Severed part of my finger

**WARNING GRAPHIC INJURY PICTURES**

Last weekend I had a small incident with a hatchet. Maybe not that small. Barely missed the bone, and it's going to be months of healing.

I was splitting wood to start a fire for an alleycat race last week, my house was a stop. Was going to have chai and a fire since it was chilly. Then I missed with the hatchet. I now know that I should have been using a second log to stabilize the log I was cutting. But it's a little late for that... 

Keep reading to see what happened and how the healing is progressing. But be warned, there is some really gross stuff, it's not for the squeamish. I have trouble even looking at some of these photos, and it's my finger!

The day before, I got some tattoo work done, too, I was really amazed at how nice June's line work looked after our mutual friends started posting pics of her work. Finally, I found someone that could do the chainring from the bikelove logo.

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I've wanted this on my body for a long, long time, but didn't know anyone that I trusted enough to do it. And I thought it would be hundreds of dollars.

She actually said that the logo would be too quick, and asked me to think of something else to do to meet her minimum.  So I decided to write something in Gallifreyan that means a lot to me. June's stuff is great for circles and straight lines, which are some of the hardest things for people to do. 

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It looks really great. She didn't take long with it, just zip-zip-zip and then it was done. Many artists wouldn't even take a design like this, and she looked at it like it was nothing. 

I'm so happy with both pieces, my first new ink in probably 7 or 8 years. I can't recommend her work enough.

Keep reading if you want to hear about the injuries from the hatchet.

**** WARNING - GRAPHIC CONTENT AHEAD ****

How It Happened

I knew as soon as the hatchet fell that my fingertip was gone. It was actually good that my neighbor had sharpened it for me a month or so ago. It was a really clean slice. The duller edge that it had before that would have just mangled things horribly. But it was a perfect severing. Apparently just a millimeter or less from the bone, though.

The woman who was volunteering with me turned out to be a nurse at the VA hospital, which was great. We got some fairly lint free paper towels on it almost immediately. Then I was like "Hey, we should use real gauze." She seemed shocked.

"You have real gauze?" 

"Yup, and tape."

"Do you have gloves, too?"

"Of course, here you go."

It was admittedly a really quick bandaging job, but the hospital was just a few blocks away. We dumped a bunch of ice into a plastic bag, tossed in the bit of tip that had been cut off, then put the ice on the wound.

I learned later that you should put the fingertip inside of a bag with saline or clean water, and then put that in the bag of ice. Direct contact with the ice can do more damage.

Slammed 800mg of Ibuprofen. Banged on the doors of my neighbors that have cars and got a ride to the closest ER.

It's great living in this building where we all know each other. At the end of the night, my other neighbor picked me up and drove me to a 24 hour pharmacy, then brought takeout Chinese food since I hadn't eaten all day. The next day my other neighbor brought soup and crackers. They're seriously awesome.

Turned out that they were having a slow night - no people waiting, not even a desk attendant. The security guard told me to fill out the intake form and called someone. By the time I was done and had posted on facebook that I was not working the stop in my backyard anymore but at the ER someone came out to take me in. 

Here's what it looked like when I unwrapped it:

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I told you it was gross. It was weird, if I could keep from looking at it, then I could be jovial, cracking jokes with the attendants and doctor. But when I had to look at it, I got super queasy and lightheaded.

Since so much was removed, they wanted to xray it before doing anything. That was pretty quick, and in the same room that I was in when I broke my elbow. I mentioned that and the xray techs were all "Oh no, we have a frequent flier." 

It was a pretty long wait, but they got the results and then checked with a hand surgeon. They thought that I'd taken a small piece of the bone, too. The hand surgeon recommended that they shorten the bone and then seal it up. Apparently even though the tip that I brought in was in a lot better condition than a lot of the others they get, they couldn't use it with the bone being that close.

Thankfully the ER doctor was like "Um, no... I'm not going to preform an amputation right here and now. That's the job of the hand surgeons."

So, what they first did is irrigate it with a liter of saline. At that point, I had two fairly strong and long-acting topical shots in my finger, but the water blasting on the exposed end hurt like hell. I asked for more painkiller, and then had to wait 15-20 minutes longer to get started. But it didn't hurt any more at that point. 

Which was really good. The next thing they needed to do was use stitches to squish it together to get as much flesh over the top of the bone until I could follow up with the hand specialists later in the week. In order to do that, they had to get a special needle ad thread that they don't stock in the ER. Otherwise, they couldn't punch through the remaining fingernail to use it as something solid to pull the flesh against.

I couldn't watch while she did it, but did get a picture of it:

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They wrapped it up and sent me home with a prescription for percoset. I was supposed to get 30, but the dishcharge documents had it split into 20 and 10 on two different lines, so I only got 20. I realized that the next day, and the person I called at the ER told me I had to just talk to my regular doctor on Monday.

