I broke my ankle--No, not that one...the other one

or, The winter of Jim's discontent

A little more than two weeks have passed since the surgery on my herniated disc. The surgery and two night hospital stay went smoothly, although I did not take my friend Tiffany’s advice and opt for the better menu. I should have. The food was terrible. I did, however, end up with a private room and felt content with the care I received. The procedure ended up being somewhat more complicated than anticipated because the surgeon discovered that the hernia was bigger than it had appeared on the MRI and much older. He had to improvise when he realized the matter had ossified and that removing it left a small hole in the bone. He made the incision larger, patched the hole, and liberated the nerve that was compromised by the protrusion.

Everyone I spoke to about this procedure advised me how important it is to walk afterwards—the best therapy is to walk, walk, walk. My doctor said I could not do any official physical therapy for one month, except walking. A nurse was scheduled to come to the house every other day to change the bandage and I would not see the surgeon again for 3o days. Several days after I was home, the sun was shining brightly in Paris and I decided, with the help of Jairo and a walker, to take a Sunday promenade in the park across the street. After a short circuit, we were coming back to the apartment and I had to go up two small steps. Somehow I lost my equilibrium, the weakened right leg gave out from under me, and I came down hard on my left ankle, ending up on the ground. I heard the sound of something ripping as I fell and, sitting on the cobblestones, I watched in horror as my ankle began to swell.

My back and the wound on my back seemed to have weathered the fall without any trauma, but the left ankle clearly was injured. Being an old pro at twisted ankles, I promptly applied ice, arnica, wrapped the joint, and hunkered down for the rest of the day. First mistake: I should have gone to the ER. But we were still a bit apprehensive about the French ER system. We knew it wouldn’t be anything like the Cleveland Clinic and we were hesitant to go to the ER at the large inner city hospital, Hôpital Saint-Antoine, just down the street from where we live. When the nurse, Quentin, came by on Monday, he looked at the foot with some concern and advised that I see my primary doctor to be sure that everything was OK. I made an appointment for the next day, Tuesday. The doctor’s office is a short walk from the apartment, but we took an Uber. The doctor examined the ankle and expressed concern at the amount of swelling, writing me an order for an X-ray. Second mistake: She should have sent me to the ER. But I was not in that much pain. Of course, I was taking a lot of pain medication for the back incision, which continued to heal nicely, so my perceptions were not to be trusted. I secured an appointment for an X-ray at the laboratory nearest to the apartment for early Thursday morning.

Thursday was the day of a national strike in France—the mother of all strikes—against President Macron’s proposed pension reforms. He wants to extend the retirement age from 62 to 64 and all of the unions are rising up in opposition. Since schools were closed and most people were working from home because of the lack of public transportation, we were able to borrow Kena’s car to deliver me to the radiology laboratory. Result: a fractured fibula! Now we could no longer avoid the ER and we made our way to Hôpital Saint-Antoine, which is located between Bastille and Nation, directly on the line of the protest march planned for later that day.

At the ER…

Surprisingly, the ER was not too busy. I think the hospital’s cleaning staff were on strike because the waiting room was a mess, with empty coffee cups, sticky floors, and smears of blood. However, I was triaged quickly and sent to another area to wait for the orthopedist to examine me. There were no orderlies, no one to assist me. Kena’s mother had loaned me some cannes anglaises (English crutches), the kind that work under the elbows rather than the armpits. Jairo had gone to deal with the car and I looked around for a wheelchair, but it seems that none were available.

The triage doctor told me to follow the blue arrows. I took a deep breath and slowly began to make my way down the long corridor, blue arrows leading the way. While I waited in the hallway outside the ER orthopedic examination rooms, at least five other patients came and went with ankle injuries. Apparently, twisted ankles are the most common reason to visit the ER in Paris. One young man, with a bone that had broken through the skin, was taken by ambulance to another hospital. Others had their ankles X-rayed, wrapped, and were sent on their way, teetering on their fashionable high-heeled boots or limping pathetically down the long corridor and out the door. I had a new X-ray taken and it was decided that I needed surgery. However, there was no one at the hospital who could do the surgery right then. The staff began to call around for another place to send me. After about three or four hours, they put a plaster cast on my ankle and sent me home with an appointment for the next day at noon for what I thought would be surgery on my ankle at a private clinic in our arrondissement, Clinique Mont-Louis.

This was a day of a lot of firsts for me: first national strike day, first French ER, first broken bone, first limb in a cast. My stress levels were extremely high, and by the time we got to the clinic the next day and were informed that there would be no surgery, only a consultation with the doctor, I lost it. The doctor’s secretary received the brunt of my vitriol, but the doctor himself got some, too. He kept his cool and explained that it was not an emergency situation and would be better to wait and do the surgery as an outpatient on Monday. I had fallen on Sunday, it was now Friday, and I had to wait for Monday to get the fracture fixed with a plate and six screws. There was nothing else to do. We met with the anesthesiologist, went through pre-admission protocols, and went home to wait for Monday.

