My New Titanium Elbow

“You’ve got your bum out” a nurse said.

“I know” I replied. They’d given me a broken bloody gown and I had a broken bloody elbow.

How was I supposed to tie it? I had run out of clean knickers and I wasn’t about to put dirty ones back on.

“Your bum’s hanging out” a middle-aged patient said, offended.

“I know, they gave me a broken gown!” I replied. A shower would sort it.

A wet wipe clean had never looked so appealing.

Your mission was to heave yourself out of bed with your abdomen and your good arm, without making your elbow spasm, causing a horrific shooting pain.

Then you had to get to the wet room down the hallway to the left, again without moving your bad arm, and early, otherwise it was always occupied. Annoyingly, you had to hobble past a closer shower, which was out of order the whole four days I was on that ward.

“‘Scuse me” the nurse looked flustered.

“Can you tie my hair for me please?” relieved, she obliged.

I had been told that I was definitely having surgery today (day three) and I was determined to be clean for it.

Somehow I washed everything using one arm and a bit of creativity (resting a leg on a grab rail, keeping liquid soap steady on your shoulder…). I wondered how I was allowed to risk another fracture on a daily basis. Later I was not surprised to find that falls were the most commonly reported health and safety incident in England and Wales in hospital, with over 240 000 a year reported.

If I had fallen on my bad arm before the bone was healed, I would have had a “comminuted peri-prosthetic fracture” – a particularly complex fracture made worse by the interaction of internal metalwork on bone.

Nurses only had time for observations, support workers only had time to help with meals and making the beds. And my ward had a “very good” level of staffing according to the Royal College of Nursing.

A support worker came round and fussed about my table being “messy”.

I had most of my belongings there because that was the only way I could access them. But without asking, she chucked everything in a plastic bag saying it was a hazard, and shoved it in a cupboard out of reach.

I had a felt tip arrow drawn on me and three visits from various members of the surgical team.

They were so kind, helpful and understanding. They also explained that the reason I was in so much pain was because when my arm muscles contracted they were pulling my fracture apart.

ORIF surgery was Open Reduction and Internal Fixation.

I was going to have a titanium plate inserted over my elbow and that would be screwed into the bones to hold it together. They would clean out the wound first and remove any smashed bone. I would need months of physiotherapy. I was reassured that I was first on their list after lunch.

I was given the option of an uncomfortable one and a half hour surgery lying on my side conscious, being pushed and pulled about, or general anaesthetic, so I opted for the latter. They said they might have to insert a breathing tube but I didn’t want to be intubated so they said they would use a mask instead.

“You’ve become sensitised to pain” the anaesthetist observed, “that’s understandable given the nature of your injury.”

They looked enthusiastic and alert and and appeared to enjoy their work. I was even allowed to gingerly climb onto the operating table so I didn’t have spasms from being transferred. The mask was placed over my mouth and nose with an air gap but the anaesthetist saw that I was still conscious and sorted it.

***

I came to with a jolt in an unfamiliar white ward, like some kind of afterlife.

There were no curtains, just rows of beds, except I couldn’t see the other patients. Two curious faces loomed above me in green scrubs. Suddenly my body started convulsing.

The figures above me said something about pethidine and I was injected. My body relaxed and I felt much better as they whisked me back to the Trauma Ward.

The Traumatic Trauma Ward

Two cheerful young men in green scrubs came by in the early hours and introduced themselves as orthopaedic doctors.

I said “hi, can I have some morphine please?”

Codeine was not making any difference, there was an intense burning pain in the joint and if I moved my arm it was so strong I would cry out. Then there was the constant ache.

They exchanged glances. “Yes we can sort that. We have had another look at your X-rays and we think you probably don’t have an open fracture after all, so your operation can’t be prioritised. We might send you home for a week or two and bring you back in for the operation.”

I thought about trying to manage the agony with codeine.

“I want to stay in hospital until the operation.”

The medics acknowledged this and left.

I needed the toilet but I was on my own. I wasn’t prepared to pee myself and I couldn’t reach the buzzer.

Fortunately two support workers down the corridor heard me scream from the shooting pain of my muscles pulling my fracture apart, and one had to help me off the toilet.

After that I finally got morphine, but then a high-pitched voice jarred me awake. It was coming down the corridor accompanied by the squeak of wheels.

Lily was an advocate of LGBTQ rights, she said, and she wanted to be a counsellor for the LGBTQ community because one had really helped her.

