Once diagnosed and home I was keen to explore 🤓  more about this injury. I went straight to  Google only to discover it was limited in this regard. Particularly the NHS website  which states “grade 3 – a complete muscle tear. Severe hamstring tears  will usually be very painful, tender, swollen and bruised. There may have been a “popping” sensation at the time of the injury and you’ll be unable to use the affected leg.”

According to  the much more detailed Wikipedia “A grade 3 hamstring strain is a severe injury. There is an immediate burning 🔥or stabbing pain ⚡️and the individual is unable to walk without pain. The muscle is completely torn and after a few days  a large bruise 🌑 may appear below the injury site caused by the bleeding within the tissues.”

The Wikipedia description is more akin to my own experience.  My report on my initial visit to A&E was that the muscle was burning, on fire 🔥,  it felt like a dead leg and I was unable to walk or sit. Although not evident at this presentation, the bruising 🌑 appeared when we were in Harrogate 3 days after the event and was certainly visible on the second visit. I felt I had made the correct representation of my symptoms but it had not resulted in a diagnosis at either of these  visits to A&E and I’m still not sure why that was the case.

There were also a couple of blogs 📄 from doctors or physio’s who had also sustained  a hamstring strain but most of the information related to lesser injuries sustained as a result of training or sports  🏋️‍♂️ and threw no light on my situation.

However I did find some academic studies that  reported sufficiently on  Grade 3 injuries to suggest a diagnosis was possible. Grade 3s were more commonly  associated with slips 🤸‍♂️ and falls (caused by block heel boots). Individuals aged between 40-60  👵🏼 (I just made that) were more at risk  and women 👧  (definitely made that)  were approximately 3 times more likely to suffer hamstring strain than males with the majority of these being  from non-sporting scenarios.  (again those block heel boots)  Yep, it was all out there,  but I’m guessing Wikipedia is not on the trainee doctor reading list.😨

And, with the absence of diagnosis, of course comes the guaranteed lack of treatment. 🔬The recommended treatment for this injury is  the RICE protocol — rest, ice, compression and elevation.  This treatment is the same regardless of the severity of the injury, and should be commenced within the first five days.  RICE  is primarily used to reduce bleeding and damage within the muscle tissue. Of course this would have been useful if that was what I had been advised but the first and second visit to A&E failed to even identify the problem.  😳

In the immediate aftermath I needed to know this. Instead of going to Harrogate I should have been home with my hamstring  rested in an elevated position with an ice pack applied for twenty minutes every two hours.  Lower grade strains can easily become worse if the hamstring is not rested properly. Bleeding needs to be reduced but in my case this had not been addressed and my blood loss was significant. 🤭 Complete ruptures require surgical repair and rehabilitation but as I had not had my diagnosis for over a week the window for repair had apparently weakened and surgery was less likely.

On this evidence an apology from the consultant  does seem appropriate, but I have also raised this as a concern with the NHS so that others with the same problem get  the right help when its needed…….

 

 

I entered A&E for the third time somewhat relieved 😕 that, on this occasion,  I had a diagnosis. While waiting to be seen I heard a nurse 👩‍🔧 call out to everyone, and no-one in particular, that they were at 4 breaches (presumably of the four hour waiting time). The four-hour A&E waiting time 🕰 target is a pledge set out in the NHS Mandate.  The operational standard is that at least 95% of patients attending A&E should be  admitted, transferred or discharged within four hours. On this visit, as with the previous two,  I was discharged around the 4 hour mark.

I would argue this level of performance is more applicable to McDonalds 🍔  than our hospitals.🏨  It is only likely to hinder treatment and hamper diagnosis especially in situations a little bit more complex  than ordinary. It’s  not just patients🤒  who suffer,  staff  are likely to be frustrated and constrained 😡 in their effectiveness  by such measures.  It’s not unrealistic to presume that in my situation this measure did impact  on the effectiveness or  accuracy of my diagnosis.

Additionally, without question,  on each visit I made resources were stretched 🤯 to the limit  with the sheer volume of people presenting.  I have no idea to what extent the people waiting required to attend A&E but I’d put my pension on  at least a quarter of them being able to be treated elsewhere.  🤧 This compounds the 4 hour measurement exponentially and its not difficult to see why errors are made, it also underlines why our expectations can rarely be met.

There was a very different response on my third visit, and this was entirely due to the intervention of the Musculoskeletal Consultant Radiologist. 🤩 Thanks to his personal representation of the facts (and his opinion of them), the on call A&E Consultant managed my admission. This by no means resulted in favourable treatment, I still had to lay on a bed 🛏 in the corridor for the most part of the visit.   But she did have a purpose as I was to find out later.

For the first time bloods 💉 and blood pressure 📿 were taken. Both were low and explained by the large blood loss when the hamstring  ruptured suggesting why I was feeling so poorly and lacked any appetite.  My blood count hadn’t been taken on the first or second visits so it was difficult to see if it was improving 🔬 but on the plus side I had just managed to avoid transfusion this visit.

