Audio By Carbonatix
part 2 of 2
For families that had just come through such dramatic situations, life dwindled down to mundane problems rather quickly.
My car had died while Bill was still in the hospital. No, I didn’t crack it up; it just needed some warranty work. But that meant I had to drive Bill’s truck, the one that “saved my Daddy’s life,” as Megan told her grandmother. If I could have sprouted wings and flown, I would have preferred it. Not that the truck was still a gory mess–it had been expertly cleaned by two very good friends after the local detail shop refused to do the job because they “don’t do blood”–but because it was, well, the truck. And for two weeks, it was our family’s only form of transportation. So I drove it. Very carefully.
Mike’s truck had a manual transmission, too. Carla drove him most places, but when she went back to work, he still needed to get to physical therapy and the rehab clinic.
“It was very important to get mobile,” Mike says. “I felt trapped in the house. Workers’ Comp gave me an RTD pass, but from here it’s a long walk to the bus stop. So we fought ’em, and they finally put an automatic transmission in the truck.” “The first time he went driving alone, I just stayed home and prayed,” Carla adds.
Workers’ Comp is responsible for providing medically necessary transportation; even if the injured party decides to take a cab to the clinic, the state is required to reimburse the cost. So a new transmission for a ’66 Ford pickup seemed an economical way to go. And the psychological benefits of Mike’s new mobility were beyond measure.
Bill’s transportation solution didn’t involve lawyers, but the next best thing: his brother the NASA engineer and his laptop computer. Bob came out from Cleveland right before Halloween, armed with a program that figured monthly payments to the penny, and the two brothers joined in combat against the local dealerships. Not surprisingly, they got a pretty good deal on the newer model of Bill’s truck, since the trade-in was very clean. It was only missing the driver’s-side front reflector, which kind of fell off when I cracked the side of the garage the last time I ever drove the damn thing.
For both men, the next step to full mobility was getting their artificial legs. Although Bill and Mike had each started their rehab programs while still in the hospital–in fact, they met at physical therapy–weeks passed before they were fitted for their prostheses. And with good reason, according to Dr. Robert Meier, head of the Amputee Center of America, which is based at University.
The rehab program’s goal is to “integrate the patient into the community with the highest level of function possible,” says Dr. Meier. “We’re not here to just provide an artificial limb, but to help the patient with an altered body state to resume his role as father, husband, worker, someone who enjoys recreational activities–to return to those roles and to serving the community.”
Reintegration requires a constant reassessment of the patient’s progress during rehabilitation. A large portion of rehab is physical conditioning, preparing the body to work in unfamiliar ways. Another portion is psychological, involving both one-on-one counseling with staff psychologist Brent Van Dorsten, whose specialty is trauma and post-traumatic stress syndrome, and delaying the fitting of the prosthesis.
“We should never underestimate what a tragic loss a part of the body is,” Dr. Meier explains. “I feel strongly that, especially for adults, after a loss of a limb, the patient has two body images and it’s important to focus on how the body has changed. It’s important to take time to grieve and to come to terms with your new body. Immediately fitting an artificial limb that most likely won’t be very comfortable anyway, since the remaining limb is still healing, is not the most effective way to deal with the situation.”
Bill was ready for his prosthesis by November, and received it the week before Thanksgiving. Although he was raring to go, initially he wore the new leg only a few hours a day, working with his prosthetist, Ron Englander from NovaCare, to get the adjustments just right. Bill would walk between the parallel bars in physical therapy, and Ron would follow him with an Allen wrench, twisting here, turning there, until it felt good to both of them.
Once the fit was correct, Bill wanted to learn everything about his new leg and go everywhere on it–but the flesh was still weak. It takes about 70 percent more energy to get around with a prosthesis than with two legs, so the conditioning programs must continue long after a patient leaves the hospital. Bill tried to use the step machine he’d bought over the summer, but his artificial foot–after trying two, he settled on one the kids call the “Ken Foot,” since it’s as pale and plastic as Barbie’s boyfriend–kept slipping off. He mounted a cross-country ski binding to the pedal and now straps himself in for an aerobic workout.
So far, Bill has suffered none of the endless variety of setbacks that can occur with a prosthesis.
