By Dr. Jim Dahle, WCI FounderI don't know if this post will ever run on the blog, but I feel the need to write it. This one may be just for me.
This is the first post I've written since surgery was done on my wrist after I fell off the north face of the Grand Teton in August 2024. My surgeon said I could type afterward but then put a splint on my hand that is so big I type a lot slower now. As I start this post, it's the evening of post-op Day 2 (although it took me over a week to eventually finish this post). If my wife finds out I'm blogging right now, she'll take away this computer again. She says I shouldn't be working while on narcotics, and she's probably right. That's actually one of my biggest frustrations right now. I'm frustrated that I'm not tough enough to just be on Tylenol and ibuprofen right now.
I don't really even have anything to complain about. My disability should be temporary, a few months at most. That's not the case for lots and lots of people. I'm lucky to be alive at all (and incredibly grateful to all involved in my care). My disability is also seemingly mostly physical, although I have not yet convinced my wife that my brain is 100% OK after a pretty serious head injury 2 1/2 weeks before I wrote this. Katie is probably right about that, too.
In addition to probably being on a relatively short path to a near 100% recovery and being surrounded by a ton of supportive people, I'm also relatively divorced from the usual financial consequences of disability. While I no longer have any disability insurance, that's because we've been financially independent already for a few years, and I canceled the good policies we had ON PURPOSE years ago. My clinical partners are essentially just holding my job for me in case I still want it, without applying any pressure. We have solid health insurance, a huge HSA, plenty of investment-related income, and no need to work for money. That's just not the case for most disabled people out there, and that's why getting disability insurance if you're not FI is so incredibly important. If somebody who is not FI fell off a mountain and got injured permanently, not having the income that disability insurance would provide would be catastrophic. I'm incredibly blessed, and I AM grateful.
Yet I'm still frustrated. Frankly, I'm learning a whole lot of patience (never my strongest attribute) and empathy toward the ill, injured, and disabled. But I thought it might be useful to document my frustration. It'll likely help me to be more grateful later, when those things I'm most frustrated about are gone. Maybe it'll help those dealing with temporary or permanent disabilities feel more understood. Maybe it'll help us all be more empathetic toward the disabled.
So, I'm going to list out my frustrations, and maybe there will be some reason why we'll decide to run this post down the road and you'll actually get to read it. At any rate, here are my current frustrations when I wrote this about 11 months ago.
#1 Nobody Trusts Me
I get assigned babysitters. Don't get me wrong. I love these people. My wife. My kids. Family members. Neighbors. Friends. But people are looking at me and wondering if I'm going to make good decisions for myself and others. I even thought very briefly about driving myself somewhere before the full two weeks the neurosurgeon said needed to pass before I drove. From the way my wife reacted, you would have thought I was trying to pawn our children. That doesn't feel great. Meanwhile, hundreds of people are sending me emails asking for help with their life savings and career plans. Kind of funny to put those things together.
#2 I'm Still on Narcotics
All those studies I've been reading for years that say Tylenol works just as well as Hydrocodone, it's just not true. This is my first surgery since med school. I keep trying to get by on just Tylenol and ibuprofen. It keeps not working. Some people end up on this stuff long-term. I'm so sorry. I'm embarrassed that I might even have to ask the surgeon for a refill. I never knew things like sneezing (with bilateral first rib fractures) could be so painful. [AUTHOR'S NOTE: Update prior to publication: I quit taking opiates during the day on post-op Day 4 but still took one at night for a day or two afterward.]
#3 I've Lost Independence
With one hand in a tight splint, I can't tie my shoes or even my scrub pants. I can barely shower alone, and if I want to dry off by myself, it'll involve a whole bunch of air-drying. It took me a week to figure out how to put deodorant on my right armpit. Dressing takes forever, and I can barely help my 9-year-old with her household chores. Meal prep better not involve any bottles, jars, or bags. Scissors are my friend; pull tabs are not. Imagine if I'd hurt my dominant arm.
Even if my brain were OK to go back to clinical work today, I can't type fast enough to keep up—much less suture, intubate, or reduce a fracture. I'm definitely going to be limited to double coverage shifts for months if I can work at all. I can't tell you how thrilled I am that the AC separation on my dominant side is non-surgical (and no sling), so I can at least toilet myself.
More information here:
The Heroes of My Life — Part 2
#4 I'm Bored
This one is odd. You don't feel like doing a lot, but you can do even less. My wife tells me I need some new hobbies because I can't do any of my old ones for a few months. It doesn't take very long to burn through your list on Netflix, and even that's boring after a while.
#5 Lack of Purpose
The only reason we're still working after FI is because we're trying to make the world a better place. It gives us a sense of purpose. Well, now I can't do clinical work for a while, and my WCI work is limited. I'm feeling particularly purposeless. That's a little depressing. I think there's some post-traumatic brain injury-associated depression, too. I definitely underestimated this when I came home from the hospital.
