Broken Ankle Log

One of the first things I did when I got home from the emergency room after breaking my ankle was look for information online. My main concern was how much this whole thing was going to cost (I don’t have insurance). I also wanted to know more about what I would be going through in the coming weeks. I found a UK forum, where someone asked for advice in 2006 and people are still posting to it even now, sharing their broken bone stories and how to cope with being immobilized. So I decided to make my own Broken Ankle Log, to document my condition and progress, and to offer a listening ear to anyone else going through this.

Week 1

February 9, 2009: The weather was really mild and the streets were completely free of ice and snow, so I decided to ride my bike to school. As I was riding, the chain felt really choppy, so, thinking it might have a kink in it, I went up on the sidewalk to check it. Finding nothing wrong, I got back on my bike and continued on the sidewalk, intending to go back out in the street at the next driveway. Before I got to it, I was confronted with large mounds of snow that I wouldn’t be able to ride over, and without thinking, made a sharp turn to the right. The front wheel slipped on some ice, the bike went under me to the left, and I heard a crunchy sound. Somehow and without thinking, I dragged myself away from the bike, clutching my right ankle. I tried to get up using only my left leg, but when I took my right foot off the ground it felt like my foot wasn’t there. It was the strangest thing I ever felt.

The only comfortable position was keeping my right foot squarely on the ground, sole down, which is why I thought maybe it wasn’t broken (because I figured if it was, I wouldn’t be able to do that). Some helpful passersby called 911 for me. About 15 to 20 minutes later (more or less, I didn’t have a watch on) I was in an ambulance on the way to Detroit Receiving Hospital. The EMTs had put both my legs down, but I told them my foot hurt too much, so they unstrapped me and I put my right foot down squarely on the stretcher. In the ER they put my leg down again, so even though it hurt, I left it like that because I figured they knew best.

X-rays confirmed the broken ankle: the distal (lower) ends of my tibia and fibula were broken. By this time (about three hours after falling) my ankle had gotten pretty swollen, and a bruise was gradually appearing. An Orthopedic Surgeon numbed me up and snapped the bones back into place, which felt pretty good, to the extent that I felt it. There was a very satisfying “pop” sound. He and a med student (from Wayne State; go Warriors!) put a splint on my ankle up to my knee. Within 3 hours of being admitted I was given discharge papers with prescriptions for vicodin and ibuprofen, and instructions to make an appointment for surgery in a week. If I remember correctly, the OS said I would probably need 2 or 3 screws. After looking around on the internet, I hope it is just that few!

February 10 By the end of the day, my toes were swollen. Little sausages is a good way to describe them. For some reason, I looked at my swollen big toe and thought it looked like Peter Griffin. I’m not in much pain, even when I forget to take the meds, it doesn’t hurt too much. I’m hoping that means my injury isn’t too bad.

I emailed my professors to let them know I’d be missing class for at least 2 weeks, and with one exception the response I got was ‘Sorry. But if you miss too much you won’t do well in the class.’ Sheez. Trust me, I’d rather be sitting in the most boring lecture right now than nursing a broken ankle; my house is like an obstacle course now.

I got caught up on episodes of HOUSE and Late Night with Conan O’Brien. Thank goodness for the internet! I also have a boatload of readings for school to get caught up on. I started reading “The Apotheosis of Saigou Takamori” from Ivan Morris’ The Nobility of Failure.

February 11 I’ve got going up and down the stairs on my butt down to an art form. My toes are still swollen, but not more than they were yesterday. I continue to wiggle them about a lot, and can flex them up and down more. I hope my tendons aren’t damaged. I’ve solved the problem of not being able to carry things while on crutches by putting this pouch I have around my neck and putting the things I need to carry in it. Of course, can’t do that with food. ^ 0 ^ I’ll try to get more readings done today. It’s still early, so I’ll probably go look for a movie to watch on Hulu.

