I made a decision last week – one I’ve come to regret. A decision involving shoes.
One would think it was a simple choice: Dansko clogs or festive red sneakers for a holiday party held at a local community facility. I’ve been a Dansko loyalist for years—for their comfort and their ability to provide me with long hours complaint-free standing. I own too many pairs to count – a number I will never admit to. That night, I chose the professional version of the clogs: black, sensible, and substantial, weighing in at an impressive two and a half pounds.
There is a certain irony here. Friends have long affectionately referred to me as Safety Mary. I am the person who routinely reminds others to be careful, to watch their footing, and to think about fall risk. I say it casually, reflexively, the way physicians do when prevention has become second nature.
I don’t recall exactly how the fall took place. I do remember backing up, mis-stepping on the dry cement surface, and going down hard executing a precise landing in a seated position at ninety degrees and instinctively throwing my left hand behind me to break the fall. Everyone later told me it looked like I was falling in slow motion as gravity took over.
The pain across my lower back was exquisite – so intense that I barely registered my wrist pain. The color was drawn from my face as my nervous system kicked it. What was I to do? I sat on the concrete floor for at least five minutes, surrounded by about fifteen people, all asking variations of the same questions: Are you okay? Can you get up? Do you want to get up?
My answer to all lines of questioning were a resounding no.
Eventually, with the assistance of two friendly men, I made it to my feet and over to a table to sit again on a folding metal chair, not the best choice but I had to work with what was available. I asked for water to drink and ice for my wrist, which was beginning to announce itself more loudly by the minute. I sat quietly reflecting on the incident, made a phone call to home with three requests – a ride home (certainly I couldn’t drive), those red sneakers, and a wrist splint. I was offered lights and sirens for transport to the local emergency room but the stoic in me had to develop my own plan of care.
That plan unraveled overnight.
I didn’t sleep at all. I recall checking my phone and saw each hour tick by in an exhaustive fashion. Despite immobilization and elevation on two pillows, the wrist discomfort was relentless, deep, and unmistakably wrong. At 6:00 A.M., I texted a friend who is an orthopedic surgeon to see if he would be in the office and willing to evaluate my left wrist. My mood momentarily uplifted with an affirmative response only to come right back down with the reality that was upon me. After removing my splint to shower that morning, I saw what I had already suspected: swelling in the forearm close to the wrist and visible deformity pointing toward the thumb. My lower back was still reminding me that it had also been injured with wave after wave of painful spasms. Even with a cane, I was barely able to walk.
In the orthopedic office, after multiple painful X-rays requiring careful and increasingly uncomfortable positioning of my left arm, the diagnosis was clear: a complex and fragmented left forearm fracture close to the wrist on the thumb side of the forearm (left distal radius). The kind of fracture that does not negotiate. The kind that requires surgery for best ultimate return of motion and efficient recovery. I will now have a titanium plate and screws in the left forearm and could consider myself bionic – well, not really but wishful thinking.
I told my orthopedic surgeon I didn’t want to be snowed during the surgery, and we discussed anesthesia options briefly. I was booked for surgery the next day at an outpatient surgical center, fitted in a temporary fiberglass splint and told to report at 6:00 A.M. When I met the anesthesiologist early the next morning, he had already been briefed on my request. I tried a bit of negotiation as I was familiar with the anesthesia options but ultimately placed trust in his expertise.
That trust was promptly rewarded with a hefty intravenous dose of a sedative known as midazolam (Versed).
I have no recollection of the nerve block being placed just below the midpoint of my left collar bone. Midazolam, as it turns out, is quite effective at producing anterograde amnesia – the inability to form new memories after the drug has been administered. When I became aware again, fifteen to thirty minutes later, the pre-op nurses were asking me if my fingers were going numb yet. I looked at them in a puzzled manner and asked why they were asking me such a question. They explained that the block had already been placed and they were checking to see if it had begun to work. I tried to relax but was not a fan of the amnestic effect.
Once the block had taken effect, I was wheeled by stretcher into the brightly lit operating room. I exchanged pleasantries with my orthopedic surgeon as the anesthesiologist fitted me with an oxygen mask. For three seconds I saw my left arm being moved to a side platform, and then—lights out—until the surgery was over.
I woke up back in my pre-operative room, now a post-operative setting, and was quickly assisted with dressing so I could return home almost four hours after my arrival. One of the unexpected pleasures of modern anesthesia is the gift of time with a block: I enjoyed nearly twenty-four hours of pain-free relief from the injured forearm but was relegated to a sling to support my lifeless limb.
About twelve hours post-op, my left hand began to feel profoundly heavy. My fingers and thumb felt stuck together, as if fused with super glue. There was no numbness or tingling—just a dense, non-functional heaviness to the arm, fortunately, still supported with the sling. The arm simply would not belong to me for a while.
At the twenty-four-hour mark, I removed the sling and began to regain some finger mobility. A tingling sensation crept into my fingers, accompanied by a dull, persistent ache at the surgical site buried beneath a fiberglass half cast—a reminder that the block had done its job and was now gradually bowing out.
As my post-operative course continued, my other injury began to demand attention. The back pain from the fall—initially overshadowed by the forearm fracture—lingered and worsened. I relied on a reacher to help with dressing and slept in a recliner for three days. I needed assistance in covering my cast with a plastic bag to protect against water damage in the shower and had to manage daily tasks with my dominant right hand only. Doses of narcotics were quickly weaned to over the counter medications of ibuprofen (Motrin) and acetaminophen (Tylenol) as the lower back pain began to reveal a marginal decrease after five days.
This experience from injury to evaluation to surgery to rehabilitation has been a humbling and emotional ride. As physicians, we are accustomed to being the ones who guide, advise, and reassure. Becoming the patient—dependent, limited, and vulnerable—reshapes perspective in ways I never could have imagined. I am deeply grateful for the medical expertise and compassionate care I received, and for the many people involved who treated me not just skillfully, but kindly.
I’ve replayed the shoe decision many times in my mind. Was it really the hefty Danskos? Was it clumsiness? Was it distraction? I guess I’ll never really know for sure.
Next time as I’m standing in front of my closet, debating comfort versus caution, I suspect I’ll hear a familiar voice reminding me to be careful. And that voice will sound a lot like Safety Mary. And I may just choose the red sneakers.
Note: Mary Powell-St Louis is a board-certified physician in Physical Medicine & Rehabilitation.