The Latest Update

1 Year Later

2009-09-01T21:16:00.000-07:00

Today is the 1 year anniversary... It is also Devin's first day of school since the accident, he started high school today at Lake Washington High School.

Devin's last surgery (which if I remember correctly was on May 14) was very successful, and continues to heal very well. In his last visit to the doctor about a month ago Devin was given the OK to begin to start bearing full weight on both legs with the assistance of his crutches. Since then he has been making progress, walking a little more week by week. His body is still healing and his energy levels continue to be very low, but he is going to school this year and is hoping to be able to handle 5 of the 6 classes for almost a full load.

The nerve damage he sustained in the fall seems to be healing more slowly than anything. He still has pain, most significantly in his left heel and foot. Foot massage (mostly pressure) still gives him relief.

He has gained back all of the 40 pounds he lost in the first weeks after the accident, and perhaps a few more. he has also added 2-3 inches in height this past year. He looks like he has been lifting weights (with the exception of his legs which are still much smaller than they were), but he hasn't been (that makes me wonder what his appearance would be like if he had not been injured and was able to continue to work out).

His attitude is still remarkably good. I think he is a little concerned about his ability to do well in school, he has not been able to learn nearly as easily as before the accident and has only experienced minimal improvement in that regard in the past 10 months.

I'll try to post a picture or two soon...

Week #36 - Surgery Update #3

2009-05-17T18:12:00.000-07:00

Devin just got home this afternoon which is much sooner then the standard 5-6 days for this type of surgery. The main reason that he was able to return home this soon was due to the fact that we have a very good relationship with the surgeon and several other doctors and nurses at Harborview and they know we are prepared to take care of him at home, which really made the surgeon feel comfortable with him being cared for at home - he basically told us we could bring him home as soon as he could physically handle the ride home.

During the surgery the doctors cut his femur below where it was already broken and notched it a little to adjusted the angle, along with adjusting the angle where the bone was already broken. This helped make everything line up the way it needed to.

They removed all of the hardware put in the first surgery and replaced it with brand new (and different) hardware to hold things in place while it heals. The hardware from the first surgery was designed such that most people keep it in place even after the bones are healed. The latest hardware he got from this surgery is often removed after the bones have healed, mostly because it is more intrusive and can easily be felt under the skin (Making it very painful when it gets bumped).

Devin went directly from the car to his bed as soon as he got here and went to sleep. His trip home wore him out, but all-in-all he is doing remarkably well.

Here is a picture of Devin in the hospital with his little
brother who was very excited to get to see him.

Week 36 - Surgery Update #2

2009-05-14T22:14:00.001-07:00

The surgery has been completed, he was in the OR for about 8 hours. The surgeons were all in agreement that it went very well, and seemed much more optimistic about his chances of the bone healing. The hardware installed back in September was removed and bone grafts done and new (and different) hardware was installed to hold things in place to give the bone a change to heal.

Week 36 - Surgery Update

2009-05-14T15:10:00.000-07:00

Devin went in for surgery today. He was scheduled for a 2pm start time until last night when we got a call form Harborview to change it to noon. We got there at 10am as requested and at 11 the surgery had been delayed. Devin when in for surgery around 1:30 this afternoon and will hopefully be done between 6 & 9 tonight.

The anesthesiologist and attending doctor at the surgery preparation room were both amazed that three top surgeons all well known and respected are all collaborating on this surgery and will all be in the operation from start to finish saying that this is unprecedented. The surgeons all agree that this will be a challenge, we are hopefully optimistic that this will help his leg/hip recover.

Week 33 - Going back under the knife

2009-04-22T21:08:00.000-07:00

We have been to the hip specialist who took some more x-rays and CT-Scans, and after careful review of the CT-Scans said that there is still a chance that the ball joint of Devin's hip will not die and that it made sense to try and save it. The operation is scheduled for May 14, 2009. It would have been sooner (like tomorrow) but the logistics were a bit tricky as there will be 3 head surgeons involved in this operation, each are renowned surgeon in their own right. Finding a date that worked for all three put us out a few weeks beyond what we were hoping for.

The operation will consist of taking out some of the titanium and then filling the rather large hole in the bone that results from its removal using downer bone. Next will be grafting some of his own bone into the rather large gap between the broken bones in his femur. Best case scenario, this will set him back in his recovery several weeks, the more likely scenario is several months. This is great news compared to many other possibilities but none of us are looking forward to another surgery, especially Devin.

Week 31 - The regression of the hip

2009-04-08T21:11:00.000-07:00

Yes, it has been 10 weeks since I've updated the blog. Life is far too busy... I think however that I've been a bit hesitant to makes updates until we get some good news regarding the neck bone of the femur, which I think is sometimes referred to as a part of the 'hip joint'. The good news is slow to come, so after many weeks of putting this off I've decided that it is about time for an update...

