Sylvia's Journal

The long awaited appointments with the distinguished Boston orthopedic surgeons finally took place. Axel came along as note taker and concerned husband. We rehearsed our questions on our slow way into town. First stop was Mass General where we learned that the tendon (posterior tibial) displacement was obvious to the naked eye. How this was missed by doctor #1 when the cast went off over a year ago and in four subsequent visits with 6 week intervals since then is a mystery. But then again, all my visits to him were rather hurried and of the ‘one-minute-orthopedist’ kind.

We also learned that this condition is rare; the top doc told us he sees at most one such a case a year. It would be a very complicated and difficult operation, without any guarantee that he could actually put the tendon back where it belonged. It was entirely possible that the sheath that is supposed to hold the tendon in place could not be fixed to keep it there, especially after such a long time.

We asked our questions about the risks of the surgery and the risk of not doing anything. The answers left us hanging a bit as they contradicted each other: one the one hand, he told us, the tendon is not where it is supposed to be and could eventually tear or split. On the other hand, correcting this condition may not make things any better (considering how well I function with it) plus of course the risk of any surgical procedure such as infection or a blood clot. It is hard to improve on a 2 (i.e. pain level) he said. Still not knowing what to do but less inclined now towards an operation, we left to see our next second opinion.

We stopped at JP Licks in Jamaica Plain for coffee and to regroup. We reviewed the answers to our questions and articulated new questions that had arisen as a result. Although we had been given a considerable amount of time with the doctor, by the time new questions surface there are subtle hints that the consultation is over.

A little after noon we presented ourselves at Faulkner hospital for a fourth second opinion. First stop was a new X-ray – required for any new patient (the darn machines have to be paid for, no?), even though I was carrying a huge envelope with all sorts of pictures that were taken in July). Doc #4 referred to the operation as a heroic one which gave us pause. After seeing me walk with ease on tippy toes (‘you shouldn’t be able to do that’) he essentially counseled against a surgical intervention and proposed as an interim measure orthotics and a return visit with a scan to establish a baseline and follow me closely through twice yearly visits.

We left the building in the pouring rain with more clarity this time: no operation right now. What the consequences are of this decision in the long run is conjecture – no one knows. At least both doctors were honest with us that this was not an open-and-shut case and the economic incentives to cut do not seem to play at this level of the professional hierarchy. I asked what they’d recommend if I were their wife, sister or daughter and was given the diplomatic answer that this would make no difference (and received no recommendation). The question was suggested by my doctor-brother in Holland. These doctors apparently treat everyone alike, so they say.