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Monday, February 13, 2006
By HOWARD BUCK, Columbian staff writer
Robert Holcomb sits glumly inside the Southwest Washington Medical Center, frustrated and worried.
A hydrotherapy technician is flushing warm water through tender flesh on his right heel, where a festering ulcer has burrowed perilously close to penetrating his already shattered bones.
It's March, eight weeks since Holcomb, 46, suffered serious injury in a freak traffic crash on Interstate 5. A speeding car on the freeway's opposite side hurtled through a cable safety barrier and plowed almost head-on into his large pickup.
The blow caused a compound fracture of bones in Holcomb's right heel and crushed dozens of bones and joints in the left, requiring three surgeries and confining him to a wheelchair. As he braces for tough months of physical therapy ahead, his health, his flooring-installation business and his Woodland home all hang in jeopardy.
His was easily Clark County's most spectacular wreck on that Friday in January. But it was just one of 388 injury accidents that Washington State Patrol troopers will respond to in the county during 2005. Hundreds of other local victims will wage similar battles to recover from those incidents.
Holcomb can do little but wait and stew until the ulcer is banished. He's making 50-mile round trips three times a week to the Vancouver hospital for the water treatments. Each Tuesday and Thursday, his wife, Patricia, changes his dressing and rubs a special gel into the surface wounds.
His primary surgeon, Dr. Jay Crary, blames the troublesome complication on the initial trauma and constant pressure on the heel while it's propped up in the wheelchair, the sofa, or in bed. If the ulcer were to reach bone, the entire right foot could potentially face amputation.
But Holcomb's tenuous recovery rests in sure hands.
Crary and Dr. Scott Woll, who repaired the cracked bones in the right foot, have teamed for seven years at Rebound Orthopedics and Rebound Neurosurgery, based at the hospital. Each performs as many as 350 surgeries per year, tending to a continuous supply of foot-and-ankle cases. Only about eight specialists in Vancouver-Portland focus on these delicate repairs.
Crary says the injury to Holcomb's left foot is among the worst he will see this year. The whole midfoot is crushed. There's little sign of the bone structure that normally holds it together, he tells Holcomb.
The initial prognosis was "devastating," Holcomb says.
Increasingly, Crary and his peers grapple with similar, difficult injuries. Better highway and vehicle safety features, such as air bags, have reduced highway fatality rates in recent years. Yet surgeons today are treating more complex wounds suffered by people who in years past died quickly of head or chest injuries ---- akin to modern-day battlefield surgeons' tougher challenges. And ever more accident victims are treading an arduous path to recovery.
Aside from the nagging ulcer, which will take days more to shake, both feet now are apparently healing well. But chronic pain will dog Holcomb, his doctor warns him. He will struggle to walk on uneven surfaces.
"He's never going to have normal feet again," Crary says matter-of-factly.
A new reality is starting to weigh on Robert and Patricia. With his future earnings in doubt, it's growing less likely they can preserve the rural life they treasure. After the 1976 Ridgefield High graduate married his longtime Woodland girlfriend, they lived briefly in Vancouver while he worked for a Portland dairy and drove a truck. Within a year, they bought the Woodland property.
"We're just not city people. We never were," he says.
They have open sky and quiet nights, a place where his grandkids can "go out and ride their bikes without me knowing where they are every second," Holcomb notes. It's a place very much like the peaceful Sara area south of Ridgefield where he grew up, roaming the woods and fields with his brother and a friend.
"We'd walk miles and miles. We'd walk all over that countryside," he says.
* * * * *
On a bright day in late April, Holcomb is eager to push himself, breaking free from four tedious months of inactivity.
Whatever mobility he'll regain for life rests with his physical therapist's plan and his own discipline and drive the next 12 weeks. After that, his healing bones, tendons, cartilage and scar tissue will set into place and become much less pliant. As financial doubts swirl around him and Patricia, his focus centers on getting back to walking, back to his flooring career, back to supporting his family.
Shuffling stiffly, leaning heavily on a cane, he enters the heart of Southwest Washington Medical Center's own Rebound Rehabilitation clinic. It features a full workout gym with wide windows and mirrors, and patients of all ages gritting and grinding under close watch of coaxing therapists.