February 12 I can deal with the pain. But the itch under this splint… >_<

February 13 Happy Birthday to our cat Pantera! She’s 9 years old today!

In Ankle news, I’ve been doing the “itchy weave tap” on my splint, LOL. I think it’s a good sign that I’ve been able to make it on one less vicodin. This whole thing is a bit distracting though, so I’ve barely been able to make it through my readings for school unless I read them out loud. Luckily one of my reading assignments is a novel (The Soil by Nagatsuka Takashi), so it’s easier to get through.

Week 2

February 16 Went to the doctor, but my foot was too swollen to operate on. They told me to really keep it elevated, to basically get up just to go to the bathroom. At least I was relieved to see my skin under the splint wasn’t too bruised. But to put another splint on it, the doc twisted my foot some because he said if the foot isn’t at a 90 degree angle the Achilles tendon could shorten. All this time, since I wasn’t in much pain I thought maybe my injury wasn’t too bad…but today the doctors were like “you really did a number on it” and “that’s a really bad injury.”

I guess my life had just been going too smoothly.

I finished The Soil. On to the next novel for another class. This time it’s Paradise of the Blind by Duong Thuo Hong. I’m sorta procrastinating by reading the novels before the drier texts for school.

February 18 Ever been psychic about the wrong thing? Back in October, I went to get new glasses in anticipation of job interviews, because my old ones were getting raggedy looking. But I barely wore them, because I was worried I might fall and break them. So today, as I hopped to an important interview, my glasses looked great, but my leg…I think irony is the plague of my life.

There was supposed to be a rain/snow mix this morning, so I had my brother wrap my splint in saran wrap, lol. Luckily it didn’t really rain.

February 19 Even though I’m keeping this mini-log, the accident seems really unreal to me now, even as I spend the entire day on my bed with my foot on a mountain of pillows.

I finished Paradise of the Blind. I’m slowly catching up with my school readings. Next up: Leslie Chang’s Factory Girls. But to reward myself for finishing the other book so quickly, (it was pretty good, so easy to read), I went to waste a little bit of time on Square Enix Members (yes, I’m that big of a geek). They’ve got this silly little “matchmaker” quiz that pairs you up with one of the 3 female leads from Dragon Quest V.

Wifey?

The site tells me my taste in women matches that of 24.38% of the people that have taken the quiz. It’s a bit disheartening, because I picked the answers that described a strong, independent, (perhaps kinky) woman. Then again, I’m not looking for a wife. I loved the question: “My wife’s favorite weapon would be…”. Put a smile on me face, aye.

February 20 I’ve spent the week waiting for the clinic to call me with the date & time of my surgery, since for whatever reason when the doctor went to the nurses to get me scheduled they apparently told him they would call me and so he told me that and sent me on my way. See my rant about trying to contact the clinic (during business hours!) in this post.

Week 3

February 23 Lots of news today.

Apparently there was a mix-up with my papers. It surprised when when the woman in charge of surgical boarding assured me that she had taken my papers over to the Pre-Op Department and had seen my chart being made, because I assumed such communications were done entirely by computer now. I thought the whole hospital was online because in the ER I was given my prescription on a computer print-out that had all my info and the barcode associated with me on it, and in the one instance where a nurse didn’t know where I was supposed to go next she just scanned my wristband. Well, I guess stuff can get lost online too. Anyway, the woman was helpful about the whole thing, and I soon got a call from Pre-Op so I know they have my info now, and they have me down for surgery on Wednesday, now I just have to wait for them to call me tomorrow and tell me the time. It will be out-patient, which is good for me because then it will cost less. Specifically, what they will do to me is an open reduction internal fixation. Here’s a computer animation of the procedure. WARNING: even though it’s CG, don’t watch it if you’re squemish! If only I were so fortunate to only need it on my fibula!

