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August 20, 2006 --
Sometimes our plans for the summer go awry. That happened to me this
year when I reinjured a hernia in my stomach I had had surgically repaired a
couple of years ago.
I knew right away that it had crossed the point of no return and I would
have to get it operated on again, so I called the doctor. The surgeon
who had repaired it initially wasn't available right away, so I chose to see
his son (it's a father-son practice) instead. After a brief
evaluation, he confirmed my suspicion that I would need surgery.
He also told me he does things a little differently than his father.
He described his technique (which I later confirmed through research was the
latest thinking) and sent me off to see his scheduler.
Lesson #1: Different surgeons do things differently.
While this is especially true for Chiari, it is true in a broader context as
well. I believe this is driven by the way surgeons are trained, which
tends to be more a passing down of knowledge from mentor to student. I
think it also reflects the logistical impossibility of performing controlled
clinical research comparing every technique. Because of this, surgeons
develop their own style. Surgery is part science and part art.
While some times there may be a right and wrong, other times, it may just
boil down to individual preference and not really affect outcomes.
Lesson #2: I think surgery is one profession where I am
tempted to discriminate based on age. I believe there is a sweet spot for
surgeons where their technical skill, combined with their experience, peaks.
A young surgeon probably has not seen enough cases to have a large base of
experience to draw upon. However, past a certain age, an older
surgeon's skills may begin to decline and they may not be up on the latest
techniques and technologies. In this case, I was comfortable going to
the older surgeon a couple of years ago, but I also felt good going to his
son for the second try. So what is the sweet spot? I'm not sure
but I would say that maybe on average, surgeons are at their peak in their
40's and maybe early 50's.
A short time later, as I sat with the scheduler, she began talking about
dates 3-4 weeks out. The surgeon happened to come in again and I said
how about this Friday - I don't want to sit around not being able to do `stuff
over the summer. He thought about if for a second and agreed he could
fit me in. I went to the hospital that afternoon for a blood test so
that it would be back in time.
Lesson #3: Once you decide a course of action (in terms of
medical care), such as having surgery, it's best to get it done as soon as
possible. When I agreed to have Chiari surgery, I decided to postpone
it until after the December holidays and New Year. That was a mistake.
It was essentially dead time just spent thinking about the impending
surgery. Plus, if your condition warrants surgery, you might as well
fix it before it gets worse.
Lesson #4: Don't be afraid to ask! If you want
something from a doctor, don't beat around the bush, just ask for it
outright. If I hadn't asked, I would've wasted 3-4 weeks before the
surgery not being able to do things, plus the normal recovery period.
The day of the surgery arrived quickly (since it was only two days from my
appointment) and I began going through what was by now becoming routine (6
surgeries in 6 years). But I did pay attention to the staff's
reactions when they asked who my surgeon was. It was clear from their
responses (both verbal and non-verbal) that he was well regarded among the
nurses and other medical workers.
Lesson #5: If you're trying to find a specific type of
doctor ask as many people in the medical profession as you know.
Doctors develop reputations and it is pretty easy to find out who has a good
rep, who has a bad rep, etc.
The surgery went ok and about 10 days after I went in for a follow-up and to
get my staples/stitches out. When he looked at the area of interest he
told me there was too much fluid and he would have to drain it. As he
was doing just that, I mentioned that the swelling had gone down, but a
couple of days prior I spent some time on a treadmill and it seemed to swell
up again after that. He offhandedly replied that he doubted that anything
I did would contribute to how much fluid was there.
Lesson #6: Don't overreact when a doctor dismisses something
you say or makes an insensitive comment. I couldn't believe what he
had said. I had witnessed, with my own eyes, the changes that occurred to my
body. I had no doubt that working out on the treadmill had caused
fluid build up, but he dismissed it out of hand. However, I didn't
argue with him or get upset. There was no upside to that. The
surgery was done, and our relationship was almost over. Although I was
stunned, I let it go.
Because he had drained fluid, he asked me to come back in a week to see
if the fluid had built up again. At my return visit, he decided to
drain some more fluid and while he was doing this, he mentioned what I had
said last time. He said he had been thinking about it, and that it
could be that I had overdone it, causing some excess fluid to build up.
While I was naturally happy that he owned up to his previous comment, I
didn't do a victory dance or say I told you so.
Lesson #7: Don't judge doctors too quickly or harshly.
They are human and make mistakes. Mine owned up to it a week later,
which was a classy move and now means I will recommend him to other people.
That's how I spent part of my summer. I hope you were lying at the
beach, camping at National Parks, or traveling to exotic lands.
-- Rick Labuda
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