Seth was 20 years old when he dislocated his shoulder for the first time...

I can remember the moments before my dislocated shoulder like it was yesterday. I was playing rugby for a college team during the fall season. It was a typical blustery day, the sun was moving in and out of the clouds, and the field was a bit wet and springy after an early morning rain. We had a good side that year and we were on a bit of a roll, having won our last three games. I loved the game of rugby at that point in my life. I had never been seriously injured, and I suppose that I thought that I was never going to be. Maybe it's all in my imagination, but I remember just before I was tackled this odd feeling like something just wasn't right. Maybe it was the position of my body, or the way that I was running, because I don't really remember the exact mechanics of how it all happened, but somehow I was tackled and everything went completely quiet. I couldn't feel anything but I could hear the blood rushing in my ears and I could feel this searing pain in my right shoulder. I can honestly say that I had never felt anything quite like it before.

The word "dislocation" has a completely different meaning to me now that I have felt what it is like to have your shoulder pulled out of joint.

Before I was injured, "dislocation" had an abstract quality, but afterwards, I could associate a real feeling with it. A feeling that something was truly wrong with your body, like your arm had almost been pulled out of your chest. I lay on the ground, gasping for breath. I couldn't lay still because the shoulder pain was so terrible, but every time I moved, it just made it worse. A trainer from the other team came out and examined me. I felt his fingers push around the muscles of my shoulder, and he tried to move my arm, but I was holding onto it as tightly as I good with my good arm, clutching it to my chest. There wasn't any way that I was going to let someone move my arm, and I think he managed to figure out that I had either had a broken my arm or a dislocated shoulder. Somehow, with a lot of help, I managed to stand up. My arm felt like a dead weight. I could move my fingers and feel with my hand, but I felt like the entire limb just wasn't a part of me anymore. I sat down on the sidelines. Every time I took a breath it nearly brought tears to my eyes. I knew that I needed help, someone had to put my shoulder back into the joint, but first I had to get to the parking lot and have someone drive me to the hospital. There were plenty of offers, and maybe it was just the confusion created by the fact that the game had started again, and that time had slowed down for me, but I felt like I sat there forever before my roommate gently helped me standup and walk to the car. I have never had to count steps like that before. The numbers kept repeating themselves over and over it in my head, 1…2…3…4, up to ten, and then I would start over again. Somehow I managed to get to the car and fall into the passenger seat. I couldn't close the door because my right arm just wouldn't work, and I didn't seem to be able to reach across my body to pull it shut. My roommate shut the door, and I'm sure that he didn't mean to, but it banged into me as it closed, and I swear that I must have said some terrible things in a fog of shoulder pain.

I got to the emergency room, and of course I didn't have my wallet with me. It seemed so obvious to me that something was wrong, that I was sure that the moment I walked in the door I was going to be whisked away and all of my pain would be relieved. Instead I sat there talking to a nurse who was trying to have me fill out a form. I'm right handed, and I could sort of scribble on the form with my right hand, but I didn't have any idea what my insurance number was, or who my carrier was for that matter. I finally said the only thing that managed to come to my mind, "Blue-Cross, Blue-Shield". I'd seen enough ads on television to know that it seemed like a perfectly good answer, like it was some sort of a guarantee that someone would do something for me. Well, maybe she just took pity on me, but at some point I was taken to room inside the emergency room and told to lay down on a stretcher. A nurse came in the room and started an IV in my left hand. Strangely enough, that was almost the worst part of the entire experience, because for the first time I had to let go of my right arm, and now it felt like it was just going to fall off. Every time I took a breath I could feel this grinding in my right shoulder and the muscles of my shoulder would go into a terrible spasm.

The IV was started and I waited. I remember looking at the clock and it was at least forty-five minutes. Finally, after what truly did seem like an eternity, a nurse came in a gave me shot of morphine in the IV. For the first time in my life, I fully related to the Rolling Stones saying, "sister morphine, turn my nightmares into dreams". I was able to take a deep breath and I gradually felt the shoulder pain ebbing away. They took me to the x-ray room and took a couple of pictures of my shoulder. For one particular view they had to move my elbow away from my body. I was terrified that it was going to send me into uncontrolled spasms, but the technician was very gentle and it wasn't terribly uncomfortable. When they finished, they pushed me back to the ER and I waited for the doctor.

