Do I Have a "Kick Me" Sign?

I don't even know where to start...and I don't know why I'm surprised. We showed up for Jake's first follow-up appointment this morning. We were directed back to the cast room, which was hopping! I caught a glimpse of Jake's surgeon in the corner, dealing with a broken arm. There were several residents and techs tending to the room full of patients in for cast checks, etc. We were met by a {very} young ortho tech, who listed the procedures for us. She said first, she'd remove the cast, then we'd wheel down to x-ray, and when we were done there, we'd come back to the cast room to see the doctor.

Funny, when recalling the doctor's explanation of how things would go...I didn't remember the cast removal part. But, I dismissed it and let her get to work. She did this every day, right? As she got closer to his incisions, I pointed out to her where they were located so she'd be extra careful. Jake winced a bit, but she was able to get it off without too much trouble.

I wheeled Jake down to radiology, and was relieved that I went in with him, after they attempted to do the weight-bearing and non-weight-bearing x-rays on the opposite feet! It was entered into the computer wrong, and I had to tell them twice he couldn't bear weight on the surgical foot. The whole time, I'm thinking, "Why did they have to remove this at all? Doesn't an x-ray machine work through a cast?" We finished, and I wheeled Jake back down toward the cast room, just as his doctor was walking out of the room. As soon as I saw his expression, I knew something was wrong. He saw us coming toward him, froze and said, "What is he doing without his cast?!" whipped back around and said, "WHO took his cast off?!?" I wanted to throw up. I didn't know exactly what this meant, but I knew it wasn't good. {UGH! Not again!!!}

He gathered the techs around their work station and held a heated "in-service training" on the spot. He said he was to be consulted on any of his patients before cutting off a cast. {It turns out the tech was new, and didn't know it wasn't protocol to remove a post-surgical cast.} My mind was racing, trying to think what this could mean. He explained that for proper healing, the cast needed to be molded to the shape of the bottom of his foot, something that needed to be done under anesthesia, since he'd be applying pressure to the incision...and now he was going to have to do it over again, sans drugs. I started to shake as the scene flashed through my mind. "Is there going to be screaming?" was all I could think to ask. "Hopefully not," he replied.

{Trivia: I cannot handle my children's pain. Can't do it. I used to be a field medicine/aviation medicine hospital corpsman. I gave shots by the hundreds....drew gallons of blood (one vial at a time) and even applied and removed sutures. None of this bothered me. I've listened to the screams of grown men (kidney stones...not battle wounds) and kept it together. The screams of my kids are a different story, entirely.}

I was shaking. I thought my knees were going to give. The doctor looked at me and pulled up a chair to Jake's exam table and told me to have a seat. {I'm sure I was in shock and looked like it.} I was mentally kicking myself for not questioning the ortho tech about removing the cast. I always ask questions! Why not now?! I said, "I thought it was odd that she was removing the cast. I should have said something. I just didn't want to look stupid." The doctor chuckled and said, "Oh there's plenty of stupid to go around here for everybody, trust me..." which was welcome comic relief. After examining the incisions, the doctor started to apply another cast. He took it slowly, was very gentle...and as he rolled, he described the next steps. He wanted Jake in this next cast for 4 weeks, totally non-weight-bearing. At that point, it would be removed and his foot would be cast for a custom orthotic boot (AFO). They would reapply a traditional cast while the AFO was being made. When that was ready, he could start partial weight bearing for the next 4-6 weeks.

Suddenly, it dawned on me...we've played the orthotic waiting game BIG TIME before. MONTHS for orthotics to be made on Okinawa...because it's only ONE GUY that does them for all of the military in the Pacific. I asked the doctor how long it would take for the AFO to be made. He wasn't sure, but said he was told our hospital could order it from a base on mainland Japan. I rolled my eyes and told him that if it was the same place that did his other 2 sets of custom orthotics, we'd be waiting months. I said, "We waited around four months each time. We are two years into this process now." At this point, he stopped wrapping and turned to the tech and said, "Take it off." They removed the cast AGAIN, and molded yet another cast on to his foot so that they could order the orthotic here in Hawaii. {Maybe even have it done so that we can take it when we leave here.} When this thinner cast was set, he cut it off to send to the brace shop, and started on cast number THREE of the day! Lucky for Jake {and me}, he was very gentle and there was no screaming whatsoever.

So, the silver lining in this? If the first cast had not been accidentally removed, chances are the doctor would not have been willing to remove it in order to do the cast molding for the AFO here in Hawaii...meaning, we'd have a long wait behind everyone in the Pacific for one guy to get around to Jake's order. But since it was already off once...why not remove it again? After Jake's final cast (pictured above) was finished...we got to go down in the basement to the brace shop (which was first rate...just what you'd expect from a training hospital with a ginormous budget) where Jake picked out the style and design pattern of his AFO. Bonus! {He chose a space motif, if you were curious.} It would have been whatever scraps they could have pulled together, in the color d'jour, if it was being done back in Japan.

Regarding the fact that they were making his AFO here instead of back in Japan, he said to me, "You just may rewrite the procedure on this one." Heavens, I hope so! If anything, I hope that what we are going through here is somehow making it easy for the next person. And the next. I can dream, right?