My Scar Tissue is Beautiful

Dangerous behavior

A time will come when in the most provoking situation, one will be able to heed the warning given by respiration and sensation, and will start observing them, even for a few moments. These few moments of self-observation will act as a shock-absorber between the external stimulus and one’s response. Instead of reacting blindly, the mind remains balanced, and one is capable of taking positive action that is helpful to oneself…
S. N. Goenka, master teacher of Vipassana Meditation

Twenty years ago, on July 2, 1996, I nearly died.

I was driving my small Nissan pickup home down Hwy 410 after a climbing attempt on Mt. Rainier. Weary from lack of sleep, I dozed off long enough to veer off the road, cross over the centerline, hurl down a ditch and collide with an old growth tree stump at about sixty miles per hour.

Wham. Crumpled steel, shattered glass, splattered blood, and a motionless body slumped over the steering wheel.

Moments after impact I gained an unfamiliar state of consciousness, and in a hazy state of awareness realized I was in trouble. I could see, sort of, with my right eye, that the windshield was gone and replaced with bushes. I slowly realized that it was unusual to see the car’s wiring from the driver’s seat. The concept of movement or escape was outside my cognitive abilities. Awareness flittered in and out and around my body.

Fortunately I was wearing a seatbelt and had not become a projectile, but I was still nearly dead. The impact was so forceful that Nissan-branded embroidery on the seat belt was burned into my hips. My head had smashed against the steering wheel, breaking and flattening the complicated bones in my face. My left eye socket was blown out, my left sinus was obliterated, my jaw was broken, my nose was smashed sideways, and among the many facial lacerations, there was a long tear that started at my upper lip, went through my nose and across the top of my left eye orbit. My face was a flap of skin and the left side of my head was dented. The dashboard had collapsed on my right leg and the patella was torn away.

Although the head injury was serious and visually brutal, the internal injuries were life-threatening. As a result of the violent impact against the seatbelt my ribs were fractured and my right lung was punctured, my liver was lacerated, and my intestines were ruptured. I was bleeding to death from the internal injuries.

As I helplessly slumped over the steering wheel, rescue quickly began. One of my climbing partners was in the car directly ahead of me and had coincidentally been looking in her rear view mirror the moment I veered off the road. She quickly turned around and arrived at the accident site. Someone in the line of cars behind me was an EMT, and he helped to assess the situation. Most fortunately, another driver behind me in the line of cars had a cell phone (in 1996!) and dialed 911. Impact occurred within a mile of a local hospital complete with a helicopter pad. Harborview Medical Center in Seattle was just a short flight away, and is one of the top trauma centers in the US.

The Emergency and Trauma Center at Harborview Medical Center has gotten a few upgrades since I was earning frequent flyer points there in the mid-1990s.
The Emergency and Trauma Center at Harborview Medical Center has gotten a few upgrades since I was earning frequent flyer points there in the mid-1990s.

As the rescue progressed above and behind me I lapsed in and out of consciousness. I heard the crunching sounds made by the rescuers as they stepped on broken glass in the canted bed of the pickup. There had been a pickup shell back there, but the impact was so forceful that it tore loose and catapulted over the cab of the truck. The metallic mechanical chirping of a “Jaws of Life” machine woke me from a lapse into unconsciousness as the rescue workers cut away the crumpled wreckage from around my body. As the rescuers gingerly lifted me out of the wreckage their touch momentarily reconnected me to my body. Whatever was left of my face felt like it smiled in response to their touch.

After the rescuers placed me on the gurney I somehow gained enough composure to realize the gravity of the situation.

I felt stupid: I had just spent 16 hours on Mt. Rainier which routinely kills people every year and I was about to die on the drive home. I thought: “the climb isn’t over until you’re at home in bed.

I expect that we all have at least one death fantasy that we carry around with us. The most common is probably that we will peacefully die at home, in our own beds, surrounded by close friends and family. Since I have a very active lifestyle, death as a result of falling asleep while driving never occurred to me. Being on the verge of dying this way caught me by surprise.

At that moment so close to death I realized the folly of the “perfect death” fantasy. Death may come at any time and in any way: Be prepared.

