A week ago Thursday, a dear friend and her two kids were coming over in the afternoon to harvest mulberries from our tree. We had some plastic sheeting ready to lay under the tree as we shook limbs to release the ripe berries. They arrived at 3 PM and by 3:05 we were all in the yard. Things were moving along well. Then I had the brilliant (she said sarcastically) idea to use our 20 foot ladder, to allow access to berries higher than we could reach from the ground. Let me say two things about me & ladders: 1) I do not like climbing them, 2) I apparently do not know how to position one properly. R came out to adjust my placement of the climbing device and then because he is kind and knows I do not like ladders, told me to move and let him climb. Which I did, gratefully. While he was ascending, with our friend holding the ladder, I decided to go into the house and get the platform ladder, which is only 8 feet high, more stable and which I felt sure I COULD climb without incident. I was happy we were all going to participate in gathering berries. Yea! As I began climbing the "normal" ladder, my friend came over and said to me, "R's hurt." I looked around and saw him on the deck, with his head down and looking rather pale. When I got over to him, he explained that he slipped on a branch as he was attempting to reach higher into the tree, lost his footing & grabbed a branch above his head to prevent falling. Unfortunately, the grab along with his body weight & angle, caused something to happen to "his right arm". I glanced at the clock. How could things go so wrong in only 10 minutes? From the look on his face and the pallor of his skin, I knew he was in tremendous pain. So, as gently as possible, I looked at his shoulder and arm under his t-shirt. Even if I had never worked on an orthopedic unit, I would've recognized a dislocated shoulder. We hurriedly explained to ou friend that an ER visit was necessary immediately and asked that she and the kids continue picking if they liked and just lock up on their way out. In the car, we opted to drive to UPMC St Margaret, which is 10 miles from our house, instead of the the closer ER at Allegheny General, simply because past experience has shown us that the average wait at AGH ER is about 5 hours, while UPMC SM is generally 1.5 hours. The judgmental errors of the day are compounding. The road to UPMC SM is being repaired. The bumps were many. And poor R was already in pain. What is usually a 15 minute ride was closer to 25. Upon arrival at the ER, R goes inside while I search for a parking space. Searching produces the LAST space in the ER lot! When I enter the ER, I am astounded! It looks like a convention. Nearly every seat is filled. WTH? Since R cannot use his right arm, or hand, I fill out his paperwork and we look for seats. In all my years of involvement with UPMC SM, I have never seen so many people in the ER. It is 3:50PM. Let me just say that one of the most annoying things about waiting in the ER, is having to see people who came in after you did get called ahead of you. I mean, I understand the folks who are bleeding. I even understand those who do not appear to have anything wrong, but who may be having some sort of challenge like a heart attack or shortness of breath. What I don't get is the people who walk through the door, talk to the receptionist, sit down, chat with their companion(s) and then get called ahead of my husband who is in so much pain that he describes it as 13 on a scale of 1-10. But enough about that! The other annoying thing is the TVs. Two of them. Tuned to the same station. Until that visit in the ER, I was proud to say I had never seen the Dr. Phil Show. Can't say THAT anymore! Poor R! after waiting for just a little over two hours, his pain was becoming unbearable. He was pale. And he was having swelling in his right arm and hand. I approached the receptionist. Knowing she couldn't really tell us how long we would have to wait, I asked her anyway. My reasoning was that if she knew how much pain R was in maybe we could get pushed up in the rotation. She was very sympathetic, and even though she said exactly what she was supposed to say, I still felt a little better. Maybe it was her attitude. She seemed to genuinely care. Her name was Rita. I reported back to R what Rita had said and left him for a minute while I went to the rest room. When I returned to his side, he was sporting an ice pack on his shoulder. He said that Rita had gotten it for him. Neither she nor he knew if it would help, but the kindness was greatly appreciated. About 15 minutes later, Rita asked if R had had an X-ray yet. She said had noticed that X-rays were being ordered, so we might as well head over to radiology while we were waiting to be called to an exam room. Again, her common sense approach was greatly appreciated! After a very brief time in radiology, we were back in the waiting area. Waiting. It was now about 6:45 PM. And we waited. About 7:10 we were taken back to an exam room. We didn't wait too long in there. The nurse came in and did the preliminaries. About 10 minutes later, the Orthopedic doctor arrived. He was very kind. He explained what they would attempt and what they might have to attempt if option one didn't work. He then left and returned with the longest needle I have ever seen. The plan was to inject R's shoulder joint with a relaxant and then attempt a closed reduction (popping back into place) after the spasms in his muscles and ligaments had subsided. Then the nurse returned, as we waited for the relaxant to take hold. She placed an IV, and gave R an injection of diluadid, for pain. Then we waited a little bit longer. At 7:45 PM the doctor, Adam Ray, did the closed reduction. It was an amazing thing to see. The pain etched on R's face was palpable. I had to walk to the other side of the room to avoid over reacting. But R reported a "small pop" followed by a "bigger pop" and Dr. Ray also reported "feeling the big pop". They ordered a portable X-ray to be sure the shoulder was in proper placement. By 8:15 PM R, with placement verified, was in an immobilizer sling, with two pain pills and the phone number of the f/u doctor in hand. Not at all how we had planned to spend our Thursday, but in the grand scheme of things, it could've been worse. Of course, that's easy for me to say!