And so here we are, 5 days into my story (the fourth post) but a long, long way from full recovery.  I guess this is the pay-off post given the title, but I’ll continue writing articles after this one covering the rest of the process (I promise, I’ll condense them).  This one though is a smörgåsbord of pain, failure, morphine, bodily fluids and wide eyed terror.  Welcome aboard, I hope the journey was worth it.

NB: Hardly any pictures in this post, I wasn’t in much condition to lift the phone up.

NB: This is a long, long, long post with a lot of text.  Sorry.

Also NB: Day 1 & 2 here, day 3 here, day 4 here.

Day 5

Early start, I don’t look impressed.

This post might jump around a bit, and first off, I wanted to talk about Alan.  Alan had done nothing wrong other than fall down some stairs.  He’d done nothing wrong other than make it into his 70’s with a mind as sharp as a tack.  He deserved respect and dignity, and more than that, he deserved the best standard of care that you can find in the world.  What Alan got was a crap shoot where one minute he was being dealt with sensitively by someone who truly cared and the next he was being managed like a problematic child you wish you’d never had.  It all depended entirely on which nurse or healthcare assistant he got at the time.  We all experienced this in the ward, some of the staff were fantastic, and some were pretty rubbish and ineffective, but in some ways, we were able to fend for ourselves a little more than Alan.

He’d been lying flat for a few days by the time I was admitted, and along with incessant hiccups (which were sadly a source of amusement for most of the staff) he was beginning to get a bit wheezy (day 4).  I watched as Alan basically picked up a chest infection in slow motion (day 5).  Nurses could tell it was coming.  Healthcare assistants commented on it.  Yet it felt like the plan was wait until it took hold and then pump Alan full of antibiotics to get rid of it again (day 6).  It was like watching paint run down a wall and only when it spilled onto the floor take action mopping it up.  Could they have prevented the infection, would antibiotics a day earlier have held off the worst of it?  I don’t know, but it was tragic watching it take hold (you’ll see, later).

Alan told everyone who dealt with him that he was deaf in one ear, and hard of hearing in the other.  The best of the staff remembered and stood on his good side and spoke loudly and clearly.  The worst of the staff ignored his hearing and just talked to him like a child when he failed to hear what they said.  I started saying ‘he’s deaf in that ear’ when Alan struggled to hear what they were saying.  I was in a bed, on the other side of the ward, and I could hold a fucking conversation with Alan, deaf and hard of hearing, better than some of the staff did while standing next to his head.  He wasn’t stupid, he wasn’t tired, he was just hard of hearing.  He deserved to be spoken to like an intelligent human being, not like a baby.

There were three shift rotations a day for the nurses and healthcare assistants, and during each rotation the new and old groups would do a round discussing all the patients.  That was the handover, and it relied on short conversations, the memories of the people involved, whatever notes had been written into our folders and the words written above our beds on the white boards.  It’s always great to be talked about as if you’re not there, I often chipped in during their discussions of me, but not once did any of them say ‘Alan is a bit deaf, stand on his right side’.  I watched one set of nurses consult with a doctor when Alan was deteriorating, and they limited his water intake to 1 litre a day.  But they didn’t write it clearly above his head, nor did they explain to Alan why.  So when the tea lady came around for the rest of that day, she quite happily re-filled Alan’s jug and gave him full cups of tea.  Later that day, the nurse complained at Alan about this.  It wasn’t fucking Alan’s fault – he’s a patient, he’s not meant to be in charge of his own care.  The communication between the staff was just terrible.  Eventually one of the nurses told the lady who did the tea about the fluid limit, but the next day, it was a different tea lady … and so Alan got too much fluid again.  Eventually, myself and Alan had to keep reminding the people serving him water that he wasn’t allowed it.

Friday morning had arrived, I woke up early having had a pretty fitful night.  I’d used up a few more cardboard urine bottles overnight, but the feeling had come back in my lower body and I was able to wiggle the toes in my left foot.  While I’d been ignorant of the seriousness of my foot injury, and had been wearing the moon-boot, I’d been able to hobble around quite quickly.  Now though I was in a light-weight cast which I wasn’t allowed to bear any weight on, in any way.  I couldn’t hop because my left arm was too painful, so I was reduced to pivoting between the bed and the chair next to it if I wanted to move.

Nurses arrived with a fresh gown and a fresh pair of paper pants, along with a bowl of hot water, some more antiseptic scrub and some towels.  They left me to get cleaned, saying if I needed help just to buzz with the alarm.  That was the most painful washing experience in my life.  My left arm was still almost entirely immobile and very swollen.  I couldn’t bear even the weight of my own forearm and I couldn’t voluntarily move the arm more than 1cm away from my body.  Even getting the gown off was extremely difficult and painful, but I managed.  I changed my paper pants, washed as much of my arm as I could in preparation for the surgery and then got the gown back on (but not done up).  I buzzed for the nurse, and waited.

And waited.

So I buzzed again.

And waited.

After about 20 minutes and my 6th buzz, the nurse arrived, irritated.  Luckily, I hadn’t been choking to death, or hadn’t fallen to the floor, or hadn’t been suffering from any breathing issues or actually anything serious.  I was just in pain, unable to get dressed, unable to walk, sitting on a bed waiting for someone to come and help me.

