On Call with an Orthopedic Surgery Resident

“Trauma team to the ER, Trauma team to the ER,” erupts a flat voice from the PA system. It’s a warm summer Saturday night in NYC, and for me that means more people outdoors finding new ways to break their bones. As a medical student, the first piece of advice my senior resident gave me on my trauma surgery rotation was to take my own pulse as soon as a trauma activation comes in. Running down to the trauma bay hysterically scares yourself, the staff, but more importantly, the patient. So, as soon as I hear the announcement, I stop checking post reduction X-rays on the distal radius fracture I just reduced, take a deep breath, and start heading down to the ER.

As I approach the trauma bay, the sheer number of people outside the curtains signals intense interest. I can make out a flurry of activity just beyond the curtains and hear the trauma surgery resident methodically going through the initial survey. I carefully walk past the onlookers and open up the curtains and find myself at the foot of the stretcher. “Are you ortho?!” I nod to the resident as I look at the patient, a thirty-something year old male lying on an orange backboard with a cervical collar around his neck. Quickly, I’m drawn to the obvious deformity at his left femur, and his right ankle was pointing at a grotesque angle with the bone almost poking out of the skin. “So this is a 34-year-old motorcycle versus car, helmeted, no loss of consciousness. Only injuries appear to be ortho-related.” Motorcyclists keep trauma and transplant surgeons in business, unfortunately. However, I could already tell that this guy, aside from his lower extremity injuries, is relatively lucky.

I quickly try to reassure him, “Hey, I’m Dr. Williams, one the orthopedic residents. I’m going to do a quick exam, okay?”

“It’s my FREAKIN’ legs, dude!” he shouts.

“Oh, he’s also drunk,” adds the trauma resident matter-of-factly. Things have calmed down a bit now that the patient is stable. “Where’s the rest of your team?”

“I’m the only one on tonight,” I answer. Taking solo call was nerve racking at first. Being the only ortho doctor in the whole hospital and having that responsibility felt suffocating the first few times. But gradually, confidence is gained and measured in spurts of successfully treated patients. After confirming he had no other obvious injuries, I tell the patient about his broken femur and fracture dislocation of his ankle. “Ted, we are going to have to X-ray your left leg because it’s probably broken, but your right ankle is fractured and dislocated. I am going to have to put it back in place right now.”

“WHAT?! Naw, naw, naw, man! Knock me out, PLEASE!”

“I can’t knock you out, but I will put some novocaine in your ankle to help numb it up. After I put your ankle back in place it will feel much better.”

He frantically nods and allows me to proceed. I gather all the equipment and splint materials. Then I enlist an ER intern and a nurse to give me a hand.

“OK, first I’m going to put a needle in your ankle to numb it up.”

“OW!” He flinches. I get in position and grab his deformed ankle gently. I ask the nurse and intern to grab his knee to help me relax his ankle.

“I’m going to do some quick pulling, and then put your leg in a splint up to your knee. This will hurt a bit, but I promise you that once I’m done you will feel a lot better.”

I quickly pull his foot outward and feel the broken bones grating. He moans loudly, but doesn’t scream, the intra-articular injection is taking the edge off. I then guide the ankle back to its proper place and feel it clunk back in, and his moaning abruptly stops. Next I put the splint on and he starts yelling at me once I start molding it. After five minutes, the ordeal is over, for both of us. His ankle, now back in proper alignment, is less painful, but I’m now sweating from all the force it took to hold it in place as the splint hardened.

With his ankle fracture dislocation and probable femur fracture, Ted and I will have a couple trips to the OR and several more days to get to know each other. My pager goes off as I explain the procedures he needs in order to walk again. I quickly glance at it as I talk –6YO GIRL ELBOW FRACTURE FALL FROM MONKEY BARS–it reads. Yep, it’s summer in the city and I’m on call for another 20 hours.

Ted, a little more sober now from all the pain, reaches out his hand and says simply, “Hey, Doc. Thanks.”

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