Thankfully, I already had an appointment for something else Monday morning. I had a thing on my back that was kind of crunchy and had been there for a long time and wanted to get it checked out. IT WASN'T CANCER! There's a history of it in my family, so I thought it was best to get a biopsy. That doctor prescribed the other 10 without even seeing the discharge papers or looking at a photo of the injury. They also confirmed that I was up to date on my tetanus shots, which I was 90% sure on, but they didn't have a record of at the ER.

Here's what they sent me home with for bandages from the ER:

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When I got home, there was a nice note/card by my bottle of whiskey from several racers. I thought that was nice. Especially since they actually left the bottle and didn't drink it. They didn't even touch my beer, but left a sixer of Hamms! I don't drink Hamms, but still, it was nice. 

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That first night was pretty hard for sleeping. This whole week has been, honestly. I had only eaten some sushi from the co-op for food Saturday, and it was around 11pm when I finally got home. I took the first percoset and ate some takeout that my neighbor brought. They didn't sit well together. I ended up throwing everything up, then just took another pill and passed out. 

Around 3:30am, the dressing slid off!! Thankfully, I noticed fairly quickly. I kept worrying it would fall off and was checking it even in my sleep. I was really out of it when I tried to put it back together, though. There was a vasoline covered gauze right against the wound that didn't come off, but everything else was gone. When I put it back, I apparently made the folded gauze pad over that hit wrong. Instead of being the same distance on the top and bottom, I had it too far back on the top, so the bottom was shorter and the edge was against the wound instead of covering it. That explained why it had been hurting so much.

Talking With The Hand Surgeon

Wednesday was my followup with the hand surgeon. It took a lot to get the dressing undone, the base Vaseline layer in particular was really stuck to the stitches. It was soaked for quite awhile in peroxide but still hurt a lot to peel off. The doctor didn't think that it needed surgery, which made my day. I do worry a bit that maybe part of that was the fact that I didn't have insurance, though. It was kind of a "well, let's see how this goes before doing something drastic" vibe that I got. So if it doesn't heal well, I'll still need more work done. Hoping that doesn't happen.

They gave me a better bandage system for it. That was really all I got from them.

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The nurse that bandaged it for me specifically told the doctors that she hadn't done this type of splint before and they were just "You bend it, nothing complicated about it." So she bent it to a single narrow angle and went to strap it down. This was like putting a pair of pliers around it and squeezing. I had to ask her if I could add the second bend so that it was protecting the finger instead of hurting it.

They didn't really send me home with any follow up documentation, either. Seems like the Fairview Riverside Orthopaedics section has always been pretty bad at that kind of stuff. They tried to send me off with nothing for aftercare on my elbow, too. Then the dude printed out the first google image result and was like "do this for PT." I'm not sure why this is, but I think I'm going to be going to a different place if I need bone advice again. 

I also tried to offer some advice to the ER docs. They had me just soaking in saline for quite awhile. It was supposed to be cool, but quickly it warmed up. I suggested that they should put the saline bowl inside of another bowl with ice. That would keep it cold, but not too cold. Not sure if that will become common practice, but I tried to show them a better way.

Coping and Surviving The Week

One thing that I really like about the cycling community is how everyone comes together when someone is hurt. You see it time and again, people help get a replacement bike working, help with food and dishes, errands, etc. 

It was no different with me. I've had a lot of friends coming over and helping me do things. I'm not completely an invalid, but there are a lot of things that are really hard. I can't hold anything with my left hand to chop it to cook, for instance. That's pretty a pretty huge impediment.

One friend I've only met a couple of times came over and turned most of the veggies in my fridge into a huge batch of soup, which I've been using for a lot of meals. They said that they'd be willing to make a lot of other food for me, too. Another made stir fry that lasted for a few days with a lot of rice, served up with a side of red wine and wonderful conversation. Two more came by and helped me with dishes and making chai.

A highly respected and extremely talented bike mechanic came over and helped me convert my winter bike for the season. Putting on the studded tires and platform pedals. It's not quite bad yet, but we're right on the cusp of freezing rain and snow. If I don't get it updated now, I could be stranded. I can't use both hands like you need to in order to change a tire. That worries me a bit. What happens if I get a flat? Trying to just stay close to home, which is thankfully easy, but I worry about how long it will be like this. 

It's amazing having this network of friends that are willing and able to help me out. It would be really hard to survive if it was just me.

I have to say, it is a little weird how much more, um, enthusiastic the support has been this time. When I broke my elbow, I was pretty much just as laid up, but there weren't the same graphic photos of the injury to show. Of course, all injuries are bad, but the "optics" of this one and the fact it happened right before a race made it really visible.

Or maybe it's just that I'm more willing to actually ask for and accept help? Many of the people who have been over actually scolded me for trying to do too much. "I'm here to be your hands. Stop trying to help!" There's just kind of this independent streak in me that wants to prove I'm still able. Maybe it's an instinctual thing, trying not to be a burden on the tribe, to be abandoned when things get tough. Or just the knowledge that I won't always have help, and so I want to make sure I'm as used to helping myself as possible. Which is really pretty stupid, but it's hard to keep emotions like that out of your thought process.

