Postmortem

July 16, 2022: This story begins a few summers ago when a group of friends (similar group to The Great Snowboard Expedition) were celebrating Ronen's 33rd birthday with a bit of downhill mountain biking at Northstar resort in Truckee. I have ridden Northstar a handful of times over the years. I try to go at least two or three times a summer to keep my downhill skills sharp. A fine layer of moon dust keeps it slippery and there are a few trails in particular characterized by seriously chunky rock and steep chutes. I have never participated in a race there but it is on my list. My point being - I generally know my way around Northstar, how to keep it rowdy but also within my ability level. But this time I was at a big disadvantage.

I had tested positive for COVID a few weeks earlier and it hit me pretty hard. I was vaccinated but still completely taken out. I slept most of the day, lost my sense of taste and smell, had a fever, bad sore throat, and no energy. I have a really hard time staying in one place for an extended period of time. I get bored and restless. I knew Ronen's Northstar trip was coming up and I really wanted to go but kept testing positive. On July 15th I tested negative for the first time. I contacted the group and explained my situation - everyone was comfortable with me coming along, which left the final call to me. Deep down inside, I knew that it was probably not the best idea. Or if I were to go then I would have to take it easy and play it safe. My muscles were weak and I was so tired - there was no way I could do a proper full day at Northstar in my current condition. The group was actually headed up the evening of Friday the 15th to camp out. I decided to go to sleep super early in my own bed and drive up Saturday morning.

The day started out fine. I was tired but taking it slower than usual with some breaks in-between runs. But of course, I made the decision to do just "one more run" and not only that - I choose a double black diamond which I had only ridden once before earlier in the summer - Karpiel. This is a proper downhill trail littered with chunk. I was not thinking straight. I should have just called it.

As I came into the trail's main chute feature I failed to see the hole of doom which sucked in my front end and catapulted me off my bike. I smashed my right hip straight into a granite boulder with no dampening whatsoever. I tumbled another 10 feet or so, making sure to take advantage of my full face helmet along the way. Lying there I immediately thought to myself I probably shattered my hip. But miraculously I was able to slowly stand up and limp around without too much pain. I evaluated myself and only noticed some bruising along with some shallow cuts on my elbow. My head, neck, and back were all fine. I sat down to take a breather and make sure I did not just have a false sense of security from the adrenaline rushing through me. I was hurting but it was manageable so I got back on my bike and slowly made my way down the rest of the trail - walking a few sections I would normally ride out of caution. When I got to the car I passed out from exhaustion. I have never been so tired in my life. Post COVID fatigue is real. You would not really know I had such a bad crash from looking at me back at camp that evening. Some scratches but that is about it. Tough bones I guess? Nothing to worry about.

July 17, 2022 - September 15, 2024: Even right after the crash I generally felt ok. I was sore and limping but nothing too serious. I figured I had some bad bruising that would clear up in a month or so. I could ride a bike and do hikes. But before I knew it, summer had transitioned into fall time and I was still in pain. I had a constant dull ache deep in my hip that would turn into a pinching sensation when sitting. I usually heal pretty quickly so I was growing concerned. I decided it was time for an evaluation from my doctor. He took an Xray but did not find anything obvious. He put in an order to see an orthopedic surgeon for second opinion. I got an MRI done with my orthopedic and he was able to locate a small tear of my labrum tissue. The labrum helps to stabilize and cushion your hip joint. Tissues do not heal so your only options are to strengthen everything else around the area through PT or get surgery. I took the conservative approach for over a year with PT and a cortisone shot. I do not want to say that these things did not help, but they did not solve the problem. My pain relief was always temporary. So long as I was moving I was fine (I skied 30 days that first winter) but as soon as I sat down I was in a lot of pain.

It was around April 2024 and I was becoming increasingly frustrated by the pain and decided to get a second opinion with another orthopedic surgeon to discuss my options. My second doctor was more optimistic and in favor of surgery but ordered a CT scan to get a better idea of what was going on. Through the scan he was able to confirm his suspicions and located same areas of the hip where I had enlarged bone protrusions which were the source of the pinching. Basically I had bone rubbing on tissue and cartilage in an already inflamed area where the tear was located. PT will never solve this problem. The only way to fix it is by grinding the bone down and suturing the damaged tissue back together. My surgeon was very detailed and explained all the imaging results and surgery process. It is minimally invasive and takes about 2 hours to complete. You are in and out of the hospital same day. I thought about it for a few weeks and decided to proceed with the surgery. I scheduled it for September 16th, 2024 after a fully booked summer, but before ski season. The surgeon predicted 3-6 months of recovery time. The official surgical procedure is called "Right hip arthroscopic femoroplasty, acetabuloplasty, and right labral repair".

