I’m standing in the shower, water turned to just short of blistering, steam flooding the small bathroom. The bandage on my right shoulder looks like a sodden diaper, saggy, heavy and drooping. Below it my arm hangs uselessly and swollen to my fingertips. It’s unfamiliar. Still sticky and yellow from the antiseptic that was painted on in the operating room five days earlier. It could be a prop—a rubber prosthetic used for bad jokes and handshakes with politicians. Using my left hand, I can’t quite reach the tape that wraps down my shoulder blade, under my armpit and around my bicep to hold the dressing in place. Finally, I loosen a corner near my collarbone and start to pull, the delicate skin stretching before the adhesive releases in fits and starts. Rip it off fast or ease it slowly? The eternal question.
I started having shoulder problems when I was 17. In an over-vert halfpipe, I pulled off the wall and fell 12 feet to the flat bottom. My shoulder dislocated anteriorly. Ski patrol was called. One patroller bear-hugged my ribs while a second patroller moved my arm through a throwing motion, reducing my dislocation slope-side. I took a sled to the patrol shack at the resort’s base, and four hours later, a physician in town gave me a sling and told me to rest for a few weeks.
A month later, I dislocated again. Then again. Eight months, and a half-dozen events after that first injury, I went in for surgery to repair my shoulder and prevent future dislocations. The surgeon opened a 4-inch vertical incision just above my armpit and placed five metal anchors into the bone of my shoulder socket to reattach and tighten the ligaments that help maintain stability in the joint. Six weeks later, I dislocated again.
The bandage hits the shower tiles with a wet splat, and I peel the last strips of tape away. It’s been 22 years since my first shoulder surgery. A lifetime punctuated by recurring dislocations, where I have learned to never lie with my arms stretched overhead, to always keep the muscles of my upper back and traps engaged, to carry heavy loads only on my left side. Because of my shoulder, I changed sports, set aside dreams of professional athletic careers, taught myself to cast, eat and write left-handed, stopped swimming, stopped climbing, became accomplished at reducing my own dislocations, adapted yoga poses to avoid stressing the joint, changed how I sleep, how I hug, how I live. I accepted it and kept going.
Then last spring, my 5-year-old bumped my elbow, and my shoulder came out of its joint, the most mundane of dislocations. A month later, I tossed a Frisbee in the yard and out it popped again. By early fall, I could no longer lift my arm. I couldn’t pick up my kids, open a door, carry a cup of coffee or ride a bike. I’d become a product of my own neglect, and it was no longer sustainable.
The surgery was complex. Going over the scans in a preliminary meeting with my doctor, it was apparent that I hadn’t just mangled one part of my shoulder—I had damaged all of it, plus my collarbone and bicep. Each injury begged for an individual procedure.
“Well, I don’t like to do things halfway,” I joked, as I sat on the exam table.
We called for backup, pursuing multiple consultations, each expert seeing a different priority. Rebuild the socket using a piece of cadaver bone and screws. Separate the operation into multiple events over two years. Take a bit from the end of my already separated clavicle and use it to shore up the old repair. Protect range of motion, but not at the expense of stability.
We were in uncharted waters, and despite our planning, much of what would be done would have to be determined in the operating room, seat-of-the-pants style. Moments before going under anesthesia, I looked at my fellowship-trained, award-winning, shoulder-specialist surgeon. “Do a good job,” I said. He laughed. I didn’t. This was not my first rodeo; I needed some reassurance that it would—fingers crossed—be my last.
Back in the shower, I count the Steri-Strips covering the boreholes peppered around the circumference of my shoulder and prod gingerly at the incision that starts below my old scar and stretches down toward my bicep. Under the Dermabond, a surgical superglue used to close wounds, my skin looks plastic and alien. One internal suture protrudes from the site like leftover fishing line. There is very little blood, but beneath the extensive and colorful bruising, I can make out my initials, written left-handed in permanent marker. I had signed my shoulder in pre-op, providing the medical team with verification that, yes, this was the correct side on which to operate.
I complete my inspection and let my arm dangle loosely at my side. During the planning, the surgery itself and the days immediately afterward, I’d held it together. Now I start to unravel. Being hurt has been part of me for so long that I’m not sure I know how to trust that I’m going to come through this. I’m terrified and I’m hopeful. So I cry. Then I turn off the water and get down to the business of healing.
Throughout the years, I’ve been privileged to spend large swaths of time chasing adventure, but there have also been long stretches where getting outside and chasing fish or turns or trails wasn’t possible. Sometimes that was due to responsibilities like needing to pay bills, finish degrees and take care of loved ones. Other times—more times than I’d ever like to remember—it’s been due to illness and injury, and not just to my shoulder. I’ve been airlifted and have taken ambulances. Hospitalized and put on bed rest. Spent months in physical therapy and intensive-care units. Been thrown time and time again, then returned to climb back on the horse. With it all, I’ve come to recognize that patience is a virtue. Unfortunately, it isn’t one of mine.