There are accident victims, stroke survivors, tentative new owners of artificial joints and teen athletes bouncing back from surgery, a cross section of Clark County.
Holcomb's feet are still puffy and sore, but tolerably so. More important, as physical therapist John Majerus finds when he pinches, flexes and measures them from every angle, they already display an impressive range of motion. A healthy adult has about 30 percent flexibility in his or her feet. Majerus sees most rehab patients arrive with next to zero range, lucky to eventually regain 10 percent to 12 percent. Holcomb is already nearly to that point.
The reason? Crary's ability, Majerus says. "I see every person in town come in (for rehab)," he tells Holcomb. "I can tell the difference."
Holcomb will build on that advantage, sticking to a Monday-Wednesday-Friday rehabilitation regimen. Majerus sets up a carefully charted program Holcomb pursues with sweat and diligence: leg presses; lifts and squats; walking the treadmill; pedaling his bike forward, then backward. To improve his balance, coping with the stiff feet, he tosses a rubber ball against a rebound net, then plays catch again while crouching on a wobbly plastic platform. There are more sliding and lunging exercises.
While some friends have tried to warn how painful therapy can be, Holcomb is undeterred. Jokingly calling Majerus his personal "hellmaster," he shrugs off the dull foot pain, relishing the healthy fatigue and normal muscle aches he feels afterward. "I'm a glutton for punishment," he says, mopping his sweat with a towel.
In truth, Majerus' patients don't suffer, if they're exercising properly. Slow, steady gains marked by rising weights, repetitions and range make a "textbook" recovery, he says. Quickly, he sees enough in Holcomb to believe the man will exceed even his own high expectations. "Some people you've got to prod along. Not him; I have to rein him in."
As their initial all-out session winds down, Majerus brings out a long plastic mat, which he lays on the floor in the gym's corner. Holcomb, a county champion bowler four years ago, takes his first awkward attempts to replicate his step-and-slide bowling motion. There will be many more tries to come. The two settle on Holcomb's pastime as the ultimate goal of their long hours together.
All the while, Crary remains cautious, cryptic. He notes the progress, but continues to remind Holcomb his future limitations will be many. Choosing to believe otherwise, his patient drives harder.
"All you have to do to motivate me is say, I can't," Holcomb explains.
* * * * *
Patricia grabs a soda from the fridge while Robert rests on the green sofa in their cramped new family room. On the television, 1970s bowling stars flash their plaid-slacks form on the ESPN Classic network. Out the back window, the sides of neighboring houses rise over a tiny, square green lawn hemmed in by wooden fencing.
A $975 monthly rental in the heart of Woodland's fast-growing east side is now home for the couple, their daughter, son-in-law and Austin.
In the end, the Holcombs have downsized their lives in order to stay afloat. Unable to work, Robert's $50,000 per year income dwindled to nearly nothing. After 25 years on Woodland's roomy flatlands, they've abandoned their spacious home, with its wide yard and a tall conifer hedge that kept their scattered neighbors out of view.
The couple reluctantly put their home on the market. Almost immediately they got a good offer from a Michigan couple and departed on an emotional moving day in July. Scoring several thousand dollars to help dig out from under debt was an obvious move, yet it feels like a hollow victory. "We both had the same heartbreak over it. The last thing we ever wanted to do is leave there," Holcomb says.
Now they're perched on a crowded subdivision street. Holcomb's tall, white Ford work van parked out front is the lone feature to distinguish theirs from dozens of look-alike houses.
"I don't know what kind of a neighbor I'll be. I've never had to be a neighbor," he says.
So far, folks have been friendly. Grandson Austin has made new playmates. But the boy and four adults now share little more than 1,100 square feet. That's less than half the space at their former residence, a triple-wide manufactured home Robert and Patricia purchased in 1997 to replace the single-wide where they raised their three sons.
Robert Holcomb's splintered life is slowly coming together but has been permanently transformed.
He sits idle on this weekday morning. He's working again, but sporadically. His injuries limit the weights he can carry and the length of time he can tolerate on his feet or his knees. Shopping with Patricia, he often stops to sit and rest. He won't hunt deer with Jeff on the steep Klickitat County slopes this autumn as they usually do. His feet can't handle the terrain.
