Footholds by Mike Freeman and Hannah Freeman

 Footholds:

How I Nearly Died Four Times in Ten Days

by Mike Freeman and Hannah Freeman

Count to five.

That's how long it takes to become a quadriplegic.

Like you just now, I am given no warning or preparation. In the months and years after, I am never able to piece together exactly how those few seconds unfold.  All I have is a hole in my memory and a handful of clues that vaguely point toward a complete story. Here is what I do know:

While hiking with my dogs one Friday afternoon, I cross a pedestrian bridge that connects two parts of a Carlsbad golf course. I start to descend the concrete stairs.  My left hand hovers over the handrail as I hold my two dog leashes in my right hand. I blink.

When I open my eyes, an expanse of cloudless sky fills my entire field of vision.  Bewildered, I realize I am lying in the vegetation bordering the stairway. Fortunately, I land face up. I can breathe. Landing face down could have been fatal. I do not grasp until much later that my life was virtually a 50-50 coin toss in that moment — and I was the coin.

Get up, I instruct myself. This is a ridiculous situation to be in. But my arms and legs refuse to move. A powerful wave of exhaustion and disorientation overwhelms my desire to address my strange predicament. I feel the echo of my seven-year-old self fighting anesthesia before a tonsillectomy, struggling fiercely until the idea of a nap suddenly sounded much nicer than staying awake. Now, much as it did then, consciousness slips gently away.

I am told later that while I lie unconscious, my dogs manage to slip their collars, yet stay by my side. They bark but do not stray from where I lie hidden in the shrubs next to the trail. Within a few minutes, their barking attracts the attention of golfers on their way to the next hole, leading them to find my body and call 911. If my dogs had left my side or stayed quiet, or if the golfers had decided to play a couple hours earlier or later, I may not have been found in time. 

Sirens drag me back to consciousness long enough for me to grasp that I am in an ambulance. An EMT asks me some basic questions to assess my mental state. I am conscious enough to tell him that my name is Mike, I am in Encinitas, and today is February 7 of 2020. This basic communication exhausts me. I murmur to the EMT that I cannot move my arms or legs. I recede again into darkness.

My frantic wife, DeeAnn, arrives at the hospital as the staff carries out a battery of tests. I catch phrases, but I cannot make sense of what I am hearing. If I had been able to follow the conversation, I would have understood that I fractured my C3 vertebra — located almost at the top of the spine, just below the skull. While no spinal fracture is good, this location is particularly serious. The closer you move toward the brain along the spinal cord, the more an injury to the area will affect the central nervous system. This impacts not only voluntary movement of the limbs but also automatic processes like breathing, swallowing, and controlling the bladder and bowels. Imaging reveals that I have ruptured my vertebral artery and surrounding ligaments on one side of my neck. At this time, I am still breathing and talking on my own, and the grave demeanor of the medical staff confuses me. As I struggle to understand my situation, I am still under the impression that my injuries are significant but not critical.

I am stabilized for transport, and another ambulance transfers me to Scripps Memorial Hospital La Jolla, which is better equipped for severe trauma. Surgeons schedule an operation for the following morning. They will attempt to repair my ruptured artery and install a titanium plate to stabilize my damaged vertebrae. One of my doctors remarks that he is surprised I am able to breathe and speak on my own.

The morning of the procedure, while I am still under anesthesia, I stop breathing. Fortunately, being unconscious, I do not experience the full sensation and emotion of an emergency intubation — during which medical personnel shove a tube down my throat and into my lungs before hooking me up to a ventilator to force air in and out of my airway.

After surgery, the drugs wear off. Not only can I not move my arms or legs, but now I am completely paralyzed from the shoulders down. Worse still, my intubation renders me completely unable to talk.  Overnight, I have also gained over 40 pounds of fluid weight from the surgery and am puffed up like a blowfish. No one prepared me for any of this.

I cling to the hope that all of this is a drug-induced nightmare. I cannot fully escape the looming dread that this living nightmare may be my reality from here forward. Unable to move, speak, or breathe, a ghastly claustrophobia creeps into my mind and body. The depth of my helplessness is so extreme that it registers as a profound violation, and I have no escape or reprieve. It becomes impossible not to panic as I lie in my hospital bed, deprived of my senses, suffocating and choking on the tube. I am being buried alive inside my own body.

