Wednesday, January 14, 2009

Does this thing open in the back or front?

How do you stop being a doctor? When it's time to walk into a medical office by the front door and ask someone else's opinion on a problem with your physical engine, how do you lay aside the whole language and culture to step into the shoes of the guy who sits in the chair that doesn't spin?

I'm currently staring down the barrel of major surgery. An orthopedist, whom I trust, thinks I may need my pelvis broken and realigned to delay hip replacement. But he is trying to be neutral and leave it up to me. He gave me the information (He referred to it as "realigning my expectations.") and asked me to do some research. Another physician, a friend, whom I also trust, in Sports Medicine, thinks that I should get a second opinion.

In fact, every physician I have talked to about this has a opinion. And they aren't shy about sharing them, even with limited information. This is not a common surgery or even a common problem, so it's not like everyone I mention it to understands the intricacies of hip dysplasia in the adult and corrective surgery for it. I guess it's a product of how the medical system has raised us into big, grown-up doctors. We're too used to sharing our opinion, informed or not. And we assume that the person in front of us is interested in what we think.

Add to that the fact that even a family doctor, like me, who avoids to operating room as if it were covered in capsacin can imagine all too well what it might mean to have your pelvis cut apart to the point that the hip socket is free-floating and then may be screwed back into place. We can picture the incision, the osteotomes, the blood loss, the ICU stay, the clot risk, the weight bearing restrictions. And most doctors want to ask about those things. And discuss them, in gross and fine detail. They ask intellectual questions about the interestingly rare problem and procedure in order to learn more. They don't think about the immediacy of the issue for me, the interesting patient.

So who do you talk to? Laypeople often don't understand the magnitude of what I'm talking about. I've gotten a lot of "Yeah, my grandmother had a hip replacement." But it's not a hip replacement. And I'm betting your grandmother wasn't 31. Which is a large part of the problem. It's not that simple.

Part of me- greater than 50%- wishes that for this, I could just return to laymanship. I want to not be able to imagine what is going on after the anesthesia kicks in. I want to not know what questions to ask, so that I can't get the utterly terrifying answers. I want someone to just say to me, "I have the expertise in this area, so let me make the decision." Because as it turns out, I don't have expertise in this area. And I don't know that I can make a decision. I certainly can't make an objective decision. And I feel like every new opinion makes me doubt my previous resolve.

I don't know how to lay aside a lifestyle that encompasses my work, home and social lives. I don't even know if laying it aside is the right thing to do. I just know that sitting on the exam table, when you're used to the rolling stool, is pretty uncomfortable.

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