Because it was a home game, we had a fairly standard procedure for such things; I called the head trainer and briefed him. It was decided that I was taking her to the hospital for x-rays and the emergency physician would call the team physician for orders after the injury had been assessed. Meanwhile the team physician called the emergency room to tell them we were coming in. Casey did not want any family or friends called until more was known about the injury.
The emergency room was completely empty when we arrived. From my days on the ambulance I recognized the expressions on the faces of the ER staff, who were mildly glad to have some business, but still cautious in their joy because a first patient can be quickly followed by many. I didn’t know any of the ER nurses, but gave them a report on my patient as I would have if she were an ambulance patient. Before I knew it, I heard myself saying, “ Nineteen-year-old female with a witnessed traumatic event to the medial aspect of the right knee approximately 1.5 hrs ago. No prior dizziness, no LOC, no KON, vitals stable and good throughout. Patient was iced immediately and treated with I.C.E. Exam shows instability of the medial collaterals, guarding and localized pain.” They knew that LOC meant loss of consciousness, KON meant knock on noggin and I.C.E. meant ice, compression and elevation for treating the injury. Casey looked at me with a mixture of confusion and fear.
The nurse tending to Casey asked me, ‘‘Are you the boyfriend?’’
‘‘No, I’m the student trainer for the team. I tended to her injury in the acute phase.’’
She nodded and went on, paying no attention to what I had said. While it annoyed me that they were not using the info I provided, I understood it. In the emergency care situation, bystanders and helpful friends were not reliable witnesses and often would embellish the truth. To the ER staff I was not “on the job,” so my information could not be trusted. I needed to form a relationship with them to build trust. That was not going to happen today, but it was going to start today.
The ER visit went fairly predictably from my perspective, so I spent a lot of my time keeping Casey apprised of what was happening and translating the ER jargon for her. I even explained my mini report to the ED staff to her. She kept asking me what had happened and what was wrong with her leg, and I had to tell her, “I am not a doctor, so I cannot do a diagnosis.”
“OK, so what do you think MIGHT have happened when I twisted my knee?” she said sarcastically.
“Casey, I think you MIGHT have torn some ligaments in your knee,” I said.
She looked at me and got very flushed in the face. Tears started to well up in her eyes and she stared at her knee angrily as if it had done some terrible wrong to her.
“I’ll probably lose my ride,” she said, referring to her basketball scholarship.
Right now, more than anything in the world, I wanted to help Casey, but I couldn’t. Not until the x-rays were back and a diagnosis made. Once we trainers had a diagnosis, we could start on treatment and rehab. Even if the diagnosis meant surgery, we could do lots of pre-surgery conditioning to help speed her recovery afterward. If an athlete is scheduled for surgery, the advice we usually give is to NOT take it easy. Strengthen that limb and work that joint as much as the surgeon will let you. Often the surgeons will say, “Do what you want—if you injure it more, I can fix it when I’m in there.” While this statement may seem a bit cavalier, it is somewhat true. If a ligament is torn in half, exercise will not tear it more. But all of these things needed to wait for the diagnosis. For now, my job was to keep Casey entertained and make sure that when we got her marching orders they were followed, which they would be.
The x-rays came back with no bone damage. The team physician would see Casey first thing tomorrow morning. Casey was prescribed some mild painkillers and RICE (rest-ice-compression-elevate) treatment for tonight. Tomorrow we would be doing a more complete exam. Although I was not scheduled to work tomorrow, I would be there because Casey was on my team. Even though I couldn’t play with them on the court, I felt like I was a member of the team and she was part of my responsibility as a teammate.
The head trainer, Scott Patt, and the team physician, Charles Bowen, did the exam on Casey. She no longer had any obvious ligament supporting the inside of her knee. This was clear because her right knee could be bent out to the right with very little pain or resistance on her part. I had done this same test last night, but not to the extent that Dr. Bowen now did, making her knee look like it had a hinge enabling it to move from side to side like a pendulum. Her ACL was then tested by seeing if the knee would slide forward or backwards. This was done by having Casey sit on the training room table with her feet on the table and the knee bent about 45 degrees. Dr. Bowen then pushed and pulled on Casey’s knee. It slid back and forth by what seemed like inches, making her knee joint look like a dresser drawer being pulled out and pushed back in again. This was all indicating that the ACL was damaged, but maybe not as severely as the MCL. Finally, to see if Casey had the terrible triad, Dr. Bowen palpated the inside of Casey’s right knee while moving it in different directions. He soon declared that the cartilage in the medial meniscus was damaged too. The medial meniscus is a large piece of cartilage that acts as a buffer between the femur or thighbone and the tibia or shinbone. The medial meniscus is also attached to the MCL, so the two are often injured together. Casey indeed had the terrible triad and would need surgery. Casey only wanted to know WHEN she would be able to play. Shaking his head, Dr. Bowen said not this season.
Casey was inconsolable. Her parents came to pick her up from the university later that day to get a second and third opinion. All the opinions were the same. She had the triad and needed surgery. I promised Casey I would work with her to get ready for the surgery and help her rehab the knee for next season. She decided to take the rest of the term off, so I could not work with her on rehab. She assured me she would do some “stuff” at home. Her surgery was not very successful and she did not return to the university. Casey lost her ride. Despite my best intentions and all of my efforts to be encouraging, I could not help Casey.
I missed Casey and so did the team. We still had a great season, only losing 7 games out of 30. I had a few more trips to the ER during the season, but fortunately nothing as serious as Casey. I did, however, build a rapport with the ER staff and they began to trust my clinical reports. They would report my vitals in their charts, which was a big vote of confidence on their part.