Shoulder Injury

Shredded Shoe Next
to Plaid Umbrella
AREMENIA, Colombia
October 12, 2019

And then I was writhing on the ground in pain. My left arm was splayed out along the pavement at an odd angle up above my head where it had never reached, before. I couldn't move it.

A couple passers-by knelt down to lift me up. When one of them took me by my left hand I grunted out, "¡No! ¡No!" My left shoulder was gripped in searing pain.

I tried to pick myself up but could do so using only my right hand. As I sat up my useless left arm dangled off in pain. I hefted myself up from the sidewalk with my right arm by gripping the wooden slats of a truck parked on the street alongside where I'd fallen.

One of the passers-by who had tried to help lift me from the ground said he was callling an ambulance. I took inventory of myself. My right hand was bleeding in several small places. My left elbow was badly scraped and bleeding as well. The worst seemed to be that my left arm wasn't functional and the area around my shoulder hurt immensely. Though in a severe state I decided I was intact enough that I asked him not to call the ambulance. I was less concerned about any medical expense (I knew costs would be low in this part of the world) so much as getting caught up into some random hospital across town with little language ability. I asked the good Samaritan to instead call the number of the older couple I've been staying with.

He dialed and informed them of my situation. They were on their way back into town and said they'd come to where I was in 10 minutes.

"What's your name?", I asked using what was probably one of the few sentences I could yet say in Spanish without consulting a textbook.

"Mario," he replied.

"Good to meet you. Thanks so much," I told Mario.

Jagged Metal Post
He then pointed out what had happened. Mario gestured toward the protruding stubs of two pipes jutting straight up from the sidewalk. They had once been the metal legs supporting a city litter bin. But those had been hacked off (perhaps by somebody looking to sell the bin as scrap metal, somebody later suggested) leaving a pair of jagged stumps poking out of the cement. While walking downhill to the city center my shoe must have snagged on one of them.

Normally, when tripping over something in my path I might have stubbed my toe, stumbled, or even fallen to the ground suffering only minor injury. But, because my shoe was caught on the pipe as I was in motion it slammed me straight down onto the pavement with all my forward momentum.

Somebody led me into a restaurant next to where I'd fallen. As I trudged up the steps I could feel my arm pop itself back into place. It would turn out that, among other injuries I'd sustained in that fall, I had dislocated my shoulder. A waitress took me to an open table and offered me a cup of fruit juice.

The large family taking their lunch at the next table over kept staring at me. I meekly tried to put on a smile and wave back. They invited me to come join their meal. I tried with my limited language ability to communicate that I had friends who would come for me in a few minutes. They seemed to understand. But, it wasn't until two women from their party came directly over to where I was sitting, first again inviting me to join their lunch, that they pointed out additional details about my condition. I was bleeding slightly from my nose. I hadn't noticed that. They also informed me that one of my shoes was completely shredded. I looked down and saw my toes through wispy fibers of what had been the tip of my shoe. Somehow the jagged metal had caught my shoe and my sock... but as far as I could see, reach, and feel it somehow had managed not to cut into any of my toes.

Eventually, the couple I've been staying with--Gladys and Díogenes--arrived to pick me up. I hobbled down to their car. At first they drove me to an orthopedic specialty hospital. However, as we pulled up to the front door we found the whole building was closed: I don't know if that was because it was lunchtime or because it was the weekend. Just down the street was a city hospital. They drove up to the emergency entrance where Gladys helped admit me to urgent care and stayed alongside for the entire afternoon.

Her English was rusty: her total practice amounted to a couple years taken at university several decades prior. But, it was far better than my Spanish. Of even more value was the fact that she had heard the accounts of the witnesses at the restaurant next to my fall. That allowed her to communicate clearly to the hospital staff the circumstances of my injuries and when and where they'd taken place.

There were long waits in several rooms before I finally was discharged. First, we had to take a number to be admitted to triage. My shoulder and upper arm ached horribly but seeing other people grimacing in pain, being wheeled into the lobby on gurneys, or with intravenous tubes ending in needles that connected sacs of fluid into their arms all made my pain feel relative.

After admission and paying a deposit we were instructed to further wait along a frigid corridor outside a row of consultation offices. Gladys told me that she thought that, given their apparent youth and the fact that the hospital was situated at the edge of a university campus, these were medical students in their residencies and not yet full-fledged doctors.

Analgesic IV Drip
Once my full name was called out we consulted with the resident in one of the consultation rooms. He was also named David and spoke fair English. He examined me then told me that they would need to take x-rays to determine if anything was broken. But first, I would be put on an IV drip whose main purposes were to ease the pain and inflammation.

When it came time to take x-rays I was ferried about the hospital in a wheelchair. I said there really was no need. Despite being in a bad state I felt I could make it anywhere on my own accord. It was my shoulder and arm that were the main problem, not my ability to walk. But, no: the hospital staff insisted an attendant had to bring me in. So, I was wheeled into an elevator to go up a few stories to the radiography unit.

After the x-rays were taken, I was wheeled back down once again to the same frigid corridor outside the resident consultation rooms. Another long wait finally ended in relative good news when my name was called once again. The x-rays were back and nothing appeared to be broken. By the resident's reckoning my shoulder must have indeed been dislocated but popped itself back into joint sometime thereafter.

The doctor said that having suffered this injury meant I was at greater risk of experiencing a similar dislocation in the future. He wrote a prescription for something called naproxeno to ease the inflammation. When I asked him how long it would take to regain use of the arm he estimated around five days. But, he would later turn out to be mistaken.

Leaving the hospital did bring another bit of relative good news. My bill was presented with a 30% discount. I had paid a flat cash fee upon intake: that amount was higher than the total cost of services rendered. Even without the unexpected discount the total tab itself would have been another silver lining. Including the cost of the x-ray, the IV drip, the consultation, being escorted about in a wheelchair, and all other services the bill came to 75,600 Colombian pesos. That's equivalent to roughly $22 USD.

That low bill confirmed to me that my general policy (or lack therof?) of not taking out travel insurance has been the right way to go. Over my many years out on the road whenever an emergency has arisen my costs of medical care have always been far, far lower than what I would have paid in one monthly premium, alone.

It struck me that the last time I had a major medical emergency out on the road was under similar circumstances. Fifteen years ago two tendons in my right hand were severed and had to be re-attached in emergency surgery in the middle of the night. Then, as with recently coming here to Colombia, I had just arrived into a new country to begin studying a language new to me. The total tab for that other, long-ago injury--including the hospital stay, treatments, and for the surgery itself--was also so low that if I had travel insurance any deductible probably would have been higher than the total medical bill, itself.

Now, I'm recuperating as best as I can. Writing this entry several days after the injury I've found the doctor made an overly optimistic estimate as to how quickly I would recover. I think he missed something. I still have throbbing pain not so much in my shoulder but in the muscle below, too. I don't know whether it's the biceps, the triceps or some other muscle that allows you to raise your arm up above your head. Whichever muscle performs that function is clearly torn. I can extend my arm out fully in front of me but raising it to any level above parallel with the ground is impossible. Fortunately, Gladys works out at her gym alongside a physical therapist whom she can ask for a consultation or referral to an orthopedic specialist, if need be.

I wake up and roll over often at night when the pain flares up. Unexpectedly, it helps to ease the pain when I apply pressure by sleeping on the injured side. Thankfully, staying with Gladys and Díogenes I am in a place where I can comfortably recuperate. This would be such a depressing state to be in were I on the ther road alone and staying in some lonely guesthouse with my minimal language ability.

More details on my living situation, day-to-day routine, and--hopefully, recovery--in my next entry.