WARNING:This letter may contain excessive amounts of information

Note: It might make more sense if you read the previous post before reading this one.

To whom it may concern.
I am writing with respect to recent medical treatment that I have received at the [...] County Hospital in the orthopaedic fracture clinic.
It will be easier if I first explain the circumstances of my visit to the hospital together with the resultant care and diagnosis at which point I will raise my concerns.
On the morning of 11th December I crashed my pedal bike and fell over the front bars breaking my fall with my left hand and resulting in trauma to that arm. Initial symptoms were limited movement, swelling and pain to the elbow. At the time my hand seemed largely unaffected.
I visited the A&E department at circa midday on the 11th. After being examined by an A&E nurse (whom I shall refer to as Person 1) I was sent for x-ray of the elbow (2 were taken). On being re-examined with reference to the x-rays, Person 1 diagnosed effusion of the elbow with displaced fat pad signs and a radial fracture at the elbow. No traumatic injury of the hand was decided upon. Person 1 then arranged for a follow up appointment at the fracture clinic on the 14th December and I was sent home with a sling. Pain relief and anti-inflammatory pills were given. I was very happy with the care and information provided by Person 1 during that visit based on the information available to him at the time.
I returned to the fracture clinic on the 14th and met with Dr. Gajidan (I am fairly sure that I have mis-spelt his name and for this I apologise). I shall refer to him as Person 2. Person 2 showed particular interest in my left hand and did this via a physical examination coupled with the use of an x-ray of that hand. In what was a fairly brief consultation Person 2 diagnosed a suspected fracture of the scaphoid. He also indicated that I had a fracture of the left elbow. Person 2 arranged for me to have a below elbow cast fitted with a follow up appointment on 24th December. No further x-rays were taken.
Later on the day of the 14th it dawned on me that Person 2 had based part of his diagnosis on an x-ray that had not been taken at A&E on the 11th. I recalled the left hand being x-rayed at the [...] Clinic earlier in the year, 27th April to be precise. I was also somewhat concerned that no thumb spica cast had been applied, as my understanding is that it is important to immobilise the thumb when there is a suspected scaphoid fracture so as to reduce the risk of displacement.
Based on these concerns I phoned the fracture clinic on the 24th but unfortunately it had closed. I left a message asking them to contact me on Monday morning. I then phoned the A&E department in an attempt to speak with somebody there but this was denied. I called NHS Direct for advice. They confirmed that a thumb spica cast was normal practice and that I should return to clinic on Monday about this and to confirm the use of an old x-ray.
Come the morning of Monday 17th my elbow and hand were now both heavily bruised and swollen, movement was greatly restricted and the sites were uncomfortable. On returning to the fracture clinic I was told that I would need to book in via A&E a second time before my concerns could be addressed. This I did. It just so happens, that Person 1 examined me again. Person 1 was able to confirm very quickly that the only x-ray the hospital had of my left hand was from a visit to [...] Clinic on 27th April and that the only x-rays from my visit on the 11th December were 2 of my left elbow, neither of which contained images of my hand.
Person 1 then arranged for my cast to be removed and a number of x-rays of my left hand to be taken. These x-rays were reviewed in my absence by another consultant at the hospital, whom I shall refer to as Person 3. Once again I was very happy with the care and information provided by Person 1.
I was informed that Person 3 had diagnosed fractures of both my capitate and scaphoid. I was placed in a second below elbow cast, which once again did not include my thumb. The cast was top arm/back of hand only and did not extend under forearm.
I returned to the hospital on 24th December for my 2nd follow up appointment. I met with Dr. Williams. Based on a physical examination and the x-rays taken on 17th December, Dr. Williams confirmed the radial head fracture and also diagnosed a chip to the little finger side of the wrist, which I understand to be to the triquetral bone. I believe the radial head fracture is of a straight type I. Dr. Williams was adamant that I had not broken either my capitate or scaphoid. I left without a cast and with no follow up appointment. Dr. Williams was very confident in his diagnosis and at the time I was convinced by it. Dr. Willians demonstrated point sensitivity to the triquetral and there appeared to be a displaced fragment on the hand x-ray, he also demonstrated point sensitivity to the radial head and what appeared to be a fracture line on the elbow x-ray.

[At this point in his first draft, Bert wrote:
As an addition please note that my source of income results from manual labour and software writing and I have been a triathlete for the past 15 years as well as being engaged in other physical activities. It is crucial to me therefore blah de blah de blah.
Having stated all of the above there are a number of concerns that I now wish to raise.
OLD XRAY INDICATES SCAPHOID NEW XRAY INDICAES SCAPHOID UhmF

And now I return you to the final version.]