#6 I Can't Exercise
You know what I usually do when I get depressed? I go for a run. Welp, can't do that. Or play a hockey game or go for a mountain bike ride or go climb a mountain. In fact, as I finish this post, I've already lost 12 pounds, and judging by the size of my left arm, a lot of that 12 pounds is muscle I'm going to have to work hard to get back. Exercise now consists of going for a walk for a mile or two. You know how non-exercise-y that feels for someone who was recently in good enough shape that they were playing on three hockey teams and planning to spend 16 hours straight ascending and descending 7,000 vertical feet at altitude?
#7 I Can't Coach
I'm also signed up to coach two hockey teams this fall and winter. I don't dare even get on the ice now. If I fall and hit my head again right now, it could kill me. Same thing if I took a puck to the head. I can't do anything with a hockey stick anyway, given the cast on my arm. And how would I tie my skates anyway? It's hard to feel super effective coaching like that. Luckily, both of those teams have a great staff of coaches to cover for my disability.
More information here:
The Importance of Real Partners
Why I Dumped My Disability Insurance Policy at 43 Years Old
#8 I'm Not Feeling Super Attractive
I've got new scars on my face, a pointy shoulder, and a hand in a cast, and my muscles are rapidly wasting away. I'm not feeling super attractive right now. It's amazing how much reassurance I now need from my partner that she still loves me.
#9 I Worry About Little Things
My most serious injury (multiple facial fractures) threatened four of my five senses, but it seems to be healing up OK without any special treatment. I'm using my reading glasses more than I used to, which makes me wonder if there is some optic nerve injury. Will it go back to the way it was a few weeks ago? And when anything runs out of my nose, I worry it might be CSF rhinorrhea again, which I had after the accident. Is that snot or CSF? I just don't know. When music seems too loud, I worry that it might be a sign of traumatic brain injury. The anxiety is all amped up to bonkers levels.
#10 I'm Not Grateful Enough
Before my accident, I had no idea it was possible to feel as grateful as I now do toward all who have helped me. And yet, I feel a little guilty that I'm still not grateful enough. Not to mention the guilt for getting hurt in the first place. The decisions that led to my fall were all mine, and I now look at how much work and, in some cases, risk others took on because of it.
More information here:
#11 I Can't Use My Own Comforts
We have a hot tub, and Katie just ordered a fancy massage chair. I can't use either one right now. The risk of submerging my head is way too high for one, and the other will just push all over my fractures and cause pain and possibly further damage.
#12 I Can't Start PT Yet
As a typical Type A “doer,” I want to do something that will help me heal faster or more completely. But I can't. I just need time right now. And that's frustrating. Even PTing my separated shoulder needs to wait a couple more weeks. I can't exercise too hard as I need to avoid any sort of Valsalva maneuvers for now, and I certainly can't risk falling.
We often talk about the financial issues with being disabled, but I'm learning there is a whole lot more to it than money. Even a temporary disability can be incredibly frustrating and even depressing to you, your family, and those with whom you work.
What do you think? Have you been disabled? How did you feel afterward? What surprised you the most?
That sounds like a seriously challenging situation. I’m hoping you have recovered completely this past year.
Most of my worst injuries happened while I was doing activities I loved (hiking, running, or playing a sport) and left me with a mild residual pain or susceptibility to repeat injury. This is also true of some surgery I’ve had that left a mark or some pain.
Injuries can take away independence, the ability to move well, and many have a residual. When I’ve been in recovery mode, I’ve been more acutely aware of the good fortune of having savings, time off, a supportive family, and access to care.
Best wishes to you Jim in recovery for your health, hobbies, and physical pursuits. You never know the true value of something until it is gone.
When I was an intern I had an MI caused by a SCAD. Not only did this effect my career at the time, but forever effected my life. When it happened, I was hospitalized for 3 days after the cath, all the tests, and a few minor complications. I took only one week off. Why? Financially we couldn’t afford for me to have to take unpaid time off and I was in my best friends wedding just 6 weeks later with a full vacation planned that used up my time. Today? I am constantly worrying about if something happens again and how it would affect my family. It’s not exactly a disability, but it’s permanent and it halts my ability to get private disability insurance so I have to always hope my employer provides that and that they have enough coverage without having to fill out health history. Like you, I feel lucky to be alive and I am so grateful for all the help I tried to decline at the time. But, unlike you, financially another event could mean disaster.
Thank you for writing this. I often feel like the least healthy of my healthy colleagues. Not only did I grow up with severe chronic life threatening illness (asthma that led to multiple cardiopulmonary arrests and intubations before age 8) but I have also dealt with severe endometriosis necessitating 5 surgeries (including major GU reconstruction) since residency. The feeling of lack of security that illness and disability bring are something that I know intimately. Yet somehow I don’t think that most physicians have experienced it personally. It takes a lot of luck and physical fitness to get to the place we have gotten. I don’t wish what you are going through on ANYONE. I am happy, though, that someone who can reach a large audience and be so vulnerable and eloquent about the struggles can remind people that disability can happen to anyone. Thank you.
