But First...

I'm still having some problems getting my thoughts sorted out on the nightmare mentioned in the previous post; just thinking about it brings up some degree of post-traumatic stress. So, until I can deal with those demons, I figured I would put this online for your perusal.

What follows is the text of the Operation Report from December 17th, 2009, the day on which my ankles were fixed. I just received this after asking for a copy of it during a follow-up appointment I had on Tuesday. Certain portions have been omitted to keep swarms of lawyers from descending on my family. Also, a few reformats have been done here and there to make it more readable, and I've added a few explanations of some of the more technical terms, trying to limit those so that I don't defeat the goal of improving readability.

Here we go:

OPERATION: 12/17/09

PREOPERATIVE DIAGNOSIS:
1. Left bimalleolar ankle fracture.
2. Right bimalleolar ankle fracture.

POSTOPERATIVE DIAGNOSIS:
1. Left bimalleolar ankle fracture.
2. Right bimalleolar ankle fracture.

OPERATION:
1. Open reduction internal fixation (a.k.a. ORIF - fixing a fracture after incision into the break site - ed.), left bimalleolar ankle fracture.
2. Open reduction internal fixation, right bimalleolar ankle fracture.

ANESTHESIA:
General.

ESTIMATED BLOOD LOSS:
50.

COMPLICATIONS:
None.

DRAINS:
None.

TOURNIQUET TIME:
Left 25 minutes and right 27 minutes.

INDICATIONS FOR PROCEDURE:
The patient is a 46-year-old male who suffered significant bilateral ankle fractures after a fall 5 days prior. He was eventually medically cleared and due to the displaced subluxed (dislocated - ed.) ankle fractures bilaterally was indicated for ORIF. He understands risks and benefits of surgery and consents for the procedure.

SUMMARY OF OPERATION:
Following successful induction of general anesthetic, both ankles were prepped simultaneously. Ancef 1 g (an antibiotic - ed.) was administered prior to start. Calf tourniquets were applied. The left side was done first.

Following exsanguination (I assume this means either free bleeding or some removal of blood from the site - ed.), toruniquet was inflated on the left. Lateral incision was made through skin and subcutaneous tissue. The fibula was dissected down to and underwent reduction. There was minimal comminution (breakage into a number of pieces - ed.) but somewhat softened bone.

Fracture site was irrigated of hematoma and a curette was used to remove any loose bony fragments. It was then reduced anatomically with a bone-holding clamp, and a single compession screw AP (anterior/posterior - ed.) was placed to hold the reduction. A 6-hole 1/3 tubular locking plate was bent to conform and placed along the lateral aspect. Initially, 2 compression screws, cancellous (i.e., into spongy bone material - ed.) was placed distally (at the far point - ed.) and cortical (dense bone - ed.) placed proximally, followed by 3 locking screws of appropriate length.

We then moved to the medial side and made a small curvilinear incision over the medial malleolus. Opened the deltoid ligament to identify the fracture, irrigated it, and reduced it anatomically and held in place with a bone clamp. Two 50 mm 3.5 partially threaded screws were then placed in parallel through the medial malleolus obtaining good compresion and good derotation (stability - ed.).

X-rays confirmed good hardware placement and anatomic ankle mortise reduction on AP and lateral images. The limb was then wrapped snugly with an Ace wrap and the tourniquet deflated.

We moved to the right side and performed a similar procedure after tourniquet inflation; first the fibula and then the medial malleolus in similar fashion. We used a 7-hole 1/3 tubular locking plate laterally with a single AP compression screw for this similar short oblique fracture. Anatomic reduction was achieved on both sides. Final X-rays confirmed good hardware placement, screw length, and mortise reduction.

Both ankles were then irrigated thoroughly and closed with 0 Vicryl (absorbable sutures - ed.) for the deeper tissues including the deltoid ligaments medially followed by 2-0 Vicryl for the subcutaneous tissue. The wounds were then dried, Mastisol (an adhesive - ed.) and Steri-Strips were applied to all 4 incisions, Xeroform (gauze - ed.) and sterile dressings followed by a soft roll and boots placed bilaterally.

The patient was then reversed from general anesthesia and taken to recovery in stable condition.

The aforementioned nightmare happened either during the operation or during recovery. I'll never be sure which, but from what my wife tells me I'm guessing it happened in recovery.

I promise it'll be up soon. It scared me, but it might give you a good laugh once you've read it. Go ahead, if you can't laugh at the walking wounded, who can you laugh at? (Hawkeye Pierce, M.A.S.H., if memory serves.)

More Omens and More Operations

So, here we are, four days following my re-admission to Hospital X. According to my wife, I've since had several pints of blood transfused, had several more pints of other fluids and nutrients infused, and now have a piece of titanium permanently wedged into a major blood vessel to keep clots from killing me. The internal bleeding appears to have stopped and my blood pressure is up a bit, so I'm finally out of ICU and am being given morphine for the pain. Meanwhile, both my ankles have been somewhat re-set after sustaining both dislocations and multiple fractures and are now wrapped, awaiting an operation to put everything back in its proper place.

