Tale of a Broken Ankle

There are worse accidents to have, but a busted ankle is bad enough for me, thank you very much. Ironically, it happened minutes after leaving my annual physical. I’d gotten a clean bill of health, more or less. There was some blood work left to be done, but otherwise fine.

I needed to get to work. My wife had dropped me off at the doctor’s office before going to work herself. My plan was to walk from the doctor's office to the bus.

Earlier that morning, when I first stepped outside, I had been happy to see that the ice had receded. Sidewalks and roads seemed mostly clear. Still, I was careful as I walked along, sidestepping any areas that looked dangerous. It was about minus three with a light wind blowing. Not too bad a walk.

I remember peering ahead, trying to spy a bus stop sign. I don’t even remember falling. I just remember suddenly finding myself flat on my ass. My backpack protected me from hitting my head. When I went to get up, I spotted my left foot, encased in an ankle high-winter boot, twisted around in the wrong direction. So twisted that I gasped aloud upon seeing it. “Aaagghh! Aaagghh!” The sight was worth a good two gasps.

I couldn’t stand on that. It was wrong. It needed to be right. I reached out, grasped the boot, and started to twist it back in the right position. It resisted, giving me time to realize that wrenching my foot back into the proper position myself was probably a bad idea.

What to do? I couldn’t stand. There was traffic along Brock but no cars stopped. There was nobody on the sidewalks. I considered trying to crawl forward along Brock with no real plan other than to move. I was, I realized, in a bit of a pickle (I had completely forgotten that I carried a cell phone).

Initially there was no pain. I anticipated a physical reaction, figured I’d go into some kind of shock, but having never experienced a similar injury, I didn’t really know what to expect. Would I have some kind of panic attack? Right then I felt pretty calm about it all, just trying to work out some sensible course of action. I thought, maybe I should start calling for help.

I managed one half-hearted “help” before a woman stepped out of a store across the street. Traffic had paused, so she ventured into the street. “Do you need help?” she asked.

“Help!” I said. “Yes!”

She came closer, caught sight of my foot. “Oh my God,” she said.

A man came out of another store and jogged over. He wasn’t dressed for the weather. “Do you need an ambulance?” he asked.

“Yes,” I said. “I think that would be good. But you should put some clothes on.”

“I’m fine. Did you hit your head?”

“No. My backpack protected me.”

“Good. Just to be sure…” He held a finger up before my face. “Follow my finger.” He moved it back and forth. I followed it with my eyes.

“Are you a doctor?” I asked.

“No. Just had First Aid training.”

“What’s your name?” I asked him. I wanted to remember the names of the people who helped me.

“David,” he said, getting out his cell phone. He began talking to the folks at 911, got them up to speed. Then he went back into his store, quickly retrieved some coats, and covered me with them. He put some under my head too. I noticed that I was still lying on the patch of ice that had done me in. I laid my head down on the coats and felt well-looked after.

A fit, outdoorsy-type stepped up. “I’m a trained ski instructor,” he said, sounding a bit like Patrick Warburton. “I can snap that foot back into position for you if you like.”

Briefly, I considered it. For like a fraction of a second. Sure would be nice to have it facing the right way again. “I appreciate the offer,” I told him. “But I think I’ll wait for a doctor.”

He accepted that.

Another fellow seemed to take over, a younger fellow, maybe around thirty. He asked me how I was doing. I told him fine. I asked him his name. “Anthony,” he said.

“Thanks for sticking around, Anthony. Thanks everyone,” I said, craning my head around to see who else was there. I couldn’t see anyone else. Perhaps they’d moved on, confident that Anthony had everything under control.

As we waited for the ambulance, I asked Anthony to snap a picture of my twisted foot as I lay there on the sidewalk. I figured it would be fun to show people later. 

Anthony snapped the photo, handed me back my cell phone, and then stepped out into Brock Street, where he waved his arms like someone directing a plane on a runway. I don’t remember any sirens. An ambulance pulled over and two paramedics got out.

“Careful,” Anthony instructed. “Pretty icy.”

Seconds after that, one of the paramedics (Derek, I learned shortly afterward) slipped and almost fell. I wondered how many others had fallen victim to that treacherous patch of ice.

