Saturday, October 10, 2009

Writing About ......... Headaches

A week has already gone by, since the last blog entry. It has been four weeks since I broke my face in three places. I have been back to work for about three weeks. I can wear long pants now, since the wounds on my legs are closed and just scared now. I have a big scar on my forehead that actually is not totally healed yet. I still can't chew food on the left side of my mouth, as the pain in an upper tooth is excruciating, radiating up into my head.

When you fracture your maxilla bone, the one in your face below your eye, there is a branch of a nerve, your fifth cranial or trigeminal nerve, and a side-branch (inferior orbital) that comes through that bone and inervates or provides sensory to a part of your face and upper mouth. That may be causing part of the problem. When the bone is broken the nerve is traumatized. If the nerve is not severed, (no way to know for sure), the feeling should return and numbness should resolve in about 6 months. It is strange become my upper teeth feel like a dentist’s Novocain, yet it also hurts.

The worst part is I have been getting headaches, in my right temple and forehead. It is only four weeks, since the fracture, and the bones should heavily be into healing right now.

This is the toughest part, you look sort of healed and you are back at work, and all the actual injury stuff is over and you are supposed to be normal, except you have headaches and you can’t chew. Yet with the exception of obvious scars, you are supposed to be normal and better, even though things are not the same and I have lousy headaches.

The process is exactly like grief. When all the excitement of a wake and early days following a death or loss, there is lots of diversion and activity. Then it all stops and you are supposed to go on.

With my injury there were lots of doctor appointments, and my face looked like hell. Now the doctor appointments are less and less, and more and more of "well its going to take a really long time" to heal. You have to go back to life and keep going. Just like grief. You know things will never be exactly the same and you wonder if the pain will ever stop.

Daily life pressure ensues. If I do not go to work every day, I can not pay the heat bill, (it snowed in Duluth last night), I can not pay the mortgage and I can't afford to get the snow tires on.

I know it is taboo for a doctor to even discuss paying the bills. The indignance this provokes in most people is so prominent, if you even go near the subject. We collectively embrace a "romantic prejudice" about "rich" doctors.

Being that I am a private practice psychiatrist, I have no grants or funding to cover things. A private disability insurance policy is a bigger joke than the cost of health insurance. So that does not exist for me. Yes I suppose there are some doctors in certain specialties that can afford to take a month or two off or three, but maybe not so many anymore. But I won't complain too much about that pressure, because it inflames people and promotes indignant feelings and bias and stereotypical prejudice against the profession, so I am not allowed, so I won't complain or even try to make people understand. I am not allowed to complain about that.

Moreover, since I am in a private practice, my patients depend on me to be there. If they can't come to see me, it is pretty hard to go and get another psychiatrist in these parts; you have to wait months and years. My patients depend on me to be there, so I will be there for them. In psychiatry, if you are doing a good job, it is about the relationship, the therapeutic alliance. You don't just go to a doctor and form one, it is like any relationship in that it takes time to form a trust and alliance and understanding. Any good doctor knows you give 100% every day, headaches or no headaches. It is expected and anything less than 100% to every patient is not adequate.

The system in my state and many places around the country is really set up to drive doctors out of private and small practices, there is a reason I am the only remaining private practice psychiatrist in this NE region of Minnesota. There is a reason there are few young doctors choosing the specialty of psychiatry, less than ever. There is also a reason people wait a really long time to get to see a psychiatrist. Yet I remain committed to the value and ideal of choice and a private practice, as it turns out many patients do to. I will do that for as long as I can.

The other part is I remain committed to access to care, it is a constant flux of new patients, and I am also constantly working with new people attempting to build an alliance. It is not just about the meds, remember if a person does not trust their doctor, the treatments are not very trusted and usually don't work as well without a reasonable therapeutic alliance.

Unfortunately we are a society based on mistrust more than ever. The virtual and technological world we now live in breeds mistrust. It breeds more of immediacy and an instant need for gratification and an entitlement. “I want it and I want it now”. “You better fix me now or else”.

We are more wounded and traumatized as people and a society and more impersonal than ever. Try to tell anyone under thirty that social networking is still virtual and not the same as real human interaction and you will get a profound emotional tirade.

We still need human connection in our lives, our families, our professions, our communities. The human connection between a doctor and a patient has been crucial since the beginning of time, yet there is not too much rhetoric given to this idea in the proverbial health care debate, now is there?

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Talking about the book with the Lake Superior wind....... a calm day