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I was proudly living what I thought was my best life during the pre-pandemic years, as I shared in previous ENTtoday articles on self-care and well-being. My weekend routines were always the same: long walks chasing sunrises and sunsets, life-affirming and anger-releasing tennis, and intentional vacations immersed in nature—after all, I couldn’t be an “imposter” while speaking or writing about well-being. On-call weekends simply meant everyone got woken up early so I could do rounds at 6 a.m. and still play tennis.
As I write this, it’s August 2021 and I’m here in Florida amidst countless unmasked, unvaccinated people who unapologetically sandwich me at the grocery store checkout line. This COVID-19 surge is foreign to us, despite over a year of learning from others. Our hospital is at capacity, we have a critical staff shortage, and we anticipate losing more staff soon due to the rollout of mandatory vaccination for healthcare workers, which I support. For the third week in a row, I’ve had daily calls to notify and cancel cases due to COVID-positive preop tests, dealt with symptomatic and asymptomatic children, seen adults break quarantine and come to the clinic anyway, and—new this week—cancelling all cases that require overnight stay.
I’m also not at my best physically. The greatest unexpected challenge I’ve endured this year was surgery on my right shoulder in May 2021 from an ongoing problem that I ignored for too long. Although I’m recovering, I’m not okay. I like to think that I am, but I’m not. Who would be, living our realities?
For the past several weeks, I’ve agonized over how I’ll be able to deliver both pediatric and surgery grand rounds in September. Those of you who invited me to speak on this topic at your institution met a strong and resilient person. I’ve filed a missing person report on that version of myself; I can’t seem to find her lately.
We need to realize that we’re humans too, and we need to put our personal health first to be able to help others. I get that now. —Alexander Chiu, MD
A Surgical Conversation
It turns out I’m not the only one recovering: ENTtoday’s esteemed editor-in-chief Alexander Chiu, MD, recently underwent knee surgery. We both believe our experiences are worth sharing. Here’s how our conversation went:
Julie: How did you injure your knee?
Alex: I tell people who ask that it’s “an old man injury.” I tore my medial and lateral meniscus hitting fly balls to my 14-year-old’s baseball team. In reality, the injury has been building for a while from a life of playing sports, and the acute event that pushed it over the edge was trying to out-hit a teenager. I should have known better.
Julie: Alex, be compassionate and gentle with yourself. You should not have known better, and you certainly aren’t alone. I had developed progressive right shoulder pain and had received repeated injections between June 2019 and April 2021. I was that almost-50-year-old hitting tennis balls as if I were still in high school. I never stretched or warmed up properly, fully believing every minute out there ought to be high yield with maximum intensity.
On the Friday before my 50th birthday in April, I had ice wrapped all around my shoulder during seven or eight quick routine cases; then, after a three-hour functional endoscopic sinus surgery for allergic fungal sinusitis, my shoulder froze. I cried in pain and drove with one arm to the orthopedic surgeon. There was a bony spur on the acromion, causing tendonitis and calcification in the bicep tendon. I had surgery in May. Did you need or try physical therapy [PT] before surgery?
Alex: The injury was bad enough that I couldn’t bend my knee past 30 degrees without pain. It was swollen like a grapefruit and I couldn’t walk, sit down, or use the stairs. I waited a couple of weeks to see if the swelling would go down, and when it didn’t, I got an MRI and met the surgeon. There weren’t any options other than surgery. Ultimately, I pushed the surgery out an additional three weeks to accommodate my work and OR schedule—a classic example of putting our patients first, before our own health.
Julie: After my shoulder froze, I waited in agony until the surgeon’s scheduler called me. That experience was very humbling. I was anxious about my surgery date and the impact to my patients, given that by April our division had seen a rapid return in volume, along with several cases of acute otitis media. I scheduled my surgery for one month later. The surgeon never mentioned PT as an option, and I never asked, as it was too late by that point. What was it like as a patient during the preop discussion?
Alex: I was surprised about the lack of detail that was given to me in regard to prognosis for complete recovery, understanding the mechanism of injury, and surgical decision making. I think as surgeons, we commonly make the assumption that patients understand what we’re talking about or, conversely, that the material is too complex for them to understand. Looking back, I understand how the orthopedist acted. He knew what was best for my condition. Now, at six weeks postop, I’m reading online about my condition and I too now understand. I’m not sure if I could have reached that level of understanding without going through the process.