Breathing through a ventilator, particularly while intubated, is life-saving and sanity-threatening. The experience is particularly difficult to describe to the uninitiated. Imagine breathing through a snorkel while someone adds a few drops of water every 15 minutes or so. Each breath gurgles, and you are powerless to clear the water from the tube. Now imagine that you cannot draw in air on your own; you must rely on someone forcing their own breath into your lungs from the other end of the snorkel. There are no breaks. When you manage to fall asleep, you wrestle with the panic and sensation of suffocating upon waking. Since you are paralyzed from the shoulders down, you can't even lift your own hands in a desperate attempt to remove the tube. Your semiconscious body still processes it as a fatal obstruction. You wake up by choking to death until your body grudgingly accepts that you will not die, even though it tells you that you should.

I am not able to clear my throat or swallow to dispose of postnasal drip. I have to instead ask for suction, in which a nurse inserts yet another tube into my mouth or throat to suction out the mucus. This must be done frequently. The experience is not pleasant yet not painful. The process wears me down and makes me savor every pure breath of air I get before the mucus starts to build up again. As my diaphragm muscles gradually strengthen, I must learn to breathe with the rhythm of the ventilator, regardless of my own will or my body’s limitations.

My mouth is dry and always open due to the ever-present tube. When frustration overwhelms me, all I can do is shake my head back and forth violently. I can move nothing else: arms, legs, torso. I can't even scream. All I can do is furiously shake my head.  My intolerable helplessness gnaws at my sanity as darkness and despair chase one another in circles in my mind. 

The first night after surgery, intense, electric, abstract collisions of color and half-formed images inundate my senses. They resemble the work of masters like Monet and Van Gogh.  Faint music weaves its way through the living paintings. The colors fade as the sun rises, but I take comfort in the thought that at least sleeping will be pleasant, even as my waking reality becomes harder to face. 

I eagerly greet sleep the second night, expecting to be submerged again in the soft sea of colors and sound. This time, the colors recede from my grasp; they emerge, but are fainter, shorter, less alive but still beautiful — like a day-old bouquet. 

Regardless of the time of day, I begin drifting in and out of reality. The distinction quickly feels arbitrary, its borders blurred more often. Spectral brown moths regularly flutter in and out of my field of vision, flapping behind a person or across the room with a rustling of wings that I can just barely hear.

At one point, in the middle of a conversation, I notice a cash register has appeared on the table next to me. I start sorting coins in the drawer, inserting and removing money, and tabulating the changing dollar amount with a calculator. This menial task is suddenly the most interesting thing in my universe, and it easily eclipses my interest and participation in the conversation. Something nags at me in the quiet corners of my mind, tugging me away from my fascination with the machine: a warning. Some small part of me knows that the cash register, the moths, and similar apparitions will isolate me from everything real if I allow them to. They create distance, not just between me and the heavy, painful things I cannot bear to face, but between me and everything — my loved ones, my faith, my sense of purpose, my ability to recover. These mirages only pretend to be an escape, but they are pits of quicksand. 

The warning carries an afternote of hope. I have approached the edge of the pit and have only just begun to sink; I can still turn back with some effort. I feel a bit of sadness to leave behind the magic of my mirage.  But it is a relief to know that I still have an atom of agency. I let my imaginary hands fall from the cash register and recenter my attention on the people speaking around me. No one has even noticed my absence. 

For the first time, I begin to grasp that focus, a clear mind, and grounded decision-making are key to my recovery. Nevertheless, each day is a growing struggle to contend with my reality. My mute immobility continues to corrode my capacity to sustain my focus. I struggle to manage my thoughts, to choose the ones that can help me through this.

The stagnant air in my room only adds to my restlessness and suffocation. At some point during those first few days, a small fan appears. My son, Zach, attaches it to a stand next to my bed. Even the gentlest breath of moving air across my face is a lifesaver. It opens a portal to memories of being on the beach, feeling a cool sea breeze over my skin. The minute current of air helps me escape the absolute boredom of the stagnant air, the claustrophobia of being trapped in a body that I can't move. I am shocked that something as simple as a gentle breeze could give me just enough of a foothold to steady myself above the pit of hopelessness beneath me. Rather than begging for a miraculous escape hatch, I start searching for more footholds.

