Q&A with C.B. Brooks, MD

As a doctor I’ve seen every bed in the ICU (Intensive Care Unit) filled with closed head trauma victims. The open head traumas usually don’t make it to the ICU, they’re DRT (Dead Right There). As a firefighter, I’ve extricated mangled people from mangled wreckage. As a cop, I’ve searched terrain far from the accident site looking for the missing rider’s body. As a surgeon, I’ve lopped off more legs than I can remember. As a bagpipe band drummer, I’ve played at some sad funerals of young people.

The dream of cruising down the open road on your motorcycle, free as a bird, seduces many people. The reality is you are a human missile with no protection. The deck is strongly stacked against you. Sooner or later you will hit a slick oil spot, loose gravel, a rainstorm, a mule deer, or a patch of ice. You may be the toughest hombre or chick in the area, but the lowliest driver of a car, truck, or minivan can abruptly end your reign.

SURGERY STORY – I can’t tell you how many times I’ve been called to the emergency room for motorcycle injuries. Sometimes it’s a burn or road rash abrasions with dirt and pebbles hammered into the skin. Far more commonly, it’s one or both legs shattered with the skin and muscles ground up like a big pile of chopped meat sprinkled with denim.

If the tibial nerve that provides sensation to the sole of the foot is part of that ground beef; then forget it, even the best microsurgical miracle won’t work. I’ve been faced with so many of these injuries. Usually you see a foot and an upper leg, with a big interval of bloody mess in between. Sometimes the only thing still connecting the parts is a little skin bridge at the back of the leg. This can unceremoniously be cut through with your bandage scissors in the emergency room. Ta-dah.

If the motorcycle victim’s nerve is intact, then a series of operations to try to “save” the leg can be considered. These may include reconnecting blood vessels with interposition reversed vein grafts (microsurgical revascularization); trying to repair other damaged nerves; cleaning everything up and removing all the dead muscle, tissue, asphalt, and skin (debridement); trying to realign the shattered bones and holding them together with threaded pins and a big external fixator frame that looks like an erector set. That’s just for starters.

Future operations include repeat debridements, bone grafts to fill in gaps and try to get the broken bones to heal, skin grafts and flaps to cover all the damaged areas, removal of the external fixation hardware, possible bone internal fixation hardware, application of casts and braces, maybe a microsurgical free flap operation where muscle, subcutaneous tissue, overlying skin, and sometimes bone are taken on their own blood vessels from another part of the patient’s body and moved to the damaged area where the blood vessels are spliced (anastomosed) into any available local vessels. If the flap survives, it can provide coverage and missing elements to the injured area.

If everything goes well, these patients usually face about a year of recovery. But things don’t usually go well. Bone fracture healing is commonly slow or doesn’t occur (delayed union or nonunion); infections of the bone or soft tissue (osteomyelitis and cellulitis) occur because the damage zone is big and beaten up; deformity, stiffness, pain, and prolonged physical therapy are expected. Social consequences of bankruptcy, job loss, relationship strain, and lawsuits from the accident, are prevalent. Depression, addiction to pain medication, drug seeking behavior, and mental health troubles can occur. In other words, satisfying the need for speed on a motorcycle is a life altering bad idea.

As a teenager and young adult, you and your friends will be tempted to test the limits and see how fast you can go on various machines. Cars also produce devastating injuries and death. Teach your radars the physics of high velocity projectiles meeting solid objects, and how high speed rollovers can be caused by small curbs, bumps, or road shoulders that wouldn’t be a problem at a slower speed. Also ponder our human anatomy. Our protective skeleton is on the inside. If we were lobsters with our protective bone structures on the outside, an exoskeleton, we’d be far better equipped for high speed fun on things like motorcycles.

The need for speed can clearly jam our radars. Fortunately there are many ways to satisfy the need, some much less risky than others. Weigh the risks versus rewards and make choices with radar on full.