So, here is the news: Almost 4 months after surgery on his femur, and after we were told that it was healing very well we went to see the doctor that did his many surgeries on his feet and ankles. This doctor decided to do some additional x-rays on his hip area prior to giving him the OK to start doing some 'vertical' therapy (that just means doing stuff in an upright position, in chest deep water). The x-ray technicians cursed his name as they did the x-rays (they specialize in x-rays of feet, not hips), well long story short the bone appeared as though it was not healing - in fact it was a major regression from the x-rays from last October. I have no special training in reading x-rays, in fact I could not tell from looking at an x-ray that my own leg was broken, and it was not only broken but it had twisted 90 degrees... but in looking at Devin's x-ray it was pretty obvious that not only was it not healing, but the two ends of the broken leg were not even connected... In fact, not only were the two ends not connected, but they weren't even close to touching... In fact, it looked to me like you could drive a truck between the two bones. Well, a very small truck. Ok, you couldn’t drive a truck between them at all, but they were still pretty far from being connected (not to get to far from the subject, but a side effect of going through something like this is that the lack of sleep does affect you in much more dramatic ways than you might imagine, for example my becoming more Dave Barry-ish in my writing style, that is with the exception that I don't have a talent for writing, and... well I don't have a sense of humor... but I think that you most likely understand what I'm trying to say..).

To get back to the point, this was a regression that was, for us, totally unexpected given the previous x-rays showed that it had been healing very well. Since then we have been back to the doctor every month to get additional x-rays, CT scans etc only to be told that it was still showing no progress, but didn't appear to be getting better. Given all of the various factors of this particular situation there are no good options, the bone just needs to somehow heal by itself. if not... a bone graft won't help due to the location and type of break. There is already an assortment of titanium holding it together, although not very well. A hip replacement is possible, but given his age he would need multiple replacements in his lifetime and due to where the break is he will run out of bone to connect everything too before his need for additional replacements leaving him with no working leg unless some unforeseen and unimaginable scientific breakthrough occurs before then to give him some type of alternative, however at this point that is less likely than winning the Lotto (and I've never purchased a ticket, which I think reduces my odds of winning, if only slightly).

Two months ago we were told that if it wasn't showing significant improvement by the next month that he would be going into surgery - not sure what exactly they planned to do and neither did they... last month they decided to hold off one more month. Dr 'B' knew a specialist that he regarded, and wanted to confer with him before taking any action. We are going to see this specialist Friday, and are hoping for some long awaited good news.

The first picture shows the x-ray from October and the second shows a more recent x-ray taken in February.

Week 21 - In the pool

2009-01-27T20:17:00.000-08:00

Devin is at home, and going to a nearby pool where he has worked up to being able to walk in chest deep water without assistance. His ankles, feet and toes still have almost zero mobility. Pain, while ever present, has not been a critical factor so far and we are hopeful that he will regain full mobility in his joints.

Week 15 - Children's Hospital

2008-12-16T12:48:00.000-08:00

A lot has happened since the last post, but getting time to write it down is another story...

Devin is now in Children's Hospital in Seattle, where he will be starting rehab today. We don't know yet how long he will be there, most likely 2-4 weeks. We are still very hopeful that his feet and ankles will respond well to the rehab and he will regain the use of them again. After 15 weeks, he has still not been able to stand up, even with assistance. He will hopefully be able to stand up in chest deep water with assistance soon.

Last week we learned that the neck of his left femur has not healed and the two parts of his femur are not even in contact with each other. There is a gap of about an eighth of an inch. The doctors are concerned that this will cause problems for the hip joint and were discussing surgery either a hip replacement or a bone graft. They have decided to give it more time in the hopes that once he starts to put some weight on it, it will push the bones together and they will heal. This doesn't even seem like a remote possibility, but we are still hopeful.

Looks like Christmas in the hospital this year. That should be memorable.

Week 11 Post #19 - Playing at the park

2008-11-23T17:54:00.000-08:00

Devin was able to spend about an hour in his wheelchair at the park this afternoon where he shot a few baskets and played catch with his older brother. It was a cool sunny day and Devin was very happy for a chance to enjoy being outdoors, if only for a short time.

As we are quickly approaching the third month since his fall Devin's patients with his confinement continues to diminish. It continually becomes more difficult to find a comfortable position that does not hurt and the days seem to drag on forever - its hard for an active person to be off their feet for extended periods of time and especially hard when thinking of activities that his friends are participating in that he would like to be. Having friends over has been a real boost, helping to keep his spirits high. He has also been keeping very busy catching up with school work having two months to catch up on and having only two hours a week of tutor time is giving him the opportunity to lean on his inner drive to keep focused and make forward progress every day.

We have a lot to be thankful for this year as we approach the holiday seasons - among other things we are thankful for your friendship and support - there are many people who's prayers have made a difference and a handful of wonderful people who have made sacrifices of their time and/or money to help in these uncertain times. Thank you.

Week 10 - Post #18 - The Bodycast comes off!

