Introductions
October 22nd, 2006 by The Doc
In keeping with the idea that any new relationship begins with an introduction, let me tell you something about myself. I was a board-certified Family Physician until 2005. I trained at the University of Utah School of Medicine and completed my residency at the McKay-Dee Hospital Center (the old one, before “modernization”) in Ogden, Utah. For what it’s worth, during my first year of clinical rotations in med school I was elected to Alpha Omega Alpha, an honorary medical society that forever brands the top 10 percent of students in a given class. Worth far more—at least in my mind—is that I practiced rural family medicine and emergency medicine for most of two decades, and I was reasonably good at it. I was privileged to be called “doc” in some of the most nondescript towns in southern Utah, southwestern Wyoming, southern Idaho, northwestern Montana, and coastal Oregon.
I loved being a physician. But stuff happens.
Ten years ago, in the middle of a typically hectic clinic day, I developed some stiffness and swelling in the joints of my right middle finger. I figured I had jammed the finger in a racquetball game the previous evening, and I went about my business. It did occur to me that the swollen digit might make it easier for me to communicate with other drivers on my twice daily commute to the hospital, but I didn’t spend much time worrying about it.
By evening, though, the swelling had increased considerably. The joints of two fingers were red and warm. I finished charting my last patient’s visit, headed for my small surgical suite, splashed some disinfectant over my hand, stuck a needle into one of the joints, and withdrew a sample of fluid. I locked the clinic doors and headed for the hospital to round on my patients.
As I passed by the hospital lab I dropped off the sample of joint fluid. I only had two patients to see, so I was able to get back to the lab within a couple of hours. By that time, I felt like I had a case of flu—low-grade fever, body aches, etc. A preliminary report on the sample I had left revealed an abnormally high white cell count, most of those cells being inflammatory. No crystals were seen in the fluid (so it wasn’t gout), and no bacteria were noted—reassuring, since an infected joint can be an ugly problem.
Two days later, final cultures on the fluid ruled out any infection. I had had some blood drawn in the meantime; initial results on those samples were equivocal, but eventually pointed toward a diagnosis of lupus or rheumatoid arthritis. Sad to relate, by the time those final results had arrived I was feeling better, so I didn’t pursue the matter. I was too busy (I told myself) to get into one of those medical loops that, more often than we care to admit, consumes patients to no benefit.
For the next five years or so, I was troubled by intermittent joint pain and swelling: hands, wrists, and knees, mainly. Occasionally, I repeated the blood tests, just to see if anything new was going on. But I kept working; I was indispensable, after all (we all have our delusions).
Then, in 2000, while I was forking hay out of a barn for our pet cows, my eyes got into the act. I can only describe what I saw as a slowly expanding, doughnut-shaped pool of magma across my central visual field. There was no pain—just a puddle of white light—and the episode only lasted a few minutes. For a short time afterward I was troubled by an afterimage, very much like one would see after looking into the sun and then going into a dim room. Again, foolishly, I minimized the problem: it must have had something to do with the morning’s exertion, or maybe the play of light and shadow within the barn.
The details of the intervening years would make this story tedious, and that is not my intention. Suffice to say that I saw several competent physicians whose expertise was hamstrung by their overwhelmingly busy schedules. My eyes were pronounced healthy, the arthritis waxed and waned, and my blood tests were vexingly inconsistent. I was informed by one ophthalmologist that I might have a psychiatric disorder; that I was suffering from a conversion reaction in response to stress in my own harried life.
Finally, a caring, thorough optometrist in Libby, Montana, took the time to hear my story and peer into my eyes. He respectfully disagreed with the diagnoses (rather, the absence of a diagnosis) proposed by my medical colleagues, and he sent me to a retinal specialist. Once the appropriate tests were done by that physician, it was quite clear that I had developed a condition called cystoid macular edema– essentially, a collection of bubbles beneath the retina in that “sweet spot” we use for our central vision. Undoubtedly, the problem was related to the rheumatoid, or autoimmune, disease that was affecting my joints.
Needless to say, I have since been subjected to the best treatment available to practitioners of conventional Western medicine. I have put my trust in some wonderful doctors who contributed their best skills and talents to my case, and who worried at my side as, in spite of their care, my vision continued to deteriorate. I have experienced the side effects of various medications and ministrations. Today, I am left with at least one semi-useful orb in my head, and I am grateful for that.
Unfortunately, my medical career ended three years ago.
The fates have led me to places where I would not have ventured, had I been given the choice. I have had a chance to step back from my chosen profession, and to see its shortcomings as well as its benefits. When it comes to taking control of our health, I have discovered that we all have choices beyond what we see advertised in those slick, glossy magazines or on television (which is even slicker and glossier).
We will spend some time discussing these things. A journey is more interesting when we have companions to share the view…