SCFE, suicides, crisis and happy endings...

My last afternoon at work before I left for a couple of days (to do a Board exam) was kind of heavy. A young lady (pre-teen) came in for evaluation of hip pain and a limp. As she told me the story and I noted that she was obese, I was almost sure of the diagnosis before I asked her to get onto the examination table. As she was doing that, her mother told me that she had SCFE at about that age. I stopped in my tracks. That was the diagnosis I had in mind and was afraid I would find. SCFE stands for Slipped Capital Femoral Epiphysis. It is where the head of the femur (thigh bone) slips off its neck slightly. If not corrected, it can lead to hip dislocation, loss of the femural head (due to necrosis) and some pretty severe disability. Unfortunately, the only way to correct it is surgery. Pins are placed in the head of the femur connecting it to the neck (of the femur). On x-ray, SCFE looks like a scoop of ice-cream slipping off the cone (kind of appropriate image for summer time). I got the x-ray. The diagnosis was confirmed. Most 12-something year olds do not know what SCFE is. Unfortunately, this one did and immediately began to cry "I don't want pins!" Evidently, she had seen mom's scars and heard the stories. My heart went out to her.

Later that afternoon, I got to see an older girl -- a 3o-something. The appointment schedule said 'depression' and in dispassionate computer print on my screen told me I had 20 minutes. Needless to say, a box of tissues was involved, a pelvic exam and screening for sexually transmitted diseases and definitely more than 20 minutes were needed and spent.

At the end of the day, I get to take them all home. Not literally, of course. Nevertheless, they come home with me. It's Friday night -- a couple of days later, and 10:30 pm. I'm sitting in the dark in front of a computer screen writing this blog entry because I'm still thinking about them.

This afternoon while driving to the DMV to get my license updated, I saw a patient of mine walking in town. Just last week, this macho 50-something biker had sat in my office and bawled like a baby. About a year ago, he came in with back and leg pain. In the course of working this up, we diagnosed him with prostate cancer. He underwent a spiffy robotic surgical procedure to remove the cancer (and most of the prostate). Everything went well in that he has no cancer. The collateral damage is not so good. He lost the ability to have an erection. For a month, he was loaned a pump device that enabled him to get an erection. The pump had to be returned since it was a trial and he could not afford it. The reason he was crying in my office was that his fiance of 4 years was leaving him. There was some infidelity involved (it was not him) and she did not want to continue with someone who could not...well you know. He wanted to kill himself. He wished he had never had the surgery. Oh, and he still has leg pain. Ah, the wonders of modern medicine, no?

Okay. It's not all depressing. I don't know why, but the sad cases stay with me longer than the happy ones. Maybe it's my personality type. Maybe most people come to the doctor when something is wrong, not when things are going well.

It's summer time and was the last week of summer vacation (alas, for the school kids, not me). I've had a lot of kids in here for their sports physicals and 'back to school' exams. I enjoyed seeing lots of happy kids with stories of adventures and vacations during summer. Some have scars, scrapes, and tans to prove it too.

Several of my co-workers from my residency days have had babies and picked me to be their baby's doctor. I feel like a chosen godfather, an unofficial grandfather, a surrogate dad and big brother all in one. I've kept my professional demeanor (well, sort of) but I'd rather leap out of the white coat, hug them and then dance across the hall with their newborn craddled in my arms. Okay, so I can't do that on the outside. But hey, I'm dancing on the inside and no one can stop that. Of course, nervous nellie that I am, I examine these babies carefully. I listen to every historical detail the parents offer. I don't what to miss anything bad but I don't want to find anything bad either. Truth be told though, if there's something to be found or diagnosed or treated, I'd rather it be me doing that that someone else. That's why I do this. Those are my babies too!

Okay, good night!