2008-11-14T10:09:00.000-08:00

After another visit to Harborview, the back surgeon said that the damage to Devin's spine was healing very well - ahead of schedule - and that he could remove his body cast. The original estimates were 3-6 months. This is great news! If his ankles/feet continue to heal as quickly as they have been, he might even be able to start rehab as early as mid-December. This is amazing progress - there is no doubt in the minds of anyone close to this situation that we have truly witnessed miracles - even friends who have never set foot in a church of any kind, at any time, for any reason...

Week 9 - Post #17 - The cast comes off!

2008-11-11T20:25:00.000-08:00

Time has not permitted an update in the past several weeks - we are long overdue.

On Wednesday October 29th Devin returned to Harborview for several xrays and other tests, and the highlight of the day was the removal of his cast from his right leg. This was the leg that suffered from the partial amputation when Devin hit the ground. If you wish to see more photos with the cast removed, scroll down the the next post - if you prefer not to see somewhat graphic images, you might not want to look.

This is his last non-removable fiberglass wrapped cast! He will be in removable casts on both feet for several months - like the one you can see in the picture on his left leg - getting this cast off is a huge milestone for Devin. He also had the 'External Fixation' removed from his right leg, and so far he does not seem to miss it.

Week 9 - Post #17 - right leg pictures

2008-11-03T08:45:00.000-08:00

These are not nearly as graphic when scaled from three megabyte images to 16 kilobytes - which might be a good thing.

Day 50 - Post #16: The War of the Ring!

2008-10-21T21:17:00.000-07:00

On Saturday Devin was able to play his first board game since his accident. Our good friends and proprietors of housefullofgames.com gave Devin a cool new board game called "War of the Ring" and his friend Alex came over to try it out... It was the longest time Devin has spent awake and focused on anything and he has paid for it since then - he has been feeling pretty wiped out.

Devin has started to read a little, which is very encouraging given the problems with his eyesight, and he continues to work on regaining range of motion in his left leg as a part of his recovery from the broken femur. He cannot lift his leg by himself, so help is required for him to do this and with the various other things going on, that is one that does not happen as much as it needs to, but as often as possible under the circumstances. He also continues to have a type of massage therapy on his left leg and right toes designed to help his damaged nerves heal such that normal sensations return, and also to relieve him of the constant cramping that he has in his left foot. Cramps in your calves and feet can be very painful as anyone who has experienced them knows very well... Imagine not being able to do anything at all to get the cramping muscle to stop.

He has been able to eat some solid foods, but never much before he begins to feel sick. He has thrown up a few times a week since leaving the hospital and his daily caloric intake is only 20-30 percent what what it should be. He has lost about 90% of his muscle mass which equates to a little over 30 percent of his total body weight and so far has not started to regain any of it back (it is hard to imagine how he could loose more weight). The time from injury to when he can start his rehabilitation will be so long that he will need to relearn much of what comes automatically for most people regarding balance and motion. That phase will not start for 2-3 more months.

Devin continues to have a good attitude even with all of the ups and downs and we continually focus on keeping the mood light. Our family is very grateful for those that have been able to help and for those that have taken time to pray for Devin. The many challenges associated with this type of situation is more than most people can imagine - the support we have received has been helpful and much needed. Thank you.

You can email Devin at RecoveryUpdate@Gmail.com

2008-10-13T13:33:00.000-07:00

I've heard that some people were having trouble sending to recoveryupdate@Live.com, so I have created an additional account: RecoveryUpdate@Gmail.com

There has been little change since the last post, but Devin seems to get just a little better every day. The healing process for his injuries will take time, and for a 14 year old that is bedridden, time certainly seems to move slowly, however Devin is handling this situation so much better than anyone could expect. His family is doing great but a bit tired. There are just so many things involved with taking care of anyone in this condition and the lack of sleep is taking a toll. The opportunity to serve brother/son has been a blessing even though this family has always been close (the biggest argument in this house is who loves who the most), it has helped to teach the important lesson of serving others and the joy that can bring into your own life.

If you have questions about anything specific, you can include those questions in your emails.

Day 39 - Post #16 - Devin's First Day Outside and first trip back to the Hospital

2008-10-09T21:43:00.000-07:00

On Tuesday, with the help of friends, we were able to get Devin into a reclining wheelchair and take him outside! Just in time too because it started raining Wednesday and hasn't stopped yet ;-)

It took 5 people to safely move Devin from his bed to the wheelchair and about 25 minutes from the time we started until he was actually outside. His stomach still gets queasy very easily, and he went pale with just the movement from the bed to the wheelchair even though the move was very smooth. We waited several minutes before going down the ramp, then waited another several minutes - and so on... But it was worth the effort! Devin really enjoyed being in the sun if only for a relatively short time, and as an additional bonus he got to watch his Mom and Dad to some yard work and not have to help (although I think for the first time ever, he might not have minded helping...)

