A year ago I burst my spleen snowboarding. A year ago I wrote up this description of what happened. I didn’t have a blog then; I do now, so here it is!
â€œ77 over 37â€.
I was descending into shock rapidly. My limbs were going to sleep one at a time and the doctors were obviously worried. I couldnâ€™t tell exactly how worried, exactly, because of the language barrier â€“ which was to become a major feature of the next 14 days!
It all begun on the last Saturday in February; the penultimate day of our long weekend snowboarding in Les Arcs. That morning weâ€™d done our big off-piste adventure, guided down the north coast of BellecÃ´te from La Plagne. We all survived unscathed; most of our group continued with the guide down the Aiguille Rouge off-piste in the afternoon. My fiancÃ©e and I decided to go to the park instead. Again we stretched ourselves with a mogulled black run followed by the boarder cross. So far so good.
By this time it was getting late and we headed back for the long journey to where we were staying at Peisey. This should have been the easiest part of the day â€“ I wasnâ€™t even sticking to my cardinal rule of forcing myself to ride the last run switch.
Imagine my surprise, then, when 40 yards from the bottom of the blue run to Peisey, somehow I found an icy patch and slammed forwards onto the ground.
Never mind that it shouldnâ€™t be possible to catch an edge on an icy patch. I donâ€™t know how it happened, but it hurt. I felt winded, but I had much more pain on my left hand side in my ribs â€“ where Iâ€™d stupidly kept my mobile in my only dry pocket â€“ the inside pocket. I knew then that something was wrong. I optimistically hoped Iâ€™d â€œjustâ€ cracked a rib or sprained an intercostal muscle. But I also knew it could be my spleen, after we’d swapped stories about friends who’d burst their spleens snowboading only a few days before.
I shouted a fair amount, and other slope users started to peer at me. Stupidly insisting I was OK, I kept sticking my thumbs up at them, and gradually proceeded to slide down to the bottom of the slope to my fiancÃ©e. She could see that things were wrong and unstrapped me from my board. The doctors were just around the corner but I decided not to go â€“ painful though it was, I still hoped it was a muscle problem or cracked rib. I reasoned that the doctors could do nothing about it, except prevent my flying home the next day.
So we went to our chalet â€“ a painful experience. One of our friends gave me a couple of ibuprofen which all but removed the pain. (The chalet chocolate cake was beneficial too!) But I found there was no way to get comfortable in bed, and it was ominous that no individual rib specifically hurt when I prodded it. Thoughts turned to the doctors again. If it was just a rib, at least he could give me stronger painkillers. One of the chalet hosts was going up to the area of the doctorâ€™s again; he gave my fiancÃ©e and I a lift â€“ though we resolved we would get back in the car straightaway if there was much of a queue.
The queue was only one person: this may have saved my life.
â€œGood, we wonâ€™t miss dinner,â€ said my fiancÃ©e. I sat and read leaflets â€“ as you do â€“ before deciding I needed the loo. For some reason this worried me a little â€“ the urge to pee came on rather suddenly. But I went.
I was half way through the act when I began to feel faint â€“ very faint. I remember trying to prioritise my options before I collapsed:
- Zipping up flies
- Lying down
- Calling for help
- Unlocking door
I decided that 4 and 5 were pretty important (although somehow I managed my flies too). I remember stumbling half way out of the loo and calling for my fiancÃ©e before everything disappeared.
And thenâ€¦ I dreamed. Several minutesâ€™ worth of dreams, even though I was apparently unconscious only for a moment.
I awoke with my legs on the shoulders of the doctorsâ€™ receptionist: this was a nice way to wake up â€“ she was cute. They manoeuvred me onto the bed in the adjacent treatment room. Doctors flitted past occasionally but paid me little real attention. I worked out later that they must have assumed I had fainted due to the pain â€“ pain which no longer really existed due to the ibuprofen Iâ€™d taken.
About five minutes later, a doctor arrived to give me his full attention. My fiancÃ©e reports that the conversation went something like this:
â€œIs it very painful?â€
â€œNo â€“ Iâ€™ve taken two ibuprofen. It hardly hurts at all.â€
â€œThatâ€™s bad, isnâ€™t it?â€
The doctors took my pressure â€“ it was a little low but not too bad. They took a while to get a drip into my arm â€“ obviously not something they do very often; several painful stabs were needed.