We got the gown tied up and then the nurse tried to put the foam sling back on my arm.  She failed, getting the strap in the wrong place, despite me having explained how it needed to go.  So I explained again how it needed to go over my shoulder, and she tried again, and failed.  Both attempts were excruciating painful.  I told her, rather angrily, that I’d sort it out myself thank you very much and she cleared away the water and towels and left me to it.  The gent with the motorcycle injury looked over and said, “She’s rubbish”.  And she was.  I got to know her and her shift quite well over the small number of days I was there, and she was indeed, rubbish.  She didn’t communicate, she didn’t listen, she didn’t care and she turned up at her own pace.

I got into trouble once on Facebook when I said something like 20% of people are shit.  That includes hospital staff, the police, the army, the clergy, bin men, gravediggers, chefs, teachers, shop keepers, etc.  Someone told me that people in the NHS deserve our respect.  It’s true, they do.  But equally, people are crap.  Great people have crap days, and some people are crap all the time.  Some people start out great and then get worse over time.  Some people are great on day one and great on the day they retire.  But the truth is, people are fallible, they have shit days due to regular issues we all suffer.  When I have a bad day and go to work, the worst that happens is I write a snotty e-mail and have to apologise for it later.  If you work as a nurse and you take your frustrations or stress in to work with you – people can suffer.  I wouldn’t ask anyone to do it – I have the utmost respect for anyone that does.  There are more good people than bad, more good people in the NHS than bad, but that doesn’t detract from the truth.  Some people are rubbish and shouldn’t work in a role which requires them to help people.

This nurse was one of them, or she needed a holiday, or she needed more support from her own management, or something, but whatever the problem was, it impacted my health, and the health of the other people in that ward.

And, she wasn’t even the worst health care professional I was going to experience that day.  That was to come much later.

When the nurse with the drug trolley came around that morning, I still wasn’t listed for any drugs, but I explained how much pain I was in and she gave me some codeine after much pleading on my part that paracetamol really wasn’t going to cut it.  Then I got a visit from a surgeon.  She wasn’t the lead surgeon or consultant doing my shoulder, but she’d come to do the pre-surgery assessment.  She asked me how I was feeling, and I was pretty angry at that stage.  I explained I was in pain.  She asked if I’d been offered any pain relief and I explained I’d pretty much had to beg for codeine.  She asked why I hadn’t had any morphine and I told her I hadn’t exactly been given a list of what I was allowed to ask for.

At which point she stood up, and said to the nurse team which were currently doing hand-overs, “Mr Evans doesn’t seem to be happy with his pain relief”.  After which, I was fitted pretty quickly for subcut morphine (morphine administered via a subcutaneous line).  Hilariously, the dose of morphine I got was delivered to me as I was lying on the bed on my way for a shoulder surgery and a general anaesthetic (GA) but you can’t have everything.

You have to consent to surgery, and they’re very serious about it.  Before I got the morphine, we did that little dance with the surgeon explaining the risks and me trying to explain I’d already consented to shoulder surgery on Wednesday during my first appointment with the fracture clinic.  But no one could find that paper work so we had to go through it all again.  I got a visit from a new anaesthetist, and we discussed options, but given the location of the surgery and the intrusive nature, the only real option was general anaesthetic for this one.  Then I was onto the trolley and getting some morphine.  I did ask if there was any point and if it would interfere with the GA, but was pretty much dismissed by the nurse administering the dose.

I waved to Alan as I was pushed out of the ward and down to theatre.  It was 9:42am and my day had already been a bit challenging.

I texted Greté around 4pm when I woke up, back in the bed.  My arm was back in the sling, the only difference being the presence of some pretty big wound dressings.  The surgeon I saw that morning would be the last time I spoke to a consultant or surgeon until after I was discharged.  At no point did anyone come and tell me if either surgery had gone to plan or had issues, at no point did anyone tell me how to manage either of my injuries.  I did, in frustration, explain that to one nurse and the next morning (I told you this would jump around) the on-call doctor came to speak to me, but all she could offer me was “there aren’t any comments on your notes, so I think it all went okay”.  Come on NHS, I’m the patient, where’s the communication?

Anyway, I woke up, I was still groggy, Greté and her mum visited me.  Over the days I was in, Simes and Sarah visited as well, but I’m ashamed to say I can’t remember on what days they visited.  I’m grateful for their visits, but I just can’t piece together when they were!  I stumbled through a conversation with Greté but I was clearly still recovering from the GA.

At some point during this day, I had a visit from the clinical pharmacist and we got my medication sorted out.  I was prescribed codeine, paracetamol and ibuprofen, and my own diabetic medication was documented so I could use those as necessary.  I’d had a couple of visits from the nurse with the drug trolley and one of the questions they and the healthcare assistants ask while doing hourly observations is, are you in pain and can you rate it from 1 to 3.  They use 1, 2 and 3 in Derby because they found with 1-10 most people would just pick 1, 5 or 10 anyway.  Mostly I responded 1 or 2.

