Quality Time

Professional Courtesy


The work day is over at the hospital. Our town is famous a few weeks for its Tulip Festival. I will have enough sun for an evening bike tour of the fields before the crowds hit this weekend.
"It’s Dr. Jensen. How's the hand?" I ask. He is parked next to me. Three months ago he fractured his wrist, got it x-ray, and we looked at his films together.
He looks up from unlocking his car door. In recognition he holds his right hand up for me, so I step over to have a look.
As always, he is almost stern in his bearing. He is a serious man-- a straight backed Scandinavian blonde with a fully bearded face that could be on a box of Smith Bros. cough drops and always looks like he's about to deliver a sermon. He is tall and his head tilts back as he looks down through slightly condescending blue eyes. He speaks in a controlled quiet voice.
"Three months and it's still swollen," he says. Indeed it seemed almost twice normal size. "It still hurts." He moves the hand up and down to show me its range of motion. It is only about thirty degrees. He gives this report carefully and dispassionately, the facts, no emotion...as though his is just another interesting case. His wrist doesn't work well, and it hurts.
As I take in his report, I consider its consequences, and the news sucks the freshness from the spring evening. He is right handed. He has had complications from the fracture...getting to be long term by now...degenerative changes in the wrist can be anticipated in the future. His face is stony--he has tight control of his emotions.
"I can still do surgery. I can work." He pauses to contemplate. "There's nothing I can't do with the instruments. That's the bright side." He has no enthusiasm for it, no smile. We both know that there are things besides work.
"But I can't do a push up." He pauses, both of us thinking of the things that he can't do. He continues, "Except for surgery, with that arm, I am a cripple." This flat statement lands like a body punch. He doesn't look away to hide his feelings; they are safely under wraps. He looks straight into my eyes, waiting for my inner turmoil to subside, so that he can continue his report.
It began as an emergency call in mid-February, on a bleak Sunday afternoon...three problems to deal with: Cervical spine x-ray films from the emergency room, a CT scan of the head for subdural hematoma, and Dr. Jensen. He wanted the Radiologist called in. Hospital emergency for Dr. Jensen had been rare in the past and always had meant a difficult medical problem. My stomach tightened at the door. I expected something ominous.
As I passed the reception area the technologist said, "The c-spine is on the view box, Phil is in the ER getting the head CT, and you have a personal consult waiting..."
"Thanks." I said as I headed down the hall. I recognized the tall gaunt bearded silhouette.
"What's up?" I asked as I approached the statuesque figure.
He handed me a film, and I put it on the view box. The identification marker at the corner of the film was blank indicating that the film was not in the system to be formally interpreted--a favor to spare him hospital registration, insurance claims and waiting. It showed a fractured wrist at joint surface of the radius. Though not greatly displaced, there were many fragments. Because joint involvement, future degenerative arthritis would be a future concern.
"This is your wrist?" I guessed.
He brought his wrist up for me to see. It was terribly swollen. He showed off a good range of motion.
"How did you do it?"
"Snow boarding...with my son."
"Have you been a boarder for long?"
"This was my first time."
"We see plenty of these fractures in fathers of boarders." Then to the technologist I said, "I want to get another lateral, a little rotation to get a true lateral view." A few minutes later they were back with the film, and I put it up.
"How does it look?" he asked.
"Alignment is pretty good, but the joint surface is involved. So I don't know if they'll want to pin the fragments to maintain the joint surface, or immobilize what you have now with a cast."
"I won't have a cast," he said.
This sounded strange. Did he mean he would refuse a cast or that it wouldn't be necessary.
I looked up at him, "Seriously?" on my face.
"I'm doing surgery next week," he said dead serious, confident that it was adequate explanation. For a minute I thought it was a joke. No joke.
"I have a full week of surgery next week. I can move my wrist just fine."
He fully believed that he was so important in that operating room, that none of his three partners could replace him.
Wasn’t the long term outcome of his fracture worth any change in the OR schedule or giving emergent cases to a partner?
"Maybe you can negotiate with the orthopods...some kind of a removable splint they would let you take off for the surgeries." I was trying to take his side. Find a treatment that he could accept as a patient.
"We'll see," he said.
Smart people can do dumb things.
He intended to just go home...with no treatment...happy with good movement and fairly good position of the fragments.
I grabbed the phone.
"Hang on a minute," I told him. Then, I called the orthopedic floor.
"Are any of the orthopods around?" I asked the ward clerk.
"Dr. Armstrong was here...he just left the desk. You can page him," she answered.
"Thanks," I said and hung up.
"Armstrong is in the building. He could take a look--see your film. Would he be okay?"
Dr. Jensen shrugged. "Sure."
I dialed the operator to page. Dr. Jensen said, "Give me the film, and I'll find him on the ward. I'm going there to see a patient anyway."
"Do you want me to read it for the record?" I asked.
"Either way," he said.
"Might as well. I'll get the tech to make a label for the film when he is done in room one."
"Forget it. I'll just take the film. I don't have time to wait."
I handed him the film.
"Okay," I said. "Good luck." Just as well. Armbrust would leave soon, best to find him. He was off with his film. I went to start an IV for that CT scan of the brain, and life went on.
Now, three months later, in the parking lot, he continues his report to me. "I can't do a push up," he says a second time.
"What stops you, the range of motion?"
"That but mainly the pain," he answers. "I can still do the surgery," he repeats the litany.
"Can you do anything that's fun?" I ask hopefully.
"Not much." He pauses to think and repeats, "I can't play basketball anymore." I can feel him calculating. He is still deciding what that means to him. "That's not too bad," he says. I can see his eyes giving up basketball as he says it.
"I can't play racquetball anymore." For the first time his voice drops, ever so slightly. "I was good at that," he says quietly with hint of a quaver, but keeping control. I know that he has his own racquetball court. He is like a stone statue. It is Scandinavian pathos, and I feel like I could cry.
"Did you ever see an orthopedist?" I asked him.
"We talked on the phone, but that's all. I should have taken six weeks off." He pauses.
"Now, I'm paying for my mistake with the complications." I hope he can tell someone this story…someone that can cry, maybe get him to cry.
"Glad you can work. I hope you get back to the racquetball." I am like jelly inside. He can see it. He tries to think of something nice to say.
"How about you? How have been?”
“Good. No fractures.” I try to smile as I start my car and pull out. I feel terrible. As I drive home I realize-- I gave him the professional courtesy; ultimately, I let him make a decision when he was not thinking straight. A regular patient would have had to see the orthopod in order to get the x-ray. A lot heavier on “professional” and lighter on “courtesy” would have served us better. We’ll both do better.