Two Patients with Broken Ribs

I recently went mountain biking in Moab, Utah. Unfortunately, I fell just as our ride was starting. It was soon apparent to me that I had broken some ribs on the left side of my chest. I painfully rode back to the trailhead and found a ride back into town, rather than trying to ride the rest of the 26 miles we had planned for that morning.

Since there is really no treatment for broken ribs, I knew there was no reason for me to seek medical care. I just set myself up on the couch of our rented condo and tried not to move around too much until I could head back home.

A week later, I was back at work, feeling better and was taking only ibuprofen for pain. “This has not been that bad,” I thought to myself. Little did I suspect that a surprise setback lay ahead.

I woke up on Saturday morning, eight days after my fall. As I got out of bed, I was surprised that I had more pain in my chest than I had been experiencing the previous few days.

While I was in the shower, the pain got a lot worse and any movement was now causing severe pain. Getting dressed was really tough but I pressed on, feeling sure it would soon pass.

As I started down the stairs into the living room, I was seized with a muscle spasm along my left spine that left me completely incapacitated. I hollered, stiffened and became unable to breath or move until the muscle spasm relaxed and the broken ends of my ribs were not being driven against each other.

The spectacle I presented on the stairs caused everyone in the house to come running. My wife, son and daughter-in-law rushed to my side, trying at the same time to understand what was wrong and wondering how they could help.

Several things went through my head as this was going on. I know enough about this sort of thing to understand, basically, what was going on. The pain from my broken rib was causing my back muscles to go into spasm. That was causing severe pain which was making the muscle spasms worse. Whenever I moved, I was caught in this terrible cycle and the only thing that helped was to not move, at all. Understanding this, I was not worried that I might have some terrible, life-threatening condition. I recognized that this understanding helped me a lot, compared to people without my training and experience who might be freaking out, wondering if they were dying or something.

I next thought that I always have to ask my patients to rate their pain on a scale from 0 to 10. In doing so, I sometimes wonder what pain I would rate at a level of 10, the most pain anyone could experience. “Now I know,” I thought.

After I was through with my clinical and analytic thoughts, my attention turned to how to get off the stairs. If I moved my trunk at all, like to take a step, the pain would come back and I couldn’t move. There was nothing I could do about it. With help from my wife and son, I forced myself down the stairs and collapsed on the couch, trying not to scream the whole time.

There I stayed the rest of the day, unable to move without triggering the same terrible pain. When it came time to try to take a nap, I needed help from my wife and son who moved me as if I were a piece of fragile furniture, trying to keep my spine from moving.

At bedtime, they helped me in the same way back up to my bed. The next day I still had pain and had to be careful but was some better. By the following day, I still had the rib pain but all of the spasms were gone. Today, I am almost pain free. I am back to riding my bike with no problems.

Now, I told you that story to tell you this one:

The next week at work, I introduced myself to my next patient. She was a lady about my age who told me a sad story about being attacked three days earlier by her mother, who suffered from Alzheimer’s Disease. She had been knocked to the ground and injured her chest. She told me she was pretty sure she had broken a rib and, knowing there was nothing to do for it, had just been taking ibuprofen and putting up with the pain.

What brought her in was that she had woken that morning with severe muscle spasms on the same side as her broken rib. The pain was so severe she was incapacitated by it and was worried about a complication of her chest injury.

As I listened to her, I had a hard time not smiling, which I knew would not be perceived well. As soon as she had a chance to tell me of her concerns, I briefly told her of my experience the weekend before. I explained what I thought had happened to both of us. I reassured her that what she was going through was completely understandable and she had nothing to fear. I also assured her that we would get her feeling better in a short time.

After some intravenous morphine and valium, she was feeling much better. She went home relieved to know she was going to be fine, happy to be out of pain and appreciative of a doctor who was able to empathize so distinctly with her suffering.

There is some irony in recognizing that she went to the emergency department and got some help while I just stayed at home and suffered.