“Yeah” Bobbi said, with a giggle. “I would. I’ve done it before”
“Me too” Sarah said. “It was… fun”
Bobbi and Sarah were having breakfast together and discussing, with surprising frankness, the subject of sharing their bedroom activities with a third person.
“Yeah, if you wanted”
“Only if you did too”
“I’m not saying…like… you’re not…”
“I know you’re not”
“But yeah… maybe…”
“Sure… depends who though”
“But if we found someone… and they wanted to”
“And if you wanted”
The conversation ended in blushes and giggles, and with them both feeling slightly turned on. They were both wearing only light dressing gowns, and Sarah even had slipped hers off her shoulders and knotted the arms around her waist as she sat at the table, which meant that her chest and arms were completely bare. Bobbi had a wonderful view of Sarah’s large breasts and her nipple rings glinted in the morning sunlight.
“But anyway…” said Bobbi, finishing her mug of tea. “We haven’t got time to think about that anymore – we need to get ready or we’ll be late!” Bobbi rose and limped off into the bedroom to dress, followed by Sarah on her crutches. Sarah was in the unusual position of having her ‘good’ (relatively) leg in a long leg walking cast which she was able to put weight on, while her other foot with its pulverised big toe was in a heavier short leg plaster cast with an added toe spica.
Once Bobbi was dressed in her hospital uniform and Sarah in her usual casual student clothes, they went down to the waiting taxi which took them to the hospital. Today was different to a normal working day, however, as Bobbi and Sarah had both been invited to a seminar.
“I still don’t know if we’re going to be there to be trained or used as training examples!” Bobbi joked. Sarah laughed. The reason for Bobbi’s joke was the subject matter of the training seminar – ‘The Study and Advanced Treatment of Broken Toes, by Prof. Lily’.
“I’ve never even met Professor Lily” Bobbi said.
“I have; she agreed to mentor some of my studies” said Sarah. “She’s a bit… odd… but yeah, she’s nice. Very knowledgeable, if a little eccentric.”
On arrival at the hospital, Bobbi and Sarah made their way up to the floor where Prof. Lily had her offices. Prof. Lily’s offices had their own reception area, and what appeared to be a comprehensively equipped private casting room off the foyer. At the reception, they were met by a trio of nurses; the dusky brunette Nurse Yvonne, golden-haired Nurse Xanthia, and Nurse Zara, who had short hair dyed ice-blue.
“Ah, you’re here for the seminar” said Nurse Xanthia.
“Yes, but I’m not sure if we’re students or exhibits!” Bobbi said with a grin, repeating her joke of earlier.
“Both” said Nurse Zara. “It’s an interactive seminar”
“Oh, I see” said Bobbi, not seeing at all.
“Of you could both come this way?” Nurse Yvonne said, gesturing towards the casting room.
“What for?” Bobbi asked.
“To remove your casts. Don’t worry! We’ll replace them afterwards!”
“Right…” Bobbi said, thinking this was highly unusual. Nonetheless she followed Nurse Yvonne into the casting room and lay back on a padded bench while the three nurses removed her angled long leg cast with a cast saw. They even had warm, scented, soapy water to wash the accumulated dead skin off Bobbi’s leg, and a razor to delicately shave it until it was silky smooth. Bobbi peered with disgust at the large scar on the back of her ankle from her Achilles tendon surgery; the long scar down the inside of her of her foot where Nurse Mayleen had accidentally cut her while cutting Bobbi’s boot off after a previous injury, and finally at the ugly scar on her toe from when she had an external toe fixator fitted and then removed. Still, Bobbi had to admit, her toe looked in better shape than Sarah’s, which was still black and blue from its unkind treatment with a sledge hammer.
“We have a choice of a wheelchair or crutches for you for use while at the seminar” Nurse Xanthia explained.
“I’ll take the chair” said Sarah, who was thoroughly sick of crutches and not willing to risk any further injury to her damaged toe while in was in a vulnerable uncasted state.
