An Injury Repaired

Part One
I saw a sports medicine doctor on Tuesday. His confidence at dealing with this issue was, at first, inspiring. I thought, 'this guy knows what's going on'. Of course, what this is leading to is my complete failure to believe or trust in him, beyond even the level of lack of trust that he deserves, and it's hard to say when this started to happen during the appointment. One point was when I told him I was considering spending the summer mountaineering in the Tetons rather than climbing, to give my finger a rest, and he said, "Oh, yeah, you can boulder up those hills all you want. That will be fine for your finger." For those of you that don't know, that is egregious climbing language.
He said it with the same confidence that he said everything else. Then I realized that when I had, earlier, told him I had hurt my finger bouldering, he thought that that meant that I was walking on talus or something ( -? still kind of mystery to me).
"Well, I mean, you weren't toproping, so I'm kind of surprised that you got that bad an injury." To be clear, I believe he was saying that toproping is significantly more risk-fraught than bouldering, in terms of potential injury. For the non-climbers, this is absurd to the point of hilarity (except he was a doctor trying to treat me, and was speaking in all seriousness, affecting more knowledge than he had, which is the opposite of helpful or inspiring, but more like terrifying, disheartening, and particularly scary for me, a future doctor, who wants to actually inspire, educate, and have humility, and maybe I'll end up like this guy, who is talking out his ass and being unintentionally disrespectful).
There were a number of other things that happened. It could also have been when he walked into the room, and he scowled at me immediately. Unintentional, sure, but he's either really pissed, was trying to affect some look other than 1)what he was actually feeling - fear? doubt? sadness? exhaustion? and 2) the look he ended up having, i.e.: pissed.
A little background: I have been taking prednisone for several months. Not high doses for the last three, but high doses before that. It makes tendons more prone to rupture. It makes some sense that I would have sustained a more serious injury than I have before after taking this drug for so long. On the other hand, I have experienced very few/no side effects of prednisone since I switched to the lower dose (and very little when I was on the higher dose), and I am climbing significantly harder stuff than I, really, ever have before. So the level of climbing I am doing may alone account for the injury.
"Prednisone pre-disposed you to this injury, and will make your recovery difficult. That said, you are taking prednisone for your kidneys, and they are more important than your sport, whatever your sport is."
So suddenly, he's telling me that because I have a kidney disease that has required prednisone, that this has caused my injury, and that climbing is probably not something I can do as long as I have this disease (which could be for the rest of my life). Now to me, the kidney disease just about took my entire life and psyche apart during fall term last year, and I had to fight really hard to pull myself together enough to be able to keep studying, keep learning, keep fighting. What I really don't want is for the disease to have also taken my passion from me.
He also said it with a stern attitude, like, 'c'mon, what the hell is the matter with you?'
That typical American arrogance about people who injure themselves doing something other than sitting on the couch and eating cheetos (which is the American way)(1).
Then he starts using vague language concerning the tendons and ligaments in my fingers "the sheath... the tendon... muscles come in here". This was after I discussed why I thought it might be A4, not A2, not a cruciate, incidence of injury of A4 in climbers, etc. The impression I was getting, I realized later, was he knew less than he was letting on. Let me be clear, that, at the time, I was not forming any of these judgments, that my esteem for him was basically static. One thing he said didn't make sense, even at the time.
He had told me that I should do nothing with my finger except RICE for at least 6 weeks. I asked,
"So I've been doing some reading, and a number of anecdotal accounts have said that people are responding better to starting putting some weight on the finger, using an open-handed grip, not after six weeks, but sooner, soon after the swelling goes down, which 1)keeps the person from losing the fitness they have, 2)actually encourages recovery of the ligament/tendon." (not that eloquently, for sure, but that was what I hope he heard as the gist)
So he says, "No, look, you're on prednisone, and that just isn't going to work. You have to stop climbing for a long time". This bothered me, in terms of logic.
"Okay, so pred slows down the recovery process, but shouldn't the principle remain the same? Start working with the injury in ways that use the joint, but don't exacerbate the injury further? I mean, it may just take longer for me to heal than others, because I'm on this drug for this nightmarish kidney thing, but that doesn't mean that the principle doesn't hold true".
"I would agree with you, but you are on prednisone. You need to stop climbing for six weeks".
...
He made no diagnosis, as far as I could tell, unless you count scowling at my guess at what was going on.
So there could be something there that I just don't get. That the recovery and regeneration process is somehow fundamentally different in people who are taking prednisone than in people who are not. But I don't think so. I think it's probably a prolongation. What he said sounds like horseshit, and like he wasn't listening, and was just posturing.
Basically, what he was doing, was hedging his bets. The more I think about it, the more it feels like: he did not know the anatomy very well, had no idea of the circumstances of my injury, little understanding of the injury itself, had little to no regard for me as a person, and didn't know what to do. So he said that I had to stop climbing for a really long time, maybe longer, and let my body heal. This implicit message here is that if I get hurt again, it's because I have not waited long enough, and I am stupid. That really, this is because I was stupid in the first place, and I should know better than to think my 'sport' is worth that much. He's hoping that, whatever it is, and he has no idea what it is, it will heal itself if I do absolutely nothing with it for the next six weeks, and hoping that I will get the impression that I am solely to blame for any complications that may occur later, because then I would have started climbing too soon, and 'didn't listen or respect my doctor's orders'. Maybe even that I have no self control.
That's the safe thing for the doctor to do, and what my previous nephrologist did when I expressed to him that I had concerns that he was not communicating in a way that I felt was respectful: "Well if you weren't eating so much protein, your kidneys would be fine by now".
Jesus that hurt, and, it turns out, was pretty cavalier in that you can't exactly do forensic cause and effect here (and more than unfair, because he never mentioned anything about that in any of our previous meetings). The point being that both doctors can't fix (or understand) what is happening, so they shift the blame to me to feel safer.

