Santa Barbara lies on a rare portion of the California coast that runs east-west rather than north-south. This geographical feature allows daylong sunshine to warm a backdrop of hills which nestle the town. Offshore, a string of islands define the large cove, giving the entire area a feel that, while quintessentially Californian, is also a gentler Mediterranean climate than most of the state.
It is a place wealthy executives go to retire, and for movie stars not living around the corner in Malibu, a short drive to escape Los Angeles. Just up the road was Ronald Reagan’s ranch, and over the hill was Michael Jackson’s Neverland.
Santa Barbara is also unusual in that it is a place where multi-million-dollar mansions happen to overlook oil drilling rigs just off the coast. The local beaches have occasional globs of sticky tar; an entirely natural seepage that the Native Americans used to seal their canoes. For better or worse, in 1969 the third largest oil spill in the history of the United States occurred in just this spot. You can imagine the residents of Santa Barbara did not take their beach despoilment lightly. The first Earth Day and a fresh environmental movement started the following year.
By random chance, I ended up temporarily in Santa Barbara in 1994. I had been traveling the country with my partner, who had signed on with a traveling nurse company. While she had a guaranteed apartment and position at the local hospital, I looked for odd jobs. I found a position downtown with a medical laboratory, sorting specimens on the evening shift. In such a beautiful location with lovely weather, it was only natural that I ride my bicycle to work, both for exercise and to soak up the atmosphere of Santa Barbara.
The most direct route to work was along U.S. Route 101, a very busy freeway. Although a bicycle path was separated from the road by a concrete barricade and chain-link cage, the freeway noise was disconcerting. That route also involved another stretch of road with lots traffic and businesses with car park entrances - a great hazard of being hit by cars swerving into or out of the entrances to the busy road. Exploring, I found another route that crossed the freeway and ran along the edge of Hope Ranch, a coastal development with its own golf course, homes on large lots, and its own beach.
Since I worked the evening shift, I rode home in the dark, around midnight. The Hope Ranch neighborhood, in order to enjoy the starry nights, save money, and also being a very safe place, did not have street lights. The ride home was always quiet, pleasantly relaxing. At one spot I discovered, by their hooting, owls nesting in a tree. My most hair-raising encounter was a night when there was a skunk on the the bike trail that ran alongside a creek. I had come up on it so suddenly that it was running along very close to my front wheel. The skunk and I were equally frightened. I was afraid if I slowed down, the skunk might have enough pause to gather its wits and spray me; if I sped up, it could possibly turn and bite my ankle. After a few tense moments with the skunk’s tail waving madly as a stink-bomb warning, it dashed off the side of the path and I rolled by, thankfully remaining skunk-scent free.
It was on another night an accident occurred that would affect my life for years. The night of the accident started off like any other, with one exception; there was a beautiful full moon. Although I had lights for my bicycle, the moon was so bright that I turned them off to save batteries. There was a large hill on the road along Hope Ranch, and I was enjoying the warm breeze as I gained speed down it. Probably up to about 30 kph, I passed into the moonshadow of a tree. In the dark shadow, my peripheral vision noticed a piece of firewood in the bike lane. I swerved, and believe I missed it with my front tire, but something caught.
In the next moment, I was standing on my feet in the street looking for my bicycle. I spotted my bicycle about six metres away. As I started towards my bicycle, I suddenly felt woozy, as if I would pass out if I didn’t lie down. So I laid down on the sidewalk. The sidewalk was cold, hard, and as I lie there feeling woozy and sick, I tried to move my arm, but it only jiggled slightly; there was something very wrong.
The nearest house was about 100 metres away, but I was feeling too sick to stand up again. Fortunately, I had a whistle, and remembered the distress signal - three long, three short, repeat. These were the days when cell phones were the size of bricks, and only in cars or golf carts. Finally, a couple of guys came out of the house and down the hill towards me. My first request, call an ambulance. Then, thinking about not having any health insurance, “Wait - Call my girlfriend.”