Keeping Up With Work

My clients have been great, too. I was supposed to start a project last Monday but there was no way I could. I'm still mostly out of commission, but they've been willing to work with that and potentially move around due dates if needed. That was another pretty big concern. I have a bit of money right now, and more invoices out. But it's not enough to survive for months. And if I lost projects because of this injury, I'd be in a quite precarious position.

It was great hearing people say that they were willing to wait specifically so that they could work with me. In this industry, a lot of people kind of look at developers as a commodity, where anyone can be interchanged with anyone else easily. "Coding? How hard can it really be? My 15 year old cousin made a website!"

But that's not what I'm seeing. Which makes me feel a lot more confident about my skills. Just to know that my code is worth waiting for is awesome. Objectively, I know that I'm a good programmer. But it's hard to know if other people see that. I know a lot of people that are much better than me, and worse. It's a great feeling, really. The future seems a lot more optimistic because of that.

Healing and Moving Forward

I'm able to kind of type now, at least with both hands. But it's still slow, and I haven't tried a lot of stuff that needs modifiers like shift, alt, and ctrl. Mostly I've been using one hand, and getting pretty good at that. So coding is probably going to be a bit difficult for a bit.

My neighbor is actually going to work on a lighter weight splint that will mostly be on the bottom of the finger on a 3D printer. That's part of the issue. I have to keep the finger lifted out of the way to type, and the metal full-wrap splint is pretty heavy. That puts pressure on the nail and end of the finger, which makes it hard to be motivated to keep typing.

Really, how freaking cool is that, though? I need a custom splint, and we're able to draw it up in SolidWorks and 3D print it ourselves! That was so far into the realm of science fiction when I was a kid, and now it's not unusual at all...

Also, keeping it below the level of my heart tends to be noticeable, too. The blood settles more, and each heartbeat is a little painful "twitch." It happens when riding, too. It's not too bad to start and stop, between I just keep the hand up. But even with it up, if I start pushing it at all and getting the heart rate up, the throbbing is there. The rear brake and shifter are all I really need, which is good. I haven't tried using the front brake, but I don't think I could without a lot of pain.

Treatment

I am starting to clean and dress it quite a bit more often. Once a day at least. 

This is where it's at now, one week later:

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I typically take a shower, and keep it down for a few minutes. Let the water drip down my arm and off the finger. Certainly no direct water on it. Then a couple drops of some trauma-specific soap, with the finger held up to soak it in for a minute or two. Then back down to rinse, and done.

I picked up some wound saline solution at Walgreen's tonight, but it's in a pressurized can. Not sure if I can do that directly on the tip yet. But I might use something like that to clean it when I don't feel like a full shower. Apparently, using peroxide can be counter-productive, because the effervescence can lift off new tissue as well as contaminants and dead skin/blood. 

After it's cleaned in the shower or however, I let it air dry. Then dab in some generic triple antibiotic cream on it all. I take a Teflon gauze pad and add a light layer of the ointment to the middle part. That way it's all somewhat lubricated. You don't want to just do the whole finger in it, because then you can get wet fingers with wrinkles like from being in a bath too long.

I put tape on the gauze pad before putting it onto the fingertip, that way I don't have to really try to keep it in place. Then it's a careful wrap with some loose weave white elastic gauze. The metal/foam splint goes around that, and then the stretchy self-adhesive brown stuff goes around it all. 

The 3d printed cast that we're working on will keep just the inner bandages, with some rubber bands further up the finger to hold it in place. That will be better for the PT for bending the knuckles, too. When I need to go out or do anything that requires a lot of use of the hand, I'll put the heavier splint on, but it should work well for typing and just chilling around the house. 

I get the stitches out on Halloween. At least, that's when it's supposed to be. Hopefully by then the fleshy bits will have grown back enough to allow removal of the string. It would be great if that made it a bit easier to look at it. Cleaning can be really gross.

The pain is getting more manageable, too. I think there's starting to be a bit of a protective layer grown back on the wound now. The main level of the pain is just kind of dull most of the time, and I've been taking a fair amount of pain killers which might explain the fact it's not worse. The last couple days, it's been less, but also with a continuous tingling and kind of 'warmth' to it. I'm hoping that's healing. Then there have been a lot more sharp pains like getting a needle poked into it. Those are fleeting, but still there. Mostly if I'm actually using it for stuff. 

I talked with a friend who had a partial finger amputation as well, though worse than mine. I wanted to know if he had tricks for confronting the cleaning stuff. He said that you just have to do it, or lose the finger. Which is true. But he also said that you get to see it heal. That gave me hope. I can already see some improvement, and knowing to think of it on terms of watching that healing process happen could help with my mental outlook on it. 

So, yeah, that's been my last week or so. How's your's been?

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