“I’ll try some crutches; I think I need to exercise this knee… ooooh! Ahhhh!” Bobbi said, as she slowly straightened her knee and tried to bend her ankle, which had been stuck in the same position for so long.
Bobbi was brought one forearm crutches and one ‘gutter’ crutch, which had an attached plate which rested under her casted left arm, and meant that she could use it with her arm still in plaster.
Unsure as to quite why her cast had to be removed, and feeling very vulnerable without her protective plaster, Bobbi crutched awkwardly into the seminar room and was met by someone who could only be Prof. Lily. Prof. Lily was of average height, with broader hips and bright red hair. She was casually dressed in jeans and white top and barefoot on the luxurious aubergine-coloured shagpile rug which was centred on a hard wooden parquet floor. There was no-one else present.
“Ah, you’re here! Good – we can begin” Prof. Lily said by way of a greeting.
Bobbi looked about her. “This seminar is just for us?” she queried.
“Of course – you’re the head of the Serious Toe Injury Section, aren’t you?”
“Er… yeah, yeah I am” Bobbi said, inflating with pride.
“And Sarah’s your deputy…”
“Eh? When did that happen?” Bobbi interrupted.
“…so that’s all we need.” Prof. Lily carried on, ignoring Bobbi.
At a nod from Prof. Lily, Nurse Xanthia dimmed the lights and Prof. Lily turned on a projector.
“I thought we’d examine some real examples” Prof. Lily began. She put a slide up on the projector, which turned out to be a blown-up x-ray of the front part of a foot, showing a badly broken big toe.
“This first example is actually you, Roberta” Prof. Lily said.
“Oh… great… thanks… and please call me Bobbi” said Bobbi. She looked with curiosity at the x-ray of her own toe. She guessed this must have been taken after the time she smashed her toe in the courtyard between the two hospital buildings recently.
“Now…” said Prof. Lily, using a stick to point at various parts of the projected image. “…observe the bone fragments here and here. In a case like this, as indeed was done, it is necessary to secure these with a fixation device…” She changed the slide to show the same to with a lot of metalwork now screwed into it. Bobbi winced at the memory and her toe throbbed as if through remembered pain.
“Of course, Roberta’s toe was able to be saved, but amputation remains an option…”
“What?!” yelled Bobbi. “No-one’s cutting my toe off!”
Prof. Lily shot her a scowl. “Remains an option in more severe cases, especially when there are fractures here, or here…” She used a dry-wipe marker to draw on the background behind the projected slide, showing the locations she was talking about.
“Now, for toe-fractures such as Roberta’s, what is the length of time that the digit should be immobilised in a cast?” Prof. Lily asked her tiny audience.
“Twelve weeks as standard” said Bobbi, who obviously knew because it was her toe. “And please, it’s Bobbi…”
“Twelve weeks is the minimum time that we recommend, yes, very good, but I personally advise casted immobilisation for a period of six to eight months” Prof. Lily explained. Sarah scribbled down notes.
“Isn’t that a little… excessive…?” Bobbi asked.
Prof. Lily looked at Bobbi over the top of her glasses.
“How long has your toe been in plaster since this accident Roberta?”
“Bobbi! And… er… ten and half weeks thereabouts”
“And does it feel fully healed?”
“Yeah, pretty much… AHHH!”
Bobbi yelped as Prof. Lily leaned across and prodded Bobbi’s exposed toe with the end of her pointing stick.
“You see?” Prof. Lily moved away from the projection screen and came over to Bobbi. She very gently raised Bobbi’s foot with her hands and peered at her big toe, which she then gripped between her fingers, making Bobbi wail.
“You can see here…” Prof. Lily said, seeming talking just to Sarah now and treating Bobbi as if she were a piece of display equipment. “…the bone remains weak and vulnerable to pressure at these points…” She demonstrated and Bobbi howled. “…so that, unprotected, a sudden application of pressure can…”
“AHHH!” Bobbi yelled. “OW! You broke my toe!”
