Washington goes about obtaining this enforced payback is by placing a lien on the victim! So without warning, or without even allowing a chance for appeal or time for the money to be paid, the state gives notification of demand for repayment through its action of placing a lien on the victim. I am still baffled and frustrated with this injustice.

You can be certain I did appeal to the state's CVC program, and ultimately to the Governor of the state of Washington, Christine Gregoire. Here then is an exact copy of that letter:

September 17, 2006
RE: Crime Victim Compensation Program Lien for claim ID ######

Dear Governor Gregoire,

The purpose of my letter is to re-appeal through your office the roughly $7,800 lien the Crime Victims Compensation Program has placed upon me requesting repayment of money they had provided to me over 12 months ago. My initial appeal to the program was rejected. Financial analysis revealed the funds were distributed correctly; and I must say all initial correspondence did not clearly communicate to me the possibility of repayment of those funds. Repayment of which I am now facing via a lien from the CVC program. I am the victim of a crime in which a 19 year old very intoxicated driver struck me while bicycling on Bainbridge Island August 23, 2004. He subsequently pled guilty and served 4 months in prison.

The Kitsap County Courthouse ordered the driver to pay $182,152.87 in restitution damages nearly one year ago (see attached letter). Most of that amount was to compensate my medical insurance company, though $8,629.71 was also to come to me personally. To date nothing has been paid to either party, nor is it ever likely to be paid given the dire financial situation of the entire family of the teen that nearly killed me.

Ironically, I was an Emergency Room physician, who in my nearly 17 years of practice had treated over 50,000 patients. Many of these were themselves victims or perpetrators of a crime; and many of these patients were themselves treated by me without compensation as I was then a part of America’s safety net for all who arrived through the Emergency Room doors to receive care regardless of their ability to pay. Unfortunately due to the severity of my injuries, which included a C5 spinal cord injury, and other significant nerve injuries to both arms, I am and will always remain an incomplete quadriplegic (having some movement in all extremities, but never a chance of regaining normal or near normal function). Although my recovery has been in many ways amazing, my injuries will prevent me from ever practicing in the Emergency Room again, that career ended.

I greatly appreciated receiving $11,508 from the CVC program over a year ago, but now I am having great financial concerns over the lien they have placed against me asking for repayment. I have not been able to work at all since this accident. It is quite difficult for me to walk, stand and use my arms; only through ongoing physical therapy several days per week am I able to move about. A recent fall due to lingering gait instability resulted in 2 hand fractures requiring surgery. Monthly I continue to have out of pocket medical expenses and my COBRA health insurance benefits will end by 2008. I will someday likely be able to work in a part-time position; however my disabilities will only allow me to work in a sedentary capacity.

I am now 48. I would have had at least 15-18 more years of practice ahead of me at the time I was injured. In addition to my salary, I have lost my additional retirement funding provided by Virginia Mason Medical Center. I am no longer on medical staff there (as they do not keep inactive physicians on staff); I have also lost the retirement benefits I was to receive in 2004/5 of $12,137.40. This Virginia Mason contribution would have been received annually with yearly increases, and this too is a big loss for me and my family.

The driver who struck me only had $50,000 in liability insurance. The lawsuit we filed against him is soon to be settled for that amount as he and his family have no assets whatsoever. The driver testified that he obtained the alcohol he drank prior to driving and striking me from unknown persons at a teenage party. There is no one besides he who is potentially liable. Yet, my ability to earn a living, provide for our family of five, support 3 children through college years, pay the mortgage, and perhaps find sources to fund retirement ALL have been severely compromised, and will for the rest of my life remain so. If I have to pay back the CVC Program’s lien out of the $50,000 settlement, it will cause further hardship to me and my family.

In summary, I have 3 points I would ask you to consider. First, give consideration to rewriting the initial CVC application and wording of subsequent letters from the CVC program to make it clear that repayment of funds distributed is intended. Second, if legally possible, repayment liens should be placed on the perpetrator or victimizer, and not on the victim. Third, carefully consider forgiving payback of dispersed funds when the victim will never be “made whole”, that is, faces permanent disability.

