When we were kids, snow wasn’t something we dreaded. We longed for it. Winter meant snow skiing, sledding, the kids at the local college building creative snow creations – an entire dormitory once landed on the Wicked Witch of the East, her enormous icy legs protruding from either side of the main doorway – and the off-chance that school would get canceled.
(Snow days were a particularly exciting time at my house, as my father was the superintendent of schools, which meant that I had an all-access, backdoor pass to the wonderful machinations that would eventually result in the announcement on AM radio that we had been granted a weather-related holiday. If my father decided to cancel school, he had to call local radio affiliates and solemnly intone both the school name and the secret code word that would validate the cancellation. So, groggy with sleep, unshaven, and croaking with Early Morning Voice, my dad would utter the magic words: “Michael McGill. Snowflake.” And just like that, no school.)
But step into a prosthesis and your view of winter, snow, sleet, and ice immediately changes. The same elements that you once waited for with anticipation now threaten your well-being. In the absence of an ankle and/or knee joint, putting your prosthetic foot on the ground becomes an exercise in second-to-second awareness.
This past Thursday I traveled to New York City for a business meeting/lunch. I and my compatriots sat next to a huge glass window two stories off the ground overlooking 47th Street between Broadway and 8th Avenue. While it hasn’t snowed yet in this part of the world, it has gotten cold, and it didn’t climb above 28 degrees on Thursday.
As we ate our lunch in the warmth of the restaurant, I pointed out to my peers that I had parked in the garage directly across the street. It features a short but very steep up ramp, so the sidewalk between 47th and the garage is pitched rather significantly. If you wanted to illustrate the benefits that more sophisticated prosthetic feet and knees provide, this environment would be a choice example.
As we watched, garage employees inexplicably turned on a hose and started spraying water down the ramp towards the street. If their intent was to prevent people from parking inside by creating a pile of human debris in front of the entrance, they did a fair job.
Within minutes, the water froze, creating an icy sheen that was difficult to see but that produced dramatic results. A nicely dressed woman walking with her husband went down hard. I flinched as she bounced off the pavement.
The next 10 minutes consisted of me and my fellow lunchmates watching, spellbound, to see what sort of havoc the icewalk would wreak on unsuspecting pedestrians. We quickly learned a few important lessons.
People wearing sneakers and other rubber-soled shoes fared reasonably well. Men in expensive (read: hard-soled) dress shoes and women in heels, on the other hand, slid, skittered, and violently sought to right themselves as their feet suddenly lost traction. (A second observation – people walking while texting, irrespective of shoe type, should have booked a room at the local hospital as a prophylactic measure.)
And while all of this was going on, the following thought occurred to me: “I have to walk up that ramp that they just made into a bobsled run.” I was filled with a feeling of impending dread, because I knew exactly how these poor souls on the street felt. My driveway at home, whenever it snows, warms up during they day and then freezes during the afternoon hours, making it difficult to traverse in an all-wheel-drive vehicle, never mind my hiking boots. And yet, I’ve tried to get the garbage cans from top to bottom in these conditions, usually with poor results.
One of the things I’ve learned from my icy driveway forays is that your world becomes very small when the ground underneath you becomes less reliable. Your eyes seek out safe terrain amidst the ice, snow, and slush. You hop from safe spot to safe spot like Indiana Jones trying to prevent poisonous darts from flying out of the wall if he missteps.
But there’s still nothing like that instant of realization when your foot slides from where it’s supposed to be – underneath you – to empty space while your remaining foot simultaneously goes airborne, unable to keep your body upright. The pain shooting up your elbows and wrists as you barely get your arms in front of you to cushion the impact. The seconds after you hit the ground, doing a personal triage to see what body parts are still working. For every thousand successful steps you take, the one you remember is the one I just described.
Contrast this with my experience two weeks when ago I traveled to Copenhagen, Denmark, for work. As we flew into the airport at dawn over the Danish countryside, it looked like a Christmas card. But when I walked around the city over the next few days, the situation on the ground was quite different. While sidewalks were often clear, there were many areas covered in snow and, in some places, ice. A howling wind and some rapid-walking able-bodied companions didn’t make it any easier. I made it to and from all my destinations without incident, but I missed much of the local architecture and flavor as I focused on the 10 feet of ground directly in front of me at all times, choosing my path carefully and taking smaller, slower steps as the terrain got more slippery, fighting to keep up with my more sure-footed compatriots.
