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A doctor who's sick with worry

October 21, 2002|Samuel Shem | Special to The Times

One problem with being a doctor is that when you are the patient you worry like crazy. For every little symptom, you use all of your medical training to make the diagnosis, and you inevitably conclude that the symptom is of the worst possible event; that is, you are about to die. You have informed worry. This sense of impending doom can be augmented by a bad doctor and dissipated by a good one. With a good doctor's attention to worry, healing can occur. Let me give an example from my recent total hip replacement surgery.

A pain in my knee while running led to an X-ray of my knee (normal) and then of my hip. This revealed a joint which, in the words of "Dr. Hip" at a great Boston hospital: "If you told me you wanted it done today, I would do it today." He then added that they were developing a new polymer that would make the joint last longer, so I should delay the operation as long as I could stand it. How would I know when I was ready? "It's the Necktie Sign," the kindly old man said, smiling. "It's when you come in here and reach across my desk and grab my necktie and scream, 'Now! Do me now!' "

Four years later I went to grab his necktie, but he had retired. He referred me to his protege, whom I will call "Dr. B." Like many orthopedic surgeons, he looked like a day laborer -- a big guy with big shoulders and hearty hands and not much neck. He had a broad face that broke into a smile a lot, a boyish head of hair and an appealing shyness, as if he were sorry to have to do surgery on me. My wife liked him. Done deal.

Things mostly went well. Just before surgery, the anesthesia doctor came in and said I had a choice of general anesthesia or a spinal. "General" puts you totally out, so a machine breathes for you; "spinal" is the administration, into your spinal cord, of drugs that anesthetize and paralyze you from above the operative site down to your toes. You can be conscious during a spinal, although routinely you are given drugs that leave you sleepy or asleep, but there is no "hangover."

Four days of worrying

I asked the anesthesia doctor what she would do, and she said a spinal, no question. Dr. B. came along, in a charming lime-green shower cap that made him look like a woman shot-putter on her way to the showers, and said the same thing, so I went along. Somewhat doped up, I fell asleep. I woke up only once to hear a loud noise nearby -- my surgeon hammering happily on my hip. But I didn't feel anything and talked to him for a while and then went back to sleep. I woke up totally dead from the chest down -- unable to feel anything or move anything. My first worry was that they had severed my spinal cord and no life would ever come into my lower body again. This was the first of many worries during my four days in the hospital, witness:

When I turned out to be exquisitely sensitive to narcotics and my blood pressure plummeted to that of an amoeba (60 over 50) and I was about to pass out, I worried that the narcotics plus the beta blocker they had given me for the surgery had eradicated my normal heart action and I was going to die.

When I sat up and had the most severe headache of my life, I worried that it was a ruptured cerebral aneurysm and that I was about to die.

When I suddenly had a shaking chill -- a rigor -- in which all my muscles clenched like steel traps all at once (including the un-narcotized muscles around my hip replacement that sent a blast furnace of pain through my body), I diagnosed a septicemia from which no one recovers. I knew I would die before sunrise.

Through all these worries, the nurses helped and Dr. B. was always available. His words were always reassuring, his face sometimes not.

But I made it through and went home and, suddenly alone in my bed and unable to move much, the real worry began. All day and for great snatches of the night I had many different symptoms, each igniting a fuse of worry that I just knew would end in the implosion of death.

It was three weeks post-op. I lay in bed worrying about the pain in my calf, which I had concluded was a DVT, or deep vein thrombosis -- a blood clot that, in a whimsical break for freedom, would dislodge at any moment, travel up into my lungs and result in pulmonary embolus, leaving me dead as a doornail. For the first two weeks I had been on Coumadin, an anticoagulant used to prevent DVTs. Now I was off Coumadin, and I pictured my red cells and platelets clogging like a crowd at a South American soccer game trying to exit all at once -- with many deaths. I worried and worried and thought to call Dr. B. I had called him a couple of times before with minor stuff, but now I didn't feel I should bother him. After all, I'd had this calf pain for a while. Why wasn't I dead yet?

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