When a title like this comes to mind, it usually means a story is begging to be told. Well, here’s my story. While a child may sing “All I want for Christmas is my two front teeth,” an older woman like me probably won’t sing “All I want for Christmas is a few fractured ribs.” But I have them, and the title came to me today, so I want to tell you what I’ve learned so far.
1. Accidents happen. Since I fell and broke my hip nine years ago, I’ve said in jest that my mantra is to stay standing up. And I’ve managed to do that until two weeks ago, Saturday, December 12. We were having a delightful tour of a young relative’s home, when I missed a step and tumbled down another, landing on my left side on the side of a couch. I got up, seemingly none the worse for wear.
2. Delays happen. We were en route to the airport in Orlando when I had my mishap, so first we had another hour’s drive there, then a three-hour wait, followed by over a two-hour flight, so we got to O’Hare around 5:00pm. I told my husband since I was now having increasing pain I wanted to have my left side checked out just in case. He insisted we take a cab directly to our hospital near our home downtown. He went on home with our suitcases. I told him I’d text when I knew something.
My pain began limiting my ability to move in my seat, so I sat quietly waiting my turn in the ER waiting room. After a very long time, I went up to the receptionist to ask where I could charge my phone, when he said, “Are you Lois?” Yes. A nurse next to him said, “I’m so sorry. You got missed somehow.” Yes, indeed, I had noticed that people who had come in after me were being seen. So yet another delay. My first text to my husband was at 6:22pm that I’d been checked in and was in the waiting room, and now it had to be well after 7:00pm.
3. Mistakes happen. I’ll spare you the texts of the evening to my husband who eventually joined me around ten, just prior to my having CT scans, and to my kids. I wrote the following text at 1:21am. “Home. No clots. Spleen normal. No broken ribs. Severe bruising of rib cage. Pain still awful. But we are home. Long day. More later.” My discharge sheets identified my admitting diagnosis as flank pain, acute, and my discharge diagnosis as rib contusion.
4. Mistakes can be corrected. In the recommended follow-up appointment I had with my internist four days later, Wednesday, I complained of the severe muscle spasms and boring-type pain in my left side. He said that was to be expected in the area I pointed out because that’s where the fracture was. “Huh? What fracture?” I asked. A fracture of the 10th rib noted on the two CT scan reports from the Emergency Department. Wow, I thought, it certainly would have been nice to know that I had more than a contusion, that I had a fracture. He explained that the tests I had in the ED were primarily for checking for other things, not fractures, and that he normally, with my history, would have ordered a chest x–ray.
So, after thinking about it for a day, I emailed and asked if he would order one. With the enormous amount of increasing pain, I had to know what was going on. I had the x-ray the next morning, Friday. I asked the technician if he could see a fracture or was I crazy to think I had one or what. He said, “Oh my, lady, you are not crazy. You’ve got a whopper of one. Of course, the docs have better machines than I do, so your doctor will get their report in a day or two.”
I walked out to the radiology waiting room, took one look at my husband and burst into tears. “I do have a fracture,” I cried. “Apparently a big one.”
On Sunday afternoon, my internist informed me that I not only had one fracture, but four.
What worries me about my experience is that I’m a nurse and, of all people, I think I should have known to push further for answers to my pain. I entered the ER with my pain at a ten and, after several unsuccessful attempts at pain relief, left with it at a ten.
In retrospect, I think of the data that should have been obvious from 1) my chart, 2) my account of what happened, and 3) their exam: 73 year-old woman; severe left-sided pain subsequent to falling down two steps landing full force on her left side on a couch; long history of osteoporosis; prior history of falls and breaks; history of multiple bone scans documenting osteoporosis or osteopenia; history of taking bone density medication.
What else would they need to know? To me, those are red flags. How a doctor could come in and tell me after my CT scans, “You can go home now. You are so lucky you didn’t break anything,” when at least one fracture was documented on the reports of two CT scans, and when I had this loaded bone history, is hard to comprehend. At the time, of course, I couldn’t believe my luck either, and just wanted to get out of there, after the seven more hours of pain, and get home.
But I will forever wonder why they didn’t question more in the light of my age, the force of my fall, my osteoporosis history, the scope and intensity of my pain, and my lack of response to their pain measures.
So you might ask, What difference does it make that you didn’t know about the fractures? I can tell you that it would have made all the difference in the world, physically and emotionally. As I wrote a friend, “Every half inch that I move produces horrific pain.” Had I known I had bone fractures, my pain would have made sense. Had I known I had bone fractures, I’d have been able to account for the pain. Had I known I had bone fractures, I could have made the pain tolerable. The not knowing, the anxiety of not knowing, therein lies the emotional toll.
5. We can learn from our mistakes and those of others. My parting message from what I have learned is always feel free to question. If something doesn’t feel right to you, trust your judgment. It is your body; you know it best. Ask your questions and don’t stop until you are satisfied with the answers.
6. An untoward event is not over until it’s truly over. Now, I work with pain control. There, again, the patient is pretty much on his or her own. You have a prescription. You’re told it may make you constipated. You go home. You take the pills. You get nauseated. You get constipated. You take something to combat those. You get diarrhea. You get creative with plastic and newspapers. You take something else. You… you… you…it’s a challenge even for me who has administered medications to others for years.
Is it any wonder patients get anxious, frustrated, overwhelmed? Oh, I wish I were still teaching my nursing students. I would have such a wonderful case study to discuss: What is right with this picture? What is wrong with this picture? What could have been done differently?
Wishing you all a Merry Christmas and a Healthy New Year! And for all my older friends, just letting you know, I’ve renewed my motto to Stay Standing Up.