lessons from a CMR

This is the second time I'm in the situation where people ask: Is there a doctor here?

I wasn't about to let this moment pass without doing anything.

We were having my dad's side family reunion at Janda Baik. Of course, with the river beside the house, the stairs leading into the house would inevitably turn wet with so many people walking up and down. When my Auntie Nurul was walking down, she somehow slipped. Seconds after that, I heard the commotion downstairs and saw that she was limping and being led to sit on a chair. The fourth toe on her left foot had a slight deformity between the distal and proximal phalanges. Fortunately, Auntie Nurul is a doctor, doing her masters in OnG. So she explained (very calmly amidst everyone's horror) that her toe has been dislocated and that can she please just have someone to pull it to align it back in place.

My granduncles, cousins and relatives dare not to touch her toe and neither did I for that matter. But when people asked around "Who is a doctor?" (and someone did point out that Auntie Nurul IS a doctor herself), I felt like the responsibility weighed heavier on my shoulders (despite the fact that I had no idea what to do). When nobody seemed to want to do it, I had to quickly muster the courage and offered my assistance.

Just when I was about to, people called out that my grand-auntie Opah Wah could fix it back in place. Soon after, she massaged Auntie Nurul's foot with massaging oil. It took about 5 minutes to massage. When Auntie Nurul told her to just pull the toe, Opah Wah assessed the dislocation, frowned and said (in Malay with Perak dialect) "I cannot fix this."

The other alternative would mean to send her to a clinic but that would be about an hour's ride away. I discreetly confided in my mom and said that I can TRY to do it. My mom took one look at me and said, "Alright". I prayed Asar first (with my hands cold) and prayed hard that I would help and not cripple her (seeing that I had no idea what the consequences could turn out to be).

After that, I walked into the house as confidently as I could. First thing I asked Auntie Nurul was, "What's the worst that could happen?" and she replied, "Pain." I nodded. She instructed me, "Pull it (the distal phalanx) as hard as you can until you hear a click, then pull it upwards."

She took a towel to bite on for when I would pull her toe. I took a cloth, held her toe between my fingers and my thumb and pulled as hard as I could with both hands. It slipped because of the oil. There was no "click".

The second attempt, I held her foot with my left hand and pulled with my right hand. Again, no successful outcome. I thought that I couldn't do it after all. Beside me was her husband and after having been proud enough that I have actually DONE something, I gestured to pass the cloth to him (an engineer). But he hesitated. Auntie Nurul's dad (my granduncle) was sitting next to me and encouraged: "Alia, just try it one more time." I dejectedly replied, "No, I really can't do it." but he pushed me on and said, "Just try one more time. One more time."

So I asked my mom to hold down Auntie Nurul's foot and used both my hands to pull as hard as possible. Just when I thought all hope was lost, there was an unexpected "click" and I pushed the toe upwards. I looked at Auntie Nurul in momentary speechlessness. Auntie Nurul, while red in the face, exclaimed, "It's fixed!" My mom hugged me tight. My granduncle shook my hands and referred to me as "Doctor Alia!" I just stared at Auntie Nurul and the first thing that came out of my mouth was, "Thank you for trusting me." She replied with a smile: "Of course I trust you."

Later that evening after Auntie Nurul announced that "that young doctor was the one who fixed my toe" and reassured everyone that she was fine, we sat for a quiet chat.

I told her (in English of course): Auntie Nurul, I only did it because you believe I could do it. If not, I would not have dared.

She looked at me: Alia, one of the things a doctor needs is to be brave. You had to have the guts to do what you did just now. Eventhough you've just finished 1st year, you still did it. This procedure is called Closed Manipulative Reduction (CMR) and you will only learn it in 3rd year during Orthopedics.

Honestly, anyone could have done it. I don't know what made me feel so confident to do it. But I told myself that I just HAD to do something, or else I would have lived the rest of my life wondering What would have happened if I actually tried? The first time I faced such a situation was when an old lady fell while walking and there was blood gushing from her nose. I was only a few months into my first year. I didn't know what to do and neither did anyone around. At that moment, I vowed to learn Basic Life Support and First Aid training should I ever face the situation again.

Lessons from today:

1. I have renewed spirit to become the best doctor I can be. I could finally apply some things I've learnt in classes.
2. What we need is mostly courage (but be sure to know what's the worst that could happen), And you're lucky if there's a medical doctor around too!
3. Despite the fact that you have no idea what to do, belief from other people is all it takes to lend you strength to make you confident in whatever you do. Thank you Ummi and Auntie Nurul =)