In a flash, I experienced a rush of lifelong memories. I remembered the faces of everyone I had ever ignored, gossiped about, or dismissed. I reflected on the meaningful and important relationships. I recognized my interpersonal connections as threads in the fabric of my identity. The catastrophe resulted in a deeper experience of my interconnectedness with others.

Thinking I was about to get glimpses of the afterlife, I watched my feelings and sensations in the minutes after the wreck and waited to see what would happen next. At least as far as my experience took me, I didn’t recognize anything “next.” I experienced pure, stark nothingness. I realized that the reality of this moment is all there is. As I observed myself dying I realized that this moment is all there is. The crash enabled me to experience the importance of this moment at a depth that would not have been otherwise possible.

So much seemed to happen in that short time, then the gurney jerked forward and was loaded and clamped into the ambulance. I briefly felt completely disconnected from my body: As the gurney rolled towards the ambulance I observed it in the third person, from above.

The rescue team was amazingly efficient. After a speedy emergency prep in the Enumclaw hospital, my body was loaded into the helicopter and I arrived at Harborview within an hour after impact. Despite the enormous trauma, I somehow maintained a sense of humor throughout the experience. I thought: “My first helicopter ride and I’m not going heli-skiing!” This kind of positive attitude probably made a significant contribution to my recovery.

I laid in the emergency staging area of Harborview for several hours while a surgical team was assembled. I initially refused morphine. I was aware that I was dying and since I didn’t feel pain (I was in such a state of shock that I may have been in a state in which pain was irrelevant) I didn’t want drugs to dull my awareness any more than it already was. I uncontrollably lapsed in and out of consciousness, and even when I was conscious, it was of a kind that was unfamiliar and uncomfortable. I felt as though the reference points for my normal state of consciousness were obliterated and it was taxing to adapt to the unfamiliar quality of consciousness I experienced during those hours.

Eventually, a relative arrived at the hospital to identify my body, tenderly held my hand and advised me to take the morphine. I consented. With the morphine dripping into my bloodstream I was seduced away from trying to maintain awareness and into a pleasantly narcotic state of sleep.

An all-night emergency surgery triaged the injuries and initiated the long painful recovery process. Early the next morning I awoke in intensive care surrounded by the haggard surgery residents who had been up all night saving my life. Their faces were sagging and tired, their eyes were bloodshot and their hair was matted from sweating all night under their surgical caps. Although most of the talk was about my body as an interesting surgical case, one resident leaned over to whisper that my jaw was broken. I thought he was joking, since at that point I didn’t even know whether I was going to live, and as it turned out the broken jaw was such a minor detail that it wasn’t mentioned in my medical record. I moved my jaw around to confirm and nodded my understanding. The residents moved on to the next patient in their rounds.

July 3, 1996. A ~12 hour emergency surgery got me on the road to recovery.
July 3, 1996. A ~12 hour emergency surgery got me on the road to recovery.

Intensive care was a nasty experience. I felt like a cyborg: A respirator breathed for me, a maze of tubes dripped fluids and medications into me, and a catheter directed waste fluids into a bag that hung disturbingly within view. As I lapsed in and out of consciousness I could see, through my right eye, friends and family sitting around me, heads in hands, and looking worried. I had apparently complained about some kind of pain, and I was asked about how I felt. I began to write out in the air with my right index finger “L” “O” and one of my brothers, then a medical student, quickly concluded “Lower back pain!” I waved to indicate “No, wrong, let me finish.” I began again: “L” “O” “V” “E.” The astute nurse announced “He feels Love.” I meant this in two ways: I felt the attentive loving care of those around me, and I felt a loving compassion towards everyone in the room and the medical staff who were caring for me. The tension in the room eased, and everyone smiled with relief.

A week later that nurse tracked me down to tell me that my recovery was the most remarkable he had seen in ten years of working in intensive care.

After my friends and family left that first day I was the only body in intensive care that wasn’t comatose. I didn’t know whether I was paraplegic or going to live. All I could hear were the mechanical and electronic sounds of the hardware keeping us intensive care patients alive. My mind roiled with a range of undesirable outcomes and I fell asleep feeling angry that I had been rescued at all.

