Always Hold the Handrail

Attending my kid’s high school graduation with ankle elevated

On a Thursday morning at 6:45am, I was upstairs in our kitchen, I filled a water glass and grabbed my phone to head downstairs to the room where I work from home in this pandemic. I was thinking about the 7am meeting coming up and planning the rest of my workday.

The stairs in our house are whimsically carpeted in giraffe print. I was wearing comfy socks. I slipped on the stairs and fell to the bottom where a tile floor met my ankle and promptly dislocated my ankle and broke a few bones.

The glass of water was still intact, no spill, and both glass and phone were still in my hands. Later in ER, a nurse joked with me that my ankle is worth much more than a glass and a phone and advised me to Always Hold The Handrail.

My family said I made pain noises that they’d never heard from me before. I cried and cried while I wrapped up my ankle in a lot of ice, realized it was swelling and needed to take off my leggings, and then grabbed a pair of sweatpants and cut off the cuffs. I compared, side by side, the shooting pain ankle with the fine ankle and, with my wife’s encouragement, decided I needed an ER.

Our car was in the shop and we asked a neighbor to drive me to the ER. She had COVID. I was in so much pain I didn’t care. Another neighbor provided a strong shoulder for me to use to hop to the car. We all wore masks and kept the windows open.

The ER checked me in quickly and told my wife she couldn’t come with me due to COVID. They scheduled me to get an x-ray and said they’d get some pain meds for me after x-ray. The x-ray was horribly hellishly difficult because my ankle hurt no matter where I set it down or turned it. The tech put a superwoman x-ray cape on me, apologized, and I took deep breaths and cried while he tortured my ankle.

Back in an ER room, a nurse gave me Dilaudid for the pain and Zofran for nausea caused by the pain. I know myself and pain meds — they often don’t take away pain for me. I mentioned this to the nurse and she said they’d try fentanyl next.

The ER doctor came by and had the x-rays on his phone and showed me that my ankle was dislocated and the inside knobby bone was cracked in half (at bottom of tibia, a.k.a. medial malleolus) and the fibula (skinny bone on the outside of leg) was broken in a few places.

They started to prep to do “closed reduction” and reset my ankle and bones. They brought my wife in for moral support (she spent all day in/around the ER for me and she’s awesome).

My ankle hurt SO BAD just staying still I couldn’t imagine how I could handle the bones being reset. I got some earbuds, turned on my favorite opera (Cavalleria Rusticana), pulled my knit hat over my eyes, grabbed something to use a temporary squeezeball, and said let’s do it.

The nurse gave me Fentanyl, waited a few minutes, and the doctor started manipulating my ankle. I screamed and moaned and cried and turned the music up and breathed. The Fentanyl didn’t change my pain level. The reduction was done and I was sent back to x-ray to see if everything is back in place. By this time my leg is in a splint and wrapped in ace bandages. That felt safer since moving my ankle felt like someone was slamming a sledgehammer into it.

The x-ray tech had some easier ways to get images this time and I appreciated he’d thought about my level of pain and the need to get images from certain directions.

The doctor came back to show how everything was almost, but not quite, back in order, and he’d have to do the resetting/reduction process again. Now they would move me to another room where I would be given Propofol so I wouldn’t feel or remember the reduction.

Meanwhile, the ER was filling up with other patients and I kept myself distracted with my iPad.

I was prepped for Propofol with oxygen stuck in my nose, blood pressure band on my arm, oximeter on my finger, and round things stuck on my chest to monitor me. I hung out with all of this for a while since higher priority cases were coming into the ER.

Then it was my turn. The nurse gave me more Fentanyl, talked me through how Propofol knocks you out quickly, for just a handful of minutes, and then you don’t remember what happened. The doctor asked my height and weight to estimate how much Propofol would be needed and then he pushed 50 mg. A few minutes later I was still awake. He pushed 50 more. I’m still awake. He consulted with an anesthesiologist and kept giving me more Propofol. At 230mg I was out.

When I woke up from the Propofol the pain was huge and the fentanyl wasn’t reducing my pain. X-ray needed to be done again. This time they brought x-ray to me. I almost crawled off the table (trying to get away from the pain) when I had to move my leg for a different x-ray view.

The x-ray showed that the second reduction had gotten everything in place. The next day the ortho surgeon said the ER doctor had done a great job.

Then there were instructions (get an appointment with ortho surgeon, keep ankle elevated, take pain meds), prescriptions, crutches, practicing on crutches, getting to finally use a real bathroom (instead of bed pan), and heading home.