“No” Prof. Lily corrected. “Your toe was broken before you came in here. I just demonstrated how weak it was. Nurse, can you get some ice for Roberta’s toe?” Nurse Zara obeyed.
“So you can see…” Prof. Lily continued, resuming her lecturing voice. “…that the requirement for the toe to be fully immobilised for a long time is very important.” Sarah wrote rapidly in her notebook as Prof. Lily spoke.
Bobbi was nearly speechless. “You… I… My toe…!” she spluttered.
“Doing is the best way of learning” Prof. Lily said dismissively. “Example Two!” she went on, replacing the slide with a new one.
“This toe belongs to Sarah…” she smiled kindly at Sarah. “As we can see, the fractures are similar in some respects but different in others. The smashing, crushing, flattening, mangling nature of this injury meant that surgical pinning of the bone was not an option. If I had been consulted about this injury…” Prof. Lily’s tones suggested that she was slightly annoyed that she had not been. “…I would have recommended amputation”. Prof. Lily seemed to have something of a mania for cutting off toes.
“However…” she conceded. “…I do have to say I approve of the treatment undertaken, which was, of course, carried out by Roberta here”. Prof. Lily smiled the same kind smile at Bobbi, seemingly ignoring the fact that she had been inflicting pain on her moments before.
“Bobbi!” hissed Bobbi.
“Roberta’s treatment plan of immobilisation with a short leg cast and close-ended toe spica is excellent, however I would suggest that the immobilisation period is extended from that which has been stated in the patient’s notes.” Prof. Lily began to move towards Sarah’s wheelchair.
“As I will, demonstrate, the toe remains prone to re-injury…”
“Yes Professor, I can see that” Sarah suddenly cut in. “My toe is weak and vulnerable here and here…” She lightly touched her own toe. “…and should remain encased in plaster for… at least nine months I should say.”
Prof. Lily nodded and retreated away from Sarah’s toe, seeming both pleased that her student had such knowledge and disappointed that she had not been able to get her hands on Sarah’s toe to illustrate her point.
“Excellent Sarah” she finally said. “For the second part of this seminar, I want to concentrate of diagnosis and assessment of broken toes. Constant assessment throughout the healing process is vital, or else…well… what can happen?” Prof. Lily again addressed Bobbi and Sarah.
Bobbi sulked, but Sarah spoke up. “They… might… not heal straight?” she ventured.
“Exactly!” Prof. Lily replied. “I have a real example here…” A new slide went up, showing five bent toes. “Patient reference 402297 Wondering, J.”
“Hey, I know her! That’s Jessica!” Bobbi said, finding her voice again.
“Indeed? Sadly, Miss Wondering’s toes have not healed straight from the several previous breaks that they sustained, which is why I have written to Miss Wondering today recommending that she comes in for toe-corrective surgery. If her toe fractures had been regularly checked while they were healing, it may be that this wouldn’t have become necessary.”
“Please Professor, without subjecting the patient to excessive x-rays, how do we check the toe fractures during the healing process?” Sarah asked, sucking the end of her pencil as she looked over her notes.
“By feel, which is what I want to come onto now. For that, I have some patients who have kindly volunteered to assist. Nurses?”
Nurse Yvonne and Nurse Xanthia left through a side door, and returned presently wheeling in two wheelchairs, which held Annie and Kathy. Each had both legs propped up on supports sticking out from the front of their wheelchairs, and all four lower limbs were castless. The same was not true of Kathy’s upper half; she had a large plaster shoulder spica coving her torso and left arm. Bobbi remembered Annick telling her about the latest exploits of Kathy and Chloe. Apparently the pair had injured each other (again) fighting (again). Kathy had ended up with a broken left shoulder, a broken left knee requiring her short leg cast to be extended to a long leg cast, and five (re)broken toes on her left foot.