She had been using a pedestrian crossing because the traffic lights had changed to red. A taxi had sped through and over her, breaking her back and legs. The driver had got witnesses to agree with his side of the story, that the lights were actually on green.

When she was not telling everyone about it, she was moaning in agony.

I was kept nil by mouth the next day, so I missed breakfast and lunch.

In the morning I waved goodbye to the smiley staff who had helped me, as I was wheeled out of the Theatre Recovery Unit and onto the orthopaedic ward. I hoped it would be quieter. It wasn’t.

The orthopaedic ward was larger and open plan, with a blocked dirty toilet and one shower serving 12 patients. The spare toilet and shower were both broken. Unlike the Theatre Recovery ward, it was usually fully occupied and half staffed.

My four day neon hell of noise and pain had begun.

It was Sunday morning and a woman was being gently and firmly reassured by a nun.

Next to her was 88 year old Brenda, who was visited by her son and the two laughed together. She was outspoken and her bright eyes took everything in. She beckoned me over and we had some good chats. She had survived breast cancer and then she had had a fall. She said she would probably die soon. “You seem pretty healthy, I don’t think so” I said. “Oh love” she smiled, “I’m not afraid of death, I know I don’t have long left, that’s just how it is. My husband passed eight years ago so I don’t mind, I’m ready. I’ve already survived breast cancer” she said proudly.

The table was put on the side of my broken elbow, so I could not reach anything and no staff were available. They had even put the call bell out of reach. I lay there looking at the clock, counting the hours until my boyfriend would break the monotony.

Finally, my first meal of the day was served, a flavoursome beef curry. My boyfriend brought home-made banana cake for dessert and it was so comforting to see him.

He brought in my medication which I had not had for two days. A nurse had not arranged it as she promised, when she refused to let him bring it in onto the Theatre ward.

Night fell and so did the staffing levels. Once again I was without morphine for hours and I couldn’t help making a noise about it, it was the only way of processing the mental stress of being in constant agony and helpless.

I apologised to my fellow inmates as I groaned through the hours, waiting for two nurses to be able to sign off the only thing that would let me sleep.

I played a pain management meditation and calmed down as I watched the clouds lighten. Pain was part of life, it was temporary and it wasn’t always a bad thing. I shouldn’t resist it or be worried about it.

A bed pan was brought but I somehow wet myself and an exhausted zombie nurse had to change the bed. She said how she was on her fourth or fifth 12 hour night shift.

The closest patients both had dementia, one lovely lady was unsettled by my moaning and repeatedly asked if I was ok. The woman opposite repeatedly asked for help even though she didn’t need it. Flustered staff checked and eventually she was ignored. This seemed to increase her harassment of them.

When I finally got morphine I was still in too much pain to sleep, so I got the nurse to get the doctor. Finally, a girl in her 20s sympathetically doubled the dose so I could finally drift off. As the dosage increase hit my system I suddenly vomited, and then spilt some on myself putting the bowl on the table. I had to sleep in it as no one was available to change the bed again.

Maybe I would get surgery tomorrow…

A Sharp Brake

Bluebells illuminated the forest floor, birdsong reverberated, bright green leaves curled round us and treecreeper birds hopped up to the heavens as we cycled through the woods. Abdominal cramps slowed my progress up a disused side road leading up to the main road.

Years of temperature changes and heavy rains had carved a ditch up one side. The concrete underbelly had been exposed, jagged rocks protruding like blunted shark’s teeth.

Having made it to the top I admitted defeat. “Go on, have a nice ride” I said, “I can’t manage it”. My boyfriend protested, but accepted it and I rolled back downhill.

I should get off and walk, I thought, the road was so uneven. But my suspension would take it.

Towards the bottom, I was speeding towards the ditch, so I gently squeezed the brakes and skidded. Abruptly, like the wheels, time accelerated. Instinctively I braked too hard as I slid, catapulting myself over the handlebars. I was aware of flying and saw that my arm was held out at 90 degrees, protecting my head. I shut my eyes and braced myself for impact.

I was rolling onto my left elbow.

An overwhelming burning sensation had doubled me over. It was impossible to tell where it was coming from, my brain would not compute.

I wondered when someone would find me. I tried to get up but my body would not allow it. Putting weight on my cut right elbow made me scream, so I let my forehead support my weight so I could see whether anyone was coming down. At least it wasn’t my writing hand.

I decided to keep screaming, it was comforting to think that somehow my boyfriend may hear me. It also helped to slow my breathing down. My fitness tracker watch somehow had not been smashed and my pulse shot from 80 to 130 beats per minute, as my body trembled in shock, my temperature dropping.