Today Devin had his first return trip to Harborview Medical Center. He had the neck of his left femur x-rayed to see how it was healing, and the doctors said it looked great. He could start rehab if it weren't for his other injuries. He also had his right arm x-rayed. The doctor said that they were going to have to re-break it because the positioning of the two ends of the break did not heal in proper alignment, but after more consultation with other doctors they decided not to do anything yet and see how it feels after a while and see if he is able to regain full range of motion in his wrist, so I guess time will tell... They removed his fiberglass cast and replaced it with a removable cast and gave him some hand and wrist PT exercises for his right hand/wrist/arm...

PT in some fashion takes up much of his waking hours every day. He can do very little on his own at this point, so his family helps him as much as possible. We all want to help give him the best chances of a full recovery as is possible.

Through all of the pain, suffering and bed ridden boredom, Devin has really demonstrated all of the characteristics of a true hero. I read a quote of Hellen Keller once that read "Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved." I don't know if this experience is in some ways helping to shape his character or merely making it more clear for others to see or perhaps a little of both but I can say that he has been an inspiration to all who have had the privilege to spend time with him over this past month.

Thanks to all of you who have prayed for Devin's recovery.

Sending messages to Devin

2008-10-08T09:07:00.000-07:00

Several people have sent messages to Devin while in the hospital, however he is no longer able to get messages sent via the Harborview site. We setup an email account for those of you that wish to send Devin a message: recoveryupdate@Gmail.com

Costs related to Devin's injury have exceeded several thousand dollars so far (above and beyond what the insurance company has paid), please help - every dollar makes a difference.

Day 30 - Post #15 - Devin Released from hospital

2008-09-30T10:23:00.000-07:00

Devin was released from the hospital after 4 weeks. He still requires care 24/7 and is restricted to remaining in a prone position. He cannot get upstairs, where all of the bed and bath rooms are, so we have done some minor remodeling to accommodate him. He is currently in the dinning room, which has been converted to his new room for the next 1-2 months when we are hoping that he will be healed enough to go into inpatient rehab at Harborview or possibly the Seattle Childrens hospital.

Day 23 - Post #14 - One week since Devin's last surgery

2008-09-23T10:37:00.000-07:00

After spending a week in the intensive care unit and two weeks in the acute care unit of Harborview medical center, the doctors are now starting to discuss the next steps... Devin still needs professional care around the clock. With the severity and locations of the injuries, Devin is unable to do anything for himself. He is not able to even sit, let alone stand up or walk, infact it takes 3-4 people to help him change positions in bed (Try laying on one position, and see how long before you want to move). The doctors are still trying to determine what is wrong with his eyes, as he is unable to open his eyes without pain... When you are in the hospital, time seems to go by very,very slowly... and with the trouble with his eyes he cannot do things to help the time go by like watching TV or playing any type of video games or even read... Either Mom or Dad have been with Devin around the clock since he has been in the hospital - mostly Mom who has only left the hospital once in the past three weeks while Dad goes between home and the hospital trying to take care of things at home including three other children, and spending as much time at the hospital as possible to give Mom a chance to get out for fresh air, eat, catch up on some much needed sleep (both Mom and Dad have been surviving on 3-4 hours a night the past three weeks). Mom and Dad have spent a considerable amount of time ensuring that Devin does not suffer from a mistake made by any of the hospital staff, and as good as they are mistakes do happen on a daily basis and having someone here who understands all of the various complexities of what is going on has helped tremendously. They have also been able to read to Devin (He cannot yet read due to his injuries) which has helped the time pass and hopefully lower his anxiety.

Because of the eye problems that Devin has, when he first opens his eyes after having been asleep, everything is a total dark blur. This is very unnerving, as you can imagine. Initially he was also seeing double, but this problem has slowly subsided as the swelling in his face began to come down, after about two and a half weeks this problem went away.

The doctors are currently discussing the next steps for Devin as it will be several months before he is able to start rehab. Mom and Dad would love to bring him home as soon as possible, however the house is no where near ready for someone with his level of care needs and getting him to and from the hospital for the various doctor appointments that he will need will require the equivalent of an ambulance ride to and from the hospital (which cost $12,000 per round trip which make a $2,000 per day stay at the hospital seem cheap). There are a lot of unknowns, and not too many answers... The doctors are currently saying that they think he will be ready to be moved from the acute care unit by this weekend - but to where?

Day 21 - Post #13 - X-Ray images: Surgery-Left Ankle

2008-09-22T01:12:00.000-07:00

During the long surgery on Devin's left ankle, he had over 20 pins inserted into his foot to help hold things in place while two large pieces of bone from a donor about the size of two cherry tomatoes, were grafted into place after the surgeons made wide gaps in the Calcaneus when trying to reshape that bone back to its normal size, shape and position. The Calcaneus bone had been severely crushed, misshaped and misaligned, and getting the normal size and shape were critical to the healing process. The good news is that the cartilage between the Calcaneus and Talus bones was still there (unlike in his right ankle).

After hours of reshaping the bone, and putting the pieces all back together again including the new bone grafts and pinning it all together, then the plates were added as a more permanent way to hold everything together while the bone heals over the next several months. Most of the initial pins driven into the bone were removed once the plate was secured with larger screws, however as you can see from the x-rays, not all of the pins were removed.