I explained that my legs were starting to go numb â€“ they took another pressure reading â€“ 77 over 37. I was going into shock rather quickly.
At this point they really got agitated. A phone call to the local hospital began, demanding an ambulance and relaying my condition. They kept asking me questions, and encouraged me to stay with them. I did. My fiancÃ©e was asked to return to the waiting room, where she paced for the next fifteen minutes.
Having got a drip in, they gave me a shot of adrenalin. Boy did that hurt. It forced my heart rate and pressure up so much it felt as though my heart would explode. The doctors kept saying â€œthis is normalâ€ â€“ one of the few occasions when I got any English out of them, but I was very glad of it. I was also wondering how much of the panic I was feeling was due to the adrenalin itself rather than my reaction to the physical effects on my body. I still donâ€™t know. Can adrenalin affect the brain â€“ or does the brain just produce adrenalin to affect the body?
Up until this point, Iâ€™d been holding it together emotionally. The adrenalin undid all that, and I whimpered and moaned from the effects. I also started to think about what a lucky life Iâ€™d had, how much I loved my family, and what Iâ€™d tell my fiancÃ©e to tell my mum. All the usual soppy stuff you see on films when people are dying.
My fiancÃ©e in the waiting room was similarly upset: she later reported â€œI thought I could hear the electric shocks [of a defibrillator] but then I heard you moaning so I knew you must be aliveâ€.
Fortunately, the adrenalin did the trick. I had done a first aid course a few months previously, and I knew its purpose was to tighten my blood vessels to increase the pressure. It worked. My pressure returned to normal levels and I gradually stabilised. At this point there were two doctors, the receptionist and five ambulance people in the tiny treatment room.
Claire was allowed back in, then they moved me across to a stretcher and took me out into an ambulance. I got another brief glimpse of Claire. The doctors and receptionist from the resort clinic waved goodbye, looking relieved and proud. I was conscious enough to get out a few â€œmerci beaucoups!â€ â€“ although I suspect I repeated it rather often.
The ambulance ride wasnâ€™t much fun. For one thing I felt travel sick â€“ I figured that the strains of vomiting would really not have done my organs any good, but I didnâ€™t think Iâ€™d be able to get the concept of â€œtravel sickâ€ across to the French-speaking ambulance crew. For another, the ambulance crew said my fiancÃ©e had had to stay in the resort. In fact this wasnâ€™t true â€“ she was following in the other ambulance â€“ but I didnâ€™t know.
The ambulance crew were none too friendly or reassuring â€“ they wouldnâ€™t answer my questions even when I tried to ask them in French. And they asked me the same questions again and again â€“ â€œwhich way did you fall,â€ and â€œwhen did you last eatâ€. I knew this was to monitor my consciousness, but for anyone too dozy to realise this, it would give the none-too-reassuring impression of incompetence or forgetfulness. Oh well. Although I was smug about knowing why they were doing this, it did actually work: since lying on my bed in the doctors Iâ€™d been insisting that I last ate at lunchtime: at some point during the journey I awoke enough to remember the slice of chocolate cake Iâ€™d eaten at the chalet. I felt that it must be a good sign Iâ€™d regained consciousness enough to remember this!
From then on, it was all uphill, more-or-less.
Upon arrival at Bourg-St-Maurice hospital, I discovered my fiancÃ©e was there after all – which was a terrific relief. They put us into an observation room and connected me to beeping machines, measuring my heart rate, pressures and blood oxygen level. They explained that I might not need an operation, depending on the size of the whole in my spleen. I badly wanted to avoid an operation â€“ it would have meant the removal of my spleen, and I suspected it wasnâ€™t quite as useless as the appendix Iâ€™d had out years ago. (I turned out to be right â€“ it helps to fight off infections).
