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FractureAdventures of a broken body$

Ann Oakley

Print publication date: 2007

Print ISBN-13: 9781861349378

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781861349378.001.0001

Show Summary Details

An accident at White Creek Lodge

An accident at White Creek Lodge

Chapter:
(p.1) 1 An accident at White Creek Lodge
Source:
Fracture
Author(s):

Ann Oakley

Publisher:
Policy Press
DOI:10.1332/policypress/9781861349378.003.0001

Abstract and Keywords

This chapter is a detailed account of the accident that occurred to the author a few years back which led her to writing this research study. The incident occurred at White Creek Lodge, a small lodge offering several recreational activities for its visitors. The chapter narrates the author's incurred accident, starting from how she broke her arm, admission to the hospital, surgery, and flight back home to Heathrow. From then on, the ‘impact fracture’ had an impact on her life.

Keywords:   surgery, research study, White Creek Lodge, Heathrow, impact fracture

The three of us had planned a short break before a conference in Denver, Colorado. Clare had found the hotel on the internet. It described itself as a ‘Lodge’, and attracted custom at this time of year with a decor of fairy lights hung over snowy trees, artificial log-burning stoves, and menus of floridly described American food – homemade wildberry muffins, pork ribs with maple BBQ sauce, French fried corn fritters, and so forth. ‘Nestled in the foothills of the Rockies’ said the internet blurb, ‘White Creek Lodge is a quaint and charming country inn, featuring antique quilts and comfortable overstuffed furniture. There are trails for walking, and many recreational facilities, including canoeing, skiing, snowboarding and snowshoe trekking, sleigh rides and horseback riding. Antiqueing and great outlet shopping near by. White Creek Lodge is a haven of tranquillity – your stay with us will be quite unforgettable.’

The last clause of White Creek Lodge’s inviting self-description proved horribly prophetic. Seven years on, I’m left with a series of jerky monochrome images. I closed the door of my hotel room, which was in an annexe in the grounds of the main building, and prepared to (p.2) make my way to Kate’s room, where we had organised massages for ourselves as a reward for a long snowy walk. I stepped outside onto the path which led from my room to hers. We had noticed the ice on the path earlier, and had suggested to the hotel staff that they might usefully add some grit to it. It was intensely cold; there was very little light beyond the front door of the low hotel building. The surface of the ice was dark with lumps of grimy snow. I remember putting out my right arm to stop myself falling. I remember lying on the ice. The whole of the right side of my body felt pain, except for parts of my arm and my hand which were completely numb. I felt very nauseous. Then I noticed through the sleeve of my coat that the bone in my upper arm was sticking out, pushing at the confines of the cloth.

I wanted to close my eyes and go to sleep, but instead I waited for the nausea to subside and then got up very slowly and steered myself to Kate’s door, which I opened with my left hand. I announced that I had fallen over, and went through to the bedroom to lie down. Then, when Kate and the masseuse checked on my strange silence, I told them that I thought I’d broken my arm. Remarkably, my brain had come up with a definition of the event without any conscious help from me. The masseuse, whom I recall as blonde and broad-cheeked, but who may have looked entirely different, knew a bit about bodies and so took charge of the situation: she asked Kate to fetch some ice from outside the door and she managed to get my coat off. Much of this is just a blur. I lay on the floor beside the high floral bed. I could hear someone screaming. We waited a long time for the ambulance. The masseuse held my arm, which was encased in my favourite purple polo-neck jersey. At one (p.3) point, she grasped the jersey with her teeth, to free her hands for other manoeuvres. I thought of it as a bag full of loose old bones, like chicken drumsticks or a medical student’s toys.

This was the rural backwoods of the USA, an area staffed only by a volunteer ambulance service led by a journalist with one paramedic and another in training. As they carried the stretcher up the path, the crew were nearly all victims of the same accident as I had been. The van itself was mechanically shaky, and it didn’t seem altogether obvious that we would make it to the nearest hospital, some forty miles away. The light in the ambulance was very bright; it was very cold in there. They reassured me that I’d probably sustained just a simple break: I’d be back in my bed at White Creek Lodge that night; arrangements for the conference in Denver would proceed exactly as planned; I’d just have my arm in a sling, that’s all. The incident was only a minor interruption in the ordinary flow of my life.

This being the USA, the first thing that happened when we got to the hospital was that they wanted to know who was going to pay the bill. Kate’s search for my insurance documents was the start of a long saga involving many phone calls, two insurance companies and the university in London that employed me. (We could all write a vindictive paper along the well-known lines of how insurance companies do their best not to help.)