The other news is that I got the bill for the ER. I’m relieved that it’s just $230. When I got to the ER, I told them I didn’t have insurance, and the woman doing the paperwork told me there was a $75 co-pay. I’m a bit confused about that, because how is it a “co-pay” when I don’t have insurance at all? Either way, I paid $20 that day, it was all I had on me. I don’t know if the bill I got today includes the remaining $55 of that co-pay; I assume that it does. I’m hoping the ambulance fee is equally reasonable; I don’t know if Detroit has a flat fee or one based on what the EMTs had to do. CORRECTION: This $230 bill seems to be for the actual doctors, since I’ve learned that the services of the doctor are billed separate from those of the hospital. Wtf, right?

Physically, I think the swelling’s gone down more, because the splint feels a wee bit loose. This morning my toes were pruny, which is weird because they certainly haven’t been in water. I assume that’s also from the swelling going down. I’m starting to worry though that my pinky toe sustained some damage because I can move it to the side, but not up and down. I can trace a circle with my left pinky toe, but that doesn’t necessarily mean my right one was always capable of doing that also. Still…

February 24 Oh fuck fuck fuck…I was awakened today by a call from the hospital that went something like this:

“Hello, is this Miss A? I see you’re scheduled for surgery tomorrow, and you don’t have any insurance correct? You’ll need to sign a payment agreement, and make a downpayment of at least $200. Can you pay at least that much, or more?” And I’m thinking, $200 down, maybe the whole operation won’t cost so much, I had been thinking 10K at most. So I ask what the total price is…and she ways $20,000 >_<;;;;;;;;;;;;;;;;

It had been a while since I let anyone see me cry. Twenty thousand dollars, to be paid over 3 years. Oh fuck. I’m hoping the doctors work fast, since then it could be less. The woman told me the charge is hourly: about $4600 for the first hour of surgery, and about $2200 for every next half hour.

I downloaded the application for Medicaid, what else can I do? My mother told me not to worry about it, that we’ll work it out, but how can I not? The one thing I always told myself was that if I was going to keep on living at home I wouldn’t be a financial liability. I was already budgeting like mad, forgoing a cell phone, shopping, eating out, and of course, a car. I didn’t get some sort of independent insurance because the rates are crazy and what would I pay it with, being a full-time college student on a scholarship, buying books with savings from 2 years of being a full-time volunteer? Plus insurance itself is a fraud. When big shit like this happens to people, the companies don’t want to pay up and you have to fight them tooth and claw. Insurance is more about ensuring the companies get money than it is about ensuring you can get care when you need it.

I just hope the surgeon works fast. I’m still waiting for the call about the time of the surgery. Of course the money business gets taken care of first.

February 25 Last night the hospital called to say I was scheduled for surgery at 5:45PM today. This morning they called to say that that surgeon couldn’t get me in after all, so it’s been pushed back again. Now I’m on for tomorrow at 6AM. With all these setbacks, surely my bones can heal on their own?! (Please?)

February 27 It’s done! I am now the FullMetal Alchemist Ankle!

The Surgery: I got to the hospital at 6AM. After struggling to give a urine sample (hard to do when you’ve fasted), the anesthetist gave me two options. I could either have an injection in my spine to paralyze me below the waist, or…I didn’t quite get the other option, but it involved having me breathe through machines rather than on my own. I went for the spinal. It was almost a pleasant sensation. I don’t recall falling asleep. Before I knew it I woke up shaking from cold. The procedure was over, I hadn’t felt a thing and had very little sense of elapsed time. They put some lights on me to warm me up. I was in the recovery area for a while hooked up to some morphine, when one of the surgeons came and said he thought I should stay overnight (they had been telling me it was an out-patient procedure all this time).