Thank you for sharing this. Chronic minimal disabilities due to autoimmune disease and old age, with acute broken toe nonhealing properly due to further repeated grandchildren and self inflicted trauma. Which is frustrating enough that my one main exercise- walking- makes healing slower and that I only had two pairs of my extensive shoe collection I was still able to wear. Your loss of so much more from such excellent health had to be barely bearable.
Jim, definitely you are tough man! dude take the narcs when you need them! part of modern medicine includes controlling pain. I love how writing (or dictating?) was therapeutic for you during such a terrible time. It seems from your article I not only should prepare financially for disability, but mentally as well.
Are there still things on that list that have not fully resolved? Hopefully #1 is resolved!
Just the wrist (I ended up with a scaphoid non-union and I’m doing BID PT exercises at least until March) and I think maybe I’m a little worse at remembering names and juggling stress than I was a year ago. But otherwise a pretty darn complete recovery. I was back to work by November and alone in the ED by January. I even had a speaking gig in September like 5 weeks after the fall.
I was at that speaking gig (Bogleheads ‘24) and first met you there while you were still casted. You shared your story about the fall with us at the hotel bar (promising to share this post “soon”) and it was pretty harrowing.
Thanks for sharing the story and for contributing as well to the BH community.
Yes, it was the Bogleheads conference.
This post wasn’t really the one I was talking about sharing (nf fact I wasn’t sure if I was ever going to actually run this post), but this video is probably better than “that post.”
https://youtu.be/FbX2EAuWTVk
I think “that post” was really the two podcasts that were published in November or December. This video is the 4 minute version of those 3 hours of podcasting.
I ran a half marathon last fall. I was pretty pleased with my 45 year old self. Then I hurt my knee playing basketball with my son in February. Fast-forward to the end of April and I needed micro fracture surgery for some cartilage I destroyed on my lateral femoral condyle. Wasn’t allowed to ambulate for six weeks on the left leg. Four weeks postop, I developed a large superficial vein thrombosis in my greater saphenous vein which then led to neuropathy in my left foot. The day after starting Eliquis, I tripped jumping up the last step into my house and of course, landed on my surgical knee. Developed a large hematoma under the quadriceps tendon. At the time, I got pretty low. I never thought things would go back to normal. It is very humbling going from triathlons and a half marathon to laying on the floor in your shower and then having your wife put on your socks and underwear for you. Happy to report that at now four months post op I was able to go for a five mile hike with my dog last night in our local national forest. I’m not 100% yet, but I am 100% sure that I will keep my disability insurance even though my wife and I are FI. We bought our disability insurance during residency and we pay $250 a month combined. I don’t know how that compares to others, but you just never know when a disability could occur. I have a high school senior and twin 8th graders that just started school today, maybe I’ll at least keep the disability insurance until they are through college.
Via email:
I just read your disability post, and it really hit home. I’m a …..specialist and this past February I had a tibial plateau fracture while skiing. It required two surgeries, and I was off work for almost three months. All of the points you highlighted were things I went through in addition to others. I’m still [early career] so I think the frustrations were amplified by the fact I felt I should be stronger and able to improve quicker. Thanks for sharing your experience. Hang in there, eventually you will turn the corner.
Maybe I didn’t make it clear in this post, but I wrote this a year ago. I’m dramatically better now.
Via email:
Thank you so much for writing this post.
I will spare you the long details, but I have been long-term partially disabled for almost 10 years… trying to struggle through days, weeks… will I ever feel normal again?
Anyway, thank you for pointing out all of the things that I feel every day, and amalgam of depression, guilt, anxiety… pain 😩
Via email:
Sorry to add to your inbox, but this one hit home. Had a serious accident while doing a favorite hobby with spinal cord injury a few years ago, very lucky to recover with minimal deficits (after surgery), but it was completely humbling, took away my favorite hobby and has made me fearful of other activities I loved that risk a fall/neck injury.
I still struggle against the new normal. We can be grateful and still frustrated/sad/depressed. There is a clear before and after, isn’t there. But there is some degree of adaptation to new limitations even when we hate it. I guess this is how the elderly are able to function.
No words of wisdom, just thinking of you. You are not alone. Praying for healing for you.
As an aside, as a surgeon and Palliative physician, have the same conclusion about postop opioids that you came to. Tylenol and ibuprofen do not cut it for the big stuff. We do a disservice to patients when we tell them to tough it out.
Diagnosed with MS in med school. I’m still in med school and WCI is really motivating so thanks for that. It’s definitely changed my perspective on things. I was so set on wanting to come to the USA after I graduate but everything feels less straightforward now! People do have it way worse though. I think I would go for Family medicine and then branch into sport med with the mentality to save up early and be able to work less hours over time/have a good emergency fund in the case I can’t work.
I think we all thought we had MS (and lupus and hemochromatosis) in med school, but you really did. I hope yours is easily treated and allows you a long and wonderful career.