The course of Mike’s adjustment hasn’t been as smooth. He got his leg two weeks before Christmas, just as his son Alex had predicted. Because the leg is held on to the stump by a vacuum, it’s critical that the inner socket, made of flexible plastic, conform to the contours of the stump. As healing proceeds, the shape of the stump changes; in Mike’s case, it’s changed a great deal. His socket has already been refitted three times in order to keep the leg securely in place. The second time, the outer shell was also replaced.
“I’m getting stronger, but I’m still limping,” Mike says. “And I’m still learning–how do I do this, how do I do that. I can’t run until the socket fits, but every now and then, I’ll be wrestling with Alex out in the yard and I’ll forget. I’ll try to run and go over.”
Both Bill and Mike recall hearing from various therapists that they could expect to do everything they’d done before their accidents. “But nobody said how it would be different,” Bill says.
As the debate over health-care reform rages on, the most specious argument is that government intervention in health-care delivery will result in rationing. Folks, health care is already rationed–by insurance companies. The situations of these two families offer textbook examples of that.
Since he works as a per diem employee, Bill is not covered by his employer’s medical plan. His medical bills are being handled through my former employer’s private, small-group policy. (I’m doing freelance work now, having lost my job last month after a long-delayed meltdown–a reaction Dr. Meier says is not uncommon.) We have the option of continuing coverage through September, as long as we pay the monthly premiums and the employer doesn’t switch insurance companies. The policy has no specific rehab benefits, will pay for one artificial limb and no more, and attempted to exclude coverage of air ambulance service (but finally paid all $6,000 on a technicality). As we shop for new coverage, we are confronted by the “pre-existing condition” exclusions.
Because he was injured while driving a company truck in the performance of his employment, Mike’s medical bills are being handled by the Colorado Workers’ Compensation program, which was “reformed” two years ago. Part of the reform package limited the state’s responsibility to one artificial limb and no more. The cost of a prosthesis is roughly equivalent to that of a new luxury car; the flexible liner, which holds the prosthetic limb to the stump, costs another $3,000. Because of the changes his stump has undergone, Mike is on his third liner.
“If Workers’ Comp wasn’t paying, I don’t know what we’d do,” says Carla. The family has additional insurance coverage through Mike’s employer. If Mike were terminated, he would have the option of continuing coverage for eighteen months, since his employer has more than twenty workers. The owner of Carla’s three-person shop can’t afford to cover her employees; as a part-timer, Carla wouldn’t be eligible for benefits anyway. Last year, Mike and Carla decided to take the optional accidental death and dismemberment coverage offered on his policy, “just in case.”
Both Mike and Bill are beginning to think about the consequences of not having a spare leg. At six months out, they’re about ready to have the cosmetic covers added to their limbs, which means the legs will be in the shop for anywhere from three days to two weeks. Without a backup, they’ll be back on crutches for the duration.
“The loss of independence being without the prosthesis is mind-boggling,” Bill says. “If I don’t have my leg, for whatever reason, I’m disabled. I can’t go to work; I don’t have the mobility that I’ve been working toward.”
And no matter what, both men will need a new prosthesis within the next several years–one they’ll have to pay for themselves, since insurance doesn’t cover it. Dr. Meier estimates that prosthetic limbs need to be replaced every three to five years. “It’s a real problem,” he says of the one-limb rule. “Hopefully, it’s something you can build into part of the down side of being an amputee, but it’s not easy to deal with.”
The constitutionality of Workers’ Comp’s one-limb limit, along with other provisions of the reform, is being challenged in a lawsuit brought immediately after its passage by the AFL-CIO and other parties. The suit, which is now in the Colorado Court of Appeals, is funded by the Workers’ Compensation Education Association. Lawyer Neil O’Toole expects the suit to eventually reach the Colorado Supreme Court. No matter what its decision, though, private insurance programs will not be affected.
Another part of the “down side” for amputees, Dr. Meier notes, is that insurance carriers attempt to get a better price on the limbs they do pay for by bidding out the prescriptions to various prosthetics companies. The catch, he says, is that in Colorado there are no certification requirements covering the manufacture of artificial limbs or braces.
“So the carriers can get a bid that’s thousands of dollars lower, but it’s not really what we talked about in clinic,” he says. “It’s mixing apples and oranges.” His center deals with two prosthetics companies: NovaCare in Aurora and Seattle Orthotics, which has an office in Fort Collins.
