Showing posts with label emergency room fracture management. Show all posts

Fracture Timeline - It's The Way Hours Crawl

By | Published Monday, October 17, 2011

"Snap, crack, pop" those sounds are the catalyst for split-second assessments, instinctual decisions, and tears that fall somewhere between wailing and shrieking. Sometimes, unfortunately, these motions are routine. Here is one routine of the many -
(The below actually happened, the times of course are roughly estimated).

  • 10:18:27AM - A rubber ball in a game of four square bounces off my arm the wrong way in P.E. class in the 5th grade. 
  • 10:18:33AM - I am gripping my forearm; I look at my teacher and in those 6 seconds I try with every millimeter of my wide eyes to send her the message that "something bad happened."
  • 10:19:04AM - I've been ushered out of class and someone has run to get the school nurse. I wait in the hallway with my aide. My tongue is bleeding because I bit it; still, I am trying to hold the screams in. I'm not far enough away from my classmates.     
  • 10:22:14AM - Running down the hall is the school nurse with a bag of my slings, splints, and other bandages. She tries to do an assessment, I don't let her touch me, and pull my arm closer towards my body. Whimpering for my mother.
  • 10:24:08AM - My mother has been contacted. I am now sitting in the nurses office. The burn of the fresh fracture has somewhat subsided. I continue to grip tightly and hold still, I found the place and position where it doesn't hurt and by god I'm going to keep it there for as long as possible. I've begun to sweat through my clothes. 
  • 10:40:12AM - My mother arrives at the school, she has a sling. I tell her that it hurts too badly for me to go back to class this time. I tell her that I know it's two fractures in my upper arm. She knows how much I love school, I would never willingly miss time with my friends; she understands that this time it's serious - she calls Dr. Shapiro from the nurse's office.
  • 10:50:02AM - Dr. Shapiro will see me in the cast room once we get there. We just page him once we arrive, it's business as usual.
  • 10:52:15AM - With great care and coaxing my mom has transferred me from my wheelchair and into the car. My arm is jostled slightly from the transfer and that's when I let the screams out. 
  • 11:48:32AM - We arrive at Children's Hospital in Boston and race to the second floor. The cast technician recognizes me, but instead of a cheery hello his face quickly frowns when he sees that I am hunched over my arm, my face twisted in discomfort. He knows the deal, Dr. Shapiro is paged. 
  • 11:49:18AM - Dr. Shapiro has been paged and now the waiting begins. I am 10 years old but I know that we will be waiting for at least an hour or more. Dr. Shapiro is also the attending orthopedic surgeon; of course, today is his operating day and he is in surgery. I slip into a quick nap, my body growing cold in places because I refuse to move. I try to get some rest before the dreaded part comes, the x-ray.
  • 3:36:12PM - He strolls slowly down the hallway, everyone knows Dr. Shapiro is notoriously slow and unbelievably friendly. I see his bowed head looking downwards at the floor, his posture belies his reputation as 'hot-shot surgeon & O.I. expert.' Always in a dark suit and jacket, never in a hurry - the sight of him fills me with relief. We may have waited over 2 hours but he is always worth it, he always makes things better, most importantly -- he's the only one we trust. 
  • 3:46:17PM - First question from the doctor is always "where does it hurt?" He then places his fingers around the sore area, the first person aside from myself to touch the injury. Every time he does this I remember in Kindergarten how I thought his fingers were actually spider legs with x-ray vision at their tips. He never hurts me, and when he does his face winces in advance so I know that the discomfort is coming; to this day I have no idea how he knows! He scribbles out directions for the x-ray order form, telling me aloud everything he writes so that by the time I am in 7th grade we both know that I could probably fill out the form myself.
  • 3:50:12PM - My mom and I are waiting in the waiting room of radiology. It is only down the hall and no matter how many times I've been in this room there is always something new to distract me from the pain. The faces of children all around the world smile down at me from the ceiling in bright primary colors; there are actual x-rays of stuffed animals, robots, dinosaurs, and clown faces on the walls; the t.v. is always on; coloring books litter the tables. My mom settles in next to me after she has called home to make sure my older brother is home from school, she has updated him on what happened to me. He is my older brother and knows how to take care of himself my mom tells me, he is used to this too.  
  • 4:07:09PM - A radiologist finally calls my name, she looks at the form Dr. Shapiro had filled out and I plead with her silently to pay attention to the part that says "O.I. type III, fragile." She tells me we are just going to take a few pictures, I know the deal and zone her out. As we go down the hall to the x-ray room my heart is racing, I begin to sweat again. 
  • 4:08:12PM - My mother suits up and puts on an apron, she carries me onto the table and lays me down on my back. Already I am beginning to get uncomfortable. This is the first time all day that I was in this position with my broken arm, I had not yet found the 'comfort' position for laying down. As the radiologist asks me to put my arm down along my side the tears begin. My mom has to hold my arm down for me, and hold my other arm away from it. I squirm and cry through the entire process, it seems like I lay there for a year on that metal table.   
  • 4:20:03PM - Finally the pictures are done and I fold my arm back inwards. But now my bones are all riled up, confused and broken, they are uncertain of where to go to get comfortable again. I glare at the radiologist on the way out, she had done this to my arm. Stupid. Moron. Idiot. We go out to the waiting room and wait for her to give us the pictures to present to Dr. Shapiro.
  • 4:37:19PM - Finally the pictures arrive in a large red folder that covers my entire body. It is heavy. (This was sometime in the 90's so digital x-rays had not yet existed). We make our way back to the cast room, I hope that Dr. Shapiro would be waiting for us there, I wish with all my might that he hadn't gone back to the operating room. But of course that never happens. We will have to wait for him to come back. 
  • 5:03:21PM - Dr. Shapiro flicks on the light table and snaps the x-ray on top. He confirms what I had already known that morning, there were two cracks in my humerus, it was time for a cast. He put on his apron and Odie the cast guy got the fiber glass ready. "Dark blue" I say, "just like always" and that is the first time in the whole day I thought about something other than the fractures in my arm.  