Once admitted to hospital, a nurse cut my purple jersey off me. I perversely minded the loss of the jersey very much. ‘Closed intra-articular fracture of the distal right humerus’, say the medical notes. It was an ‘impact fracture’, a break caused by the circumstances in which (p.4) I’d fallen. The sanitising and obscurantist medical language does have the word ‘fracture’ in it, but what is ‘intra-articular’? I assumed that ‘closed’ just meant the broken bone didn’t open the skin. Interestingly, ‘distal’ means ‘situated away from the centre of the body’, a point that later seemed to me psychologically quite incorrect.

When he came into my room, the surgeon’s opening gambit was, ‘Ah, a university professor!’. To this I could only reply, ‘But I don’t look much like one at the moment, do I?’. ‘Oh, I don’t know,’ said he. When Clare and Kate, looking after my best interests, interrogated him before the surgery, Dr Finnegan disclaimed all knowledge of evidence-based medicine, an international movement designed to base health care decisions on sound evidence of effectiveness. Most people who’ve never heard of this wonder what medicine was based on before the evidence movement, and they’re quite right to wonder. Dr Finnegan, who fixed my arm, must have wished that it didn’t belong to a sociologist with two assertive friends in tow, but he bore his interrogation well. Having established that he didn’t know what evidence-based medicine was, Clare and Kate questioned him about his experiences of this type of surgery. Yes, he was an experienced man. ‘I should tell you,’ though, intoned Dr Finnegan most memorably from the bottom of my bed, ‘that we rarely manage a good outcome in such cases’. Somehow I had gone from being an ordinary person spending a few days in a nice hotel with friends to being a potentially unsuccessful ‘case’. I didn’t like this turn of events at all, but I had no choice other than to proceed with my new case-like existence and see where it would take me.

(p.5) The surgery lasted four hours and happened the next day, a Sunday. There was a holiday-like atmosphere in the ante-room to the operating theatre – Kate and Clare were there, and someone made tea, on the premise that the one thing English people always want is tea. Because of the pseudo-sanctity of informed consent in the American health care system, I was offered a choice of anaesthetics, together with a long list of all their known side effects, which, like the adverts for cleaning substances which kill all known germs, doesn’t reassure you about the unknown ones.

The pain after the surgery was of morphine-demanding proportions. I heard that voice screaming again. A nurse said I’d had the maximum amount of pain relief, which I couldn’t understand, because in that case, where was it? My arm wasn’t in plaster, but tightly bandaged and very swollen. Dr Finnegan told me that he’d had to use all his skill as well as seven metal plates and two screws to fix the arm together again. I couldn’t, of course, use it at all. I had no sensation in my fingers, although I could move them. I was also attached to a drip, whose purpose was to correct some metabolic abnormality.

The hospital, set in the plains by the eastern slope of the Rocky Mountains, was started by a group of local women in 1892 who knew that any community needed primary health care in order to thrive. Today it’s a notfor-profit corporation staffed by more than 2,000 health care professionals and support staff, specialising in family care and emergency medicine, and housing a regional trauma centre for injuries. The Rockies are famous for their ski resorts – Aspen, Jackson Hole, Deer Valley, Snowbird – all a product of 1960s hippie culture and (p.6) located in scenery that President Roosevelt said ‘bankrupts the English language’.1

After the surgery, my fracture and I are put in the second bed in a two-bedded room, next to a person called Mrs Purdy, who is on the telephone all the time, ordering things from cosmetic companies and complaining to her daughter, whom she alleges doesn’t care about her. Mrs Purdy is very nice to me. She’s welcoming, and she explains how everything works. She’s never been out of this small town in her life and I think she finds me and my Englishness, and my friends quite riveting. Periodically, her entire very large family troop in and sit noisily at the end of her bed, eating hamburgers and staring at the TV, which hangs high up on the wall, and for which we must pay extra. The dietician and the physiotherapist work hard on Mrs Purdy, and the young doctor is angry that his prescription of daily exercise is repeatedly ignored. A nurse marches her round the floor a couple of times a day, but Mrs Purdy, who seems to have real problems, says she can’t breathe and goes back to bed to make more phone calls. It isn’t her fault, but every time she eats she goes to our shared toilet where she deposits the kind of mess a simple flush won’t deal with. After my first few post-operative hours, I get used to taking myself and my drip to the toilet and flushing it again – no mean feat with only a left hand – and Mrs Purdy never realises what she causes me to get up to.

I’m preoccupied with the maintenance of bodily function. You get like that, when you lose it. It’s surprising how quickly you can, as a right-handed person, learn to feed yourself with your left hand. I’m immensely hungry, having missed more than 24 hours of meals. The hospital meals service includes a man with a bow tie who comes (p.7) round flourishing a menu card. But how can you floss your teeth or wash your hair or put your socks on with one (left) hand? One of the nurses shows me how to manage the socks: you roll them down over themselves and then it’s easy. Well, easy-er.

