How Lack of Focus in Training Landed Me in the ER

I walked up to the counter and signed in at the surgeon's office. My hand, still bandaged tight from the night before, was able to scrawl out a signature on the HIPAA privacy act notification. The secretary took that, with my insurance card and ID, and handed me some paperwork. "Fill this out and then bring the clipboard back to me," she said, rather absentmindedly. I looked over the form for a moment. "Ma'am?" I said as she made her way back to her other duties. She turned around. "This form says 'For Breast Reduction patients only'." She looked at it a moment and squinted. "Huh, I guess that's probably the wrong one?" she said without humor in her voice, and handed me the correct new patient form. I made my way to a seat next to my mother, and had her get started on the paperwork.

I'm getting ahead of myself here. Let's back up a few years.

My new katana had just come in the mail. A "beater", it was plain but had a good edge and decent fittings. The saya didn't fit 100% right and the koshirae were very plain, but it was a great sword for the price. As I took it out, my wife looked at it apprehensively.

"What's wrong with the sword you have?" she asked.

"This is actual steel, not an aluminum-zinc alloy," I said. "It's heavier, it's stronger, and it has an edge, which means I have to remain focused while I work kata."

"But it's a live blade," she said, still staring at it. "What if you hurt yourself?" I shrugged.

"There's risks in everything," I said. "But all the instructors have used live blades for a decade with no problems. So long as I stay focused, and keep good form, there's really no danger."

Fast forward a year. I was at lunch with my head instructor. We were discussing some of the new students and I voiced my concern that they were allowed to use shinken in their iai training. "It's all I've ever used," he said. "Me, the other instructors, you-- we all use them, and we've never had a bad injury."

"Sure," I agreed. "But we have enough respect for the weapon and enough focus that I'm not worried about us. At the least," I said, "we need a decent medkit for if something DOES happen." He agreed and we purchased a trauma kit. Aside from some very minor injuries, it's gone unused.

By now, you can probably see where this is going. If this essay were a jigsaw puzzle, I'd have filled in all the edges so you could see what it was supposed to be-- a picture of an injury. Unfortunately, I was too close to one side to see what I was looking at, and wouldn't get a chance to zoom out to what the inevitable picture in the middle was in until last night.

I showed up at Katori, admittedly, in a bit of a funk. There was nothing in particular that was wrong-- in fact, I had just hit a personal record with a 5k run that day. I was firing on all cylinders, but had a bit of a fog about me as I walked into the dojo. This is not necessarily abnormal; in fact, clearing my head is one of the reasons why I enjoy training so much. I bowed in with my shinken (a much nicer blade with custom koshirae and saya, designed and built by a fellow Katorika). I began working my iaijutsu. I did the same kata I had done thousands of times, and felt strong and focused. Everything was fine.

Until it wasn't.

I knew immediately that something was wrong-- not that I could have hidden it. I looked down where my left hand had apparently slid forward off of the scabbard and saw the blood flowing. I put my sword down and ran toward the bathroom. "I cut myself," I said brusquely. My father, who trains with me, asked if I needed anything. "No," I said. "I think I'm okay."

As I got to the bathroom sink (a BIG surprise to those who had gotten to class late and were still changing), I realized I was, to quote Marsellus Wallace from Pulp Fiction, "Pretty fuckin' far from okay." The cut was deep. Blood flowed freely from my wide-open palm. I saw white bits that I thought were bone. I would learn later that this was my tendon, cut cleanly in half. "I'm going to need to go to the hospital," I said meekly to no one in particular. I continued to hold pressure. The thought that I had nearly lost my thumb began to creep into my head.

Despite this, I did manage to keep my wits-- something for which I would be praised by the ER staff shortly. I'm a critical care nurse by trade, and I'm proud to report that even when I was my own patient, I remained professional. I kept hard compression on the wound, kept it elevated, and continued working the diaphragmatic breathing I learned all those years ago in Aikido (see? I told you Aikido had benefits!). "Gauze," I called out. Our dojo medkit, that I had chosen and helped to stock, appeared. An ABD pad was thrust into my hand-- I hate ABD pads (generally preferring 4x4s), but any port in a storm. "No ambulance," I said. I had worked at the hospital nearest the dojo long enough to know I did not want to wind up there for any reason. After a few minutes, I released pressure. The bleeding had stopped, meaning I had missed any major arteries. This is a good sign for anyone looking to keep all of their body parts. I grabbed 4x4 gauze just as the adrenaline dump hit me.

"I'm okay, but I need to lay down a minute," I said, walking out of the bathroom. To be clear, I did not know if I was okay. I felt unconsciousness creeping in, so keeping my wound elevated I laid down, trying to keep perfusion to my brain. Don't pass out, I thought. Keep focused. Keep going. Keep alive and keep pressure on your wound. After a minute or so, it passed. I checked the cut again. The bleeding was still minimal. "Okay," I said, standing under my own power. "Let's get to the hospital." I walked back into the main room of the dojo. A senior student was cleaning blood off my blade (real life chiburi!), and two more were putting hydrogen peroxide on the mat. A wide eyed visitor took in the scene. "This kind of thing doesn't normally happen," I said. "I hope you decide to come back." Always the salesman.

