Author’s Note
This piece is drawn from a real injury and its aftermath. The story reflects my subjective experience of pain, disorientation, and dependency during recovery. What follows is a factual medical narrative written for clinical clarity, included here for completeness.
Robert Cushman
Clinical Appendix
Patient Injury Narrative – Knee Injury After Syncope in Shower
Patient Information
- Patient: Robert Cushman
- Date of Injury: December 28
- Relevant History: Psoriatic arthritis; chronic joint pain; recent back injury (improving prior to this event)
1. Precipitating Factors (Context)
- Travel from Guadalajara to Puebla
- Significant sleep deprivation (awake most of Saturday, early flight Sunday)
- Full day of activity on arrival
- Physical fatigue and baseline joint pain related to psoriatic arthritis
2. Bath and Presyncopal Symptoms
- Evening hot bath in a deep hotel bathtub
- Bath duration approximately 15–25 minutes
- Water temperature was quite hot
- Remained in bath longer than usual due to fatigue and joint soreness
Upon attempting to exit the tub:
- Tub was deep and difficult to exit
- Required significant effort and repositioning (hands and knees, then kneeling upright)
Upon standing:
- Experienced lightheadedness and visual black spots
- Brief presyncopal episode that seemed to pass
3. Syncope and Fall in Shower (Primary Injury Event)
- Entered the shower to rinse off bathwater and oil
- Shower and floor surfaces were marble and slippery
- Water temperature was comfortable
- Loss of consciousness occurred shortly after entering the shower
- No memory of the fall
Upon regaining consciousness:
- Found lying on the shower floor in a "wishbone" position
- Both knees bent and forced outward, pinned against the sides of the shower space
- Head positioned under the shower bench
- Immediate and severe bilateral knee pain
4. Immediate Aftermath and Functional Limitation
- Unable to stand or reposition legs normally due to pain
- Used upper body strength to partially reposition and slide out of the shower
- Called for wife for assistance
With assistance:
- Able to stand
- Walked with a severely altered and painful gait
- Attempting to lift legs onto the bed caused extreme pain
- Required assistance lifting legs into bed
- Pain described as intense, deep, and persistent
- No obvious deformity noted
- Minimal visible swelling or bruising
- Significant emotional distress related to pain and concern for long-term mobility
5. Symptoms Over the Following Days
Days 1–3:
- Severe bilateral knee pain
- Very limited mobility
- Walking only possible with extreme care and altered gait
Pain worsened with:
- Weight bearing
- Certain knee angles
- Lifting legs (e.g., getting into bed)
Days 4–7:
- Gradual improvement in ability to walk
- Persistent baseline pain even at rest
Pain worsened with:
- Walking longer distances
- Getting into or out of a car
- Sitting and then lifting the leg (knee flexed ~90°)
- Occasional popping sensations in knees (not constant)
- Minimal swelling or bruising throughout
6. Current Status (Approximately Day 7 Post-Injury)
Able to walk independently with:
- Deliberate movements
- Altered gait
- Ongoing pain
- Constant low-level knee pain at rest
Significant pain with:
- Knee flexion
- Lifting legs
- Getting into a car
- Taking tramadol (previously prescribed for psoriatic arthritis), which provides partial relief
- Over-the-counter anti-inflammatory medications provided minimal relief
7. Patient Concerns
- Concern for internal knee injury (meniscus, cartilage, ligament, or bone contusion)
- Concern for trauma-triggered inflammatory flare related to psoriatic arthritis
- Desire to rule out injuries requiring:
- Imaging beyond X-rays
- Orthopedic or sports medicine evaluation
- Physical therapy or other interventions
One-Sentence Clinical Summary
After significant sleep deprivation and a prolonged hot bath, the patient experienced a syncopal episode in a marble shower and awoke with both knees forcibly abducted and pinned, followed by severe bilateral knee pain persisting for seven days, with difficulty weight bearing, lifting the legs, and entering a vehicle.