One Step Changed It All

One simple step can change your world.  

I had just gotten home from an intrathecal pain pump refill.  Yes, I got the pump!!  I wrote multiple times  about that years ago, and it finally happened.  I will write about the pump, the insertion surgery, recovery rules, living with a pump and how it is refilled.  How it has absolutely changed my life for the better.  But this is the time now to write about that one step.

I was outside my apartment, simply walking, on a slight slope that's very sandy.  I stepped forward and the next step was suddenly on uneven ground, I slipped on the sand and down I went.  I passed out and woke up on the ground, crying.  I was not sure exactly what had happened, but it became very apparent that something was horribly wrong with my right leg.  Both my knees were bent under me which was weird because I can't bend my right leg under me due to two past knee surgeries.  I tried to move that leg, and I felt and heard a grinding unlike anything I've heard before.  I could feel bone against bone, I knew there were two bones where there should have only been one.  

I just cried and knew that I could not get up.  I was very disorientated.  Just when I was realizing I would have to call out for help, my neighbor walked out.  I called his name and said, "Help me", and he ran over to me.  I asked him to pick me up--I don't know why, I just wanted to get off the ground and off my bent knees.  He lifted me up under my arms and my legs unfolded.  I screamed.  I cannot explain the pain in my right leg.  He helped me to a place to lean against a couple steps away and I just kept crying, the pain was so bad.  I could not bear any weight on my right leg.  He went and got another neighbor who called 911 and we waited for the paramedics to come. My other neighbor came over and I asked her to go into my place and grab my purse and phone and lock my door.  When the paramedics arrived it was an issue for them to get me into the ambulance safely, with the sand and uneven surface--for their safety and mine.  They finally found a way and carried me, oh my--the pain with any movement at all was just horrible, I was screaming, it was the worst pain that I have ever experienced.    

The ride to the hospital seemed to take so long even though it is relatively close.  When we arrived to the ER, they transferred me to a bed, and while I waited for the X-ray tech, my leg was swelling and bruised, also on my ankle, but above my knee it was very swollen, like another knee above my knee.  That's the best way I can describe it.  They gave me a bag of ice for the swelling.  The tech came over to me with the X-ray machine and the X-ray was taken. The tech said, "You broke it, and you broke it good."  I wasn't surprised that a bone was broken, I just needed the doctor to clarify it for me.  When the ER doctor came to talk to me, he said that I had fractured my femur.  I was shocked--my femur?  From a fall like I had taken?  Then he informed me that I had fractured my distal femur, which is the 'end' of the thighbone near the knee.  It is part of what forms the knee joint, and it is the longest and strongest bone in he body.  Most femur breaks are proximal, otherwise known as a broken hip (which is actually a broken proximal femur.)  To fracture the distal femur, it is normally done in a car accident, a gunshot wound, or a fall from a height.  Being older, breaks like mine are usually seen with Osteoporosis.  The ER doctor said that femur fractures are 'no joke', the pain is some of the worst of broken bones, and that he had ordered an aggressive pain management protocol for me.  He told me I was going to be admitted, and they started giving me IV Morphine right away.  It felt like it barely touched the pain.  Any movement of my leg at all was terrible pain.  He said that an Orthopedic Surgeon would be in to see me in the morning, that I would most likely need surgery, and would need help around the house, home health nursing, physical therapy, possibly time in a facility.  That was a lot to take in.     

By the time I got into my room, I was exhausted.  It had been hours and I wanted to sleep but the pain kept me awake, and I had so much on my mind.  Everything had changed in such a short time.  So much to think about.  The nurses were so wonderful, kind and caring, telling me that the minute I felt pain, I was to call them.  I was taken in for a CT scan and being transferred onto a gurney then onto the CT bed was horrible.  Got back to my room and waited for the surgeon to come in.  Because they didn't know if I may go in for surgery that day, I had no water or food allowed.

The Orthopedic surgeon came in after reading the CT scan.  He said I had an oblique fracture with displacement, meaning the fracture was not linear, it had broken into two separate pieces apart from each other.  The fracture was long, from the end of the distal femur to the middle of the thighbone in an oblique line.  I had severe swelling that is called a Lipohemarthrosis.  This is a mixture of blood, water and fat that has leaked from the bone marrow.  A surgeon can not cut into a leg with that present, it needs to go down all the way before safe surgery can proceed.  The surgeon told me that I needed a plate and screws, a surgery called ORIF, open reduction with internal fixation.  The reduction is to line up and close the broken apart pieces, then the internal fixation is putting in the plate and screws. Later, my physical therapist likened my fracture to splitting a log, the bone is literally split in two.  It didn't look like surgery would be done that day, due to the swelling, he left it that a week from then he'd perform the ORIF.  He told me I would need to go to a SNF after surgery for inpatient physical therapy, and I would be in the nursing facility for 'quite awhile', that my safety was paramount.  Living upstairs just added to the time, needing to be able to navigate the stairs.  I would need nursing care and physical therapy once I was able to go home.  He said that my fracture takes over one year to heal fully.  He was a bit unclear on the time I'd be in the inpatient physical therapy care center, saying my fracture is a 'long road' to healing, that it was months, not weeks.  

He ordered a full leg immobilizer, which felt a bit better being tight on my leg from ankle to thigh.  It never came off--I wore it for over 4 weeks, wrapped in a plastic bag for showers.  No weight bearing.  Physical therapy came the next day to get me out of bed, even though I was on bedrest.  Now that was painful.  Really, really, very painful, log rolling to the side of the bed then very very slowly bringing my legs to the floor, then using a walker to take a few one-leg steps, then repeat to get back in bed.  The physical therapist and I made sure I had pain meds before I did all that. It really hurt.  A lot.  Weird guttural yells would come out when my leg was moved--in any way.  Quite a few swear words were screamed, all these were simply automatic.  But I did it, I pushed myself very hard and got up and out of bed.  I was determined to do anything I could to start on the road to healing.  Little did I know, I would not go back home for 2 1/2 months. 

I was receiving anti-clot medications, being in bed, on my back, for 23 1/2 hours a day.  I ate everything they brought, I knew I needed protein, calcium, Vit D and lots of veggies.  I eat a lot of veggies and a salad every night with dinner.  I had not been inpatient in the hospital for more then a few days, back in 1977 for a big knee surgery- I was in for a week-things were much different then, after surgery doctors kept the patient in bed; no physical therapy for a few days and insurance didn't boot you out like most surgeries now.  I stayed just one night for my cancer surgery/total Thyroidectomy, and the two open spine surgeries, I stayed a few days.  For this fracture, I was in the hospital for 12 days.  I came to know just about all the nurses on every shift--a couple would come in after 3 days off and say, "Are you still here?"  As a nurse, I saw things through a different lens and I will say that the nurses at my hospital were amazing--every single one of them.  I was absolutely blessed.  There was talk about having me go to the SNF while I was waiting for surgery (insurance of course) and just the thought of all the transferring and movement really scared me.  In the end, thank God, I stayed in one place.  And I just so happened that night to be brought into a private room!  Timing.  God was with me from the minute I fell until this moment.  He is always with me, and He got me through some very tough days to come.     

Next is the surgery.  I find this all so fascinating and what the surgeon planned for pain control after surgery was new to me, and I am so grateful I had the surgeon I did.  Keep reading for the next leg (haha) of this journey.                                    

Gentle Hugs....and a tolerable pain day.