Derek the paramedic cut the laces on my boot and gently removed the boot. With the boot off, it was even more obvious how badly broken my foot was. Later, a nurse would describe it as twisted 180 degrees. It was probably closer to 90 degrees in the wrong direction, but still.

“Ever broken a bone before?” the other paramedic asked me.

“No,” I told him.

“You’re handling it pretty well,” he said.

I resolved to continue handling it well.

We negotiated how to get me on a stretcher. I suggested that if they helped lift me, I could get up on my good foot and get on the stretcher. We were all concerned that my good foot would slip on the ice, but with the help of the paramedics I managed to get up and lay down on the stretcher.

“On a scale of one to ten, how’s the pain?” Derek asked me, once ensconced in the back of the ambulance.

I considered. “Four.” It was quite manageable.

“It’ll probably get worse,” Derek warned. “Any allergies?”

“Only cats.”

“I’m gonna give you some Ketorolac,” he said. “It’ll help for a bit.” He injected me with a needle.

As we drove along, again no sirens. Not a big deal, taking a guy with a broken ankle to the hospital.

In the Oshawa hospital, Derek parked my stretcher in the hall and stayed with me as we waited for a room to become available. “It’s busy,” I observed. Emergency was crowded with patients and paramedics and nurses and other hospital personnel.

“Most of them don’t need to be here,” Derek told me. “You need to be here.”

After only a few short minutes someone directed Derek to push my stretcher into an emergency room. Derek and I parted ways. Two nurses took over, one experienced, the other a student. I believe the student’s name was Kristin. I don’t remember the other nurse’s name. Events get a bit blurry here, because the pain and discomfort suddenly ratcheted up enormously.

I was taken for an X-Ray. Deb, the X-Ray technician, was young and confident and had partially blue hair. She directed a team of two other technicians how to properly X-Ray my twisted foot. It took some imagination to figure out how to get the proper angles.

I lifted my head to have a look at my naked twisted foot.

“Don’t look at it,” Deb commanded.

I decided Deb was right. I didn’t need that image burned into my brain. Still, I caught a glimpse of it before lowering my head. It was so much worse than seeing it while still in the boot. I longed for a time when it would be facing the right direction again. Old enough to know how time works, I reminded myself that this too shall pass.

The pain was now a solid nine out of ten. I’d had no medication since the Ketorolac. Back in the emergency room, the experienced nurse took a look at my foot and drew the curtains. “No one needs to see that,” she remarked.

Later, Kristen, the student nurse, told me that she’d said to the other nurse, “I don’t understand why he’s not screaming his head off.”

I wasn’t screaming my head off because I was doing my best to contain it. I had one arm behind my head and my good leg drawn toward me, trying to reduce the discomfort and pain. It helped a hair, but not much. I wondered how much longer I could stand it. As long as I needed to, I decided.

Kristen started setting up an IV. The IV included both Saline and Morphine. She apologized for the needle, but it was nothing compared to the rest of the pain I was feeling. 

The morphine wouldn’t flow. The vein had collapsed.

“He’s in shock,” the other nurse said. She tried the other arm, then a second location on the other arm. Every vein she tried collapsed. “Three’s my max,” she said.

“Don’t give up,” I encouraged her. “Go for the gusto.”

She tried the first arm again. No luck. I was starting to feel like my luck had run out. I overheard one of the nurses say it was Friday the 13th. I’m not superstitious, particularly. Still…

“I can only stand this another seven or eight hours,” I joked.

The experienced nurse chuckled. “I’ve decided you’re my favourite patient,” she said.

“You tell all your patients that,” I said.

“No,” she said in a way that convinced me that she didn’t. Later, I would overhear several patients moaning and complaining and carrying on outrageously, and I realized that in comparison I was probably not a bad patient to have to deal with.

The nurses conferred. “We need such and such a nurse,” the experience nurse said.

“She’s been called away,” the student nurse said. “What about so and so?”

“No, not her,” the experienced nurse said in tone that suggested Dear God, no, not her. I felt like this nurse was looking out for me.

They finally got ahold of the one they were looking for, the talented IV nurse. It took her two or three tries. I believe between the three nurses it took eight or nine tries before they got a vein that didn’t collapse, before the morphine flowed.

I felt it going into my arm. “My fingers are tingling, if that’s useful information,” I said.

