“Listen, when I was your age, I did the same thing …”
The words came out of my mouth too fast for my frontal cortex to weigh them or to monitor, let alone modulate, the intensity of my delivery.
He was a relatively new patient, 17 years old, scheduled for a well-child exam. A tall, athletic young man, he was alone in the exam room. His right arm was in a sling.
“What happened to you?” I asked.
He started telling me about how his right arm got pulled out of its socket a week earlier and how the emergency room had done an x-ray and a CT scan that were both negative.
There was a knock on the door and Autumn produced the ER note and the radiology reports. The disposition was to see the on-call orthopedist at Cityside within a few days.
“Did you get an appointment with the orthopedic doctor? It says here you were supposed to see him within a couple of days,” I said.
He shook his head, adding, “But it doesn’t hurt as much as it did the first couple of days. My dad told me to climb the wall with my fingers like this …”
“I wouldn’t do that until the orthopedist says it’s OK,” I interjected. “Let me call Dr. Fazad and see what’s going on with your appointment.”
I pulled my old Motorola from my pocket and called. My young patient looked at the clock on the wall. Dr. Fazad’s office said they didn’t have anything from the ER. “But, he’s under 18, so he needs to be seen by pediatric orthopedics,” the secretary said. “I’ll connect you.”
A minute or two later the pediatric orthopedic clinic wanted to know his name and date of birth.
“No, we don’t have anything on him, but I can see from the ER note that he needs to be seen. We’ll call them later today with an appointment.”
I repeated what they had told me and what I had blurted out before.
“Don’t do any range of motion exercises until the orthopedic doctor tells you to. Usually, you need to be in a sling for six weeks with this type of injury.”
His whole body revolted and he got up from his chair.
“Six weeks?!”
“Yes, that’s how long it takes for the tissues around the joint to heal. When I was your age, I had the same injury. I was away from home and figured since it popped back in, I must be OK. That’s why I’ve dislocated it twenty more times since then.”
He cringed at what I said.
“You might even want to tie the sling behind your back,” I added.
He gestured toward the loops on his sling that were just for that purpose.
“I say what I say because I wouldn’t want you to have to be guarding that shoulder for the rest of your life,” I said.
I know you usually can’t tell a young person very much — I should have remembered from raising my own children. But I wanted to spare him the complications I suffered from ignoring my injury.
I didn’t tell him about the other medical regrets in my life.
A few years after my shoulder dislocation, my grandfather developed double-sided groin hernias, and I didn’t know then that two simultaneous hernias sometimes means there is a growing tumor inside the abdomen.
When I was already a young doctor, I watched my mother during one July visit stop and catch her breath now and then in the summer heat. I thought she was just suffering from the heat, and didn’t consider paroxysmal atrial fibrillation. She had to have a stroke before that diagnosis was made.
I hope he follows my advice.
“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.
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