The toll of recovery, including the financial cost, time commitment and time-out requirement, the draw on overall resources and the disbelief in the possibility of success are the primary reasons why after my first failed shoulder surgery, I didn’t immediately sign up for a repeat attempt. Rather, I tried to ignore the problem. When that wasn’t possible, I changed paths and tried to work around it. I could reinvent myself over and over again, but I was afraid of what would happen if a second attempt to fix my shoulder was unsuccessful. Ignorance, though often painful and disruptive, was bliss.
Messing around outside is my passion. It’s what inspires my work, where I live, how I raise my kids, how I vote and how I shop. It also represents a huge chunk of how I spend my days. Without it, there is a void that begs to be filled, and the filling is complicated.
If you type the words “sports injury” and “mental health” into a search engine, you’ll be inundated with articles talking about the mental toll of injury, how to cope emotionally and the psychological journey that is the return to activity. Common complaints from patients participating in research studies on the mental impact of injury include sadness, isolation, irritation, lack of motivation, anger, frustration, sleep disturbances, increases in drug and alcohol abuse and general ennui, among other issues. To counteract these negative effects, the experts suggest “redirecting your energy,” journaling, focusing on gratitude, engaging with friends, finding new hobbies appropriate to your injury, seeking out therapy and planning future activities.
Based on all of this, it seems like there are two primary responses to being hurt and getting better: fall into a dark pit of depression, anxiety and desperation, or find another way to fill the space normally occupied by activity. On paper it’s an easy choice, but like most things, the reality isn’t so simple.
Before surgery, I made a list of things I planned to accomplish over the course of the next eight months of recovery—my anticipated timeline for returning to fishing, mountain biking, skiing and trail running. In no particular order, my list included write a book, strengthen my core muscles, learn a language, call my congressman, walk five times a week, bake the perfect croissant and convince the children to pick up their damn LEGOs. In the middle of relaying my list to my partner, he stopped me.
“What?” I asked. “You don’t think I can do it?”
“You can definitely do it,” he said. “But you don’t have to. You could just do nothing. Work on healing and not have any expectations beyond showing up for yourself.”
He is the unflappable partner. I am the excitable one, the one prone to overthinking and worrying, the one who attempts to squeeze every lemon to fill the cup, only to wind up with juice in my eye and paper cuts that burn like fire. I could see his rationale, and I value his insight, but also knew I was looking at dark times ahead if I had nothing to look forward to but sitting on the couch and bi-weekly sessions of physical therapy. I taped my list to the refrigerator.
For most of the world, saying it’s been a hard few years is a gross understatement. We are more isolated than ever before, more alone and lonelier. The Lancet, one of the world’s oldest and most respected peer-reviewed medical journals, published a 2020 study describing the impact of COVID-19 on global mental health. The study’s authors found that major depressive disorders had increased by 27.6 percent worldwide since the start of the pandemic and documented cases of anxiety disorders had gone up by 25.6 percent. That was two years ago, and despite the availability of vaccines, not much has changed.
According to the Mayo Clinic, a nonprofit academic medical center in the US, since the beginning of the pandemic, there has been a major increase in the number of adults reporting symptoms of stress, anxiety, depression and insomnia—many of the same symptoms reported by injured athletes. While isolation and lockdowns have worked to prevent the spread of disease and preserve life, they have also left more people than ever on their own without a healthy outlet in which to recharge, let off steam and find some modicum of happiness. Again, a situation in which many injured, outdoor-loving individuals will find themselves. This doubling up feels exponential in its depressingness, and it’s clear that the sports psychologists talking about alternate activities during injury hadn’t planned for a pandemic.
All of this comes up as I’m lying on my physical therapist’s table at eight in the morning. She is pulling traction on my arm and slowly trying to rotate it past 90 degrees.
I am cringing away from the burning, stretching, marching-fire-ants sensation.
“How are you doing?” she asks. She moves my arm past 90 and is working to gain another five degrees.
“Not great,” I say. “Bad, actually. Did you go skiing yesterday?”
It snowed 20 inches two nights ago. Of course she did. So did everyone else in town. She gets the five degrees and holds it there.
“Deep breath out. Try and relax. Let me know if it’s too much.”
There is no relaxing, and it’s all too much.
“I hate this,” I tell her. “Not the stretch. It’s fine. But all of this. Being hurt. Missing out.”
She inadvertently opened a floodgate.
