Category Archives: Self-Referential

self-indulgent, self-aggrandizing, self-explanatory, self, self, self, …

Evidence Of Bipedality Discovered In Northern Illinois

Unretouched photograph taken during witnessed performance of bipedalism

Live Demonstration Met With Astonishment

Following the completion of today’s physical therapy session, DrHGuy, fulfilling his father’s oft expressed wish, is standing on his own two feet, his right leg now fully authorized to bear any load not exceeding one-half his body weight.1

To cries of delight from his offspring,2 DrHGuy has – within a single 10 minute period – stood on both feet without assistance of any sort, walked with only moderate support from the walker, and, as prescribed by the perpetually perky Physical Therapist,3 lifted his body toward the heavens by rising on the balls of his feet – not once, not twice, but a total of two sets of ten reps.

Implications

Since shuffling along behind a walker is markedly less onerous and significantly less disruptive to others than hopping madly about on one leg while using the walker as a portable set of parallel bars, DrHGuy is optimistic about the prospect of launching significantly more self-propelled expeditions, especially now that this advancement in locomotive mechanisms has obviated the need for the obsessive internal debate justifying the necessity of the trip and the extensive D-Day level logistical preparations that have marked each such journey over the past two months. He is especially excited about treks to the mens’ room, confident that journey’s end will find him assuming his proper place vis-a-vis the facilities.

And, of course, today’s steps bring DrHGuy within 3-4 weeks of the ultimate goal – mankind’s dream of unassisted solo ambulation.

  1. Readers unaware of the events that led to DrHGuy’s need for physical therapy and his limited use of his right leg may wish to review these previous posts: Sick Call II, Sick Call III, Awaiting Weight-bearing – Still and Walkernastics []
  2. The referenced cheers may, admittedly, have been triggered not only by the Prodigal’s and the Mesomorph’s love and admiration of their paterfamilias but also by their anticipation of a diminishing role as papa’s surrogate legs []
  3. DrHGuy acknowledges that “perpetually perky Physical Therapist,” applied to female Physical Therapists at least, may be considered by some a redundancy []

Awaiting Weight-bearing – Still

Medical Status Report

This past week, I made my way to an appointment with my orthopedic surgeon in follow-up to my July 27th hip-pinning,1 all the while nurturing hopes that I would forthwith be exchanging my walker for a cane – a switch which would signal a quantum leap2 along the path to full ambulation and, more to the point, represent a dramatic improvement for DrHGuy in the area of fashion accessories.

Well, it turns out that forthwith falls especially late this year. One can imagine my disappointment when the surgeon opted for conservative management, decreeing that the much desired transition from walker to cane would not take place for at least another month.

In hopes of accelerating my progress, I will begin Physical Therapy next week with the attenuated incentive that, should all go well, my right leg will be able to handle “touchdown weight”3 shortly thereafter. Regrettably, anticipation of that milestone does not set my heart aflutter.

Beyond Walkernastics

For now, however, I have been – emphatically and repeatedly – instructed to continue to avoid using my right hip to bear any weight. While I am a tad dejected by the medical mandate, this turn of events has at least led me to extend my repertoire of walker-assisted activities beyond Walkernastics .

Because dance has always held a certain appeal, I explored the possibilities in this discipline, but the obvious choices – the tango, clogging, and the polka – proved unworkable because of the restriction against weight-bearing on my right leg. And, while it is hardly surprising to learn that something called “The Two-Step” includes movements beyond the capacity of the walking (on one leg) wounded, even the Bunny Hop, one finds, requires a different sort of hopping than the type I’ve been executing behind my walker for the past few weeks.

Happily, I discovered that many passages in the Alvin Ailey style are walker-friendly, and intricate routines in this genre can be choreographed that do not demand weight-bearing by the right leg. An example from a quotidian daily workout is pictured below:

  1. My hip fracture, the gory details of the hip repair, and the aftermath are reported in Sick Call II, Sick Call III, Pimp My Assistive Device, and walkernastics []
  2. Ah, I recall with great fondness, a time when I could actually consummate leaps, even sometimes pairing them with bounds []
  3. “Touchdown weight” is approximately 10% of ones body weight. “Touchdown weight” should not be confused with “Touchdown wait,” which was the three and one-half quarters we typically had to wait for the University of Missouri football team to score their first touchdown. []

OK, Call This One – An Appreciation Of Nursing

The Emergency Room In July – Fear And Trembling

According to a cynical aphorism,

If God loves you, you won’t be admitted to a teaching hospital in July

As tends to be the case with cynical aphorisms, underlying the bitterly sardonic veneer of this expression is a fundamental truth – about the hopelessness of the human condition.

