On December 1, 1991, John Miller, MA, PT, marked the anniversary of a year of tragedy, recovery, and triumph. On December 1, 1990, he was traveling with his younger brother, who also is a physical therapist, on a snow and ice covered mountain highway near his home and private practice in Puyallup, WA. They had gone to his cabin at Mt. Rainier to winterize the plumbing. They stopped for breakfast on the way back, and from there they were stopping to visit an elderly patient at home who was recovering from a total knee replacement. Grateful to be saved a trip into town, the patient told Miller he would be waiting with hot chocolate on the stove. An unexpected turn of events prevented that home visit from taking place.
Along the way, their Jeep Cherokee hit ice and spun out of control. In trying to avoid on-coming traffic, they slid broadside into the path of a larger Jeep with a large winch mounted on its front. The other Jeep speared the passenger door where Miller sat.
“I would not have survived if not for the fact that our Jeep was as high off the ground as the Jeep that hit us. The winch completely caved in my door, squashed and shoved my seat over to the driver’s side, tore two tires off, and flipped us on our side,” explained Miller, who was left hanging unconscious from his seatbelts. His brother, who narrowly escaped serious injury, helped support him during the 45 minutes it took rescue workers to remove him from the vehicle.
Miller, who had been a physical therapist for nearly 20 years, was about to become a physical therapy patient. His interest in the profession developed when he met his then future wife, Joyce, at the University of Washington in the late 1960s. She was a student in the PT program, and the more he learned about the field through her, the more he realized it was a profession that suited him. In 1973, he graduated from the Stanford University PT program and joined the physical therapy staff at Good Samaritan Hospital in Puyallup. In 1979, John and Joyce started a private orthopedic therapy practice, which has now grown to employ three other physical therapists, five physical therapy assistants, and three front-office staff members.
In looking back at that year, in which he underwent intense physical therapy treatments and six surgeries to repair serious damage to his right wrist and hand, spine, pelvis, and right lower leg, Miller is able to see a positive outcome. The experience has reinforced his deep commitment to his profession, his family, and the staff at his clinic. As a physical therapist who suddenly became a physical therapy patient, he says there have been many lessons. In the following paragraphs, he shares his story:
My earliest memory after the accident is being loaded out the back window of the Jeep. When they put me in the ambulance, I was awake but pretty spaced out. My brother was questioning me and I couldn’t remember why we were there or where my daughter went to college. But I knew that my right forearm was broken, and when he began to palpate my right lower leg, I could tell him it involved both bones. At that point though, I was not aware of the fractures to my spine and pelvis.
Once they put me into the ambulance and began the 45-minute drive to Good Samaritan Hospital, my concern was, and I must have asked 15 times, who the orthopedic surgeon on call was. I have several friends in the area who are fine orthopedic surgeons, and I hoped one of them would be there to look me over. When I got to the hospital, I was elated to find Dr. (Donald) Mott on call. He’s an excellent surgeon, and he’s been my patient a number of times. To be with someone I had so much confidence in gave me a great sense of calm.
What I find ironic now is that I was so calm that I had them wheel me in the gurney to a phone so I could call my family and friends and tell them I was okay. Of course, as I was to find out later, I was far from okay. But I guess that was my way of coping.
After four hours of extensive testing, Dr. Mott decided that my pelvic injuries were so severe that I needed to be transferred to Swedish Hospital in Seattle. He contacted Dr. Robert Winquist, an internationally known orthopedic surgeon who specializes in pelvic injuries, and Dr. Alan Bach, a well-known hand surgeon, and had them standing by.
Once I got to Seattle, I was prepped for what turned out to be nearly eight hours of surgery. Dr. Bach started with my hand and wrist. The spine was stable so they moved down to the pelvic injuries, which were the most serious. Dr. Winquist made an incision over the pubic symphysis and also over my right iliac crest and proceeded through the abdomen to plate the pelvic ring fractures. From there they went on to my leg and performed an anterior compartment fasciotomy to relieve the pressure in my muscles and put an IM rod through my tibia.
After the surgery, I was moved to intensive care and in just a few days I was moved to a regular floor. It was that first week that I experienced my only real downtime. The first time came when I was moved back to intensive care. They didn’t like my blood gases, and I was bleeding from a kidney. When they send you back to intensive care, you worry. But that second stay in ICU didn’t last too long.
I remember another time during that first week when I had been sleeping too much during the day and I woke up at 1:00 am. I lay there and watched the second hand drag around the clock. I started projecting ahead and thinking about how long it was going to take to recover and what that would involve. That was really the only time I came close to depression, which surprises me. But that gets back to being a physical therapist and the kind of control that gave me over my own recovery and rehabilitation.
On the fourth day after the accident, an OT came to see me, and she began to describe finger exercises I could do while wearing my hand and wrist splint. It was at that point that I really began to assess my injuries. The hand concerned me the most. I had suffered dislocations of three carpal bones in the right wrist, multiple fractures of the right distal radius, and injury to the DIP joint of the right fifth finger. At that time, I couldn’t curl my fingers or even lift my thumb. I realized the wrist and hand were in bad shape, but I wasn’t afraid to immediately concentrate on the range of motion (ROM) and strength exercises I was allowed to do.