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911 Fractures

By | Published Tuesday, July 26, 2011

Andrew, my younger brother, would later tell me my mother thought he was annoying me yet again when she heard my screams. “But I wasn’t doing anything. I was just sitting on the kitchen floor flipping through the dictionary – you know the yellow one? I was looking at all the pictures.”
Meanwhile in my bedroom I was face down on the floor with a pool of blood around my head, my wheelchair tipped forward onto me, and both of my legs had snapped in half. The events of this incident are choppy in my memory, like some mind-twist of a horror film the scenes cut in and out of my mind. When I really think about it I remember the fall (I can see it happening to myself): the front wheels of my wheelchair had hit something and I was lurched forward, still seat belted in, but by the time I had hit the floor my wheelchair was at a forward tilt two feet behind where I was sprawled. I screamed. I don’t remember who I was screaming for or what I screamed, but I made the loudest noise I could possibly muster; it wasn’t from the pain of my two broken legs, at that moment the pain hadn’t even registered to me yet, I screamed because I was totally freaked out by the endless amounts of blood that poured out of me. There was so much of it!

The next thing I remember my mother had rushed in my room and made a sickening groaning noise. Up until that point I had never had a fracture that involved THAT much blood (when my rod migrated and protruded from my skin there was just a little trickle); what happened after my mother came in are now just a blur. Suddenly I was on a pillow on her lap and my older brother had called 911. I could hear him just outside my room giving the emergency dispatcher the information “my sister she has Osteogenesis imperfecta, and she just fell from her wheelchair. There is a lot of blood everywhere…it’s a brittle bones disease.” Next I remember he was shouting at my mother “Mom! Mom! They said don’t move her spine or her neck, it might be broken!” But at that point I had recovered a bit from the impact of the fall. The pain from my fractured legs had begun to settle in, all I knew was that some part of my legs had broken – so searing and encompassing was the sharpness that I couldn’t pin point an exact location of the fractures. I also knew that no other part of my body was broken, or at least that my back and my neck were fine:
“No. My neck and my back are fine. It’s my legs. I broke both of my legs!” I hollered back out. It seemed only a few minutes while we waited for the ambulance to come. During that time I had never seen my mother look so horrified and confused while she had me on her lap, not even touching me because she was afraid of what other damage she might discover or cause.