“Normal,” the talented needle-nurse said.

Somebody arrived with some forms. “Can you sign these?”

I signed them. Something to do with giving the hospital the right to treat me.

A doctor showed up. “We need to straighten your ankle,” he said. “I’m going to give you Fentanyl. It’s ten times stronger than morphine.”

“Go for it,” I said.

He injected it via needle. It burned going in. Later, my wife, who’s a pharmacist, reminded me that Fentanyl was the drug killing everyone in British Columbia. Of course, the illicit users weren’t using it correctly.

I became drowsy almost instantly. I closed my eyes. When I opened them again, all was quiet. I glanced at my foot. It was swathed in bandages. It was straight again. I couldn’t believe it. I had only closed my eyes for an instant.

Nurse Kristin spied me awake. “When did this happen?” I asked her, indicating my bandaged, straightened foot. “Did I lose a couple of hours?”

“It’s just been a few minutes,” she said.

I checked my watch. Time was acting funny. It was about two pm. It didn’t feel like four hours had gone by since I slipped and fell, but it had.

“A few minutes ago this room was crowded,” Kristin said. “The doctor straightened your foot and the sound it made… everyone in the room cringed. It was horrible.”

I was glad I hadn’t been awake for it.

My wife Lynda arrived. I brought her up to speed. She was (not surprisingly) sympathetic and waited patiently with me. I’d texted her earlier but she hadn’t received the text. The nurse had phoned her at work, but hadn’t talked long. “I have to go straighten his foot now,” she’d told my wife, who hurried over shortly afterwards.

I had another X-Ray from Deb and her team to see how well the doctor had done. Turned out he’d done pretty good, but the break was too bad. Both bones on either side of my ankle were completely broken. I’d need surgery, followed by weeks of no weight on that foot, and then physio and several more weeks if not months of recuperation. It was a severe enough injury that the surgery had to be done pretty soon, but there were no beds left in the hospital for that night, so they sent me home.

I slept uncomfortably with a leg I couldn’t straighten because the temporary cast went up to my knee. I couldn’t get clothes on or off my bad leg and could hardly get about anywhere. I couldn’t even use the washroom properly because our bathrooms are tiny, with the tub close to the toilet. Unable straighten my leg, I had to prop my leg over the side of the tub to sit on the toilet. Hard to get a good seal that way. (Too much information, I know – sorry).

Surprisingly, there wasn’t much pain, although at night my foot sometimes wound up in a bad position, forcing me awake on the verge of a scream. During the day it was fine, as long as I kept it elevated. I’m not sure how such a lack of pain was even possible with two broken ankle bones and screws inserted into my foot, but I wasn’t complaining. The worst was the lack of mobility. I had crutches and a rolling chair and I could hop and crawl, but what a pain in the ass. Still, it could have been much worse. Could have hit my head, or broken my hip.

The next day, Saturday, my angel of a wife waited on me hand and foot while we waited for the hospital to call me in for day surgery, which they finally did around supper. But after three hours back at the hospital, they sent us home again. No more surgery that day.

Surgery finally happened the following day, Sunday. It was pretty straightforward. Still, I was a bit nervous. I was thinking of my paternal grandfather, who died shortly after exploratory surgery for cancer back in 1954. A blood clot got him, I’m told. I didn’t really think anything like that would happen to me, but it was on my mind. 

As I lay on the operating table, the nurse asked me if I had any questions. I had lots, but my brain wasn’t completely functioning. 

All I came up with was, “You guys have done this sort of thing before, have you?”

“Google’d it this morning,” the nurse assured me. “We’re good to go.”

And they put me under.

I woke up later with much better questions on my lips, but the surgeon, Dr. Ibrahim, had left, so my questions had to wait.    

Before the surgery I had worn a cast that went slightly above my knee, preventing me from being able to bend my leg. After the surgery I wore a cast that went a little more than half way up my leg. It was a huge improvement being able to bend my leg.

I was also pleasantly surprised to find that the pain was quite manageable. I’d heard it could be pretty bad. That’s not to say there wasn’t any, but it was more discomfort than pain per se. At times it just felt weird, making me wonder what was going on down there. I had narcotics (Oxycocet), but I never took any. Ibuprofen seemed to do the job. The cast began chafing after a couple of days. I didn’t realize it, but the chafing was doing a number on my foot. I would find out just how bad it was about a week and a half later, when they took the cast off. 

