“How much morphine?!” the nurse asks. I see across the room in the faces of the ten staff gathered around looks ranging from shock to disbelief to not certain they heard right. “Seventeen,” my preceptee says. Again some looks, understandably. 17 milligrams of morphine is a lot, but after all we are in the trauma room and the patient does have an open fracture. That fracture isn’t apparent to everyone. All they can see is a big pillow wrapped around the ankle with toes visible. They haven’t undone it yet to. The patient can wiggle his toes on command and he does. The toes are warm to touch, the resident notes. The head doctor enters the room now and looks at the grimace on the man’s face and say, “Let’s get him some dilaudid.” He is told about how much morphine the man has already received. “Well, it doesn’t seem to be doing the job, does it?” I stay in the room, while my preceptee goes to write up the report describing how the patient’s leg was snapped when the refrigerator fell on him, and how after we had given all we could by standing order, we had to call for permission to give more morphine. I stay for one reason, I want to see their faces when the splint is undone. They have already cut off all his clothes and rolled him to examine his back. “Let’s get a look at this,” the doctor says approaching the splint. They are all there – doctors, medical students, nurses, paramedic students, x-ray techs, registrars. All waiting to get a peek. The pillow is undone, the trauma dressing unrolled. There is the foot — looking more like a shoe without a leg in it. It just hangs there by a big several inch flap of skin. From the rip protruding out about five inches are the bloody distal ends of the tibia and fibula. In other words, the leg bones are intact, but completely exposed to the air – an open dislocation. The impressiveness of the injury is confirmed by the grimaces. “Let’s add some fentanyl,” the doctor says. And pass the bottle of percocets for everyone else.
