Venice

A Broken Friday

Maheen Riaz

Why am I so annoyed, you ask? Why am I cranky? Let’s review.

I get ready to go to the hospital; it’s a Friday. Beautiful morning in Islamabad. Keeping my pledge to myself, I had awoken earlier than usual. This is the fifth day in a row, and I’m proud of myself. Waiting to get to class to tell my friend she’s late again. I’m looking forward to an aesthetic row of all Ps on my attendance sheet for the week, gritty on the inside. It’s the little things, they say.

My mother, oh my lovely mother, she has always woken up in the mornings before my siblings and me to make us breakfast. She’s had that responsibility for far too long. I’ve told her many a times not to wake up just for me and ruin her sleep. She has finally started to listen to me. How I wish she had woken up for me just that one Friday.

It began as a usual day. A glass of my mother’s ginger water first thing in the morning. A slice of watermelon in an attempt to beat the summer heat. My family is asleep as I take my car out of the garage, all ready to leave for the hospital. What’s going on in my mind? My fiancé is waiting for me to call him while I drive, like I do every morning. These little rituals lessen our distance in our long-distance relationship. Those fifteen minutes every morning before I get to the hospital make every day easier without him. I have to share with him my story of finally booking a photographer for our upcoming wedding. 

I take the car out and go to close the gate, leaving the car door open and AC on. I close the heavy sliding gate, and in a matter of seconds I see a Netter’s Atlas of Human Anatomy image of a right foot. I have run my foot over with the gate. In the next few seconds I see blood gush out of my foot. I’m thinking, Can I still make it to the hospital and go straight to the ER? I take one step towards my car and I know in that instant I cannot. I turn and struggle to get to the front door, excruciating pain from my foot making my gait abnormal. I’m barely able to scream for help.  My father, my mother behind him – worried but unsure about what they’re walking in to – run to the front door. 

“I’m hurt, take me to the ER please,” I groan, all the while my blood is making a landscape on the floor. I sit down on the step, growling in pain. That’s when I see a 5th metatarsal and an Extensor digitorum longus tendon. 

“Be careful,” my dad has always said to us. Just that. That “be careful” contains one too many instructions so beautifully. I have to drive to the hospital; be careful child. I have a flight to catch; be careful girl. I have to climb stairs to go to my room; be careful. I wasn’t careful Papa. I was in a hurry to tell my friend she’s late. I was in a hurry to get to class earlier than usual, my usual being fifteen minutes late. I was in a hurry to drive on a relatively empty highway. I was in a hurry to call my fiancé and share with him everything I had done the day before. I’m sorry Papa, I wasn’t careful like you’ve always asked us to be.

My dad is frantically shifting me to my already started car, careful to not hit my right foot that my mother has wrapped in a kitchen towel. I have lost a lot of blood. Fifteen minutes until I get some medical aid. My foot is elevated, my little effort to control the bleeding. I’m trying to recall my five years of training from medical school, to apply on myself, as I slowly lose track of my lucid thoughts. 

I’m getting lightheaded as time passes. I can feel my right leg get colder. My pain scale is 9/10. I let my dad know from the backseat. He’s talking to me, telling me we’ll pull through. He’s trying to keep me awake as he speeds on the relatively empty highway I was looking forward to drive on. Why did I think of the worst-case scenario: hypovolemic shock? Are we trained to think about and rule out every possibility before it starts to show symptoms? I gather my thoughts and take deep slow breaths to stay conscious. It wasn’t blood loss as much as it was lack of breakfast. How I wish my mother had woken up just that one Friday.

My fiancé, my dear fiancé, is always making weird little comparisons between Pakistan and Canada. I despise this one habit he has. You guys should get an automatic gate, he always joked every time he had to open and close it last month when he was visiting. Did I get annoyed every time he said that? Yes. Did I wish that one Friday that we had an automatic gate? Also, yes.

I’m in the ER. I have a nurse securing an IV line on my left. I have another nurse on my right taking and recording my vitals. There’s an ER resident at my foot-end inquiring about the accident, scribbling it on the ER admission form, and there’s a team of staff ready to expose and clean my wound. The bleeding has stopped.

“Can you feel this?” the resident asks, touching my toes. My superficial peroneal and sural nerves are intact. 

“Movement is restricted due to pain,” she announces as I attempt to extend my toes on her command. As of now, she cannot rule out injury to the extensors of the foot.

Plastic surgery consultation is required. I’m shifted to Majors. IV Paracetamol, normal saline, prophylactic IV Co-Amoxiclav. I’m briefed about passive and active immunity as they tell me I’ll need tetanus toxoid and immunoglobulins. I consent to it. The plastic surgery resident visits and opens the dressing to expose the wound. Her smile is reassuring. She informs Minor OT’s staff of a medical student they need to perform an emergency procedure on.

Approach the patient from their right side. Greet the patient. Get their consent. Build a rapport. We are taught how to engage with the patient from our first year in medical school. Do not violate patient’s privacy. Build a rapport. Build a rapport. I have now assimilated the importance of our training. Treat the patient, not the disease.

Will I be able to walk?

Will I be able to stand? Will I still make it to my OSCE exam in two weeks?

Tendon repair and a few stitches later I’m sent home with the strict instructions of keeping my foot elevated at all times. My father, accompanied by my friend, wheels me to my car. Papa is not speeding now. Highway is busy. The backseat is much calmer. Quieter. I am to spend the next two weeks or more in bed. No school, no hospital. Bed rest at the age of twenty-four. Bed rest during my Pediatrics clerkship. Bed rest amidst my wedding preparations. Complete bed rest. 

Why am I so annoyed, you ask? Why am I cranky? I cannot get up to get myself a glass of water.

Maheen Riaz is a fresh MBBS graduate of Shifa College of Medicine, Pakistan. With a passion for creative writing and an ample medical background, Maheen likes to paint pictures with her words about her everyday experiences in her professional field. She hopes to pursue a career in Forensic Psychiatry in the future. On her time off, she likes walks in the park, a nice cup of tea and absolute lazy Sundays.