Adventures with Ankles - Part 1

On the island of Male (pronounced Malay, as there should be an accent over the ‘e’ but I can’t find the way to get my computer to do this), which is one of the Maldives, most women are considered immodest if they don’t cover their hair and their arms and legs.  And here I am, wearing nothing but an open-backed hospital gown.

A few days ago, I tripped and fell.  I was carrying a full plate of stirfry, and when I felt myself going down, the only thing I thought about was keeping the plate level so it wouldn’t break and the food wouldn’t spill.  This wasn’t out of any concern about losing the food, because there is always more than enough on a cruise ship, it was simply my innate Canadian need to be neat and tidy.  I succeeded in that goal, only a couple of pieces of green pepper ended up on the floor, but because of my keeping my upper body straight up, I fell badly, landed on the outside of my right ankle, dislocated it and broke two ankle bones and, for some strange reason, the upper part of my fibula, just under my knee.

The medical staff on the ship is wonderful.  That’s an understatement.  The guests, too, were there for me.  After I fell and looked at my ankle, I knew something was seriously wrong, because there was a large bulge where there hadn’t been one before, but it didn’t hurt much yet.  I became very dizzy and nauseous, and lay down on the deck.  Our silly brains, or mine, at least, after worrying about something spilling, my only concern at this time was that I was going to be sick and I didn’t want to do it in front of everyone, especially since they were just about to have lunch.

Someone crouched beside me, probably saying something, but I suddenly remembered that Melissa was waiting for me at a table and I asked if she could be told what had happened.  The watching crowd became a Greek chorus, repeating, “Her daughter is nearby, go and tell her.”

I might have blacked out for a moment, but I became aware of Paul, one of the book club members, standing by me, holding my hand.  I looked up along the line of my arm to where our linked hands were, and the line shone bright and golden.  (I know, this is rather cliché, but that’s what I saw.)  The human contact was a lifeline keeping me from sinking, our two arms joined together.

I then don’t remember the next couple of minutes until I heard a voice, telling me there was a wheel chair and I had to get up.  I lifted my head but felt dizzy and told him about my fear of grossing out all the other people and asked for a bowl.  I’m pretty sure I heard exasperation in his voice, but he kindly got me a towel, said I could use it, and told me that I needed to get to the infirmary if I wanted help, and I did need help, so I should get to the infirmary.  I thought about this, decided it made sense, and sat up enough for people to lift me into the chair.

When we reached the elevator, a couple of other people were about to get in, but the person pushing me gestured towards me, and they stepped back.  Wow, I thought, a staff person taking precedence over guests.  I worried for a moment about this, but then forgot about it.  Melissa had joined me by then, but I gave up on being aware of anything, choosing to bend down over my knees, towel clutched on my lap.

Things happened fast.  We got to the infirmary, I was lifted onto a table.  Someone asked if there should be photos, I saw some flashes go off, and then an X-ray machine appeared.

The ship has three doctors and two nurses on board, and the clinic can do basic medicine, but no surgery, mainly due to the lack of an anesthesiologist and the necessary surgeons.   Still, the level of care I experienced was astonishing.  At least one doctor, the only one I asked, has a lot of experience in Emergency Medicine, which is probably good preparation for working on a ship, because they see a wide variety of problems, as do doctors working in the ER of any hospital.  The clinic seems bigger inside than it does from the outside, and holds several consultation rooms, offices, a reception area, storage rooms, and other mysterious places.

My ankle by now had let me know it was unhappy, and I was told I’d get pain medicine as soon as possible.  I warned them that I needed higher doses of drugs, my body just needs more to feel the effect.  To emphasize this, I said I’d never been able to drink enough to get drunk, and the nurse, Bud, (who’d been the voice telling me to get in the wheelchair), gave me his sympathy.  I’ve discovered that no one ever believes me about this need for higher doses, but they did do what was needed.  I ended up with something whose name I can’t remember, maybe Thorazine, then 10 mg of morphine and then, since I could still feel the pain, just less so, and I was frightened of how bad it would get when they put the joint back in place, they gave me something more.  This was apparently risky, as I could, and actually did, stop breathing, but they were prepared and it helped me get through the reduction.  I am forever grateful to them for listening to me.  I might have a high pain tolerance, but I’m a wimp when it comes to severe pain.  As I suppose just about everyone is.  (I’m not sure why putting a joint back in place is called a reduction, but it probably has something to do with the big bulge I saw when I first fell, and how much smaller my ankle was after the procedure.)

I was able to move in and out of consciousness while they worked on the ankle.  By now they knew about the breaks in the ankle, which made the reduction much more difficult, but they pulled it off.

Disclaimer - my medical knowledge is very limited plus I wasn’t at my best during all this, so don’t believe anything I say about the practice of medicine.  Especially - kids, don’t try this at home.

I remember being nagged, someone kept telling me to breathe.  I got quite indignant, because obviously I was breathing, but the nagging worked, because here I am.  One doctor told me he’d slap my foot if I didn’t breathe, and since the lightest touch was awful, that threat was effective.  Clearly they had different bedside manners, nagging and threats, but it all worked out.  The doctor who threatened to slap my foot is the one I’ve since found out laughs the most during practically any type of dire moment, which lightens the whole atmosphere.

Anyway, I shook off the effects of the third drug, and the pain was much less.  I could begin to look around and take an interest in what was happening.  Melissa was with me most of the time, although she went off at times to provide necessary information.  I remembered that I had bought extra medical insurance before leaving Canada, something I always do when leaving the country.  I had no idea what I’d done with the little card they gave me, but I did remember I’d got it through my Visa card.  I told her where the card might be in the cabin, but thought it might also be on my desk at home, which meant it was somewhere in a box in the basement, since I’d cleared off my desk so one of the renters could use it.  Melissa was just a wee bit stressed at this point, and couldn’t find it, and didn’t want to spend more time away from me searching, but she went on line to find the number to use so we could call the insurer, and then Bud made the call.

Bud is Canadian, the Chief Medical Officer on the ship.  One of the doctors is also Canadian, living in Halifax.  Come to think of it, I don’t think that any of us once mentioned the Olympic hockey game.  Amazing.

I spent several hours in the infirmary, most of which passed in a reasonably comfortable drug haze.  Eventually it was explained to me that I was most likely going to need surgery on my ankle, and that as we were currently in the middle of the Indian Ocean, the next port, the Maldive Islands, was three days away.  India was another three days from there.  India is known for the excellence of its education system, and in particular, its medical education and quality, but Bud had done some research and learned that there was a hospital in Male, our stop in the Islands, that was very highly rated, and there was also an orthopedic surgeon there who was supposed to be very good.

Thus, my stay in this mostly Muslim city, and the hospital gown.

Another disclaimer – Please forgive me for not letting any of you know about my injury until now.  Melissa was able to phone Jesse and Matt from the ship, but we decided to wait until we saw the surgeon before sending out a mass email, so that you didn’t have to wait and worry until we could tell you more.   And once we arrived and saw the doctor, we had no internet access.  So I am writing this from my hospital bed, and will send it once I’m back on the ship.