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Metatarsal

7/11/05 21:30 Casualty

Broke foot whilst warming up for the Gym, which is in my garage. Very embarrassing. I should have been wearing trainers, but was doing an aerobic warm-up barefoot. I rolled about on the floor in absolute agony for about 30 minutes. Then I crawled upstairs and called Steve the Chiropractor. He came round and pronounced it as a probable broken 5th metatarsal. He called St. Bernards Hospital and asked them if they would X-ray a 5th metatarsal fracture if we came in 1 hour. They would not say. So he took me wincing and screaming in the car from Guadiaro over the Gibraltar Border to St.Bernards Hospital. we waited in Accident and Emergency (A&E) for about 1 hour. There was one person in front of us. about half way through the wait, we got hot brown water from the coffee machine, and, as if by magic, a dr. appeared. We were the only people there. They must have a bell linked from the coffee machine to the Dr.s waiting room. He said I should finish the coffee and disappeared. Half an hour later, Steve went in to find him, as Steves family were waiting for him. The Dr. Was having a fag out the back, and had completely forgotten us.

Anyway, he looked at the foot and pronounced it as a 5th Metatarsal fracture, and that the X-ray technician had gone home and it was hospital policy not to get them out for a 5th metatarsal fracture, only 1st metatarsal ones. he said I should come back the next day, and that I would be walking in a week.

What a complete waste of time.

Have you ever noticed that the Morgue is right next to the A&E dept? Doesn’t say much for their success rate, does it?

8/11/05 10 - 2:30 Casualty (again)

Took half day off work, got taxi to Gib (25€ each way + £4 gib taxi) waited an hour for an X-ray (not bad). There were about 20 people in the waiting room, and they all looked fine. Not a thing wrong with them. Perhaps they were just resting.

Waited 1 hour to see another doc. in A&E. He looked at the X-ray and said it should heal, so it should go in a plaster.

Waited 1 hour for a plaster. I was in a lot of pain at the time. The plaster they put on was a "Slab", which is a solid L-shaped slab of plaster which goes under the foot, with mainly bandages over the top of the foot and front of the calf. After the cast was on, the nurse said that my ankle would be fine. I said it was not my ankle which was broken, it was my metatarsal. She didn’t know. She said it would probably be ok. My foot was about 45 degrees down. It was supposed to be 90 degrees.

I went back to the doctor and complained that it was too tight and the wrong angle. He said it was supposed to be like that.

For the next 7 days, I was in Agony. The Plaster was much too tight. My foot swelled up like a purple and black blimp. I could not sleep. I had to keep moving my foot in the plaster to get rid of pins and needles. This caused pain in the broken bone. It was a miserable time. I had to have the foot elevated all the time. To lower it was to be in agony.

15/11/05 11:00 - 13:30 Dr Malec

The appointment to see the orthopedic "specialist" was for 11 am. So i arrived at 10:30 in the hope of being seen early. At 11:15 I got to see Dr. Malec, who just said it will be fine, and to go and get a "walking" plaster. he did not ask me any questions or look at the foot.

After exactly 1 hours wait in A&E, I got a coffee. As soon as I had the steaming cup of hot light brown water gently spilling down my fingers as I hopped back to my seat, they called me in for the cast. It was the same nurse. She took of the old cast - what a relief. I said it had been too tight, and can she make this one less so. She put on a fiber glass cast. I felt like a boat. It was much lighter.

That night I knew the real meaning of agony. My foot swelled up worse, my toes looked like a dead persons, pins and needles constantly and the pain. I got up at 4am and went to the garage. I tried various tools, and after about an hour managed to hack a cut either side of the foot in the cast with a pair of blunt garden flower clippers. This gave some relief.

17/11/05 10 - 13:00 Casualty (yet again)

I could stand it no longer, and went back to the hospital to have the cast removed. I queued for 1/2 hour in A&E where I was sent by the reception desk. The Nurse in A&E said he could do nothing with the cast without authorization from an orthopedic surgeon, and sent me upstairs to the Trauma clinic. The Lady there said there were no orthopedic doctors, one was off, one was in surgery all day and the other had had a heart attack or something. She sent me back to A&E where I waited another 30 mins. I explained the situation to the plaster nurse, who said they could do nothing. i then grabbed the cutters and said I would have to do it myself. He then had me wait while the nurses consulted with the head nurses about my case. Eventually they agreed to remove my cast, but could not put on a new one without the authorisation of a surgeon, who would not be back till the following Tuesday. Great.

Over the next 4 days, with no cast, my foot started healing, and the pain started going. The swelling went down, the colour changed, I could sleep. I could even start to move the foot without pain.

