By Dr R Neerunjun Gopee
As the expression goes, I am living with a taste of my own medicine. As I expected, everybody who was involved in one way or another couldn’t help exclaiming, ‘what an irony, you’re an orthopaedic surgeon and you have got a fracture!’ Yes, I would reply, what an irony.
Later I mused that, well, cardiologists too for example get heart attacks, and so on.
What this proves, most importantly, is that doctors are ordinary human beings subject to the same vulnerabilities and responses when faced with the vicissitudes of life. As long as everything is going on fine we do not think twice about carrying on with our daily routine, and less even about ourselves, especially where are we headed with all this buzz within and around us. But when something untoward happens, especially if it’s injury or disease, then we begin to interrogate ourselves and/or pose rhetorical questions: why did this happen to me? (should it have happened to someone else?); what did I do to deserve this? (that stupid enemy of mine should have got it, and worse!); what will I do now? (follow your doctor’s advice); when will I get back to, uh, work? (when the doctor says it’s ok); how will I cope with the backlog? (sure enough it won’t take care of itself!); who’s gonna get the baguettes in the morning? (such creatures of habit we are!).
Of course there are other questions, but broadly they fall into two groups: the ones having to do with practical matters (e.g. there are alternatives to baguettes; one has to find a way to have a shower with a plaster cast on, and protect it too – and so on), and those that I would call of a philosophical nature. I think it is George Bernard Shaw, the Irish writer, who is credited with observing that we ‘should all get married: if it is successful you will be happy; if it is not then you will become a philosopher.’
I remembered sayings I had read and noted down: adversity introduces man to himself; the test of a truly educated man is what he does in his spare time – amongst others. Am I educated, now that I have time on my hands? Definitely, adversity makes one ‘philosophise,’ but I will spare readers from my wild imaginings during this period of trial, and rather share the more mundane aspects of coping with an unexpected episode.
It was the most silly thing to happen, of course, but what amazed me was the rapidity with which it did, under my very eyes sort of. It was cold, for having snowed, and there was a slight biting wind about. So we were all rushing from the car park to the entrance of the restaurant where we had decided to have a pause café. I think I was looking in the direction of the hill slope covered with immaculately white snow, to my right, at the same time as I lifted my foot to step on to the verandah leading to the entrance, to my left. In this split moment of inadvertence, I put my foot on the edge rather than on the flat surface adjoining: I realized that much later when I was trying to figure out the sequence of events. The next thing I know was quick sharp pain, and then no pain as I heard a rather loud sharp crack, like dry wood snapping. I tried to lift my right foot, only to realize that I had no appui on the left side: ergo, my ankle had twisted, and could not bear any weight.
I slumped into a squatting position, observing myself going down as it were, and saw the ankle ballooning right under my very nose! Looking back later, I recalled how one of the first patients involved in a road accident whom I treated told me how she saw her whole leg assume an S-shape: she did not know, but the bones of the thigh and leg were breaking (fracturing) simultaneously at that moment. Like me, she could only be a mute witness. The difference between what happened to me and to her was that it was her whole family that was being subjected to trauma together with her, her husband and two children in their tender years (NB: they all recovered, and the children, including a third one who came afterwards, are professionals in their own right now, nearly thirty years on).
My friends, who were about to enter the restaurant, looked back and saw me – horror! They rushed to my side, lifted me up, and helped me inside, showering me with care and sympathy. The restaurant owner promptly led us to a sofa, and you bet I sighed as I sat down, and a low stool was brought on which I laid my injured ankle. As my whole body was shaking with tremors, I gazed at the ankle in contemplation: what the hell have you done, I told myself! I had had a sprain of the opposite ankle, the right side, years ago, but instinctively I knew that this was different. First aid was at hand quickly: a pack of ice, arnica gel, and effervescent paracetamol. While this was going on, coffee was ordered, and it was most welcome.
Half an hour later we were back in the car, on the way to the hotel, where we reached about 7 pm when it was already dark. My friend had to support me all the way through the lobby, into the lift and then into my room, where cautiously and awkwardly I lowered myself on to the bed, relieved to be able to stretch the leg out. Gradually I found a less painful position. As my friend left to go to the pharmacy to get some pain killers and stuff for the night, I pondered the obvious question: what next?
Perhaps to comfort, or fool myself, I thought more in terms of a severe sprain rather than a fracture. I even found the courage to joke with my friend when he came back: ‘If you want a big name for what injury I have got, it’s a sprain of the anterior inferior tibio-fibular ligament!’ A mouthful, which made him, and I too, laugh momentarily – for my smile disappeared for the rest of the evening and night as I battled the pain that was by then establishing itself as the dominant mode. It was to peak in the next few days, and I learnt that pain killers could only go so far.
The next day the truth was revealed in an XRay: I had sustained a fracture of my left ankle. I listened to the young orthopaedic surgeon as he, with great respect towards me I must say, proposed his treatment: an operation to fix the fracture with screws, which meant an overnight stay in hospital, followed by a long plaster cast, and on discharge walk with the help of crutches without putting weight on the injured leg for six weeks. Plus a prescription for daily injections during that period, and other medications. It is said that doctors are the worst patients ever, and I was not likely to be the exception. However, the young colleague saved me from the burden of proof. When he had finished, he then added, probably as deference to my age and seniority, ‘but of course, since you are an orthopod yourself, you tell me what you would prefer and I will do that.’
In the British school of Orthopaedics in which I was trained, this type of fracture is never operated. Instead, it is treated ‘conservatively,’ as we say in the jargon. That is, the ankle is immobilized in a plaster cast below knee level, analgesics are ordered, the patient is instructed to walk with crutches keeping the foot off the ground only until such time as the pain does not allow one to bear the weight, and as soon as the pain has reached a tolerable level one is encouraged to start walking on the leg. There is a rationale for this option rather than operation, which is the preference generally on the continent and in North America.
This was not the time for academic discussions, so I simply thanked the colleague for his explanations and proposal, and requested him to have a plaster cast applied. I was due to travel shortly, I told him, and it would be rather difficult for me to cope in the plane with an operated ankle and a long plaster cast. Besides, I was alone, and I was already trying to figure out in my mind how the hell I was going to manage for the daily routine, especially for my toilet and bath rituals, and getting dressed – not to mention packing the suitcase and getting through the other activities essential during travel.
In the end, I did handle the situation by learning some tricks, as I had no choice. I found that I could swing myself on my bum towards the angle of the double bed that was near the bathroom door; this allowed me to walk only a few steps on my normal right leg, and once near the wall of the bathroom I took support against the wall with my right hand as with my left hand I gave a push forward to the injured leg. I used the plastic bag in which the crutches had come to slip over the cast and fastened it at the thigh with tape: nevertheless some water did still seep in at the bottom.
Sure enough, and true to the adage that doctors tend to get the complications, about a week later I developed a nasty infection over the fracture site, and it is taking longer that usual to settle down. Thank me for being an orthopod! I look at my swollen foot and I am tempted to say, damn it! Well, to tell the truth, I have used the expletive a number of times as I get alternately irritated and frustrated at not being able to do my ‘normal’ things. Being forced to slow down is the most unnerving thing that can happen to one – but what can I do, sob sob!
Of one thing I am sure though: if ever the fracture was different and did need to be operated, I would have taken the next flight home and have the surgery done here. But now, let me busy myself with my reading, which is the best way to occupy oneself in such times as I am passing through. Nothing like a bit of self-education…
* Published in print edition on 18 February 2011