Over the summer I enjoyed as much as I could. My lovely wife and I guided a climb of half dome for the fourth time with my dad and his friend from college, did our longest trip ever to Singapore and Indonesia (3.5 weeks!), learned new skills working on the Jeep, grilled some pizza from scratch, hosted friends from Polska, and did some last minute backpacking in Yosemite! You may be thinking "Tim, you seem fine...why do you need surgery?" You are not entirely wrong as I was able to do the things I love the most. But the pain comes in waves, there are good days and bad days. When I was not moving, things would get rough. Long drives, plane rides, and office work became brutal. Plus I was worried about longer term damage.

September 16, 2024: I was thoroughly impressed with the surgery. It was professional, efficient, safe, and respectful. Everyone in the surgery center were kind and caring, easy to talk with, and gave me confidence. I know this country has its problems with medical insurance, but I am grateful to be living here with access to some of the world's best doctors, medicines, and technology. I woke up from the surgery feeling pretty awful from the anesthetic but this was expected.

I do not want to sound dramatic, but I do think it is important to recognize the series of events and decisions which ultimately lead to my injury. I will be the first to say that it was my fault. Injury is, unfortunately, part of any extreme sport when you are pushing yourself. Finding your limits is a risky game and sometimes you face the consequences. Things go wrong for all kinds of reasons - it could be your own technical limitation, human factors, genuinely bad luck, or some combination. I made a choice - that is on me.

Ian McCammon is a mechanical engineer by background that has transitioned from robotics to avalanche and snow mechanics research after a fatal accident of his friend in the backcountry. He has completed quite a bit of work for the industry that is taught through various certified avalanche safety courses such as the AIARE series. One of his most notable pieces of work (which I learned in AIARE 1 class) is the human factors flags of Familiarity, Acceptance, Commitment, Expert Halo, Scarcity, Social Proof (FACETS). There are loads of papers on FACETS and other human factors written around the context of backcountry skiing and avalanche safety that are worth reading as they are relevant to any relatively high risk/high consequence type of sport like wilderness backpacking, mountaineering, or mountain biking.

Familiarity - I have ridden Northstar many times, therefore in my mind I had convinced myself the risk was low.
Commitment - I told people I was planning on going a few weeks ago and did not want to back out last minute.
Scarcity - I do not get many opportunities to go to Northstar each summer.

I would not say I was a complete idiot and reckless, but I do recognize the shortcut my brain took. In the interest of continual improvement, I hope to better remind myself of these factors. And I hope anyone reading this takes it seriously. I am fortunate to not have had that bad of a crash - it was a close call. But this is why I document and communicate the true side to my outdoors projects. Sometimes things go wrong, and it is important to gather the facts with a fresh mind. I had not been on the bike for awhile and my skills were rusty. Enjoying a day out with friends injury free is always a great time. But that day - I made the wrong call.

Over the course of the next few weeks I was pretty spoiled. My wife took great care of me, made sure I was comfortable, well fed, and there for me through a pretty rough first few days out of surgery. As I grew stronger I became more independent but she did not like that ;) Food is an important part of our relationship so we took advantage of the extra time for some tasty meals together!

As I said earlier, I have a hard time staying in one place. So always being in bed during my recovery at the beginning was tricky. I found ways to keep myself occupied like working through some detailed CAD for an up and coming project or attempting to learn some more Polish to speak with my wife's family. It is easy to get into a downward spiral of too comfortable routine. Finding ways to use your time differently is important and leads to the development of new skills you may not have gained otherwise.

November 25, 2024: Two months after my surgery and celebrating my wife's 31st birthday in Las Vegas! I am out and about, able to do light hiking and bike riding. It is still sore and my surgeon says I need to be patient. I have a follow up in January, 2025. I am hoping to be cleared to ski!

It turns out that I had more damage to my hip than originally anticipated. Some of my cartilage had been torn up from the bone protrusion rubbing up on it. My surgeon said that was almost certainly there before and I did not even realize it. This is the kind of long term wear and tear that can lead to arthritis and other problems when you get older. So at the end of the day, even if I do not get back to 100% from this surgery, the repair work that was completed was a win. He was able to grind the bone down, remove some of the damaged cartilage, and suture the tissue back. If that does not solve the problem, I do not know what will.