They put Dilaudid in my IV while detaching me from everything. It didn’t reduce the pain. I asked for ice packs and that helped a bit.

That day I spent 8 hours in the ER and every single person I encountered was kind and compassionate and calm in midst of a “ballistic ER” (as one person mentioned to me).

The next day I started calling orthopedic surgeons and got an appointment. My wife drove me to the office. I sat in the back seat with my ankle elevated on a pillow and a squeeze ball in hand because every little bump in road caused ankle pain.

At the ortho’s office, more x-rays were done, and we started planning for surgery. I had so many questions and the surgeon answered them all. I really appreciated when she brought up Amazon on her computer to show me what type of knee scooter (any) and crutches (MobiLegs Ultra) to get.

Surgery was scheduled for 7 days out to give the ankle time for swelling to go down and also to accommodate my daughter’s high school graduation.

The ortho surgeon needed a CT scan to see the damage more closely (my words, not hers). We scheduled that next, after leaving her office, and continued on the bumpy roads causing more and more ankle pain. Then I crutched around the medical center to get the scan. The CT scan diagnosed a trimalleolar fracture.

I bought a knee scooter for $118, much more economical than renting for $30/week, and I’ll likely need the knee scooter for a couple months. I brought the knee scooter, and, a pillow to the high school graduation. I put the knee scooter where a wheelchair would usually be in theater, pillow on top of knee scooter seat, and kept my ankle elevated for the entire graduation ceremony.

I also bought the MobiLegs Ultra to use when I’m in less pain. The knee scooter helps me feel confident moving from couch to bathroom, however, we have a small house and I could move more easily with crutches.

Those 7 days between ER and surgery were daunting with almost nonstop pain. Ice and elevation and ibuprofen helped me more than Norco. For me, it would take 3 hours before I felt any relief with Norco and then the relief only lasted 90 minutes.

I worked (from couch at home) for 2 of those 7 days to get some work passed off to others and communicate my plan for days out and my return. I work for a tech company and can work from anywhere.

Before surgery, I had a COVID test (negative) and phone call with anesthesiologist.

I had been told not to eat or drink anything (including water) after midnight and surgery was scheduled at Noon. I thought 12 hours would be too long without water. Based on looking around the internet, UCLA says drink water until 2 hours before surgery, the American Society of Anesthesiologists also recommends water until 2 hours prior, and a hospital in the UK had done some research that shows staying hydrated reduces nausea and vomiting. I used this research and data to get approval from anesthesiologist to drink water until 2 hours before I arrived for checkin.

I had some toast and hummus at 10pm before surgery the next day, and I drank water into the morning.

What happened on surgery day

  • I was at the hospital for 7 hours for outpatient surgery and it was the first time I ever had surgery. I had half of a century of life without broken bones or surgery.
  • Checked in and change into hospital gown and grippy sock
  • Nurse brings me warm blankets to add to the blanket I brought
  • Lots and lots and lots of questions asked of me
  • IV put in my hand — ouch! I’d never had IV in hand before. At ER the IV was put in my arm at elbow.
  • I was glad that they didn’t use a catheter
  • Anesthesiologist comes by to do a nerve block. That was fascinating — they use ultrasound to find the nerve in my leg and then use a needle to put in something to numb the nerve. The needle HURT. Once the nerve was numbed I had the first relief from pain since I’d fallen down the stairs.
  • I talked with anesthesiologist about nausea and vomiting. They gave me an Aprepitant capsule to swallow and put a Scopolamine patch behind my ear and said they could give me Zofran in IV throughout surgery.
  • I was wheeled into OR and was surprised to see so many people in there (I think I counted 8 or 9 people). I didn’t have time to ask questions. I was moved to a different table and a mask was put over my mouth and that’s all I remember.
  • When I woke up from anesthesia I kept asking the same questions because I would forget I’d already asked them.
  • Between waking up and leaving for home, I got lots of instructions and paperwork, and managed to use the bathroom.
  • Using the bathroom is a new challenge with bulky splint, keeping weight off that leg, and the throbbing pain I feel when my ankle is not elevated.