After a while he came in. I could tell he was in a rush, but I wasn't exactly looking for a psychiatrist either. I wanted him to fix my dislocated shoulder and just send me on my way. After asking me to do a couple of things with my finger and thumb, he slipped a bed sheet around my chest and pulled it up into my right armpit. The nurse flattened the bed out and gave me another shot of morphine and something that they called "Versed", which they said was a muscle relaxant. I closed my eyes and tried to pretend that I was lying on a beach, because I was feeling very warm, flushed, and sleepy with the medications that they had given me. When they started pulling on my arm, it was like having someone trying to wake you up when you are so tired that you can barely open your eyes. I knew that they were moving my shoulder, and it did have a dull throb that was getting worse the harder he pulled on it, but eventually I felt, and I swore that I also heard, a "clunk" as my shoulder slipped back into joint. The pain didn't go away, but I sure felt better afterwards.

Eventually I felt, and I swore that I also heard, a "clunk" as my shoulder slipped back into joint.

They let the medications wear off, gave me a sling, had me sign a bunch of papers, and I left the ER with my roommate. He said that I had been there for four hours, but after it was all over, it seemed like a lot less. I had a prescription for pain medications, and they gave me four to go home with. I took two the first night, and the next morning I felt so groggy and fully of cobwebs that I didn't take the last two, and I never filled the prescription. They had given me the name of an orthopedic surgeon who was on call for that ER, but I never made an appointment to see him. Maybe it all went in one ear and out the other, but I certainly don't remember being told that my shoulder was likely to dislocate again. I went to see the trainer at school after about a week and he gave me a bit more information. He said that I had to strengthen the muscles around the shoulder in order to prevent it from slipping out again, and also avoid certain activities that would put my shoulder at risk.

I started by doing something called pendulum exercises, where I took arm out of the sling, bent forward, and gradually made little circles with my hand. After about a week or two of that, the trainer gave me some rubber tubing that I tied to the doorknob in my dorm room, and I started doing the exercises that he showed me. My shoulder was sure sore, but it felt more like a deep bruise in the muscle than anything else. I could feel that my shoulder still moved easily, but if I got it too far away from my body, I would feel really nervous that it would dislocate again. I continued following the trainer's advice. After about six weeks, I started using weights again. When I looked in the mirror while lifting weights, I could tell that a lot of the muscles around my shoulder had shrunk and the entire arm seemed much smaller. Spring came and went. I didn't play and rugby for the rest of the spring semester, and while I was pretty diligent about doing the exercises and getting into the gym four or five days a week, by the time that finals came around I had let the program slip. My shoulder felt fine. It was strong, and I was back to doing nearly everything that I wanted to do again.

I flipped my boat over, tried to roll back, and somehow, in the currents and the push of the water, pulled my shoulder out of the socket again.

During the summer break I went home and worked as a landscaper again. I love the feeling of sunburn shoulders, and feeling strong again after spending the year in classes. My friends and I do a lot of whitewater kayaking during the summer, and it's the perfect way to escape the heat. I've been around the water all of my life, and its something that I've always been comfortable with, and I never gave it a second thought the first time I loaded my kayak on top of the car. The spring run off had kept the rivers running pretty strong and we were playing in a stretch of water that has a lot of strong hydraulics and some good surfing waves. I'd rolled a couple of times early in the morning and my shoulder felt fine, in fact I never really noticed it at all. It happened the way it usually does when you are whitewater kayaking, I flipped my boat over, tried to roll back, and somehow, in the currents and the push of the water, dislocated my shoulder again.

The shoulder pain was unbearable and I was terrified that I was going to drown because I couldn't pull my spray skirt free and get out of the boat. Using my left hand, while my right arm was flailing around, I eventually managed to get out of the boat and swim to shore. I lay on the bank, gasping like a fish out of water - struggling to get my breath back and breath through the pain at the same time. Luckily, the road was nearby and my friends managed to help me back to the car. We went to a hospital near where I live, and after a similar four-hour visit to the emergency room, I went home again in a sling.

This time I kept the number of the orthopedic surgeon that the ER doctor gave me. I went to see him the next week. He examined my shoulder, and compared the amount of looseness from side to side. While I was lying on the examining table, he stretched my arm back over my head and I was shocked by how queasy it made me feel, as if my shoulder was starting to slip out of joint. He explained that this is called the "apprehension sign", and he said that it was evidence that I had an unstable shoulder. He explained several things about my shoulder that I hadn't understood before - that there was certainly a risk of my shoulder coming out of the socket again. Especially now that it had happened twice, I was almost guaranteed to have it happen again, unless I gave up nearly all of the sports that I played. I couldn't imagine a life without sports, so I was pretty interested in hearing about the surgery part.

