After some time away, it’s time to begin writing again. I have several excuses for not writing – the two most prominent being a broken wrist (which had to be re-broken) and excessive travel and work.
While the wrist is on the mend, travel and work continue unabated. As I often do when I’m behind with the blog, I will commit to methodically catching up. Given that this is a general account of my experiences, I don’t really enjoy skipping things. Life tends to come at me fast and hard and lots of things happen that should be recorded.
 |
| the shorter left forearm bone (radius); tilted wrist |
As mentioned previously, my wrist that was broken last November and it didn’t heal properly. But a cast was put on it in the hopes that it would. When the cast was removed in late December, it just didn’t feel right. As much as I invested time and energy to rehabilitate it, it just didn’t get better. Not only did it feel wrong, it looked wrong.
After I returned from my previously mentioned trip to Mogadishu, I booked a follow-up appointment with my doctor in Nairobi. He confirmed that indeed I needed surgery. While he refrained from speaking negatively of surgical care in Kenya, he did discuss with me the complexity of the break and hint at the need for me to explore options outside the country. In my case, that meant the US. He also said it needed to be done urgently to avoid further complications.
I immediately began to look at my options. I haven’t had much medical care in the US over the past several decades so I wasn’t sure where to start. I contacted my sister and brother-in-law who pointed me in the direction of the sports medicine facility at my alma mater. They, after grasping the complexity of the break, pointed me in the direction of a clinic that specializes in hands. That’s all they do. I didn’t even know that existed in my home state. But I figured that if they could take me in as a patient, that would be fantastic. I just wanted it fixed. So I sent them my information and doctor’s referral, including a scan of the x-ray, and, thankfully, they booked me an appointment.
The frustrating part was that they were reluctant to let me know how this was going to unfold exactly. Apparently, until the doctor had a chance to see me, there would be no determination of a surgery or anything else. I needed to book a ticket to the US and just guess how this might play out. I was very much in the dark as to what was going to happen. The only thing I knew was that I had an appointment the first week of March.
I proceeded to go online to try to find the lowest fare to the US, regardless of my mileage program allegiance, and I randomly guessed that the whole process would take about six weeks, hoping that it would be less, all the while fearing that it could be longer (in the end, it turned out to be exactly the duration needed).
While I was sad about being away from family that long, I was tired of being in pain and knowing that something wasn’t right about my wrist. There was a steely resolve that helped me maintain a focus on doing what was necessary to get it done. I booked a flight on Emirates the same day I secured my appointment and things were set in motion. I would leave the following week.
* * *
The next thing was to figure out how this was going to work for my job. I knew I wouldn’t have enough sick leave to be out that long. And besides, with my deputy director out on extended medical leave (and some other leadership out for other reasons, including maternity leave), I was backed into a corner. I would need to work throughout the time that was away. That would mean managing a 10-hour time difference six days a week (the Somalia week runs Sunday-Thursday; Kenya/NY runs Monday-Friday; only Saturday is really off). I’m used to working six days a week but the thought of managing that with the time difference over a long period of time made me sick to my stomach.
I left on a Friday night to avoid the need for a vacation day due to travel and to get there in time for my appointment on Monday. By the time I arrived in the US, it would be Saturday night and I would be able to work the next morning (albeit jet lagged). Before I knew it, I was at my all-important initial appointment. The doctor pulled up the x-ray that I had sent him (actually, a phone photo I took of the x-ray hard copy since I was told the clinic in Nairobi couldn’t send x-rays via email). He more or less confirmed the diagnosis of my Nairobi doctor. My interior forearm bone (radius) had been crushed at the wrist and had healed shorter than the exterior forearm bone (ulna). As a result, my hand was dislocated from its normal position and thus causing the constant pain and the lack of mobility.
What needed to be done was to re-break the radius (saw it into two pieces), extend it out to its normal length about 2 cm. such that it’s even with the ulna, add a plate and some screws to hold it in place, and then bone graft in between so that the two parts of the radius bone are able to fuse. Simple as that. I could see very quickly that the doctor was intrigued by the complexity before him. I was glad to see his interest in my case. I was hoping it would translate to a successful surgery.
He did leave the door open to the possibility that things may not go as planned for a couple of reasons. One was simply the complexity of the break, something he’d never seen before. The other was the fact that there had been previous injuries in that area (about six previous fractures to my forearm, wrist and hand) that added to the complication. But at least we had a plan. Surgery would be in ten days. Not bad given that operating rooms were backlogged due to the pandemic.
* * *
While I waited for surgery, I proceeded to continue working and spending my time with family. For the former, drought has been raging in Somalia. Moreover, my management team has been short-staffed. On top of this, Mr. Putin decided to invade Ukraine on Feb. 24, not only devastating the lives of millions, but also sucking valuable aid resources away from East Africa. While I was happy to see the international response to a crisis in Eastern Europe, I was sad to think that a crisis of similar magnitude in Africa never generates the same kind of visceral response in the Western world. It’s not surprising. It’s just sad that the world seems to value some lives more than others.