Holcomb has not replaced his totaled pickup. Whether driving the van or just riding, he still flinches when there's some abrupt movement on the freeway. Sensations of the wreck, of rending metal and the exploding air bag, haunt him. "Sometimes, I still hear that noise. I know I'll never forget that noise," he says.
On the positive side, Holcomb hasn't had a cigarette since the accident. Crary made it clear immediately that smoking would jeopardize the healing of his feet, so he gave up his Winston Lights without hesitation. The cravings still surface, though.
Crary consistently warns it will take two full years for bones, muscle and tendons in the crushed left foot to fully heal. Holcomb is barely one year down that road. Crary is still holding off on removing the remaining steel screws. He is thinking of fusing some of the bones together for keeps.
Still, the surgeon is pleased with his patient's strong comeback, which has bested his suggested time frame.
"He's returned to some semblance of a normal life. He's done very well, considering the injury he's had," Crary says. He gives Holcomb full credit for capitalizing on his chance, "his determination to make it work, to move on with what he has."
Now 47, Holcomb does seem largely at peace with the sternest test life has tossed him. A proud, self-sufficient man, he's had to solicit help from friends and strangers. His family has been a rock, underscoring his belief in what really matters, he says. He's been humbled being lifted into and out of beds, wheelchair vans, automobiles and the toilet. The self-described "perfectionist" realizes letting go is the only way to push forward.
"One thing I've learned through all this is, it's gonna happen the way it's gonna happen," he says.
Of the couple's new station in life, he simply says, "We've come out of it OK."
There is some solace that the young Vancouver driver who hit him pleaded guilty to felony vehicular assault in Clark County Superior Court. Rogelio Camerena, now 21, receives a 90-day jail sentence and is ordered to pay $23,352 restitution to offset medical expenses covered by the state. There is also hope that a lawsuit Holcomb filed against his insurance company will pry loose a larger settlement.
Patricia refuses to abide any self-pity, he adds. Nor does he suffer an internal "Why me?" debate. WSP detectives told him after the crash that behind his truck was a small sedan carrying three young women. Had his big Dodge not taken the impact, the women would've taken a direct hit. Instead, they were not injured.
* * * * *
Wednesday night inside Allen's Crosley Lanes in Vancouver: 42 lanes of bowling bliss. A thunder of rolling balls, the crashing of pins, a murmur of voices punctuated by hoots and cheers.
Serene amidst the familiar din, Holcomb leans over to pull his custom blue-and-plum ball from the return rack. He cuts an imposing figure in the noisy crowd, the more so with his shaved head and neatly chiseled goatee. But he's just one cog in his Sew & Stuff winter league team, the foursome wearing matching mint-green polo shirts. Once again he's just one of the guys, at last.
A year removed from his last season, Holcomb is back on his game, leading the squad's charge in this match. He hasn't yet regained his normal average of nearly 200, but he's creeping higher. Tonight, the stroke is there. After an off game, he carries the group this time with a confident string of strikes and spare pick-ups that adds up to an impressive 225.
Holcomb's form is more technique than muscle. With a barely noticeable hitch in his five-step approach ---- his right foot sometimes splaying on his follow-through ---- he bends and smoothly sends the ball shooting down the lane. The spinning, 16-pound missile tracks perfectly, executing a gentle right-to-left hook that ends with a crackling collision between the 1 and 3 pins.
What follows is a textbook display of mass and speed and vectors, summoned by muscle memory honed by years of competitive repetition. Each ivory-colored pin reacts perfectly, a calamitous wave sweeping all 10 off their thick bases.
This time, physics and violence work in Holcomb's favor. Everything's in the right place at the right time.
Strike.
Quickly the pins are mechanically lifted, righted and restored to their neat order: standing tall again, awaiting the next challenge.
Howard Buck can be reached at 360-759-8015 or via e-mail at howard.buck@columbian.com.
How we reported this story: After Robert Holcomb's truck was struck by an uninsured motorist Jan. 14, 2005, The Columbian reported the story on its Clark County cover with the headline "Crash snarls evening commute." But the collision, one of several hundred injury accidents during 2005, had far-reaching consequences for Holcomb and his family. With Holcomb's permission, reporter Howard Buck and photographer Steven Lane followed his first year of recovery.
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