A bourbon biscuit!

Greté left, I had some food and dozed for a bit.

Then around 8 or 9pm Alan started having trouble.  He was clearly running a fever and was beginning to get very confused.  He hadn’t been diagnosed with his chest infection at this stage, and wasn’t on antibiotics.  Twice I watched him try and get out of bed, thinking it was time to go home.  It was heart breaking.  We’d had the evening nurse shift change and had a male nurse, a female healthcare assistant and another member of staff (not sure if she was a nurse or an HCA).  I’d never see any of them before.

Alan was considered a high risk patient.  He needed the compression on his feet, and he needed to be turned a couple of times a day and he was on hourly observations.  I’d just come out of surgery on GA, and needed hourly observations.  I was also in an increasing amount of pain.

Between 8pm and 11pm, I noticed the HCA walk into the ward a few times and stand in the middle, and then look confused and walk back out.  She kept looking at a piece of paper in her hand, but would then simply leave the ward.  Alan was restless, trying to get out of bed.  My pain was increasing but I was still very groggy.

At around 11pm I watched the HCA, and she looked stoned; I’m sure she wasn’t, but she looked it.  Maybe stoned, or in shock, or suffering from PTSD, or lost, or she could have been a zombie.  Whatever it was, she was clearly out of her depth in a major way.  Neither myself nor Alan had had any observations done for over 3 hours, no one had asked me about my pain, Alan had tried to get out of bed twice.  He was singing, talking, thrashing and clearly distressed.  I was starting to breath heavily to try and deal with the pain in my arm.

The Zombie HCA walked in, looked at her bit of paper, hung around, and then left.

I think I called out saying I needed something for the pain and she mumbled something.

A while later, I was hyper-ventilating and groaning involuntarily.

Alan was singing.

Zombie HCA walked in and straight out.

I started sobbing.

Alan sounded like he was coughing up a lung.

Eventually the male nurse came in.  I don’t really remember much about the conversation, but he was irritated at the Zombie HCA, he was irritated at me, he wasn’t happy that I wanted some pain relief, but eventually, after another 50 minutes, he came back with some subcut morphine.  I’d been in pain from 8pm, in serious pain from 10pm and in almost unbearable pain from 11pm, but around 12:30am I finally got some pain relief.

I say relief, but by them it was too late.  Essentially, whatever they used to block the pain as part of the GA wore off in one go between 10pm and 11pm, so I went from being uncomfortable, to being in all the pain having your arm cut open and metal plates screwed into the bone can induce in the space of 60 minutes.  The morphine just took the edge off and made me dozy, it didn’t kill the pain.  Not long after this, the HCA spoke to me for the first time all evening, she said, “Can you rate your pain level between 1-3?”.  I asked her if she was fucking joking, given she’d just watched me go from normal to sobbing in the space of an hour and beg for morphine, but she didn’t really show any signs of understanding what I was saying.  I told the male nurse that “I didn’t trust the other nurses”, and he very angrily pointed out they weren’t nurses, they were healthcare assistants.  I guess he was having a bad day.

I dozed in and out of sleep for a while, and when I woke up in pain, I buzzed and got more morphine.  That happened another couple of times overnight, each time I’d wake up, buzz, and get more morphine.

Finally the night of the zombie healthcare assistant was over, and day 6 (Saturday) had begun.

Before day 6 however, here’s a section of other stuff that happened on day 5, but which I can’t place in the timeline because it’s all so fuzzy.

• During one of the drug rounds, after my surgery, a nurse pulled out a large needle and said ‘I need to inject this into your stomach’.  It was pretty abrupt, and I said, ‘Why?’  She just said, ‘I need to’.  So I told her no.  I wasn’t prepared to accept some random medication that she couldn’t explain to me.  She looked a bit confused but just left.  Here’s a top tip, if you want patients to take medication, then you should explain to them what it is.  I know that not all people are the same, some don’t care, some don’t understand, but some are intelligent, articulate, interested and aware, and when you have one of those patients you really need to do more than say ‘I am going to stick this in you’.  Tune in on day 6 to see if I ever accept my heparin or heparin equivalent.
• Despite not being nil by mouth any more, they left that phrase written on my whiteboard and I had to explain it away every time the tea lady came by.
• While Zombie Healthcare Assistant was failing to do her observations properly (she did eventually take some, but she wrote them up wrongly on the system, mixing up the numbers) both the male nurse and the other female member of staff had conversations with her, explaining she was screwing up and trying to get her to correct the issues.  But it didn’t help.  I didn’t get any proper observations until the next shift change, and Alan was pretty much ignored all night.  I assume the ward was understaffed, and I hope Zombie HCA gets the help she needs in whatever form it takes, but someone needs to manage their staff better.
• There had been a trainee nurse on the ward earlier – she was doing the HCA role.  She was the only one who actually wrote everything in the folders, and she was constantly aghast at how little information there was.  She took care of Alan before the shift change to Zombie HCA.
• The next day, the regular nurses complained amongst themselves at how much the trainee nurse had done.  They were pissed off that she’d done lots of nurse stuff, not just HCA stuff, even though she was supposed to be doing HCA training.  I think they were mostly pissed off that she made them look bad.  Which of course, they were.  I don’t know the relationship between nurses and HCAs or how the training works, or what role everyone was doing.  I just know she was a nurse in some capacity, but was only covering, or learning, or supposed to be doing the HCA role in that ward, but because she saw holes in the care of the patients she just covered where she could and I appreciate that.
• Alan finally got some sleep, although he spent much of it mumbling and unhappy.