They are quite kind in this hospital, when they’re not doing painful things to you or reading out lists of the untoward effects of the drugs they want you to take. I’m called ‘the English patient’. I try to live up this image, but I prefer coffee to tea. I behave quite idiosyncratically – for instance, I take myself and my equipment for energetic walks round the ward floor, not because I want to shame Mrs Purdy for her slothfulness, but because the exercise makes me feel better. If I hadn’t landed up here, I’d be in the White Creek Lodge’s nice indoor pool, or striding through the snow with my friends.

When I wake up the day after the surgery, there’s a large, morose-looking man in a dark suit beside my bed. He’s a lawyer, what they call an ‘ambulance chaser’. He wants me to let him sue the hotel for breaking my arm. Dr Finnegan, a friend of his, had called him and asked him to come. The lawyer has an agreement he’d like me to sign – with my left hand (he’s not fussy). I tell him I’ll take it back to England and think about it there. He nods and goes away, but comes back later to report that he’s driven himself out to White Creek Lodge and examined the scene of the crime. The hotel is apparently incriminating itself by having now put up signs warning people to be careful of slippery paths. Someone from White Creek Lodge with a baby and a big bunch of flowers comes to visit me. At first, I welcome the visit as kindness, then, à la ambulance-chasing, it takes on an air of incriminating guilt.

(p.8) This isn’t my first time in hospital, and I do what I’ve learnt to do before, which is to concentrate on negotiating my route as a compliant patient through the hospital system. I take their medicines, I eat their food, I smile at the physiotherapist, I thank Dr Finnegan, I don’t complain about Mrs Purdy’s lavatorial habits, or her loud late-night conversations with her daughter. The only thing I do wrong is to assert my independence a little too much. I decline the wheelchair which is brought to take me for another set of X-rays. My legs work fine, and it’s very uncomfortable to squeeze my hugely bandaged arm into the wheelchair. This rebellion is held against me later by one of the insurance companies, which gets hold of my medical notes and argues that, if I can walk to X-ray, there can’t be that much wrong with me, and they certainly don’t need to fly me plus an accompanying person back to England.

Four days later, I fly home alone first class, astonished to learn that the price of a first-class ticket is 18 times that of an economy one. A chauffeur-driven car is sent to take the three of us to the airport. The driver, a grizzly bear in uniform, spins us an endless patter of tales about the history of the Rockies: mountain men trapping beavers, dollar-hungry cattle barons, the discovery of silver in a place called Leadville, how the native Indians call the Rockies, much more poetically, ‘the shining mountains’. He’s so taken with his tales of pioneer masculinity that he doesn’t notice our preoccupation with other matters. At least we get to sit briefly in the first-class lounge. This, like the whole experience of first-class flying, is wasted on me, although I do allow myself one glass of champagne. On the plane, I have my own steward, Gary, who takes the glass of champagne away (p.9) on a silver tray as we take off and then brings it back when we’re in the sky. It’s a revelation to find that, in first class, there aren’t any silly rules about stowing bags safely away in lockers and under seats – they lie around just anywhere, and the passenger (unlike the patient) is always right. Gary cuts up my food; he used to be a nurse in a former life. My escapades visiting the toilet with an arm in a temporary plaster cast remind me of a Peter Sellers film in which he has similar troubles with a broken leg. During the eight-hour flight, there’s plenty of time for such details; I have to get up and walk around every hour because of the risk of deep vein thrombosis following a general anaesthetic. Some months later, back in my former life, I advise the English Department of Health on the methodological soundness of an expert report on the relationship between air travel and deep vein thrombosis. It seems clear from this that I shouldn’t have been allowed to travel so soon after surgery, but I’m glad I didn’t know it at the time.

‘Wheelchair assistance’ notes my ticket, although there’s nothing wrong with my legs; I just can’t carry anything. A person to carry my bags would have been much more helpful than the hour-long wait at Heathrow for the wheelchair with its sulky attendant, while conversations of the ‘Does he take sugar?’ variety waltz over my head. A fleeting exposure to dis-ableism is terribly convincing evidence of the humiliation and hardships that others must endure and challenge for a lifetime.

The trip from Heathrow is grey and cold, but there’s no ice that I can see. I know I’ll always be scared of ice in future. Something has happened to me, but I’m not sure what. I should be in Denver, in a plushly carpeted (p.10) pink-lit hotel, giving a paper about the importance of evidence in making policy decisions, instead of which I’m nursing a smashed-up arm and beginning to wonder what impact my ‘impact fracture’ will have on me and my life.

Notes:

(1) Ackland, D. and Freeburg, J. (1988) The Rockies, Singapore: APA Publications.