Travis Rieder - In Pain: A Bioethicist’s Personal Struggle With Opioids

May 23, 2015, started out as such a good day.

Awoken by the sweet jabbering of my daughter, I quietly slipped out from under the covers, snuck out of the bedroom, and pulled the door closed behind me. The giggles were coming from just one room over, and I smiled as I entered to find Baby Girl standing in her crib, holding her favorite blanket, waiting patiently for her rescue. Stretching her arms up as I approached, she inquired, Baba?

Good morning, sweet girl, I whispered as I crossed the room. Now lets be quiet so we dont wake mommy, okay? I hoisted her out of the bed and pulled her tightly into my chest with a shush, before sneaking her quickly downstairs, leaving my partner, Sadiye, to get just a little bit of extra sleep. Those are the rules in our house: if youre planning to leave for the day, you get morning duty. And I had a date with the beautiful, winding roads of the Shenandoah Valley. Just me, my riding buddy Nathan, and our motorcycles on a sunny, Memorial Day weekend.

One-and-a-half-year-old Sinem was in a good mood, and for two blissful hours I enjoyed one of those perfect mornings of early fatherhood, where the work of parenting is easy and you just get to soak up the good stuff. We made breakfast together, played on the floor, and watched cartoons. I had been lucky enough to stay home for the first eight months of Sinems life, and now that I was almost a year into my new career as a junior faculty member at Johns Hopkins, I really missed this. Soak it up, I would tell myself, looking at her face and realizing how much shed already changed. Although her incredibly fine brown hair remained short and fuzzy like an infants, that was the only sign of the baby she so recently was; she was tall and lean, and her looks of curiosity and happiness seemed to reflect more depth of personality than I would have thought possible at this age. If I blinked, I was sure Id be dropping her off at high school.

Later in the morning, Sadiye woke up and took over kid duty, and I pulled on my leathers, body armor, and full-face helmet. Have a wonderful time, sweetie, she said, walking me to the door. I smiled and bounded down the few steps from our townhouse to the parking lot where my bike waited, and turned around to see Sadiye with Sinem on her left hip, both of them waving goodbye. Although Sinem was thin like her mom, she had gotten more of my complexion, and her fair skin contrasted with Sadiyes more olive tone and thick, dark hair. I blew them both kisses through my helmet, threw my leg over the seat, and fired up my Triumph Daytona. Relaxed and excited for the days adventure, I pulled out of the driveway and settled in for the thirty-minute ride to meet Nathan.

As it turned out, my morning with Baby Girl would be the only good part of that day. I hadnt even gone three blocks when I saw an ominous-looking white van ahead to my left. My riders sense of alarm went off because the driver, although seemingly looking right at me, appeared to be nudging into the intersection. I had no stop sign and was simply going straight, and it looked like he was going to turn left out of a housing development onto my street. Although I had the right-of-way, I didnt trust him; I closed the throttle to decelerate and looked to my right to see whether I might have an escape route.

I hadnt even fully taken in my options or begun shifting my body weight for evasive maneuvers when I felt the impact. In just those few seconds, I had covered the distance to the intersection, and the van hit me squarely on my left side.

Although it happened in an instant, I seem to have recorded minutes worth of memories.

I remember seeing the vans bumper contact the front wheel and the bikes fairing, and the feeling of the bike rippling underneath me. I remember the fleeting thought that maybe I was just getting bumped a little, and while that was certainly not good, maybe I could stay on the bike. Somehow, in that mere instant, I feel like I had an entire debate with myself about whether this was going to be an unfortunate incident that made me late to my ride or if I was about to really hit the ground. Id crashed before, and I knew what it felt like to go down; I also trusted my gear to protect me from the asphalt. I wasnt panicked. At least, not at first.

But then everything felt different: there was what I can only describe as pressure on the whole left side of the bike and my left leg, as the full force of the collision transferred from van to motorcycle. One moment, I was in control of my body and my bike, and the next moment I wasnt. I was in the air. For an improbably long time. I clearly remember landing on my back and the bike landing on top of my left leg. My head snapped back as I hit the ground, my helmet cracking against the asphalt with a sickening sound. But even after that, I wasnt worried. No pain yet, I remember thinking. The helmet seems to have done its job.

But then the pain did comejust not from my head. The bike was sliding on my left foot, and something was wrong. My foot really hurtin that very alarming, this-is-not-okay, danger-alerting sense of hurt. As I slid to a stop, the bike flipped off of me and I felt an explosive pain on the bottom of my foot.

I had barely stopped moving before I was reaching down to take off my boot. The pressure on my foot was more painful than anything I had ever experienced, and I had to get it off. Armored boots arent the easiest things to put on or remove quickly, but I was motivatedwhile one shaky hand fumbled to open my helmet visor so that I could breathe, the other was undoing Velcro flaps and unzipping. At about the same time that I had the boot completely open and was pulling it off, I heard a voice from across the street. A witness to the accident was jumping out of his car to come to me, yelling. I think he was saying, Leave the boot on!

But it was too late. I slipped the boot off with a gasp and was relieved by the release of pressure, but only for a second. Because almost immediately after the pain from the pressure had eased, it was as if the contact between my foot and the air caused a vacuum, sucking a new, more intense pain into my foot. I had traded the pain that my boot was keeping in for the pain that my boot had been keeping out, and it was not a good trade.

I thrusted my head back and gritted my teeth, breathing in sharply while muffling a cry. I closed my eyes and took a moment to gather myself before opening them again and looking down to see what my boot had been hiding. My thick, wool riding sock was red with blood, and what should have looked like a foot from the top looked like a fat, shapeless mass. The sock had somehow torn on the bottom of my foot, which I thought was weird; it was as if something had exploded outward from inside my foot. And indeed something had. As I folded my leg to get a closer look, I saw that sharp, broken fragments of bone were sticking out through the large hole they had torn in the bottom of my foot. The hole was deep, but there was very little blood in the wound itself; instead there was raw meat, bone, and white tendon.

I gingerly set my foot back down and started shaking as the first witness arrived at my side. The street sign above me read ISLAND COURT . I was three blocks from home.

It had started out as such a good day.

Someone called an ambulance. A helpful witnesswho had some medical trainingstayed by my side while we waited. He kept me calm, assuring me that the accident hadnt been my fault. I was relieved, but also still in shock. I wondered out loud whether I would make my Memorial Day plans to cook out at a friends house the next day. My new friend smiled sadly at me. Im sorry, he said, but I dont think youll be doing anything very soon.