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Welcome to day 4, being the third post in a series of posts about my recent injury and recovery.  This post contains bodily fluids, pictures of cannula and a lack of dignity.  You can read part 1 here and part 2 here.  They don’t contain any bodily fluids.

Day 4

Post-surgery cast and bandage.

We never got a chance to call the trauma nurse on the morning of Thursday 25th August to check if I was on any surgery lists, because she rang us first.  The shoulder specialist had found his foot specialist the day before, and I had a serious lisfranc fracture of the foot – which needed urgent surgery and fixation (again, plates).   I really should not have been putting any weight on it all, and the misdiagnosis in Carlisle had put my ability to ever walk properly at risk.  Untreated lisfranc injuries can result in instability of the foot and serious issues with mobility.  So I was being admitted at 11am, and despite expecting to be going in for shoulder surgery – I was going for foot surgery at round 2pm.  We’d prepared a little overnight stay bag the night before when we got home so we were ready to go when the call arrived but it was still pretty fucking scary.  I’ve had a broken arm (in my teens) and I knew I could get through the day only being able to use one of them, but foot surgery inevitably meant being off my feet for some time.  I had no idea how long for.  Also, with both the arm and foot injury being on the left side, I knew I wasn’t going to be using a crutch to get around – it was starting to look a little bleak.

We headed in, found our way to Ward 311 and on Thursday 25th, I’d gone from falling over playing tennis to being hospitalised four days later.

It’s around this point that my dignity became a victim of necessity.  It’s also around this point that I started taking a lot more codeine a lot more regularly – and as a result, my memory is shit.  All of the things I’m going to write about happened, but lets say that the order in which they took place or the exact sequence is more fluid.

Look how pretty it is.

Admission was pretty swift, they had the details from the previous day and the team were very efficient.  With the surgery deadline in place, there wasn’t much time to get used to my new surroundings.  I had to have conversations with the anaesthetist, the surgeon and the rest of the team.  Before all of that though, I had to get ready.  And by getting ready, I mean I had to shed my dignity.  If hospital gowns are the worst invention of the modern age, then paper surgery pants are the worst invention of any age.  Greté helped me get changed into both gown and pants, after washing down my leg with hibiscrub (or something similar), and I lay back in the hospital bed, feeling a bit like a turkey ready for basting.  Do you know how easy it is for pubic hair to get trapped in paper underwear?  Very easy.

I’ve only had surgery as an adult once, and I found that the person who seemed to care most about my well-being during the whole process was the anaesthetist.  That was matched this time (although the surgeon was nice, to be fair).  I had a long conversation about the style of anaesthetic I wanted.  On offer were full general or, essentially, a spinal injection which would kill any sensation from below the waist and an injection freezing my foot in place.  I never realised that general anaesthetics don’t come with any pain relief as such, where-as the other option was all about the lack of pain.  However, if I went for the spinal injection, I’d be conscious for the operation – and I’d get something to help me relax without putting me to sleep.  The anaesthetist asked which one I would prefer – I think I said, well, I’ll defer to you given it’s your job.  He was insistent that I choose though – which I still find weird.  In the end, I opted for the spinal injection because I quite liked the idea of being awake during the surgery.  It was an excellent decision as my shoulder surgery later would prove.  It wasn’t until much later that I realised the reason anaesthetists care so much, is because they’re basically holding your life in their hands, and in most surgeries, have more control over your well-being than the surgeon or anyone else in the theatre.  If they fuck up, you don’t wake up.

The surgeon then paid a visit – and explained for the first time what the foot injury was and how it showed up on the x-rays.  He also said that the bruising on the bottom of my foot was a classic symptom of fractures, if your foot bruises like that, it’s almost certainly broken.  He explained the surgery, and drew three marks on my leg and foot.  A massive arrow on my left calf, a dotted line on my foot where he said he was going to make his incision, and then another line on the inside of my foot with a question mark, because he wasn’t sure if he’d need two incisions or not.  I finally got to wash those marks off my leg on the 18th of October, 54 days later.  I spent some of those 54 days wondering if the ink was toxic when absorbed by the skin.

The surgeon also tossed in a throw away comment, that after the plate goes in, sometimes they take it back out after the swelling goes down, a couple of years down the line.  Yep, two years of swelling around the plate.

Post-surgery selfie, complete with oxygen line.

What didn’t happen during all these conversations, was a proper discussion with the clinical pharmacist or anyone about medication or pain relief.  Likely because I was being admitted quite late and going straight to surgery – but it would prove frustrating later on.