How it is going 2 days after surgery

  • Peak pain
  • I was told that the nerve block would last 10–18 hours. It lasted 36 hours for me. It was such a relief not to feel pain during that time and really weird to not be able to move my toes.
  • I keep my ankle elevated and wrapped in frozen gel pads (like this one) for 30ish minutes at a time. The splint is thick so it takes a while for the coolness to reach my ankle. The gel pads don’t melt or get any liquid on the splint.
  • I keep track of all the meds and timing of meds in Evernote. It’s easier for me, when I wake up in middle of the night with pain, to look in Evernote for what I took last and then know what I can take now. The meds have different schedules — every 4 hours, every 6 hours, every 8 hours. I thought of getting a pill tracking app but I’m too worn out to learn a new app.
  • I can manage sleep 2–3 hours at a time before pain wakes me up. I am very careful to slowly lower my ankle when I need to get up. Getting up results in throbbing and swelling that isn’t helped by any of the pain meds I’m taking (oxycodone, ibuprofen, acetaminophen). I only get up to use the bathroom right now.
  • My wife and daughter refill my water bottles, bring me meals and smoothies, and my wife plays iPad Scrabble with me.
  • So far I haven’t felt any nausea!
Toes above nose! My view from couch looking towards a mirror

How it is going 4 days after surgery

  • I’m worn out from the activities of the past 12 days and not sleeping well (usually I’m a good sleeper).
  • Days 2 and 3 after surgery were the worst for pain.
  • By day 4 the horrible terrible pain has subsided.
  • Much fewer pain meds now with alternating lower doses of acetaminophen and ibuprofen.
  • Leg is elevated most of the time on a couple pillows (following doctor’s instructions). It’s take-a-deep-breath painful, with swelling pressure, when I move leg to sitting or standing (hanging down) or bent on knee scooter. The doctor said that’s normal (my favorite phrase) and suggested moving my leg every once in a while.
  • Sometimes the cast puts pressure and causes discomfort so I fidget around to get cast in a different position.
  • Toes have some pain that is similar to how they used to feel after going for a long hike. I wiggle them and massage them a bit and that helps.
  • Constipation (caused by pain meds, anesthesia, stress, everything) was managed with daily colace and high fiber diet and lots of water, and then, on Day 3, one dose of milk of magnesia (which worked within 6 hours).
  • I need to take a shower. The last shower I took was 5 days ago (garbage bag and saran wrap over splint). A friend recommended a “leg condom” and I got this one. I’m not using it yet because the pressure of pulling it over splint, while I’m sitting, is painful.

How it is going 7 days after surgery

  • 2 full nights of sleep and I figured out how to arrange pillows, to keep ankle elevated and sleep on my side.
  • Showers are still a challenge. Washcloths and the sink are barely sufficient.
  • Even fewer pain meds needed. I didn’t take any yesterday. I only took 400mg ibuprofen today and likely won’t need more.
  • Yesterday I got outside with a friend using these mobilegs crutches. It felt good to move around a bit and I want to use crutches more to get some exercise.
  • A panic attack gripped me a couple nights ago because my toes felt stuck to the splint/cast and I kept checking and they weren’t stuck. The splint/cast can feel so uncomfortable. Xanax helped. The next day my wife went to one of our neighborhood dispensaries and got some CBD:THC tinctures for pain and for anxiety. Those are helping.
  • Toes are the most uncomfortable. They want to be free. I meditate to calm them down.
  • I created a routine for managing the bizarre instant swelling when standing up: let leg dangle off chair for a bit while ankle swells up like a balloon, take 10 breaths, get on scooter, take 10 breaths, continue onward and breathe.
  • There is a new pain sensation on top of my ankle that feels like rug burn when ankle swells up. Doctor says it sounds normal and that’s all I need since everything about this experience is new and strange for me.
  • Always needing to ask for help is a skill I am improving. I’m usually the one getting things done, organizing, planning, and I really super duper appreciate my wife and daughter attending to everything I need.