My condition quickly improved and within a couple days the respirator and the tube in my punctured right lung cavity were removed and I was relocated to “intermediate care.” Life in intermediate care was a morphine-induced hallucination. For example, during a phone call with a friend I told him that even though I might have lost the use of my left eye, not to worry, an eye transplant was possible. Denial has a bad name: I routinely made unrealistic comments like this while I was recovering, but I had such a deeply held conviction that I would recover to a state as good as new, that I did in fact eventually recover to a state nearly as good as new. My left pupil is permanently dilated, but I can still see with it, I just need to wear sunglasses all the time.

Sadly, I had to fend for myself in the intermediate care ward. There was a night shift nurse who hated her job and who I nicknamed “Nurse Ratched.” Because I was bedridden I had to periodically roll from one side to the other in order to keep fluids from accumulating in my lungs. But, I was unable to do so on my own. While the other nurses provided assistance by pushing and pulling, Nurse Ratched’s bedside manner was limited to yelling at me to roll over. “If I could roll over on my own do you think I’d be here?” I eventually talked with her supervisor and she was replaced.

I hated being in the hospital and tenaciously orchestrated my exit from the hospital bed. The hospital bureaucracy was confusing and difficult to understand. I directed my mother, who had a diminutive personal style, to chase down all the requisite signatures and approvals. The process wore both of us out, but a short eight days after the wreck I returned home in Bellingham where a spare room was set up as a makeshift hospital room.

August 1996: I set up a makeshift hospital room at my home in Bellingham while friends rotated stays with me.
August 1996: I set up a makeshift hospital room at my home in Bellingham while friends rotated stays with me.

That first surgery was about 12 hours long, and then later that fall I had another major surgery that lasted over 10 hours. I’ve been under anesthesia for a total of about 50 hours in surgeries related to the crash.

Several factors worked in concert to lead to a remarkable recovery:

–I was in excellent physical condition: Although I lost over half of my blood volume, my circulatory system remained stable. At a time when an increasing number of Americans are afflicted with lifestyle-related diseases, there is much to be said for exerting the effort it takes to stay fit.

–As soon as I got home, a childhood friend scheduled a series of visits by other friends who stayed with me and helped me during the first eight weeks after I was released. They also provided important emotional support in the following months. The support and attention I received from friends and family during this time was key. There is much to be said for maintaining a rich set of interpersonal relations.

–I had an established Vipassana (buddhist) meditation practice that helped me to maintain a balanced mind even in “the most provoking of situations.” I am convinced the meditation practice attenuated a potentially long-term bout with post traumatic stress disorder. I am also convinced that the meditation practice helped me to maintain a balanced mental state through extraordinary physical and emotional pain which in turn accelerated the healing process.

From the moment I first regained consciousness in the wrecked pickup I remembered my meditation practice and tried to wrestle control of awareness in order to observe any sensation that I was experiencing. I can authoritatively report that it is extraordinarily difficult to maintain awareness when you are dying. The consciousness flitters around trying to find familiar sensations with which to connect, but the dying process is unlike anything in a day-to-day meditation practice, and adapting the mind to the unfamiliar experience is difficult.

At the time of the accident, I had been meditating for seven years and hosted weekly group meditation sittings. As my health improved, I began to hold the weekly sittings again. In addition to the group sittings one of my meditation friends, who had also been in a severe auto wreck, visited periodically and we meditated together. Although it was very difficult to meditate because of the physical pain and traumatized state of my mind and body, having the additional support of these weekly sittings and visits from this friend helped me to maintain a continuity of meditation practice that played a key role in my healing process.

The pain I experienced during the first 10 weeks was excruciating. The pain medication only provided relief for several hours at a time, and as each time interval waned I anxiously anticipated the next dose. It turned out that I was in fact healing much faster than usual. During a phone call with the insurance company handling my account, the claims adjuster told me that they expected someone with my grade of injuries to be in the hospital for at least 30 days. I was released after 8. 39 days after the accident I began a daily routine of taking a 2.7 mile walk around a nearby lake. Within 6 months I was backcountry skiing again, and within 11 months I summited 10,781’ Mt. Baker in the North Cascades.

