An Avoidable Tragedy

A Tale of Two Accidents

For so many, 2020 was a year of COVID illnesses and deaths. For us, it was a year of devastating accidents: two bicycling accidents, neither involving a car, but resulting in very different outcomes due to a single, inexpensive piece of equipment: a helmet.

Accident #1

On October 23, 2020, my sister went for a bike ride. This was something she did two or three times a week with an informal group of riders who always chose quiet city streets for a recreational ride of an hour or more. Near the end of the ride, my sister’s bike clipped the back tire of the bike in front and to the right of her. Her bike went down. Neither she nor the other rider was going fast and there were no cars around. As was her habit, she was not wearing a helmet – more than half of all bike riders do not. The right side of her head hit the pavement, knocking her unconscious. After a minute or two, she regained consciousness, but was confused and disoriented. A 911 call was made. A few neighbors and passers-by stopped to offer help and the police came. An ambulance arrived after eleven minutes of waiting. She was loaded onto a backboard and taken to the ER at a Level 2 Trauma Center where she was met by her oldest son.

Following a CT scan, my sister was admitted to the ICU at the hospital. She had intracranial bleeding, causing swelling, that was treated with IV medications. Over the next week she seemed a little better, was taken off the medications, and plans were made for her to be discharged to a rehab hospital. By the end of the week, however, her situation deteriorated, requiring an emergency craniectomy, a procedure in which a large piece of skull is removed, frozen, and then restored several weeks or months later in another surgery called cranioplasty. The procedure was performed to accommodate brain swelling; without it, my sister would have died. Forty-eight hours later, she required an additional emergency surgery. She had been intubated prior to the first surgery and, while the ventilator ensured she could breathe, her two sons, their families, and John and I waited for her to regain consciousness. She remained in an unconscious or minimally conscious state for twelve days. Her neurosurgeon began the process of preparing us to make difficult decisions – there were no end-of-life directives in place. Then, on the thirteenth day, she began to respond to commands reliably and was extubated. After four weeks in the hospital, three of which were in the ICU, she was discharged to inpatient rehab, where she would spend another four weeks.

I should tell you about the person my sister was before the accident. She was, unquestionably, one of the healthiest and most active sixty-nine-year olds you’ll ever meet. She ate a healthy diet and maintained a healthy weight, did not smoke or drink, and took only one medication, a statin drug for a hereditary cholesterol issue.  She stayed in shape by bicycling, walking, and yoga, and she was one of the most socially engaged people I know. She belonged to three book clubs, a brunch bunch, a DaVinci group, a church group that meets to discuss TED talks, and a Pokeno group. She is a Master Gardener and was part of a “Dancing Girls” group that participates annually in a neighborhood Mardi Gras parade. She regularly welcomed friends and family to her Florida beach condo, where the day started on the balcony drinking coffee and watching the sunrise and included beach walks, working on puzzles, Scrabble games (you would only play with my sister if you don’t mind losing), lazy afternoons by the pool and hot tub, and excursions to quaint nearby towns or the outlet mall.

She was a world traveler, travelling to Italy, China, Australia, and New Zealand in the past couple of years alone. She has also visited much of Europe and South Africa and journeyed to Tanzania to climb Mount Kilimanjaro and to Peru to hike Machu Picchu.

My sister indulged her whimsical and eclectic taste, decorating her forties-era bungalow with a glass-topped coffee table with a lizard as a base and a chair that looks like a rooster, to describe just of couple of her pieces. Any holiday was an excuse to decorate everything in sight. At the time of the accident, her house was in full Halloween regalia. For years, she drove a succession of sporty Mini Coopers, usually red, the latest being a larger version to accommodate car seats for her three grandchildren: six-year-old twins and a four-year-old. She was a super grandmother, picking grandchildren up from school and taking them to her house for sleepovers, treating them to doughnuts, buying them little surprises, and taking full advantage of grandma privileges. She was also there for her younger son and his girlfriend. The day before the accident, she lined up a renter for their house, as they planned a move into a larger place they had recently bought.

On December 17, my sister was discharged from inpatient rehab. Her sons, their families, and I worked hard to ready her house for her, clearing away clutter and setting up her bedroom with bedrails and a bed alarm, among other things. At present, she requires 24 hour a day caregivers. In a twist of irony, she is required to wear a special helmet at all times, except when she is in bed. She can walk only with assistance, due to neurological damage and some muscle weakness from being in bed for such a long time. She has lost use of her right hand, in the same way many stroke victims do, and she has significant speech aphasia. She understands most of what is said to her but has difficulty remembering words and she struggles to remember basic facts, such as what January 1 is – she knows it’s important but wants to call it Valentine’s Day. Her vocal cords were damaged from two weeks on the ventilator so it’s often very difficult to hear her speak.  

My sister has gone from being an active, engaged retiree to someone who is facing a long road back to recovery. Once a mainstay of support to her two sons and their families, her health has now created a major disruption to their lives. She will require months or years more of physical, occupational, and speech therapy, a surgery for cranioplasty, and a possible surgery for damage to her vocal cords. Recovery is expected to take at least two years, with no way of knowing what her end point in recovery will be. She may never be able to drive a car again or live independently. In short, her life has undergone drastic changes, many of which may be permanent.