Annie, Bobbi knew only too well, had broken her left foot on her first day at work at the hospital, and the fourth toe of that foot at home soon after. Bobbi herself had then been responsible (well… partly responsible, maybe) for breaking the four small toes on Annie’s other foot by stepping on them at a restaurant.
Bobbi was surprised to notice that both Annie and Kathy had straps around their ankles, legs, thighs, waist, arms and forehead, which held them rigidly in their wheelchairs. They also were gagged.
“Why are they… er… restrained like that?” Bobbi asked.
“While we will be as careful as possible, I don’t want them moving while we are examining their toes. A sudden movement on their part might inadvertently cause them further injury” Prof. Lily explained.
“And the gags?” Bobbi asked.
“It would be tragic if either of them bit their tongue in a moment of pain” the professor said, matter-of-factly. She crossed over to the two patients, stepping off the thick rug onto the parquet floor where the two wheelchairs rested.
“So here we have Annie…” Prof. Lily indicated Kathy. “…and Kathy” she said, pointing to Annie.
Both the restrained girls squeaked and mumbled through their gags.
“Actually Professor, it’s Annie and Kathy” Bobbi said, pointing out the correct girls.
Prof. Lily picked up two thick files of medical notes. “No Roberta, this is Annie Barker…” she said, while pointing at the redhead, “…and Kathy…”
“No Professor; Annie’s my friend and I’ve treated Kathy before…” Bobbi interrupted.
“Roberta, I think I can read a pair of medical files, thank you very much!” Prof. Lily cut in. She carried straight on without giving Bobbi a chance to speak again. She crouched down next to Kathy’s feet.
“Annie here as, unfortunately for her, broken the four small toes on her right foot” the professor said, pointing to Kathy’s healthy right foot. “We will therefore leave those toes alone, and instead examine the toes of her left foot, but imagining as if those were broken.
“Er… Professor, I think it’s…” Bobbi began.
“No more interruptions please, Roberta!” snapped Prof. Lily.
“For a normal diagnosis, a simple pinch can often determine if a toe is fractured or not – observe” Prof. Lily said, seizing Kathy’s shapely second toe, which Kathy’s (correct) medical records would have shown as having three separate fractures, courtesy of Chloe. Kathy issued a muffled scream.
“Nothing to worry about” the professor soothed. She pinched the toe hard and Kathy wailed. “Be aware that the second toe, being the longest of the ‘smaller’ toes, is often the one most prone to multiple fractures. These can occur here…” She pinched hard. “…here…” Kathy wailed. “…and here” Kathy squealed and tears rolled down her cheeks.
“Another school of thought…” Prof. Lily went on. “…is to apply pressure to the top of the toe and wiggle it back and forth.” She demonstrated this agonising procedure on Kathy’s middle toe while Kathy sobbed quietly .
“This should show if the toe is broken on not but in my opinion is of limited use as it will not accurately show us where exactly the break is.
“A far better technique, is to hold the toe firmly and move it from side to side. This way, you should easily be able to feel where the fracture or fractures are. I will show you – oh, hang on!” Prof. Lily ran her finger down a page in Annie’s file.
“Ah, yes, poor Annie here has a fractured fourth toe on this foot. That was a close one, wasn’t it?” the professor joked, speaking to Kathy. “I nearly moved your broken ‘ring’ toe there!” Kathy wailed into her gag.
“Don’t worry – I’ll move onto the next one” Prof. Lily said with a smile. Kathy looked pleadingly at Prof. Lily but she didn’t get the message. She took told of Kathy’s broken pinkie toe and bent it sharply out to the side. Kathy screamed a muted scream.
