Bagan, Myanmar. February 1, 2017

I struggle to type due to the limited mobility of my left arm. This should contribute brevity to what I am about to say.

This trip is about getting out my comfort zone, which I’ve accomplished in both large and small ways.

A handful of my latest adventures: Riding a bicycle for the first time in 17 years.  Meeting and hanging out with strangers (without booze even!).  Hiking a gorgeous island mountain. Kayaking the Thai sea with a new friend. 

But riding a motorbike was not on the list.

It seemed too dangerous, especially for someone just getting reacquainted with a regular old bicycle.  Yet, if you want to see pagodas in Bagan, renting an e-bike is the only way to get around. 

The small pagoda roads are too hilly and sandy for basic, multi-gear bicycles. Tour groups in buses go to the most crowded pagodas for sunrise and sunset and are scheduled to the hour for the rest of the day.  That’s boring as hell, let’s be honest.  Horse carriages move at a snail’s pace and the drivers are cruel to the animals.

I weighed the pros and cons of trying out a motorbike while the Burmese sun beat down on my forehead.  I asked the universe to blow a candle in a certain direction if it didn’t want me to ride the e-bike. Of course, it blew in that direction.  I promptly dismissed that as meaningless and focused on trying to feed my bubbling and churning stomach.

Then, I picked up my very much alive and present fear, walked back to the homestay, and together, fear and I scrambled onto the e-bike.  I could barely hear what the homestay worker was saying over the din of terror roaring in my head.

I teetered around the driveway of the Ruby True for a minute or so, feigning confidence while consoling myself with the idea that I’d get used to riding after a few minutes.

In Myanmar, e-bikes are battery-powered scooters, with max speeds of 60 km/hr (~37mph).  This falsely assured me that I couldn’t do much harm because it wasn’t even a real motorbike!

My tense arms and hands gripped the handles and I had to keep reminding myself to relax. My tense legs dangled, feet hovering above the ground in case I needed to make an abrupt stop.  I kept the bike speed hovering around 20-30 km/hr, which felt slow and safe.

Bagan, Myanmar, e-bike, accident
Wheeee . . . . (minutes before I crashed)

Suddenly, the paved road went right and my bike spun a hard, uncontrolled left. The details are difficult to remember. I grabbed the handles to brake but I must have accidentally sped up instead.

My bike jumped the curb, launched into in mid-air then fell to the left.  It slammed the left side of my body, shoulder, and forehead into the pavement.

I pushed the heavy bike off of me and slowly stood up.  Immediately, wooziness came over me and I had to sit back down on the curb I just hopped over. In microseconds, my left shoulder began to scream with excruciating pain. I couldn’t move it. My left forehead felt ‘heavy’ as a fluid that could only be blood started to drip down my forehead and into my eyes.

A tourist with kind eyes and a cropped boyish haircut saw my accident and stopped to ask if I was okay. She took my pink, black, and blue Parisian scarf from around my neck and fashioned a sling for my shoulder. It was so nice of her. I wish I had asked her name.

Now, anyone who knows me knows that I hate hospitals.  Reason number 217 why I left medicine. If I’m outside of work, someone has to literally be dying for me to go back to a hospital.

Dying, I was not. But the shoulder wound plus the almost certain fracture or dislocation needed medical attention.  And not the kind that I could give to myself. 

I stayed calm because panicking never does anything. Except, you know, makes you slam your bike into the pavement by accident.

But I knew that I couldn’t lose consciousness. 

A severe head injury (a skull fracture and underlying epidural hematoma, if you are curious) can cause a post-traumatic loss of consciousness.  I knew that whatever hospital we were heading to in Podunktown, Myanmar would not have a CT scanner necessary to diagnose this injury.

An epidural or large subdural hematoma would be a death sentence because there wouldn’t be a helicopter available to fly me to Mandalay (closest major city) in time for the life-saving treatment, a surgical evacuation of the hemorrhage.

If I remained conscious though, such a bad injury would be far less likely. The impact has to be pretty strong to cause a skull fracture and the underlying hemorrhage. Plus, I have a thick skull. Seriously.