When the emergency medical crew arrived they first cleaned up the blood and then shone a flashlight into my mouth and up my nose. “Where did all of this blood come from? Well she has braces on her teeth so maybe the metal cut her mouth when she fell? She’s not bleeding anymore though.”
“She was born with OI, it means she has brittle bones, it’s a very rare condition. This has never happened before. But she says her legs are broken, she knows when something is broken” my mother told them.
It was clear to me that my mother was being fiercely protective of me, not letting them touch or move me at all. The emergency crew moved around my room slowly, at that point they were all trying to figure out how to move me from my mother’s lap to the stretcher.  
“This is going to be a challenge guys, we’ve never come across this before.”

I don’t know whose idea it was but someone had contacted Dr. Shapiro, my orthopedic and surgeon. The phone was handed to one of the emergency personnel and I could imagine my doctor, who has known me since birth, catching him up on the fast facts of O.I.
“Alright guys, the doc says to not apply any pressure anywhere. We can’t use the head or neck stabilizer on her; he says to just use medical tape instead of straps or buckles. We can slide the board underneath the pillow that she is on now and then put that on top of the stretcher – he says we absolutely cannot touch her. The doc is going to be waiting for us in the emergency room at Children’s in Boston… alright so let’s do this slowly and steadily.”
At this point I don’t remember every lying so still or stiff my entire life. I was afraid to move, to breathe, to know what would happen and all I wanted was for Dr. Shapiro to make me better. I wanted to skip all of this stuff and get to the point where I could just pass out on the hospital table as the heat of the fiber glass cast was cooling against me.   

When we got to the emergency room at Children’s Dr. Shapiro trusted no one else to touch me but him. He took all of the tape off of my head and asked me what was hurting the most, he then ordered an x-ray machine to be sent into the room and took the pictures himself. He gently touched my hip area and when I whined he quickly backed off “Okay so it looks like there’s some soreness to the pelvic area so we should get a few pictures of that too.” After he looked at the x-rays it was confirmed that both of my femurs had broken and there was also some damage to my pelvic bone, my head had severe bruising and he when I didn’t cry out as he gently touched the bones in my face he knew all he had to do was focus on the lower half of my body. I was put under general anesthesia and when I woke up two bulky light blue casts were on my legs; I remember feeling the relief that it was all over now, the crisis had subsided and while usually I would be excited to get back to school – this time I just closed my eyes and fell into a deep sleep.

911 Fractures:
  • The fast facts of telling someone in an emergency setting about O.I.: it means she has brittle bones, there have been numerous fracture before, there is a specific doctor and hospital that she always goes to. This allows strangers to the condition to know what it is they are dealing with and where the end destination for them is
  • If possible it's important to keep awake. During the wait for the ambulance and on the ride to the hospital I remember that everyone was trying to keep me awake and conscious
  • In this incident I was in middle school and old enough to know what was broken, but this might not always be the case for younger children. Use your best judgment because you probably know the child the best! And if you're unsure it is probably best to have them be transported to a hospital right away so that x-rays can provide the confirmation for you
  • I was lucky  that my doctor was around at this time and I would advise the emergency team handling the situation to speak directly with the orthopedic doctor. Otherwise, now you know to that added pressure is not the way to go and should be avoided at all costs when transporting someone with O.I. Use tape! 
  • It was helpful that my family and the emergency crew remained calm. I probably would have been in far more discomfort and unable to focus on where I was most injured
  • Listen to the person who is injured
  • I don't know how my mother got me from being face down on the ground to being on my back on a pillow, but she did it - and the best thing about all of that is that I don't remember the transition so I don't remember how much that probably hurt
  • If there was a traumatic fall of some kind it will probably take a few minutes for shock to subside and for the person to connect with their body again - trust that the injured person will tell you where it hurts when the time comes!

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