“Now, this is interesting, medically speaking” Prof. Lily told her audience, leaving Kathy’s smallest toe jutting out to the side at an awkward angle. “Annie here appears to be double-jointed in some of her toes. If her pinkie toe here really was broken, this would of course cause agony. Luckily for Annie, she’s got very flexible toes!” Prof. Lily moved Kathy’s pinkie toe about some side to side and back and forth like a miniature joystick.
“Very interesting” she finally said, scribbling a note in Annie’s medical file.
“Moving onto Kathy here…” the professor moved over to Annie. “Kathy has, let me see… all the toes on her left foot broken in at least one place each. So, as before, we will leave those alone and look at her healthy right foot.” She gestured at Annie’s right foot with its four shattered toes.
“This is also a good example of what we were discussing earlier – Annie’s toes have not healed as they should from previous breaks, and so… hmm… yes… I think I will recommend you for toe-corrective surgery as well. Would you like that? Hmm? Yes?” Annie moaned and struggled against her restraints.
“Excellent; I will have one of the nurses make an appointment for you. Anyway, for today we will just concentrate on these undamaged digits here.” Prof. Lily playfully wiggled all of Annie’s broken smaller toes. Annie looked as if she might have leapt out of her wheelchair with the pain if she had not been strapped to it.
“A third method for identifying broken toes, and one that I am hoping to have adopted as standard practice in this hospital, is one that I have developed personally. The method requires the doctor to observe the angular flexion exhibited by the toe; or, put more simply, to see how much it will bend. It is, of course, common knowledge that a healthy toe will be able to bend more than an injured, fractured or broken one, and so by using this method not only will we be able to assess if a toe is broken, but we will be able to gauge the severity of the fracture too. I am compiling a list of the average degrees of flexion for all types of toe and toe injury, and I hope to be able to publish the study shortly.”
“To measure the angle of the toe, I use a device which I have invented myself.” Prof. Lily crossed to her desk and produced a metallic gadget. It appeared to closely resemble an old-fashioned sextant that a ship’s navigator might have once used to ascertain the position of his ship. It had a large metal arc, which looked like it was marked with degrees, and a metal tube which started at the point of the arc and continued up past the curved measuring section and finished with a small handle.
“The bottom of this tube is hollow and it fits over the toe.” Prof. Lily explained, fitting it onto Annie’s broken second toe. We can then move the toe, by moving the metal tube…” She pushed and pulled it back and forth to demonstrate. Annie screamed and sobbed. “…and, once the resistance of the bone is felt, we can read off the angle. If the toe cannot be moved to the average angle without causing the patient pain, we know that the toe is therefore broken. The amount the broken toe is able to be moved should tell us how bad the fracture is!” the professor concluded, beaming triumphantly.
“She’s insane!” Bobbi whispered to Sarah.
“What did you say Roberta?” Prof. Lily asked.
“She said it’s amazing, Professor” Sarah answered.
“Why thank you. I am rather proud of it. All that remains is to compile all the data regarding to average toe bending angles, so it can be published in a chart which will be available to doctors and nurses. Now, since we know that Kathy’s right toes are unbroken, we can bend them until the resistance of the bone is felt and note down the angles…” Prof. Lily now seemed to be talking less as a lecturer and more to herself.
“Second toe… ten degrees, twenty degrees, thirty, forty… normally we would expect to feel some resistance now…” Annie howled and struggled but to no avail as the shattered bones in her toe we misaligned once more.
“Sixty, seventy… Kathy has some very flexible toes! Eighty… a complete right-angle! Oh dear, oh dear, this will change all the data I have collected so far…”
Prof. Lily removed the curious device from Annie’s mangled second toe, which remained more or less at the angle it had been bent to. Prof. Lily didn’t seem to notice or care.
“How are the others?” she muttered to herself, fitting the device over Annie’s middle toe. More swiftly than before, she bent the toe right back until it was at a right-angle or more to how it should be.
“Extreme flexion with limited resistance, fascinating…” Prof. Lily said, speaking to herself again and she did she same to Annie’s fourth and pinkie toes. Annie howled, shrieked, sobbed and wailed, but the professor continued regardless.