My partner arrived slightly before or about the same time as the ambulance (my memories are a bit vague). As I thought about sliding into the bucket seats of her low car, I realized it would be awfully painful on my shoulder, and might do more damage. I reluctantly went with the ambulance, knowing it would be a very expensive ride the short distance to the hospital. I think I was placed on a board and in a neck brace, in case there were spinal injuries, but I can’t really remember - what I do recall is that it seemed like an incredibly long, painful ride considering how close we were to the hospital.
Because I was in shock and cold from lying on the sidewalk, the nurse had trouble placing an intravenous line. My shoulder was in horrible, dull, aching pain, and after being needled several times for the IV, the sheriff walks in. She started interrogating me as if I had broken into a house or something. “What were you doing in this neighborhood on a bicycle at midnight??” She seemed unconvinced by my answers.
It turns out I had fractured my shoulder blade, a difficult and impressive feat. When I later examined my bicycle, the top of the frame was bent. Seemingly, it could only have been bent that way by hitting the pavement from the top. Apparently, the bicycle and I had flipped completely upside down from the forward momentum, where we parted ways. I continued the somersault, landing back up on my feet. My surgeon speculates that I hit the top edge of my scapula on the pavement so hard that the force split off the side and cracked it across the middle. The muscles could no longer pull properly on the bone, which is why when I tried to move my arm, it only quivered. Fortunately, I was wearing a helmet, and my shoulder took most of the force rather than my brain. One of my hips was also banged, and although it was quite a bruise, it was minor in comparison.
I left the emergency room with a bottle of pain pills and my arm immobilized by being taped to my body. I was to wait a few days for the swelling to subside, then consult a physician for the next step.
A few days later, my partner and I visited an orthopaedic surgeon’s office. He described an elaborate repair operation. Coming in, we had told the office that I didn’t have insurance, and would be paying cash. When the physician finished his description of the elaborate repair process, we asked how much it would cost, since we (or realistically, my partner) would be paying cash. The doctor stopped. “Oh. If you don’t have insurance, I wouldn’t do it.” The treatment in that case would be to keep my arm in a sling until the bones healed and locked into their new position, giving me about a 20% loss of range of motion (meaning I wouldn’t be able to swivel my arm out to the side, nor lift it over my head).
“We’ll pay you cash?”
“No, I won’t do it.” We suspect it wasn’t just the matter of payment, it was also the fear of a lawsuit, in case anything went wrong with the surgery. Patients without insurance covering the bills would be more likely to sue to get out of paying the bill. Such is the state of medicine in the United States.
Informing my employer that I wouldn’t be able to work, I was greeted with wondrous news. I had worked long enough to get health care coverage, but hadn’t applied, since my partner was in a temporary position and we were planning to move in a few weeks. The laboratory was going to provide insurance, even though I hadn’t filled out the paperwork. I attribute this to some wonderful people rather than corporate policy - it was likely I would not be returning to work after I healed, since we would be moving to my partner’s next assignment.
I signed up for the least expensive policy, an HMO (Health Maintenance Organization). This type of plan is generally known more for bureaucracy and low cost than top-notch care, but their tight management allows many people who wouldn’t otherwise be able to afford coverage to have it. I visited their orthopedic surgeon, thinking he’d probably opt to keep my arm in a sling, like the previous doctor.
Dr. Jeffrey Holman was a young doctor. He enjoyed rock climbing in the hills around Santa Barbara, and had gone to work for the HMO so that he could get lots of experience - a high volume of patients - before settling into a quieter and more lucrative private practice. My shoulder was a challenge he couldn’t pass up.
The surgery involved disconnecting the muscle from the bone, repairing the bone with three screws and a metal plate, reconnecting the muscle and inserting metal pins above, to be removed once the bone healed sufficiently. It was an extraordinary piece of work, with the goal of restoring full mobility. Full mobility though, would take a year of physical therapy on pain medication; first to pull apart the layers of tissue that adhered together from being immobilized while the bone healed. Then, the muscles that had been cut had to be built up and retrained. Raising one’s arms above one’s head involves a complicated coordination of muscles - first the muscles hold the shoulder blade in place, then when a certain angle is reached, those muscles release as others complete the motion.
