Was It Broken or Just a Bad Sprain?
Lesson #2: If you must have an emergency, choose Saturday afternoon.
The hospital is less than one year old with all the bells and whistles you would expect from a 4-Star hotel – clean, colorfully appointed, generous seating areas, Peets coffee, and even (note to self} valet parking. Steve pulled into the emergency department lot that had mostly spaces reserved for labor and delivery patients. All full. We double-parked and Steve went for a wheel chair. Security met us through the double doors. “Any knives?” Fortunately I wasn’t feeling snarky, and no, I didn’t have any knives – only a melting baggie of ice.
The lobby was thankfully all but empty, with only one patient ahead of me. Sharon called us to triage and fitted me with an ID bracelet. 4:10 PM. Blood pressure 140/85, pulse 68. She asked what happened. “I fell off of a ladder while I was pruning a tree”. She didn’t seem surprised and proceeded with what she called a mandatory question. “Are you concerned for your safety at home?” She said that 30% of older adults suffer abuse of some kind or another.
Sharon pushed her finger gently on my foot. “Does this hurt?” “No.” “What about this?” “No” I closed my eyes thinking maybe if I concentrated, I could help her find the pain. “Maybe you’re not pushing hard enough?” “No, I think your foot is frozen from the ice.” I showed her where I felt most of the pain, reaching down and tracing along the instep near my heel. “Well, let’s get you to X-ray and then to a room”.
Magically, Shavonne appeared to whisk me away, Steve in tow. He’s fond of machinery and there was plenty to see on the way to X-ray. The double doors opened to a sparking cavern bigger than our living room with a table situated like an alter in the center of the room. Shavonne called out. No technician. “I’ll see if I can find him.” Steve walked the room admiring the pulleys and cables. Sebastian appeared. 4:20.
Sebastian wheeled me to the table and pushing a button, lowered the table to match the wheelchair’s height. “You can slide over and lay your head here” motioning to the top of the table. He adjusted my foot and skillfully placed the camera to capture three views: foot flat, foot rotated inward and foot rotated outward. “OK, done. I’ll wheel you to Room 6.”
Back through the double doors, into the high-security bowels of the Emergency Department, rooms surrounding the hub of action – the nursing station. Machinery beeped and buzzed and Sebastian parked me into Room 6 with an orange and green linoleum floor. Trendy. The wall mural of a treasure map caught my eye as a good distraction for patients of all ages. “Did you notice that the names of all of the people we’ve met start with an ‘S’?” Steve asked. I was trying to remember the name of the triage nurse. We sat.
In strode the doctor, hand extended “I’m sorry to keep you waiting.” It didn’t seem that long to me – although there was only cold water left in the baggie. “Let me wash my hands and take a look, then we’ll look at the X-rays together.” All right, down to business. 4:50 PM. He was able to extract more pain from my foot then the triage nurse – testing the motion of the ankle and pressing in a variety of suspect locations. Then, satisfied that he could explain what he felt, we turned to the flat screen TV.
There was my left foot. He zoomed in on the shadowy images of each bone, carefully scrolling over them, explaining what he saw. I nodded, looking hard to see what he saw among the fifty shades of gray. Then he zoomed in on AP view. There on a pebble-like metatarsal, he showed me a splint. “This is an avulsion fracture”. There is a tendon attached to that location – one of the points of pain he found – and the twisting force of the fall pulled the tendon and its foothold on the bone.
I visualized the fall again. I recalled the rolling motion of my foot –landing on the left, taking the force of my weight times velocity (wish I understood that) and the poor little tendon did it’s best for the team – stretching it’s little heart out and taking a boney prisoner along.
“I would like to put you in a splint until you see a podiatrist to confirm the findings.” And then he was off. I wanted to talk more about my bones. They fascinated me. There were so many working in tandem. I’d seen skeletons before and X-ray images, but this was my foot. I could relate to it. I wanted to understand the overlap of the 5th tarsal with the metatarsal. What was that knobby thing on the first tarsal? Moments later he was back. “Can you come in on Monday?” Trying to recall my meetings and what I would have to reschedule, I said of course. Steve, of course, was key. And he said “of course”.
The efficiency of the next step was impressive. A nurse and technician in training appeared with a bucket and gauze to splint my foot. “Please lie on the bed face down.” Humm? That seems weird. As I lay on my stomach with my left foot bent in the air behind me, the discharge nurse came in, showed me the instructions, including the picture of the podiatrist I would see on Monday, and collected my signature. The splint conformed to my calf and bottom of my foot, held in place with an ample wrapping of ace bandages. Done. Snap. “No, you can’t walk on it.” Sigh, crutches. “No, you can’t get it wet.” Sigh, no shower.
“Take small steps” they said as I swung my way out of Room 6 to the cashier. “$150.” Yikes. Maybe I shouldn’t have switched to the ACA plan.
“Would you like a wheel chair?” Yes, please. 5:10 PM.
Kathleen Cody, Executive Director, loves advocacy and education, and believes prevention is the key to a long healthy life. She sorts through the latest scientific and research data for information that can help people make good decisions about their bone health and is focused on providing easy to use and understandable tools and resources for the public. Kathleen is a Tarheel at heart from the University of North Carolina, Chapel Hill and an honors graduate of the University of San Francisco’s MBA program.