How it is going 2 weeks after surgery

Splint off and cast on, 2 weeks after surgery
  • At the 2 week point I went in for an appointment with surgeon where my splint was removed, I saw the incisions (eek! That’s my new ankle?!?), stitches were removed and then needed a cast (I chose cheerful pink for pride month and a nod to the “Free Pussy Riot” movement).
  • My ankle needed to be moved into 90 degree angle (for casting) and that was painful and difficult. I massaged the tight achilles tendon, pushed toes against my wife’s knee to work on moving my heel down to get into angle and then surgeon worked to push it the rest of the way. It was disheartening to realize I can’t easily control my ankle and how much it hurt to move it into this position.
  • I’m sleeping much better now, and back to my normal routine of 8 hours without waking, which is a relief after a couple weeks of managing pain.
  • In the morning I take 400mg ibuprofen to help with the initial swelling that happens. Otherwise, no pain meds, and a couple THC:CBD:CBN tinctures are helping me.
  • Fight the muscle atrophy! Exercise is getting easier by going outside and doing laps on crutches across the courtyard, using stretchy bands while sitting, finding youtube videos for chair exercises. Next I’m going to try getting on yoga mat and do everything that doesn’t put weight on my injured ankle.
  • I have embraced getting myself clean sitting on a stool in bathtub with and a bowl and a washcloth, as though I’m preparing to soak in an onsen. I don’t yet feel confident standing on one leg, propping non weight bearing leg (waterproofed) on a stool, in shower.
  • My ankle still swells instantly when standing up and then throbs. I’m kind of getting used to it. Not really. It’s debilitating to feel swelling and pain every time I stand up. I’m looking forward to the swelling going away.

How it is going 3 weeks after surgery

  • Going up and down stairs! I live in a 3 story house and have been living on the ground floor with this injury. Upstairs is kitchen and living area. I ask my wife or daughter to bring my knee scooter upstairs and keep my crutches downstairs. Then I crutch to the stairs, leave crutches at bottom of stairs, sit down and go up the stairs on my bum, one stair at a time, one hand holding handrail, one hand pushing up the stairs with my healthy leg. This has felt so good! It gets lonely living downstairs.
  • I started back to work about a week after surgery. I sit in a comfy chair with this elevation pillow on top of a pouf. My laptop is on a rolling desk and I spent most of my work day on Zoom. I’ve gotten used to this though I miss a bigger desk where I can put a bigger monitor.
  • As it has been since the injury, my ankle still swells when standing up though it doesn’t throb as much now as it did a week ago. Outside of the case I watch my toes turn purple. As soon as ankle is elevated again, toes return to their usual color and swelling reduces.
  • New pains in new places are not welcome. I can feel the papercut pain of the incisions every once in a while. This past week I had new short term achy pains at different places in my ankle.

What to grab on your way to ER with broken ankle

If you have time to grab anything …

  • Squeezeball or anything you can squeeze to help with pain since you won’t necessarily get pain meds right away.
  • Comfortable clothes that are easy to put on and take off, packable blanket, layers. ER rooms are cold and they piled multiple warm blankets on me that got tangled up in a puzzle. Next time I’d grab my own blanket on the way out the door.
  • Pants with wide legs. On the way to the ER you just need to get pants over swollen ankle. When you leave the ER you’ll likely have a bulky splint or cast.
  • A case for your glasses (if you wear glasses) because you might need to take them off at some point.
  • Entertainment — there’s a lot of downtime in the ER when injured people come in who are higher priority.
  • Earbuds to listen to something other than what people in other rooms area saying
  • Postits — or notepad — and pen (I like to write things to remember on postits and I grabbed some before we left for ER)
  • Water bottle (because nurses aren’t always available to get you water)

What to bring to hospital for outpatient surgery

  • I am a minimalist when I travel and I didn’t know what to bring to hospital and I completely over packed. Scheduled hospital surgery is VERY different from ER.
  • For example, in the ER they never changed me into a hospital gown. I was in my street clothes (including shoe on one foot) all day.
  • My outpatient surgery experience was efficient and I didn’t have the waiting time like I had in ER. I had brought my watch, an iPad, earbuds, bottle of water, notebook and pen, hand cream, hat, compression sock for my healthy leg, and so on.
  • I was changed into a hospital gown, and one hospital issued grippy sock, almost immediately and my backpack was taken away so I didn’t use most of what I packed.
  • Next time I would only wear (though I hope there isn’t a next time):
    - Tshirt
    - Zip up hoodie
    - Wide leg sweatpants
    - Comfortable sock and shoe on healthy leg
  • Next time I would only bring:
    - Phone
    - Packable blanket (because hospitals are cold)
    - ID and insurance card
    - Earbuds
    - Lip balm

While I was searching the internet for stories of ankle injury and surgery experience (to compare/commisserate with my experience), I found this: Tips on how to survive a broken ankle by Daina Lightfoot. Thanks so much, Daina for writing this up in 2018 for everyone who has/is experiencing ankle injury and surgery. Especially since the first time can be so terrifying and knowing what to expect is helpful.

This was my first ever experience of broken bones and surgery and I’m going to follow the nurse’s advice and Always Hold the Handrail from now on, especially on carpeted stairs when I’m only wearing socks.

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Leanne Waldal

Leanne Waldal

I like you. San Francisco.

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