Eventually it was time to head out – and I hopped across onto the surgery trolley and told Greté to go home rather than wait since we didn’t know how long it would take.  Off I went, paper pants and all toward the operating theatre.  I had another conversation with the anaesthetist, we reviewed all the questions again about loose teeth, and then it was time for the injections.  Leaning forward was pretty painful (see: fractured humerus) but once the various cocktails were in me it was a lot easier.  I was in surgery and looking up at some bright lights.  My memory of the surgery is strange.  Time was really compressed, and I must have been dozing on and off, but I do remember talking to the surgeon and other people in the room.  I remember seeing an x-ray of my foot with the plate and pins in it.  I listened to the surgeon discuss where to put the next pins and how to lock the plate in place.  I never felt a thing.

I woke up back in the ward, in bed, thankfully with my paper pants still in place.  I could not feel my legs, or my back, but my leg had a half cast on it and a lot of bandage, so I knew something had happened.  Luckily it was the correct leg as well!  I’m piecing a lot of the rest of the day through a mixture of SMS and Facebook messages.  Thanks to technology, I never felt far from Greté and friends, and most of the photographs in this post I took to send to Greté to let her know I was okay.  I woke up around 7pm and texted Greté as soon as I could reach my phone.  There wasn’t much point her coming back in that night so we just spent the time talking on SMS or FB.  This is my favourite part of the whole conversation, Greté’s text is in grey, mine is blue.

Facebook messenger chat

I hope you appreciate that.

Flapping cannula.

So far, other than some confusion early on, the experience with Derby hospital had been pretty good.  I can’t fault the consultant, the anaesthetist or the admission team.  However, it was all about to start going downhill.  I’d not eaten anything or had anything to drink since midnight and it was now 7pm, long after they serve evening meals.  A lovely nurse ((note that I refer to a lot of staff as nurses, they may have specific roles and names, but I don’t know them)) checked with me and asked if I was hungry and wanted a sandwich.  She brought two sandwiches back with a drink, and said I looked like I had an appetite.  I was then informed that it would be nil by mouth again from midnight, because I was going in for shoulder surgery the following morning, at 10am.

I had a chance for the first time to get to know the other patients in the small ward I was in.  Alan was in the bed opposite mine.  Alan was in his 70’s, deaf in one ear but mentally sharp as a tack.  He wasn’t from Nottingham or Derby, but had fallen down some marble stairs in a building somewhere in the region and broken his hip in three places.  He was pretty immobile in the bed, had been in for a few days and had some kind of air-powered compression slippers on to keep the blood flowing in his legs.  There was a gent on my far right who’d been in a motorcycle accident, broken both arms quite badly.  He’d already been in surgery a few times, metalwork sticking out of his arms.  His legs worked though so he spent a lot of time out of the room walking around.  In between them was another guy, who I didn’t get to know, he was pretty much asleep and then discharged the next morning.

I had a bit of a chat with Alan which wasn’t easy, we were both drugged up and he was half deaf, but at least it was some conversation.  The pain in my arm was getting worse, I hadn’t had any pain killers since the night before but I checked with the healthcare assistant (HCA) while she was doing my observations and she said the nurse would be doing her rounds with the drug cart in a little while.  I also mentioned that my cannula appeared to be coming loose, but she didn’t seem very worried.  Eventually the nurse with the drug trolley arrived, and we spoke about pain relief.

“There’s nothing down next to your name, I can give you some paracetamol.”

I was a bit frustrated by that.  I explained calmly that I was in quite a bit of pain and really could do with something stronger than paracetamol.  It turns out that because I was admitted and moved into surgery so quickly, I hadn’t had the review that happens when they work out what drugs you’re going to be prescribed.  I told her I had a bag full of ibuprofen, codeine and paracetamol all prescribed to me the day before by the consultant.  She said, “you’re not supposed to take your own tablets, but if I don’t see you taken them ….”

So I took them.  Along with my diabetic medication.

While I was calming down from that (and enduring ‘hourly observations’) I noticed that Alan’s pressured foot things weren’t on his feet.  I was just about to mention it to someone when one of the nurses / HCA’s noticed and replaced them, making concerned sounds about how long they’d been left off for.

I finished the day off with a massive wee; into two cardboard urine receptacles.  I’d taken on board a lot of fluids during the surgery, and despite not having anything to drink since the previous night, I’d also not been to the loo since around 11am, so there was plenty of water to get rid of.  When the nurse came to collect the used bottle, I had to let them know they were both full – I don’t think she believed me initially, but she took them both and returned with two empty ones.  That would be a pattern for the next day or so, where I think I passed a volume of liquid equal to Loch Ness.  I can’t quite describe the subtle terror of lying in a bed, not able to feel your own legs or find your own penis by touch, weeing into a carboard bottle which is resting on the bed, trying to work out if you’re holding it at the right angle so that it doesn’t just spill out of the top.

Luckily for everyone concerned, I have great pelvic floor control.

Despite several queries and reminders no one really bothered fixing my cannula, and despite the fact that my arm was seriously painful I eventually just nodded off, ready for day 5.  You’ll be pleased to know that day 5 is finally the Night of the Zombie Healthcare Assistant.

