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

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

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

Coming soon...

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

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

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

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

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

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

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.