After my retirement from the fire service, I let my paramedic certification expire. I guess that many believe “once a paramedic, nurse or doctor, always one.” Many of my immediate, extended and church family still come to me when an injury or illness occurs. Last week was no exception, as one of the children had hit her foot on a tree, swinging in one of the swings attached to that tree. It had happened prior to my arrival in West Virginia, but she was still having issues with it. I was asked if I would look at it and give my thoughts. Her foot was bruised on the top, with swelling on the top and bottom. The swelling on the bottom of her foot was a bit unusual, located at the ball of her foot. She had good movement of her toes without pain, movement of the ankle joint with some pain, good pulses and no apparent crepitus, but she could not put weight on it, Based upon all of that, my unofficial opinion was that she had probably sprained her foot. We wrapped her foot with an ACE bandage, applied ice and told her to elevate the foot. For the next day or so, she could be seen crawling everywhere she went. By the end of the week, she was walking and putting weight on her foot again.
To help you understand the picture a little clearer, mom and dad were not with her. She had traveled up with aunts, uncles and cousins. In the course of talking about her foot, it was stated that an X-ray was the only way to know conclusively whether it was sprained or broken. One family member, who was a retired nurse, stopped in one day and said she needed an x-ray because she thought her foot was broken. One uncle made her a set of crutches and we taught her how to use them. She walked with them for a couple of days, but as I said, by the end of the week, she was walking on that foot.
You may wonder where the phrase “hero or zero” came from. When I was working as a firefighter, we always used to say that, based upon our calls or decisions, we would come away a hero or a zero. A hero if we made the right decision or diagnosis. A zero if we made the wrong decision or diagnosis. Once getting back home, her parents took her to the ER to have her foot X-rayed. Though missed by the ER doctor, the orthopedic doctor found that she had a break all the way across the growth plate and at the base of two toes. I saw a picture yesterday, where she now has a purple and pink cast from her toes to her knee. The orthopedic doctor stated that the break was in one of the worst places that it could have been. My prayer is that her foot will heal and that there will be no long-term issues with the growth or use of her foot.
We all have a tendency to downplay injuries and illnesses. No matter what we think, we cannot overlook the fact that certain medical diagnostic tests are the only ways to determine the extent of an injury. As a medic and a camp medical director, I always used to lean towards the idea of it being better to be safe than sorry and go get the issue checked further. Hindsight being 20/20, we should have erred on the side of caution concerning this little girl’s foot. I tell this story as a reminder to all of us: without proper diagnostic testing, our opinion is nothing more than a guess.
