When the Provider Becomes the Patient

It has been quiet on the blog for the last week because I have been in too much pain to work, to play, or to write. It finally reached the point where the provider had to become the patient, negotiating the health care system as it exists in western Alaska.

It all started a few weeks ago, when I had a bizarre mushing accident on my last dog run with Henry. It was on my birthday, actually. (Yes, that makes me an Aries, and a pretty typical one, from what I know about it.)

At the very end of our good snow, Henry and I went out with seven dogs on what we figured would be the last good run of the season. The weather was fairly warm, about 20 above, and we’d had a good six inch snowfall a few days earlier, probably the last we would get.

We were having a great run. The young dogs were performing well and all were lively and energetic. I was riding in the sled and we came around a sharp bend in the trail. A large birch tree with perhaps a three inch diameter trunk was leaning across the trail, right in our path. The dogs went under it easily, but it clearly was going to hit the sled, and maybe bust the driving bow—and possibly Henry’s hand.

I stuck my right foot up to deflect it as we went by, as most of our birch trees are pretty flexible. This one was not. It was solid as a rock, and like hitting a wall, it stopped us hard. The tree rammed my foot back so that I was hyperflexed at the knee and hip, and wedged firmly between the tree and the sled. I couldn’t move, and my knee was next to my ear (a place it hasn’t been in years, I can assure you). When we hit, I screamed. Then I yelled “Back up! Back up!”

Henry was able to yank the sled back a few inches, and I got my leg down. I waited for pain to appear, but there was none. I had felt nothing snap or pop. Gingerly, I stood up and walked around a little, and there was still no pain. Henry was nearly freaked. He thought I must have dislocated my right hip. Apparently not. We made it back to the dog yard without any further problem. I told him that I thought we had dodged a bullet that time.

About three days later, my left hip began to hurt. It bothered me off and on for about two weeks, and then suddenly began to get really painful. After about five days of escalating pain, it became excruciating. I had x-rays done; no fracture.

I was off work and on hydrocodone four times a day for pain control. As soon as it wore off, the pain was right there. I was limping heavily on a cane and not sleeping well at all. Pain was exacerbated by hip extension and medial rotation, and relieved somewhat by partial hip flexion.

My FP, Dr. H, looked at the films and discussed them with the radiologist. They both felt that I should have an MRI of my hip to look for soft tissue damage, and see an orthopedist for further evaluation. That meant flying to Anchorage, as we have no MRI or CT available in Bethel.

On Friday, Dutch and I flew over. I saw Dr. L, the orthopedist, in the afternoon, and focused plain films again showed no fracture, though he felt that the physical exam was consistent with one. The MRI was scheduled for Saturday morning, after which we could return to Bethel. He will see the films and discuss them with the radiologist on Monday, and call Dr. H with the results.

The MRI was the most painful experience I can remember. The test itself is painless. It was the position I had to maintain for about twenty minutes that was the problem: fully supine, legs straight with toes taped together and heels about a foot apart. I could not achieve the position without pain, and within moments I was in agony. By the end of the test I was sobbing and begging the technician to turn the equipment off and let me flex my hip and knee. The pain was so intense that I was hyperventilating, and a mild tetney response set in. Breathing shallow and fast blows off too much carbon dioxide, leading to hypocapnia which causes muscle contractions of the face, drawing the mouth into an “o” and which can cause temporary flexion contractures of the wrists and hands. The lips and fingertips tingle, and getting one’s breathing under control (deep and slow, deep and slow) can be difficult.

I was wheeled back out to the waiting room looking quite the mess—red, swollen eyes and pale, sweaty complexion. Dutch said I probably scared the other people waiting there.

After a bit of rest I felt much better, and Dutch and I went to our favorite coffee shop for a light lunch. We even managed to do a little shopping in the afternoon before catching the evening flight back to Bethel. We both arrived home exhausted.

So I am still limping, not sleeping well, and taking opioid medication for pain control. And I still don’t know what’s causing the pain. I hope the MRI revealed some indication for it. At least then I’ll know how long this may last.