8 AM. They were lined up at the door like shoppers eager to get in on a new sale at Target or Walmart. Only these customers are patients and instead of rushing the door when the office manager arrives it’s more like the parade of characters in Michael Jackson’s Thriller video. It’s not so much that they look like ghouls, goblins, and monsters. It was more the shuffling gait, the limping and dragging of one’s appendages that made it a bit surreal and a little scary. Not that I haven’t seen this cavalcade before; nearly 25 years of treating people injured at work just gives you thousands of chances to see the traumatic travails of the best people on the planet. Why the best? I’ve alluded to this before. These men and women build and maintain our cities, they make America run, and sometimes break their bones.
That was John’s problem. He crushed his thumb so severely that he may lose it ; it’s certainly pointing in the wrong direction . He told me as he walked by that he was in the military before and he knows it’s broken. I have to agree with him. “Oh, and thanks for serving”! They maintain or clean our offices while cutting themselves or falling down. That happened to Maria yesterday from a nearby hotel. She can barely move yet she has her English-speaking daughter with her to tell me that she has to go back to work tomorrow because her husband is gone and she has three other kids at home and bills to pay. I told her, “no te preocupas” we will find a way. I wonder if her husband is dead or has just deserted the family, something I see far too commonly.
They are out there welding but you can’t weld without burning skin or getting metal in your eye. That was José from a nearby steel company. Two minutes under the slit lamp exam and presto the metal is gone and I’m a superhero! I love fast medicine. Back in the suture room Rigoberto is laying on his side on the procedure table recumbent like a Rubens painting. The only difference being the exposed part of his ass is blackened and burned from an acetylene-tank that exploded next to him. His melted shirt is stuck to his skin and has to be removed “Al la chingada, that hurt”. More fast medicine but no superhero this time. I think he’s mad at me. I debrided most of the dead skin in one fell swoop. Interesting that his melted phone still rings. He can’t open it but it probably saved him from deeper burns. Large dressings will need to be applied daily.
How do you deliver thousands of cases of beer every day without hurting your back? That was Jesse from the state’s largest beer delivery company. These guys are supermen; as much as they hurt they almost never want to be taken off work. That would be acceptable except for the numbness in his toes. Oops, looks like a herniated disc. This could be a big problem. I may need to order an MRI and am hoping he does not need surgery. He’s just 26 with two young ones at home.
How do you place hot tar on a new road without burning your feet? That was Miguel’s dilemma. He’s diabetic and lost a lot of skin. He didn’t much care that he had two or three weeks of wound care in front of him, just whether he could go back to work tomorrow. “Sure, why not”. Cut away a bunch of dead, skin wrap it up and out the door. Tough hombre, or maybe he doesn’t feel his feet so well anymore because of the diabetes. I need to bring that up with his foreman.
Back to John, with the south pointing thumb. The finger looks really dusky which is to say poorly vascularized. The x-rays show the distal and proximate bones of the thumb are in multiple pieces. As luck would have it there is a great hand surgeon upstairs finishing a case and he takes him immediately for surgery. Got a call later that the thumb would survive and probably function adequately. Semper Fi Marine.
I run into heroes every day. Some are military, but unlike cops or firemen that get all the press most others are men and women quietly managing some of the toughest jobs dealing with the cards as they’re dealt. They bring home the bacon to their families and are the unsung heroes who have pride and a sense of honor in their work. They are the backbone of our increasingly more fragile nation.
Between treating the walking wounded I run into rooms to perform pre employment physicals . These are the moments when I actually see uninjured and generally healthy people who desperately want to start a job. I am not really their doctor at this moment but more like a gatekeeper for companies who are looking for physically qualified individuals. Conversations, though brief, usually go like this. “Jesus Christ are you pregnant? Where did that front end loader come from”? “ Well Dr. I’ve been off work and and gained a bit of weight”.’ A bit, how about 50 pounds of blubber! It’s 110° out there in the shade! I don’t think you’re going to make it. How bad will I feel if you have a heart attack your first week at work”.’ Doc, I need this job’. Now I have their attention. The next 10 minutes of the exam are about eating better, eating less, exercise, vitamins and the ergonomics of work. I’m sure they want to punch me in the nose and it’s been close. But I swear almost always when they leave I think I’ve made a new friend. If even one bit of advice I pounded in takes hold, they will be healthier and hopefully live longer.
When they return for re-certification physicals one or two years later my hopes are often exceeded. Most have made some positive changes. “Hey Doc I lost 20 lbs, I did what you said” while others have done remarkable things like quiting smoking! Yes I am hard on those guys. “You know your going to die 20 years sooner than the average person. What, you don’t want to see your kids graduate”? One guy lost a hundred pounds! It blew me away. I congratulate them and shake their hands. I hugged that last one because I didn’t want him to see me cry. Someone just had to give a damn and challenge people to improve their health. It does work. Most seem thankful and I feel like I’ve done my part. These daily encounters are why after nearly a quarter century I still love my work.
So… eat less, eat healthy, and exercise. Make the small changes and become a hero in your own life.