Remember Nadia Comaneci? Montreal Olympics, 1976? At age 14, she won three gold Olympic medals, receiving several perfect scores of 10 along the way. I was nine, five years her junior, and I remember being completely enthralled with both the Olympics and Nadia. Especially Nadia. When she looked into those Olympic cameras after finishing a routine, I just knew her big smile was meant for me. Yes, even at 9, I had a little bit of a pathetic yearning to me.
Unfortunately, my next patient in Room 33 was no Nadia. Not even close.
I walked into the room to find a 52 y.o. male lying in the hospital cot, writhing in pain. He looked older than his stated age, was short in stature, and chunky. His wrinkled forehead merged fluently into his bald scalp, framed by a skillful comb-over. His wife, wrapped tightly in her overcoat, had pulled up the corner chair to sit alongside her husband's cot. As she nervously tucked wisps of gray hair behind her ears, the concerned look on her face tightened.
"Sir," I asked, after my brief introduction, "what happened?" I wasn't going to pussyfoot around when he appeared to be in so much pain.
"Ohh, ohh," he moaned, "I slipped in the shower." With those words, both of his hands instinctively went under his sheet to his groin area.
"What did you hurt? Your hip? Your head?" I asked, looking from him to his wife.
"No," his wife jumped in, "he did a split. Like a cheerleader. He hurt his groin."
"A split? Like a cheerleader?" I asked, my mind immediately picturing Nadia and her floor routine. "You mean as in a full split to the ground?"
The middle-aged man nodded "yes" as his wife spoke again. "Yes, that's what we mean."
I could hardly picture this patient bending over to tie his shoes, let alone having one foot slide north while the other headed south. It sounded like a true, black-and-blue ball-smacker. And at his age, no less! My thoughts of Nadia, unfortunately, were replaced with images of this patient in his shower. Naked. Dripping wet. Finishing up his wash cycle. And slipping. Laying on the bathtub floor, under the hot streaming water, yelling for help. Ouch. Dreadful.
Suddenly, my groin hurt, too.
"I'll be right back, sir," I assured him. "I'm going to go find your nurse and order some pain medication for you." Male groin pain is a true emergency in my book, any day. After all, you know how wimpy us men can be. Women, on the other hand, are tough as nails. They laugh at pain like this.
I found his nurse, who promptly brought this patient some injectable relief. After that, I was able to get a better history and perform my physical exam.
This patient had had a long, exhausting work-day and, short of a drink, all he had wanted was to have a nice, relaxing shower to wash away his stress and burn down his tension-candle. As he was finishing, ready to turn off the shower nozzle, the freak accident happened. His forefoot slid forward, along the length of the slippery bathtub basin, while his back foot slid in the opposite direction, towards the drain. All the while, his groin ligaments tautly stretched to their limit. When they would give no more, he felt the horrendous pain from the strain.
Did I say "ouch" yet? I did? Okay, then how about "Oh, shit!"
So, there he laid, in a split position, the warm water continuing to rain down from the shower-head onto his naked body, his groin aching and throbbing. Luckily, he didn't strike his head or hurt any other part of his body. Just his groin. Not to say that his split was graceful, mind you, but at least he kept the injuries to one area.
"Help me," he yelled, praying his wife would hear him.
She did. Not knowing what had happened, she called 911. Promptly, our prehospital emergency crews arrived, untwisting this patient's legs before drying him off (I don't think that was in the job description). They helped him into a robe before transporting him to our ER.
His physical exam? Well, it probably goes without saying, but this patient smelled clean, in an Irish-Springy kind of way. I wish all my patients could smell this good. Otherwise, his vital signs were stable. He had no neck pain. No head pain. No chest or abdominal pain. No extremity pain. Again, just pain in the groin. Pain that made this patient twist his unsettled body back and forth in his cot, probably aggravating his pain more. On testicular and scrotal exam, he had only some minor tenderness, which told me that his ball-smacker was no perfect 10. No swelling or abrasions. His hips and pelvis seemed stable, and I couldn't reproduce the pain by rocking his pelvis or rotating his hips. All good. The only thing I could really find, sadly for him, was significant inguinal ligament pain, made worse with his own torso-twisting.
We x-rayed his hips and pelvis to confirm that there was no fracture. And there wasn't. Sometimes, a ligament can avulse a small section of bone from where it is attached, but, luckily, I didn't see any avulsion fractures, either. We also performed an ultrasound on his testes, and, I'm glad to report, his jewels were without any significant trauma. Mild swelling at best. Nope, despite this fall, I don't think the patient would be packing much heat in his Levi 501 Button-flys.
It looked like he had a pure and painful ligament strain.
After controlling his pain and reviewing his tests, our ER team was able to get this gentleman up from his bed and have him walk in our hallways. Despite a little wider and inhibited gait, he did much better than I had anticipated. With every step he took, though, I found myself thinking "ouch," "ouch," "ouch." We offered him crutches in the event he got too sore to walk, but encouraged him to walk as much as possible without them. We advised him that if he wasn't significantly improved after a few weeks of conservative therapy, his family doctor may need to pursue a CT scan or MRI of his pelvis. Finally, I gave him icing instructions ("Yes," I assured him, "you do need to pack your groin with some frozen vegetable bags.") and some prescriptions for pain control. "Oh yeah," I thought to myself, "and don't attempt to run a marathon in the next few weeks."
The patient seemed to appreciate all of our efforts. I hope as much as I appreciated his flexibility.
Even though I work out frequently, including some intense stretching, I could never imagine doing a full split. Never, ever. I'm still cringing thinking about this poor guy and his accomplishment. Between discovering me and the laughing spell that would follow, I don't think my wife would have been able to call 911. She's the type that needs to see blood if you want to call yourself injured.
How this guy was able to walk after his fall was beyond my comprehension. I actually thought of including him in my "Heroes Among Us" column, but realized that half of my readers, the ones with two XX chromosomes, probably wouldn't find him so heroic. But when I think of a patient and hear Rocky's theme song playing in my mind, it's at least worth the consideration, right?
As I stood in the hallway and watched our tech transport this patient, via wheelchair, from his room to the ER pick-up bay, where his wife was waiting, I couldn't help but let my mind wander back to amazing Nadia again. A perfect 10. Can you imagine? The first gymnast ever to achieve such an honor. Heck, she was probably doing a split as her mother birthed her. I just don't know how the human body can do such things, though.
As for this patient, I thought back to the details of his slip and fall. I ran and got a sheet of paper, wrote on it, and held it up for the ER team to see. They all chuckled.
3.5. Because I was not the Russian judge, I was very generous with my score.
Although this patient was a long way from a perfect 10, in my book, he still deserved a gold medal. Or, at the very least, a pair of dangling bronze trophy balls.
And a bag of frozen peas.
As always, huge thanks for reading. Next post will be Friday, April 9th. I want to sincerely thank those of you who wished me a Happy Birthday and a Happy Easter in your kind comments. It was a great, memorable weekend. Especially, I thank those of you who shared a piece of your life story with us...very cool.