Things would appear to be getting better, right? Well, you've probably guessed it - another bad omen popped up earlier in the week, this time involving the doctor scheduled to fix my ankles. He had a death in the family and had to go out of town for the rest of the week, meaning his associate would be performing the surgery. (Someone upstairs apparently took notice and showed a bit of mercy, though, as my employer told my wife on the same day that the company was willing to put me on FMLA leave until I was physically able to return to my job.)

The ankle repair surgery took place Thursday afternoon. It was supposed to last around three hours, but after a four hour wait my wife has still not heard from the surgeon. She says she got someone to call and check on me at that point and was told that I was already on my way back up from the recovery room. The surgeon didn't even bother to stop by and talk to her about the operation. I heard about this from her later on, and she was supremely pissed with the whole situation. Our relationship with this doctor would not improve until much later (after I'd left the hospital, in fact).

Up to this point I'd been going in and out of consciousness and lucidity, thanks to my physical condition and/or whatever drugs or anaesthesia was being used on me at the time. Aside from feeling goofy at times and at other times thinking that I was in Austin instead of Dallas (see the previous update for info on the latter), I hadn't had anything disturb me mentally other than the sheer pain of the situation. Something different happened during the ankle surgery, though - I don't know if it was in the operating room or in recovery - but I had some kind of dream that scared the hell out of me for a while. It was disturbing enough that I apparently felt the need to describe it to the recovery nurses, who then told my wife so that she could have a good laugh at my expense.

I'll describe what I saw in the next update and let you be the judge.

Extremely Silly Walk Not Attempted

As I mentioned, my wife took a photo of my feet while we were in the ER.  The doctors had not yet worked on them in any way when she took that photo.

The photo is NOT FOR THE SQUEAMISH.  It includes an angle that is not normally seen in nature, at least not on the human body.

If you are absolutely certain you wish to see that photo, click here.  It has not been photoshopped at all.  The black spot is from a magic marker and indicates the foot has been injured.  More on this in a moment.

You will note that the left foot doesn't look too bad when compared to the right foot.  That is true, until you consider that it has been snapped off and is now lying at a 90 degree angle to the rest of my leg.  Believe me, it's not supposed to point that direction on its own.

My wife says the doctors and nurses kept walking past the end of the gurney and bumping one foot or the other, not realizing that both had been broken.  They did this several times, and each time she says I would let out a blood-curdling scream of pain.  Eventually, someone got the idea to tie red tape around both of my feet so that everyone would know that both were off limits.  That worked better than nothing.

The worst part about the situation is that the doctors could neither operate to fix my ankles, nor could they give me morphine for the pain.  If you'll remember, my blood pressure was 60/20.  I was bleeding internally, and until they could stop it there was a huge risk that a blood clot would break loose and enter my lungs, killing me.  As a result, all they could do was wrap my feet in gauze, put Fentanyl patches on me, and move me to the Intensive Care Unit so that they could try to find the source of the bleeding.

I don't have much memory of what went on in ICU.  I remember a lot of pain, and I remember a terrible thirst because I couldn't drink anything due to the stomach bleeding.  My wife brought in ice chips made from a zero-calorie fruit drink and slipped them to me when the nurses weren't looking.  I also remember having IV tubes stuck in me several times until the doctors finally decided to give me a PICC line (one line that led toward my heart and had three connectors hanging out of my left arm).  I saw at one point that they were feeding me through the IV, again since they couldn't put a tube into my stomach.

All this while, for some reason I guess I will never understand, I thought I was in Austin.  Don't ask me why.  I just thought Austin was outside, waiting for me once I got better.  There were a lot of other strange things that happened, like me demanding my wife hand me my cell phone so that I could call in sick (my boss asked if I could come in to work in a wheelchair - the doctors nixed that), and me asking the doctor how many days I would be out of work (he said it would be weeks, not days).  Again, my wife says she will not fill me in on the other blank spots in my ICU amnesia.  Based on what I do remember, I guess I should be grateful.

To continue, my wife says they ran all kinds of tests on me while in ICU but never found the source of the bleeding, despite eight different doctors being assigned to me all at once.  Nevertheless, the bleeding stopped on its own after about three days in ICU.  At that point a pulmonologist decided to put something called a Greenfield Filter in my vena cava.  The filter is essentially a titanium mesh umbrella which is designed to catch and stop clots headed to my lungs. (I still have that filter implanted in me.)  Once the filter was in, the doctors were finally able to operate on my ankles, and I was able to begin a whole new series of hospital nightmares.

Stay tuned.  The ankle operation was anything but routine.