This is the second post in a series of posts covering my injury and subsequent recovery.  You can check out the first part here.  This one’s not to bad, but if you don’t like to hear about bodily fluids, you probably want to skip the next one (which I’ve not written yet, but I already know how it goes), and to be fair, most of the ones after that one too.

Day 3

Bruise starting to develop nicely.

After an uncomfortable night, muted by a lot of codeine, I was up and hobbling around on Wednesday 24th August ready for my appointment at the fracture clinic.  I prefer the Royal Derby Hospital over Nottingham (we live in a place that lets us choose) for various reasons – so we squeezed me back into the car, padding in place, and got there early.  I’m always early.  Usually, very early.  I was once an entire day early for a medical appointment (I had to go back the next day).  Luckily the fracture clinic isn’t far from the main car park but despite my protests, Greté made sure I was in a wheelchair rather than allowing me to walk.  I’m grateful now, but at the time my pride was a little fractured too.

The fracture clinic system at the hospital is a bit free-form.  You arrive in the main reception, and sit for a bit, then someone calls your name and you go through to an examination room, and then you wait as long as it takes for the consultant to come and see you.  The nurses seem to be just as confused about what is going on as everyone else, and it felt very chaotic.  However we’ve been a few times now and I think what it means is that, because people need x-rays or casts and other procedures during the whole appointment, they can basically manage the list of people without being overly rigid.  If your appointment time is 2pm but you arrive at 1pm, you’re likely to be seen before 2pm, because there’s a gap while a brace of more mature patients are having casts put on, or whatever.  So we were in an examination room pretty quickly, but it took more than half an hour for a consultant to then come and check me over.

Lovely bruise on the base of my left foot.

To add to the confusion, we weren’t coming in via a normal route.  Normally, you fall over or suffer a trauma, and either go straight to the clinic or get referred immediately by A&E.  We had kind of self-referred a couple of days after the accident, so they had previous notes to look at from another hospital, but no one had done the normal trauma / fracture questionnaires that Derby usually do.

Lastly, as a patient, you tend to get told nothing until the last minute.  We’d not been to the fracture clinic before and didn’t really know what to expect, so the waiting was even harder (with or without pain) and people would come, ask questions, and leave and we’d not be sure what that all meant.

However, eventually a consultant came to see me and we went through a few basic questions – and then were immediately sent off to x-ray.  X-raying fractured limbs is painful, because you invariably have to get them into positions they do not want to go into.  I was still blithely and happily standing on my foot when required, but moving my arm around was agony.  X-rays done we wheeled back to the reception and went straight back into an examination room.  What followed was one of the most amusing and yet uncomfortable hospital interviews ever.

More bruising

Our consultant had a couple of student doctors with him that day.  He sent them in, telling them to do the regular trauma stuff and he’d be along in a minute.  He obviously got delayed, so we spent nearly an hour in a room with two doctors who knew they were out of their depth making small talk.  We filled in the questionnaire, that they’d never seen before, talking about what the injuries were and where they were.  When it came to the physical examination, they took one look at the bruises and my pained face and didn’t bother.  A lot of the questions pertained to serious trauma but they felt they had to ask them anyway.  They were really nice about it, and we had a good chat about lots of non-medical related stuff, but they can’t have been enjoying the experience.

Eventually, the consultant arrived having looked over the new x-rays.  He was a shoulder specialist himself, and the delay had been because he was trying to find a foot specialist to review the foot x-rays.  We were about to get the first full and accurate diagnosis, the fourth of the whole process.  The initial nurses had gotten it wrong (can’t blame them), the GP was close but ultimately not detailed enough, the Carlisle orthopaedic department were plain wrong, and this guy, as you might imagine, was about to be correct.

The arm was clearly fractured, across the top of the humerus just below the actual ball joint (surgical neck fracture), it was also displaced.  So not dislocated, but not properly aligned either.  Had we not taken any action, it wouldn’t have healed correctly, if it healed at all, and I would have been screwed.  The consultant explained I was going to be screwed in a more literal sense, because it needed surgery and fixation (i.e. a plate).  He explained that he wasn’t sure if there were any spaces on the next immediate surgery lists, and also explained he’d been trying to speak to the foot specialist, because he was concerned by the x-ray, but he wanted to get a better diagnosis.  After writing up a sick note and giving me a prescription for some much stronger pain relief, he left to do that, and we started filling in (shoulder) pre-surgery questionnaires with the trauma specialist nurse (not sure of her title, but she was doing the admissions stuff).

Just a tiny bit of swelling on my elbow.

After a standing start, things were beginning to move quite quickly.  I’d gone from being suspicious about the first few diagnoses but assuming I’d be in a sling for a few weeks, to being told I needed quite invasive surgery on my arm at the very least, and that I was going to be admitted to hospital.

Shit was getting real.

We talked at length with the trauma nurse, she cursed a lot at the missing information that neither the consultant nor his students had collected, I completed a surgery consent form for the arm (we’ll come back to that later) and we got ready to return home.  The trauma nurse explained that they probably didn’t have any slots free, but that we should go home, do nil by mouth from midnight (standard practice just in case) and then call first thing in the morning (Thursday) to see how things lay.

We left and headed home.  Not really sure of what would happen next.