The Hospital

A taxi appeared from nowhere to take us to the hospital. I made jokes to my travel buddy to lighten the mood and to keep him from freaking out.  He’d gotten pretty pissy a few days before about losing his iPhone 7 in a Bangkok taxi and I didn’t feel like dealing with that shit again. Plus, jokes kept my mind off the pain and from dwelling on the possibility of passing out.

We entered a small room with light blue or green or beige walls, the hue bleached by years of sunlight and unbearable thick heat. Turns out this unimpressive room wasn’t the reception area but was the entire ER. Sigh.

A balding, chubby man, with a bright smile and a surprisingly young face appeared. He looked like a resident. He asked me some questions in good enough English while scrawling my answers in a small notebook, which turned out to be my medical chart!

Fortunately, medical terminology translates well.  E-bike injuries are also quite common in Myanmar, unfortunately.

I’d left a healthy patch of my beautiful cocoa skin on the pavement. The doctor examined the gnarly, bleeding wound on my shoulder, and noted the adjacent joint swelling. 

The nurses, dressed in traditional British-style uniforms with caps and skirts, removed bits of gravel and dirt from my wound before dousing it in an iodine-based cleaning solution and dressing it with gauze.

A fracture seemed likely.  Archaic x-ray technology revealed a type 3 acromioclavicular joint dislocation with a probable distal clavicle fracture.

Yes, guys, I had to read the x-ray myself. There was no radiologist in the hospital and no digital equipment to send the image to a remote radiologist.

The ER doc told me that locals with this injury are treated with an ORIF, K-wire fixation. Surgery in a 3rd world country was not the type of adventure I had in mind! In the US, this injury is treated conservatively unless you are a professional athlete. What would have happened if I hadn’t been a doc and hadn’t known that?

I got an IM injection of an NSAID, a tetanus injection, and instructions to return in the morning to consult with the orthopedic surgeon.

hospital, ward, nurse, myanmar
The orthopedic ward. Nyaung-U, Myanmar

The Lesson

For the first time in awhile, I felt lucky to be a doctor.  It made navigating the whole process easy and way less scary than it would have been for almost anyone else.

I suppose I was lucky to have a pal with me too. Talking to him kept me from getting too deep into my own shock and from obsessing over the concern of losing consciousness.  But even if I had been solo, I would have handled the situation like the boss bitch I am.

I appreciate how lucky I was that I didn’t sustain a serious head injury. I definitely should have been wearing a helmet.   As a doctor who has read thousands of head CTs of motorcycle accident victims, I fully know better!

Why didn’t I? The anxiety of riding the e-bike made me forget to ask for a helmet from the homestay. It wouldn’t have spared my clavicle from breaking/dislocating or prevented my shoulder wound. But, I could do without the forehead lacerations and black eye that I’m currently rocking.

injury, Bagan, Myanmar, black eye, gauze, accident, fear
1 day post accident. It doesn’t look THAT bad, right?

I was fucking scared as hell on that bike but like I used to tell one of my friends, sometimes you just gotta grab life by the balls. Even if there were other reasonable options besides the e-bike, I’m glad I tried it. 

Two years ago and certainly 5 years ago, my fear would have been insurmountable.

My wounds will heal and my scars will fade (hopefully). But I will be a little less hesitant to try the next terrifying opportunity that arises.

That doesn’t mean that I’m going to bungee jump next month (zero interest) or not wear a helmet on a bike. But when you are taking a chance on yourself, when you are living at the edge between what makes you comfortable and what scares you, you have to take risks.

There is always the chance that life will slam my hopes and dreams shoulder first into Burmese pavement. And there is also the (much higher) chance that I will make it to the pagoda for the beautiful sunset, intact. But there can’t be a beautiful sunset without first trying to get there.

So, like everything else on this trip so far, the accident was yet another metaphor for life.

I’ve struggled this past year (2016) to give myself proper credit for my personal accomplishments. I supposed I have struggled with that for most of my adult life. I’m pretty proud of myself for acting in spite of my fear in this situation.

I’m grateful to myself for developing this outlook. I spent so many years focusing on the worst in situations, in other people, in my choices, and in myself. 

Next time, I’ll be better prepared with motorbike lessons and a helmet. But, there will definitely be a next time.

beach, quote, adventure, find yourself, Fear

TL;DR— You can’t escape fear but you don’t have to let it stop you from taking a chance on yourself.  And wear a helmet.

Existential or medical questions are always welcome!

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