Posted by: medicblog999 | February 20, 2010

Just so Surreal!

music-notesThe best thing about being a paramedic, is just getting the opportunity to meet so many unique and wonderful people, but sometimes things just get so surreal……

Called to a 64 yr old female, fall, ankle injury.

Off I go, working on the rapid response car.

Once at the house, I am shown into the front room by a young gentleman who introduces himself as Steve.

Steve informs me that the patient, Marjorie, was walking past his house when he saw her slip and fall on ice on the pavement. She was unable to get up due to pain in her ankle and so he assisted her into the house, virtually carrying her, and placed her in the chair that I now find her in.

“Hello Marjorie, I’m Mark from the Ambulance service, what have you been up to today then?”

“Oh, that bloody ice, the council never clears these paths….It’s a disgrace!!, it was an accident waiting to happen”

“So what actually did happen? Steve tells me he saw you slip and fall”

As I ask, I look at her legs and notice that her right foot seems to be facing the wrong direction!

“I just slipped! I must be a silly old fool; I think I have hurt my ankle haven’t I”

“Err, yup! I would say so. Does it hurt very much?”

“Well, it’s just like a horrible ache. It hurt more when I tried to get up and walk on it!”

Cue a subconscious shudder from me! The thought of her trying to walk on that ankle…..Blurgh!!

In cases like this, with such a dramatic injury, it is important to continue and do a thorough survey, as it is too easy to become focused on the obvious, so I continue on with a full secondary survey which shows no further apparent injury from the fall.

It appears to be a simple mechanical fall caused by slipping on the ice. No neck pain, back pain, or other aches or pains. Just that horrible looking foot.

“Right then Marjorie, I’m going to get an ambulance down as well as there is no way that I will be able to take you up in the car. I know that you are saying that the pain isn’t too bad, but I have a feeling that it is going to get worse soon (as I realise that it is highly likely that I am going to have to pull it) so I am going to pop a need le in your arm and give you some strong pain killers OK?”

I start off with giving her some entonox whilst I find a suitable vein and insert my cannula. The entonox appears to be taking the edge off the pain, so I feel it’s time to remove her shoe and tights to have a good look at this ankle.

As gentle as I can and with the assistance of a slightly reluctant but brave Steve, I manage to cut through her laces and tights and remove her footwear without much off a problem.

Steve, bless him, can’t help but mutter a “bloody hell” when he sees the shape of her lower leg.

Her foot is literally pointing 180 degrees in the wrong direction; her distal tibia is also deformed which leads me to believe that this is a fracture dislocation. Fortunately, it is a closed fracture, so there are no open wounds to attend to; however, the skin overlying her medial malleolus is white with the pressure of the underlying bone.

I have difficulty finding a pulse in her foot, so my decision is made.

“Marjorie, as you can see you leg is in quite a bad way. The way it is pointing at the minute is stopping blood getting to your foot and that needs to be rectified. When the crew gets here I am going to have to pull your ankle back to the correct position. That’s going to hurt a bit, but once it’s done, things should feel a little better.

The Crew will be here soon, so I am going to start giving you some Morphine now, to get you comfortable and ready, OK?”

I start giving her the Morphine. 3mg, then 2mg, then another 2.5mg until her pain score is down to a 3 (out of 10). As I am pottering on, we start chatting and I find out the Marjorie here is quite a star. She used to be an opera singer with some pretty famous opera companies in the UK, and as is my want whenever someone tells me that they can sing, I have to ask…

“Go on then, give me a tune”

Don’t ask me what it was that she sung. I think it was Italian, but my god, the sound that came from her was beautiful….and loud!

I started to feel a little self conscious just sitting on the floor in front of her, getting a private performance like this. Steve was mesmerised too. She finished after a couple of minutes, but all I could say was…..Wow!

Shortly after the crew arrived, we discussed my plan. Joe took up position holding onto Marjorie’s knee and proximal tibia whilst I took hold of her foot and ankle. I had just given her another 2.5mg of Morphine, and had Julie (the other crew member) ready with the Vac Splint, so that we could immobilise her leg as soon as it was back in line. As well as the morphine, I got her to have a couple of minutes of deep breathing on the entonox as well.

Now comes the surreal moment….

“Marjorie, this is the bit that is going to hurt. You can do what you want, don’t be afraid to swear or shout out if you want to “

“Would you mind if I sing?”

“Err, no not at all. In fact I think it would be wonderful for Joe and Julie to hear your voice too”

Now, Julie and Joe hadn’t been told about Marjorie’s talent, so they shot me a quick glance with a quizzical look.

“Don’t worry guys, you are in for a treat”

We all stood frozen in our places for the next 30 seconds whilst the room was filled with her voice again. I could have sat there just happily listening for ages, however, there was a job to do.

Whilst Marjorie lost herself in her music I looked over to Joe..

“Ready mate?”


“OK, 1……2…….3!”

With that I apply traction to her foot and ankle and rotate the foot back round towards its normal position. Joe is pulling hard on her upper leg, to apply the counter traction that is essential to reduce fractures like this.

Marjorie’s notes suddenly become louder and a little less perfect as she obviously battles with the sudden pain, but just as quickly as it started, it’s all over.

I feel the bones of her ankle click back into some form of normality. Her foot is now facing the correct way, and although still deformed and swollen, I can see the reassuring pinkness start to return to the foot. Julie places the vac splint and removes the air with the pump. I peel back the part of the splint covering the top of Marjorie’s foot and feel for a pulse.

Champion! X Marks the spot – I place a pen mark X over where I can now feel her pulse.

Marjorie is still singing, although she is quieter than before. I don’t know if it was a quiet part of the song or if she was just so weary now.

“Its all done Marjorie, you did a fantastic job! Well done!”

The crew take her off to hospital where I check up on her later in the day. She was going off to theatre to have an ORIF (Open reduction and internal fixation) of her ankle, but not before I had the chance to tell her once again, how beautiful her voice was.

“Make sure you give the ward nurses some of your magic too Marjorie!”



  1. Such an amazing story, Mark!!! Wow. I am in awe!!And I'm quite jealous. I adore opera… and giving morphine. That combined makes me a rather jealous little medic…

  2. What a wonderful post. I'm not an EMT, but a laboratory scientist. But, I am involved with several musical groups and take voice lessons. I really enjoyed the story and wish Marjorie the best of luck. I'm sure she's a “trooper.”

  3. I wish they bottled whatever brand of intestinal fortitude little old ladied seem to possess…I know a few people who could use some !

  4. YES!!! You captured the very essence of what we do. Jobs that become memories…for me AND the patient.

  5. Doncha wish they were all like Majorie? What a trouper!

  6. A lovely story triple 9. I have never treated an opera singer (at least to my knowledge) but just the same, some quite interesting and remarkable folks have too graced the hollows of my ambulance.

  7. It will certainly stick with me, I know that!Thanks Ronnie!

  8. And isnt that just what makes our job the best in the world!!

  9. It will certainly stick with me, I know that!Thanks Ronnie!

  10. And isnt that just what makes our job the best in the world!!

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