Lessons to Learn

On Friday, at 2pm or thereabouts, my son broke his leg.

Sounds so innocuous, so simple, to say it that way.  But what a maelstrom of events was set in motion, what repercussions there are from that one accidental moment of bad fortune.

First, my son Gabriel is two.  Two and a little.  He’s a very happy, very active two-year-old with five brothers and two sisters, and he was romping about with them like he always does, chasing them around on a day off from school coming into the President’s Day holiday weekend.  I was at work, preparing for my annual Twelfth Night Charity Ball, to be held that evening.  My wife was home, baking cakes for the same event.  She was in the kitchen (that’s where you do that stuff), and heard Gabriel fall, and start screaming the “I’m hurt” scream.

If you’re a parent, you know what I’m talking about.  There are different cries for different circumstances.  There’s the “I’m tired” cry, and the “that was really frustrating” cry and the “my brother is a dork” cry, and my favorite, the “you won’t let me do that because you hate me” cry.  But then there’s the “I’m hurt” cry, and nothing brings a parent running faster than that one.

Problem with it is that for a two-year-old, there’s no discrimination about deployment of that cry.  It only comes out when they get hurt, but the level of hurt is irrelevant.  Everything  from “hangnail” to “my arm has be severed” gets about the same level of cry, so you learn to react a bit slower after a while, because it’s pretty much always a hangnail.  Clarification: FATHERS learn to react a little slower.  Mothers, in my experience, are wired to respond to all instances of that cry as if an actual emergency were occurring.

So she got there pretty fast.  Max was screaming and grabbing his knee.  Not unusual.  He didn’t seem to want to be held – also not necessarily unusual – but he settled down on the couch and started watching TV.  After a bit he fell asleep.  It was about nap time anyway.

Meanwhile the preparations for the charity event that evening went on unabated.  Kids went places, cakes got baked, Max was sleeping.  The babysitter came over a couple hours later and we went off to the ball.  From such innocent mistakes come the phrase “hindsight is 20/20.”

The event itself was disappointing, but that’s a subject for another time.  It was fun, though, and we stayed all the way to the end, being the hosts.  Eventually Jeanette left as we were cleaning up.  Half an hour later I arrived home, at about 10:30.  We were unpacking, and the babysitter was gone (no reported problems), and I heard Gabriel cry.  Not a sustained cry, more of a whimper, but to me, it was a clear signal that something was wrong.  I know this kid.  He doesn’t whimper like that.

So I went over to where he was sitting on the couch, and pulled the blanket off him, and made to pick him up, and he screamed again, a serious cry.  This was a pain cry, but that should have been over hours ago.  When I looked at his legs, I could see that the left one was swollen about double, and in a place where there was really only one possible cause.  It was the upper leg, about halfway between the knee and the hip.  I took one look at it and called Jeanette and said, “this is a broken leg.”

We have eight children.  Our kids are tough, and lucky.  In the nineteen years we have had children, we have never been to the emergency room.  Read that again.  NEVER.  Not one of our children has ever had an injury serious enough for us to visit the ER  We’ve been to InstaCare a couple of times.  Two broken arms (cracked, not broken through), one set of four stitches.  And that right there is the sum total of our entire medical experience as parents.  I’ve actually never seen a broken leg before, not in person.  But there was no question.  There’s nothing to sprain there.  The leg was busted, and I knew it.

But even if you know, you have to go to the hospital and have them do the requisite x-rays.  It was too late to go to InstaCare by this point (see “hindsight”, above), so we were forced to go to the American Fork Hospital ER.  This was a mistake, but that mistake will be explored in the next post.  It’s only moderately relevant to this account.

The hospital is not very far away, only about 10 minutes.  We took the van, because the first problem we ran into was transport.  We couldn’t possibly put him into a carseat.  He screamed even when we went over bumps.  In the end, I picked him up and held him, bracing his leg as best I could, feeling his little body tremble because of the pain.