Day 17 - Post #12 - Major Surgery #5

2008-09-17T10:25:00.000-07:00

On September 16th, Devin had what we are hoping will be his final surgery. The surgeon could not keep from continually yawning as he briefed us after Devin's surgery... It was a long one - Devin left his room at 6:30am and did not return until 8:30pm and all of that time was spent on the Calcaneus and the cartilage between it and the talus bone, which, unlike on the right foot, was mostly salvageable... When I asked the doctor what he thought the chances of the cartilage healing correctly, he said that it sure better because this was his good foot and his right foot has no cartilage there at all, and that he spent over an hour just repositioning and cleaning up the cartilage and did everything he could to save it...

The doctors did a new nerve block on Devin's left leg and his foot is totally numb. He cannot feel it when I rub my finger across the top of his foot, however he has significant pain the same area that he did pre-surgery in the area around the bottom of his left foot and this nerve block has done nothing for that pain. I suggested that I thought it might not have anything to do with his foot at all since his foot was totally numb, that perhaps the pain was actually happening due to the damage to the nerves in his back, and the signal to the pain center in his brain were getting mixed up as a result. This theory was relayed to the pain management team and they decided after some discussion and review that this theory was most likely correct. As a result they have increased the medication given to patients with neuropathy, which seems to help but only to a small degree. They cannot perform a nerve block to the nerve in his back due to the recent back surgery, so it looks like his only option is to suffer through it, and hope/pray that it somehow stops. The doctors have told us that his injuries put him in the same pain category with giving birth, which might put this into perspective for anyone that has had that experience without the use of an epidural, except that this level of pain has been there going on three weeks know and time tends to have a exponential effect on ones ability to tolerate it.

This morning was the first time the doctors brought up a potential release date saying that at the earliest it would be is in about a week, but that Devin would need constant care around the clock 24/7 for the foreseeable future. He will be bed ridden for several months and will need help doing physical therapy several times throughout the day. We do not yet understand how this will be possible...

Day 15 - Post #11

2008-09-15T11:58:00.000-07:00

Devin has really had a lot of very painful days/nights. The doctors consisting of his "pain management team" are doing their best to keep the pain level to tolerable levels, but his injuries are so severe that he is still unable to rest due to pain. With his inability to move or do things for himself, it has made for many very long nights...

The doctors expected severe pain with the surgeries done to his right ankle/foot/leg, but the pain to his left foot has been much more severe. The doctors think that is due to nerve damage so bad that the nerves are sending pain signals to the brain for areas that were not even injured.

Devin goes into surgery tomorrow (Tuesday) for his left foot. He is scheduled to be the first and only operation for his surgeons and they expect that it could take all day. Please continue to keep Devin in your prayers, he is only at the beginning of what will be a very long recovery. He has appreciated the cards and messages he has received (you can send messages to Devin from the Harborview web site).

Day 12 - Post #10 - The second Foot & Ankle surgery to the right foot

2008-09-13T01:40:00.001-07:00

Devin was scheduled for a 12 hour surgery to his right foot. This foot was just operated on 3 days ago and the surgeons were going in to finishing putting what was left of his foot and ankle back together again. Based on the information that we got concerning missing cartilage and bone fragment, it has been difficult to feel very optimistic about his chances for a recovery that would enable him to compete in track as he had done previously. Osteochondritis is most certainly going to occur, and walking pain free let alone running are statistically very unlikely.

The surgery today seemed to go well. I don't have all the details, but it only lasted half of the expected duration. The surgeon was able to determine why Devin had such severe pain when the general surgeon team made its daily rounds and insisted on grabbing Devins big toe... The extensor hallucis longus tendon was misaligned due to the trauma and was actually stuffed inside of the joint between the talus and calcaneus bones - very painful...

Day 10 - Post #9 - Post surgery update - Right Ankle & Foot Surgery X-Rays

2008-09-12T01:00:00.000-07:00

Devin has had a significant increase in the pain in not only his right ankle/foot (which is expected post surgery) but also in his left foot. In fact the pain in his left foot has reached unbearable levels, well beyond the post op levels of the right foot. One of Devin's surgeons, Doctor Novak postulated that it could be due to the extensive nerve damage at least in part in the ankle region, possibly in the sciatic region as well. The severity of the pain that Devin has been experiencing is very difficult for someone to comprehend who has not had the opportunity to experience that type and degree of pain themselves, so they often think of his pain in terms of their own experiences with pain that leave them somewhat apathetic to his current condition... Having suffered severe pain myself (Broken neck, back, calcaneus, leg, foot, skull, and other traumatic injuries resulting in nerve damage, to name a few...) it is very difficult to be patient with apathetic care givers.

