A middle-aged chronic ethanol-abuser (alcoholic, for you folks at home) came in after a nasty fall. He was wheeled in as he couldn't stand, and his knee, elbow and ankle were swollen beyond belief. He got x-rays of all three joints, which I took to my consultant (boss).
"Boss, I can see a definite fracture in the ankle, maybe a fracture in the elbow and the knee is intact..."
"Yes, the knee is intact, there IS a fracture in the elbow, but... I don't know about the ankle. I think what you're seeing is an old fracture."
O, but I was sure. I argued my point, demonstrating the interrupted cortical bone, the exquisite tenderness of the medial malleolus, the massive swelling of the ankle.
Finally, my boss agreed, and I put the man in a plaster from knee to toe.
He also needed a sling, which meant he couldn't use crutches, and so we had to admit him so we could keep him safe. (Alcoholics are not very well people, and definitely not good using one crutch with two broken limbs). Admitting him meant I had to I call the Orthopaedic surgeon to let him know about the broken boned patient.
Let's call him Bruce.
"G'day, Bruce here, I've had a squiz at the X-ray and there's no new fracture. It's an old fracture."
"But, we're admitting him to hospital..."
"Nah, he's fine. He can go with a walking boot."
"But...I already put him in a plaster!"
...silence....
"Are you one of the new interns?"
"Er. Yessir."
Hysterical laughter down the line.
"Look, love. Take the plaster off, find him a boot, send him home. He's not coming into hospital"
The only upside was that my patient had serious DT's by now and really wanted to go home, where he could drink in peace. I cut the plaster off, found him a boot and sent him home.
Another fine day for intern medicine.
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