Forget the X-Ray, LOOK. TOUCH, LISTEN, THINK

My mother fell a couple of days before I left to go camping. The nurse called and gave me a good clinical picture "Her foot is rotated outward, she can't move her leg and is in a lot of pain."  The hallmarks of a fracture.

The ER claimed no fracture and sent her back.  Still in pain, still unable to move her leg.

I know something is broken, I request another evaluation and a diagnosis. I also know x-rays are often wrong. So, a quick x-ray is done at the nursing home. Negative. (she didn't return to the hospital in part because one nurse who phoned them was told "We'll just send her back"---they were done...thanks Concord Hospital...just an old lady, demented too...)

She cannot bear weight, they tell me. but attribute her difficulty transferring herself to the commode as "fear".  "She is in pain." I say. I say that I don't want her to be in pain and that a negative x-ray is not a diagnosis and doesn't mean much at all. The doctor wants to wait, "give it a few days". I don't want her walking if she can't bear weight and is in severe pain.

As one nurse said "This a woman who is up walking by 5am every day. She is not herself."

I saw her before I left, she lay there grimacing, screamed when I slide my hand flat behind her knee...pain, lots of pain. Something is broken, I told my daughter.

So, I call during my camping trip (blog on that another time)---I am not happy. She is in pain, they are walking her. I know something is broken.

Today, a full 9 days later, another film and---gee, a broken acetabulum (that's the socket  in your pelvis that the head of the femur sets into). So, for over a week she has been walking with constant prodding, transferring with constant prodding and has had only ibuprofen for pain.

So, when I stopped in after work today, I am told there is a fracture and I say "Duh. ya think." (I know the nurse and she knows too).

I can't get over the failure of health care professionals to use the clinical evaluation and presentation as the better part of diagnosis/evaluation. Classic symptoms. And now, who knows how much damage may have been done by making her do activities with the assumption that "nothing's broken, she's just afraid..."  Oh, and the pain, it isn't so bad. Right?

I am angry. But, that is part and parcel of nursing and care-giving these days.