The Accident
Back in the early 2010s a friend in Sydney (mid-30s, let’s call him Paul) had an awkward fall from his bicycle, which resulted in him sustaining a messy elbow fracture. As you would expect, he went to emergency, got it checked out and they sent him off to get surgery. The surgeon then opened up his arm, screwed the pieces of bone together with a metal plate, and sent him home with his arm in a sling – all thanks to the government-provided Medicare.
Though admittedly this was was a bad break and pain was to be expected, as soon as Paul got out of surgery and the drugs wore off, he already knew something was wrong. The pain was excruciating and as the days went on was not subsiding at all. His arm was stuck in a sharply bent position at the elbow, with his hand hovering near his shoulder on the same side (you can picture the cliche pose of a socialite holding a small handbag). Paul also couldn’t feel or control his hand which was perpetually numb, grey and clammy.
Despite the clear indicators of a problem, the doctors and surgeons assured him that that this is just ‘how it is’. “You totally smashed your elbow, what do you expect?” and so on, and they sent him to physiotherapy.
Physiotherapy
Paul’s first physiotherapist was “useless”, so he complained and they escalated him to a different guy who dealt with more serious cases. This therapist (who was also a martial arts instructor) happened to be interested in his case for some reason, and was willing to advocate for his cause.
Medicare originally said that Paul could only have 6 or 8 physiotherapy sessions, but the therapist said that was nowhere near enough. He was going to need at least 6 months worth of sessions at 3 times a week (ie. in the region of 72 sessions).
Fortunately he was able to pull some strings so the sessions were done at a discounted price, otherwise Medicare (Paul didn’t have private health insurance) would never have covered it.
Painkillers
The therapist told Paul that he was going to need serious painkillers, since when he pulled on his arm it was going to cause intense pain. The pain management people, however, said they couldn’t give Paul opioids for 6 months since he’d end up addicted and at that point it would be almost impossible for him to stop. As a result, after the first 1-2 weeks of opiates, they provided Paul with only Nurofen/Panadol standard headache tablets, which did essentially nothing.
From here, Paul was doing 3x excruciating physio sessions every week, and every 2 weeks he would get perhaps 5 degrees more movement out of the ‘frozen’ muscles on his ‘dead’ arm. Since there were no ‘official’ medical personnel who were able to help him, he was regularly driving out west to track down and buy blackmarket pain pills from ‘flexible’ doctors, just to get through the sessions.
Second Opinions
Even with the pain pills, Paul was still struggling to sleep at night and his life was essentially a nightmare, not knowing if things were ever going to improve.
As the weeks went on, the physiotherapist started to agree that there was something not right. Paul should have been making some improvements and not be in so much pain after all these weeks – but he was.
Paul booked appointments with the original surgeon, asking if he could remove the plate or try something else.. but was essentially just fobbed off and told to stick it out with the rehabilitation. Will it get better? Maybe, maybe not. Great.
Of course Paul contacted numerous other doctors and surgeons, attempting to get second opinions and to see if they would help. None of these people wanted to touch his case (or perhaps second guess a fellow surgeon?) so Paul would end up going back to the original surgeon who refused to do anything, and the cycle continued.
This dynamic persisted for close to a year, with Paul miserable, depressed, in constant pain, basically unable to work, and surviving on black market painkillers.
The Expert Ex-surgeon
Finally Paul managed to get referred to some big-shot retired ex-surgeon who did private consulting on special cases. Paul got $1000 cash together for his fee and drove out to the the surgeon’s rural mansion.
Paul was let into the house by the man’s wife to find him sitting at a desk holding tweezers, intensely focused on putting a ship into a bottle. Apparently these guys enjoy flaunting their fine-motor skills even when people are paying effectively thousands of dollars an hour for their time.
Anyway, Paul explained his story, and showed the surgeon his clammy, numb, useless hand, which the surgeon briefly glanced at.
“Yep, it’s f$#ked.” he said, barely looking up from the ship. “Okay, so what do I do then?” Paul asked.
The expert surgeon then told Paul he would just write a recommendation to the existing surgeon who did the procedure, suggesting that he pull the plate out.
“But that’s what I’ve been asking him to do all year” “Let’s see.”
Returning to the Original Surgeon
The next week, Paul went to another appointment with the original surgeon, and showed him the recommendation letter.
He was immediately irate, and shouting Paul down. “Why did you go talk to this guy?” “Who said you were supposed to do that?” and so on.
Paul asked what him what the difference was – and anyway was he going to take the recommendation or not? The surgeon said he’d think about it, and told Paul to come back the following week.
Paul returned the next week to find that this surgeon – in the space of mere days – had retired, and moved to Tasmania. That was it. No further details or explanations were offered.
Sitting in the office instead was a brand new young surgeon from the UK who – strangely – was only too happy to remove the plate. They booked a date for the surgery, Paul had the plate removed, and he felt better immediately – even as he walked out from the hospital.
Reflection
So what happened here?
It would appear that Paul suffered some kind of Ulna nerve damage, and the plate was impacting on that nerve, on blood flow, and causing the arm to be ‘stuck’ somehow. Nobody knew apparently, and it was ‘not common’.
But why didn’t the original surgeon want to fix it? Was he concerned about staying under some kind of accident quota? Was he concerned about liability? Or his insurance premiums? His reputation? Ego?
And why didn’t any other doctors or surgeons want to get involved? Was it professional courtesy to one of their fellow brothers-in-white? Did they not want to dig up a fellow surgeon’s mistake and then have to not only expose them, but also deal with the problem itself? Was it a ‘no-win’ scenario where they figured they were not going to be able to fix the problem anyway?
More importantly, why were they – along with the original surgeon – willing to let Paul spend the rest of his life in constant pain with a frozen dead arm, just to avoid whatever career inconvenience this may have caused?
Some Anecdotal Research
I haven’t gone deep into this, but I have spoken to some surgeons (overseas, not in Sydney) who claim that when they work in a hospital, it is the HOSPITAL itself which has the insurance policy, not the individual surgeons – who are all covered by that overall policy. Apparently as long as they behave within certain guidelines (which are not difficult to stay within), the surgeons don’t have to worry about being liable for any kind of harm to patients regardless of whether the patient ends up dying or whatever. How encouraging to know.
If anyone has insight into why the original surgeon (and the others) didn’t want to touch this with a ten foot pole, please email since I’d be interested to hear what mechanisms could be at play.
Closing Thoughts
For now I’ll leave this on a positive:
One thing my friend did take away from this year of physical and psychological hell, was a newfound healthily expanded distrust for the medical system – something that served him well in seeing it for what it was in the years to come.
He realised that if you don’t proactively complain or call out problems that you see in front of you, they will happily ignore you and allow you to ‘fall through the cracks’, for their own convenience. Most others around him just accepted what the doctors said at face value, to their detriment.
Paul also said that he feels extremely lucky to have gotten through this as he has, with his arm now fully functional. He believes that the proactive physiotherapist saved his life, and that ‘something’ happened. Maybe it was a guardian angel or who knows what, but something helped him get through it.
