Site of dislocation Photo: Scott Willoughby

"You must make a friend of pain. Otherwise it's an enemy to be feared."
- Marlon Brando, Apocalypse Now

There is a very genuine feeling of dread when you simultaneously feel and hear your bone structure altering in class V whitewater. The bones themselves seem to conduct sound, like the keys of a vibraphone, channeling it in real time to the tiny crevasse separating your inner ear from your brain, the one where dread resides.

You reach instinctively for the support of water under your paddle blade, but it is your shoulder blade, or some other vital link of your body's most complex and tenuous joint that fails with a violent and sickening tear. The pain is slow to come, or so it seems in the cold, blinding chaos surrounding you. The dread is instant.

Your paddle, after all, had been positioned with purpose, a brace against raging current. Without it, odds of successfully negotiating the maw are minimal. The river is not done with you.

Trying in vain to pull your hips back under your torso, you lean on the tattered limb until your kayak slams another rock and the pain is no longer worth the luxury of breathing.

Upside down in the swift, shallow river, dread regains its hold over pain. In its disturbingly frank manner, the emotion grips your soul and offers up varying degrees of agony to come. Unsure of your ability to right the boat, much less get out and swim, jagged rocks rattle your skull and gnaw at your battered bones until the only option is concentrating all your remaining strength in the healthy portion of your body. Time is short, but the timing is critical.

With a sadistic push off the paddle, the boat rolls upright, still clanking off boulders as you whimper and shimmy your hips over each potential flip or pinning. You are muttering to yourself now. If God is listening, he has only one good ear.

But wait, you think with the sudden clarity that comes with oxygen. Maybe that wasn't really the sound of your arm being ripped out of its socket. You managed a decent roll, and you're still upright. Maybe it was just a strain, you lie, as you try to will yourself into a micro-eddy before tumbling through the class IV rapids around the bend. Dread and agony unite once more as the sensation of grinding bones leaves you scanning frantically for enough calm water to park a kayak with one arm. There is none. Not yet. Doubt creeps into the mix to create unadulterated fear.

Where is it safe? Across the river? Can I make it? Then what? Can I get out? I don't know if I can do this.

But what choice do you have? For the moment, at least, you are alone. Death is a possibility, not a viable option.

The bank is within reach, but the flowing water remains indifferent. You lunge across your bow for tree limbs, shrubs, roots, anything to slow you against the current without dragging your head back underwater. On the third, fourth, fifth - who knows - attempt you manage to wedge your boat against a rock near the bank and wait for help to come.

The faces of your friends provide modest relief. Soon you will be off this hateful river, climbing the steep bank and dragging your kayak the two miles to the road. They paddle the remainder of the river to your SUV, hopefully without incident, meeting you at the road for the long drive to the emergency room.

"you focus on each shallow breath, searching for salvation in the exhaleÉ"

On dry land, the stinging reality of a lost paddling season vies with the ache of a vice wrenching tighter around your mangled shoulder as muscles seize with every measured step. There comes a point of diminishing returns in your pace. Too fast and the anguish is intensified. Instead, you focus on each shallow breath, searching for salvation in the exhale. The hand below your dislocated shoulder begins to swell and discolor. Fingers tingle as the sense of touch diminishes. I hope they don't try to cut my drytop off of me, you think. These are the most expensive clothes I own.

Finally, perhaps two hours later, you meet the medicine man. Stripped bare, curiosity gets the best of you and you manage a stomach-wrenching glance at the bone visibly dislodged from its joint, protruding beneath the skin several inches from where it was when you dressed that morning. You close your eyes once more, exhaling again as the physician begins to manipulate your skeleton.

Relaxation is labored at this point, but necessary to reconnect the distressed joint, so you shut out the cold stainless steel and blinding lights of the emergency ward, attempting to close your mind to pain and Zen the bones back into place through the doctor's guiding hand. The arm is raised slowly higher, contorted like some medieval torture until your threshold for pain is pushed to a new peak. When winced breathing turns to mere gasps, the doctor asks if you are all right and lowers the arm slightly.

I don't know, you tell him. I'm not sure I can do that again.