Arm-ageddon For Flute Practicing

Fluting Will Be on Hiatus Till Some Healing Takes Place

B and I were taking down a few small dead trees—something we have been doing for 25 years. He had felled and delimbed a fat 8 foot long log that I was going to pull out of the ditch it was lying in. The ditch was 2 1/2 feet deep. Being more limber than B, I stepped into the ditch, lifted one end of the log and then took a very strong stride backward to pull the log up and out of the ditch. I knew the log was heavy, but I had no problem handling its weight. I pulled very hard on the end of the log as I stepped up and backwards out of the ditch. My left foot that was extended above and behind me landed on something that completely gave way taking my left foot with it. I was left in the air flying backwards, almost horizontal, submitting to gravity. I extended my left arm behind me to break my fall. It did break my fall by taking the full force and weight of my fall —it spared my head, shoulder, tail-bone and clavicle, but at the price of of the integrity of my two wrist bones. There was instantaneous severe pain and obvious deformity to my left wrist. Fortunately the log slid back into the ditch and didn't follow my arc to land on me. Our work day was over.

I’m telling this tale in more than the usual detail with purpose. Not because it is a fascinating or exotic story, but because it is a very common injury, particularly to older women, and because I suspect that many of my experiences are almost universal with serious injury, but are not talked about. Perhaps the detail will interest those who have experienced similar things or it may reveal to caregivers aspects of what the patient experiences while they are impaired.

While I was reconning with the fact that this was not an injury I could handle on my own, I was surprised to experience major total body sensations that were far from normal and indicated that I had a serious systemic problem. How otherworldly to realize you are in shock, but completely lucid—that your body has decided to activate its emergency life-saving protocol—presumably just till the problem is resolved. Even seated I was light-headed, very queasy and my whole body felt stunned. Standing increased all the bad sensations.

My head and body immediately knew something was serious wrong. I’ve had many hard falls in my life and suffered some bad sprains, but I had never felt this way. I was lucid, calm, and thinking clearly about what I had to do. My body was reacting very differently. It didn’t want me to move and made me feel so rotten and unsteady that I moved as little as possible. The body was shutting down to conserve vital functions, but the brain was unclouded, focused and rationally dealing with the problem. It was bizarre to recognize that this disassociation between intellect and vital functions for life were going on in parallel. This disconnect went on for two days and then seemed to be over in about 15 minutes— brain and body got back in synch. Immediately after the fall this dissociative brain/body phenomenon continued without letting up. I never felt “afraid” and had no sense of '“panic” while I was coping with the pain and shock which I found strange. I would have expected more mental-messiness and confusion. A wise friend, on hearing me describe this phenomenon of two distinct brain pathways functioning simultaneously said this was an example of “mindfulness.” Whatever was going on, it seemed a highly effective self-preservation mechanism. Something I would love to be able to tap into at will.

The emergency department was able to evaluate me within 30 minutes of arrival. The diagnosis was clear before the x-rays. I soon got an IV dose of Zofran and one of Dilaudid “to reduced your pain 50%” They gave me Ketamine and Propofol to knock me out before trying to perform closed reduction of the fracture (realign the bones with manipulation). The necessary pulling on the wrist to lengthen and straighten the bones was felt right through the conscious sedation. I remember yelling loudly through my haze when the pulling apart happened. B tells me that after the first attempt they took x-rays to look for improvement in alignment, but were not satisfied so gave me more meds and pulled again. I yelled again and then slipped passed conscious sedation into general anesthesia—I stopped breathing. Respiratory therapy was there and ready to bag me till I decided to breath on my own, When I became aware, my left wrist was ace-wrapped in a splint that immobilized my wrist and elbow. I still hurt, but less. Dizziness and nausea continued with the sense of being stunned and not right. I was given more Zofran (given for nausea) which seemed to take me from nausea to barf. With barf-bag in hand I was wheeled out to the car. I sat in the back so I could lie down and have more room to barf—which I did all the way home. I was miserable, but it was so much better to be home!

When the propofol and dilaudid wore off, the pain became serious. Over night, despite keeping my hand elevated (not hard as sleep was impossible), my arm and hand swoll and impressive bruising became evident in my fingers that became too swollen to bend. There had been no bruising prior to the attempted setting, but post-procedure it was not surprising to have some as pulling on bones hard enough to pull them apart will be tearing other anatomy in that neighborhood. Still, the amount of tissue damage was alarming. They said I could loosen the wrap around the splint if I got paresthesias (pins and needles sensations). My fingers looked like cooked sausages, but I never got the pins and needles signal to loosen the wrap. On the third day, I couldn’t stand the pain from the swelling into the tight splint and got B to help me loosen and rewrap. My fingers remained purple and sausagey, but stopped hurting. Now I could isolate the pain from the bones that gave a steady deep ache with twinges of severe pain if I got jarred or moved wrong. It felt like the bones were shifting and grinding against each other when the pain was searingly hot. The hand was completely unusable.

My strongly preferred sleeping position is prone—on the belly. I was told by the Emergency personal, and emphatically confirmed by Google, that I needed to sleep with a sling on for 6 or more weeks. No prone sleeping allowed—as though sleeping was going to happen. It was a long night.

When I got up the next morning, I found that the unpleasant, “stunned” feelings of light headedness, dizziness and queasiness were still strongly present. Those feelings persisted for another 48 hours. To avoid light-headedness and to make any urine, for two days I had to drink over 3 times the amount of water I normally consume despite no external blood loss and no activity. I think this was evidence of hypovolemic shock. I wasn’t able to maintain adequate circulatory blood pressure due to my body’s reaction to the injury, not through any loss of fluid. It is evidence of how seriously my body considered this injury.

We got to see an orthopedist 5 days after the injury to determine whether the closed reduction (bone setting) was in a good position and to arrange future therapy. Good news was that using a sling was optional and not required for sleeping. I mad a home made one to support the arms weight when upright.

Alas, I did not get a good report on bone alignment…

This was typed with one hand, be kind about the errors.