Hi... this is Rick...
On Tuesday morning, it was sprinkling, so I walked to work with an umbrella (rather than riding my bike). I had my backpack on my back with my planner and a bottle of water and a sandwich inside. About half way to work I noticed some pain in the middle of my back--more on the right side--and with each step the spasm seemed to get a little worse. My backpack seemed to get heavier with every step. I had been fine when I left the house, but by the time I got to the hospital I could barely get to my office without some serious discomfort. As distressing as the pain itself--which was distressing me enough--was trying to figure out what I had done to myself to have such a back spasm. I hadn't done any particularly hard work during the past few days. I had been on call over the weekend and done a couple of cesarean sections, but I couldn't recall anything out of the ordinary. I took 2 tylenol tabs and laid down on the examination table in my office for about 20 minutes, and it gradually calmed down enough for me to get up and start my rounds for the day.
A little later on I bumped into Moses, one of the operating room assistants, and I suddenly remembered how I had strained my back! I felt so much better just knowing that there was an adequate reason for this back spasm I'd had this morning. Three days earlier, on Saturday, we'd had an accident patient come in to the emergency room. He was in agony with his shoulder. He'd been the passenger on a motorcycle and they'd had a collision with a car. On exam, it was obvious he'd dislocated his shoulder. X-rays showed it wasn't broken, just dislocated, and so we took him to the OR to reduce the dislocated joint. I knew it would be a tough one, because the guy was pretty muscular. After 10 mg of valium and 30 mg of pentazocine (a narcotic) i.v. to sedate and relax him, we applied traction to the arm to try to reduce it. This is actually a pretty funny looking maneuver--The patient is lying on a stretcher. Person A holds a sheet wrapped under the patient's arm and pulls up, toward the head, while person B (me) places their foot in the patient's armpit and pulls the arm down and outwardly to allow the head of the humerus to pop back into place. We tried several times and I couldn't get anywhere! (imagine my face turning red at this point)... So I asked Moses to help me. He stood next to me, lifted his foot up and placed it right on top of mine in the gentleman's armpit, and we both hauled his arm as hard as we could. Even with the two of us pulling as hard as we could, it was three long hard desperate pulls before we felt that satisfying "pop" as the shoulder went back into proper alignment. The patient was able to go home a couple hours later in a sling and feeling much better!
And after having taken a couple more doses of tylenol and a couple hot bucket baths, I seem to be much better too!
I find myself wondering if this is how they do it in America these days.... : )