One morning several days after the surgery I woke up to find that a good portion of my leg had turned black, especially under the knee. This freaked me out. I actually looked up gangrene, just to rule that out, but it was just severe bruising. Probably because I was keeping my leg elevated and the blood had pooled toward my knee. It made bending my leg really uncomfortable. It lasted about a week before clearing up, at least on my leg. Five weeks later my foot was still bruised. There was also quite a bit of swelling.

Sleeping was pretty uncomfortable for the first little while. I was sleeping downstairs in the guest bedroom. I could negotiate a path from the bedroom to the washroom more easily down there with crutches. Also, I wouldn’t disturb my wife with all my clattering about if I had to get up in the middle of the night. 

The bed in the guest bedroom, I discovered, isn’t anywhere near as comfortable as the bed in our master bedroom (my apologies to all our guests over the years). And having a cast on my leg didn’t help matters. I like to sleep on my side. The only way to make this comfortable with a heavy cast on one leg was to stick a pillow between my legs.

The worst, though, was the lack of mobility. I was warned not to put any weight on my bad foot. The last thing you want to do is to break it again while it’s fragile. Maybe there’s a way to get up and down stairs with crutches when you can’t put any weight on one foot, but if so, I never figured it out. I was reduced to crawling up and down the stairs on all fours. It was kind of pathetic. I felt like we had suddenly acquired another dog, and I was it. Sometimes as I crested the stairs into the kitchen I would announce my presence with a bark. 

As if having to crawl up the stairs wasn’t bad enough, I couldn’t even shower by myself those first few days. Not exactly safe standing on one foot in the shower, and I had to be careful not to get the cast wet. I went several days without showering. Instead I just knelt by the tub to wash my hair and scrub my body. I realized something would have to be done about this when my stench started knocking people unconscious. 

Coincidentally, my friend Fergus happened to have broken his ankle a couple of weeks earlier. (So did two other friends—it’s been a virtual pandemic of ankle fractures this year.) Fergus suggested a stool in the shower. My wife borrowed a special waterproof chair for seniors from a neighbour that sat half in and half out of the tub. The idea is to sit on the part outside the tub, then gradually work your way in. Fergus also mentioned something called a Seal-Tight Brownmed Cast and Bandage protector. Between the chair and the bandage protector, I was soon fit for human companionship again.  

One day my wife arrived home with a walker she’d borrowed from someone. I liked it at first, but it required a lot of hopping on my good foot, and after three or four days of this the heel of my good foot started to hurt so badly that before long I couldn’t walk on either foot, so I reverted back to the crutches. 

Crutches are great, but unfortunately you can’t really carry anything when you’re using them, unless it’s small enough to jam in your pockets. So my wife and kids had to wait on me, fetching stuff for me, carrying bowls and plates to the table during meals, and cleaning up without my help. They did all of this graciously, but I hated being dependent, and tried to refrain from asking for anything. Often I would just figure out how to carry or move something myself despite my inability to do so with ease. Which, if it was even possible, was usually time consuming, and sometimes dangerous, especially if it involved stairs. 

During this period I felt a lot worse for my wife than I did for myself. Suddenly she had to do all the chauffeuring, and dog-walking, and grocery shopping, and waiting on me, in and around going to work. It wasn’t fair to her. I tried to compensate by doing most of the cooking, and cleaning up in the kitchen afterwards, which I discovered I could manage by resting my knee on a stool, or leaning on my crutches, and hopping around a lot. Of course, it still didn’t make up for everything she had to take on.

And then there was all the sitting around. I imagined I could feel my body deteriorating with the massive doses of inactivity. Before breaking my ankle, I was reasonably active, walking the dog, doing Pilates. I was contemplating returning to Karate. That was out of the question now, and Pilates classes would have to wait. I did some Pilates lying on the floor, but I couldn’t really get into it. Not vigorous enough, for one thing. Had it been summer, I could have hobbled around outside on the crutches, but with ice still coating the sidewalks and streets, that wouldn’t have been particularly wise. Still, I did manage the odd outing, such as accompanying my wife to Costco one day, which helped shake off the cobwebs.