After a while they sent me down for an X-ray and ultrasound. The former showed nothing â€“ the latter showed the cut and half a litre of escaped blood. Apparently this wasnâ€™t too much â€“ theyâ€™d only do an emergency operation if there was more than a litre. They were primarily concerned about me only due to the sudden shock in the doctorâ€™s surgery; since this didnâ€™t seem to be recurring they decided to monitor me.
They put me into the room where I was to stay for the next few days. It was a room for one to three people: other beds shifted in and out continuously. All were snow sports accident victims. I shared the early days with a Dutch teenager whoâ€™d broken his collarbone and needed an operation to put it back. Somehow he persuaded his insurance company to let this operation happen in Holland. He was flown back on a regular flight from ChambÃ©ry to Rotterdam, chartered by the Dutch insurance industry purely for people with broken bones. (The British insurance firms I spoke to later were very impressed by this level of organisation!)
They monitored my blood pressure and heart rate. If the latter went up, it meant I was bleeding hard. Fortunately it remained low â€“ my resting heart rate of 40-45 being unusually low, regularly setting off alarms and waking everyone up at night. But most importantly, they monitored my blood haemoglobin levels. Haemoglobin can only be produced slowly by bone marrow, so it was a good indicator of what was happening â€“ whilst it was going down, I was bleeding faster than my body could replace the blood.
For the first three days, it declined, and it was a pretty good reflection of my mood. The 9.8 on the third day was particularly depressing â€“ it was announced as â€œ9â€ and meant I was still bleeding: even though I felt OK it was depressing to know my body wasnâ€™t capable of fixing itself. I also knew that as it headed lower and lower, at some point the surgeon would decide enough was enough, and remove my spleen.
But the 9.3 on the fourth day was good â€“ we were worried it might be 8 (a few years ago, blood transfusions were given at this level â€“ nowadays itâ€™s 6 due to shortages). The doctor felt I was well enough to take am ambulance journey to the CT scanner in MoÃ»tiers. That was an experience in itself â€“ the ambulance man had eyes that pointed in different directions and overtook constantly on the windy two-lane road. (There was another member of the crew â€“ I was able to console myself that he might have been driving.)
The CT scan â€“ a 3D X-ray machine â€“ involved being trundled through a doughnut shaped machine on a stretcher. It even had smiley faces that lit up to tell you went to breath or hold your breath. It wasnâ€™t too scary except for two factors. One was the positioning lasers; youâ€™d be blinded if they shone in your eyes, yet you had to keep your eyes open to see the smiley faces. It seemed to work out. The other factor was the injection to show up the arteries and veins more vividly in the images â€“ scary stuff â€“ they said it would make my thorax burn inside. My surgeon in Bourg St Maurice had decided I shouldnâ€™t have this â€“ something to do with my allergy of horses. But the staff in MoÃ»tiers thought better of it and decided to give it to me anyway. Oh well. It didnâ€™t kill me, or even hurt as much as theyâ€™d said.
They also allowed me to eat a little that evening â€“ which I thought was great news as it indicated they werenâ€™t going to operate. Unfortunately they later explained it just meant they werenâ€™t going to operate that particular night, and I would be back off food the next day.
But â€“ the next morning â€“ my blood test was 9.9 â€“ elation! The surgeon was as delighted as me. He explained that there was now only a 10% chance of needing to operate, and all being well, I could leave 10 days later. Claire flew home, I started to eat regularly, and I had one drip removed. I also got started on the sudokus â€“ and the insurance details.
By this time about one and a half litres of blood were swoshing round my abdomen, and my poo was black for weeks as I gradually reabsorbed it all.
Claire had already informed my insurers, Direct Travel. I phoned them with basic questions: how do I organise my flight home, etc. They explained that they did the whole thing. The first step was to get a medical report from the hospital; the second, for them to send a guarantee of payment to the hospital. Surprisingly they asked no questions about how Iâ€™d done it â€“ I was glad Iâ€™d chosen insurance that covered off-piste without a guide â€“ even though I had done it on-piste, it meant I didnâ€™t have to worry about proving it.
Later, they required a â€œfit to flyâ€ certificate from the doctors. They provided this on day 10 â€“ but unfortunately did not fly me out until day 14. This was due to debate between my doctors and those at the insurers, about whether it was necessary for a nurse to accompany me, and whether I needed to go into hospital when I reached the UK or if I could go straight home.