I was also getting up in the wee hours to attend meetings, respond to emails, provide approvals, etc. The earliest critical meeting so far has been 2am Idaho time though it has been averaging between 3am and 6am. I’ve been doing my best to keep up but I’m not sleeping well (i.e. not enough) and it’s difficult to keep up with everyone’s schedule here. I’m trying to go to bed early though often circumstances don’t permit it. I do think people here have been understanding. I just don’t think they get how hard this is. It’s not only keeping up with a job in a different time zone. It’s keeping up with my particular job – helping get aid to thousands of people are in dire circumstances at this time.
* * *
The day of the surgery, my dear sister took me to the hospital in the dark of the early morning. Despite the complexities, the surgery would be outpatient. I would be provided necessary anesthetic but I would be able to leave that afternoon. It’s pretty amazing, really. I’ve had a couple surgeries before, years ago, possibly even less invasive than this one, and both involved a night or two in the hospital. It’s good because it keeps costs down and allows people to go home to their families. It is weird, though. After all the cutting and digging around in your body, they just sew you up and get you home by tea time. No medical professionals hanging around to make sure you’re okay.
The surgery prep was pretty straight forward, except for the fact that you’re in a room with a few others also heading into surgery. You’re only separated by a curtain. You can hear the prep conversations with other patients and it’s less than comforting. You can sense the anxieties others are experiencing. I was already looking forward to a sedative.
A nurse came in and shaved my forearm. Another doctor came in and explained how the anesthetics were going to work. Someone else came in, jabbed my arm and hooked up my IV. Things were getting real.
After only about 20 minutes, they began wheeling my gurney towards the operating room. On the way I asked the nurse if indeed I would pass out during the surgery. She said normally, yes. It was that word “normally” that bugged me. I didn’t want to hear/see, bits of my forearm bone flying across the room as they sawed it in half.
Once in the operating room, they started hooking me up to equipment and putting all the tools in place. The last thing I remember was the clanking of the metal instruments on the tray next to me. After that, my next memory would be waking up in the same place where they did the surgery prep. It felt like five minutes but it had actually been about two hours. As I was coming to my senses, nurses immediately began talking to me as if they expected me to be coherent. I did my best to get it together and speak in complete sentences. One asked me if I felt pain. Another asked me if I was nauseous. My right arm, from the shoulder down, had a block and I could feel nothing at all. They pulled my IV out of my left arm, which I did feel. They said I would lie still for about an hour or so and then I’d be ready to be escorted home by my sister. She had apparently been briefed by the doctor so that she would know how to look after me, particularly for the first 24 hours.
Sure enough, after about an hour I was helped to my feet and I was able to walk out, into the sunshine, with my surgery finally behind me. I’m still amazed how all that works, but I was thankful to be done with it and have the ability to go home, or at least my sister’s home.
 |
| post surgery: on the left, the metal plate; side view on the right shows the six screws |
I'll refrain from showing the post surgery non-x-ray photo. It was pretty gross.
* * *
Once at my sister’s house, I planted my butt on one of the sofa’s and didn’t move much. My arm was bleeding quite a bit and I was trying to keep it elevated as much as possible. As well as I was prepped for the surgery and recovery, the continued bleeding was unfortunately not discussed. I wasn’t sure if it was normal. I was also feeling the block begin to wear off. You’re supposed to begin the pain killers before that happens. I was a bit more delayed than I should have been and I was able to have a sense of the seriousness of the pain I would be masking.
When I woke up the next morning, I had a pool of blood on my chest where my arm had been resting. By Sunday, two days after surgery, it was still bleeding quite a bit and we decided to seek support from an urgent care facility. For reasons I don’t understand, I was turned away from two different facilities (connected to the same hospital where the surgery was done). Both said that it was the type of urgent care that they didn’t care for (??). Both said yes, I should probably have it looked at but it didn’t meet their criteria. The one even mistakenly referred me to the other. It was basically, go to the ER or wait until Monday and go see the doctor who operated on you. Seriously. How can two urgent care facilities see a patient with blood oozing from a surgical incision 48 hours after surgery and not even offer to re-dress the wound with some clean bandages.
I honestly don’t understand the American health care system. I went from praising the system for the amazing outpatient repair of my forearm to the realization that there are gaping holes in how the system really works.
Anyway, the bleeding stopped after about 8 days. As for the pain, I was off meds after the first 48 hours. There was still pain but I preferred to monitor how things were going. It’s hard to do when it’s masked. I would occasionally take an ibuprofen but I avoided the prescription stuff. The Wednesday after surgery, I had my first follow-up visit. They removed the bloody bandages that were put on post surgery. It was disgusting, needless to say. The forearm was Frankenstein-ish with the metal clips, discoloration, dried blood, etc. The technician wiped it with antiseptic and proceeded to fit me with a brace that was supposed to be my companion for the next few weeks. In the end I used it a little over a week.
Two weeks later they removed the metal clips and I was told I would have one more appointment before I could head back to Nairobi. The timing of my return flight, booked well in advance of knowing how all this would play out, was, according to the doctor, ideal to allow for the last check-in appointment.
* * *
Little by little I’m gaining my movement back. I was given
exercises to do to slowly improve my mobility. It will be a long road but,
again, I’m happy to be where I am. I have been in pain since November and now,
a little over a month from the surgery, it’s the best I’ve felt since the
accident. I can’t do anything heavy with it until the 8-week point but that’s
fine with me. It likely will never be like it was, but I'll be happy if I get back all my basic functionality. Time to move on from this break.