In this instance, the verity referenced is the fact that in July a high proportion of a teaching hospital’s front line medical staff is composed of new trainees. More poignantly put, if you come to such an institution for healthcare in July, the young whippersnapper who was yesterday a mediocre medical student requiring constant supervision lest he rip out another spleen by tugging on the retractors with too much force is today – ta da – magically transformed into your doctor.1

And so it was that on a particularly nice July day a few years ago, DrHGuy, who had, in fact, legitimately garnered the “Dr” portion of “DrHGuy” only two weeks earlier, arrived for his first shift at the Emergency Room of the medical center where his residency – his psychiatric residency – was located.

And, it was only a short time later that same day when the medical responsibility for the care of a thin, black teenage boy, who had apparently gotten on God’s bad side, settled on the shoulders of this newly minted physician.

Rural Missouri As Preparation For The Baddest Part Of Town

Let us pause the narrative at this point to reflect upon DrHGuy’s training at the University of Missouri Medical Center, a tertiary care center with a busy emergency department that drew patients from a large geographic area. Consequently, medical students and residents were exposed to many cases of acute illness and trauma, a significant portion of which were either unusual or dramatic in presentation. Had, for example, a denizen of Chicago’s south side entered DrHGuy’s ER that day in July as a consequence of coming in second best in a confrontation with a rogue combine, that would have been one lucky patient because he would have been under the care of a resident with experience in exactly that kind of accident.

On the other hand, one might be surprised to discover how just how few thin, black teenagers in respiratory distress had in those days found their way to to that facility in the mid-Midwest where DrHGuy had, until his arrival that day at his residency, undergone the entirety of his medical training.2

Back to our story.

DrHGuy and Patient Enter Dire Straits

DrHGuy’s reaction to the 16 year old black male, who was unable to talk because of his desperate wheezing, was not, as one might anticipate, the stunned aspect and disabled thinking attributed to the fabled deer-in-the-headlights. The pertinent metaphorical animal was not the deer but the zebra, as in the hoary medical catchphrase, When you hear hoofbeats, think horses, not zebras.3

The encounter with this patient, in fact, resulted in DrHGuy trying to control a stampede of zebras in the form of possible but unlikely diagnoses, including, among others,

  • Vocal cord dysfunction
  • Chronic obstructive pulmonary disease
  • Bronchitis
  • Bonchiectasis
  • Endobronchial diseases and tumors (primary and metastatic)
  • Aspirated foreign body
  • Extra-or intra-thoracic tracheal obstruction
  • Cardiogenic and non-cardiogenic pulmonary edema
  • Pneumonia
  • Pulmonary emboli
  • Chemical pneumonitis
  • Hyperventilation syndrome
  • Carcinoid syndrome
  • Fungal infections
  • Congestive heart failure
  • Psychogenic dyspnea
  • Mitral stenosis

And, of course, atrial myxoma.

Cue The Cavalry

Just then, the nurse, encumbered with a variety of medications and all manner of associated accoutrement, addressed DrHGuy, whose differential diagnoses list was eclipsed only by the compilation of diagnostic tests he intended to order, uttering, in a skillfully modulated voice that expressed experience with, respect for, and, above all, absolute confidence in that nascent physician’s professional expertise, those five words that proved so glorious and life-changing that he’s never forgotten them:

The usual asthma setup, Doctor?

DrHGuy, happily, had enough of his wits about him to recognize the correct diagnosis when he heard it and to reply “Yes, thank you, nurse.”

Most importantly, he managed to (1) forgo automatically appending to his response any phrase along the lines of “… and make it snappy” and (2) express his appreciation to that nurse without a concomitant attempt to deny the plight from which he and the patient were simultaneously rescued.

DrHGuy has a thing for nurses.