My mother came back with me for a preoperative appointment, she said that she just wanted to meet him before he operated on me, but I liked him and I knew she would too. We talked about the procedure - something he called a "Bankhart repair". He explained that he would start with a shoulder arthroscopy in order to determine what was wrong inside the joint. Then, depending upon what he found, he would either be able to fix it through the scope, or he would have to make a larger incision. I had x-rays taken the first time I was in the office, and he told me that I wouldn't need an MRI because the arthroscopy would give him more information, and we had already decided that I needed a more stable shoulder than I had currently. I had a date for surgery three weeks later. I caught a bit of a cold, and they postponed it for another two weeks.

By the time the date came around, my shoulder was feeling good again and I was starting to have doubts about whether or not I really needed to have an operation. However, all I had to do was reach back over my head and that feeling of queasiness would convince me otherwise. I had surgery at an outpatient surgery center. The day of surgery was a bit of a blur, but I remember being unbelievably thirsty the morning of surgery. All I could think about as I lay there, waiting for them to come and get me, was how good a glass of water would taste. I had changed into a gown, and I was feeling like I was the only guy in a speedo swimsuit in a room of fully dressed people. A nurse started an IV in the back of my hand, an anesthesiologist came in a said a few words that made it sound like I was headed for the moon and unlikely to come back. I personally found it hard to relax right after he told me that the risks of anesthesia included death, but a shot of something that the gave me certainly took the edge off. I was wheeled into the OR on a gurney where it was absolutely freezing cold. I lay there shivering under the thin blankets, and the anesthesiologist told me to count up to ten. I think that I got to three. When I woke up, I was in the recovery room. A nurse was asking me to tell her how bad my pain was on a scale of one to ten, but my mind was stuck on the problem of counting to ten, so I said the last number that came to mind, "three".

I drifted in and out of sleep, but my shoulder certainly wasn't bothering me much. The whole thing felt pretty numb, and it was strapped into this giant sling with a pad that supported it away from my chest. The surgeon came to see me before I went home and told me that he had fixed everything with the scope. There seemed to be a lot of technical points that he wanted me to understand. I think that I had told him I was a biology major in college, but the whole thing was really confusing. My mother seemed to have a better grasp of it all, and they talked for a while. My dad came to the hospital after work, and they took me home at the end of the day. I went home, struggled to get upstairs, took two pain pills, and fell asleep. At two o'clock in the morning, I woke up feeling like my shoulder was literally on fire. I couldn't believe how painful it was. I always thought that I was a bit of wimp when it came to pain, and I certainly whimpered a bit that night as I lay there. Luckily, my mother had left the pain pills on the dresser next to me and I took another two, had a swallow of water, and drifted back to sleep over the next couple of hours.

The first week after surgery was really boring. I watched a lot of TV. Some of my friends came and visited me, but it was hard to see them coming back from the river, kayaks on top of the car, sunburnt and happy. I looked in the mirror and I looked terrible - pale, unshaven, and haggard. I went back to see the surgeon a week after my surgery. I had taken my dressing off three days earlier. Underneath there were some neatly applied little tapes that were covering up three small incisions in my shoulder. He examined my shoulder pretty briefly, glanced it over really, gave me a pat on the back, and sent me down the hallway to the physical therapy department.

I almost laughed when I tried to use my right arm, because it felt so weak.

I had this image in my mind that physical therapy would be like a Rocky movie. Everyday I would get stronger and I could see myself hitting a punching bag as a trainer shouted at me. Unfortunately, it wasn't anything like that. For the first week, I didn't do anything but more pendulum exercises and have the therapist move the joint around a bit. I was glad that I had someone to keep track of my progress, because I found it hard to tell that my motion or strength was improving at first. I guess the first time I felt like I was eventually going to get better was when they gave me a set of rubber bands. I went home and tied them to the workbench in the garage. I almost laughed when I tried to use my right arm, because it felt so weak. Everyday I did the exercises and wrote down the number that I did, the time of the day, and how I felt during the session in the little booklet that they gave me. Once a week I went back to therapy and they taught me a few new exercises and gave me pat on the back again. I went back to see the surgeon 6 weeks after surgery. He seemed pleased that I wasn't taking any more pain pills and he looked over the sheet that the physical therapist had given me to take to the office.

I went back to school in the fall. The trainer and I started working on a program to build the strength back in my shoulder, but it wasn't until October that I started to feel halfway back to normal. I started going to practice with the Rugby team again in November, and just being back on the field again made me feel like I had accomplished a lot. Maybe it's a combination of being a little bit busier in school, but I haven't made my mind up yet if I am going to play during the spring season. We'll just have to see.

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