​On breaking a leg during a pandemic: Reflections of a doctor-turned-patient

Part I: Before the surgery

The English language is bizarrely replete with phrases that are fundamentally counter-intuitive to their intended meanings. 'Break a leg' is one such phrase that has always irked me, given its illogical nature. It is meant to wish someone good luck just before they perform on stage (drama, music, dance, etc.). How can breaking a leg be good luck, you ask? Now, if you believe the nebulous and oft-disputed etymology of the phrase, per one version it originated when a backup actor wished the main actor good luck by telling him to break a leg because he wanted the latter to actually break a leg so that the former could get a chance to perform in the play. How twisted is that?

Another version attributes the phrase to the assassination of Abraham Lincoln by the infamous actor John Wilkes Booth, who quite literally broke his leg when he jumped from the upper box seat onto the theater's stage after shooting the President.          

I digress, but how is the above relevant to my story? Well, read on….

It started during the lockdown and quarantine phase of COVID-19. In order to keep sane, I had settled into a nice daily exercise routine: 2.5 km of outdoor running followed by 15 minutes of creative movement (aka Zumba-like dancing, to be precise).

“You need to slow down, you are no longer 16 years old!" exclaimed the in-laws from the safety of their terrace as they practiced social distancing while watching me sprint across their apartment building.    

“You aren't certified for Zumba," said the wife as she observed me carry out my pseudo-Zumba routine at home.  

I refused to pay heed despite my family members feeling that I was pushing myself beyond my limits, likely because I was genuinely enjoying the exercise routine irrespective of its imperfections.

On the eventful Sunday morning before leaving for my ER shift, I had the urge to work out. Given the added stress during these coronavirus times, I felt particularly motivated to do so as I was convinced that it would attune my mind and body to fighting against COVID-19 in the long shift ahead of me.

It was too hot to run outside, so I decided on just the 15 minutes of Zumba at home. Donning the proper shoes and exercise attire was followed by adequate stretching, and then my Zumba routine started. By then I knew quite well the steps to the popular bhangra song, “London Thumakda". As the song progressed, so did my moves, and I imagined myself performing on stage with a dance troupe. It was at the grand finale of the song - when the singer crooned “Oh ballay ballay"- that I jumped rather energetically, perhaps higher than normal. It wasn't the going up that mattered. While coming down, I didn't realize that my right ankle was bent, and I forcefully landed on that twisted joint instead of on the sole of my right foot.

Crack! I heard that, and I immediately realized that I had damaged something and that it wasn't going to merely be a sprained ankle. Within minutes my excruciatingly painful ankle had swollen to the size of a tennis ball. Ironically, yours truly - the ER attending on-call - landed up in the ER as the patient in the fullest sense of a blunt trauma-related emergency. 

Being there during COVID-19, not as a care-provider, but as a patient, was like a nightmare come true.  Honestly speaking, I didn't want to be there as a patient during the pandemic, given the high likelihood of exposure to coronavirus in any hospital. Although I was taking strict precautions, including an N95 mask for respiratory protection, I would've been much happier being there as the ER attending. That way I would've been rounding on my patients versus being rounded upon by the ER team!

“What if I hadn't been working out? This wouldn't have happened. What if coronavirus had not been ravaging the world, then I wouldn't have gone insane during the lockdown and I wouldn't have been so obsessive about working out. Then this wouldn't have happened…"  

Lying there on a stretcher in a corner of the ER, trying to tackle such rhetorical and circular questions, I was merely correlating my accidental injury with COVID-19, knowing empirically well that correlation did not prove causation.

While reflecting on my predicament as an immobile observer, I realized that being a patient in the same ER that I work for provided me with an interesting vantage point. I observed that the team of healthcare providers including nurses, doctors, and ancillary staff were very gracious in patient-centric care provision, for which I was immensely grateful. Whether the enhanced care was simply because of my departmental 'status' and thus a confounding factor, I couldn't say.   

After one of the nurses placed an intravenous line, adequate dosages of pain medications were quickly administered; in tandem, another nurse placed a large bag of ice on my elevated ankle to help reduce the swelling. X-rays were swiftly obtained and an orthopaedics (or orthopods henceforth) consult was called.

After the X-rays were taken, I didn't have to wait long for the orthopods to come see me.  

“Sir, I am with the ortho team. You have a fracture in the lateral aspect of your right ankle; it involves the distal fibula. We recommend surgical intervention." This was reported to me by the orthopod resident after conferring with his attending.   

And thus, my worst COVID-19 pandemic-related hospital-based fears were realized. Not only was I going to require further time in the hospital, but my recovery was seemingly going to be much longer than I had initially anticipated.

It wasn't just a sprained ankle secondary to ligamentous injury as I had initially hoped, but a truly broken leg.

I had taken the English idiom a bit too seriously.    

Story to be continued...

DISCLAIMER: Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences. The views expressed do not necessarily reflect the views and policies of CCIT or AKU.​​


About the Author

Asad I. Mian MD PhD is a pediatrician, ER physician, and researcher by profession, at the Aga Khan University. His proclivity for writing is his means of creative exploration and expression. His articles on health, education, children, humour and popular culture have appeared in newspapers in the US and in Pakistan. Other than the Biloongra series of bilingual books for children, he has authored 'An Itinerant Observer' a book of brief narratives first published in the US in 2014 which will be reprinted by Bookgroup in Pakistan in June 2020. He can be reached on Twitter @amian74 and he blogs at anitinerantobserver.blogspot.com.​