Orthopedics was a busy part of the Accident Room. There was a dedicated orthopedic area in one corner with a desk, x-ray view boxes and room for a couple of rolling gurneys. There was our own x-ray machine for getting post reduction films. In the hallway, there were several chairs which seemed to be always full of patients with various fractures. At any one time, there would be patients hanging in finger traps allowing traction to reduce a fracture, or a patient lying prone on a gurney with weights applying traction to reduce a dislocated shoulder. There was also a closet with all the supplies to put a patient in skeletal traction. This was usually for a femur fracture. A pin would be drilled through the tibia under local anesthesia and then with some ropes, pulleys, and weights you would pull the femur fracture out to length. At first this was time consuming, but after a few weeks, a decent first year resident could put a patient in skeletal traction in ten minutes.
At the orthopedic desk, chained to the wall was the three volume text book Rockwood and Green. This was the bible of fracture care and it was always there. Some of the pages were a little worn and some pages had some dried plaster on them, but it was referred to frequently. As a first year orthopedic resident, you were in charge of this little area. All patients in this area were your responsibility. It was never good for patient confidence when they saw you looking through the book, but it had to be done. I can remember patients asking me if there was an older doctor that could help them, I had to tell them I was it. There were two upper level residents available, but they were usually in surgery. One would come down to the Accident Room every couple of hours to check on you. You could call them, but that was a sign of weakness.
Most fractures were reduced after a hematoma block. This is a block where local anesthetic is injected into the hematoma around a fresh fracture. It would reduce the pain of the fracture, but varied from patient to patient in effectiveness. There was not enough time or room to sedate every patient with a fracture. Reducing a displaced fracture would require the orthopedic resident to manipulate the broken bone, usually recreating the deformity (making it look worse) and then applying longitudinal traction (pulling the bone out to length). This maneuver was painful for the patient and watching it as a patient made it even worse.
This led to the term “o-kay anesthesia.” During the fracture manipulation, the orthopedic resident would often be saying –“almost done, your o-kay, your o-day, your o-kay.” It was made worse, with a crowd of patients with broken bones sitting there and watching while the patients in front of them got treated.
I remember one little boy with a displaced wrist fracture. He was sitting quietly in the chairs waiting his turn, probably 8 years old. His mother and sister were with him. His sister looked to be the same age, they may have been twins. The sister kept telling her brother, “you gonna be cryin when they do that to you.” She said it over and over. He would answer, “I ain’t cryin!” He was trying to be so brave. When it was his turn, I reduced the fracture and he didn’t let out even a whimper. As I was putting on his plaster splint, a couple of tears rolled down his cheek but he was otherwise stoic. His sister pointed at the tears and said “told ya, told ya, your cryin.” He took in a deep breath and looked at her and said, “I ain’t cryin, but I am sayin OOOW WEEE that hurt.” He was tough.
The “OOOW WEEE” term stuck with us, and kind of became a motto between me and a couple of other orthopedic residents. When something was especially tough during residency – sleep deprivation, or some horrible case or clinic or presentation that we had to do – we would just look at each other and say –“Are you cryin?” We would always answer, “I ain’t cryin, but I am sayin OOOW WEEE!”