I could provide more detail, but I believe I have made my point. I have discussed these points with US Representative Jay Inslee (our neighbor) and am waiting to hear back from state Senator Phil Rockefeller. As a crime victim with a very uncertain financial future, I am asking you to remove the lien placed upon me. If a lien must be placed, it would only seem appropriate to have the state place that lien against the driver himself who has forever altered my life.

Thank you for your careful consideration of this matter.
Sincerely,

Ernest A. Franz, MD

This appeal was also rather quickly denied, and our family did then pay to the state of Washington approximately $7,800 in order that the lien be removed.

State Senator Phil Rockefeller did then in 2007 introduce SB5394 and championed the specific legislation that would change the potential repayment of funds given to a crime victim based on what he had witnessed in my case. In this bill he proposed several of the ideas I had put forth to the Governor; primarily that if a victim can never be made whole and is left with permanent disability, that repayment of funds distributed should be forgiven. In the early spring of 2007 I drove to Olympia and testified to a Senate subcommittee in favor of this legislation. Not so much for my own behalf, but for others who may be required to pay back to the state funds they have received as a crime victim. Yet due to ongoing CVC program state funding issues, complicated further at that time by embezzlement of CVC funds by someone apparently within the state offices, the proposed bill fell dead and to date has not been resurrected.

Life Update #1

Ernie Franz — Fri, 07 Mar 2008 10:08:53 -0800

I will attempt to quickly bring you up to speed with how I currently fill my days. It has been both a challenging life, and yet a satisfying one at the same time. Still hard for me to comprehend, but my family, and particularly my wife, believe I am now a much better person post-trauma, than I was prior to August 23, 2004.

A few of the activities I have mentioned in detail below these paragraphs were recently covered in The Trauma Report, a publication printed once every three years by Seattle's Harborview Medical Center. It was an honor to have been chosen to write a brief article for that publication, in which 3 trauma stories were featured, mine being one of those. By following the link in this paragraph you will find the article. Reading further below will certainly give you a more complete idea of the service activities I have pursued in this new life...

As of this date, I am not yet "working" in the typical American sense, but rather have thrown myself into various service activities. Those volunteer opportunities keep my mind active and enable me to give some of myself and my experience to others, whom in many cases are going through much of the loss and change in identity that I found to be initially depressing.

Thanks to the invitation and kindness of my spinal cord rehab physician, Dr. Barry Goldstein, I have been involved as a teaching assistant with the University of Washington medical students for the past three years running. Currently I volunteer as an assistant senior faculty member in 3 classes each Winter/Spring. Those are specifically Musculo-Skeletal Anatomy with 2nd year students, including assisting in gross anatomy dissection lab. Also working as a tutor in Problem Based Learning where I work with 9-10 students in a small group setting in which they discuss medical cases; beginning the transition from scientific medical head knowledge to actual problem solving involving clinical scenarios. With a variety of medical issues to work through in addition to finding a diagnosis, they will touch on refusal of care, cost effective medicine, end of life issues, medical malpractice, and various ethical situations. As this is in a small group setting, I thoroughly enjoy getting to know each student over the course of those two months. Lastly, I serve as a senior faculty member in Introduction to Clinical Medicine for first year students as they learn basic physical examination skills. These three classes are a highlight of my year. It is extremely satisfying to pass on some of my knowledge and approach to patients that I had learned during my time "in the pit", or the ER.

I am also part of the Patient Advisory Board at Harborview Medical Center in Seattle which is a group composed of former patients or their family members. We are involved in everything from patient/family/hospital staff communication, to the layout of the gift shop, to giving opinions regarding artwork chosen for the new hospital wing, to re-evaluation of hospital literature shared with patients and the public. What is currently termed Rehab Night @ HMC is also an idea formed by this group. Once a month between 2 to 5 of us meet for a panel discussion, information sharing time with newly injured patients and their families on the Rehab floor at Harborview. There we share our experiences and attempt to coach others whose lives, like ours, have been completely interrupted and seemingly destroyed. As a group we have found that the transition time between hospital discharge and re-establishment of life is the most difficult period to process. My intent is that in sharing our group experiences we can bring some hope to those patients and their families. We work primarily with those who have a SCI (Spinal Cord Injury), TBI (Traumatic Brain Injury), Stroke or Amputation.

