Thursday, February 9, 2012

Just a broken arm

I see a medical rant coming on. Brace yourselves. Tonight, I had some evening plans to spend a bit of time with Betty and her little sister Joyce but as I went to pick them up one of the neighbor boys that I know, Kenneth, showed me a cast on his left arm and told me how painful it was. I had heard that he fell from a tree and had a compound fracture a week or so back but his mother brought him to a doctor in town and I kind of figured I didn’t need to be involved as broken bones seem to be something that a doctor would be able to handle here. Well…. Kenneth’s thumb was swollen to twice it's normal size and there was a large ugly wound where the unpadded plaster was ripping a large ulcer on the inside of his wrist. The cast went from just below his fingers to just under his arm pit but was obviously too tight from top to bottom. The wrist wound was clearly deep and infected and so tight I couldn’t even lift the plaster away from the skin. There was absolutely no padding so the sharp edges were cutting all the way around and it was evident that given just a little more time he would have some matching wounds on the upper arm as well. I couldn't figure out how he had managed this long.  Deep breath…. It is 5:30 in the evening. Ken’s mother was told 4 days ago (by Beckie) that she needed to take Ken back to the doctor and Ken says his mother knows it's bad but there is no money. So option #1, which was getting his mother to take care of it seems like a bad choice. Option #2 is to take him back to the clinic that put the cast on in the first place. But the odds that I’ll find a doctor there this time of day seems slim to none and if they did this shoddy of a job in the first place why should I pay them to do it again? Option #3- Try to deal with this myself. I’ve taken several casts off in ED and kind of enjoy it and I have the plaster to put a new one on and I love casting….this shouldn’t be too hard. I picked option #3.  In hindsight option #3 wasn’t as easy as I thought but I still don’t know what a better choice would have been.

The first problem was getting the old cast off. It was the tightest cast I’ve ever seen so there was no margin of error between plaster and skin. I don’t have a cast saw so a hack saw blade seemed like it would do the trick. I took Ken into town with me to purchase one. The mechanic’s shops were rapidly closing and I just couldn’t find one that had blades to sell. I’m sure I checked at least 6. Finally I called Steve (a team mate and bit of a handyman) to see if he had one. He didn’t but he was pretty sure he could do it with his sawzall.   So just as the sun was setting we pulled into his yard and got Ken settled into a chair. For some crazy reason he trusted us so Steve started sawing. It was slow going as Ken’s arm still hurt and the wounds were very tender but he was tough and without bloodshed we got the cast off. But it took a long time. There was old blood inside the plaster in two different places and poorly healing sores inside from the initial accident. There was also much dirt and it was really evident that they just slapped the plaster on. As I was putting the new cast on, Ken told me that last time they rubbed the plaster over and over, pressing it down. No wonder it was so tight! I explained that once I had it in place he was just to sit still and not touch it. (For those of you who care- because of the wounds, both the newer ones from the plaster and the initial ones, I just put on a partial sugar tong and held it with elastic bandages. I know the bones aren’t quite as well protected but I can’t stand the thought of putting that big infected sore under solid plaster.) So that was my evening. Not what I planned at all. I can’t stand the thought that even a broken bone can’t be treated correctly here. I had asked Ken to see his x-rays (anything that we would put in a medical file here becomes property of the injured/sick person to take care of) but Ken said that his mother hadn’t paid all of the doctor’s fees so they won’t give them their radiology stuff. I’m a tiny bit glad that I didn’t see them because I can only imagine how well lined up his compound fracture is. I just hope and pray that he still has good functional use of his arm when all this is done. 
Hey! Tanya took pictures!

Steve cutting the cast off.  Ofcourse there was no power so we were doing all of this by flashlight.
"Peeling" the plaster out of the wound.
I could still feel the bone edges not sitting well and Ken clearly still had pain.
Ken recovering after I put the new cast on.

1 comment:

Sailor RN said...

Nice work Jennifer!