Chapter 6 - The Anatomy of a Fracture
The Orthopedic Center at the University of Rochester was housed in a massive glass-and-limestone complex on Crittenden Boulevard that smelled of floor sealer, latex gloves, and that particular high-velocity air-conditioned chill that belongs only to surgical suites.
It was 8:30 AM on Tuesday.
Dr. Gregory Vance—no relation to the lake, he had pointed out with a dry, surgical grin that didn't reach his eyes—was sixty, had silver hair that looked as though it had been trimmed with an electric sheep shear, and held an iPad with both hands while scrolling through the three-dimensional MRI reconstruction of my right shoulder girdle.
"Well, Tessa," Dr. Vance said, clicking his tongue against the back of his front teeth. "The good news is you have excellent bone density for thirty-four."
"And the bad news?" I asked, sitting on the edge of the examination table in a blue paper gown, my right arm resting in the bolster like a broken wing.
He turned the screen toward me.
The joint looked like an aerial photograph of a train derailment.
"You have a circumferential labral tear," he said, using the stylus to trace a jagged, irregular black gap between the white crescent of the glenoid bone and the gray shadow of the cartilage. "It’s not just a SLAP tear anymore. The superior, anterior, and posterior segments have all detached from the bone. The long head of the biceps tendon is subluxated out of the bicipital groove, and you’ve got a three-millimeter Hill-Sachs lesion on the posterior aspect of the humeral head where the bone impacted the rim of the socket when it came out."
He set the tablet on the stainless-steel rolling tray with a sharp, metallic clack.
"How much force was applied to this joint?" he asked.
"Two hands," I said. "Between the shoulder blades. I was thrown forward about four feet into water."
"Did you land flat?"
"I twisted," I said. "I tried to catch myself with the good arm, but my right side hit the surface first at an angle."
Dr. Vance shook his head, his mouth pulled into a tight, severe line that I had seen on dozens of doctors during my seven years working as a compliance coordinator for a regional healthcare system.
"Water is non-compressible at high-velocity impact, Tessa," he said. "When you hit at that angle with the arm semi-abducted, the hydraulic pressure acted like a wedge. It drove the humerus right through the anterior capsule. If you were a professional pitcher, I’d tell you to look for a second career."
"When is the surgery?"
"Thursday morning," he said, already writing on his digital pad. "Seven AM. We’re doing an open repair. We need four titanium suture anchors in the glenoid rim, a capsular shift to tighten the stretched ligament, and a biceps tenodesis to move the tendon out of the groove so it stops pinching the nerve. You’ll be in a hard abduction splint for eight weeks, no passive motion for six, and then twelve to eighteen months of physical therapy."
"Will I get the full range back?"
He looked at me over the top of his half-glasses.
"Eighty percent," he said honestly. "You won't be serving a tennis ball again, and you’re going to know when a cold front is coming across Lake Ontario for the rest of your life. But you’ll be able to drive a car and type with two hands."
The door of the examination room opened two inches.
His clinical coordinator, a woman named Marsha with a badge covered in pediatric vaccination stickers, stepped inside.
"Dr. Vance? There’s a gentleman in the waiting room who says he’s the patient’s father. He’s asking to speak with the billing coordinator before the surgical consent is signed."
I closed my eyes.
The smell of my father’s car—the cold salmon, the damp wool, the cheap peppermint candies he kept in the glovebox—seemed to seep through the ventilation grilles of the clinic like a gas.
"Tell him to wait, Marsha," I said.
"He says it’s urgent, Tessa," Marsha said, her voice dropping into that cautious, defensive neutrality that healthcare workers use when a family dynamic starts to leak into the hallway. "He says there’s an insurance pre-authorization issue regarding third-party liability."
Dr. Vance paused with his stylus mid-air. He looked at me, then looked at Marsha.
"Third-party liability?" the doctor asked.
"He told the intake clerk that the injury occurred on commercial premises during a private event," Marsha explained, reading from a pink post-it note. "He wants to know if the venue’s general liability policy has to be billed before your primary Blue Cross coverage kicks in."
A small, cold laugh caught in the back of my throat.
He wasn't here to hold my hand while they marked the surgical site with a purple felt-tip pen.
He wasn't here to bring me an extra pillow or drive me back to my apartment on Park Avenue.
He was here to build the paper trail for the insurance adjuster. He was trying to shift the cost of my titanium anchors onto Alder House’s premises liability coverage, because if the hospital billed my Blue Cross, the subrogation department would automatically open a third-party claim against the person who pushed me.
And that person was named Lena Vale.
"Dr. Vance," I said, sitting up as straight as the foam bolster would allow, my voice steady, flat, and absolute.
"Yes, Tessa?"
"Give me the surgical consent."
He picked up the stylus and handed me the tablet.
"Are you signing as self-pay for the deductible?" he asked.
"I’m signing as the patient," I said, using my left hand to draw a jagged, unpracticed signature across the digital line. "And Marsha?"
"Yes?"
"Tell the man in the waiting room that if he touches my billing file again, I will have the hospital security detail escort him to the parking garage under the state stalking statute."
May you like
Marsha didn't blink. She took the pink post-it note, crumpled it in her fist, and dropped it into the biohazard bin with a dry, satisfactory plop.
"Have a seat in the pre-op lounge, Ms. Vale," she said, holding the door wide. "We’ll make sure your father stays on the other side of the glass."