  1. A lingering, unreciprocated loyalty to science compels me to note that while the results of some studies, such as Specialty differences in the ‘July Phenomenon’ for Twin Cities teaching hospitals, have been consistent with this concept of a “July Phenomenon,” others, including the especially extensive (“Retrospective cohort analysis of 156,136 consecutive eligible patients admitted to 38 ICUs in 28 hospitals in Northeast Ohio from 1991 to 1997″) Is There a July Phenomenon?, have found no evidence of its existence []
  2. Perhaps more to the point, the total number of young black males in respiratory distress DrHGuy had seen at that point – including the ER patient just described – was precisely one. []
  3. This saying, sometimes phrased “When you hear hoofbeats behind you, don’t expect to see a zebra,” has enshrined “zebra” as the preferred slang medical term for an obscure and unlikely diagnosis from ordinary symptoms. []

An Homage To Nursing

DrHGuy Meets The Director Of Nursing

The Director of Nursing at the Medical Center where DrHGuy served his residency once remarked to him that during her own training at that same institution, her nursing class was taught to stand respectfully when a doctor entered the nursing station and to serve properly chilled orange juice to physicians.

The Director of Nursing did not, it should be noted, relate this anecdote in the spirit of those were the good old days and, in fact, appeared to regard those experiences with more than a modicum of distaste. During the pause that followed her comments, DrHGuy, who, as a result of attending a minimum of three fundamentalist church services a week throughout childhood and adolescence, was familiar with the purpose of parables, asked the Director of Nursing if she would care for an Orange Crush (no juice then being available).

Fortune (and, more to the point, The Director of Nursing) smiled upon DrHGuy through the remainder of his training and his first years on the attending staff of that hospital.

Walkernastics – The Walker Dismount

Rehab Report

After reading the posts about my femoral neck fracture, subsequent hip pinning, and post-op orders to use a walker to avoid weight-bearing on the pinned hip,1 SportsBizPro, groom elect of Very Very Good Girl,2 emailed this recommendation, “Please make sure to get a few ‘action shots’ of you walking around and post them!”

Now, one can hardly begrudge the inherent psychological drive of the young, hale, and hearty to point out and comment on the physiological deterioration of their elders. Ridiculing photos of the impaired is, after all, at least somewhat more sublimated than shoving the old folks onto ice floes.

Still, because I found it difficult to believe a photo of me as walker-gimp would appeal to viewers other than (1) ungrateful whippersnappers all too eager to replace the Boomer generation who currently (and rightfully) run things and (2) individuals with a strong skew toward the sadistic, I deferred any action on that idea.

Since that original suggestion, however, I’ve received enough similar requests that, in acquiescence to the wishes of the Heck of a Guy audience and without passing judgment on the possible motivations – regardless of how sinister and perverse those may be, I offer this shot of me on my assigned apparatus, the pommel walker.

I apologize for the low level of expertise demonstrated. Snapping the shot by first setting the camera’s self-timer and then trying to be in the requested action pose when the shutter fired complicated the procedure to the point that I had little choice other than the simple loop dismount shown here. Despite several attempts, for example, I could never get the timing right for a photo of the handstands, and, as for those Russian Wendeswings, well, a picture of those would have just been grandstanding.

  1. See Sick Call Summary and Pimp My Assistive Device []
  2. The betrothal of these youngsters was the subject of I Knew The Bride When She Used To Rock and Roll – Heck, I Knew The Bride When She Sang Her ABCs. These hip and trendy kids even have their own SportsBizPro & Very Very Good Girl wedding web site that is a quantum leap or two up the quality scale compared to most such efforts I’ve seen. []

Sick Call III

The Long Version

The Diagnosis

After two or three weeks of Physical Therapy for a vacation injury initially diagnosed as an adductor strain (aka groin pull), treatment with which DrHGuy was, of course, fully compliant, brought about no symptomatic improvement, a second appointment with the primary physician seemed prudent.

This clinical visit occasioned an x-ray to rule out a hip fracture prior to an anticipated referral to an orthopedic/sports specialist. It required, however, only one glance at the completed X-ray to transform the rule-out into a confirmed diagnosis.

The Treatment – AKA “A Chance To Cut Is A Chance To Cure”

A few minutes after the hip x-ray viewing, the Mesomorph was chauffeuring DrHGuy to the hospital with a referral to an orthopedic surgeon. Quick as a wink,1 DrHGuy was domiciled in a room, ownership of impressive quantities of his bodily fluids transferred to a variety of laboratories, and his signature affixed to multiple pieces of paper which must be read by someone someplace sometime.

