Broken Ankle Week 1
--
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 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. Ice worked better than opioids for managing pain.
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.
My daughter’s high school graduation was exactly 1 week after I broke my ankle (and the day before surgery). My wife secured a wheelchair space for me at the theater. I timed the Norco, and took it 3 hours before ceremony, so that the 90 minutes of relief would happen during the ceremony. I brought the knee scooter and a pillow. 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 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 helped throw a graduation taco party for my daughter in the evening and then had a snack at 10pm before next day’s surgery. Then I drank water into the morning.