Using my good left hand, I began stretching right finger joints, going through passive range of motion exercises for my other extremities, and working on bed mobility. I borrowed my brother’s belt while he was visiting, and alternately looped it above each knee so I could slide my legs up and down like a marionette. I was already beginning to problem-solve like a PT.
By the eighth day, a PT was visiting me two times daily. She was helping me regain bed mobility, sitting, and later transfers to a wheelchair. The hospital staff appreciated that as a physical therapist I could play a more active role in my own treatment. I could step out of the patient mode and assist the staff in how to slide and position me during early bed transfers. I was able to save myself a lot of discomfort.
My therapy team was comfortable with the role I was playing in my own recovery. But they had strong concerns that because I was a PT I would overdo it. It turned out they were right. At the end of my second week in the hospital, I made a very human mistake. I asked the hospital staff members to help me stand up and balance me so I could do some toe push-ups on my good leg. I had been in very good shape before the accident, and I didn’t think this would be a problem. At first I couldn’t get my heel off the ground and then I made myself finish ten toe push-ups. By that evening and the next day, my calf hurt so much you couldn’t even touch it. I realized I had strained my calf muscle just from underestimating muscular atrophy.
On December 15, I returned home. Two days before I left the hospital, the staff told me they wanted to send someone out to the house to help us set things up. But by that time, my wife and I already had a ramp installed at the front door and exercise equipment, a hospital bed, a wheelchair, and a commode chair set up in the house. My mother and father-in-law were home during the day to assist me, and Joyce, in the evening, would help with my program after her day at our clinic.
Just one month after the accident I was able to visit my practice. By then I could transfer to a car, and I was tired of being home. It turned out to be a good decision because the staff at the clinic could keep an eye on me. I could exercise more fully, and, as I happily found out, I could be a motivation to others. Clinic patients could see that I was making progress, which also encouraged me. After a few days, I would wheel into people’s rooms and visit with patients I knew and share thoughts about the progress we each were making in our therapy treatments. Later, therapists in our clinic would occasionally ask me into a room to do some troubleshooting.
I spent two months in a wheelchair and then graduated to a walker with a platform on the right side because I could not bear weight on my right leg or hand. I progressed from the walker to crutches and then to a cane. Once I was up and walking, I could begin more advanced exercises, but had to continue to be careful not to overdo. By May 15th (5½ months after injuries) I had started seeing patients on a part-time basis. Finally, on August 1st, I returned to full-time practice.
I wasn’t allowed to do any gripping with my right hand for three full months after the accident. I now have about 125 pounds of grip in that hand. Before the accident it was 130, but when I started therapy it was zero. I still have slightly less than normal range of motion in my right wrist, periodic stiffness and discomfort in my back, and I am careful about lifting activities. All in all, though, I am now back to normal daily activities and exercise and with much to be thankful for.
Of course, there are concerns about the future. Will I get arthritis in my damaged joints? Will hardware in wrist, pelvis, and lower leg bother me and need to be removed? Will stiffness in my back or wrist someday limit me from activities I enjoy? I may not be back to a full 100%, but I worked to come as close as I could. I’m able to run a bit now on softer surfaces and I will cross-country ski again this season. I could even climb a tree if I had to!
When I look back on that year, I realize that I’ve gained from the whole experience. The insight I’ve gained as a physical therapist is high on my list of positives. My experience as a patient was much better than most and I’ve focused on what made it positive so I can give some of that back to my patients.
I was always a strong believer in having patients actively involved in their treatments. I am even more dedicated to that idea now. I am more attentive to the little things that make a big difference for patients, such as their comfort and positioning. I can remember looking at my hand when it was barely moving, and yet I could see daily progress. I knew everything would be a step-by-step process and I had the ability to realize each step would lead to functional gains. I am now in a better position to help my patients understand and appreciate the same.
My recovery process confirmed that, even though I thought like physical therapist, I often reacted first as a patient. It was so easy for me to make the mistake of overdoing it even when as a therapist I knew better. I see my patients now as even more human that I did before. It is so important to cut them some slack and accept them with all their shortcomings, such as procrastination and overdoing and under-doing exercise programs. Yet, one only gets what one wants to achieve if you work at it!
I am still applying thoughts I had as a patient to my work as a therapist. I can remember the times I was in our clinic in a wheelchair and the effect my motivation had on other patients and the effect their determination had on me. Now I look for opportunities to introduce patients with similar problems and situations to each other.
I have never had any doubts about my choice of physical therapy as a profession. Being a physical therapy patient has reinforced for me the difference that we can make in people’s lives and the magnitude of what we can help them accomplish. Also, I would have a hard time believing that anybody else in medicine could suffer a serious accident and be as well prepared to deal with disability and rehabilitation as could a PT.