So, back to my road to medical informatics. I had mentioned that I was struggling to find a way to get my master’s degree while in general surgery residency. Well, if you want a story about trying to make the proverbial lemonade out of lemons, this may come close. This is not to say that my journey is one that deserves more recognition than those of countless patients who have come before me and that will come after me. In fact, many of these patients have been the most profound life teachers I have been fortunate enough to meet.
In December of 2010 I fell in the driveway of my house. It was one misstep on some black ice while taking my recycling bin out to the curbside in the early morning before I left for surgical conference. I was rushing because it was freezing out and the grass was frost-tipped. Instinctually, I broke my fall with my right hand but hopped right back up. I didn’t think much of it at the moment or even for weeks after. Gathering up my cans, which were rolling down the hill of my street, seemed the more pressing issue. Fine-tuned workflows do not apply only to surgical rounds and the hospital for me. My mornings, too, are seemingly perfected down to the minute. Falling and retrieving recycling from the street and the frosted yards of neighbors is not something I factored into my plans that morning. As a result, there was no time to think twice about the slip on the ice.
Fourteen years as a ballet dancer, you fall from time to time when you are trying to hit double and triple pirouettes (turns). You slip while on pointe on a slippery patch on the dance floor. Sometimes it is in the privacy of your dance studio and sometimes in is on stage, in front of a full audience, during your solo. The only reasonable solution in all cases is to get up, recover, and move on as gracefully as possible. There is no time to dwell.
A few weeks passed and I noticed that my right wrist hurt when using my mouse, iPad, and while typing. I was halfway through the first year of my research fellowship, the majority of which had been spent in drafting numerous IRB proposals for my research projects. I chalked the pain up to bad wrist ergonomics with all the typing. In reality, at this point, I had pretty much forgotten about the fall. Soon my right wrist was hurting while operating and I started to get a little nervous. Though, still, I hadn’t put it together that it might be the fall.
My hands and wrists are how I do what I do as a surgical resident. I didn’t want to overreact to the discomfort because it seems reasonable that your wrists could hurt sometimes when you operate. Believing that it was my own lack of knowledge in the proper ways to hold my wrists during operations seemed like a reasonable place to lay initial blame. The alternative option of there being something really wrong with my wrists was not one that I wanted to entertain.
Four weeks later, my wrist was hurting more. Then around 2 am on December 30th, I awoke to a pop in my wrist that could only be described by the word F***. It even woke my husband, who was in a deep sleep next to me, and told him that my wrist just popped and it is throbbing like I have never experienced. Neither of us knew what to do with the information. I lay there unable to fall asleep for the rest of the night the pain was so intense. The throbbing made my pulse seem it was isolated to that one little spot on the top of my wrist. A spot of pain the size of my fingertip marked the start of a 3-year, eleven surgery ordeal.
Years ago in Germany, while playing soccer, my husband had fractured his lunate, a small bone in the wrist. He described to me how he had awoken with throbbing pain and struggled to even open the refrigerator door to get frozen peas to ice it after the injury. I was starting to get suspicious and worried that something may really be wrong. But was I being hypochondriacal? I spent the New Year’s Eve going back and forth in my mind on whether I should tell one of my hand surgery attendings about this or just wait? Back and forth, back and forth I went for a good part of the day. It was hard to focus on much else with the pain as well. Later that evening, I settled on asking for the trusted hand surgeon’s opinion. I pushed the send button, nervously. I instantly regretted the decision, convinced I was just being a weenie. It hurts, yes, but really, am I going to make a big deal about it by asking a hand surgeon? The thing with emails is that there are no takesies-backsies. It was done. I feared being branded that hypochondriacal surgical resident. I got a reply about thirty minutes later. There was no mention of my being a wimp. As with any other patient, my attending was supportive we came up with a plan to see what was going on.
As an aside, I appreciate what may seem like my hypocrisy and judgment for other patients, even those I have cared for. I worried about being seen as weak and pathetic for wanting to understand where my pain was coming from. The truth is that I do not at all see my own patients as weak for coming in because of pain or discomfort or concern. So, why the double standard when I am the potential patient? It took me a long time to fully understand the root cause of this fear. Turns out, I was and still am terrified of the loss of control over the situation. Calling myself weak for asking for help was my way of bullying myself into not losing control, or false, perceived control. We often have varying levels of controls over our illness, but the awareness that we could have no control can predominate. In my case I didn’t want to know if something was really wrong. All I wanted to hear was that it was going to be fine. The wrist pain needed to be insignificant. But, I wanted to let myself off the hook by convincing myself that I performed my due diligence at least by asking about it.
Things started out fairly smoothly with a wrist exam, some xray images of my wrists, and a splint for pain control and support. The wrist exam and images of my wrist did not seem very worrisome so we agreed to try the splint for a few weeks and reevaluate. Things were getting harder and harder to do at home alone. Previously simple tasks like opening a jar, using a can opener, pulling on the fridge door, holding a mug, and turning doorknobs was causing pain and popping.
My husband lived in Cambridge, MA during the week and was only at our house, 80 miles away, on weekend. He was finished his post-doctoral work at MIT and founding a new start-up company. There was little room for my injury in our busy lives. This is not at all to say that my husband was not fully supportive. Quite the contrary, I did not want my injury to be disruptive or for others to change their lives around it. It was much like talking about it will make it real, and I didn’t want it to be real.
Again, I was unsure if I should mention the pain with simple, daily activities or just hold off. We were only about ten days into our trial with the splint. I caved and emailed. My surgeon replied and he wanted to consider an MRI. This was becoming real. An injury to my dominant hand could potentially end my surgical career.
Ironically, as things would play out, I would end up battling serious injuries to both wrists. After twenty nights in a hospital, eleven surgeries, 56 weeks of casts, and 3 years of wrist splints and hand therapy, I would make my way back to surgery residency. This road was filled with fear, pain, doubt, support from loved ones, outstanding surgical care, and tears of sadness and joy. The medical informatics master’s was a lifeline for me during this time. It was far more than me supplementing my education and finding that voice for residents and surgeons in informatics. Graduate school became a place I could exert some control over what was happening to me.
The product of school is often a positive linear relationship. The more effort you put in the more benefit you reap. I desperately need something where I could apply my energy and get something predictable out. The outcome of my wrists seemed beyond my control. I felt helpless. As repairs failed because of my own genetics, it became harder to know where things were going to go. The master’s program was different; there I was Ruchi, surgical resident, medical informatics graduate student. All the other times, I was Ruchi, hand surgery patient with terrible wrist injuries. In my classes, I could forget how difficult things were. Outside of the bubble of graduate school, I struggled daily to get dressed, worried if I would even be able to open the door to my apartment building myself when returning from hand therapy, or how I would open those containers of food my husband prepared for lunch. My master’s was my escape.
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