The lingering hockey injury forced the science writer to reconsider his criticism of American medicine
I have always worked very hard on American medicine. I think that Americans are over-tested, over-diagnosed, and over-treated, because doctors and hospitals in our capitalist culture care more about profit than patients. In 2019, I touted the medical nihilism of philosopher Jacob Stegenga. Stegenga believes that most medical interventions are ineffective (if any), and many do more harm than good. Therefore, we should be more cautious in testing and treatment. Stegenga's diagnosis and prescription seemed wise to me.
But two episodes, one big and one small, forced me to reconsider my attack on drugs. First, I accuse its greedy and dishonest pharmaceutical industry for developing a safe and effective vaccine for COVID-19 at an unprecedented rate. When I got my second Moderna photo in March, I was extremely grateful. Then, on Memorial Day, my stupid right elbow underwent emergency surgery. This is the story of the latter episode.
Every winter for the past 25 years, I have played hockey on the frozen ponds in and around Cold Spring in New York. (That's why I called my old blog "Cross-Check".) Checking is not allowed, but sometimes we accidentally bump into each other. In addition, cracks and air pockets in the wild ice made us trip over. I wear a helmet, padded gloves and knee pads, but I don't wear elbow pads, despite repeated advice from my teammates. I almost never fell, and I assured my friends that the elbow pads made me very uncomfortable.
Last January, I fell and hit my right elbow so hard that my jersey bleeds. In late February, I was playing on a dangerous ice surface, still without elbow pads, I fell and hit the same elbow. After a week or two, the elbow was swollen and red. In mid-March, my attending doctor in Hoboken, New Jersey (where I live and work) said that I may have bursitis, bursitis, which is a fluid-filled bag that lubricates the joints.
My doctor referred me to a plastic surgeon in Hoboken, who I will call the first plastic surgeon. I met him on March 24th. After taking an X-ray, no fracture was found. He confirmed that I had bursitis. He drained my elbows, gave me cortisone injections, and advised me to apply ice to my elbows and wrap them with elastic bandages after exercise. My elbow felt and looked better for a few weeks, and then it swelled again. To my shock, my right armpit also bulged.
On April 21, I returned to the orthopedic surgeon No. 1 and he assured me that my elbow bursitis had nothing to do with the swelling of my right armpit, and there was a lymph gland under my right armpit. If the underarm swelling persists, he said, I should ask my attending doctor to check it; as for my inflamed elbow, the bursitis may go away on its own with further icing and compression, although it may take a while.
My girlfriend, a Manhattan snob, bothered me to get a second opinion from a doctor in New York. On May 10th, I saw the No. 2 orthopedic surgeon recommended by her doctor. Unlike orthopedic surgeon No. 1, orthopedic surgeon No. 2 believed that my armpit swelling was caused by an elbow infection. She recommends a bursectomy, which involves surgical removal of the bursa of the elbow.
Surgery! ! ? ? This is just a small collision! Not bigger than golf! I have never had an operation before, and I don't want to start now. Those friends who had undergone surgery due to sports injuries later became different, or so it seemed. I also don't believe in No. 2 orthopedic doctor. The surgeon always wants to cut us, right? Moreover, she does not accept insurance; I must first pay her the full service fee.
The next morning when I saw Number Two, I unwrapped the bandage she wrapped around my arm, and a hole in the tip of my elbow leaked out a turbid liquid. This is where Number Two punctured. This secretion is a mixture of pus, bursa fluid and blood, which is shocking and disgusting. But I used my left hand to squeeze more fluid from my right elbow, like a huge pimple, and the swelling and soreness subsided. My elbow feels much better.
Nevertheless, at the insistence of my girlfriend, in the following week, I saw three Manhattan experts: No. 3 orthopedist (recommended by a friend of my girlfriend); wound specialist (No. 3 recommended to Mine); and orthopedic doctor No. 4 (wound specialist referred me to him). No one likes the look of my elbow, it has a hole now; surgery is recommended. But they said I can treat bursitis with antibiotics, and if my elbow worsens, I can have surgery later. No. 3 orthopedic doctor asked me to take sulfamethoxazole/trimethoprim and cephalexin, which seemed to work, at least I convinced myself.
On May 29, after two days of fever, nausea, and pain, I was admitted to the emergency room of Hoboken University Medical Center under the urging of the attending physician. The blood test showed low white blood cell count and elevated liver enzymes; according to the emergency room doctor, these results, plus my fever and chills, were consistent with sepsis. She immediately asked me to inject antibiotics intravenously and checked me into a room.