I have been discharged from the hospital.
I am adamant in requiring that the care and treatment I receive results in the very best long-term outcome. This is important on many accounts; I have been a triathlete for the past 15 years and wish to continue in this sport. My income is generated from manual labour coupled with software writing. Any detriment to my hand or arm will severely limit my potential in all of these fields with a resultant negative impact on my future well-being.
Since my visit with Dr. Williams I have become concerned at the differing opinions that have been put forward. Despite Person 2 using information from an old x-ray his diagnosis of a fractured scaphoid was also based on a physical examination. Person 2 came to the same conclusion but felt that the capitate had also been broken. Person 1’s use of an old x-ray also brings into some doubt the diagnosis given back in April. Since my cast has been removed and my hand is now exposed I have been experiencing point sensitivity on the left hand in a location other than the triquetral. This is at the base of the pad on the underside of the hand at the intersection of lines drawn from the thumb and third finger, and is in an area sensitised by Person 1 during his examination.
I do not wish to create additional workload for the NHS but it is imperative that a definitive diagnosis is arrived at. The immediate and effective treatment of a broken wrist is paramount in preventing future medium to long-term detriment including loss of mobility, arthritis or worse. The lack of consistency in diagnosis suggests to me a rather cavalier approach as to what my injuries may be or that there is insufficient information being provided by the x-ray data to arrive at a consistent outcome, this then begs the question as to whether or not other techniques should have been employed.
In conclusion I ask that my injuries be reviewed with immediate effect and, if your consultants cannot reach definitive agreement between them, that further investigation be pursued. Without this I will remain concerned at what the future may hold for me.
This letter has been hand delivered to the hospital and I therefore expect it to be processed quickly. I would be grateful if you would send an acknowledgment of this either by writing to the above address or more preferably making contact by telephone (see above) or via email to [...]. I would also be grateful if you would confirm my injuries in writing once these have been reviewed.
Should I be required to attend the hospital I will be able to do so at short notice.
Yours sincerely,

[Bert]

Christmas Break

This Christmas will be remembered as 'the one when Bert had a broken arm'. Or possibly had a broken arm. He has had more diagnoses than we've had turkey dinners, and his cast has been on and off like ... well ... like a tart's drawers.

And Bert has talked of nothing else. I now know everything I need to know (and a bit more besides) about scaphoid, capitate and triquetral fractures of the hand.

Spot the red electrical tape on the cast - this was Bert's addition after reading up about scaphoid fractures on the Internet, and deciding that they hadn't supported his thumb properly. (I don't know what he is doing with his 'good' hand...perhaps expressing his views about the various doctors he has seen.)

For those of you who can be bothered to find out the whole story, see my next post for the letter Bert has just hand-delivered to the hospital (using his good hand, obviously). In the meantime, here are a few pics of Bert 'taking it easy' over the Christmas break.

	Hey - a unique advertising opportunity!
It's surprising how many household tasks can be undertaken one-handed (although squeezing the mop and changing the water were quite challenging - thank goodness he's got me on hand to order around).
	Another of those essential Christmas tasks - refitting the kitchen plinth (as you do). Oh dear! Bert's good hand just got stuck and all I can do is laugh (and take photos).
When the electric mixer broke down at a critical stage of making the christmas cake, Bert had a brainwave. Lucky he's got so many powertools. And yes, that's a wooden spoon fitted into the drill. The cake was fab.

I've just been tidying up my text messages, and I thought I'd share a few from Bert. These are the more wordy ones; usually they consist of "yes", "no", "maybe" etc. in response to texts from me. Of course I've generally forgotten my question by the time I get the cryptic replies. However, the messages below prove how articulate Bert can be when he wants to be (i.e. when he is pissed, which applies to all of these except the last one).

I went camping without him in the summer. Night 1:

Weather iffy sat
shit sunday
u may want to come back then

Night 2:

hows ur curry?
meaning 'I'm in the middle of a gorgeous Agra curry and you're in the middle of a field'

Night 3:

how big is your steak?

In October Bert went on a trip to Antwerp with some pals from his university days. Night 1:

Da da doo
doo doo
doo doo doo doo
doo doo doo
doo doo doo
doo doo doo
doo da doo
doo da doo
love
me

Night 2:

Am I drunk?
No
do I love you?
Yes
am I having a piss?
Yes
does that matter?
No
as it is
bert
xx

Night 3:

We need to enjoy each other more
btw having another piss
x

21st November:

Woman in bakers
thinks i look like
famous tennis player

I've just asked Bert if he minds me putting his texts on the blog. "Texts? What texts? *sigh* Oh, do what you like." He's got other things on his mind, like trying to make his bedtime cuppa when he's only got the use of one hand. Filling the kettle seems to be particularly challenging.