After the second bout of screaming, my boyfriend blurred into view, jumping off with the bike still moving, wide-eyed.

Seeing my position and pain, he said “we need to call an ambulance.” My rational brain woke up. “My phone is in my bag” I croaked, struggling to speak loudly.

Our first Good Samaritan stopped, a tall, middle-aged man wearing glasses. My boyfriend did not have his phone and had not processed what I had said. “Does he have What Three Words” I asked. Incredibly, the stranger had the GPS application.

My boyfriend put me on the speakerphone and in between shrieks I answered. I was warned that an ambulance could take up to three hours.

They apologised, that was the non-urgent wait time as my life wasn’t immediately at risk. I wondered whether I would eventually pass out in agony.

My boyfriend jumped back on his bike to get the car.

Then Adam, my second knight in shining armour, rode to the rescue. He whipped out a full first aid kit, keeping me warm with a silver blanket and a thermal coat from his backpack.

“Yep, that looks broken” he said, and helped me to shuffle off the road on my bottom so I could rest against the wall.

With his encouragement I dared to extend my elbow slightly so it was supported on my helmet. The burning, pulsating sensation was increasing and I was glad that this kind man was keeping me company.

Distracting me, he told me how he had been a mountain bike guide for decades. He loved the outdoors. If I had not braked as hard I would have been OK, you have to let yourself skid.

My boyfriend arrived about 15 minutes later and we stashed my bike in a cottage driveway.

Every bump and corner caused strong shooting pains. The full waiting room of patients stared in horror as I staggered into Accident and Emergency like a zombie from Shaun of the Dead, my bruised and swollen elbow dangling out.

Administrators put me to the top of the queue and within minutes I was being checked over by a friendly triage doctor.

As she helped me into a hospital gown, I asked “it’s just a standard break isn’t it?”

“I think that’s optimistic.”

“They can just put a pot on it and send me home can’t they?”

“Again, I think that’s optimistic” she smiled.

“Go on, what do you think it is?”

She winced at my bulbous hinge joint. “I’d say it’s an open fracture, I don’t think you’ll be going home tonight.”

“Oh.”

We waited about an uncomfortable hour for assessment. I could not bend my elbow enough to sit down, so I was glad my boyfriend was there for me to lean on and he put a comforting arm round me. The patients sat in silence, until a man walked in, cheerfully telling someone on his mobile phone how he had sliced the top of his thumb off whilst preparing dinner.

An intact elbow for comparison.

The X-ray was interesting, it still looked like an elbow, until the medic pointed to where the olecranon, the funny bone, had slipped, the internal injury and the air that had infiltrated the joint.

A nurse tried to lift the elbow to put a pillow under it and ran off after I screamed, sending medics running to my aid. “Open fracture” I explained, they nodded and left.

WARNING: GORY WOUND

Then it was time for a temporary cast. I would not lie down as it increased the pain, so they made an exception for me and started it with me standing, then gave me gas and air as they urged me to get on the bed. I experienced a powerful bout of nausea followed by nearly blacking out. “It worked” the nurse said “or that would’ve really hurt.”

There was a panel of medics in scrubs looking at computer screens in front of me like traffic control.

Woozily, I slowly hauled myself up and asked a nurse where the toilet was. “I’ll show you when I’ve finished this”, she replied. Then she conferred with another nurse and I blearily followed that woman past resus until she sat down at another A and E ward.

“Sorry, I thought you were showing me where the toilet was”.

“Er, no” she responded, completely bewildered, “you’re best off going back”. After she pointed me there I got lost again, walking into “resus”, past people gasping for breath, staring wide-eyed at the ceiling. This was more intense than my holding area. It was a relief when I bumped into the cast lady.

“What are you doing here?” she asked kindly, and showed me to the toilet.

It took over three hours to get a bed. The Theatre Recovery Unit was a long ward with many rooms. Mine was only half full. The nurse, Joy, was either elsewhere, chatting about her recent holiday with support worker Gloria, or telling demented Doris to go back to bed. Doris would then get up again, preferring to twirl a chair at the nurse station.

I smiled at a bespectacled middle-aged lady opposite and she just stared gloomily back and asked Joy “can I go home tomorrow?”.

After being kept “nil by mouth” pending the “highly unlikely” possibility of surgery, I was finally given a ham sandwich for dinner at 10.30pm, when I begged for it. Maybe I would get my elbow fixed the following day…