Wednesday, April 7, 2010

No Nadia

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.

25 comments:

911RN said...

Loved Nadia and Mary Lou Retton! Gymnastics is still one of my favs for Olympic viewing.Bet the old guy with the groin pull in the ER didn't demonstrate quite the same grace.

My MOM and I were doing cartwheels and splits in the front yard a day or two before my wedding. Had been years since I was a cheerleader- what was I thinking??!!Long story short- I hobbled down the aisle with a little hamstring pull.Not quite ER worthy but remains painfully memorable:)

Perhaps, the "Slippery Tub" event will be added to the next Gynmnastic Olympics. Your guy can judge for the gold and hand out the bag of frozen peas!

Great post!

rlbates said...

Poor guy

Jabulani said...

Landsakes man! Will ya stop writing such funny stuff when I'm drinking coffee...tsk *wipes keyboard*

Fantastic post. I could not contain the laughter with the "black-and-blue ball-smacker" and totally agree with the "Women,...laugh at pain like this." I confess, yes I did. But just a little. Ok, no. A lot. Great big guffaws and coffee-all-over-the-place laughing.

My daughter is a gymnast. She is currently working her way through left leg, right leg and box splits. And I'm working through the "Mummy look at me...look how far I am!" We're about an inch off the floor one way, 2 inches the other and I have no idea how to judge the box splits, because her nose usually hits the floor before her bum. I'm guessing that's wrong, right?

As I read this post, I was reminded of a skit that great Scottish comedian, Billy Connolly, did about testicles. It is hilarious. All I can picture now is 'elbow skin' hitting the deck. Thank you :)

Heather said...

OK, for real...I kept waiting for the part where the nurses all had sheets of paper with scores on them --because, um, I totally would have---and I would have been more generous with my score.. that gets a 6.75 for difficulty (a shower is not real big) and for embarrassment (EMTs getting you UN-naked).

Glad you had a good weekend. I went to take a bra picture for you but it was gone. I did, however, find another jewel. ;)

Happy rest of your week!

Tanya said...

Poor guy-my husband has tried to explain this kind of pain to me but being female, I just can't relate. And as for the scoring-funny~ I worked years ago in an upstairs office and people fell down the stairs all the time. I fell once, fortunately without injury, but when I finally made it up the stairs, my coworkers all were holding up numbers. My highest score was 7.5.

Katie said...

First of all, when we're on break from school I remember days of the week by weird things like blogs (otherwise the days merge together). Well, there was no class on Monday AND no blog, so I was totally confused. Thanks a lot. :-P

Second, no I don't remember Nadia in the Olympics of 1976...

Thirdly, another great post. I have XX chromosomes but doing the splits still sounds painful. Then I imagined my father doing them... Ten/fifteen years ago I taught him how to do a cartwheel but the splits were always off limits and now I understand why. :-)

Oh, and I think the scoring was clever!

<>< Katie

Webster said...

Oh my. And I understand that soft tissue damage takes longer to heal than broken bones. I imagine his tissue will be soft for some time.

Loki said...

Ouch ouch ouch oucchhhhh.

It is a testament to the pain of these types of injuries that any other man informed of it will immediately feel for the injured. When the story is told we often instinctively protect ourselves with our hands from some as of yet unknown threat.

rheumablog said...

Poor guy. The pain of embarrassment must have been almost as bad as the physical pain. I'm another XX here, but any sudden, unexpected, large pain is traumatic, wherever it occurs on the body. Perhaps one day he'll be able to laugh about it ...
-Wren

paedsnurse said...

Ouch! The poor man. Hope he got a tub mat to prevent slipping next time!

Anonymous said...

I've always wondered how the hockey goalies do it.

Babe Ruth said...

"It sounded like a true, black-and-blue ball-smacker." - Too funny!
You certainly how to turn a phrase.

And as far as the fairer sex being unimpressed with his pain, I would think anyone (XX, XY, undecided) could appreciate the pain of "a pure and painful ligament strain."

maryrn said...