I was leery of being on pain medication for such an extended time, but the physical therapy office assured me it was necessary. Otherwise, the required exercises to pull the adhered tissues apart would be too painful to perform properly. For me, being incapacitated was a strong motivator for doing the exercises in a bid to return to normal. Slowly, over the course of months I was able to lift my bad arm, using a pulley and my good arm. Since I wouldn’t be able to help load our belongings in our cars to get to my partner’s next assignment, they allowed her to extend until I was in better shape. After nine months, my shoulder still made popping noises when I moved it, but it was strong enough to help load the cars (minus one bent bicycle) and travel to my partner’s next assignment (and continued physical therapy for me, under the existing insurance coverage). I had stopped the pain medications cold turkey, though from later surgeries, I learned the best way is to taper off gradually. The shoulder surgery was so extensive that when Dr. Holman was getting his board certification, the panel pulled this case to be discussed. Dr. Holman told the panel that the patient needed full recovery and use of his arm.
In our next location, the San Francisco Bay Area, I bought a used mountain bike from a friend who lived in the area. I had vowed to get back on a bike after I healed, but I couldn’t fully enjoy racing down a hill anymore. I used that mountain bike to commute for a couple of years, but the handlebar position put pressure on my wrists and shoulder, and irritated my shoulder a bit. I had heard about recumbent bicycles because a school I had attended entered into human powered vehicle contests. Bicycle speed records had been set on faired recumbents, but I was interested more in the comfortable riding position.
In the San Francisco Bay Area, I worked a series of low-paying jobs, and it took ten years to get into a position that matched the high cost of living. At that point, I finally started investigating recumbent bicycles, and had enough money to buy a new one.
Unlike traditional bikes, most recumbent bikes are still made in small shops at small volume - which makes them more expensive. Since they use the large leg muscles more efficiently than traditional frame bikes, they are not allowed in traditional bike races. The most popular competitions involving recumbent bikes use faired (aerodynamically enclosed) bikes, and they are also used to set human-powered speed records.
Recumbent bikes are seen as bizarre or highly specialized machines - word of their comfort hasn’t reached the average person on the street. The cost of one-off production can be daunting (though less than a carbon-fiber traditional racer). There are two and three-wheel models, though in cycling, weight is everything, and it’s easier to make two wheels lighter than three. Even without fairing, recumbents are more aerodynamic, which is most obvious in a headwind.
I’ve reinvigorated my joy of speeding down hills - where the recumbent also has an aerodynamic advantage. The big question is always “what about uphill?” Recumbents usually carry a broad gearing range. But a more surprising feature is how much power can be generated by the large leg muscles - the rider now has a seat back to brace and push against. Riding recumbent uses a slightly different set of muscles than a traditional bike, and this is more obvious going up hills. The manufacturer of my bike claims it’s just as fast as a traditional bike going uphill. I’m a lazy rider - I go slower than most even on flat ground, so it’s hard for me to validate any notion of going fast up hills. But I do know I was able to get up the steepest hills of San Francisco (after getting in shape!).
People also question the visibility of recumbents in traffic. Many of the lower three-wheel recumbent riders use flags when riding in traffic. My recumbent sits a bit higher, with my line of sight about the same height as a car’s rear-view mirror. Of course, due to their relative rarity, people are always surprised to see a recumbent. I’ve had no more problem being seen in traffic than I did on a standard bike. The other big safety factor of a recumbent bicycle is the lower center of gravity and having your legs, feet, and a chainring out front instead of your head. If there is an accident, you are not going over the handlebars to land on your head and shoulders.
Although it is difficult to find a shop that sells recumbents, there are manufacturers in Australia and several other countries. Many traditional shops can order a recumbent, though I went directly to a manufacturer who happens to be just up the coast from Santa Barbara.
About the author: James Lamb is from the midwestern United States. He met an Australian who convinced him to get married and move to Sydney. He is still looking for work here.