One thing I forgot was to pay for the doctorâ€™s surgery – â‚¬160. They asked me to ask Claire to visit the day after my accident, but being semiconscious I had forgotten this. Subsequently this caused all manner of trouble â€“ they only accepted payment in person, so I had to try to persuade chalet staff to go and pay (after we had electronically transferred the money to them). This didnâ€™t work out â€“ so I eventually persuaded them to accept a Euro cheque â€“ expensive both for us and them.
The insurance claim itself is as yet unknownâ€¦ but the assistance team were very helpful.
What to do for two weeks in a French hospital?
My friends were very kind and sent me many cards, flowers and â€“ best of all â€“ parcels of novels. Claire had also bought me lots of newspapers and puzzle books. I was only bored at one point in the middle before a further box of books arrived. For the second week, I buried myself in Japanese language textbooks, so it didnâ€™t even feel as though the time was wasted.
The food wasnâ€™t too bad either â€“ they usually took my orders the night before. It gradually improved through my stay as they felt able to feed me more and more.
And I met lots of other patients â€“ I spent most of the last week with a Dutch expert in the manufacture of artificial limbs.
The view from the hospital was great too â€“ although the constant, unceasing snow reminded me what a great holiday I would be missing the week after I returned!
Part of the struggle was to find out when I might leave, what was happening to me, etc. My French is terrible. The surgeon didnâ€™t know much English â€“ he was pleased to learn â€œpointâ€ from me (as in 9 point 9) â€“ and neither did nearly any of the nurses. However I was pleased to be able to translate from German to ropey French on behalf of fellow patients on occasion.
It never really caused a problem â€“ it was clear that decreasing haemoglobin was bad, increasing was good. Although it did lead to uncertainty about when I could go home â€“ the date kept changing â€“ and a series of unpleasant surprises about short-term restrictions on what I would be able to do when I got home. Had we spoken a common language properly, this wouldnâ€™t have been an issue.
The nurses were, as everyone says, angels. Grumpy ones sometimes though. Especially when the machines went off in the middle of the night due to my low heart rate!
So, on the second Friday â€“ after 14 days â€“ the insurance company flew me back. I had to do nothing. An ambulance collected me from the hospital and drove me to Lyon airport â€“ their local expertise was invaluable in getting around queues. There, I was met by a nurse called John, who accompanied me for the journey to the UK. I didnâ€™t bother with a wheelchair; I was more mobile than the insurance company expected and they wouldnâ€™t normally have given me a nurse escort â€“ but the French doctor had insisted. A second ambulance took me from Heathrow home.
Because I have been lucky enough to keep my spleen (and thanks to a conservative surgeon who was patient enough to wait until it recovered) I should have no long-term effects!
In the mean time, the doctor says I have to stay at home and avoid work for nearly a month, then do no exercise or physical activity for two further months. This doesnâ€™t do my honeymoon plans any good, but Iâ€™m happy!
I have been very lucky â€“ I should have no long-term effects. Iâ€™m very glad I went to the doctors â€“ and that there was no queue! Otherwise things might have been different.
- Have insurance. Check whether it covers off-piste without a guide: even if you wouldnâ€™t do a big off-piste expedition without a guide, you might be on a sticky wicket even just off the edge of the piste if you got in trouble.
- Have a European Health Insurance Card (the E111 replacement). Although your insurance would pay for a hospital stay, they will normally give you an incentive to use your EHIC by waiving your excess.
- If in France, get â€œCarte Neigeâ€ when you buy your lift pass. For â‚¬2.50 per day, you are covered by the resortsâ€™ own insurance as well as your own. This will cover you for the costs of helicopter rescues and similar, without any need to prove insurance.
- Donâ€™t store a hard object in an inside pocket!
Epilogue – a year later
I am fine. The insurance company paid up. I have no long-term effects. I am not scared of snowboarding. My fiancÃ©e is now my wife, and the spleen didn’t affect our honeymoon too much. Thank heavens for that conservative French surgeon who didn’t chop my spleen out in a hurry!