Most significantly, he and the surgeon completed a physical examination, review of labs, and a diagnostic interview notable for featuring the refrain “And you continued X’ing (where “X” walk, exercise, riding the recumbent bike, …) on that leg with the broken hip for how many weeks?” as a Greek chorus. Numerous staff seized upon the subsequent opportunity to offer comments to DrHGuy along the lines of “Well, I’ve never seen an order for “Strict Bed Rest” with seventeen underlines and 8 exclamation marks. See that, where the Dr’s pen has ripped through the paper?”

In any case, the expected clinical intervention, surgery to pin the fractured bones, was indeed recommended, and DrHGuy awaited his fate, as ordered, abed.

DrHGuy’s Hospital Wish List

In reconnoitering the scene from his semi-recumbent position, DrHGuy discovered that while the hospital was, in many respects, a fine and dandy place, Internet access is not one of their patient services.

DrHGuy, being email-dependent, was bummed.

Said hospital could also use a spin doctor among its medical specialties. DrHGuy’s first regular meal was this no doubt nutritious nursing home cliché.

Yep, stewed prunes, green gelatin, soggy spinach, stuffing, generic tea, and the other white meat.

Yum.

DrHGuy’s Op and Post-Op Report

Thanks to a some fortuitous cancellations on the O.R. schedule, DrHGuy’s hip pinning became a late morning matinée rather than a special midnight feature.

The Operation
After a couple of whiffs from a mask, DrHGuy found himself gazing at the walls of a recovery room cubicle, his hip well on the road to recovery.

The Post-Op Hospital Stay
The remainder of Friday was a trip to the spa. From that point on, for example, no knives violated DrHGuy’s integumentary integrity, no metallic rods were hammered into the shafts of any of his bones, and no paralyzing chemicals were were introduced into his central nervous system.

And, the dinner delivered that evening not only corresponded to the dinner ordered (roasted chicken) but was both aesthetically pleasing and tasty.

Nor were luxuries withheld. DrHGuy was not, for example, required to make that annoying jaunt to the bathroom; instead, such bodily necessities were executed without leaving the bed with implements emptied by a grateful and worshipful staff.

Why? Because.

The day after the operation, DrHGuy passed along the news to his mother, who had undergone the same procedure a few years previous. Her question had to do with why the hip fracture occurred, a fine query given that there was no traumatic event, and DrHGuy is far, far younger than the modal hip fracture patient.

Well, none of the possible reasons are happy ones. The smart money (i.e., the surgeon’s) is on a lifetime of hypothyroidism leading to osteoporosis, but that’s only a guess, That diagnostic conundrum is DrHGuy’s next medical adventure.

Although DrHGuy’s preference is focusing his worries on long-term, catastrophic problems, just now he is most concerned about how he is going to take a shower with his walker and the lump of dough into which he will transform now that he’s restricted from exercising for 4-6 weeks.

Given that DrHGuy is forbidden to exercise – and he asked about every option in every way until the folks in charge began giving off signals of being miffed – becoming a lump of dough is a given. Diet remains, at least theoretically, under DrHGuy’s control so just how huge a lump of dough he is to become is unknown.

Regardless, underlying disease will just have to wait a bit until DrHGuy can free up enough angst to properly address it.

The Final Discharge Criterion

The final step to discharge was the requirement that DrHGuy demonstrate to Physical Therapy2 that he was capable of locomotion without re-injuring the fracture.

And thus it was that yet another narcissistic defense bit the dust when the young, vivacious Physical Therapist stuck with Saturday inpatient duty suggested that a walker might prove easier to use and more efficient than crutches.

Being of the manly man persuasion, DrHGuy informed the young lady that he would indeed keep an open mind toward both methodologies but frankly saw himself more the injured jock on crutches than the crazy old codger with the walker adorned with a macramé pouch dangling from the crossbar.

That notion persisted for perhaps 3 nanoseconds, which is coincidentally the length of time required to make the preparatory move preceding the preferred swing-through crutch maneuver.

DrHGuy is now aiming toward a less athletic, more dignified man of a certain age image – think Maurice Chevalier with a limp – and a walker.

Walking In the Sunshine, sing a little sunshine song
Put a smile upon your face as if there’s nothing wrong
Think about a good time had a long time ago
Think about forgetting about your worries and your woes
Walking In The Sunshine, sing a little sunshine song3

  1. 1 Healthcare System Wink = 8.5 Earth Hours []
  2. Astute readers will note the ironic symmetry PT provides for this tale []
  3. From Walking In The Sunshine by Roger Miller []