Chad Hill was looking forward to opening his new shop, Marlie's Garage. The opening was scheduled July 8 - just one week away. He had no way of knowing that on a warm June night his dream of opening an auto repair shop might be crushed.
Hill was working in his new shop on James Street a little after 10 p.m. on June 30. He was downloading some software, and while he waited, he decided to take a spin around the parking lot on his all-terrain vehicle. He revved up the cart and took off. But in the dark, Hill didn't see the hole that would change his life.
In hindsight, Hill said he should have kept his hands on the wheel, inside the cage. But he put his right arm out to brace himself.
Sara Zorn, occupational therapist, left, and Nancy Freybler, wound care nurse, examine the recovering injury on Chad Hill’s arm. Hill sustained the injury in an ATV accident last June. Following three surgeries and a skin graft, Hill has regained substantial mobility and fine motor control in his arm and hand.
"I didn't know any better, it was just a natural instinct," he said.
The cage of the ATV came down on top of his arm.
"I thought I had broken my arm," he said. When his friends and son were able to upright the four-wheeler, he climbed out and started walking to the shop.
"But then I noticed that I had some issues," Hill said. Blood was dripping from a cut and he could feel the road rash from the gravel.
His wife, Brooke, rushed him to Van Diest Medical Center about 10:40 p.m. The emergency room personnel started to clean up the wound. He had a good-sized gash on his arm. From the pain, Hill was sure he had broken a bone in his arm.
"I told them I must have broken it, so they x-rayed it," he said. But there was no break.
"They told me I might need some plastic surgery on the gash," he said. "So they made an appointment the following Friday with Dr. (Kyle) Ver Steeg (II)."
He was bandaged up and sent home. Early the next morning, he got a call from the hospital staff, telling him that Ver Steeg was stopping by and wanted to see him.
"I came in and met with him at 10:30. He didn't think the gash underneath my arm needed plastic surgery, just needed to be sewn up," Hill said.
Hill said then the doctor noticed a bruise on his forearm.
"He asked me to move my wrist and I said I wasn't going to move it for him or anybody, that's how bad it hurt," he said. The physician looked at the x-rays from the night before and also checked for a pulse, Hill explained.
"I hardly had one in my wrist," he said.
That's when the doctor told him his wounds were much more serious than just road rash. He was in danger of losing the arm.
The doctor explained to Hill that he had compartment syndrome - a limb and life-threatening condition that can occur after an injury when there is insufficient blood supply to muscles and nerves due to increased pressure within the compartment - his arm.
Hill would need immediate surgery to repair the damage and to save his arm.
"The doctor told me if he didn't get the blood flowing through my arm one of two things would happen," he said. "I was either going to lose the arm or I'd get a clot and die from that."
Just 12 hours after his accident, Hill was being prepped for surgery - the first of several to save the arm. His second surgery was the next day to clean out the wound with antibiotics. The third surgery came two days later to repair the two muscles crushed in the accident and to repair the back of his arm.
Wound care nurse Nancy Freybler said after that surgery, wound vac therapy commenced.
Freybler said the wound vac applies pressure, drawing up all of the granulating tissue, to fill in the wound bed and to aid healing.
"It helps with drainage and it's supposed to help with pain," she said. In Hill's case, Freybler said the vac was right up against muscle and nerve, which resulted in tremendous pain. In fact, Hill had to be sedated several times to remove the vac for dressing changes.
Freybler said they were able to find an alternate dressing which helped reduce the pain, and even eliminated the need for sedation on the last few dressing changes.
Ten days after the surgery to repair the muscles, they discontinued the wound vac therapy and began to get ready for a skin graft. On July 19, three thin strips of skin tissue were removed from Hill's thigh and were prepared to cover the open wound.
"We put the skin through a machine that stretches it, puts little holes in it and then we lay it on top of the affected area," Freybler said. "It looks like a piece of netting."
Hill admitted he's always been a bit squeamish when it comes to cuts, blood and wounds. His wife warned him not to look at the wound.
"She didn't think I could handle it," he said. Neither did his nurses.
But just before the skin graft, he did look at the enormous open wound on his forearm.
"'I've got to see it,'" Hill told Freybler. He looked over as they removed the last dressing before the graft. The wound was roughly the size of a flattened football.
On July 31, Hill started occupational therapy at VDMC. His therapist, Sara Zorn, helped him begin to regain use of his arm. They worked on range of motion and functional activities, including picking up coins and turning a door knob. In the beginning, he wasn't able to make a fist or grip. Then what seemed impossible, slowly began to improve over the weeks of therapy.
"Without the therapy, he wouldn't be gripping and able to squeeze your hand," Freybler said.
He knew rebuilding his the fine motor skill movements would be necessary if he wanted to work in his shop. So he practiced by picking up bolts and small tools to build up his dexterity.
"I kept pushing myself and pushing myself," he said. Freybler, Zorn and Hill agreed that his positive, cooperative attitude helped with his recovery.
His hard work payed off. He was able to open his shop on Aug. 19, just six weeks after his accident.
Freybler said Hill's case was a very complex. Many rural hospitals would have sent him on to a university facility.
"The outcome could have been very different," she said. "We had a great team effort here. From the night he came into the emergency room until now, without the knowledgeable people here, he probably would have been sent somewhere else."
Hill said the accident changed his perspective about many things. He said that when he learned of the neck injury Webster City wrestler Brandon Jessen sustained recently, he reached out to the teen via social media. He shared his story with the Jessen and offered him some words of encouragement.
"I'd never met the guy, but I wanted him to know I hoped he would get better," Hill said.
Hill said he's looking forward to riding his motorcycle this summer. That's something he wasn't sure he'd ever be able to do with his injured arm. Now he's ready, he said, but added he'll definitely be wearing a helmet.
"I'm looking a things a little differently now, looking at how fragile life is," he said.
And there's a big "For Sale" sign on the four-wheeler.