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 SATURDAY, NOVEMBER 21, 2009 4:36 am |
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Local News 
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A new elbow -- or no arm at all After a car accident, years of pain left Becky Fuller with only two choices. ARLINGTON -- Becky Fuller couldn't help but wonder: Should I just get it over with? Should I tell the doctors to amputate my arm?It had been four months since the March 2000 accident near Island Crossing on I-5 ripped the door off her light blue '97 Mustang and left the front of her car squashed under a yellow Peterbilt log truck. The impact crumpled the car's dashboard, steering wheel and steering column, trapping Fuller in the wreckage from her lower chest to her feet. Rescue crews worked with a chain and hydraulic tools to free her. She was flown to Harborview Medical Center in Seattle in critical condition and was in a coma for three weeks. The injuries to the left side of her body ran nearly from her head to her toes: cuts to her face, a fractured pelvis that surgeons pieced together with screws, a fractured lower leg that needed a metal rod to straighten it and fractures to her upper and lower arm. Of all these injuries, it was her elbow that would cause the longest-lasting problems, forever altering her life and launching her on a nine-year journey to recovery. For the three months following her accident, Fuller bounced from Harborview to a nearby rehabilitation center back to the hospital for more surgery. She went to a recovery center in Everett before finally going home. But life would not fall back into its familiar rhythms. Although she was right-handed, Fuller learned how difficult it was to live with only one arm. Her left arm was held at a 90-degree angle with a metal brace to help it heal. "I was not able to dress myself and had to wear these men's XXL shirts just to be sure it slipped over the arm that I could not bend," she said. "I was frustrated not being able to function in a normal way, although that was pretty silly seeing as I had been in such a bad accident. "I realized then that life would never be back to what it was again." With her arm having little practical function, and a near constant source of pain, Fuller silently wondered if it would be better to amputate the limb and get on with her life. Dr. Doug Hanel, an orthopedic surgeon at Harborview, had a less drastic solution: remove the brace and replace her elbow. Hanel performed two surgeries to try to repair the joint using donated or "cadaver" bones, the first in early 2001, the next about two years later. Both eventually failed for the same reason. The bones that form the elbow joint dislocated. "Once it starts to fall apart, it goes very quickly," Hanel said. The day before her third surgery in early November 2006, her left elbow was swollen nearly to the size of a softball. The dislocation caused one bone to sag out of place. Her left arm hung at her side, nearly an abandoned, forgotten part of her life, until a slight movement or the wrong twist of her arm electrified it with a shock of sudden pain. So Fuller was forced to use her right hand and arm for everything, even the simplest of tasks, like pushing her glasses up the bridge of her nose. Fuller had just turned 40, but her life was like that of someone much older. Her one-armed daily routine had her taking the clothes out of the washer piece by piece. She couldn't lift her left arm to put on a blouse. She always slept on her right side. And in public, she always guarded her left elbow, fearful that even an inadvertent tap could set off a cascade of pain. "You can see where the bones are doing goofy things," she said. "It can't be held straight out. There's a big crook in it. It looks like those witches at Halloween time where their arms are bowed out. That's what my arm reminds me of." Out of options Fuller had one final option. It was to replace her elbow joint with an artificial one made of titanium -- the same light, tough material used in 787s -- and cobalt-chromium alloy. Even in an era when knee and hip joint replacements have become commonplace, mechanical elbow joints are still something of a novelty. Some hospitals in the Puget Sound area perform hundreds of knee and hip replacement surgeries each year. Only about 12 patients a year get new metal elbow joints at Harborview. In part that's because arthritis, a common problem, can be better tolerated in the elbow than on hips or knees, Hanel said. When told about the possibility of getting an artificial elbow, Fuller didn't hesitate. "Whatever Hanel says, I say: Go! It can't be worse than it is now." Fuller's surgery began just after 8 a.m. on Nov. 3, 2006. It takes a lot of work to replace a human hinge. A medical team of eight people gently turned her anesthetized body over onto the surgery table, covered her bare feet in booties and propped a pillow between her legs. Orthopedic surgery is inelegant. The sounds of its drilling and hammering have more in common with an auto body shop than the delicate, precise surgical cutting and stitching usually associated with the operating room. The joint Hanel and the surgery team installed into Fuller's arm has two long metal prongs. Using X-rays to double check the alignment, they tapped one of the long supporting posts into the upper arm bone. The actual joint is shaped vaguely like an hourglass with a bearing in its middle. The device's other long, metallic prong was hammered into one of the bones of her lower arm. About two weeks after the surgery, Fuller returned to Harborview for a checkup. It was time for Hanel to examine his handiwork. He asked Fuller to gently bend her arm up toward her face, then to slowly extend it. "That's all I want you to do these next couple of weeks," he said. Hanel handed Fuller a blue ball, slightly smaller than a tennis ball. "Squeeze on it all the time," he said. "That gets those forearm muscles back into shape." A nurse gently unwound the three elastic