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Posted by on May 28, 2016 in CRPS / RSD | 0 comments

No symptoms yet…  (28.05.2016)

No symptoms yet… (28.05.2016)

I’d broken my right arm (fractured my radius; a Colles’ fracture) in early March 2016, and had gone to a local community hospital. The emergency physician there had done an excellent job of setting it; I know, because she proudly showed me the before and after X-rays! While she’d evaluated me, we’d been chatting about bioethics (or medical ethics) – my field. She knew that I was interested in what she was doing from a healthcare worker perspective, so explained everything her process in detail. It was a relatively quiet night in the emergency department, so she could take the time to do this for me!

When I left the emergency department I was told that the hospital’s orthopaedic department would call me within a few days, to book an appointment for an outpatient follow-up about 10 days later. Luckily I was given a copy of the referral form; a carbonless paper form. After 5 days no one had called me, so I called the orthopaedic department myself. Good thing I called; it turned out that somehow my referral form had been lost, within the hospital.

Because the healthcare system in Québec is operated by the provincial government (including hospitals), and paid for with taxpayer funds, we lack a functional electronic medical record (EMR) or electronic health record (EHR) system. This means that our healthcare institutions still function largely on fax technology to communicate patient information. So I was asked to fax my referral form, from one department in the hospital to another department – at the same hospital!

Because of the heavy snow and extreme cold during our winters, I hadn’t been able to get out on my bicycle for a few months. I wanted to be sure that my hand and arm were ready to start cycling as soon as possible after the cast was removed, so I’d already scheduled physiotherapy (PT) appointments.

I called my PT clinic to explain the situation, and they kindly offered to fax the form to the hospital for me. I’m not sure what patients who don’t have access to fax machines are supposed to do in these types of situations; drive to the hospital to hand-deliver the form? Or use a carrier pigeon?

Once my PT clinic had faxed the referral form, I quickly received a call from the orthopaedic department and was scheduled for a follow-up appointment in mid-March. I was assigned to an orthopaedic surgeon, even though it didn’t seem that I’d require surgery; the hospital assigns physicians in this department on a rotation basis, and he was the next in line.

The surgeon told me to sleep with my cast raised on a pillow, and to keep my arm on my desk at work, as my fingers seemed swollen. He also advised me not to hold my arm in a specific horizontal position, as doing so could cause the not-yet-set fracture to change positions. My husband and I were going on vacation for a week, so I was prescribed some pain medication in case the pain bothered me while we away.

He then had the orthopaedic nurse to remove my cast, so that I could walk over to the radiology department for an un-casted X-ray and then return to the examining room while he read the X-ray. He explained that he wanted to be sure that the fracture was healing properly, and that the two ends of the bone were still aligned in the correct positions.

The X-ray showed that the bone was healing well, and the surgeon advised me that I wouldn’t require surgery. I was very relieved, and feeling rather pleased with the way things were going.

He told me that he wasn’t yet sure whether I’d need to have a cast for 6 or 8 weeks, but that I’d probably be out on my bicycle within a couple of weeks after the cast came off at the end of April. My husband was sitting in a guest chair, and gave me a thumbs up; everything seemed to be going so well.

The nurse came back into the examining room and began to recast my arm, and the surgeon left to see to another patient in an adjacent treatment room. I noticed that the nurse was holding my arm in the exact position that the surgeon had told me to avoid. When I mentioned this to him, he replied (in French) that he knew what he was doing and handled fractures just like this one all the time as a specialized orthopaedic nurse.

At that point I felt an unbearable pain, and one of my legs started to shake violently. I had no idea what was happening. The nurse looked down at me, as I sat huddled on a gurney in excruciating pain, and told me (in French) to “stop exaggerating ma’am, it’s normal for this to hurt”…

My jobs, for years, had involved protecting patients’ rights – yet I was unable to utter a word in response to his comment. It was so inappropriate that I was completely stunned. My husband later told me that he’d been furious with the nurse, but hadn’t said anything as he didn’t want to interfere with my “care”. After a moment the pain subsided somewhat, and the nurse was able to finish casting my arm.

Before we even left the hospital, the pain had come back in full force, and I had to sit down as a wave of nausea washed over me. I was in so much pain that I thought I was going to be sick, right there in the waiting room. The nurse had said that pain was normal during re-casting, so I thought the pain would subside after a little while. It never did…

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