And yet, remarkably, traversing the same ground as I were Danes of all ages and both genders on bicycles. (You know you’re dealing with something different when, driving from the airport at 8 am, you see dads with 3 year-old kids bundled up on the back of their bikes in temperatures south of 20 degrees.) Going through a frigid city with icy roads at high speed on a bike isn’t something I’d do. But these men and women apparently didn’t spend a lot of time debating the sanity of the endeavor, as I easily counted upwards of 75 people cycling their way into Copenhagen on the ride from the airport alone.
So which activity presents a higher risk of injury? People with limb loss/difference walking on snowy or icy roads, or able-bodied individuals cycling over them? If you measured the risk by what each group of people does, you’d undoubtedly conclude the former.
When I was the owner of a prosthetic facility, our schedule had an attrition rate of 70-80% if there was snow on the ground or forecast for the immediate future. Similarly, I’ve seen research data showing how prosthetic wearers’ activity levels change based on the season (winter usually = less activity). On the other hand, our friends from Denmark apparently think little of forgoing the stability of their own feet during winter for two spoke-filled substitutes.
Are we prepared to admit that walking on a prosthesis in bad conditions is riskier than cycling in them? I’m not. But if I may extrapolate from an overly small sample size in the interest of drawing a stunning conclusion, let me offer a hypothesis.
I believe that people with LL/D are preconditioned to see walking as an exercise in disaster avoidance first, and a way of living a full and complete life second. What are the first lessons of gait training? How to walk so that you don’t fall, how to maximize stability. Now, there are perfectly appropriate reasons for that being the case – letting a 75 year-old grandmother topple over 8 times to learn how to walk isn’t an appropriate rehab protocol – but we should be aware of how we’re fundamentally shaped by that initial training.
Consider this: kids learn to walk by falling. And we encourage them to do it. Falling hurts them too. We’ve all seen our share of split chins, fat lips, and enormous bumps on the noggins of our children. But that’s just part of the process at 6-12 months old. Because we expect kids to fall and never stop them from doing it, they learn to walk without fear.
However, we don’t tolerate those risks at age 20 and older with one or more prosthetic legs. We learn that our environment can hurt us, and avoiding pain is a powerful motivator. These initial “avoidance” messages remain ingrained in our consciousness, and we make decisions for the rest of our lives about what’s safe and what’s unsafe as a result. Rarely do you see people with limb loss/difference doing too much during the winter. Rather, we give risk such a wide berth that it stops us in our tracks, keeping us in our homes.
Now consider the able-bodied Danes on their bikes. They live in a society where everyone cycles. A lot. Year round. To the best of my knowledge, they’re not told, “Don’t ride your bike during the winter – it’s dangerous!” (And if they are, they’re not very good listeners.) The fact that so many of them do it suggests that the danger of injury isn’t all that high. And the fact that my reaction to their activity – “These folks are out of their minds!” -says more about me than it does about them.
As winter closes in much of the country – and for those of you in Minnesota, I’m sorry that this is coming about a month too late – think about what you are choosing to do (or not do). Are you avoiding rewarding December-through-March life experiences because the risks are real, or because you just assume they are?
As I thought today about my walks on the wind-swept, icy sidewalks of Copenhagen, I realized that I wouldn’t have ventured outdoors on foot under exactly the same conditions in New York. I chose to walk the streets of Copenhagen – a lovely city, by the way – only because I wanted to get the flavor of a foreign place I had never seen before. Even though the walking conditions weren’t ideal, they were, generally speaking, safe. The bicycling Danes showed me that.
I’m not suggesting that every prosthetic wearer who reads this should immediately rush outside to walk on snow and ice. But winter gives us the opportunity to re-evaluate which barriers in front of us are real, and which we create in our own minds.
For those of you who live in Southern California and other warm climes, you may have some difficulty relating to this. But try and find the equivalent of the icy sidewalk in your world. Maybe it’s a steep hiking trail. Maybe it’s a treadmill. Seeking out the uncomfortable usually tells us more about ourselves than the familiar.