I had high expectations for recovery. First world problems: I had a difficult time skiing that first winter. I telemark ski, and felt uncoordinated when turning to the right. During a doctor visit I complained. He laughed: “Um…99.9% of humanity can’t do a telemark turn…you are doing just fine.

The most striking part of the healing process came after about 3 months, when I was fit enough to attend a 10-day silent meditation retreat. After the crash I suffered from post-traumatic stress disorder which expressed as an irregular sleep pattern. I was only able to sleep for about an hour at a time, after which I would wake up soaked in sweat. Then after several hours of restlessness, I would again doze off for about an hour, and the cycle would continue. My doctors and psychotherapist all advised this pattern would continue for at least a year and maybe for as long as five. Three days into the meditation course the PTSD symptoms disappeared: My sleep pattern returned to normal, which allowed me to get plenty of rest, which in turn enabled my body to relax and heal.

Several interesting phenomena resulted from the injuries to my face. In addition to the tears and lacerations, a major nerve was severed, and as a result the left side of my face and mouth are permanently numb. It feels like there is a layer of wax on my face, and I’m constantly aware of the difference in the quality of the sensations on the two sides of my face. The odd numb sensation results in an uncomfortable sense of self consciousness when I’m interacting with others. When someone looks at my face it feels like they are staring at my dilated eye, or notice the asymmetry in my dented head, or something else about my face that isn’t quite right.

A self-portrait that demonstrated how fragmented I felt after the crash.
A self-portrait that demonstrated how fragmented I felt after the crash.

Having a dilated left eye is interesting. Most people don’t notice. Some notice after knowing me for years then all of a sudden ask: “can you see with that thing?” Occasionally someone notices immediately: “how come you have differently colored eyes?” Sometimes I get a compliment: “Cool eye! Just like David Bowie!” Other folks who don’t know my history get annoyed or feel insulted that I almost always wear sunglasses: “Could you take those sunglasses off!? You aren’t that cool, you know.” One time a business contact discontinued a working relationship because he said the eye was too weird and he couldn’t hold a conversation with me.

Because of the fractures in my head and the scars on my face, for several years (and even sometimes to this day), I didn’t recognize my reflection. I would think: “Hmmm. Who’s that? Oh yeah, that’s me.” Because of the combination of the numbness and scars, the visual cues and bodily sensations my ego formerly used to identify “self” had dramatically changed. The familiar set of physical reference points were gone, morphed or rearranged. I no longer looked or felt like “me.”

What I see when I look at a selfie: I still don't look like
What I see when I look at a selfie: I still don’t look like “me.”

Even now, when I notice the odd numb sensations in my face, or don’t recognize my reflection, I experience something like “disorganized ego,” or maybe “disoriented ego.” Here I mean ego not as self-importance, but as the sense of identity, the set of sensory references we all constantly and unconsciously use to feel a sense of “I-ness.” This experience provided me with the unique opportunity, with rearranged body parts, to experience how, moment after moment, the ego constantly “pings” different reference points within the framework of the mind and body to maintain itself.

Now twenty years later the question I get most often is “how long did it take to recover?” Honestly, I don’t think I’m recovered, I’ve just done a good job of adapting to my situation.

Because of the damage to my abdomen I periodically have bowel obstructions, several of which have required hospitalization, and on one occasion surgery. The scar tissue from the abdominal injuries is prone to forming adhesions, which in turn can cause the bowel to constrict or kink. There is no kind of “normal” pain that compares to an obstructed bowel. When a bowel obstruction is in full-force, the intestines writhe beneath the surface of the skin and it looks as though “Alien” is trying to escape. To date, I have these experiences about every five years.

When I was in the thick of it I never thought I’d make it this far. I got lucky that the rescue happened so quickly and efficiently. Despite the intense pain and disorienting sensory and visual experiences, I’ve been able to keep a relatively positive attitude and a relatively balanced mind.

But, most of all, now twenty years later, I mainly reflect on gratitude. I’m grateful for the rescuers and medical staff and especially the nurses who helped me out. I’m grateful for the generous help my friends and family extended to me during the weeks and months after the crash.

Because of everyone who has helped me, my scar tissue is beautiful.

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