The Trauma Team (you may recall I was referred on the first visit) take referrals 📥 from A&E. They hadn’t yet contacted me but I was still  hopeful they would. However the Consultant disavowed me of that expectation; having  reviewed my notes  🗂 following the first discharge, they determined that their intervention in my case was unnecessary.

The Consultant  was surprised 😳 about this herself  admitting she had made an assumption that referrals for similar  injuries  would at least warrant contact.   I slowly realised why the radiologist had been so angry  and she saw this.  Without prompt she offered an apology on behalf of the NHS.  I could see this was an uncomfortable truth for us both and awkwardly 🙄  I dismissed it as if it didn’t matter, but it had. It mattered  a lot that she did that and  I was so thankful.

There’s very little you can do for a stage 3 hamstring other than wait for it to heal, but the consultant  re-referred me to the Trauma Team and summoned the Occupational Therapist to assess my mobility needs.  My husband was dispatched to collect my medication 💊💊 and I began to relax to the point of sharing a joke, we’d mended the professional rift between us, order had been restored. We even shared a laugh 🤼‍♀️ about the need to provide me (at my age) with some assistance at home.

Then the OT arrived with a zimmer and raised toilet seat…………………………………

 

 

When the telephone ☎️ rings early in the morning, in our house anyway,  it’s generally been sad news. So the call at 8am the morning after Ben, was answered in trepidation, but instead  it was good news! 😀   I had an appointment with an ultrasound scan at 1030. I was elated and immediately guilty  that I had been so disparaging of Ben.😢

In stark constrast to last Friday when my preparations included getting my nails done and wearing block heel boots. 👢This Friday, owing to the fall,  I had to wear my clown 🤡shoes; (my husbands name for them) ultra comfortable, flat brogues in bright blue leather with pink leather lining. Suitably adorned with sensible shoes,  👞 loose clothing and crutches under arm my husband drove me to our local hospital. The journey, only 7 minutes long, was excruciatingly painful.😬

Again like Frankenstein🧟‍♂️  I stumbled  into the department where the scan would take place while my husband parked the car.  Rather nervously I gave my details to the receptionist fearing that someone had made a prank call👅 ( Ben?) and I  had  in fact no appointment at all. But after a few tentative clicks 💻 of the computer she directed me to have a seat.💺 Now, as you know,  this is not an easy manoeuvre for me but my options were limited.  I sat, clinging to my crutches and with the walk in taking its toll, my distress 🤦‍♀️ was palpable.

A nurse 👩‍🔧 wandered past and, wowed by my shoes, she stopped in her tracks to admire them only then noticing at this point I was wincing in pain.  She swung into immediate Nurse Mode and got me onto a bed🛏 , thank you so much shoes!  She then went off to try to hurry my appointment on but advised me I was being seen by a consultant👩🏻‍⚕️  so  would have to wait.   I didn’t mind this, it gave me some comfort, although I nervously admitted to my husband I was worried they would not find anything wrong. I had lost all confidence in my own assessment of my condition.😟

When the Consultant  arrived he was brusque 😠 and I felt instantly guilty at being there. He slaggered gel across the front of my leg and asked me what happened. I regailed the story in summary.  “When were you in A&E ?”   “A week ago” I whimpered  and  fresh from the Ben experience felt again I was wasting his time. “And last night” I added . He asked me to flip over. ( like it was easy)  and slaggered more gel on the sore bit of my leg. “ They have asked me to scan the wrong part”  he seethed.  He seemed astonished 😱 at the discolouration on the injury site  and asked if I was in pain or unwell.  “Both”  I mumbled. He sighed and muttered under his breath and I caught “ it beggars belief”. “OK”  he said “get dressed.”  “Am I ok?” I enquired.  “ You have the worst hamstring injury I have ever seen.” 🤐

I have to admit I broke down in tears 😭 with relief at this statement. He outlined the size of the tear; width 5cms, the depth 6cms and length 18 cms accompanied by a massive  blood clot. He suggested I had lost a lot of blood 💉 and I should never have been sent home. He  summoned my husband into the room.  “Take her back to book her into A&E while I make this report personally”, he stated  “this  warrants it.” 🎉

 

It’s never straightforward getting from A-B is it? The train ran  so late  we missed our lift. My husband organised a taxi to take me to the doctor then drive him to collect our grandkids👫.  The train had made us both late and stress 🤹‍♂️ levels were extremely high. The rabid dog 🐕 stuck  with me as we parted company for our respective appointments.

Naturally  the dog didn’t make it into my consultation but I was in some distress😢  by then and my  leg was swollen so badly I thought my jeans 👖 would need to be cut off.  The GP took one look at me and advised a second visit to A&E  🏩 for further investigation was necessary.