“I’m mad all the time. I swing from jealous and frustrated to exhausted and melancholy. I feel like a complete jackass for feeling sorry for myself while so many people are suffering and the whole world is basically on fire. I thought I’d do better than this.”
I continue, saying that I know my problems are small and that everyday people who love being outside as much as I do are getting hurt and some won’t get the chance I have to recover. I tell her I can see my privilege and fortune staring me in the face, and I’m still acting the spoiled brat. I’m like a pig in mud, wallowing in my sadness, then feeling guilty for getting dirty.
Because she is good and kind, even while she’s putting the pain and torture into PT, she listens. She reminds me that I’m not hurt, I’m healing. That being sad is part of recovering and there’s a long road ahead. She gently says that it’s possible to see the big picture and feel broken-hearted for the world, while also grieving my own situation. Both things exist, and though they aren’t equal, they are both valid. One does not negate the other. I tell her maybe when we schedule surgery and subsequent physical therapy sessions, we should also sign up for conventional therapy.
“We tried that once,” she says. “A patient wanted to set up a sort of group therapy.”
“How did it go?”
“We sat in a circle, everyone said how frustrated they were, then they went back to their exercises.”
I tell her that sounds about right.
A month and a half pass and I have a routine post-op appointment with my surgeon. He has a new baby at home, and while he checks over my incisions and range of motion, we talk about kids, lack of sleep and retaining a personal identity after becoming a parent. He reminds me the biggest risks to my repair are falling, moving my shoulder before being given the green light and smoking. I have no plans to light up anytime soon, but the other concerns are real. I mention that we are hoping to get my youngest child skiing on the magic carpet for the first time in the next few days, and I am feeling fairly despondent about missing it.
“Don’t miss it,” he says. “We didn’t fix your shoulder to ruin your life.” He tells me to put some traction on my boots, not to even think about stepping into my skis, to be careful and to go.
The next day, I do.
We load all three kids onto the free bus and head to the mountain. It’s a fiasco. The plan was for the two older boys to ski the beginner area, taking fast laps on the magic carpet, while I watched from the sidelines cheering on Dad and Little Sister, but she wants nothing to do with it. I send the guys off to ski while I sit down with her to have a snack. After 10 minutes, we begin making our slow careful way back to the base area. This is not easy. Toddlers and ski boots are a tough match on the best day, and before long, I have my daughter slung over my good shoulder like a sack of potatoes, my other arm still securely immobilized in my sling. We make it midway up the bunny hill before stopping. I ask her if she wants to click into her skis and I’ll give her a tow the rest of the way. She agrees, and after sliding the first 10 feet, she decides she loves skiing. Her voice pipes out across the slope, “Skiing is so fun!”
At the top of the hill, she wants to ski back down. I jog backward, letting her ski to me, slowing her down, then letting her go again. Back at the top, she proclaims, “Mama, you not help me. I can do it.” And she does. For almost two hours. She skis down, I tow her back to the top, she skis down, I tow her back. I’ve skied thousands of days and had so many “best days ever” I’ve lost count. While this isn’t the greatest day on skis I’ve ever had, it is one of my greatest ski days.
Today, I’m two months into injury rehabilitation with another six months to go. I have my fingers crossed that I’ll come out of the sling next week and physical therapy will move to a more active regime. I’m excited to pull up my pants with both hands and zip my own coat, even though it will still be a while before I can carry a gallon of milk in my right hand.
At home, life continues to be relentless; there’s no stopping just because I’m moving a little slower than normal, and something always seems to come up. Last week, it was four cases of strep throat in our family of five and projectile puking at the dinner table. Then school closures due to a COVID-19 outbreak. On days when it feels like my world is confined to four walls and there is negative fun to be had, I look at my list on the refrigerator. It’s been there long enough that now the edges are starting to curl.
Amidst the daily grind, I’ve been checking off the boxes: baking bread, writing letters, walking around the neighborhood, doing my PT. I’m filling the gaps in my days, and it’s often rewarding. It’s satisfying to pull a tray of perfectly risen, naturally leavened croissants out of the oven. Time spent writing politicians about reinstating and creating a more robust Clean Water Act and introducing practical, achievable climate policy feels well spent. But still, I’ve never loved going for strolls around the neighborhood, and satisfaction and reward are different than foot-to-the-floor, all-out, no-questions-asked-no-answers-given fun. The kind of fun that comes from chasing fish, pushing knobby tires deep into left-hand berms or dropping off a ridge into eight inches of fresh snow with no one else in sight. I miss that fun.
I miss it so much, and I’m just crossing my fingers that a year from now, when I’ve finished everything on my list, the world will once again feel big.