The Mechanics

The Mechanics

By

Leo de Natale

            I spent much of my life as an optometrist.  It’s one of those professions that is in the middling section of the health care food chain.  We serve a vital purpose in the wellbeing of society but it’s not a sexy occupation.  Dentistry, podiatry and chiropractic are also in this category. You never watch television or movies whose plot includes filling cavities (although Woody Allen wrote a humor piece entitled ‘If van Gogh Had Been a Dentist’), having a spine cracked, removing bunions  or arriving at a proper eyeglass  prescription.

            No, that’s left to the superstars: physicians.  Medicine is a long-honored occupation – Marcus Welby, ER, Coma, etc.   People hold medicine in esteem.  Optometrists, for example, are viewed as untermenchen. A colleague recently texted me this message: “A patient yesterday asked ‘Do you do surgery or are you just an optometrist?’”  That’s what is known as the proverbial stake through the heart but we get used to  contempt that borders self-loathing.  Such insults go with the territory.

 Health care   is indeed changing, the docs still take top billing but should they be prepared, as European physicians have, to decline in social status.  Socialized medicine has that effect.  Optometrists are lucky – we’ve already accepted our diminished status.  Over the years of referring patients to ophthalmologists and other sub-specialties and now even more because my life is filled with doctors’ appointments, I concluded that in many respects MDs are  merely mechanics and the machines they fix are human bodies.   Urologists and gastroenterologists are plumbers, cardiologists are HVAC repairmen, the aforementioned ophthalmologists are TV repairmen who correct visual system glitches.  Proctologists are sewer workers,  psychiatrists are software engineers. Surgeons are city road crews who fix burst waterpipes, street potholes or gas explosions.  Dermatologists are house painters- they sandpaper a house, fill in cracks and apply new paint to a rough exterior.

Think about it. As sexy as physicians appear to be, many specialties aren’t as sexy at all. Also, they won’t admit this to the outside world but within the medical profession there is a caste system. Neurosurgeons are the demigods, dermatologists, stablehands. How many persons want to observe dermatologists dealing with the “heartbreak of psoriasis” or obese patients with pink scaly lesions under sweaty, fatty slabs or squamous cell carcinomas. The traditional war cry for dermatologists is “If it’s wet, keep it dry, if it’s dry keep it wet!” They don’t have to deal with blood and guts nor do they work weekends or emergency visits. Most derm appointments are scheduled at least six months out or greater. But think of it. They deal with ugly warts, patients with layers of fat that smell and fungus-ridden appendages.

            Second lowest in the pecking order are psychiatrists.  They, too, don’t deal with blood.  The conveyer belt for them is a new customer every 50 minutes and see you next week.  Most psychiatrists are attracted to the field because many if not most of them are  themselves usually screwed up.  Their job is to pigeonhole and treat various neuroses and psychoses.  An obsessive-compulsive goes here, a manic depressive there.  Throw in a schizophrenic  and a garden-variety neurotic in shelf no. 12.  Every patient is categorized with psychiatric criteria.  It is the essence of this discipline. The specialty is so stressful most psychiatrists in the Northeast escape to Truro, Massachusetts during July and August.  It’s their way of detoxing and getting away from the madness.

            We ascend through the medical strata.  Think of what it takes to specialize in urology.  Day in, day out, these poor bastards inspect and fondle penises and insert their index fingers into anuses to evaluate the odious prostate gland.  The prostate, or as many laymen refer to it as the “prostrate”, is the scourge of every man over age 50.  Sooner or later it morphs from a walnut to a grapefruit and causes millions of men to recollect days when they could sleep eight hours without urinating.

            A similar specialty is gynecology.  Why would anyone want to spend his or her day evaluating women’s vaginas and uteruses.  I picture these docs arriving home after work with their spouses saying “Tough day at the office, honey?” 

The same could be said for colo-rectal specialists.  They deal not only with the anus but the entire colon, always in search of a dreaded malignancy or malfunction.  I personally dealt with one of these guys for a bad case of pruritis ani, aka an itchy heinie. The guy was incredibly arrogant and condescending.   He fixed my problem, but I left his office saying to myself, it takes an asshole to fix an asshole.

The gastroenterologists are roto-rooter specialists.  They diagnose and treat stones, moans and groans.  Gastric ulcers.  A bum gall bladder with rolling stones aplenty.  Renal specialists are plumbers who deal with kidney disease and dialysis.  Endocrinologists have the unenviable task of treating diabetics and such weird conditions as acromegaly – Andre the Giant—and dwarfism.  Amazing what misery the endocrine glands produce.

            Moving up the body, there are the cardiologists whose function is to diagnose and treat so many patients with heart disease.  The human heart is similar to a house furnace.  It circulates heat (blood) flowing through pipes.  A house turns cold with a malfunctioning furnace.  So does the heart.  Many patients are usually overweight or morbidly obese.  Many are diabetic and also have elevated cholesterol levels and high blood pressure.  It’s called the Trifecta.  The chubbies often develop clogged arteries that lead to stent surgery.  Do they lose weight?  Usually no.  Non-compliance is a biggy with the heart guys.  An overweight neighbor  celebrated at a Super Bowl party by consuming three pounds of fried shrimp and a case of Bud Light. At 3 am he awoke with severe chest pain. A nice guy, but he had the near fatal combination of being stupid and cheap.  Instead of calling an ambulance, his wife drove him to a nearby hospital.  The pain and symptoms were intensifying and he sustained breathing difficulties.  His condition was dire and was immediately transferred to Massachusetts General Hospital.  The heart mechanics performed a quadruple bypass surgery.  In automotive parlances, he had four valves  and an oil filter replaced.

            He survived and was told to lose 50 pounds.  He lost 20 and told me “I don’t like being so thin.  I look better with a little weight on me.”  He died 12 months later after sustaining a massive myocardial infarction.

