Coming of Age

I am in theatre for only the third time since my medical student days. We’ve got two displaced fractures on the list, and my registrar, S, has decided it is time I get involved in some proper orthopaedics.

 

As we wait, S talks me through the principles of manipulating displaced fractures. Contrary to all you have been told, orthopaedics isn’t just about playing with hammers and pins and casts. There’s plenty of brains, and science, involved. Really.

 

The first patient is wheeled in and we commence. I am slightly nervous but S is amazingly patient and encouraging. I pull and push and apply pressure in what I hope are the correct places. After a few minutes of poor progress, S decides to take over. “You’re too gentle,” he tells me, and promptly proceeds to yank and tug at the arm in a most alarming manner.

 

What does he mean, gentle. I am Orthopaedics Senior House Officer Extraordinaire, and Violent is my middle name. I vow to do better with the next one.

 

And I do. I’m getting comfortable with the routine- pushing on one side, pulling on the other, lifting slightly, tilting at an angle, smooth and sure, when suddenly…

 

CRAAAAACCCCCCCKKKKKK!

 

I freeze in mid-motion. For what seems like an eternity, I gaze at the tiny hand I am holding, unable to fully comprehend what has happened. I am lucid enough to realise a bone has been broken, and alert enough to also conclude that I am probably the one who has done it. I feel vaguely sick in the stomach and start thinking I should never have come, orthopaedics is not for me, what on earth made me think I could do anything remotely surgical without messing it up. I sense that everyone has paused whatever they are doing and are now looking at me.

 

I slowly raise my head and meet S’s smiling eyes. He is laughing in amusement, obviously enjoying my discomfort.

 

“I’ve broken his bones,” I say inanely, as if that weren’t already obvious.

 

S takes the arm from me and pulls it a little bit more. And as he quickly and expertly applies the cast, he says:

 

“Sometimes, the biggest barrier to total healing is an intact piece of bone. That’s why some folk say the best way to properly fix someone’s bones is to completely break them.”

He grins and winks and we look at the almost perfectly straight bone on the films and then we walk out to have lunch.

 

And I reflect that maybe, there is a lot more wisdom in orthopaedics than any of us give it credit for.