As the adrenaline wore off, the pain was getting worse, but I couldn't stop laughing as I sat in the waiting room. Here I was, in tennis shoes and a gi and hakama that were spattered with blood, in an ER. It was ridiculous, and I felt ridiculous.

Would you believe me if I told you this was BEFORE the morphine?
I always tell my patients in the ICU that it's a good thing to be boring. "I like interesting people and boring patients," I'd say. "If you're interesting, that's almost never a good thing for you." So I had some trepidation when the ER doc, nurse, and resident came in and the doc proclaimed "Wow, this is really interesting." They remarked on the nature on my injury, and congratulated me on staying conscious and triaging and treating the wound as I did. They offered me morphine, which I declined, telling them I'd save it for when it was time to close the skin. They cleaned the wound, took a picture of my hand (devoid of any identifiers, of course) and showed me the inside of my hand, the snapped tendon included. While waiting for the hand surgeon to arrive, I tried to change out of my gi and hakama, but only got halfway-- the tapered sleeves on the shirt I had worn into class were not cooperating with my stiff dressing and unbending thumb. I was now in a gi top and jeans. My situation had not improved. I made a joke about this to the medical staff. They did not laugh. I looked over at my dad.

"Well," I said with a sigh. "They say the first thing to go when you have massive blood loss is your sense of comic timing." They laughed at that one. "Heeeeey," I chuckled. "I still got it."




The hand surgeon arrived shortly thereafter, did an exam, and said that while I wouldn't need emergency surgery (yay!) I would definitely need tendon repair surgery if I ever wanted to bend my thumb again (boo!). She told me that I'd be receiving a call from her attending physician's office in the morning. Sixteen stitches and 2mg of morphine later, I was on my way home to my very worried wife and mother.

Post Morphine and Stitches

 Here's a picture one day out, with stitches. It's slightly less gross.

The next day I found myself in that surgeon's office, where he laid it out for me. I had cut the flexor tendon in my thumb as well as two of the nerves. With surgery and three months of rehab, I'd likely regain all function of my thumb, though regaining all sensation was much less likely. It would be a win if I regained enough sensation to determine if "something is hot or sharp". I told him I now feel much more comfortable discerning when things on my hand are sharp. He put me in a splint (making the typing of this article remarkably difficult!) and said his office would be calling me soon to set up surgery for next week. I nodded, already feeling sorry for myself, and headed home.

Ready for my career as a hitchhiker


It's now two days out from my injury, and it's still a lot to process. It crept into my head quickly that this would definitely keep me from competing next month, which is devastating. I've really gotten hooked on BJJ, and having a definite goal toward which to train has catalyzed a lot of good in my life-- since September I've lost almost 20 pounds as I committed myself, as fully as I could, to competitive training. I was in the best shape I've been in since I boxed competitively over a dozen years ago. I know that there's no good time to get injured, but with a baby on the way in April and plenty to do until then, this was really not a great time for it.

Above all, the worst thought that keeps creeping into my head is the knowledge that this whole thing is my own fault. I didn't have to use a shinken-- I chose to. I didn't have to go to Katori that night-- I chose to. I didn't have to lose focus, letting my mind drift for just long enough to change the course of my life for the next few months--

I chose to.

A few weeks ago, I wrote an article about how, with one momentary lapse in my focus and intensity, I allowed myself to lose what was otherwise a winning roll in BJJ. I think of this in the same way. The Japanese term zanshin comes to mind. Literally translated, it means "Continuing Mind", and it's the art of learning how to remain focused, even when it seems there is no danger or that the danger has passed. This lesson never ends, and it never will. Unfortunately, some lessons are more painful than others.

It's been difficult not to feel sorry for myself over the past few days. All of my short term goals-- to compete at the Atlanta Open, to paint my daughter's nursery, to lose that last five pounds-- have gone up in smoke. The knowledge that this setback was solely my fault does not help matters, but, as always, we must try to see the positives in any situation. I am expected to make a mostly full recovery. I still have all my fingers, and my friends and family have rallied around me, offering help with everything from helping me around the house after surgery to things like painting said nursery. While I won't be able to train until at least April, I can still write (and intend to, if only to stave off insanity). Once the splint comes off I can do some limited cardio again.

Ernest Hemingway once wrote "The world breaks everyone and afterward many are strong at the broken places. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry." 

The world did not kill me (it is in no special hurry), but I am currently a little bit broken. Over the next few months, I will have to continue my mental training to ensure I never have such a lapse in focus again, and my physical training to ensure that this setback does not become a complete reset on all the progress I've made in BJJ and all the weight I've lost as a result of my training.

However, there is some comfort in knowing that even if I do backslide and regain all the weight I've lost, I know a good place to get a breast reduction.

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