            Next we turn to another trade: otolaryngology – the ears, nose and throat guys.  They deal with ventilation and acoustical engineering.  They also deal with such plumbing supplies as faucets and drainage systems (runny noses and post nasal drip).  These specialists have the unenviable task of looking up hairy, snot-filled noses, ears that often have enough wax to fabricate birthday candles.  They have the unpleasant task of assessing slimy, mucous-laden throats. 

Twenty years ago, I developed nasal polyps that were exacerbating my seasonal allergies.  I was referred to an ENT guy and my assessment of him was compromised when I notice he was wearing a toupee.  He would wear and remove those circular head mirrors very, very carefully.  He performed the surgery but the anesthesiologist overjuiced me with an anesthetic that affected my breathing.

 The so-called day surgery turned into an overnight (for “precaution only”) and left me loopy for nearly a month.   The moral of the story is never trust an ENT mechanic who dons a hairpiece.

Ophthalmologists, the video repairmen do perform an admirable service. Problem is they’re probably the most sub-specialized of all the mechanics. The specialty has been balkanized. There are few general ophthalmologists remaining. They’ve subdivided themselves: cornea, glaucoma, cataracts and oculo-plastic surgery, i.e., removing sagging, baggy eyelids. These docs perform micro-surgery. Most procedures require a loupes or computer magnified cameras. It is ultra-precise. I know because some ophthalmologists aren’t talented and that’s when screw-ups, expecially with cataract surgery, occur. I knew one ophthalmologist who, in his later years, developed a tremor. We used to call him “Shaky”. He very quickly segued into treating patients who didn’t require surgery. At least he was honest with himself.

Then there are the orthopedic surgeons. They’re carpenters. Millions of older Americans eventually develop arthritic joints – knees, hips, shoulders elbows. Total knee replacement involved cutting skin, sawing bones and reattaching a fake knee. A lot of banging and hammering. There’s a lot of noise when these guys enter a surgical suite. You can hear drills, surgical saws; you see a lot of blood, you see a lot of sweat. It’s messy, exhausting (for the surgeon) work. Ortho guys usually retire earlier than their medical colleagues. That’s how tiring surgery can be.

Neurologists are electricians.  They deal with the body’s nervous system.  It’s a fascinating specialty dealing with the wiring system – all those neurons and axons.  The human brain is a supercomputer with billions of cells that maintain electrical activity throughout the human body.  Their task is to evaluate and diagnose such conditions as Bell’s  Palsy, transient ischemic attacks – mini-strokes—and outright strokes.  They also have the unfortunate task of diagnosing and treating neurological maladies that include multiple sclerosis and brain tumors.  As a patient I can attest to the methodical process of differential diagnosis and an exercise in the process of elimination.

            Last spring I awoke at 2 am with a sharp, shooting pain behind my left eye.  It was as if some sadist had inserted a 10 guage hypodermic needle and wiggled it around.  The pain then shifted to my upper lid and again created searing pain. It recurred later that day.   This event occurred while my wife and I were vacationing in hot, sunny Phoenix.  Being an optometrist, I started to ponder the diagnosis.   It could be a space-occupying mass, the beginning of the dreaded tic doloureux – an inflammation of the giant trigeminal that has literally caused persons to commit suicide.  The pain is that severe.  I was destined to be on the receiving end of  three step diagnosis and treatment plan.

Step 1 was a visit to a neurophthalmologist after returning home. This subspecialty is the first stage where they determine if the problem is limited to the eye. They perform an eye examination on steroids. Everything internally seemed to be within normal limits. There were no internal eye tumors. Step 2 was performing an MRI (Magnetic Resonating Imaging) that will identify if there was a growth/tumor within the eyeball socket. The neurophthalmologist was through with me and shipped me out. Step 3 was an appointment with a neurologist – in my case a middle-aged woman with a charming South African accent. Her job was to sift through the various test findings and determine a final diagnosis and treatment.

            After performing the usual physical testing – the famous rubber reflex tester—and flexing and pulling my arms and shoulders, she made a final diagnosis.  It was trigeminal neuralgia, a relatively common and benign malady.  She prescribed a medication originally used for controlling epilepsy, but, because of its beneficial neurological effects, it’s used off-label for neuralgia.  Four pills daily was the ticket.  The unknown is how long I’ll be taking this drug.

 She was somewhat evasive, but hinted I may be taking the drug for an undetermined period – maybe for the rest of my life.  One has to place things in perspective.  I fortunately have no hypertension or elevated cholesterol levels. Many persons my age aren’t so fortunate.  I regard the neuralgia medication as an alternative.  It’s solved my problem.

There are various medical specialties who are included in the “Mechanics” moniker.  There’s the infectious disease docs who are basically pest control workers.  Their job is to diagnose (usually via blood test) what critter has afflicted the patient. I’ve noticed regardless of the discipline there’s always a certain level of elitism.  Most physicians do regard themselves and different, perhaps better than the hoi polloi.  So many of them have those goddamned stethoscopes wrapped around their necks.  “Hey, look at me!  I’m a doctor!”  And those starched white laboratory coats with embroidered names on the left that make it official.  Yup, I’m and M.D. 

For the rest of us ancillary health care folks, we wander in a world making patients see better, feel better.   Eyes, teeth, spines, need a lot of loving.

In my case I have embraced a profession without airs. We are in the trenches. Optometrists help people see and without much pretense. We talk and listen better. We’re user friendly.

So remember the next time you’re in a physician’s office you’re really in a parking lot full of human motor vehicles who are there for a tune up, brake job, a new muffler or tire rotation.  The difference between cars and humans is the  MD doesn’t greet you with grease stains on his white jacket.