(Personally I think he should get pissed instead.)

Tasting the tarmac

"I can't push the teabag against the side of the cup."

Then Bert farted loudly. "That's not like you!" I remarked. (It really isn't like him - he doesn't like to show a lack of control.) "I know," he said, "But I'm in pain here."

I've mentioned Bert's physical jerks before. He goes for a long run or bike ride four mornings a week, whatever the weather and no matter how he's feeling. This morning, for example, was freezing and as he was setting off I said, "You really know how to punish yourself."

Forty five minutes later I heard the key in the door and then wondered why Bert took so long to appear. I looked up and saw that his posture was strangely stiff. He said, "You know what you said about punishing yourself...?"

He'd crashed on his bike in a rather spectacular way and had had to phone his brother to come and pick him up in his van. I asked if anyone had stopped and helped. In fact about fifty cars had stopped out of necessity because Bert was sprawled across the middle of the road. One woman had wanted to take him to hospital.

"No, I'm fine," protested Bert. "I just feel a bit dizzy." "You're going to go over!" the woman exclaimed, and Bert said the next thing he knew he was lying on the floor. "Oh my god you fainted!" I said when he was relating this. "No I didn't." said Bert. "I just...lay down without remembering it."

Later, after a couple of hours in A & E where they diagnosed a possible elbow fracture, Bert said "I really wanted to do the skirting board today." You'll be relieved to hear that he is undeterred as ever, and as I speak is patiently doing a one-handed sand of the skirting.

Louise has just come in and said, "Does Dad ever take it easy?"

What a bunch of Dix

We're back (and we've been back for ages!). I'll offer no excuses, and simply hope that today's classic Bert story will win you round.

First, the background. On 12th November we ordered a telly from Dixons with a promised delivery date of 26th. You know the story: one delay/excuse follows another but finally we had a delivery arranged for this afternoon.

I was out and Bert wasn't sure he'd be around so my brother offered to wait in for the delivery. I phoned Bert's mobile at one point and my brother answered. "Bert can't come to the phone - he's arguing with the driver." "Oh dear," I thought. "I wonder what's wrong."

A bit later on I got a call from Bert. "I've got Dixons on the other phone. They won't talk to me without your authorisation, so you need to tell this woman who you are." So there I am on the high street with buses flying past, being jostled by the pre-Christmas crowds and shouting my details for all to hear. "Job done," I thought.

(Later my brother described how Bert had held the two phones together in a loving embrace, and coordinated the conversation by occasionally speaking into one or the other. ("Did you get that?" "Is that OK?") Afterwards he remarked "That's the best use of mobiles I've ever come across.")

A while later Bert called me again. "You might get a call from Dixons. You want a refund. I've ordered the telly from somewhere else." "Oh, okay" I replied.

When I got home Bert explained what had happened. When the delivery arrived, the driver asked Bert to sign the sheet while he fetched the telly. After about ten minutes Bert wondered what the driver was up to so he approached the van. "There's a bit of a problem, sir." We'd ordered a Panasonic, but Dixons had sent a Philips. "Do you want to take it?" asked the driver. Bert declined, and proceeded to rip up the delivery note. "What did you do that for?" asked the driver, sounding upset. Bert said that the delivery note indicated that he had received the item when he hadn't. He then tore off the bit with his signature on and handed the other bits of paper back. The driver left.

Then Bert phoned Dixons. The first person he spoke to said, "We can only talk to the account holder." (I had made the order.) "Oh that's OK," said Bert. "I'm Mrs. [...]. My date of birth is [...]. I live at [...]. Is there anything else you need?" "No, that's fine sir." That conversation was friendly enough but the guy couldn't help. A second call went similarly. Bert called a third time and got through to Mrs. Robinson. Mrs. R. denied everything, including any possibility that the delivery driver had turned up as there was no such information on her screen. After arguing with her for half an hour, Bert realised that observing niceties was getting him nowhere.

Bert: Tell me one thing, why are you working for Dixons?

Mrs. R.(sounding bemused): What do you mean?

Bert: Have you ever thought about working for the Nazis? [pause] And I suppose that'll be the end of this conversation.

Mrs. R.: I'm putting the phone down.

Bert wants me to point out that he put the phone down first. And tomorrow I have to phone Dixons and demand my money back.

*sigh*

By the way, this whole process was immediately followed by my brother going through a strangely similar routine with 02, this time with Bert in the supporting role. What is the world coming to?