I ended up staying in the hospital for four days, receiving intravenous antibiotics and numerous examinations. I saw six different doctors in total. My body temperature has never risen above 101, and tests have never found bacteria in my blood. But the plastic surgeon No. 5 in charge of my case said that I must have sepsis and need surgery. On Memorial Day, when I was under general anesthesia, he performed an operation on my elbow. He removed the bursa and surrounding tissues and scraped a bone spur from the tip of my elbow.
I left the hospital on June 1st with a 5-inch incision in my elbow, which was held together with about 40 metal nails. The doctors debated whether I should continue to inject antibiotics intravenously after I was discharged; that would require a port on my arm. In the end, to my relief, I took a powerful oral antibiotic, linezolid, for 12 days. The medicine cost me 840 dollars because the doctor who prescribed it did not notify my insurance company in advance, but I hope I can get reimbursed.
On June 12th, orthopedic surgeon No. 5 removed the nail on my arm, and soon I proudly showed my surgical scars to friends and family. So, what have I learned from this episode? It reminds me that medicine is difficult. Compared with the complex fractures and tendon tears that they often deal with, my problem is simple, "boring", as orthopedic doctors No. 4 and No. 5 said. However, there is still uncertainty in my elbow, leading different experts to come to different conclusions.
In retrospect, perhaps the orthopedic surgeon No. 1 should have realized that my elbow, considering the swelling of my right armpit, had been infected, or what No. 2 said. Orthopaedic surgeon No. 2 shouldn't poke my elbow so hard that my skin breaks, or what Doctor No. 3 said. According to the No. 5 orthopedic surgeon who performed the operation on me, the No. 1-4 orthopedic surgeon should order blood tests to check for infection, and the No. 2-4 orthopedic surgeon should work harder to get me to undergo the operation.
But No. 5 also blames me for hesitating for so long. I have asserted that Americans are over-tested, over-diagnosed, and over-treated. If anything, I have not been adequately tested, not fully diagnosed, and not fully treated, but this is largely my fault. I told all the doctors I saw in Manhattan that I wanted to avoid surgery, so they didn't push. They say that continuing to use antibiotics is an option, at least temporarily.
Another point: I accuse doctors of profit-oriented. If the orthopedic surgeon No. 1 is greedy, he will push for the operation, but he does not. The wound specialist spent half an hour carefully cleaning my wound and wrapped it in sterile gauze, and never even charged me or my insurance company.
Before I was hospitalized, none of the doctors I met was incompetent. There was no one at Hoboken University Medical Center, and I ended up undergoing surgery there. This hospital, which has recently undergone a change of ownership, has very bad online reviews. They reminded me of a recent article published by The New Yorker, "The Death of Hahnemann Hospital," which stated that healthcare companies are so keen to squeeze more profits from hospitals that they hurt patients.
But the care I get in the hospital is top-notch. Is it because I am a fully insured white man? Or because—I admit, I want special treatment—some of the caregivers I told me that I am a professor and reporter at a local university? maybe. These factors certainly do not hurt. In any case, the doctors and nurses in the hospital are capable and kind.
My ordeal forced me to admit the shortcomings of my distrust of experts. Once, when the gauze that the wound specialist put into my elbow wound came out in the shower, I actually considered repacking the wound myself. My inspiration came from a book I just read, "Innovative Delusions," which praises people who repair cars and computers by themselves instead of relying on experts. After watching a terrible YouTube video, I realized a man’s abdomen was bitten by a spider.
So, when should we doubt experts? When should we trust them? There is no foolproof formula, no algorithm can solve this problem for us. We must worry about the cases one by one, and never forget our own mistakes. In general, I support my criticisms of psychiatry, cancer medicine, and healthcare. The United States spends far more on health care per capita than any other country, but ranks lower than many countries on longevity and other health indicators. U.S. healthcare needs repair.
However, compared to before the pandemic and elbow problems, I now have more respect for medical experts. The next time three experts in a row tell me that I need surgery, I will have it. I also respect the wisdom of my ice hockey partners. When I go to the ice next winter, I will wear elbow pads.
This is an opinion and analysis article; the views expressed by the author or author are not necessarily those of Scientific American.
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John Horgan is the director of the Science Writing Center at Stevens Institute of Technology. His books include "The End of Science", "The End of War" and "Body and Mind Problems", which are available for free on mindbodyproblems.com. Over the years, he has written the popular blog Cross Check for Scientific American. Follow John Hogan on Twitter
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