Bruce D. Moore, a longtime Baltimore Symphony Orchestra French horn player, prefers thinking positively, but during some of his down moments this fall, one thought eats at him.

He worries that his 30-year career as a classical musician could be over -- after a fluke accident and a subsequent year that have included extended pain, multiple surgeries, taking meals through straws, endless physical therapy, and medical and dental bills that have topped $75,000 with more coming.

"I don't think it will be over. But I fear that it might and hope that it won't," says Moore, who has been unable to play his horn with anything near his former competence since the debilitating accident last Nov. 11.

Further, Moore, who is 54, said he won't know until at least early next year, once a recently performed bone graft heals, if he will be able to play at a professional level, particularly in the low ranges that are his trademark.

His unusual story began about 7 o'clock on a dark Sunday in late fall. That's when he got run down by a sport-utility vehicle -- his own. It happened on his moderately inclined driveway off a quiet street in Columbia's Phelps Luck neighborhood.

"I'd just pulled in to ask my son something, and then I was going to take off again. But on the way to the house, I realized the car was rolling down the driveway backward, another vehicle was coming, and they were going to collide," he said. "So I tried to jump into the front seat to stop it, but I slipped and then was hit by the open door, which knocked me to the ground. I couldn't even get my hands up. ... I hit chin-first."

Most fracture cases involve no more than two or three bone breaks, says Dr. David C. Bastacky, the Catonsville oral and maxillofacial surgeon who operated on Moore that night. But Moore's case, he says, "was like dropping a vase on the ground -- losing some of the pieces, they were so small -- and then trying to put it all together again so it will hold water."

The multiple fractures were compounded, said Bastacky, who was accompanied in surgery by Dr. Timothy Carrion, by badly torn muscles that operate the mouth. Those muscles attach in many places to the jawbone, and, Bastacky said, "Some had to be reattached to places where they don't always regain full function. ... But he's getting back pretty full ranges of motion."

A challenging case

Moore's case has been both different and especially challenging, the oral surgeon says, "because it's rare to run into people like Bruce who need full motion in their lower jaw to continue working."

David H. Shulman, a Towson physical therapist with a specialty in head and neck trauma who has been working with Moore for months, says that restoring that movement in Moore has been the case of his 23-year career.

"The jaw muscles, despite their size, are the most powerful in the body," explains Shulman, who as a former jazz and classical saxophonist has particular insights into Moore's needs. "To play properly again, he needs to make very subtle, incremental movements" front-to-back, up-and-down and side-to-side with his lower jaw -- skills that were both weakened and altered by the injury and surgery.

"His is a very, very unique case, and it's taken all the skills I've learned through my other cases," says Shulman.

Among many other therapeutic procedures, including electrical stimulation and ultrasound, Shulman gave Moore jaw-strengthening exercises to perform at home with a weighted device that he invented. "But I do believe he will be fine. He's making very good progress."

Except for a recollection of spitting out parts of the six teeth that literally shattered when his upper and lower jaws clanged shut, Moore says, the rest of that evening last November "is all a blur." Mostly, he says, he remembers pain and blood and being helped up and into his house by someone. He's still not sure who, although he thinks it was the passing car's driver, possibly a neighbor.

"I hope I thanked him, but I really can't remember," he said. "I understand now what it means when people who are badly hurt don't know how serious things are."

Through the daze of pain-killers to check "horrible pain" in his face, Moore said he realized about a week later that his left leg was extremely sore, swollen and black and blue. The bone wasn't broken, but when his Toyota SUV stopped short of hitting the other car, one of its tires came to a halt on the back of his leg. He doesn't recall being extricated.

A rushed visit to his longtime dentist, Dr. Eric A. Katkow, became a quick trip, with his son Kenneth driving him across Columbia to Howard County General Hospital and eight hours of surgery on his jaw. About a week later, he had another operation. That one took nearly seven hours.

After the surgeries, his jaw was wired shut for six weeks, requiring a liquid diet. All his remaining teeth were out of place at least temporarily; he's considering orthodontia for his lower front teeth.

Gaps from the missing six teeth, two on the right side, four on the left, he would discover, allowed too much air to escape to form some horn notes precisely; his recent bone graft will hold implants to make his teeth mesh more normally.

Playing too soon

Moore first tried playing again in February; in retrospect, he says, that was too soon, and possibly caused a setback in healing. "I felt like I just couldn't go forever without playing," he said.

In that attempt, he realized that he not only had no strength, but also that his right cheek puffed out while straining to make notes, a la late jazz trumpeter Dizzy Gillespie. But a puffy cheek doesn't create good horn notes, and Moore couldn't make it stop. That meant nerve damage, since corrected.

Part of his lower lip is still numb, also from nerve damage. He's been told that that will go away.

"It really pulverized my jaw," Moore says matter-of-factly about the accident. "I have a metal band holding my left jaw together, there's metal in my chin, and a screw holds the right side of my jaw in place."

Insurance has covered most of his medical and dental bills, Moore said, and BSO management, his employers for 27 years, "has been extremely understanding -- very compassionate. They've called, sent cards -- they couldn't have been nicer, in fact."

"When one of our musicians is in trouble, we try to stand by them," says John Gidwitz, the BSO president. "Bruce's accident was so unusual, but [what] people don't realize is that musicians are athletes, even though they don't play on a field. They use their bodies in a very high-level way, so it can take a lot of time to come back from injury."

Moore has found himself paying unexpected attention to how disability insurance works, he said, hoping it won't be needed.

"I don't know how to do anything else but play the horn," he said.

He continues what he's always done on the side, teaching the instrument; he has four students now. "Two of them play better than I can right now," he said.

The accident cost him a trip to Japan with the orchestra this fall, although he has been there before. His job has taken him not only around the United States over the years but also to Europe several times, to Korea, Taiwan and the former Soviet Union.

But since the accident, Moore said, he has not been to a BSO performance, or even a rehearsal.

"Somehow I just think I wouldn't feel right, going to my orchestra and not being able to play. I mean, that's what I do."