From the Other Side of the Exam Room Door…
Two months ago I found myself in a situation I’d not really experienced since becoming a doctor, that of being the patient when I was not as knowledgeable about my condition as the doctor seeing me for that condition. My other experiences as a patient were just for “well care,” or by-the-book pregnancies and deliveries, so even as the patient technically, I still felt like I was standing on equal footing (haha, you’ll see the irony of this phrase in a minute) with my doctor in those situations and able to reconcile his or her recommendations with the medical knowledge I already had. Not so in this situation!
It was the end of Thanksgiving weekend when I misstepped going down the stairs in my house, and broke my right 5th metatarsal (one of the foot bones that are part of the arch of the foot). As a result, I had to spend a whole month completely not weight-bearing, and only going around on crutches or my knee scooter, and then another month of “limited weight bearing” for short distances in my boot. I have only recently graduated to walking in normal tennis shoes, which I’m glad to report that I’ve been doing without pain! (though my gait still looks a little abnormal)
Denial, resulting in delay of care, can result in more serious complications. When I finally got my foot X-rayed, the ER doctor reassured me that the location of my fracture usually didn’t require surgery, but that because the fractured segment actually was somewhat displaced, the possibility of surgery was not completely off the table. Did walking around all day at the office the day after my injury because I convinced myself that I just had a bad sprain despite the snap that I felt/heard when I misstepped and the bruising that I started to notice about an hour after it happened cause the displacement? Can’t say for sure but I’m sure that it probably didn’t help! Luckily, though it may have delayed my healing, it didn’t lead to surgery being necessary.
It’s easy to go to the internet for information and be misled. My initial appointment with an excellent orthopedic surgeon was via telemed, after emailing him digital copies of my Xrays, and took place less than a day my broken foot was officially diagnosed. Since his plan/prognosis agreed with what I wanted to hear (ie, that my fracture was nonsurgical), I didn’t initially actually go to Dr. Google. I found, though, that uncertainty combined with a desire not to be a bother, is what drives even doctors to the internet, and that disappointment may lead one to be misled by what one reads. A patient’s dad asked me if what I had was a Jones fracture, but the ER doc had called my injury a dancer’s fracture, and since I didn’t want to bother my doctor with this rather trivial question of mere clarification, I decided to consult Google. I figured that if I limited the scope of my Google search, there would be a very low likelihood of harm. The search results explained that the two fractures were different, and that I actually had the better of the two, but right there on the screen was more information than I’d gone on to search for, and I couldn’t help but read statements that talked about how complete healing could take 3-6 months! This statement was likely referring to healing to the point of being able to run and jump, and though I’ve never had any intention of being any kind of athlete, I instantly extrapolated what I read to imagining that I might be walking around in that boot still this summer, since my follow-up Xrays three weeks after the injury didn’t demonstrate the healing reaction I wanted to see. It made me even doubt whether it was actually safe to start limited weight-bearing as my doctor had told me I could start doing about a week and a half after my follow-up appointment. Thankfully, when I reached out to him in panic, his reassurance was able to ground me in the truth that I already knew in my head but that Dr. Google had temporarily made me forget, that in medicine, “we are treating the patient, not the Xray” and that clinical improvement usually trumps abnormal radiology or laboratory results or abnormal instrument readings. Still, when time came to start walking in the boot, I was scared to death! Which leads me to…
It’s easy to let fear erode trust. Because I knew that my fracture was slightly displaced without any metal holding anything together, I imagined that bearing weight, even in a boot designed to distribute force away from the point of injury, would cause me to feel the bones moving. I didn’t fear pain, I feared the possibility of feeling a worsening in the fracture displacement – not even sure if that’s actually realistic. Fear literally was paralyzing me because I realized it is impossible to not have your full weight on each foot for at least a split second when you walk. How did I get past this fear? For me, reassurance comes from the impartiality and absoluteness of numbers. I could see how much weight I was putting on my booted injured foot by gradually pushing down harder and harder on it onto the scale at my office, and when I got to 2/3 of my weight, I figured that I’d be able to accomplish that in real life by leaning partially on my crutch when taking a step onto my booted injured foot. From there, as y’all can guess, it was just a matter of when leaning on the crutch became an inconvenience, and then I was walking in my boot, just like my doctor had said I was ready to do! Then, at my most recent appointment, a slight amount of bony healing was finally visible on the Xray, and to my surprise my doctor graduated me to fully walking in tennis shoes! To me, that seemed like a dramatic advancement from “limited weight bearing for short distances in a boot,” so it took me two days to decide at the end of the work day to try putting on my right tennis shoe that had been sitting forlornly in my office at work. When that didn’t cause pain (like it had two months prior, the morning after my injury), I decided to try and walk to my car. Again, I realized that my doctor had been absolutely correct when he recommended this advancement, because though I had learned to bear weight on my foot again with the boot, how I was doing so was still abnormal. I wasn’t engaging all the muscles I was supposed to engage in the process of taking a step, and the boot, though more supportive, actually made it impossible to do that and start the process of re-strengthening all those muscles, ligaments, and joints. I am glad that I was able to get past my fear to follow my doctor’s recommendations, and I am relearning to walk normally now, as many of my patients are themselves learning to walk for the first time! The boot has now joined his friends the scooter and the crutches, sitting in the corner contentedly knowing how they helped me literally “get back on my feet.”
It’s ironic that through this “dancer’s fracture” I realized that the relationship between a doctor and a patient sometimes can sometimes be thought of as a dance, with the doctor leading and the patient following. This may not be true as the relationship continues, as the patient becomes more knowledgeable about his/her own condition, but it was a very appropriate comparison in this situation where I was the patient who, despite being a doctor myself, had a medical condition outside my personal area of expertise. I went to a doctor whom I trusted to understand my priorities and goals, and just took a little bit of time with each “different step” to fully follow through with his recommendations to the letter; each time though, that little bit of delay resulted in angst (on my part only). If you watch ballroom dancers, you’ll see that the most enjoyable performances are ones where both dancers do what they’re supposed to do, but that the one dancer completely trusts the other to cue her to move on to the next step. I didn’t do that perfectly as the patient this time, but hey, dancing is not my forte, as my husband will testify to since I often try to anticipate his lead, and why he found the diagnosis of a “dancer’s fracture” crying-laughing hilarious.
