87: Impatient Patient

Reluctantly, I went for a third opinion today on my foot. I saw Rock Positano, of the Hospital for Special Surgery. My runner friend recommended him highly, and another friend who works in the sports rehabilitation division of HSS seconded the strategy. Also, because I'm already a patient with this group, they'd have access to my X-rays from throughout the year.

Listen, I'm bumbling around, taking advice from people who mean well, and letting my ambition and optimism guide me; but I can also admit that my gut's been feeling like something major is wrong here, pretty much from the minute my foot started hurting. I haven't been satisfied by the answers my doctors and even the physical therapist have been giving me. The information I was getting was confusing and conflicting, and didn't really jive with the way my pain comes and goes. But I was doing my best, trying not to be too neurotic, and trying to defer to the "experts" I've encountered.

The reason to see Rock today was his reputation. He's on the board of the hospital, is known for good work, and treats athletic and non-athletic celebrities who are very demanding (Paul Giamatti's orthotics were on the counter waiting for pickup when I went to pay my bill). You might think it's silly to favor a doctor because he sees high profile clients; but having worked in the Hollywood milieu myself for a while, I can tell you, it's really agents and managers who are finding doctors like this for their clients and they are doing a ton of research to find the very best - their 10% depends on it! So if I trust a doctor with celebrity clientele, it's not that I trust celebrities... it's that I trust their greedy handlers.

Dr. Positano was able to fit me this afternoon and I spent the requisite first hour filing out more paperwork than I've ever filled out for any doctor in my life. Not so much medical information, but liability waivers. Clearly, this guy's been sued before! (No doubt by one of his litigious celebrity clients!) I joked as I handed the clipboard, thick with signed, initialed and dated "Patient Contracts," back to the receptionist, "I feel like I just closed on a house!" She smiled in a way that said, "We have the right to protect ourselves." In short, the paperwork said, Dr. Positano doesn't guarantee the quality of his work, or the outcome of recommended treatments, and he does not accept any form of insurance so don't even think about asking them to submit a stick of paper to anyone. I can't think of any other above-board American business where you have to sign away all your rights before you get any service, and basically pay cash!

When I finally met with Positano, he was extremely approachable, and calm. He took a half-glance at the MRI report I'd brought in and told me the facility where I'd had my MRI done is notably the worst facility in the city, and the report was incomprehensible - meaningless. He said he was going to have to send me for another one. He examined my foot, looked at my X-rays, asked a few questions, and then told me I needed an ultra-sound test. I've got bad swelling around the joint, and it probably is a torn capsule, but that wouldn't show on an MRI, and certainly not on the [piece of crap] MRI I'd gotten. But really, he didn't know what was going on; there wasn't enough information yet. It wasn't clear.

That's right. It isn't clear. That was the first time anybody in this process had told the truth. I began to feel like I could trust this doctor.

I'm now scheduled for an ultra-sound on Monday. Dr. Positano insisted I have it done with one particular doctor. I tried to push back - it's an ultra-sound, can't anyone do it? I wanted to have it done sooner, so I'd get results sooner, and be able to start rehabilitation sooner... He got very stern with me and said, "Are you going to do what I tell you to do? Hm? ...Tell me! I am sending you to a doctor who does a good job, and finds information that I need to make a plan for you. I like the way he does his reports. I don't want you to go to anyone else. Are you going to do what I say?"

He wasn't so much raising his voice as making intense eye contact. I felt about 7 years old. I had been trying to control the situation. I need to let him do his job.

I said yes, I would do exactly what he told me to do. "Are you going to?" he repeated and I was surprised. Maybe I hadn't sounded so convincing. Was I actually prepared to do what he told me to do? Or am I so convince that I always know what's best for me? Was I, even then, still considering going to my marathon training class that night? I realized in an instant that I had better change my tune and fast, because this doctor was offering to help me; and he knows what he's doing. He has the reputation he does because he's helped much more important athletes with much more complicated issues. I have every reason to trust him. Whatever is wrong, he is going to find out. I took a deep breath and I said, "Yes, I will do exactly what you tell me to." I think I sounded more convincing that time. He nodded and left the room.

Before he went, the doctor had wrapped my foot tightly in compression gauze. I'm to keep it like that all day and only take it off when I get into bed. I'm to ice it as often as possible, for 15-20 minutes at a time, on the top and bottom. No running at all. No biking at all. Swimming is OK if I promise not to push off the side. And I need better shoes - the expensive, ugly kind. (I ordered a pair of Finn sandals later when I got back to my office because he said I shouldn't even wear my sneakers with orthotics and I don't have anything flat to wear except ballet flats and flip flops, which have no support) And here was the kicker, I have to stop physical therapy for now; the doctor said what I've been doing may have been doing more damage than good. When we have more information, we'll determine whether physical therapy can help.

At some point during the visit, I asked Dr. Positano if I was going to be able to run the marathon and, it's the strangest thing, you know, I don't remember his answer.