Many people assumed that I would have a lot of free time while recovering. That never happened. My sister and her husband immediately shipped me up a copy of Rudyard Kipling’s Tales of Horror and Fantasy, thinking that I would have all kinds of time to read now (thanks guys!) The truth is that during this entire time I continued to work. I only took one sick day, the day of the accident. After that, I worked from home. Why? 

A. Because telecommuting is now routine. 

B. Because I’m an idiot.

Actually, I did this for a number of reasons. One, because it wasn’t really clear what I should do. Initially, my surgeon never gave me any instructions about work. Another surgeon told me that commuting was out of the question (my commute into Toronto is an hour and a half each way, involving busses and trains and stairs and so on). Because of the nature of my job, I could continue to work remotely via emails, phone calls, and Google Hangouts, so that’s what I did. It kept me busy, and it also kept me in the loop.  There was a lot going on, I had only been in the position for six months, and I really didn’t want to fall behind. 

I spent the first couple of weeks of my pseudo-convalescence trying to get a Medical Absence Form filled out. I needed to know the surgeon’s official opinion on whether I could continue to work, and if so, how.  

This is where somebody like Jackie Chan and I differ. Jackie Chan broke his foot on the set of Rumble in the Bronx. Like me, he was told to keep his weight off that foot for several weeks. Unlike me, he had a film to finish. So he simply returned to the set of Rumble in the Bronx, painted his cast to look like a sneaker, and got on with the job. 

I, on the other hand, had no interest in hobbling into work every day on a broken ankle. The last thing I wanted to do was re-injure it and make it worse. So I sat in my basement and pestered the surgeon’s office. I offered to email the Medical Absence Form to the office so that the surgeon could fill it out and they could email it back to me and I could forward it to work.

“We don’t have email,” a woman at the surgeon’s office told me. 

“You don’t have email?” I couldn’t believe it. “How is that possible?”

“You’d have to ask the IT department.”

“What do you have an IT department for if you don’t have email?” I asked, though of course just because they don’t have email doesn’t mean they don’t have computers and other IT paraphernalia.

The woman I was talking to turned sullen, and it occurred to me that maybe I'd been rude. Which, apart from being uncalled for, probably wouldn't help my cause any.  

“How do I get you the form?” I asked.

“Drop it off,” she suggested.

“I have a broken ankle,” I reminded her. “I’m not exactly mobile.”

“Jackie Chan would drop it off,” she told me. “He’d paint his cast to look like a sneaker and run all the way here to drop it off and then run all the way home again.”

I could believe that.

Okay, what she actually said was, “Fax it.”

Which sounded like ancient technology to me, like something people did back in, say, the Twentieth Century. I couldn’t help but wonder if this reflected my surgeon’s approach toward medicine. Had he reset my broken tibia and fibula with ancient Roman bone levers? Had he cauterized my wounds with rusting iron tile cauteries? If I peeked, would I find leeches beneath my cast?

“Fax it is,” I agreed, having no real choice in the matter. 

Fortunately, I was able to find a free fax service online, and a mere two weeks after my surgery I was informed that I could either stop work altogether, or work from home. Seeing as I had already been working from home since the Monday following the accident, I opted to keep working. Because I was working from home, it wasn’t even necessary to paint my cast to look like a sneaker.   

My first follow-up appointment was scheduled roughly two weeks after my accident. My wife and I arrived at the Fracture Clinic twenty minutes early. To my surprise, they took me in for an X-ray right away, and as soon as they finished snapping photos of my broken bones they led me to an examination room. Within minutes a technician showed up and called up my X-Rays. Seconds later another technician cut off my cast. The place was a model of efficiency. During a brief lull, I snapped several pictures of the X-Rays with my phone. (Later, someone called me on my camera.)

With the cast off, I admired my injured foot. It was one damned ugly appendage. It was so ugly it was beautiful. It was swollen, blistered, battered and bruised. Rows of stitches over the ankle on either side made it look like the work of Dr. Frankenstein. A massive red bruise marred the right side of my foot from the ankle almost to the toes. Another bruise covered the heel on the left side. Four ugly red blisters decorated the right side. [Later, at home, both my daughters refused to look at my foot after an initial glimpse. Naturally, I wanted to show it to everyone.]