Part Two
Before I went to the appointment with the sports med doctor, I also made an appointment with an orthopedist. I went to that one yesterday. I have to preface this by saying that I have always disliked/hated all of the orthopedists I've had before. They say all the worst stuff, eg: Dr. W. in Maryland told me of a catastrophic bilateral groin tear from running that kept me up at night, and made it painful for me to walk for almost a year, "It doesn't show up on the CT. Are you sure you have pain? I think you just need to toughen up. Look, sometimes we feel pain, and we just have to ignore it. Sports can be really hard, but you need to learn the difference between sore muscles and injury".
And like I said in the last post, "Don't worry about your tendonitis - you won't be able to climb once you are in medical school, and it will go away on its own".

So I pretty much go into an orthopedic surgeon's office with a hell of a lot of prejudice, defenses up, even defensive scorn, before I've even met the person. This is clearly unfair, but there you have it. Contrast this with how I feel about sports medicine (which is a branch of family medicine, where I imagine I will practice), which is pretty positive.

This doctor, a different Dr. W., was unbelievable. I can't say this with enough emphasis, I was truly surprised. She didn't solve all my problems right away, and she didn't know all the answers. She did, however, 1)do her best, 2)was open to communication from me - she actually listened!, 3)told me when she didn't know something, 4)only said things that she actually knew, 5)generally, was just really friendly, and straight with me.
No affectations, no BS, just courtesy, humility, respect, and authority. Maybe she was unusually on her game yesterday, but I feel that I now have a medical interview and perhaps mode of practice, to aspire to.
She did a history, and I told her the same stuff as the other doctor. She did a physical exam, but checked my flexor tendons, in addition to the pulley system. She found all my pulleys working fine, but that my flexor digitorum superficialis was not functioning at the middle finger.
"Holy crap!" I said. This is pretty troubling, said one part of my brain, which knows that the only reason the fingers flex (ie grip) is because they are attached to two main muscles (flexor digitorum superficialis, and flexor digitorum profundus - so you really don't want to remove their attachments from the fingers), but another part of my brain went, wow, damn the consequences of this injury, I am really impressed with this doctor, and, this, combined with the fact that she exhibited all of the things I listed above, put me in a place where I was completely confident that I was in good hands, and would recover from this injury as well as is possible (at least, for someone at my socioeconomic level, which is acceptable). That is, I felt great trust.
She said that I may have avulsed my flexor digitorum superficialis from my middle finger when I was bouldering (pretty crazy injury for sure), or I may have a pulley injury, and she didn't know which from physical exam. It could be something else. Depending on the injury, it may require immediate surgery if I wanted to retain function in my hand. Although, it is more likely that the MR will just tell us what is going on for sure, and will help us plan recovery. So she helped me schedule an MR (well, the ladies at the front desk did, and then really helped my out by going to extra mile and calling me later with an earlier appointment that was much more convenient to attend (630 am Monday before class at 8am vs. last night at 6:15) and she is going to get back to me on Monday and tell me whether I need to have surgery this coming week.
I know I should be nervous about that, but I'm really not so much. I've dealt with worse, I guess. The troubling thing is that I may never climb hard again. The impression I'm getting here is that that may happen, but I think I can deal because I will have done everything I can. In the end, that's all we can do.
I love the idea that she took this seriously, that I have a pretty good shot of getting a diagnosis, and that she will know what to do about it, and do it.
I think my favorite thing came up about halfway through the interview. She said that she had the same concerns about prednisone, that it predisposes me to injuries like this. I said, "That puts me in a psychologically challenging position, because I feel that climbing is tied intrinsically to my identity."
She said, "Well, that makes sense (2), and I think you could maybe talk to your nephrologist about other treatment options. If there are no alternatives in terms of your kidney health, then you might have to get kind of creative to make sure you can still climb".
Hopefully I'll know on Monday what's happening. In the mean time, I have to get back to studying pharmacology and pathology, and frantically flinging myself up moving stairs.

(1) By this I mean, Americans are intolerant and judgmental of people doing activities that are perceived as high risk, like snowmobiling (a relative of mine called someone an "idiot" who was in a snowmobile accident. Dammit, I mean, at least the guy isn't sitting on the couch growing a third chin - he's actually out there doing something he loves - really going after it. I'm not much of a 2-cycle engine sport kind of guy - more of a 'fly by means of your own power' sort of person - but still). So someone gets hurt doing something like snowmobiling, base jumping, downhill skiing, climbing, and they are an "idiot". "It is their own damn fault". The conversation might go. But who's saying this? Go ahead and promote your waist size with a few more Big Macs, and use your evenings to watch sitcoms; your priorities are clearly better sorted out than mine.
And this tone, from a sports medicine doctor, no less, is exactly what I got.
(2) I've said stuff like this fairly often to doctors, and never once have they said it made sense. I mention that I am a climber, and people say, "Ooh that's nice". Most people see it as a "sport" at best, a "stupid" thing to do, a "fun little hobby", or some such. They want me to stop, and think that I would be way better off not doing it. What they don't realize is that if I stopped, my life might be a lot like theirs, and from where I am sitting, that looks pretty bleak.
That she was so bold as to validate my statement of identity tied to something that most people, maybe even she, believe is a pretty stupid, fanciful, or trivial thing, was pretty amazing.