Accident #2

Over the summer, John and I decided to deal with our pandemic-borne cabin fever by renting a cabin. We booked a charming place in the cooler climate of the North Carolina mountains near Great Smoky Mountains National Park for the month of August. In the third week of our getaway, we took the two-hour drive to the Tennessee side of GSMNP to visit historic Cades Cove, a 19^th century village that was subsumed into GSMNP. We purposefully chose a Wednesday, as this is car-free day on the popular Cades Cove Loop road. We brought our bikes and looked forward to pedaling through the village. Our plan was to ride the loop road, taking around three hours, then meet some folks we had met on a Danube River Cruise in 2019 for a socially distanced picnic lunch.

We were about twenty-minutes into the ride when I heard John shout and I looked up to see him literally flying off of his bicycle. We will never know exactly what happened – he may have hit a rock on a slight downhill, but whatever the cause, he crash-landed on his right side. He suffered six pelvic fractures, requiring him to be in a wheelchair for six weeks, followed by physical therapy for more than three months. John always wore a bike helmet, and that day was no exception. His helmet was broken in three places, but he had no head injury. Think about it: this was an accident in which John’s body was slammed to the pavement, creating almost no “road rash” from skidding, breaking six bones, and breaking his helmet in three places, and yet, he had no head injury whatsoever. Escaping head injury has meant that he is now, four months later, almost completely recovered, instead of possibly facing the future my sister faces.

Bike safety and the case for helmets

Since these accidents, I’ve had several people ask me how I could possibly get on a bicycle again, and yet, I continue to ride several times a week and have no intention of stopping. Even though I’ve been a regular wearer of a bike helmet for decades, I have given more thought to bike safety since these two accidents and I can’t help but notice how many people I see NOT wearing helmets. Moreover, I’ve been very surprised at how controversial helmets are even though the CDC estimates that helmets can reduce head injury in bike accidents by as much as 85%! Remember that there were no cars involved in either of the accidents I described, and the injuries were still significant. My advice is to NEVER get on a bike without a helmet.

If you don’t wear a helmet currently, or are looking to upgrade, I suggest that you check out helmet safety ratings from the Virginia Tech Bicycle Helmet Lab:

https://www.helmet.beam.vt.edu/bicycle-helmet-ratings.html

It’s worth checking consumer reviews of the top-rated helmets from the Virginia Tech Bicycle Helmet Lab, as some of the more affordable models, in the $50 to $60 range, are criticized by consumers for being too hot or too heavy.  My advice is to avoid being overly price sensitive – remind yourself that this is your BRAIN you are protecting. You only get one of these and, believe me, they do not heal easily.

There are a few new technologies that have been proven to reduce the brain-damaging torque that often comes with a bike accident. The first is MIPS (Multi-Directional Impact Protection System). MIPS technology is licensed out to various bike helmet manufacturers – a small yellow sticker lets you know if the MIPS technology is found in your helmet and should also be part of the helmet description.

Another choice is the Bontrager WaveCel  – there are several Bontrager helmets with this technology. I recently bought the Starvos model ($100) and I find it to be very comfortable.

Be sure your helmet fits properly – you should put it on your head and tighten it using the wheel on the back of the helmet. Then, without fastening the chin strap, bend over at the waist. The helmet should stay on. Of course, fasten the chin strap when you ride, and make sure you can get no more than two fingers between your chin and the strap.

Here are some helpful CDC guidelines on buying, wearing, and fitting helmets:

Click to access headsup_helmetfactsheet_bike_508.pdf

Do not wear baseball caps or woolen caps under the helmet. If the weather is chilly, wear a snug- fitting skull cap. Otherwise, the helmet doesn’t fit properly and won’t provide the protection you need.

If you ride with a group, consider instituting a rule that those without helmets may not join the ride.

Bike lights

Install front and back bike lights and use them always, even on sunny days, set to flash. There are numerous models on the market that are easily rechargeable.

See and be seen: What every cyclist needs to know about daytime running lights

Rear view mirror

There are a number of these available on Amazon or at your local bike shop. I use a clip-on type that I wear on my glasses or sunglasses. We often ride a paved bike path, with no motorized vehicles, and I’m surprised at how often other bike riders sprint past me, coming from behind without announcing themselves. The rear-view mirror allows me to see cars or other riders behind me.

https://www.amazon.com/bike-mirrors/b?ie=UTF8&node=3403241

Other safety tips

Always announce when you are coming up behind other riders, walkers, or runners. Generally, I ring my bike bell and call out “On your left,” and then slow down because one-third of the time walkers or runners MOVE to their left.

If you’re in a group and you see a car ahead or behind, announce to the others “car up” or “car back” and then go into single file, if you’re not already, letting riders near you know you’re moving.

Keep a safe distance from other riders and be sure to announce which way you’re turning when you reach an intersection using hand signals or verbally announcing.

Always use hand signals to signal your turns for the benefit of cars.

Always assume that cars will not see you – there are a LOT of distracted drivers out there!

Obey traffic laws – lots of non-bike riders do not like bicyclists – let’s not give them a reason to resent us even more.