As it happens, what happened next was that we didn’t need to call them in the morning, because they called us first.

I had intended to write a single blog post, describing a single night in the hospital after my surgery – however, as usual I am unable to write small amounts of text, and so here is part one of what looks like it will be an increasingly wordy description of my injury, my hospitalisation, and my recovery.

Day 1

In the early afternoon of Monday August 22nd I fell over while playing short tennis at Center Parcs in Cumbria during a family holiday.  Let me just give you the dictionary definition of short tennis.

short tennis : noun : tennis played on a small court with a small racket and a soft ball, used especially as an introduction to the game for children.

Jonathan serving

That’s right, I fell over playing children’s tennis.  Normally I refrain from sport.  Years of ridicule and humiliation while at school gave me a healthy disrespect for any kind of group sporting activity which involves moving around.  I can often be heard saying, “I don’t run“.  It’s not something I’m proud of, it’s just been a basic fact of my existence for the last 30 odd years.  So I was more surprised than anyone to find myself playing short tennis, even if it is supposed to be a little easier on the body than full length tennis.  It was pretty energetic, although most of the energy was spent with one of us retrieving missed balls from the courts of other players.  We were playing doubles and there were probably only 4 players on our own court for 2% of the match, the other 98% of the game was spent with one or sometimes more than one of us on someone elses court picking up balls.  Inevitably then, I chased another errant ball across our court and towards the net of the court on my left.  I was lumbering at some pace, and then I was falling.  Fate, it seems, is not without a sense of irony.

I don’t really remember what happened.  I don’t know if I tripped, or slipped, or stumbled.  I don’t know if something in my foot snapped causing me to fall, or if falling caused me to snap something in my foot.  If you know me, you know I’ve got pretty good balance, I do not fall over.  Except I had.  I realised I was basically lying flat on my face on the court of an unknown family with two young kids.  There was no way on this earth I was going to stay there, so I stood up, and walked back to the bench near our court.  I was holding my left arm close to my body and bent at the elbow, and I knew something was wrong.  Adrenalin is amazing though, so I made it back to the bench and sat down.  My oldest nephew, Jonathan, asked if I was okay, and I said no.  I think he asked if I wanted him to get someone, and I think I said, yes, get everyone.

I was pretty certain at that stage that I’d either dislocated my shoulder or broken my arm.  I couldn’t use my shoulder muscles to move my arm in any direction, although I could bend it at the elbow.  It hurt, a lot.  I got my left shoe off as well because I could feel my left foot throbbing, and it was swelling, alarmingly, but I was more worried about my arm.  I assumed I had just sprained my foot or ankle.

People from Center Parcs started to arrive.  The local first aid person told me the nurses were busy with a sick child, but would be along as soon as possible.  Until then, she tried to help.  She tried twice to put a sling on me, admitting before she’d even started that she wasn’t very good at it.  She failed both times, and the pain was just too acute for me to let her try again.  She was quite apologetic though and I tried not to be too annoyed, or too passive aggressive.  I probably failed.  Someone brought me some carrier bags with ice in them – I guess from the bar.  They really helped on my foot, although given it was just ice in a plastic carrier bag it was pretty harsh pretty quickly, but didn’t do much for my arm or shoulder.  After about 15 minutes, maybe longer, two nurses arrived, with gas & air!  The next period of time is a little blurry (gas & air)!  I remember the nurse explaining the impact of the gas, and how it might make me feel sick and to tell her if that was the case.  I remember her asking me if I had any other conditions, to which I responded diabetes and chronic sarcasm.  Then I remember everything getting very heavy and woozy and spinney.  My nephew tells me that when they tried to take the breathing mask away from me, I refused, but I don’t remember that.  The gas & air didn’t solve the pain, it just meant I cared less.  They offered me additional pain relief, which meant paracetamol.  I kind of laughed, it’s never done anything for me in terms of pain relief on its own but I took some anyway.  The nurse did manage to get a sling on my arm without any problem at all.

Me in the 4×4 on the way to the car park, an hour after the fall

The nurse wasn’t convinced I’d dislocated my arm, she said it was probably just a muscle injury and she thought I’d sprained my ankle.  This was the first misdiagnosis of the whole process, and I can’t really blame her, she’s not after all a specialist, but I was pretty sure she was wrong.   Center Parcs had called an ambulance pretty early on in the process, but the nurses had received an update saying it would be 4 hours before it arrived (my advice, never get really sick anywhere in Cumbria).  Since one of them was convinced it wasn’t a bone injury and certainly not life threatening, they asked if I was okay being driven to the hospital as it would be much quicker.  The hospital in this case was the A&E department at Penrith, about 20 minutes away from the Whinfell Center Parcs site.  My brother-in-law Paul offered to drive, so the only issue then was getting me from the sports hall, to Paul’s car.  Center Parcs staff said they’d bring the mini-bus over, until the driver told them on the radio it was full of furniture he was moving around and it would be another hour before it was free.  In the end, they found a 4×4 that was free, wheeled me in a chair to the car, got us to the car park, and after shuffling and hobbling into the vehicle, we set off.