Oh, I forgot to mention that when I found out that I had actually fractured my fibula, I tried to contact my spine surgeon to let him know about this new development. He called me back when I was in the ER, demanded that I send him a picture of the X-ray, and discussed the situation with the ER orthopedist. He wanted me to get operated on as quickly as possible. He had concerns about the effects of the fracture on my spine, the danger of infection, the diabetes spectre, and other complications that could arise from postponing the surgery much longer. When I informed him that the surgery would finally take place on Monday, he said that he thought that would be OK, and he requested that I send him a picture of the post-op X-ray when I could.

By now, you should be getting the idea of how much responsibility is put on the patient him or herself, in the French medical system. A lot of things that in the USA, we take for granted, like delivering the x-rays or communicating medical status or history, prescriptions, and equipment are left to the patient to do in France. I had to buy the walking boot that would be put on my ankle after surgery and bring it with me the day of the procedure. Also the compression stockings. I only had one surgery in the USA, an emergency gall-bladder removal, but my feeling is that a lot more things are done for the patient. Of course, that’s one reason why it’s also five to ten times more expensive.

At the Clinique…

On Monday afternoon, at Clinique Mont-Louis, the admission process took two hours. We slowly made our way (I was still using the cannes anglaises) through the clinic’s hallways and up and down elevators, from waiting room to guichet (window) to waiting room to office to waiting room to a bizarre vestiare (changing area) where I had to separate from Jairo, leave my clothes and belongings in a small locker (like at the gym), and change into paper underwear, hospital gown, slippers, and hairnet. I was also handed a white terrycloth robe. I placed my telephone in the locker and the attendant grabbed the key, put it in a plastic bag, and shoved it in the pocket of my bathrobe.

Turning the corner of the room, I saw five or six other people dressed exactly the same as me sitting on chairs, staring at their phones. What the hell? There were signs everywhere saying “No phones!” The whole scene reminded me of a scene from a Saturday morning serial I saw as a kid—it was either The Three Stooges or Abbot and Costello—in which older women, dressed exactly like this, were gathered in a room, waiting to go into the “fountain of youth” machine. I just wanted my broken ankle fixed!

When my name was finally called, the orderly took one look at me and went in search of a gurney for the elevator ride from the fifth floor to the sub-sub-basement. Once there, I found myself in surgery central with doctors and nurses running past me, patients being wheeled in and out of different surgery blocks, and intermittently, someone would come and ask me a question, put in my IV (just in case), take off my cast, and begin to administer the local anesthetic. The doctor eventually came by to chat. He grabbed my foot and I screamed in pain. The young anesthesiologist had not given me enough anesthetic in the right places. My stress level was growing. When they finally rolled me into the operating room, the nurse told me that my blood pressure was extremely high. I wonder why? They gave me something to calm down, put up a barrier so I couldn’t see what was happening, and pretty much forgot about me for fifty minutes, as the surgical team shouted at each other, stormed in and out of the room, and, somehow in all of that chaos, repaired my broken ankle. Several times I caught someone’s attention and inquired how things were going or if it would be much longer. Eventually, I think I fell asleep for a few minutes, but it was pure hell.

The best part of the whole ordeal was the hot chocolate and madeleine waiting for me in recovery. I was nervous about going home because I had no feeling in the left leg and my right leg was still weak from the spine issue. Kena drove us home and, with her and Jairo’s help, I was able to get in the apartment without any mishaps. After almost one week, I am recuperating. Tomorrow, my sutures from the back surgery come out and I see the ankle doctor again, one week after surgery. I begin physical therapy on the ankle this week and must wear “the boot” for five more weeks. It’s going to be a long, slow recovery.

Where am I now…

People keep asking me if I’m OK, if this series of physical mishaps has been caused by some existential crisis or imbalance. Am I depressed? Is that why I first twisted my right ankle three months ago? Of course, that kind of cause and effect thinking is not always helpful, but, for some reason, being in Europe, one seems closer to the trauma and suffering in the rest of the world, whether it’s Ukraine or Africa, the West Bank or Peru. Everything seems more immediate here in Paris than when I lived in Ohio or California. And, I think, my body is reacting to that immediacy. This convalescence is a time for me to come to terms with the privileged life I have led up to now, the transformation I have begun, and the opening I need to make to the world’s demands. This is a time for me to begin to understand my evolution as a human being on this planet. Before 2020, I thought that I was already advanced in my process of individuation, but I’m only entering the first stage. There is so much more work to do. My heart goes out to anyone suffering from pain and anguish right now. A herniated disc and broken ankle seem like nothing when I hear the stories of others or watch the news and notice how much suffering there is in the world—suffering that can’t easily be fixed with surgery or pain pills.

Movies I’ve watched (and liked) under the influence of painkillers: Causeway; Ray and Raymond; Official Competition; All Quiet on the Western Front.

I thought Everything Everywhere All at Once was a little too much on the small screen; I felt like I had already seen The Menu and Glass Onion bored me tremendously.

Series I’ve been enjoying: Smiley, Merlí: Sapere Aude, and Belascoarán: PI (I really like the Spanish/Catalan/Mexican sense of humor and modern sensibility).

Reading: I’m just discovering the Henry Rios detective series by Michael Nava. The novels are smart, beautifully written and structured, with great characters, a strong social-political perspective, and a gay detective. A wonderful substitute for the lack of new V.I. Warshawski books.