Post-Op: So I spent one night at the hospital. I didn’t have to give myself too much morphine; the machine lets you give yourself some every six minutes, no sooner than that. I decided I’d do it every 10 minutes, and then every 30 minutes, since I didn’t want to get used to not feeling any pain. That same night I was able to get up to use the toilet that was next to the bed with my pain decently controlled, so I was discharged this morning. The whole orthopedic team that worked on me filled the room and told me it had gone well, and the surgeon who had attended me in the ER recognized me (he earned brownie points with me on that one; or as a Star Ocean fan should say, “emotion points”). I had to ask for the “specs”, a question they seemed to find strange when I should think people want to know how much hardware they’re now carrying. They told me I got 2 screws on the inside of the ankle and a plate with some screws on the fibula, for a total of “5 or 6″ screws. They closed me up with sutures, which sorta surprised me because in most of the broken ankle stories I’ve been reading online the incision was closed with staples. Medicine wise, they gave me a stronger dose of vicodins and some antibiotics to prevent infection. In contrast to last week, when the doctors told me not to get up except to go to the bathroom to get the swelling down, this time the surgeons and physical therapists said I needed to alternate having my foot down and up. The resident surgeons kept telling me I would be able to go back to classes next week, but then the doctor that filled out my discharge papers said I was not to go to class until after my first follow-up visit.

February 28 Today our cat Angus turned 8 years old!

In Ankle News…somehow when I went to go to the bathroom, I guess I put the crutches out too far or something. Somehow I got off balance and I ended up flipping over into the bathtub, I landed on my butt. The physics of that fall are beyond me. My mother and brother came running and helped me up. Fortunately, I seem unharmed. My operated leg hurts about the same as it did before, but I am worried. They put a dressing over a splint on it, so I think if I started bleeding it wouldn’t go through the bandages. In absence of evidence something got loose though, I’m not going to the ER. I hope they stitched me up good!

I get a burning sensation halfway up my calf when I extend my leg. Guess that’s about where the plate on my fibula is. My back hurts a bit, I think from the spinal, but I don’t have any external signs of damage there.

Post-Surgery Week 1 (Week 4)

March 4 Figured I’d restart the numbering, since in a way the three weeks I spent just getting swelling down and waiting for mix-ups to be straightened out didn’t really do much for my recovery…I think.

Speaking of mix-ups…even if you have insurance I bet the bills get a bit silly, especially with something on this scale. I had a WTF? moment when I called to ask for clarification on my bills. For whatever reason, the “hospital bill” is separate from the “doctor’s bill.” Seriously? Why? On top of that, I was told that each time I go to the doctor, I will get another bill with a separate account number, and then have to set up another payment plan for that account. Considering I’ve been going to either the clinic or the hospital once a week so far (and hopefully it’ll become less frequent now that I’ve had surgery), that’s an awful lot of accounts to keep straight. It seems like they’re trying to trip you up so you don’t make a payment on time and have your bill passed to a collection agency. The guy told me the accounts could be “packeted” together, but since he did say each one was separate I was confused and didn’t ask what he meant by “packeted.”

I need a hero…

The orthopedist told me that without surgery I’d develop arthritis within a year or two, but as the bills start coming in, and I see my mother getting upset at my brother for asking for $125 to fix the muffler on the family car…I can’t help but wonder if I should have just gone with the arthritis.

March 5 More adventures in WTF Land when it comes to medical billing. It seems my accounts have already been combined. Yet, the balance remains the same. So what was combined, I don’t know. Oy vey…

Anyway, I got a fiberglass cast today, along with permission to go back to class. That’s gonna be a bit tough, but I want to go back because some of my professors are saying I’ll probably end up having to drop their classes, and that’s unacceptable to me. I’d rather get C’s than have the semester be a total waste. The day of my accident was the last day to drop classes without professor approval, and about two weeks prior to that was the last day to drop classes and get a refund.

In two weeks I’ll have the sutures taken out, and then it’s two more weeks in a fiberglass cast. Whenever they take me out of the splint though, my leg feels like it’s not mine, like it’s a zombie part attached to me. Can’t wait for it to revive!

At the clinic I saw a woman walking really slowly, using crutches but walking with both feet. I thought to myself, I can’t wait to be her!