The same insurance limitation often applies to rehabilitation therapy. The therapists who work at University’s center, which is one of three designated burn rehab centers in the country and receives referrals from all over, deal with a large volume of amputees and know what can be expected in terms of functional outcome. “An insurance carrier may have a contract with another rehab group that has little or no experience with amputees, so the ultimate outcome won’t be as much, in terms of the patient’s function,” Dr. Meier explains.
Ultimately, though, each individual rehabilitation proceeds at its own pace. That pace depends a lot on the individual patient’s personality as well as his support system. “At six months, it’s hard to say what the ultimate outcome will be,” Dr. Meier says. “We’ll have a better idea after a year.”
At 32, Mike is looking forward to “the best possible rest of my life”–although he’s not exactly sure what direction that life will take. He was expecting to go back to work about eighteen months after the accident, but it’s becoming clear that he can’t do the jobs he did before.
“I’ve always been a construction roughneck,” Mike says. “I can dig a hole and hoist a crane, but I can’t even do that all the time anymore. When it’s sunny and dry, sure, but if it’s wet and slippery, I can’t keep my footing. And just sitting around pampering myself, I don’t know how to do it. It’s not me. I’ll start to do things, like climb a ladder, and then I have to stop myself.”
Workers’ Comp no longer provides for any kind of vocational retraining or rehabilitation. Nor does it require that employers rehire injured workers. If the employer provides a written release that says the worker can return to work with restrictions, temporary disability benefits stop even before they reach the $30,000 cap, whether the employee actually returns to work or not.
“Some people at work have the attitude, `It must be nice, sitting around the house and making all that money,'” Mike says. “Well, I’d love to change places with them and let them try it.
“I’m starting to look twenty years down the road now and thinking about how I’m going to provide for my family, pay the mortgage,” Mike continues. “It’s depressing. I never used to think about these things.”
“You never used to let anything bother you,” Carla replies. “You have to think about this more and know it bothers you.”
“I think being Mr. Mom will be fine for another six months or so, but I wish I could punch a clock,” Mike sighs.
“You know, we’ve gotten used to seeing each other 24 hours a day now,” Carla adds. “It’ll be kind of sad when you go back to work. I’m going to miss it.”
The family stayed with Carla’s mother in Denver during Mike’s hospitalization and early rehab; they’ve recently moved into a new house. They’ve put their desire to have another baby on hold.
Bill returned to work at the end of January. He’s up to a three-day-a-week schedule, and has discovered that the biggest challenge is changing into his surgical scrubs. He’s on his feet a lot, but can sit while monitoring patients during operations, although he couldn’t do his job from a wheelchair.
Like Mike said, he lost a leg, not his head.
Just before he went back to work, Bill visited Megan’s class as her show-and-tell exhibit. He showed them the leg, told them how it worked and then answered questions for an amazing hour and a half. Bill’s gotten very good at show-and-tell, but one kid still came away with the impression that the leg was permanently attached, like the Terminator’s.
“They’re only fifth-graders, but they wanted to know everything that happened,” Bill marvels.
Just like the rest of the planet, darlin’.
Everyone everywhere has discussed what Bill did and why he did it, whether they would have or could have done the same thing, even whether he really had to do it in the first place. In the wee small hours, I still think similar thoughts: If Bill had waited another hour, would someone have come by to lift the rock off his leg? Maybe. But if he’d waited another hour, would he have passed out from the pain and not been able to attract the attention of a passerby? Possibly. We’ll never know. Bill’s still not comfortable with the fact that his experiences have become public property, and there are some things he hasn’t discussed with me yet. That’s okay: We’re getting on with our lives.
As for our future plans, now that I have time, we’re actually making some. Family vacations, repaying dinner invitations, sending out last year’s Christmas cards and being together as much as possible head the list. And Bill and I are both thinking of ways to give something back to the community that supported us through the ordeal.
Meanwhile, Mike and Bill are making plans of their own. A field trip to the Sportsmen’s Show in February revved up both of their fishing motors. Bill’s convinced that a belly boat–an inner tube with chest waders built in–will enable him to at last catch that trout with his name on it.
As the guys talk about how soon the ice will be off Blue Mesa Reservoir, Carla and I ask only this: Bill drives, Mike guides. And they tell us exactly where they’re going.
end of part 2