I also make myself available to mentor to SCI patients, generally those like myself who have sustained incomplete injuries. By sharing my story with them, and spending time alongside them I intend to bring some encouragement and hope for their own future. Every single person with an incomplete SCI is very different in many ways; from their level of injury, to which specific spinal cord tracts were dinged and damaged. So there is no "usual" or "anticipated" level of recovery to be expected or guaranteed for anyone with a SCI; each of us has our own story and our own specific injury which will not only vary from a microscopic level, but also will depend upon numerous other factors at the time of injury. Every factor and many more including your age, mechanism of injury, potential rapid steroid and/or hypothermic administration, your own support system around you and your personal motivation - ALL these factors, and many many more play a key part in what level of functioning you may come to realize in time.

I serve on the NextStepsNW Board of Directors; a non-profit organization which works to rehab those with SCI, Stroke or other forms of paralysis through exercise therapy. A link to their website is also provided on the right margin of this page. As a board we concern ourselves with how best to support those with disability and with fund raising strategies for facility maintenance and new equipment procurement. We have had much success in enabling clients to regain the ability to walk, gain strength and provide exercise/conditioning all in a supervised setting with trainers who themselves desire to bring new movement or strength to weakened or paralyzed limbs. Our current focus of planning is to purchase a Lokomat, the current state of the art mechanized robotic treadmill support system, which should help many to re-learn to walk again.

Lastly, I am part of our church's Stephen Ministry team. The training for this, and the involvement with others in our local community who have experienced loss seems a good fit with all else that has happened in my life. The purpose of being a Stephen minister is to come alongside those who are experiencing divorce, cancer, family stress, job loss or anything else that may impact your life at a time in which a friend can help by actively listening and bear some of your burdens. It is sad that so many of us attempt to carry our own burdens and pain at a time when we truly most need the prayers, compassion and support of someone who could come along side us and offer the love of Christ. This training has been a perfect complement to my work with everyone from medical students to those with SCI or other life traumas.

Thoughts on Depression

Ernie Franz — Fri, 07 Mar 2008 10:02:27 -0800

I wanted to share that since my injury I struggle with depression and loss of a life and career I truly enjoyed. Yet, I am even more dismayed to find that anyone, including physician colleagues, have had to suffer for their honesty about undergoing treatment for depression....

I am not ashamed to say that I take an anti-depressant, obtain periodic counseling and seek advice from those around me to pull me through. Like any normal human would, I have my better days, and I have my down days; I think this is part of life. This trauma has given me a new attitude regarding depression. While I previously thought the presence of depressed feelings would mean I had a character flaw or fault, I now know for certain that is not the case. Counseling, though not always enjoyable, is deeply beneficial (and is even a covered medical benefit!) I have come to view anti-depressant medication as more of a legal performance enhancing drug; it helps motivate me to exercise, improves both my outlook and communication with my wife, children and friends, and does provide some optimism for the future. As it turns out, if I am feeling better, then I am easier to live with, and can in turn be an encouragement to others. I believe that treatment keys in managing depression, beyond medication and counseling, are cultivating relationships with family and friends – that is more specifically being deeply connected with others, and goal setting for the future in regard to both physical (bicycling and exercise for me) and mental (future job possibilities, speaking, writing) goals.

Just mentioning the above thoughts brings me to recall the wise teaching I received in first year medical school, offered by Dr. Corcoran who at the time was in his 70's. He believed the key to happiness and satisfaction in this life was having "Something to do, someone to love, and something to look forward to". Those words have stuck with me for over 25 years since I first heard them, and I do again and again find them to be true. I also see that they are primarily "others focused", that is to say in following such advice it causes one to focus away from ones own problems and self concerns, to instead look outward to others and to the future. I have found that when I focus on my life and look to my own interests and problems, it is most often then that I enter into that downward spiral of depressing thought. Yet I tend to be most satisfied with life when I feel I have helped serve others - whether that be family, friends, community or others who have been traumatized.

It is my experience that in staying focused on how I can bring hope to others, how I can share a bit of Christ's compassion and love, and how I can impact our family and our community - in these endeavors with the help of counseling, medication and a loving family, I have learned to live again and enjoy most ( > 99%) of life.