27 April 2011

A Strappy Kind of Day

****Disclaimer: Short-Story-Long Girl strikes again!****

A little over a week ago a guy came to the outpatient department with foot drop.  His nerve damage was permanent, so they sent him to me.  At home I'd give the orthotist a call and he'd fit my patient for a MAFO, a Molded Ankle-Foot Orthosis . . . basically a fancy piece of hard plastic molded to the bottom of the foot, extending over the ankle in the back, and up about halfway on the calf.  It would keep his foot in a neutral position which would allow him more ease with walking and wouldn't require him to hike his hip up so far in order to clear his toes from scraping the floor.

But I'm not at home.  And I'm the closest thing we've got to an orthotist.

But I can't make him a MAFO . . . at least not yet.  I don't have the proper material or tools to make one that won't break after two steps or crumble to pieces once he gets outside.  My only other option was a series of straps that would help keep his foot neutrally positioned.

I told him I wanted to make him a special strap for his foot, took some measurements, and told him to come back in a week.

Step 1: Find Materials.
After rummaging through my random supplies, not finding what I was looking for, I went to my black market supplier: Urwugida M. of the Pharmacy.  She always has great old random 'therapy' goods that were donated back in the mid '80's . . . and she's been keeping our water aerobic class well stocked with multivitamin bottles that we use for resistance (my little biceps thank her!).

She had lots of knee immobilizers and even some posey woolen heel cups, but nothing that wasn't going to require deconstruction first.

Plan B . . . the OR Block.  The past few weeks we've been short a nurse anesthetist in the OR, which meant that most of the time I had to wait (and wait . . . and wait) to treat my burn patients while they were medicated.  This left lots of time for reorganizing the wound care/casting corner of the OR recovery room.

I never knew what a treasure box was sitting there under our rolls of crepe bandage and non-adherent dressings.  A drawer full of wrist splints that I'm pretty sure arrived with Dr. BurtLong in 1950something!  Enough finger immobilizers to outfit every household in Galmi Village!  Three half rolls of stockinette!  And then . . . there they were . . . balled up in an unrecognizable heap: Straps.

I had struck gold!

There's no telling where these straps originated.  Some had velcro, others loops . . . but I knew I had found what I was looking for.  I also knew I had to be creative in getting them from the OR Block to the OT Bureau.  You see, where I come from, possession is 9/10th of the law . . . we'll in our hospital, it's more like 13/10th!  'Maneni wannin?' (What's this?) I asked H. le vieux, the old man I work with in the OR.  He shrugged his shoulders.

Just as a magician never reveals his secrets . . . lets just say those straps have found a new home.

Step 2: Fabrication.
Not going to lie.  Step 2 is more like 'procrastinate an entire week and tell yourself you're working on it.' So yesterday morning when the patient showed back up looking for the strap I thought to myself 'OH CRAP!  THAT'S TODAY!'  I told him it would be ready by the afternoon.

I finished up with my hand therapy patient and headed for the residential end of the compound.  Thanks to Alheri for the last minute loaner sewing machine!!  I sat down with my straps and his measurements, ready to go.

Half an hour of blood, sweat (A LOT of sweat), and tears (maybe only one or two) and I still couldn't get the bobbin to stay in place.  A quick telephone call and Alheri was on her way.  With a flick of her wrist (and I'm pretty sure a little fairy dust) it was all taken care of, ready to go.  Before I knew it my three straps were sewn together, prêt à porter.  

Step 3: Fitting.
I had told the patient to return to my office.  He never came.  I hunted him down in room 14 . . . which I have dubbed The Trauma Ward (home to 3 of my regulars . . . one of whom is the burn patient that really wants me to be his second wife).  I started with the foot strap (it's a wide foamy strap that rests from the base of the toes to just under the balls of his feet).  Too big.  Hmm . . . but I took measurements!! 'Think Deb.!' I told myself.  'I'll be right back!' I told him in English (which he says he speaks.  'Understands' would be the more appropriate term, as he seems to catch 75% of what I say to my 1% of what he says . . . and it's only that because he greets me with 'Gud munning' every time I see him, regardless of time of day) and quick ran to the West Wing nurses station.

Step 4: Fixing.
'I don't know the word in French, but I need the thing . . . you know . . . for closing the papers together.' Blank stares from the five Nigeriens in the room.  I tried again 'I don't know the word in French, but it's the thing . . . you know . . . for the papers . . . for to make them to stay together . . . you know . . . the little thing of metal . . . for to pinch.'  My French failed me.  I tried my third language: charades.  'AH!  The ajlskvadw!' and the secretary produced a stapler.

Three clicks and I was back in the room.  It fit!

With the foot strap secured in place I moved to his calf.  It too was too big.  CRAP!  Only this time, I couldn't just staple . . . I had sewn the loop-side of velcro onto the end of the strap, I was going to have to cut first.

When I was a kid my mom taught me how to use a sewing machine.  My mother is an AMAZING seamstress!  She did not, however, pass on those genes.  When it comes to sewing, the only thing I'm good at is using a stitch puller.  And boy did those years of practice pay off!  Using my swiss army knife (God's gift to an OT in a resource poor hospital) I removed the loopy velcro without taking off any fingertips . . . and with that trusty stapler had it back in place before anyone could blink.

Good news: the calf strap fit!

Bad news: the third strap, connecting the foot to the shin was not only too long . . . if pulled to the right tension it would have been mid thigh.  SO MUCH FOR TAKING MEASUREMENTS!!!

I went back to my new side-kick, Mr. Stapler.  A dozen clicks, but it still didn't hold.  I was going to have to sew.  By this time nearly an hour had passed trying to fit this guys foot-drop strap and I didn't want to go hunt down Alheri's sewing machine again.  Next best thing: suture kit.

It's the first time I've ever sutured anything . . . and I'm pretty sure if our surgeons saw the strap, it would be my last!  But, it worked!!!  (Much to all the West Wing nurses chagrin!)

And my patient was happy that he could walk with such ease.  The nurse that has expressed interest in learning him some kiné was a little bit impressed.  I, on the other hand, was just relieved that for the next 10 minutes I was with them the whole thing didn't go 'snap, crackle, and pop' and fall to the floor!


Kari said...

I LOVE your stories (just in case I haven't told you that 50 bajillion times). This one makes me laugh so so much...from the 1950s/80s supplies to the mention of your patient who wants you to be his second wife to your stapler antics. And your police woman mom is an amazing seamstress?! What?! I REALLY want to meet this woman...preferably this side of heaven, but I'll settle for heaven if need be. I love your creativity and heart for helping these people. I know that your creativity is being stretched in a resource poor middle of the desert place. :)

Bethany Reamer said...

i cracked up at the guy who tells you 'gud munning' at all times of the day! i love it.

Galmi Mom said...

I wonder what you could do by melting and molding PVC pipe? Hmmm, I am not sure how much you could shape it for the foot. You might pick Shop's brain on that one!

Deborah Berruti said...

Yeah, PVC is what I wanted to use . . . but it's got to be heated at pretty high temps and then I would have had to make a cast and mold first, as it would be too hot to mold to him. Then there's the whole issue of pulling the splint . . . it's just a little more complicated than our departement de la rééducation can handle at the moment. :)

Shal said...

You are so tenacious! I love this story!