2001 Doctors' Writing Contest: Honorable Mention

How humiliating simply to fall apart!

Hobbled by a mysterious injury, this doctor confronts her physical destructibility.

By Kathryn B. Einhaus, MD
Ob/Gyn / Fort Wayne, IN

Between my conception and September 2000, I was indestructible. My rugged good health was challenged by little more than the usual viral diseases, a few allergies, and some nasty tonsils. Getting through medical school and residency in my 40s confirmed my invincibility. And I noted that many other physicians shared my physical superiority. They, too, could stay up all night and remain on their feet in the office or OR all day, fueled by bacon and burgers from the hospital grill. We are notorious for avoiding the labs, physical exams, and the common-sense behaviors we urge upon our patients. This, however, struck me as an altogether appropriate, just, and satisfying state of affairs. After all, we don't have the time to obsess about our health.

Well-being characterized my first years of practice. Admittedly, menopause provided a challenge or two, but some heavy-duty hormonal alchemy fixed that. Well, almost. Then something happened to my right foot. It broke. I don't know when or how; it just broke. Physician proprioception being what it is, several weeks of discomfort and multiple accusations of limping were required for me to zero in on the offending body part. I was just too busy to register the pain. When finally I realized that my right foot hurt, I got it X-rayed. The picture was negative, which I announced to my podiatrist friend.

"Weight bearing," she muttered with exasperation. "Film's no good. Has to be weight bearing."

By the time I appeared in her office two weeks later, she probably could have diagnosed my vertical metatarsal fracture by holding my foot up to the light. I was devastated. I'd never a broken bone or, for that matter, had any flawed part. Adding to my humiliation, the podiatrist presented me with a bright green boot-like contraption, ornamented under the knee with a red bulb—fire engine red. "That's the pump," she said about the red thing. "The boot is an Air Walker, and you need to wear it all the time."

Though she would tell you—unfairly, I think—that I'm a terrible patient, I have dutifully worn this green boot—with a garbage bag and bungy cord around it when I'm in the OR—for more than six months. (Once I had the bad luck of wearing both shoes and running into her in an elevator on my way to a professional dinner.) I have donned the boot even though it is an obvious badge of my vulnerability and imperfection and a hell of a fashion risk. "Who'd ya kick, Einhaus?" chortled the good ole boys in the surgeon's lounge. "Ah, I see you've been skiing," say my more refined colleagues. I wish there had been some definitive event or trauma to my foot. How humiliating simply to fall apart!

My split metatarsal and the Christmas-colored boot have not only forced me to confront my own frailty, they have also encouraged other physicians to share stories of their own falls from physical grace and reluctance to acknowledge them. A nephrologist relates how, after feeling bad for weeks, he finally made a midnight visit to a local ER, where he discovered his diastolic blood pressure was 120. (Systolic was unmentionable.) A gynecologist who had recently become short of breath was duped by his staff into getting a stress test. After a glance at the results, the cardiologist rushed him to the cath lab and placed multiple stents. The stories do not always end well. An FP talks about his former partner who watched his "hemorrhoids" bleed for many months, disastrously avoiding the true diagnosis of colon cancer. Need I say the rest?

Granted, as a class, we are probably much healthier than were physicians 20 years ago. Most of us have quit smoking, and we pay at least casual attention to diet and exercise. But we are conspicuously poor at assessing our own health, and remarkably resourceful at escaping others' efforts to do so. Some of us go for years without a physical exam. Who will order the cardiologist's ECG? Who will check the internist's blood pressure? What can I do about my internist patient whose fasting blood sugar is 135 and glycohemoglobin 9, but who declares her schedule too erratic to permit her to take medication?

After the intimations of mortality I've received from my right foot, I'm thinking about getting a physical. My parents were both diabetic, so maybe I should check my blood sugar. Perhaps I should have some basic labs, and, let's see, it's been several years since my last Pap smear. Actually, if I ignore that little thing with the LDLs, I'm willing to bet that I'm in pretty good shape. Except, of course, my right foot.

The damned foot stands resolutely between me and wholeness. Despite my fanatical orthodoxy with the green boot, tons of calcium, and Fosamax (my own addition), the crack remains, along with a lot of bone callus. I show my X-rays to orthopedists, who keep talking about hypertrophic nonunion. In the surgeons' lounge, amputation offers abound. Last week, during a well-deserved session of retail therapy at the mall, I ran into a famous local orthopedist. Gathering up my nerve, I violated his private time to ask what he might do surgically to fix my problem should healing fail. Hearing his answer, I blanched and vacated the mall without a single package.

Had I been in the familiar environs of a hospital instead of the mall, I might have listened more calmly to his talk of scraping, pinning, grafting, and the other surgical carpentry orthopedists do. On the other hand, it would certainly be imprudent to rush into things. Perhaps I should keep company with Mr. Green Boot just a bit longer. I haven't tried snake oil yet. Does anyone know a good witch doctor? Perhaps by cruising the Internet, I can find someone to inject Super Glue under ultrasound guidance. If anyone has a helpful suggestion (no more amputation talk, please), please e-mail me at kbeob@yahoo.com. I will be eternally grateful and will, of course, follow your advice scrupulously.

 

Kathryn Einhaus. How humiliating simply to fall apart!. Medical Economics 2001;22:40.