Sunday morning bright and early...almost summer.
I'd even heard some bird song as I parked the car.
The waiting room is packed however.
"Mr Pease ? Mr Herb Pease ?"
A pale,visibly hungover 50-something man stands up gingerly from the cheap plastic waiting room chair.His eyes are bloodshot,he is unshaven and his greasy ponytail hasn't seen a comb for a few days...he is clutching a takeaway coffee container form McDonald's with an intensity that makes me wonder if it is the Holy Grail...and both shambling (with his good leg) and limping (through his bad leg) slowly makes his way into the Unit.
He had clearly had a good evening with his three best friends...Nick O'Tine, Al Cohol and Gay Abandon.
To be fair to him,its like I'm looking in a mirror...except I had had a shower sometime in the past 72 hours.
"Right...good morning...what can I do for you today ?"
Well...what it is...obviously...its my knee...I hurt it last night...
"Uh huh...what were you doing...going for a run...playing rugby...?"
Ahhh...no...it was my 50th birthday party...and we had a disco...and I'd had a few drinks...
...and I fell over when I was dancing and hurt my right knee...
...and its still so painful...really really painful...
"Okay...how much did you drink ?"
I can't remember...
"Okay...did you stop dancing when you fell over ?"
No...I was having such a good time...and you only turn 50 once don't you...?
"Have you taken anything for the pain...any analgesia at all?"
No....I don't like taking tablets...
*sigh*
"Okay...if you could just take your shoes and socks off...and then your trousers...and hop up onto the bed please..."
Do I really have to take off my trousers...?
"Jah...this is why your mother always told you to put on clean underwear..."
Maybe he had listened to his mother at the start of the evening...it was a real pity though that he hadn't been home to change...just as well I am a vegetarian.
He made himself comfortable and I started to examine him. I was reassured that he could fully weight bear through the knee;that he has a full range-of-movement through the knee;and that he could straight-leg-raise.
He certainly appeared to have what is called "global" knee pain.
However his knee was not warm to the touch or red or even swollen;there was no obvious effusion;there was no bruising;he had no bony pain;and all his ligaments appeared intact although he had some pain to the specific test for his medial collateral ligaments.
We were both sweating a little at the end of the consultation.
Him from fear...and pain.
Me from the second hand alcohol fumes.
"Right...well...I think that you've sprained your knee when you fell over...there's really nothing else to find...and you need to rest it and ice it and take some pain tablets..."
But its really painful....really really painful...
"I'm sure it is painful...but...with respect...you're quite a big guy...and dancing on an injured knee is always going to end up in tears...and that's why I want you to take some pain tablets..."
But I'm a builder...how am I going to manage at work...?
"Well....and I'll try this again in English...rest your knee...ice your knee...take some painkillers...and probably take a few days off work..."
Are you sure its just a sprain...?
What am I going to tell my wife...?
(Really...you found someone to marry you...let me make a note on your chart)
"Jaaaaah...I'm 100% sure its just a sprain..."
Don't I need an x-ray...?
"No...you sprained your knee...you continued to dance on it...and now that you've sobered up you're experiencing some pain..."
Are you sure its just a sprain...are you sure I don't need an x-ray...I'm just worried about my job...thats all...
"Okay...I'll tell you what...I'm going to give you some codeine and leave you for an hour...
...and then I'm going to do an old Army knee stress test...
...we used to do it on a Monday morning when the troopers had returned from their Saturday night in the discos...
...I guarantee that if you can pass that test that there is nothing sinister going on in your knee and that you only have a small sprain..."
Julian settled him down with some 'fresh' chemical coffee and some codeine and I left him alone for an hour.
"Right Sir...please get up off the bed and stand over there next to the wall..."
He duly did that...and in a relatively pain free fashion,the codeine having kicked in already.
"Right...now...with both feet firmly on the ground,looking straight ahead,I want you to stretch out your right arm to your right side,and place your right hand firmly against the wall to balance yourself...Okay...?"
He duly does this as well.
"Now...I want you to put your right leg out in front of you,as if you were going to step over a small step..."
He duly flexes his hip...his knee..and his ankle.
Still relatively pain free.
"Good...now...keeping your leg in that position...and keeping your hand on the wall to balance yourself...I want you to point your toes forward...as if you are going to press down on the floor...Okay ?""
He manages that as well.
"Okay...now I want you to make that a nice fluid movement...bend your hip...bend your injured knee...then bend your ankle... and then point your toes down and tap the floor...Okay ?"
He manages that as well and looks expectantly at me.
Gosh...that's not bad is it ?
"Wait Sir...there's more to come..."
"Now...I want you to make that movement several times a minute...basically as quickly as you can..."
Hip/knee/ankle/point foot and tap toes
Hip/knee/ankle/point foot and tap toes
He managed about 16 toe taps.
"Now...the next part is crucial...the next time you bend your hip I want you to raise your left hand above your head and say...as loudly as possible...'Staying Alive' ...Okay ?"
Why do I have to do that then...?
"Well...firstly I want to check your balance...and secondly...I want to distract you from the pain...and shouting out 'Staying Alive' and raising your left hand will do that..."
Oh...okay...what does 'Staying Alive mean ?"
"It doesn't mean anything....we just wanted the troopers to...you know... 'stay alive'.."
"So...bend the hip...raise the arm..bend the knee...shout 'staying alive'...bend the ankle...tap the toes ...and do it as quickly as you can...."
Hip/arm/knee/'Staying alive'/ankle/foot and tap toes
Hip/arm/knee/'Staying alive'/ankle/foot and tap toes
And he managed to do it 9 times in the first minute and 12 in the next minute and attracted quite a crowd with his 'staying alive' shouts echoing throughout the suddenly quiet department.
Even Julian felt sorry for him then.
"Okay Sir...how do you feel...?"
Well I feel better now...that was a really stressful test...I'm sure if it was broken I couldn't have done that could I ?"
"Good...so I can really confirm that its just a mild sprain...or a "Travoltaitis"...as we call it..."
What regiment were you in...?'
What does that mean...?
"Basically...take responsibility for your own life and get out of my emergency room..."
"Well...thats the polite version anyway..."
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