Limping

It's been an eventful week. For starters, on Tuesday, Sam developed an atraumatic limp. By Thursday, the limp was worse and both my brain and stomach were churning (!sarcoma! !leukemia! !septic joint!) so we piled into urgent care where Sam limped obligingly up and down the clinic halls, giggling. The ped, thoughtful and thorough, sent us home with reassurance. But the next day his limp was worse yet, so back to urgent care we went. This time: plain films of the hips, knees, ankles and some basic blood work. All blessedly normal, and today the limp has more or less disappeared. I am relieved, but still a little rattled.

It's always interesting to me to be a patient -- or worse, a patient's mother. There's this out-of-body thing that happens: helpless, I watch myself morph into the kind of patient who drives me bonkers. I'm irrational, I cling to my own explanations, I demand needless intervention.

All very humbling.

Work has been less humbling. It's near the end of intern year, and I can feel myself starting to get cocky. After ten months as an intern, I can write an H&P in 20 minutes, I know where the radiologists hide in the middle of the night and I actually remember which carbapenam doesn't cover pseudomonas. I know how to distinguish between right and left atrial enlargement on an EKG, how to triage respiratory distress, how to perform a thoracentesis. I have the pager number for the on-call ICU fellow memorized. I even know where the obstetricians stash their free hot chocolate. I've got this down.

Anyway, I'm working this month on the private hospitalist service. The schedule is more or less the same as for the university wards -- Q4 overnight, roughly 80 hours/week -- but interns work directly with attendings. Some of the attendings are micro-managers and others don't seem to care at all what I do for our mutual patients so long as everyone's alive in the morning. Needless to say, the second type is my strong preference.

I was on call last night with an especially hands-off attending. We admitted a 56 year old woman who for the past four years has been inexplicably unable to walk. Apparently, four years ago, her legs developed intractable spasms and over time, she walked less and less until she became essentially immobile. Yesterday, her husband had finally had enough. He picked her up, carried her to the car and drove her to urgent care. From urgent care, they dispatched her immediately to the hospital for additional imaging of her brain and spinal cord. In fact, when I left this morning, she was in the MRI scanner. I'm not sure what's wrong with her, although the posibilities are numerous and interesting (multiple sclerosis, a severe B12 deficiency, syphillis, diseases that form benign CNS tumors like neurofibromatosis or tuberous sclerosis, probably several other things I haven't thought of), but what's really fascinating to me about this woman is her indifference to the problem. Apparently, years ago, she was a ballerina. But for the past four years, her legs just ... didn't work. And she did absoutely nothing about it. What does that mean?