One of several types of pain that Devin has had aside from the more normal pain one would generally associate with a broken bone is what is referred to as Nociceptive pain which occurs when pain-sensitive nerve endings called nociceptors are activated or stimulated. The doctors in the pain management team were unable to bring Devin's pain into bearable levels resulting in several sleepless nights. After considerable and very consistent 'discussions' with the nurses, head of the nurses, surgeons and the entire pain management team we were finally able to convince them to try a procedure called a "nerve Block". Basically Nerve blocks are injections of anesthetic around the fibers of a nerve that prevent (or 'block') the pain messages relayed along the nerve from reaching the brain. They may be used to relieve pain in specific parts of the body for a short period; a common example of this type of nerve block is the lidocaine injections given by dentists before drilling or extracting a tooth. Some nerve blocks are injected in or near the spinal column to control pain that affects a larger area of the body; an example is the epidural injection given to women in labor. The doctors were at first adamant that they never preform the nerve block procedure prior to surgery for a variety of reasons, so Devin must be the first, at least in the history of Harborview. That procedure helped enough with Devin's pain that for the first night since his surgery on Tuesday, he was able to sleep pretty much through the night.

Below are a series of X-Rays taken during Devin's surgery. These X-Rays show the procedure done to his right ankle on Tuesday September 9:

Day 9 - Post #8 - Right Ankle & Foot Surgery #1

2008-09-11T23:12:00.000-07:00

The first surgery done on Devin's right leg/ankle/foot scheduled today - September 9.

There have been several studies including retrospective studies to compares the end-stage function traumatic below-knee amputee with that of the patient with salvaged severe tibial and acute calcaneal fractures. In one study, Twenty-four patients, 12 below-knee amputees and 12 with salvaged tibiae, were interviewed and examined one year or more after the completion of treatment. Emphasis was on function of the limb, the patient, and the quality of life. I've been surprised to learn that the early amputees had higher scores, fewer operations, and only six-week hospitalization on average, and returned to work and sport within six months... However neither the amputees, nor the salvaged group ever functioned entirely normally.

According to what I've been able to determine, virtually all people with these severe injuries have had to make significant changes to both work and sports activities, and over a third believed there was deterioration in their quality of life. The results of what I've been able to find suggest that amputation should be strongly considered when confronted with a borderline salvageable tibial and/or calcaneal injury or prolonged salvage attempts.

At this point, we have not given up hope that Devin will regain the use of his feet without resorting to amputation and the use of prosthetic limbs, even though the odds are strongly against him.

The damage to Devin's right ankle region is very extensive. His foot was "partially amputated" at impact. 80% of the skin around his ankle was torn and his foot was detached from his leg. At first sight all I could see was that his foot was no longer at the end of his leg... What I could not see was that a large portion of the cartilage had been destroyed, that the talus and calcaneus bones had been fractured (Cracked) as well as compressed. There were also fractures to the navicular, third metatarsal and intermediate cuneiform bones and additionally the end of the tibia had also been compressed and the top of the calcaneus was jammed into the end of the tibia.

It is disheartening to know that once a bone compresses it does not spring back into shape, and compression fractures may not be considered serious enough to cause immediate concern they still often result in painful arthritis in the future...

Harborviews top foot surgeon has taken over this surgery from Devin's "foot team". The surgeries to both of his feet will be done by Dr Benirschke & Dr Novak.

Dr. Benirschke is a professor of orthopaedics and sports medicine at UW (since 1985) specializing in surgical treatment for foot and ankle disorders and considered one of the top experts in these types of surgeries. He co-authored several articles including "Acute Calcaneal Fractures: Treatment Options and Results" in 1994 and "Surgical Treatment of Talar Body Fractures" in 2003. He has also authored several articles in the Journal of Orthopaedic Trauma.

Prior to the surgery, the surgeons told us that they would do their best to make his foot usable again, but were not very reassuring of Devin's chances due to the extent of the damages. They also said that they would most likely need to perform at least 2 operations on his right foot due to the multiple incisions required to gain access to the different injuries.

Days 5-8

2008-09-11T23:09:00.000-07:00

Coming soon...

Day 4 - Post #6 - Not able to go into surgery today

2008-09-11T16:17:00.000-07:00

Day 4 - morning

The head ICU surgeon is still concerned about injuries to Devin's internal organs. His Spleen, Kidney and liver all suffered severe trauma and multiple lacerations. There has been some internal bleeding from these injuries, but exactly how much of what the doctors are seeing in the CT Scans and/or MRI's is from that bleeding verses other liquids from swelling is not clear... Even if what the doctors were seeing is from something other than blood, both of Devin's feet are too badly swollen to allow surgery on either foot/ankle.

The doctors are also consulting regarding the neck brace and when it can safely be removed. They are considering taking it off later today when they fit him for his 'body cast' or 'back brace'.

Day 4 - Evening

Good news from the CT Scans this morning. The trauma to the internal organs, while fairly severe, look like they have stopped bleeding. If things continue to improve as they have been during the past several days the doctors will not need to operate. That good news really helped to lighten our spirits along with the news that the back surgery went better than we could have imagined as Devin has regained the ability to move his left leg!!! There were a lot of tears of joy. There is a reasonably high possibility that kidney surgery will be required down the road at some point, but until proven otherwise, we choice to believe that will never be required until proven otherwise... We will need to have his blood pressure checked regularly, and if he begins to develop high blood pressure, that is a sign that we need to take him in for testing on his kidneys...