A slim, well-dressed man with curly black hair showed up in the examination room and began riffling through a folder presumably containing information about me. 

“So, what happened to you?” he asked me. 

“Slipped on ice,” I told him. 

“Who’s your doctor?”

“Dr. Ibrahim.”

“Oh, that guy,” he said.

I was confused. “Aren’t you him?”   

“Yes,” he admitted, with a chuckle. 

A comedian, I thought. Good. I’d been afraid he’d be aloof and impatient. I had several questions, some of which had already been answered, such as when would the cast come off (it just had), and what hardware had he placed in my foot (the X-ray clearly indicated 9 screws, 1 plate, and zero screwdrivers).

He answered all my questions patiently, such as which bones were broken, how long I should keep my weight off that foot (four weeks), and when I should come back for another appointment (also four weeks).    

Business was booming, so he left to see one of his other many patients, and a young woman in scrubs showed up. Her name was Francesca. I assumed she was a nurse, but she was actually a student training to become a medical technician. Student or not, her job was to pluck the twenty-seven staples out of either side of my leg that Dr. Ibrahim had thoughtfully inserted there. 

“Does that hurt?” she asked, digging a particularly stubborn staple out of my ankle.

“No,” I lied, effectively giving her license to dig even deeper for the next one. 

Another technician arrived with an enormous big black boot called an Air Cast, all rigid plastic and Velcro. It came with a thick white sock and something resembling a sock but much looser with a hole where the toes were supposed to be. “Use the loose one until the swelling goes down,” the technician told me.

After seven weeks, the swelling still hadn't gone down much, but I switched to the tighter sock eventually anyway. 

She also gave me a small rubber bulb with a spout on either end used to pump air into (or remove air from) the cast, to make the cast more comfortable (they don’t call it an Air Cast for nothing). I only ever did this a handful of times. Most of the time it seemed fine the way it was.

The Air Cast was a Godsend. Whoever invented it should receive the Nobel Prize. My foot felt Protected in that thing with a capital P. There was no chafing, allowing my blisters to heal properly. I could take it off whenever I wanted to, which I did when sitting for any period of time. After a while I began taking it off at night while sleeping, because if you think wearing socks while sleeping is ridiculous, try sleeping with an Air Cast. Although if I had to get up during the night, I made sure to put it back on, because apparently that’s when a lot of people re-injure themselves, thinking they can hop the few steps to the bathroom without their Air Cast, and then they trip or stumble and break their fragile ankle again and it’s right back to square one. 

The next several weeks were a blur of hobbling around. Working from home kept me busy and I assumed most of the cooking chores while my wife took over chores requiring actual mobility, such as walking the dog and chauffeuring our daughters around.  

Fast forward four weeks to my next follow-up appointment. Another quick, efficient visit. X-Rays and a short chat with Dr. Ibrahim. My foot was healing just fine. Dr. Ibrahim told me that I should start putting weight on it right away. This would allow me to return to work. I was to stop wearing the Air Cast at home, but continue wearing it outside, but spend the next week and a half gradually weaning myself entirely off both the crutches and the Air Cast. 

At home, I took off the cast. I had a pretty pronounced limp but I had no trouble getting around. On Saturday, I took a shower without having to sit down for the first time in six weeks. Glorious! I put the cast back on and took a single crutch with me out to run a few errands, including groceries. I had no trouble walking around with only the cast. On Monday, I wore the cast to work, but took a crutch with me just in case. No problem. Tuesday, I left the crutch at home. Friday, I awoke to find that it had snowed, and there were patches of ice on the ground. I figured the air cast would be more dangerous than wearing a normal winter boot (no traction), so I went to work in normal boots with no cast. It was great wearing normal shoes around work.

I remind myself that we’re just talking about a broken ankle here. To get a sense of perspective, take a look at Jackie Chan’s blooper reel. He’s broken his ankle at least twice and let’s not even get started on his many other crazy injuries. 

And then there’s Evel Knievel. According to the Guinness Book of World Records, Evel Knievel suffered 433 bone fractures performing 75 motorcycles jumps. He says he only broke 35 bones, but still. He spent a total of 34 months recovering in hospitals.

What’s a mere broken ankle compared to all that?