The doctor finds me in the nurse’s kitchen and wordlessly hands me an x-ray of a right hand. There is an obvious dislocation of the PIP joint of the fifth finger. The finger is flexed at an uncomfortable-looking angle. I raise my eyebrow at him.

“Ouch,” I say.

“You haven’t seen ouch yet,” he replies. “Come, I’m about to reduce it and I want to show you how so that you can do the next one.”

I hop up excitedly and follow him out.

“The patient is a friendly old man with a toothless smile who actually reads my badge and greets me by name.

“How did this happen?” I ask him in a broken attempt at his native language.

He grins up at me and begins to recount the story. He has linoleum floors in his kitchen, but tiled steps leading to the paving outside. I’m not sure how this is relevant until he starts talking about his gardening passion and how, in his rush to water his darlings, he dropped a pail of water at his doorway and subsequently slipped on the linoleum, slid down the tiled steps and landed–hand first–onto the concrete beyond.

“Wow,” I said, genuinely impressed by the mechanism of injury. I’d really only been asking to distract him while the doctor prepared some analgesia.

Or so I thought.

“Okay, Mr GreenFinger, we’re going to reduce your finger now.”


“Wait,” I interject. Both men turn wide eyes to me. “Aren’t we going to give analgesia?”

“I’m a man.”

“He’s a man,” the doctor echoes. Then he pulls the finger out and up.

Not even a minute and a wince later, the previously deformed finger is looking a little swollen, but otherwise no worse for wear. He’s about to splint it but this is Private Practice so it’s nothing more than a Pre-packaged foam peg with plastic supports and some bandaging. (No need for improvising and resourcefulness here!)

“I’m not quite sure I learnt anything just now,” I half-joke, thinking about all the things we’d heard about adequate analgesia before reductions, assessing neurovascular status, etc. I’m not even 100% sure the doctor did more than pull.

“That’s okay,” he smiles. “It took me a while to realize dislocations are overrated, too.”



Filed under Elective

7 responses to “Overrated

  1. OHEMGEE I am going to diiiiie when I have to do that. Can’t we just call ortho?!?!

  2. I find reducing dislocations strangely satisfying… But I am also a weakling, so anything beyond a finger is a huge challenge.
    I have popped a couple fingers back in or helped to reduce their fracture without sedation. One kid I saw insisted on being awake and aware and the parent went for it .

  3. Yes!! Quite overrated…I’m currently on ortho and all you really do is pull. None of this adduction, flexion, internal rotation ish….you just pull and move around until it back. No clicks or gives later…overrrated!!

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