Devin was fitted for his back brace, and his neck brace was removed. After several attempts at getting Devin breathing on his own again, he was successful on the third attempt and by the evening the doctors were able to remove the air tubes that were crammed down his throat (even though they keep you alive, the can be so darn uncomfortable!).

More great news! Half of the drainage devices were removed today! His rate of recovery seem remarkable considering the injuries sustained, and the doctors agree...

Day 3 - Post 5 - The 'Shattered' Vertabrae

2008-09-11T02:03:00.000-07:00

The surgery to Devin's leg yesterday went just about as good as it could have gone and we are very thankful for everyone involved. We feel very blessed to have such a great hospital with excellent doctors and nurses to care for Devin. We are also very thankful for all of you that have prayed for his recovery.

Today Devin goes into surgery for his back.

He shattered his L4 vertebrae (L4 is at highest point of iliac crest, which was also fractured).

Immediately after the fall, Devin tried a few times to get up and each time he tried, there was no movement in his legs at all... When we learned that he had 'shattered' his L4 vertebrae we were very concerned that he could be permanently paralyzed... We were really devastated...

We would not find out if he had permanent nerve damage until after this surgery. He went into surgery at 9am and 6 hours later the doctors had been able to reposition the fractured and displaced vertebrae, open up the spinal canal, place 2 rods on either end of the spinal cord and hold it all into place with 6 screws. This took pressure off of the nerves and the doctors are giving him an 80% chance of his nerve damage recovering fully. We were relieved to say the least. He will be in a body cast for 3 months, however body casts are so much different today than the plaster casts that were once used.

Additional CT Scans were done on his abdominal area. The doctors are concerned about the internal injuries to the Spleen, Liver and kidney. They also did another X-Ray on his back to verify that he had proper alignment after his back surgery.

The team responsible for his broken arm were able to set the bones, and without surgery as they had thought would be required. So much to be thankful for today.

Still no responsiveness from Devin. He remains in critical condition in the ICU. He has considerable swelling and bruising, mostly in his face and both ankles. He also has 6 medical drainage devices with tubing going into his body at both feet, hip and back. Each of these has removed a significant amount of fluids resulting in a reduction of swelling.

It is still unclear at this time if he will be able to have additional surgery performed tomorrow. He has held up very well after two days of back to back full day operations, can this continue? how much additional trauma can his body take? We will find out tomorrow when the surgery on his feet can begin.

Day 2 - Post #4 - The broken hip

2008-09-08T17:36:00.000-07:00

Between Monday night and Tuesday morning everything was pretty much a blur, almost like being in some sort of alternate reality. Time seemed to have been altered, sometimes feeling like it had stopped altogether or was somehow no longer linear almost like a really confusing dream... For Devin it was almost certainly a nightmare. Once in the ER he was given something to sedate him which put him under... and he did not communicate in any way with anyone today.

The team of surgeons working on the upper leg and hip fractures were very eager to start operating right away, starting as soon as possible in the middle of the night (Monday night/Tuesday morning) as soon as his preliminary tests were completed. It was critical that his hip/femur be put back together as soon as possible as each minute that passed reduced the odds of a successful operation. Devin's upper left leg was broken in the neck of the femur (The "thighbone" which is the area just below the ball that fits into the hip socket in the pelvis), and the lower portion of the fractured femur had detached and shifted up into the pelvic bone.

This is the compression hip screw and plate that was implanted in Devin's left hip. The lower part of the plate that runs snug along the femur is secured by 3 screws (not shown) through the femur.

When the break is in the neck of the thighbone, the fragmented ends can sometimes be realigned and fastened together with internal fixation (i.e. Titanium rodes, plates and screws), however a fracture across the femoral neck can interrupt the blood supply to the head of the femur and this will eventually cause "Avascular necrosis" which is a disease that results from a temporary (or permanent) loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. When this happens to the bones near a joint, it often leads to collapse of the joint surface and for this reason some doctors believe a total hip replacement is a better choice than trying to reconnect the bone.

This is the type of hardware used to hold the bone together.

Unfortunately, due to internal injuries to his spleen, kidney and liver, Devin was not cleared by the head surgeon for any operations as the risk of death was high enough that the risk of loosing his hip joint became irrelevant.

By 8am Tuesday morning Devin was cleared for surgery and he spent the next 7+ hours getting his hip joint reconstructed. It is not clear weather or not the break to the femur will heal at this point, nor is it clear if he will suffer from "Avascular necrosis". Even if everything goes well, and even if this were his only (or even most serious) injury, the recovery time is significant for this type of injury, in one account a person wrote the following three years after they broke their leg:

I continue to make slow progress... My recuperation is decidedly different that I expected in one specific respect. I expected my hip pain and discomfort to decrease slowly but consistently until my hip felt more or less "normal." I now realize that the recovery is a lot less about feeling and a lot more about function. Even though my hip hasn't been feeling much better lately, I am hopeful that functionally it is getting more and more capable of sustained exercise.