Casualty (I now start to know all the staff by name)

Consultation with private surgeon

Operation!

I turned up early so that I would have time to go to the toilet for a poo. Yes I was nervous - I have never had anything worse that a filling before this. Kate the receptionist went into a closet and Kate the nurse came out. I got my kit off and put on an edible gown. I assume it was edible as it was green and edible paper like.

For some reason medical gowns are designed to cheekily expose your back side. Why is that? You never see patients wearing vests underneath them either. Not that I wear vests, or have any, or received any this Christmas from any aunties.

Then she bathed my foot in a brown Iodine bath. That made me feel better, I was worried that they would forget to sterilize stuff and I would die.

Then the local began. Dr Lees proceeded to inject the same stuff that you get in your mouth into my ankle. He would say things like "If I hit the nerve its going to really hurt for a bit. If it really hurts then I’ve hit the right place". Then your foot goes numb. just like your mouth does, but you can still drink without dribbling. The next step is the Dr. takes a small sharp object, e.g. a scissor, then sticks it in your good foot "so that you remember what pain feels like". Then he sticks it repeatedly in the numb foot. Its quite spooky, you see the skin depressing under the pointy scissor tip, but you don’t feel any pain - just a dull sense of pressure.

The operating theatre was a short hop away. It was a secret room behind the normal rooms, with couch in the middle.

Nurse Kate put a tourniquet on me. I wasn’t quite ready for that - I thought that’s what they used on MASH when amputating limbs and drinking home made alcohol. The tourniquet was like blood pressure measuring device - a black thing which went round my ankle, a length of rubber hosing, and a bicycle pump with a pressure gauge.

The doctors scrub up – which I now know means washing their hands. It seems that once they have washed the hands and put the gloves on, they cant touch anything which isn’t sterilized. They cant even push up their own glasses, the nurse has to do it. Why don’t doctors sterilize their glasses? This would free up the nurse to do more important things like telling the patient how brave they are and how it’s almost over.

They are about to start, and I’m offered pillows so that I can sit up and watch. Yeah right. I throw in all the usual gags: “Are you sure you’ve got the right foot”, “If anyone rings tell them I’m busy”, “If you need a hand, let me know”, “Is it too late to change my mind?”. This doesn’t work and they start anyway. Dr Lees holds my foot whilst Dr. Thomson hacks and drills and pushes 2 metal rods inside the bone. Its pretty labor intensive. Ever few minutes the nurse has to keep pumping up the tourniquet as it keeps going down. I’m going to buy her a new bicycle pump for Xmas. Luckily, the Doctors never say “oops” or “damn” once, so it must have gone well. At one point they said “perfect”. I ask them to say that more.

It takes about 2 hours from start to finish. When its over you get a cup of tea and biccies. How reassuringly British. I wonder what you get in Spanish clinics, beer and tapas?

15 minutes later I get a lift home. I feel fine until about 6pm, when the local starts to wear off. Slowly your foot begins to tell you that its been operated on. That night I take a couple of pain killers to sleep, and the next day its fine. Amazing really.

The day after the Operation

More to follow....

Lessons learned:

  • If you break something after 6pm, and you won't die, don't bother going to the hospital.
  • Don’t bother going to the hospital. Get your own xray privately, and go straight to a private specialist.
  • Don’t get a cast - they are torture instruments from the 1800s. Animals break their bones all the time and don’t need a cast. In fact in many cases it will heal quicker out of the cast due to the better blood flow. The only danger is re-breaking it.
  • If you get a cast and it really hurts, hack it off with a pair of garden seceteurs, and go back to the hospital for a new one.
  • In the hospital, they probably won't bother lining up the bones. So you might not function the same afterwards.
  • bones heal by filling the gap between the bones. So if your break has a big gap, the new bone will be significantly different from the old one. They will heal shorter, apparently.
  • The private surgeon will give you the option of pinning the bone. This will mean:
    • you don’t have to wear a cast, ever.
    • you can start to walk on it straight after the operation.
    • you wont get muscle and bone atrophy.
    • you have the risk of infection.
    • the bone will heal in perfect alignment.
  • If you don’t have private medical insurance, get it. I’ve got BUPA silver, it costs about £1000 a year, and its tax deductible in Gibraltar. So It only costs me 1000*53/100 = £530. Yes tax in Gibraltar is 47%, starting at 19k. Unless you are a trader in Gibraltar who is a foreigner, in which case you only pay 10k fixed cap, no matter how much you earn. How fair is that?
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Page last modified on January 02, 2006, at 12:14 AM