bandages that enveloped Fuller's left arm, beginning nearly at her fingertips and extending almost to her shoulder. For Fuller, it was like unwrapping an unexpected gift, not knowing what might be under the bright paper and shiny bow. "Look!" she exclaimed. "I have a normal-sized elbow." Back to normal life Fuller's interrupted life, though, would take longer to become normal-sized. In April 2007, nearly six months after the elbow joint replacement surgery, Fuller sat at home, trying to imagine what a life might be like that was no longer in limbo, waiting, like a freight car pushed onto a railroad siding. After her husband, Ron Fuller, an electrician, left for work in the morning, she spent her days on the Internet, looking for careers she might pursue and searching for workplace equipment that could help overcome her disabilities, to make her employable. Before her car accident, she had worked as a loan processor for a mortgage company in Smokey Point. She guessed it would take up to two years to regain the skills and knowledge she would need to apply for a similar job. Since the I-5 accident, the jobs had been few and sporadic because of the problems caused by her injuries. She worked briefly for her brother-in-law doing data entry. A major nerve that steers and controls the hands was severed in the accident. Although it was surgically repaired, the ring and pinkie fingers on her left hand were still numb. "It's a short resume," she said. "It shows that I haven't worked consistently for seven years. It's like, 'What the heck have you been doing?' I don't want to use excuses, but I had no arm." All her previous jobs required typing skills, tough to do when she couldn't feel half her hand. She practiced typing on her home computer. But there were typos and she was slow -- about 25 words a minute. Two months passed. In June 2007, Fuller was back at Harborview for another checkup. She has been a patient of Hanel for so long that her visits include a playful back-and-forth banter with him and his staff. They noticed that the blonde-haired, fair-skinned Fuller looked as if she'd gotten some sun. "I'm a little burnt, actually," she said. "Gotta have some sun before I go back to work." Fuller explained that she had found an opening for a cashier, but one of the requirements was being able to lift 50 pounds. She had previously run the job past Hanel. He reacted firmly: "A big N.O.," Fuller said. He worried about the repetitive motion the job required. "But at least I tried," Fuller said. "That's good. I'll get something, I know." As Hanel examined her left arm, she told him that there had been a change in the little finger on her left hand, the one that since the accident had been "dead," because of nerve damage. "It's tingly all the time," she said. "That's huge, huge!" the usually soft-spoken Hanel responded. "Very good." On the job Fuller's persistence and determination finally paid off. In July 2007, she was hired to oversee inventory and purchasing for Sonitrol Pacific, a security business in Everett. "I'm busy working, but I like it," she said several months after beginning her job. Her husband, Ron, teased her about her duties, saying he likes it, too. "I spend their money; not his," she said. Part of her job is ensuring that all the necessary supplies have been ordered and are ready to go for the company's next job. It didn't take long for coworkers to notice what Fuller could do if given a chance. In March 2008, eight months after she was hired, Fuller was named Employee of the Month. Her photograph is displayed near the building's main entryway. Her desk is in the warehouse, down a short hallway in the building's back corner, surrounded by metal shelves neatly stacked with spools of electronic cable. Now, she reaches for a ringing phone instinctively, without hesitation, fully extending her left arm, while quickly taking notes with her right hand. She no longer protectively cradles her left arm when she sits in a chair, despite the long, zipper-like scar left by the surgery . "I believe the surgery provided me everything I could have hoped for," she said. Fuller can do things she couldn't do before the last surgery, such as eating a sub sandwich with two hands, buttoning a blouse, or as she did one recent evening, lifting a cooking pan with a browned, sizzling steak from the oven for dinner. "I just keep pushing myself, wanting to know why I can't do more," she said. She recently tried Wii bowling. Some nights she slips out to the garage to hit the treadmill, even when Ron wants to just relax at home and enjoy a movie. It's hard for her to sit still. Maybe it's because of all those years when she was forced to stay at home alone, the monotonous expanse of her days broken up with little besides phone calls from Ron or check-in calls from family members. Every day she must balance her inner restlessness against the mandates Hanel laid down during an office visit in May of last year: "No lifting, no pounding, no golfing," he said, "or it will break your implants." Ten pounds -- a little more than the weight of a gallon jug of milk -- is as much as she's allowed to lift and carry with her left arm. Before her accident, she enjoyed golfing with friends. She would like to try it again. She knows she can't use both arms to drive the ball. The torque generated by the swing could shatter the hybrid girders of science and surgery that have restored her left elbow. But she's heard about a one-armed golfers association. Tournaments are held at golf and country clubs throughout the nation. The best players can launch booming drives of 280 yards and stroke long putts across sloping greens with crispness and precision. She's intrigued by the idea of learning the skills of driving and putting as they do, even though it would be nothing like when she was a two-handed golfer. "That golf thing," she said with a spunky smile. "I'm still interested." Sharon Salyer: 425-339-3486, salyer@heraldnet.com. |
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