(From "Coming Back from a Broken Hip": http://barrygee.blogspot.com).

Given the extent of Devin's injuries it is very unlikely that he will ever walk again, even if he doesn't have permanent nerve damage from his "shattered" vertebrae.

Things really look grim at this point, and our spirits were low. Nothing short of a miracle would be enough, but would even that be enough?

Day 1 - Post #3 - The Initial Diagnosis

2008-09-07T23:35:00.000-07:00

Within the first hour after Devin arrived at the Emergency Room Trauma Center at Harborview medical center he had already had data from the initial MRI’s, CAT Scans and X-Rays that was used to determine the best strategy for keeping him alive, and putting him back together again. Seven different teams of specialists were formed to handle the different injuries. The first procedure was also performed which was to reattached his partially amputated right foot, and get it temporarily set into place using three 6 to 8 inch titanium screws that were screwed directly into the bones of his leg to help hold things in place.

Within the first several hours Devin had multiple MRI’s, CAT Scans and X-Rays as the different teams of specialist determined the extent of his injuries, which included multiple fractures to both feet and heels and lower legs. The Femur of his left leg was badly broken along with the hip and pelvic bone, all of which needed immediate surgery if he was to have any chanced of using that leg again. His back was badly broken with the L4 vertebrae “shattered”. It was not known at the time if the nerves to his legs and internal organs were severed or not. He had an ugly compound fracture to his right arm just above the wrist where both bones were broken and separated causing his arm and hand to appear disfigured. Devin also had several fractures in the bones of his face and his left eye was badly bruised and swollen shut.

Day 1 - Post #2 - The Rescue

2008-09-07T22:36:00.000-07:00

Devin's father was literally within inches of him when he landed having raced towards him as if to somehow save him from hitting the ground, but not quite making it in time. His first thoughts were an unbearable combination of shock, disbelief and total despair... Anguish... What words are there to describe such a thing? That first split second there was no doubt that he had witnessed his son's death. All but collapsing at the lifeless body of the son he loved more than life itself - falling to the ground as he felt all all of his strength suddenly leave his body after failing to somehow save his son... but in that instant a shock went through his body as he thought he detected a movement... Is it somehow possible that Devin could still be alive? He immediately checked his breathing and pulse and at that moment the overwhelming feeling of anguish was replaced with an adrenaline fed panic. There was not a second to waste if Devin were to have any chance of survival. Acting instinctively he pointed to the first person he made eye contact with - another climber in the area that he had never even met before and yelled "You! Call 911! NOW!!!! Tell them if they don't get an ambulance here RIGHT NOW, someone is going to die!". He then yelled to Devin's older brother "Get Mom NOW! Tell her Devin is hurt and I need her help".

Devin began to come to as he moaned in pain. His father did his best to calm him and reassure him that help was one its way. Devin was in severe shock, and tried several times to get up only to fade back into unconsciousness. He was only able to move his head and arms, as if his lower body was paralyzed.

Devin's father was certainly in a state of panic as he yelled at the person calling 911 "Tell them that if they do not hurry, this boy is going to die! Are they on their way? Where are they?", it didn't take long before this person handed over the phone suggesting that he speak with them. He took the phone and requested that this person hike down to the road to flag down the ambulance when they got there... While time seemed to stand still for the next several minutes, the paramedics made record time in getting there. They were outstanding in accessing the situation, getting the helicopter from Harborview medical center on their way and getting Devin down to an area where the helicopter could get him and take him to the ER.

Day 1 - Post #1- The Fall

2008-09-06T10:34:00.001-07:00

On the afternoon of September 1st, 2008 Devin was with his family hiking in the Central Cascades in Washington State on and near the section of the Iron Horse Trail near I-90's Exit 38 just East of North Bend near Olallie State park.

Devin had just led a climb up a fun 5.7 pitch named "Bottoms Up" one of the many rock climbing routes in the "Exit 38" climbing area. After setting a top rope for his brothers and rappelling down he hiked down below the trestle bridge and beyond the "Substation Wall" climbing routes hiking around and above the "Bottoms Up" route to wave to his brothers who were climbing that route.

A little later when hiking above the "Substation Wall" climbing routes the ground below Devin's feet gave way causing him to slip and he began sliding towards the edge of the cliff... He was unable to stop and went over the edge free falling a significant distance to the hard rocky ground below. Official reports state that the fall was 100 feet. I don't know for sure how high the free fall was, however he was in the air for at least 2 full seconds after I first saw him falling (I'd guess about 2.5 seconds total air time). He was falling at a rate of at least 55 miles per hour when he hit. You can do the math, all I know for sure was that this fall was much more than a person could be expected to survive.

Without making a sound (i.e no hysterical screaming, or even an "oh crap!") Devin fell this entire distance crashing to the earth with bone crushing force. In that instance all of our lives changed forever.