THE PHONE TAP (PART 1)
Living over an hour’s drive from the nearest medical center and from high-powered specialists was both an advantage and a distraction.
Certainly, the distance between us and the most specialized level of care gave us the opportunity to do procedures and to care for patients that our family medicine colleagues in the big city could only dream about.
The other side of the coin was that we would not have access to the skills and experience of the subspecialists in times of emergency. We were grateful that our colleagues in the larger cities and the medical centers in North Carolina grew used to this situation and would gladly assist rural physicians by telephone if we had a question or ran into an emergency.
One of the more interesting telephone consultations of my career occurred with a patient Louise called me to the emergency room to see.
He was a forty-year-old man—Bob Shuler—who was in ER with severe hip pain. He had no memory of an injury, but the pain had been building for several days. By the time he came to ER, he couldn’t walk on the hip, and moving the hip was extremely painful. His X-rays and routine lab tests were normal, and I was befuddled.
While I was in the X-ray suite looking at the patient’s X-rays one more time, Rick walked in.
“Whatcha got, Walt?”
“I don’t frankly know, partner.”
We looked at the X-rays together as I reviewed the case. “Mind if I take a look at him?”
“You can bet I don’t!” I replied.
After Rick had completed his exam and history, he was equally befuddled.
“Rick, if he was four instead of forty, I’d diagnosis toxic synovitis of the hip.”
Rick nodded. We would frequently see young children with sudden pain in the hip and an inability to stand or walk secondary to the pain. If their X-ray and blood work turned out normal, we’d diagnosis a viral infection of the hip and treat it with the tincture of time, Tylenol, and TLC. Invariably the kids would be better in a day or two.
“Tell you what,” I thought out loud. “I’ll call Bill Garrett.” Rick nodded again. “Good idea.”
Bill was an orthopedic surgeon at Duke. I had spent many
hours with him, caring for the student-athletes at Duke. Knowing how much Bill liked a challenge and how well he understood the dilemma of physicians in rural locations, I knew he wouldn’t mind my calling.
When the Duke Medical Center operator located him, we initially caught up on our practices, our wives, our children, and the state of Duke athletics. As was customary whenever we talked, Bill invited me to come back to Durham to join him in working at the Sports Medicine Clinic at Duke. Given the rising status of Duke basketball, I was always tempted to say yes.
After hearing about my patient, Bill sounded more somber. “Walt, I’d be most worried about septic arthritis. A bacterial infection of the hip can present exactly like this. If that’s what he’s got, your surgeons’ll need to get in there surgically and irrigate that hip immediately. If you don’t, the hip could be permanently damaged.”
“Should I just call the surgeon?” I asked.
“No, Walt. I’d recommend you tap the hip.” I knew he was referring to a procedure in which the doctor numbs the skin with lidocaine and then slowly advances a very long needle through the skin and into the hip joint to aspirate some of the hip joint fluid. The fluid is then evaluated in the lab for signs of infection.
I paused for a moment and then protested, “But, Bill, I’ve never tapped a hip. When I was at Duke, you orthopedic residents did all the hip taps.”
“Yeah, I’m really sorry about that. Sometimes our residents want to get all the experience they can at the expense of you guys in primary care. But if you’re willing, I can guide you through the procedure over the phone.”
I paused again. “Bill, wouldn’t it be better to just ship this patient to Asheville?”
“I don’t think so, Walt. Think about it. By the time you arrange a transport, get the patient there, have the ER doc see him, have the ER doc call the orthopedist, and then the orthopedic doc drives in and examines the patient and then does the procedure—well, we could be talking another three or four hours. And in that time period, the hip could be permanently damaged.”
I took a deep breath. I had never done this procedure, nor had I ever seen it done! And the age-old dictum in medicine was “See one, do one, teach one.” I didn’t like the sound of “Hear about one while doing one!”
“Just a second, Bill.”
I put my hand over the phone. “Rick, have you ever tapped a hip?”
Rick shook his head no.
