“When you hear hoofbeats, think of horses not zebras.”

Theodore Woodward, in regards to medical diagnoses

By the time I caught up to James in the emergency department, his leg had already been x-rayed. He chuckled as he told me he had overheard the technician gasp, “I think he broke his femur!”

In my naiveté I was relieved; ‘Oh, so that’s what the problem was — a stress fracture after decades of jogging! Great. They’ll put a cast on it and we’ll be home in time to watch the hockey game.’

The sound of hoofbeats retreated. 

Later, the crisis team Doctor came to explain what they knew so far. She was wonderful. Warm, direct and clear, she said we looked like two people who would want the straight story.

After some brief medical chat, the Doctor looked him right in the eye and said, “You knew, didn’t you? You knew this was something serious, right?” And then she went right to the ‘C’ word.

Ouch. 

Dr. Straight!

When a healthy man breaks his femur for no apparent reason, it is considered a pathological break. The question becomes what is the pathology? In James’ case they were very certain the answer was cancer, but what kind? 

The crisis team approved James’ first shot of morphine. He was in considerable pain and when he did not feel any relief after the shot he accused the nurse of keeping the good stuff for herself. She laughed. 

Dr. Straight told him he had a high pain tolerance. “No. No I don’t.” — “Yes, yes, you do. You are talking to me in a normal tone of voice with a broken femur. You have a very high pain tolerance.”

No kidding. He had probably spent the last three months with a hairline fracture, not to mention the night on the couch with the now infamous femur. 

Just to clarify, all the prior medical examinations had been focussed on his knee. No one thought to expand the search ‘from horses to zebras’. When the break occurred, it was two inches above the knee which is why everyone missed it. The resident who pushed with her thumbs above the knee probably came the closest to identifying the pain was not in the knee itself. And perhaps this was why Dr. Straight suggested he had known this was more than a knee injury.

After emergency surgery to put pins in his shins to put the leg in traction, he was admitted to the orthopedic ward. And the testing began.

The zebras had arrived.

Stay safe everyone.

Anne Milne is an every Sunday blogger.  Temporarily, this blog will be focussed on telling our cancer story. Please share if you know someone who may benefit. Facebook, Twitter, or Instagram.