Sunday, April 14, 2013

What do you do?

 
Well it's been almost 48 hours since the Sports Medicine Guy (SMG) stuck a needle in my back.  He put it in the Infraspinatus, about 2 inches shy of the shoulder joint.
 
 
Imagine this if you will... A giant butcher knife sticking out from that exact spot.  It is stuck there, and it kind of leaves a burning sensation.  Every - EVERY - movement you make - no matter how subtle, that knife is stuck there, causing tremendous pain, and limiting how far you can move and how much force you can exert.  Even though it has been 48 hours, it hurts (almost) as bad as when he gave me that shot.  So I am going to go on record here - DO NOT ever agree to get a steroid shot to reduce inflammation.  EVER.
 
But - there is something happening here that even hurts worse than my shoulder.  (if that is possible, at the moment...)  I didn't exactly agree to this shot.  He just sort of did it.  He pulled in a nurse, and they did some weird, well-rehearsed routine where she holds the bottle upside down, high up in the air, and he inserts the evil syringe and pulls back the plunger.  Then she holds up a second bottle and they do the same thing.  He shakes the syringe to mix up the evil elixir of hell, and then sticks it into you.  THEN he asks if it hurts...and chuckles if it does.  Evil, I tell you.
 
I've had 48 hours to think about this appointment, and how (IMHO) it went drastically wrong...
 
1. The intake nurse takes my vitals.  She asks about the injury (there was none, which is what is so frustrating) and then about the scope of the pain.
 
2.  Then we have a conversation:
Nurse: What do you do?
Me: Well, I take Ibuprofen from time to time, ice it every day, and once in awhile I apply heat.  I've had seven physical therapy appointments, but I am not getting any pain relief, so that is why I am here.
Nurse: No, I was asking what do you do?
Me: I don't understand..
Nurse: What is your job?
Me:  Oh.  I'm a SAHM.  (totally unused to hearing this question any more..)
Nurse: Oh.  (making a negative, silent judgement call right then and there..)
Nurse: How many kids do you have? (the perfunctory question to ask right after you hear 'SAHM')
Me: Four.
Nurse: Oh my!  What ages?
Me: (pause to think because we are in the midst of birthday season..) 12, 6, 5 and 3.
Nurse: So what activities are causing you pain?
Me:  Anything and everything I do during a normal day.  Chores, cooking, shopping...lifting the youngest is the most painful .  I try to let my left arm do most of the work, but it is incredibly painful, still.
Nurse: I see.  (judgement call is being made here too)
 
3.  I put on a gown that is tied around me halter-top style, per nurses request.  I haven't been able to sport a halter top since I was about 10.  This is a little embarrassing.
 
4.  SMG comes in.  He pretends he is reading my paperwork, but I know he hasn't.  Why?  Because during the course of his questioning, he doesn't realize I have already had a shoulder x-ray done.  Just two days ago!  Twenty feet down the hall, just outside this door!  He pulls up my x-ray on the computer.  Hummph.  He assesses my range of motion.  He hears a clicking sound.  That seems to catch his attention the most.  He jumps to the conclusion that it is the bursa (it lies just underneath the clavicle, at the top of the shoulder joint) and that he will give me 'something' to calm down the inflammation.  And in the meantime, I should begin physical therapy.  (Remember - he hasn't really read my chart.). 
 
Me: I have done physical therapy.  I have had seven sessions - three with ultrasound.  And I have had very little relief - that is why I am here.  That is why I came to see my GP two days ago, and get a shoulder x-ray done.  Something is wrong, that basic physical therapy is not fixing.  Both the physical therapist and the GP think that maybe there is a tear in the rotator cuff, so that I why I am here to see YOU.  The GP was thinking that maybe an MRI might reveal the problem.
SMG: Well, I don't think it is presenting as a tear.  We'll see what this shot does for you.  If you are still in pain in six weeks, it may take another shot.
Me:  Wait... So is this going to be a chronic condition?  There is nothing I can do, personally, to help heal it?  Like special rotator cuff exercises or something?  (He is the SPORTS MEDICINE GUY, after all!)
SMG:  (chuckling) Well, the good news is is that your three year old won't always be three...
 
(Oh - just let me hike up this stupid balloony hospital gown so I can get off the table and smack you hard across the face.  Wait.  I'd have to use my left arm.  That wouldn't be very effective.  Nevermind.  Go ahead with your pig-headed, sexist, you're-obviously-not-an-athlete-so-it-doesn't-really-matter-if-you-never-feel-better explanation of why you won't live up to your professional creed.  Continue..  Please..)
 
SMG: I'm sure there are some exercises that your physical therapist can show you (as he clearly decides that showing me exercises is not part of his job description and edges towards the door), and that might help too.  (he leaves and the nurse leaves)
 
I can now remove the offendingly hideous balloony gown and get dressed.  Except that I can't because I can't use my right arm at all.  I actually cry because it hurts so damn bad.  I get dressed as best I can.  I leave the exam room and stop by the nurses station because I see the SMG standing there looking at a chart, and I need more information. 
 
Me: So, are there any special instructions with this shot?  Should I not use my arm much for the next day or two (because it hurts like hell anyway)?  Or should I move it around like you need to after a tetanus or flu shot?  Are there any side effects I should be aware of?
SMG:  Well, what I tell my other patients is to avoid any vigorous upper-body exercise for two weeks or so...  So just take it easy.
Me:  Oh.  (So, once again, SMG is making assumptions about me that I find offensive)
 
You know what?  It hurts.  My shoulder hurts.  I'd take the pain of natural childbirth again over this pain any day.  But what hurts even more is the dismissive practices of the medical profession towards those who do not present as the ideal patient.
 
What do I do?  No - the question should be What did I do?
* I used to be able to hike.  I could shoulder a backpack and go for miles.  And camp.  And do it again the next day.
* I used to be able to carry heavy loads and do heavy work.  Now I can't even cart around a fully-loaded laundry basket or lift the cast-iron dutch oven out of the cabinet.
* I used to be able to 8 hour waitressing shifts and handle all of the heavy work associated with that.  I'm now relying on the 12 year old to handle the majority of the food prep at this point.  And the toddler-wrangling, the laundry carting and so on and so forth.  Not fair to the kid...at all.
 
My body is aging and falling apart.  First my arches fell and I had to see the podiatrist for orthotics.  Then my IT band on my right leg inflamed, and the bursitis in my hip made it impossible to do more than hobble around the house.  Now this.  Three pregnancies and years of inactivity have taken their brutal toll.  Don't stand there, Mr. SMG and make assumptions about me.  I'm here in your office because I am asking for help.  Help me.  Don't just stick a needle in my arm and send me away.  I want help to heal and start taking care of my body so I can take care of me and my family for years to come.
 
To his credit, Mr. SMG did call me at home, at 6pm Friday evening to see how I was feeling.  This was a first.  I had to work to steady my teary-voice to admit that still it hurt.  A lot.  He didn't even skip a beat.  "Well, give it the six weeks and then we'll go from there..."
 
And so we're back to square one.