I don’t remember the moments before the accident, but I have a very keen memory of what happened just after.
There was the earsplitting crack — probably the most powerful sound I have ever heard — of my helmet hitting the stony, half-frozen mountain bike trail. I saw a yellow starburst and felt a rush of nausea as I rolled onto my back.
Seconds later, my vision came into hyperfocus. I could see the individual wisps of cloud against an electric blue sky. I was even mildly euphoric.
My hospital notes say I was thrown 19 feet.
It was the day after Thanksgiving last year — the beginning of a four-month journey of trauma and recuperation, a seminar in the surprising tricks that brain and body play in responding to calamitous injury, including a broken neck and back. (A year later, I am almost back to normal — flexible enough to do some yoga — though still waiting to get two metal rods removed from my back before returning to biking.)
My brother-in-law, Matt, and I had been biking on the Rimrocks, near Billings, Mont., a vast outcropping of amber sandstone that encircles the northern edges of the city like a mythological fortification. Runners, bikers and dog walkers are naturally drawn to Rims for views that stretch across the Yellowstone River and out over a large plain that was once an inland sea.
I was cycling behind Matt along a single-track trail homeward into a setting sun. The light was dazzling, and I was approaching one of the narrow bridges local bikers had built to whiz over drainage ditches and rocks.
There can be little doubt of the accident’s cause: I did not have enough speed to get over that bridge, which turned out to be steeper than the ones we had crossed earlier. The bike, an older and heavier model than my bike in Belgium, must have stalled at the apex. The front wheel probably rolled over the edge before I could free my feet from clips on the pedals.
On the ground, my first thoughts were not of panic but of irritation and guilt. What did I have to go and do that for? Would I miss my niece’s dance recital? How was I going to get the bike home?
Soon Matt was peering down at me asking me how many fingers he was holding up and where we had been the previous day. I had the answers. But getting them out was a struggle. My chest and lungs felt pressured. My ability to talk could not keep pace with my thinking.
My body was radically reconfiguring — channeling blood to vital organs, releasing hormones to shut down some body parts and wake others to make the best use of energy reserves. Other chemicals were unleashed to blunt my pain receptors as effectively as a powerful opiate.
“Endorphins are just God’s way of letting you go peacefully,” my friend John said at a darkly humorous dinner during my recuperation. I responded that the most interesting thing about endorphins was how they offered around 30 or 40 minutes of pain relief — probably the length of time an injured early human would have needed to escape a saber-toothed tiger.
Dr. Thomas M. Scalea, the physician in chief at the R Adams Cowley Shock Center at the University of Maryland, did not see things that way. “You’re not back in the cave, James,” he told me in an interview later. Still, he added:
“I’m sure that there’s also some overriding psychological, psychiatric, psycho-something component to this. One thing we see pretty commonly is that people get hurt and they hang on just long enough to get to the hospital.
“It’s almost like they say, ‘Well, I’m here, they’ll take care of me, so I don’t have to do it for myself anymore.’ ”
I identified with that. I felt elation at the arrival of the paramedics and at the prospect of painkillers. But by the time I heard one of the paramedics say, “Oh man, I forgot my narcs in the truck,” my pain was already hard to bear.
Another friend, Hugo, had an intriguing explanation for why I had deleted the memory of flying headlong into the ground. “No one needs to see the Grim Reaper twice when they are trying to stay alive,” he said over tea. I liked that idea — that forgetting was another way we help protect ourselves in trauma — so I took it to Dr. Tim Lynch, director of the Dublin Neurological Institute.
Dr. Lynch started with the biology.
“The brain is soft and gooey and sits in liquid,” he said. “When the head gets knocked and the skull moves, the brain can slosh around, accelerate and decelerate, or even ricochet.
“That can shut the brain temporarily so that working memories still spinning around the hippocampus — like the moments before your bike crash — can get lost before they have a chance to get laid down.”
The phenomenon, known as retrograde amnesia, is quite common.
But Dr. Lynch also allowed that part of the story of memory loss in trauma might be an adaptive response in humans — and not just the result of chains of physiological and chemical events.
The sun had started setting and the temperature was growing colder. Matt and two passers-by, Jaye and David, had laid their fleeces on me. Jaye was holding my hand while David was helping to coordinate a helicopter rescue. Later, when I wrote an email thanking Jaye, she responded: “If I ever needed help like you did, I hope someone would do the same for me. Just pay it forward, as they say.”
We would still be nothing without the kindnesses of others. But when Matt offered to put his body against mine for warmth, I reflexively snapped back, demanding he back off.
“Is that rational?” Matt asked at the time.
I mulled that question for months. I figured some kind of ghost brain had scanned my injuries, allowing me to assess with lightning speed how best to protect myself.
I checked that with Dr. Gregory S. McDowell, the surgeon at Ortho Montana who did such a good job of fusing a burst thoracic vertebra. He told me the light pressure from Matt’s body would not have added damage; most injuries that result in paralysis do so as a result of the impact itself rather than what happens afterward. “Stress does not put the injured individual in the best position to make decisions in their best interest always,” Dr. McDowell wrote, oozing understatement.
So perhaps I resisted Matt as a way of asserting a degree of control over the situation, to keep panic at bay? That makes my bad decision almost rational, right?
Finally, I heard the whipping blades of the helicopter. Air nurses gave me injections and rolled me into a collar and onto a hard board. Within minutes, they had deposited me on the roof of a trauma center in Billings. Consciousness, when it came, meant blinking at white ceilings and trying to keep track of the endless parade of faces looming in and out of my peripheral vision.
I had one last burst of lucidity when a medic asked whether I wanted my snazzy Gore-Tex cycling jersey removed without scissors. The question still seems absurd given the extent of my injuries. But it gave me a last opportunity to impose my will before being immobilized in a brace and yoked to bleeping machines.
“Cut the damn thing off,” I said before slipping back into a fog of tranquilizers.