Getting a night of restful sleep is impossible in a hospital. The drudgery of the day becomes the weariness of the night. The constant din of alarms going off, machines making noises, and nurses hustling in and out of my room undermine the healing rest that I desperately need. If  my blood-oxygen level drops below 90%, my pulse oximeter sounds an alarm. If my respirator has too much condensation, it sounds an alarm. Two full racks of IVs — delivering medicine, nutrition, and hydration — require constant attention as they take turns running empty. Their alarms add to the chaos. Emergency codes sound over the PA system, followed closely by the commotion of staff sprinting down the hallway. 

Nurses come into my room to check my vital signs every four hours, measure my blood sugar every six hours, reposition my body to prevent bedsores every two hours. Deep, restorative, uninterrupted sleep eludes me every single night. The hallucinatory dreams no longer offer respite from the alarms, poking, and probing.

I soon discover the peculiarities of receiving nutrition through an IV line. First, I am never hungry. Second, I am not allowed to drink any fluids. My craving for just a sip of ice-cold water grows over time. In fact, it becomes an obsession.

Battle fatigue seeps into my mind. Alone as I struggle with all of this, my spirit, mental ability and optimism plunge. I fear my worst, my most overwhelming fear — that this will be my life forever.  I have little hope. I have no control over what is happening to me. I am at the End of Me. Nothing is left.

I am at a crossroads. I can let go of everything, all hope and any thought of recovering, and just dive headfirst into the darkness of depression and a miserable existence. Or I can forge another way that feels impossible. I can reach for hope that is currently beyond the horizon. I decide to explore the latter, knowing it will take something larger than me to actually achieve.

I commit to no longer wasting any energy pursuing unanswerable questions: Why is this happening to me? What did I do to deserve this? What if I had taken the stairs just the tiniest bit more slowly? I realize I am never going to wake up one morning, slap my forehead, and say, "Oh, now I get it! All of this makes perfect sense!" Pursuing these questions only drains anything positive during my struggle, so I banish them from my mind.

I have always considered myself a man of faith. Now is the time to find how deep that well runs. It is an ongoing challenge to even think while breathing through a respirator, constantly interrupted by the inevitable gurgling of fluid in my airway. As I go through the endless cycle of breathing, then gurgling, then signaling for a nurse or respiratory therapist to perform suction, then repeating from the beginning, I develop a prayer:

The only way to victory

(Breathe)

Is to breathe like this

(Breathe)

Using the power of Jesus

(Breathe)

And His loving Holy Spirit.

(Breathe)

I say this thousands of times, learning to completely surrender my life and situation to God. The only thing I can control is breathing. Keep breathing. Keep breathing. Whether it is easy or not, just keep breathing.

This meditation leads me to another foothold.  I have to hold two opposing thoughts in my mind at the same time. On the one hand, as I am practicing this prayer, I have to face up to and acknowledge my horrible situation. I have little hope of a complete recovery or even a satisfactory partial recovery. I have to confront the reality that this could be the rest of my life. Holding this possibility in my mind without succumbing to fear challenges my resolve and strength of character to the core. I must brace for the bleakest possible outcomes, but at the same time I must create space for positive results, including full recovery. 

Hope is a tremendously vulnerable emotion. It could be a dangerous fissure in the armor I will need to withstand the bleak futures that may lie ahead. But I cannot entirely harden myself against hope; it is the crack that lets the light in.

It is crucial to balance these possible outcomes consistently, like walking a tightrope. If I dwell solely on one or the other, I will fall either way. I risk floundering in depression if I shut out hope; but if I lean too hard into it, I risk becoming despondent because I am not yet experiencing any measure of recovery. This intricate mental balancing trick, along with breathing, marks the beginning of finding my way out of my deep, dark despair. More footholds.

My appreciation grows for the constant presence of my wife and three children 24 hours per day, every day. Their support helps me think beyond myself as time passes. Having at least one of these four family members present reminds me that this is not just my battle to fight, but theirs too. I am not struggling alone. Their love, support and prayers begin to lift my spirit and provide a foundation of strength as I strive towards recovery. A vital foothold. Their perpetual bedside presence ensures that I receive constant care, even as ICU beds reach capacity and nurses must ration their care between more patients.

The temptation to give up, surrender, not care anymore, relentlessly persists. My intubation prevents me from closing my mouth and clearing my throat. I can't talk; all I can do is breathe and moan.

