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These are the breaks

I met a man recently who had fractured his scaphoid bone. He is a finished scholar; an elderly, learned man with an academic’s view of the world. “I learned three things,” he said. “Firstly, I learned where the bone was. I never really knew. Secondly, I learned that it is pronounced ‘skayphoid’, not ‘skaaphoid’. Thirdly, it is spelt with a ‘ph’, and not an ‘f’.”

These are the things that doctors learned so long ago that they cannot remember learning them. Of course, the scaphoid was a great one to remember for exams, it being partial to a bit of avascular necrosis and so on. It was also known as the ‘Chancer’s Fracture’. In the days when a civil servant who haunted the pubs of Dublin would fall among medical students (as a Joycean biographer once put it), these merry lads passed on a secret: if you x-ray a scaphoid fracture, it can take up to 10 days to show on a fracture. So your civil servant who had wasted his summer holidays helping out with lambing down home in Roscommon knew just what to do. 

‘The scaphoid has not felt right since. It hurts a bit after a night playing guitar and I cannot arm-wrestle any more. That does not matter now, but I had been good at it and had made a nice few bob arm-wrestling’

He learned the location of the anatomical snuffbox in the back of the Palace Bar, stood the medical student a few pints and presented to the emergency department (ED). 

He was duly plastered, if he wasn’t already, and he presented his right arm, ironically frozen in the shape of a pint glass, to the boss the next morning. A sick note that would do for the entire Galway races was clutched piteously in his other hand. 

When he was x-rayed again, and of course had no break, he expressed relief and returned to do whatever civil servants did. It wouldn’t work now, what with keyboards and all. Of course, I genuinely broke my scaphoid when I was a student. My hand-writing was bad at the best of times and I had no chance at all with my hand locked in the shape of a civil servant’s pint, and furthermore I had to sit an exam in forensic medicine. It doesn’t seem long ago to me, but a computer was an exotic yoke then, so they found me a typist. She was a postgrad in history with a department word processor. She was also extremely squeamish. I did my best, despite her turning white at every paragraph and green at the really sordid bits. She finished and I went out into the quadrangle air for a smoke. 

The plaster came off a few weeks later and we were called back to the orals. The extern was a famous man. “This is the student who fractured his wrist,” hissed a waspish pathologist when I was ushered in, glaring at me as if I had done it to make his life more difficult. 

“Ah yes,” murmured the extern. “You obviously dictated it to somebody who has no medical training. You did read over it at the end?” Did I heckers like, not with a Marlboro Light and the college bar waiting for me. I passed anyway. 

The scaphoid has not felt right since. It hurts a bit after a night playing guitar and I cannot arm-wrestle any more. That does not matter now, but I had been good at it and had made a nice few bob arm-wrestling. I suppose it will come back and bite me when I am at a low ebb, but there is not much I can do about it now. As Tony Soprano used to remark: “Whatcha gonna do about it?” If the weather changes, it aches in harmony with my broken toes. 

I broke my toe one morning when I dropped a dumbbell on my foot. I was a casualty officer in Northern Ireland at the time so I presented to work, had my foot x-rayed, confirmed the fracture and worked on. That was the kind of eejit medical training bred in those days. 

As I hobbled about that evening, a policeman (there were always policemen hanging about the ED in those days, I never knew why) asked me what was wrong. “Broken toe,” I told him. A smile slowly grew beneath his regulation moustache. “I broke my toe last year,” he said. “It was marvellous. Eight weeks I knocked out of it. Spent a month doing up the house and a month on holidays.” 

At the time of writing, the medical profession are tired and low. The civil servants seem to be in splendid fettle. You can learn a lot from a scaphoid fracture alright.

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