It’s hard to be a patient
Today I am finally starting to resume most of my normal daily activities after getting my gallbladder removed last Tuesday. I tried to follow the advice of my doctor - given the fact that many doctors “make the worst patients” - I did not want to do stupid things for the sake of being “tough.” Yet I find myself wrestling with the feeling that I am taking it too easy, taking advantage of the fact that I had surgery so I can just sit around and do nothing (something I really like doing from time to time). I don’t want to be too “tough,” but I also don’t want to “be a baby.”
This is not the first time this has come up. Five years ago I was with my family in Puerto Rico. It was the first real big trip we had taken as a whole family (all six of us). I had planned for us spend some time on the east coast, some in the rain forest, some on the west, and then end up near San Juan in a nice hotel.
The first part of the trip was good - although the degree of poverty we saw was unexpected for us. We enjoyed the beach, and the rain forest was especially interesting for us. We traveled to Ricon’, a surfing Mecca on the west coast of the island. Our hotel was reasonably nice, and the beach seemed especially good - with big waves crashing in right at the shore next to the hotel.
On the first full morning in Rincon’ I made a point to play a with the kids. The waves were up to six-feet high and crashing in right at the beach. We would stand and let them knock into us, or we’d run to the shore so the waves wouldn’t get us. The kids were having a good time, but were tiring and wanted to play in the pool.
I decided I would try my had at body-surfing, something I had never had the chance to enjoy. These seemed to be perfect waves to learn on, so I went out to ride. By the second ride in, I was getting the hang of it. I would wait for the wave to crest and start swimming as hard as I could. The wave would push me ahead, and I would end up sliding in on the shore.
The next wave I rode on was my last. I caught one of the bigger waves I had seen and began to ride it in. I had caught it perfectly. The sound of rushing water filled my ears and the thrill of riding the wave was wonderful. My excitement was short-lived, however, as I was suddenly slammed down into the sand of the beach. I put my arm up to protect my head, but my face was ground into the sand and I felt a pain in my neck. I moved my feet to make sure I had not injured my spine; they moved. My right shoulder jolted me with unexpected pain. I stood up and walked in, arm dangling by my side.
“What did you do to yourself? Your face is bleeding!” someone shouted at me.
“My shoulder,” I said, “I think I’ve dislocated it.”
One of the patrons of the bar (which extended nearly on to the beach) told me he had dislocated his shoulder before, and knew how to get it back in. The throbbing pain begged for me to do something to fix it, so I followed him as he guided me to lay face-down on a pool table.
Others got wet cloths to put on my face, which was dripping blood. “Do you want a beer?” Someone asked, hoping it would ease my pain.
I only could moan in response as my shoulder-expert put down his drink and started pulling down on my shoulder. It did not hurt too much, but nothing felt at all better after a few attempts to put my shoulder back in joint. I told him to stop as others ran to call an ambulance and notify my wife.
The hotel manager agreed to watch our kids as Terri rode behind the ambulance as we sped to the nearest big city. The roads were bumpy, and each jolt sent new pain from my shoulder.
The experience at the hospital is a blur to me now. In Puerto Rico you are supposed to bring your own bed linnens to the hospital, so I sat in the cold ER with a paper blanket, caked in blood and sand. They gave me some Demerol, so I faded in and out for the next few hours. I remember sitting in a waiting area watching soap operas in Spanish, laying next to some prisoners in chains. I am not sure why they were there. I remember laying on the x-ray table as the technician tried to coax me to move my arm in positions it refused to assume.
“Dolor! Mucho Dolor!” I cried out in some of the few Spanish words I knew, as she tried to move my arm so she could get a better x-ray.
I had fractured my humerus in the region of the “surgical neck,” which is quite high up on the bone. As I fell and put my arm to protect my head, my arm was jammed into my shoulder, resulting in a compression fracture of the joint. The local orthopedic surgeon was not sure if it would require surgery, but I had already called some friends back in the US and had an appointment waiting for me when I got home. I wore a shoulder-immobilizer for the remainder of the trip, and my wife did her best to hold things together.
I did not need surgery to fix it, as it turned out, but it took nearly four months to recover from the injury. I could not lie down flat for over two months due to the pain. When one of my colleagues told me of his quick recovery from a fractured humerus the year before, I became very self-conscious that I was somehow not handling the pain well. My orthopedist reassured me that my friend’s fracture was not nearly as high on the humerus (it was mid-shaft), and so much easier to recover from.
The big lesson that has stuck with me from this instance (other than the “bring your own sheets” rule in Puerto Rican hospitals) is that it is hard to be a patient. Here I had a severe fracture of my shoulder, and a very good excuse to be in pain. I felt, however, very self-conscious about the degree to which I complained and the time it took me to get better. Why should it matter to me? The problem was: it did.
A good portion of my job is to listen to people’s complaints. They come in and tell me what is wrong, and I do my best to make things better. My experience with my shoulder (and my current experience with my gallbladder) teach me to be sympathetic to the emotions my patients may be feeling. They feel just like I did. They are not sure if they are over-reacting or under-reacting to their pains. This is even worse with people who have psychiatric or less-defined physical conditions (such as fibromyalgia). My patients are looking for me to reassure them that they are OK in their response.
What about the times when I do think that they are over-reacting? My experiences have taught myself that I can’t judge them too harshly. It is hard to know how to react. You want people to know that you do have pain, yet you don’t want to make too much of things.
So now I make a point to say things like: “I’m glad you came in for that,” or “Yes, it seems like you have really had a hard time.” I know how important it was for me - with a clearly painful injury - to hear the reassurance that I was OK to be feeling like I did. I don’t want to make it any harder than it already is to be a patient.