On day five, a doctor explains that I have three choices: I can live with that tube going down my throat indefinitely. Unacceptable, is my only thought. If the tube remains in, I will be in bed for the rest of my life. Second, he can pull the tube out and send me home. If I take option two, odds are high that in the middle of the night, I will “experience an event.” This will result in both of us returning to the hospital and him shoving the tube back down my throat to save my life. I immediately reject this option out of hand. Please, dear God, I pray. Please make the third option something I can grab hold of and embrace.

My final choice is a tracheotomy. A surgeon will create an opening at the base of my neck that leads directly to my windpipe. This will remove the tube from my mouth immediately and may eventually provide a way for me to talk . I never imagined picking a tracheotomy as a great life choice, but I choose option three. 

The procedure is successful, but I'm still stuck using the ventilator to breathe through the new hole in my neck. Still, now I can close my mouth, start sitting up on the edge of the bed, and gradually learn to talk. My wife and kids get a crash course in reading lips. The tracheotomy is a triumph. One decision spawns many footholds.

A few days later, it is Valentine's Day, and I celebrate by developing pneumonia. The doctors insert another tube into my chest and drain a liter of fluid from my lungs over the next couple of days. Fortunately, early detection and intervention work to my advantage. I recover.

On my tenth morning in intensive care, hospital staff come in as usual to shift me on the bed to prevent bedsores. As they talk, they turn me on my left side. I feel a wire close around my throat. All airflow ceases. I cannot flail my paralyzed arms and legs, nor can I scream to get their attention. I furiously shake my head and whisper, "Choking, choking" to no avail. Their casual conversation continues around me. I slip into unconsciousness peacefully, thinking that this is not such a bad way to die. My heart stops beating. They call a code blue; I never hear it.

Abruptly, I wake as from a bad dream. A woman I have never seen before is sitting on my chest, her legs on either side of my torso, using both hands and her full body weight to administer chest compressions. As I emerge from the fog of unconsciousness, I am struck by the sheer number of people who have materialized in my room. They are cheering, exchanging high fives and handshakes like athletes who just won the big championship game. They congratulate me and the woman on my chest, saying “Well done" to the both of us. 

I am baffled. Who are these people, what are they celebrating, and who is this woman on my chest? I am the only person in the room who has no idea what is going on, but I seem to be the cause of celebration. My terrified wife and children are outside my room, desperate for any information they can get.

Celebrants evaporate as quickly and unceremoniously as they appeared. I ask my doctor if one of my many attached tubes cut off my windpipe when they rolled me on my side. He suspects it was fluid from the swelling that still lingers in my neck. I cannot help but find the whole ordeal a bit funny — it’s not often you wake up with a stranger on top of you and a room full of people high-fiving the fact that you are alive. 

As I reflect on this fourth and most recent brush with death, it feels absurd that all of this has elapsed over just ten days. My internal landscape has changed as much as my physical state. New and crucial understandings take root in the depths of who I am and how I experience the world. 

No one is promised another day of life. No one is guaranteed a life that is happy, healthy or will go according to their plans. As one of my friends says, "Life is what happens after you get done planning it."  I realize that I take too many things for granted: talking and laughing, a refreshing breath of air, a sip of ice-cold water, being able to stand and walk, being with family and friends. My gratitude grows for each of these previously overlooked wonders. 

Those first ten days feel like a marathon, but they are just the starting pistol shot. Regardless of the total distance in front of me, the number of steps ahead remains the same: one. The next one. I learn to trust that footholds will appear if I only keep reaching for them.

My momentum builds. Three weeks into my ICU stay, I wiggle my left big toe— my first movement below the shoulders since my surgery. After forty days at Scripps La Jolla, I fly to Chicago’s Shirley Ryan Ability Lab, the country’s top rehabilitation facility for spinal cord injuries. 55 days after my fall, I pass my swallow test and am cleared to eat real food. The hospital deserves a Michelin star for that first omelet. Less than a week later, I take my first steps on a treadmill. A harness bears almost all of my weight, physical therapists help me move my legs, and I am still on the ventilator. I am the second person in the staff’s collective memory to be on both the treadmill and the ventilator simultaneously. A staff member christens me Miracle Mike. 

The path forward is uneven, unpredictable, and unparalleled in its challenges and rewards. Recovery is a mix of plateaus and forward leaps that continues to this day and will continue for the days ahead. I have no way of knowing whether a summit or a valley awaits me next. But regardless of what comes, I know that all I have to do is keep finding footholds.