‘I Heard the Bones Break’

Letting the dogs out. What could go wrong?

For Denise Clawson of South Orange, N.J., it turns out the painful answer is plenty, and it landed her in the hospital with potentially life-threatening injuries.

The 64-year-old bank records manager was at her son’s home in Bushkill, Pike County, in May with her 13-year-old grandson and it was time to let the family’s two dogs out into the backyard. Exiting the home onto a second-story deck, they started down the stairs to the yard. Each had one dog on a leash.

But dogs being dogs, the canines spied something and bolted into the yard. The dog held by Clawson pulled her off the steps about four steps from the bottom, sending her crashing to the ground. “As soon as I hit, I heard the bones break,” recalls Clawson. She had her grandson collect the dogs and get them back into the house and told him to call 911. “I knew I wasn’t getting up off the ground,” she says.

She was taken by ambulance to Lehigh Valley Hospital (LVH)–Pocono, in East Stroudsburg, where she was met by Daniel Roesler, MD, LVH–Pocono Trauma Program Medical Director, and the emergency room team. Scans showed a punctured lung and seven broken ribs, some broken in two places. In medical terms, she had a flail chest, a condition that presented a higher risk for complications, such as pneumonia or bleeding.

“It all comes down to the trauma and the way the force is applied to the body. The energy from the impact must go somewhere and in Denise’s case, unfortunately it was her chest wall.” – Dan Roesler, MD, LVH–Pocono Trauma Program Medical Director

A chest tube was inserted to allow a way for the air escaping from her lungs to exit her body. Without that escape route for the air, the result can be fatal.

“You have to be a lot more careful,” says Dr. Roesler. “Patients can decline rapidly.”

Dr. Roesler ordered the medical hardware that would be used to stabilize Clawson’s ribs – it’s not something hospitals keep on the shelf – but the first attempt at an operation was unsuccessful when Clawson’s oxygen levels dropped. She had to be placed on a ventilator and was in the intensive care unit. “I was in pretty bad shape,” Clawson recalls.

A second attempt at the multi-hour surgery a few days later was successful, though Dr. Roesler was only able to put titanium plates and screws on three of Clawson’s ribs because healing was already underway and scar tissue was forming on the others. The rib fractures will heal without the hardware. Clawson’s chest wall now had the needed strength and structural integrity.

“It almost looks like a bicycle chain with all the screws and stuff,” Clawson says.

The number of rib fractures was unusual and more than Dr. Roesler had encountered in any of his prior patients, but he says each trauma is unique. “It all comes down to the trauma and the way the force is applied to the body. The energy from the impact must go somewhere and in Denise’s case, unfortunately it was her chest wall. It was unexpected. It’s just the way it happened. She fell with enough force to cause that damage.”

Dr. Roesler says medical technology has advanced substantially when it comes to treating and stabilizing rib fractures. “There’s so much more we can do than 20 or 30 years ago,” he says. “They used to wrap the chest wall, but that also presented potential breathing issues for the patients. Stabilizing rib fractures with plates keeps the broken rib bones from moving independent of each other and helps reduce pain.”

LVH–Pocono has the highest level of trauma care in the region which meant Clawson could stay at the hospital for treatment and not have to be transferred to another facility farther away.

Clawson continues to recuperate at home and is receiving regular physical therapy in New Jersey. She’s not back to driving yet. In addition to broken ribs, the fall also caused a torn rotator cuff in her shoulder, but repairing that will wait for now, she says.

Clawson says that except for a broken toe many years ago, she’s been lucky when it comes to fractures.

LVH–Pocono staff and Dr. Roesler were wonderful, says Clawson, adding Dr. Roesler has a great bedside manner and always kept her and her family well informed about her treatment. “I really trusted Dr. Roesler,” she says. “He’s truly a remarkable doctor who saved my life.”

Dr. Roesler says he continues to encourage Clawson in her recovery. “I remind her of the progress she’s made from day one until now. She really got very sick and could have died. Now look at where she is,” Dr. Roesler says.

The doctor-patient relationship is vital and is really a partnership, says Dr. Roesler. “If we can’t communicate with one another, it’s not going to work. It’s important to develop that relationship. It’s like forming a friendship and having open lines of communication. You ask your patient how they are doing, how they are feeling, just like you would your friend on the street. It shows I care and that patients aren’t just another name on a list.”

Clawson says her son always suggested she let the dogs out from the ground level of the house and not use the second-story deck and steps to get to the yard. “I never had an issue before, but they’ve already told me you’re not walking the dog anymore,” says Clawson.