Greté had been in the lodge the whole time – she’d been resting her back after a tough couple of days.  I didn’t want to disturb her when I first fell over, and didn’t want her having to hang around in a hospital waiting for me.  So Paul drove and Jonathan stayed with me so Paul could get back to the kids.  I’m still not sure Greté has truly forgiven me yet.

Me, my sling, and my nephew Jonathan in A&E

So we arrived at Penrith A&E and honestly, I expected to be there about a hundred hours.  Small A&E, big area, plenty of people already in the place, but they saw us quite quickly.  They had a wheelchair for me and Jonathan kindly pushed me around.  We did, at one point, misplace a boot moving between the main waiting room and x-ray, but we recovered it before it walked away on its own.  Can’t fault the staff at Penrith A&E though.  The nurse who did my assessment was great, the person who did my x-rays was really apologetic about the position I had to get my arm and foot into (that hurt, a lot), and the GP who reviewed it all was thorough and explained everything.  In fact, the GP was really good, because he pretty much diagnosed both injuries.  At one point he said to me, “I’m a GP, I don’t spend a lot of time looking at x-rays ….”  He went on to say I’d fractured my humerus and my foot, and that he was also concerned by a shadow on the arm x-ray, which might have meant it was dislocated as well.

The first of many horrific hospital gown experiences.

He tried several times to get hold of the on-call orthopaedic surgeon at Carlisle hospital and failed.  I waited with him while he tried.  I thank him for that – he was serious about trying to get me referred and trying to get me the right help.  Everyone at Penrith were pretty good to be honest.  He eventually gave up trying to get hold of the specialist for a discussion and referred me directly to Carlisle, but said I’d have to go to their A&E since he couldn’t get hold of the person he wanted to speak to.  He sent me to the plaster room where the nurses put a moon-boot on my foot, and a more extensive sling on my arm.

Now I just had to get to Carlisle hospital!  Greté was pretty angry at this stage and suffering quite a lot of panic, and for that I am eternally sorry.  We had quite a fraught conversation on the phone and Paul brought her over so we could all go to Carlisle hospital.  At this stage we didn’t know if I was going to be admitted or just seen by the specialist, but there wasn’t much we could do.  I was conscious that I was starting to interfere with the enjoyment of the holiday for Paul and the kids (and Greté).

My foot.

I sat and stared at my new boot, while we waited for Paul to arrive.  A little drive later and we got to Carlisle – a regular hospital.  Greté waited with me this time, and eventually the orthopaedic specialist checked my x-rays.  He didn’t ask me any questions, didn’t really talk to me much, and didn’t examine me.  He glanced at the x-rays.  He confirmed I had a fractured humerus but was disdainful of the GP’s assessment about a ‘shadow’, proclaiming it wasn’t dislocated and simply needed gravity to heal.  Then, and in his own words, “I’m not even sure your foot is fractured”.  I’m not a doctor, I had to trust him.  The GP, after all, had said he didn’t spend all his time looking at x-rays, and this guy did.  So we asked should we head home and speak to the local hospital or continue on holiday?  He said we didn’t need to rush, finish up the holiday if we wanted and make an appointment when we got back to Nottingham a few days later.

This, it turns out, was terrible advice.  Not only was he partially wrong about the arm fracture, he was totally wrong about the foot.  Dangerously so.

I don’t know if he let disdain for the GP who referred us get in the way, or if he was just having a bad day, or if in fact, he was just sick of people from Center Parcs falling over, hurting themselves and coming to him to get fixed, but he misdiagnosed me.  He did at least prescribe some pain killers.

Myself and Greté had a bit of a chat while we waited for Paul to come and get us.  We were uneasy about his manner, and I was clearly in a lot of pain.  However by this time, it was already quite late, and we weren’t going to be driving back to Nottingham without quite a bit of effort packing and the like.  We decided that if I had a comfortable night in the lodge we’d consider staying a few more days, but if I couldn’t get any rest or was in pain, we’d head back in the morning.

I still had the sling (and had no movement in my arm at all) and boot, although I took the boot off to sleep because it was quite uncomfortable.  I slept sitting up in the lodge, and got a few hours mostly thanks to the codeine.  The longer I sat though, the more obvious it was to me that staying was the wrong choice.  I didn’t want the family pushing me around what is quite a hilly Center Parcs, and the three main things I wanted to do while I was there (walk, swim and take photos) were all off the menu.

Day 2

My lovely sling, and a padded neck rest keeping my arm off the door – during the drive back from Cumbria.

So early in the morning of Tuesday 23rd August, with the help of everyone else, we packed and started the drive home.  Since I learned to drive a few years ago, I’ve been doing all the long distance driving, and it was pretty hard work for Greté doing the whole trip behind the wheel, but we made it in one piece, and I spent the first of what would turn into many nights sleeping on the sofa in our lounge.  At this stage, although uneasy, we were still working on the assumption that the orthopaedic specialist had been correct – but Greté rang Derby hospital as soon as we got back – and they gave us an appointment on Wednesday 24th to come in for assessment at the Trauma and orthopaedics department.  At this stage, I was still hobbling about on the moon-boot, confident my foot was going to be fine.

To be continued …