Page 6 - Mecklenburg_Medicine_June-2016

President’s Letter
The Other End of the Stethoscope
By Stephen J. Ezzo, MD
My wife recently had surgery, due to an injury from a
nasty fall she had while skiing in March. To see the most
graceful skier I know — she started at age 6 — lying on
the snow taking a while to get back up, was unsettling.
I figured if anyone was going to hurt themselves hurtling down a sheet of
ice on two plastic boards, it would be this fish-out-of-water Florida boy,
who once thought skiing was only a water sport.
But my initial unsettlement was nothing compared to what
followed. “I did something bad,” she said matter-of-factly. “Either I
broke my thumb or tore a ligament.” Worrisome, since I tend to be the
hypochondriac with injuries … I was convinced I had cracked a few
ribs on a fall earlier in the week.
Now, as those of you who know her are aware, my wife is a very
astute physician, and her diagnoses usually are spot on. In fact, one of
my less-than-affectionate names for her is “My Research Department.”
I could take the time to look up info on a case, or just call her, because
she will tell me what I need to know. I am sure you can guess what path
I normally take.
A quick trip to the resort’s clinic showed she was right. She had skier’s
thumb, a tear in the ulnar collateral ligament of her right thumb. She was
casted and able to ski our last day, and even with this impediment, did
better than me.
When we got back, the orthopaedic surgeon saw her first thing Monday
morning, confirmed the diagnosis and scheduled surgery a week hence.
Pain was minimal once re-casted, and frustration was due to not typing as
quickly as she wished and navigating the world as a lefty. (Welcome to my
world, sweetie.)
Because the surgery was scheduled for the afternoon, I figured I’d work
a half day and meet her at Orthopaedic Hospital, as a friend had taken her
there. Typical doctor. And big mistake. To say my mind was elsewhere
was an understatement. Fortunately, the case load was light, everyone
showed up on time with issues of minor complexity, and my nurse
efficiently got me through on schedule.
Seeing a spouse or loved one on a gurney in a hospital gown, even
when healthy and undergoing semi-elective surgery, is jarring. It is the
result of a confluence of reality, vulnerability and potential complications.
It’s this last point where matters get sticky. Despite my best intentions
and knowledge, a maelstrom of thoughts swirled through my brain, none
of them reassuring. What if there is a reaction to the anesthesia (despite
having undergone minor procedures without problems in the past)? What
if they get in there and find something unexpected, despite this being
a textbook injury? Will I hear a code blue while waiting? Why can’t I
undergo the operation for her — what’s one more scar?
So I waited. Even though I knew they were running late and when the
first incision was made, I still thought it was taking too long. The emails/
texts from family and friends, who anticipated things being done, only
made the clock hands move slower. What am I going to do when she gets
really sick? I surreptitiously watched the nurse’s station from my chair
6 | June 2016 • Mecklenburg Medicine
to see if there was any activity that was troublesome. There were only
so many times I could check work email. If I heard one more Trump/
Hillary/Cruz/Bernie commercial, or how the incoming storm was
developing on radar, all interspersed with Dr. Phil, I was going to owe the
hospital a new TV.
Then, all at once, the surgeon stood before me, smiling, telling me
everything went well and she was fine. He was smart enough to let this
sink in before sitting down with me to describe what he found and did,
and show me pictures that, once my heart had slowed, I found clinically
fascinating. It’s called hard-wiring for a reason.
In the recovery room she was a bit wan. She wouldn’t be happy with her
hair. Other than our wedding day, I do not recall her being more beautiful.
If this is the way I, who allegedly is well-educated in medicine, have
these thoughts coursing through me in this situation, what must our
patients experience? To us it is a viral cough or a spontaneously ruptured
tympanic membrane; to them it is a possible early sign of cancer and my
child has a hole in his eardrum. Even with our best efforts to educate in
plain, non-medical language, to condense decades of medical knowledge
into a few sentences is an art learned only through repetition. It best works
alongside detecting non-verbal clues as to whether deeper fears encroach.
I remember during my residency, a colleague in family medicine related
a story about her son waking up with an attack of croup that necessitated
a trip to the ED. “I knew exactly what he had and exactly how to treat it,”
she said, “but I was paralyzed since it was my kid. All I wanted was to
hand him to someone in the ER and say, ‘Please make him better!’” That,
in essence, is what our patients are saying to us about themselves and their
loved ones.
Somewhere along our journey, we find ourselves and those closest
to us as patients, on the other end of the stethoscope. When things have
settled, try to recall the thoughts you had, including the rational ones.
I’m betting that seeing things from a different vantage point will make
all of us better physicians.
Oh, and if you can figure out a way to remove your hands from your
ski pole in the milliseconds when you are falling to avoid this injury,
please give me a shout.
The good physician treats the disease; the great physician treats the
patient who has the disease.
— Sir William Osler
Trivia Question:
What is the other — and more archaic — name for skier’s thumb?
Answer on page 9.