I can sympathize with your pt. Many years ago I slipped getting out of the shower and dislocated my knee. The pain was intense but the humility was worse as the only thing I had on when rescue personal arrived was a towel. Unfortunately the knee just didn't pop back in and I had to be transported to the ED. Back then they didn't use meds to pop the kneecap back. To add insult to injury the gurney that I was on was to high for the doc and when he hit the brake release something was lodged under and the gurney almost flipped over with me in it. I also was sent home without pain meds took lots of motrin/tylenol and when I couldn't stand it anymore had my hubbie take me back to the ED where a different doc came in and laughed when he saw me. I guess the staff had spent some time after I left joking about my bad luck. End or story this doc was very kind and made sure I got something for the pain, a script for pain meds and a referral to an orthopedic doc.
I have been reading your blog for some time and really am moved by your caring and compassion. You have a gift and I will be coming back for more.

Happy Vegemite said...

Man, I am so going to hell for laughing at this poor guy's predicament.

Or is it your great writing that caused me to laugh, and therefore you are the one going to hell? Nah, I'm pretty sure that even the guy that this was about would laugh at the story too the way you have written it.

Anna said...

Ouch ouch, and I don't even have that kind of jewels, lol. That was excellent story again. You know your stories are amazing, I am glad that you found me, because I enjoy reading every word of it, sometimes in pain, and sometimes laughing really hard, and sometimes crying too. BTW I didn't know it was your bday, happy belated one. Anna :)

IrishPoet said...

LOL and OUCH! Love the story but once you mentioned Nadia and Mary Lou, I couldn't help thinking of a famous gymnast who was a patient of ours years ago...don't want to violate any HIPAA laws but she has had a nice career as an actress since then (Peter Pan?) One of the nicest 'celebrities' you'd ever want to meet and we were able to help her so she could continue her show! As a 50 year old nurse AND a yoga teacher, I can't emphasize enough the need to stay in shape and STRETCH those muscles as we age...namaste! :)

coulrophobic agnostic said...

Poor guy. Besides hurting like a motherfucker, that has to be a bit embarrassing - at least in hindsight, once it stops hurting.

Rositta said...

OUCH...I guess when your 14 your more flexible than when your in your 50's. I should think he might consider a grab bar now...ciao

Cal said...

That sounds like a terrible injury, regardless of gender... of course there is an extra layer of Ouch-factor if you are male, but a forced split sounds terrible on anyone. I kneed myself on the nose once when I was trying to towel dry my hair after a shower, a long time ago, still don't know exactly how I did that, but it hurt!

SeaSpray said...

He had to be really short ..like smaller than a munchkin short or one long tub. Poor guy. Glad not serious.

I used to enjoy watching her too.

Great post Jim.

t. said...

Oh. My. GAWD!!

Anything story involving a potential injury of the scrote and treaured contents is not only NOT funny, but horrific!

Reading this was akin to the scariest horror movie I ever saw.

Poor guy...

Katie said...

We had an English department picnic this afternoon. In front of our entire department (faculty, staff, students, etc) our creative writing professor took a well-aimed soccer to an unfortunate location. His son grade-school aged son was too young to fully understand the "Good thing we don't want any more brothers and sisters." This whole scene split the audience by chromosomes. We XX couldn't stifle our laughter while the XYs winced in unison. The professor hobbled to find nerf-football to use in retaliation against his son. His unsuspecting son ducked at the perfect moment, and we all rolled in laughter.

<>< Katie

Elizabeth said...

Just wanted to say how much I enjoy reading your blog. I just recently started reading it regularly after stumbling across it from another blog.

You have an excellent writing style that engages the readers mind, and it doesn't hurt that many of the stories are hilarious. Of course it could be the simple fact that I can totally relate. Seems ERs everywhere are so very much the same.

Keep up the good work, and the excellent stories. From reading your blog I think you would be a great ER doc to work with.

VetRN said...

As a former (and now waaay over-the-hill) competitive gymnast, I can just picture this; since I've met very few men who could ever do a split, even in their prime competitive years. They just don't have the built-in lower-body flexibility to allow that maneuver. I can only imagine the pain he must have felt. I would have probably upgraded him to at least a 5.4!!! (BTW, at almost 57, I can still do the split; but I will admit to needing just a little help getting up out of that position!!) LOL

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