Here we made another mistake.  My sister Allison is a surgical tech at Primary Children’s Hospital.  I knew she’d know what the story was, what we should do, but it was by now well after 11:30, and she was surely sleeping, having herself attended Twelfth Night and having spent most of the day making some fairly amazing cookies for the event.  I didn’t want to bother her.  Jeanette did call her, but the number we called turned out to be a text-only number, so nobody answered.  Ten minutes later, Allison texted back, but by then the phone was in Jeanette’s coat pocket and we didn’t see it.  Alas.

We couldn’t wait, once we were there, because it was clear that he was in a good deal of pain and we needed to see the extent of the damage to the leg.  Unfortunately, the ER staff – who were exceptionally kind and gentle – decided that they could not get a good x-ray of the leg without moving him so much that morphine was essential.  So they started a line and gave him fluids, followed by some morphine for the pain.  With that, we boarded the medical train, though we didn’t know it at the time.  That was fateful, and we’ve learned lessons since that we hope to share down the road here.

He calmed down a bit and even drifted off to sleep once the morphine kicked in, and we got the x-rays done, though of course he didn’t sleep through that.  I got to hold him for the bulk of this time, and that was a blessing for both of us.  Mom could do all the other stuff that needed to be done, and I could focus on Gabriel, which is the reverse of how things normally work at the Clan.  I fell asleep on the gurney a couple of times while we waited for the results – it was, after all, pushing 1 at this point, and when they came back, they showed exactly what we thought; he had broken the femur bone.  It was a shear break, meaning that the line of break went down along the bone at an angle, instead of straight across.  It’s an uncommon type of break, but consistent with what we thought had happened.  It’s also consistent with abuse, we discovered.  That had later consequences.

Here we got the first understanding of what the process would consist of from this point forward.  We had told the ER people that we had no insurance, and that we’d be paying for everything ourselves.  This, however, had absolutely no impact on any decision that was made, up to that point or later.  Once you board the train, you get to stay on it until the end, unless you get very belligerent.  This has obvious consequences, which I’ll explore another time, but the x-ray results discussion was the first time we understood what had happened to us.

American Fork Hospital does not treat children of that age.  They are not equipped to handle 2-year-olds.  Therefore, the child would have to be transferred to Primary Children’s Hospital in Salt Lake City.  More, because he had now been given morphine and had a line installed, he would not be permitted to go by car; he would have to be transported by ambulance.

After some rather painful consultation, Jeanette and I decided that she would go with Gabriel to Primary, and I’d go home to the other seven children and two guests, and make sure everyone was good, and get people set up for the day in the morning, and come be with her in the morning after my dress rehearsal for a play I’m doing that opened a week later.  Meanwhile, I consulted with my sister, who by now was awake and working the phones, and learned a few things.

One, she approved of the personnel that were on duty there to receive Gabriel.  She knew and liked the attending nurse. Two, we were in for a surgery, complete with an anesthesiologist.  There is no good way to set this sort of fracture, or to cast it, with the child awake.  So that meant operating room time.  She had good confidence in the surgical staff, but she was also pretty sure that the actual surgery wouldn’t take place until roughly 11 the next morning, after which there would be a few hours of observation while the child came out from under anesthesia.  This was not going to be an in-and-out.  It would take all day Saturday.

But what was there to do?  So Jeanette bundled Gabriel into the ambulance and off they went, and I went to my car and drove home alone.  We were a bit frustrated about the difficulties we were facing and the expense we were incurring, mostly because some of them could have been avoided had we known what the procedures would be.  But we didn’t.  We’ve never been to the emergency room before.  We had no idea that once we got there, we would have essentially no options about what would happen to us.

Once Jeanette reached Primary, a couple of things happened.  First, we already knew who the attending nurse would be, and that was great, because she was everything that Allison said she would be.  But second was the other nurse(s), whose job it was to accuse Jeanette of child abuse.  Well, essentially.  This was the part where it was a very good thing that I was not there.  I don’t take well to being accused of abuse, especially when we have over 80 combined child-years in our house and never a single trip to the ER.  Nevertheless, after threatening full-body scans and all the rest, giving Jeanette the look that says “we haven’t found the evidence yet, but we’re going to, it’s just a matter of time,” a sane and rational nurse took over and basically said, “we’re not going to do those scans.  Nobody has called DCFS yet, and I don’t think that’s necessary.”  I suspect this nurse of having been reached by my sister, God bless her, but regardless, Jeanette was grateful.  It was about 5am, and she had had no sleep.