P-S Week 2 (Week 5)

March 11 This past Monday I went back to classes for the first time. I was worried about someone pushing me over or just tripping and falling somewhere, so one brother’s been escorting me in the morning and the other one picks me up in the afternoon. The very first day, my ankle was not at all amused by suddenly going from spending nearly all my time either in bed or in a chair to hopping around outside. I’m not putting weight on it, but I guess just the swinging around is what aggravates it. Even going to class though, I’m only up for maybe a grand total of 40 minutes the whole day, and not all at once. My toes are a teeny bit more swollen than they were the week after surgery, so when I get home I super elevate my foot.

March 14 Got the ambulance bill. So in Detroit, the cost of an ambulance ride is $425 plus $9 per mile. I assume there are additional fees if they have to do something to you. In my case they just wrapped my ankle in bandages, but it’s not like it was bleeding (externally anyway). If it weren’t so much a part of my nature not to be a burden to others, it might have occured to me to ask the people driving by for a ride to the hospital. I could have given my bike as payment. Then again, it would have had to be someone willing to not only take me to an ER, but to help lift me up, as everytime I tried I would collapse from the strange sensation in my broken ankle. Oh well. All’s well that ends not terribly fucked up, right?

P-S Week 3 (Week 6)

March 19 The cast saw tickles!

Got the sutures taken out. In general I just felt little tugs, but some parts, especially on the outer (fibula) side kinda burned. There’s a big patch of crusty blood that I thought was sutures on the inside. It felt so good when the tech washed my right foot and lower leg! For six weeks the closest I’ve had there was alcohol wipe-downs. Nothing like good old soap and water. He put these things called Steri-Strips over where the sutures were, and told me not to try to pull them off, as I’d rip my skin off if I tried. Said they’ll fall off on their own eventually, so to just treat them like skin.

My two weeks in the comfy fiberglass splint are up, and now I’m in a boot. I guess this is what people call the Darth Vader boot. But to me, with all the straps and rivets, it looks more like something from Hot Topic. So I call it:

The Emo Goth Vader Boot!

The benefit of being in a boot over a cast is that you can take it off to wash your foot and shower somewhat normally (baths are discouraged so soon after having sutures removed). And you can take your foot out to do little non-weight bearing exercises like rotating your ankle–to the extent possible without pain–in preparation for physical therapy.

P-S Week 4 (Week 7)

March 26 As disturbing as seeing my ankle full of sutures and thinking about the screws and plate within, was seeing the sorry state of my lower leg today. I took the boot off to try to do some of the ankle exercises they’d given me at the clinic last week. Now, I had already noticed that my right thigh was a full inch smaller than the left one. I figured that the loss of muscle tone would be even more dramatic on my lower let, since the thigh is still being used to at least hold the lower leg up, if not bear weight. But to see it! To so clearly see the bone under the skin, and the fat just hanging off of that…see:

My shrunken leg. (So I haven't shaved in a while. I'd say that's the least of my worries right now, wouldn't you?)

Well, at least my ankle isn’t as mad at me when I go out to class as it was on the first week out the house. The swelling is down considerably, at least on my toes and foot. I didn’t have the guts to take the cotton wrap off and see the whole sad composition, even though I saw the sutures being taken out. (I didn’t watch the whole time, but I did watch some of it.)

Two days ago I met an older gentleman student who lost his foot in the service some 30 years ago. When he saw me approaching on my crutches he smiled kindly and asked what had happened. My fellow students have generally been nice and offered to help me if I need something, but it was a bit more ‘comforting’ to talk to someone who’d also experienced being unable to walk (he now walks with a prosthetic). It made me think that there need to be more disabled characters on TV shows. It seems like we mostly see disabled people on TV as “inspiration” stories, stuff that kinda says “this teenager who lost his legs is out there surfing, so what excuse to you ‘able-bodied’ people have for sitting around on your asses?!”