I tried another route. “You ever seen one done?” I was hoping he’d say yes, and then I could let him do it.
Unfortunately, he again shook his head. “Bill, I’m willing if you are. Is it very risky?” “Nope!”
I hoped he wasn’t lying.
“Okay, let me get the patient’s permission, and then I’ll get ready. Rick’ll call you back, and you can relay instructions over the phone. Okay with you?”
“No problem. Let me review the supplies you’ll need, and then you all call back when you can. I’m available to you anytime.”
I hung up and then called Ray—who was the surgeon on call. He had never tapped a hip either, but he was happy for me to try. “Let me know what you find.”
TO BE CONTINUED
PAST STORIES FROM BRYSON CITY SEASONS
- Dead Man Standing (Part 1), (Part 2), (Part 3)
- Eyes Wide Open (Part 1), (Part 2)
- Auspicious Accidents (Part 1), (Part 2)
- Answered Prayers (Part 1), (Part 2), (Part 3), (Part 4)
- Rotary Luncheon
- Death by Emotion (Part 1), (Part 2), (Part 3), (Part 4)
- The Invitation (Part 1), (Part 2)
- Barbecue and Bacon (Part 1), (Part 2)
- A Touchy Subject
- Family Time (Part 1), (Part 2)
- Chicken Pops(Part 1), (Part 2)
- Swain County Football (Part 1), (Part 2)
- Hospital Politics (Part 1), (Part 2), (Part 3)
- The Bobcat Attacks (Part 1), (Part 2)
- Dungeons and Apples
- A Tale of Two Surgeons (Part 1), (Part 2), (Part 3)
- Tanned Feets (Part 1), (Part 2), (Part 3)
- Wise Counsel (Part 1), (Part 2)
- An Anniversary to Remember (Part 1), (Part 2)
- Mrs. Black Fox (Part 1), (Part 2)
- The Littlest Cherokee (Part 1), (Part 2)
- Christmas Firsts (Part 1), (Part 2)
- The Silver Torpedo
- Another New Year’s Catch
- Turned Tables
- Doctor Dad (Part 1), (Part 2), (Part 3)
- The Phone Tap (Part 1), (Part 2)
PAST STORIES FROM BRYSON CITY TALES
- The Murder (Part 1); (Part 2); (Part 3)
- The Arrival (Part 1); (Part 2)
- The Hemlock Inn (Part 1); (Part 2)
- The Grand Tour (Part 1); (Part 2)
- The Interview (Part 1); (Part 2); (Part 3)
- Settling In (Part 1); (Part 2)
- First-Day Jitters (Part 1); (Part 2)
- Emergency (Part 1); (Part 2)
- The Delivery (Part 1); (Part 2)
- The “Expert” (Part 1); (Part 2)
- The Trial (Part 1); (Part 2)
- Shiitake Sam (Part 1); (Part 2)
- Wet Behind the Ears (Part 1); (Part 2); (Part 3)
- Lessons in Daily Practice (Part 1) — Anal Angina; (Part 2); (Part 3); (Part 4)
- White Lies
- The Epiphany (Part 1); (Part 2)
- Becoming Part of the Team (Part 1); (Part 2)
- Monuments (Part 1); (Part 2)
- My First Home Victory (Part 1); (Part 2)
- Fisher of Men (Part 1); (Part 2)
- Fly-Fishing (Part 1); (Part 2)
- Something Fishy (Part 1); (Part 2)
- A Good Day at the Office
- An Evening to Remember
- Another New Doc Comes to Town
- ‘Twas the Night Before Christmas (Part 1); (Part 2)
- A Surprising Gift
- The New Year (Part 1); (Part 2)
- The Home Birth (Part1); (Part 2); (Part 3)
- The Showdown (Part1); (Part 2); (Part 3)
- The Initiation (Part 1); (Part 2); (Part 3)
- Home at Last (Part 1); (Part 2); (Part 3)
© Copyright WLL, INC. 2017. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.