My poor husband was trying to make the kids their tea 🍱  when I summoned him back to my GP to transport me to A&E. He dispatched me rushing back to make sure the oven hadn’t incinerated the chicken nuggets.🔥

A&E was busy; I was informed at check in there would be a three hour wait. 3️⃣ OMG three hours…😩.  I grabbed a seat closest to the exit, but sitting down was just impossible. My containment of the rabid dog now manifested into  tears  😭 the pain, gnawing so much now, was unbearable, I was close to hysteria😜 .

Around me mayhem 👀 ensued, its hard to accept that everyone there was actually an emergency although I’m mindful of assumptions. Everyone appeared to contain their distress more than me, even kids. Some lovesick  👨‍❤️‍💋‍👨teenagers,  supported by their friends did well to conceal any obvious signs of ailment. 🤒  A number of kids in football ⚽️  attire  with blood stained 🤕 faces,  suggested  theirs hadn’t been  the friendliest  match, and numerous older people 👵🏼watched  every newcomer with nervous anticipation 🙀 that they might lose their turn.

After an hour I was called for triage where I was offered some pain relief 💊💊. With only a chair to sit in I was in major  discomfort. Once through the first tier, 🚑🚑🚑 3  ambulances arrived with more patients and I  was in this line waiting to move closer to a doctor.  Chaos didn’t seem to cover it.

Then it was my turn and we met Ben. 🧛🏻‍♂️ Ben is well versed in the habits of  hysterical women.  He has nice 🐝  manners. He has honed his bedside manner 🛏 to relax you.  He tried to establish what we really wanted as he noticed we had been at A&E  last week!  Isn’t it  tedious 🗂 these people who keep coming back?  “What do you need to happen?”  He was  acutely patronising 👺  and despite my GP referral it was evident he thought we were time wasting. “I need further investigation”  I sobbed 😪 “I need to be admitted to get the pain sorted”  But any idiot  🤪 could read the signs that was never going to happen.  Ben thought it appropriate to examine my leg  but he was perplexed.  As with his peers last week he didn’t know what was wrong. “I think you should go home and I’ll try to get a scan for next week”  he said washing his hands. “She needs pain relief”  said my husband, “ its 15p at Asda” he replied 🤫 smiling and  extending his  hand as he dismissed me. “ It was so  nice to see you in A&E.” It’s not a blinking holiday Ben!!!!!!

“I don’t think they believe me I wept” as I stuttered toward the car……………………..

 

 

 

I don’t do public shows of distress (PSD). So when I  fell in spectacular fashion on St Andrews Square in Edinburgh, I was mortified when passers🚶‍♂️ by  rushed to my aid because, as I said before, I was howling 😭.  I had only one thing on my mind; I wanted to get to Bon Vivant and have my lunch🥗 🍷!

My body (not to mention my hair and make-up), however  had other ideas.  No sooner had I clambered back to my feet 👏 when I passed out 🌀 and was flat on my back again. This led to a growing number of spectators 👀 to summon an ambulance🚑.  Not me, I was against this from the start  and  quickly requested they cancel it. After all it was just a fall……..wasn’t it?  🌚

And in any case our bodies are pretty amazing.  Firstly,  despite the pain, my brain 🧠 status  automatically slipped to organise.  I was issuing instructions, handing my phone 📱 over to “ let the restaurant know we are not coming” and   “ let my husband know?”.  I noticed the latter caused quite a stir 🙀in the crowd; was this man with me not my husband?? I could see they were looking at each other trying to figure it out. (Although why I was even aware of these subtleties I have no idea!)

Secondly, however  it was the physical reaction 🤢that led me to take the sensible decision and go to hospital. Shock was screaming  at me very loudly through waves of nausea, violent shaking and spinning horizons.  ( Not due to alcohol consumption, honestly 🍹).  Not wanting to avail the Scottish Ambulance Service of their time for some silly 🤡 middle aged woman wearing the wrong footwear, the staff at Dishoom kindly  summoned a taxi 🚕to take my colleague and I to the Royal Infirmary in Edinburgh. (Bet they thought he was my husband too 🤫).

Despite my best contortions and effort to describe this accident🙇‍♀️ and pain, and an x-ray suggesting nothing was broken,  (although I felt I already knew that) the staff could not identify what ailed me. My left hamstring was on fire 🔥, I had excruciating pain when seated,💺 there was an agonising pain in both my pubic bone and the exterior of the left thigh between the hip and the knee. I was agitated because of the pain 🤦‍♀️and it was about 4 hours before they were able to get it under control. Only then could I allow them to touch my  leg.

After much deliberation the Doctors advised me I was a bit of a conundrum (nice😷),  they thought I’d likely have some bruising from this bad fall.  They agreed I could go home if I was able to use the crutches on offer.

So I did; I went home, not the least bit clear on what was wrong. I did have information that the trauma team would be in touch over the next few days but had no real advice on what to do.

All fine, yep,   but what about our trip to Harrogate on Monday????