Unfortunately, she didn’t get any, either.  Gabriel was dozing on and off, but here there was a serious problem.  The morphine settled him so he could rest, but he never sleeps on his back.  He sleeps on his side.  When he falls asleep on his back, he twitches as his nervous system tries to get him to roll over and be comfortable.  This time, when his body twitched, it hurt him, and he would cry.  No, shriek is a better word.  This happened about every two minutes for several hours.

Another complication that might be of use to anyone that finds himself in this position: cell phone coverage.  Jeanette’s phone worked fine in the ambulance, but once she reached the room in the trauma ward she lost coverage.  Our texts and calls went nowhere.  She, for her part, figured it was the middle of the night and everyone was asleep, so she never checked her phone for bars, of which she had none.  So here we were trying to get some kind of update on when they would do surgery, what was going on, and we got no response.  Finally my sister – you gotta love this gal – got hold of the surgery schedule for the morning and found that Gabriel was down for 11am.  This let me finally go to sleep about 2.  Apparently only Verizon and (in places) AT&T have coverage there.  I had it in surgery waiting, but only sporadically in trauma.  Jeanette, on T-Mobile, had nothing anywhere.  Word to the wise.

About noon, Gabriel finally went into surgery.  I was on my way there, and tried to call for an update, because now I had the room number, but Jeanette had followed Gabriel up to surgical waiting and was therefore out of range again.  But the staff there had been courteous enough to send word to the security orderly to tell me where to go.  Again, they are really very good there, and took marvelous care of us.

After an hour or so, Gabriel was out of surgery and his leg was set.  He was still out when we went to see him, and woke up only gradually over the next few hours.  He was in a spica cast, which for those curious, is a set of fiberglass pants that go from the ankle of the affected leg all the way up to the chest, with the other leg encased to the knee, and a bar welded to both legs to keep them about 18″ apart.  They cut a squarish hole in them into which one can insert a diaper, with a larger diaper to cover the whole thing.  And that’s it.  No sitting up.  No real lying down, because of the way the cast is molded.  For six weeks.

They told us  – the one doctor was especially good about this – what we could and could not do with this thing.  Specifically, that we were not to pick him up by the bar.  Except, we really could.  They ahd to tell us not to, but honestly, he said, you couldn’t get the bar off with a sledge hammer, so do whatever we liked with it.  They were very practical.  The cast will stink, whatever you do.  Don’t stress it, just get used to it.  Don’t get it wet.  Since the cast essentially doubles your child’s weight, you’re not going anywhere with him.  When you start feeding him, make sure you cover the top of the cast at the chest, because if you don’t, food will go down it and start to stink, not to mention itch and be uncomfortable.  Some of that will happen whatever you do, but do your best to prevent it.  Etc.

Once we found some sports on TV, even if it was only golf, Gabriel started perking up a bit.  He drank some juice, had a graham cracker.  One last hurdle was the carseat for home transport.  No carseat will work – the legs are just too wide in the spica cast.  So what they gave us instead was like a cargo harness, and we laid Gabriel on his side and buckled him in through the harness lying down.  We got Lortab from the pharmacy, and finally, at about 5pm, drove home.

It’s hard to describe what we felt like driving home.  Gabriel would whimper, and we’d do our best to help him be comfortable.  We were talking about the financial atomic bomb this would drop on us, we not having insurance.  We had only started looking at the logistical difficulties this would cause, with six other children at home and no other driver with a license.  For six weeks, essentially, we have a disabled child.  He can’t go anywhere, and has to be tended by someone at all times.  We can’t even use our regular babysitters, because he’s so heavy now that we need someone that can carry him out if the worst happens while we’re gone.  And so on.  Things we probably haven’t even thought of yet.

But as we think of them, I’ll try to write about them.

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