“Quite remarkable!” she finally said, turning to her tiny audience again. “As you saw, the toes bent without any pain, so we can safely say they are not broken… whereas…” Prof. Lily fitted the device onto Annie’s healthy, unfractured second toe of her left foot.
“Now, this is important Kathy; you must tell me as soon as this hurts, as it’s your broken toes we will be moving now, but with toes as flexible as yours it is important that I record the result in the interest of medical science, OK?” Annie saw consumed with pain from her mangled right toes and didn’t look as if she had even heard the professor.
“So… with toes as flexible as yours, I’d estimate about thirty-five degrees…” Prof. Lily began to bend Annie’s ‘good’ second toe back using the strange measuring device. “… forty… forty-five – ah!” Bobbi was sure her could hear the crack of the toe bone from where she was sitting, and Annie leapt convulsively as the bone snapped.
“You see?! Between forty and forty-five degrees is the limit that the injured toe can be bent before it causes the patient pain!” Prof. Lily said triumphantly, waggling the lever back and forth as Annie writhed in agony.
Prof. Lily repeated the exact same procedure on Annie’s middle toe to confirm her findings, as Bobbi and Sarah looked helpless on and winced as Annie’s middle toe snapped at thirty-seven and a half degrees.
“Sarah, why don’t you come and have a go and see exactly what I mean?” Prof. Lily said, fitting the device over Annie’s already broken left fourth toe.
Bobbi’s eyes widened with horror as Sarah rolled her wheelchair up to take the measuring instrument from Prof. Lily. Sarah rolled herself off the thick rug and onto the wooden flooring, where she performed an about-turn so that she could reverse herself up to the professor and alongside Annie. She gave herself a slight change in direction as she propelled her wheelchair the final distance.
“Awwwk! Awwwooo!” Prof. Lily squawked like a parrot twice in quick succession. The wheels of the wheelchair had rolled right over Prof. Lily’s bare toes, crushing them between the hard tyres and the solid wood floor beneath. Bobbi’s mind may have been playing tricks on her, but she was sure she heard ten individual cracks.
Sarah looked up at Prof. Lily with doe-eyed innocence. “Is something wrong Professor?” she asked.
Prof. Lily didn’t answer but kept howling and hopping from one foot to the other, which only compounded the injures in her crushed and shattered toes. Finally she collapsed back onto the soft purple rug in the centre of the room
“Ooooh! My toes!” she wailed. “Get the nurses!”
Bobbi noticed that Nurse Yvonne, Nurse Xanthia and Nurse Zara were not in the room, and with her own re-broken big toe throbbing she was quick to capitalise on this.
“You don’t need a nurse, Professor. You have the fully genius of the hospital’s Serious Toe Injury Section right on hand!” Bobbi lowered herself to the rug alongside the professor. ”
“Sarah, we must check the Professor’s toes for breaks and fractures!” Bobbi instructed.
“Yes…er… Doctor. Um…” Sarah shuffled through her notes which had fallen onto the floor. “By the pinching method or the wiggling one?”
“Ah, now remember what the Professor said…” Bobbi replied, grabbing hold of Prof. Lily’s left ankle. “This…” she pushed clearly broken baby toe and waggled it back and forth. “…isn’t as good nor as accurate a diagnostic method as this…” Bobbi pinched and pulled Prof. Lily’s second toe, which was turning red with two extra bends in it.
“However, we should use the Professor’s own method. Hand me the device” Prof. Lily howled again as Bobbi jammed the contraption over another mangled toe and seized the bending lever with glee.
“Now, do tell us when it hurts Professor! Hmm… these look like pretty flexible toes to me, so let’s try ninety degrees…!”
Chapter 100 is here! Inspired by Case Study 1 by castsandfeet, and dedicated to all the broken toe fans out there!