Julie: It isn’t just you. Granted, I was hysterical with pain from my shoulder and receiving an injection while talking to my surgeon at 6 p.m. on a Friday night. (He was kind enough to wait for me.) But it all sounded so simple. He told me my surgery could be on a Friday, and that I could be back to work the following Tuesday. I couldn’t do cases for 21 days and would need PT. It’s been three months now, and I had PT twice a week for the first two weeks but then developed capsular contraction, giving me a limited range of motion. I needed another injection to move at all to do PT after the first month. I was clueless. How long was your visit with your surgeon?
Alex: Short—five minutes at most.
Julie: Mine was 15 minutes, but my sobbing might have taken up the extra 10 minutes. Did you feel rushed?
Alex: Kind of, but he definitely asked if I had any questions and he gave me his personal cell number to call with any questions.
Julie: Mine also gave me his cell number. He even texted me after my injection to make sure I felt better. Did you search for more information on your surgery or ask others for their preop experience?
Alex: I read online blogs and talked to friends and family members who had knee surgery. But no knee surgery is the same, and every recovery is different.
Julie: Bingo. I read stuff too and frankly didn’t seem to really get it. I thought a lot of it didn’t apply to me—after all, I have a big job and people depend on me. I have work to do, family to cook for, and I don’t have time to not be okay. I don’t have time to be human. How long did the surgeon say you would be off of work? How much time had you planned for?
Alex: I think surgeon-to-surgeon understanding is that we take enough time off to be functional at work. We won’t be at 100% or even pain free, but we’ll be well enough to be able to physically do our job when we return.
I had an eight-day vacation in Hawaii with my family planned that I cancelled, and I used the time for the surgery. My first day back was a full day of operating, and the next day was a full day in clinic. Ugh—that was a total mistake.
Julie: I wish I had known; I could have warned you. I took one week off when he told me I could go back to full clinical hours at postoperative day four. No way—I was in a sling all week, and everything was a blur. I returned to work the following Monday and could barely lift my right arm to perform an otoscopy on any child. How was the day of surgery and postop experience? Did being a surgeon help you with any expectations?
Although I’m recovering, I’m not okay. I like to think that I am, but I’m not. Who would be, living our realities?
Alex: The day of the surgery was a wonderful experience. No, really—I mean that. The pre-op nurses gave me a card wishing me good luck and my anesthesia colleague hooked me up with the good stuff; the only thing I remember was being wheeled into the OR and then waking up in the post-anesthesia care unit with a coffee cup in my hand.
Julie: Mine went well too, but mine was done at a surgery center and I knew no one. They did treat me like I was special, as they knew I was a surgeon. I brought a bottle of Angel’s Envy bourbon as a gift for my surgeon and joked that he should drink it only after my case. It was humbling to have surgery amidst the pandemic. My husband couldn’t come in, and I felt scared alone. I also only remember being wheeled in for surgery and then waking up in the PACU. Did your recovery happen faster or slower than you expected?
Alex: I recovered sooner than I expected, in that I was able to walk that same day, but slower in that it’s now six weeks after surgery and I’m still going through PT and am unable to fully get back to my usual lifestyle. I was told it will take at least 12 weeks of rehab before I can do the things I could before surgery, but I didn’t believe it until now.
Julie: At least you don’t need your spouse to put your bra on for you every day, or have a crappy ponytail because you can’t raise your arm high enough. Changing into scrubs is a painful nightmare. Now I’m not able to reach any high shelves, I have constant soreness, I’m unable to sleep on my favorite side, and I can’t sleep much due to pain. PT seems to barely be helpful. Did you follow instructions for postop care, and for recommended PT?
Alex: Yes—I’ve been a good patient.
Julie: I haven’t. During my 11-hour days, when was I supposed to stretch three times a day? When would I apply heat for 20 minutes then ice for 15 minutes? It’s a poor excuse, but with the pandemic, I remain overwhelmed.
Julie: If you had to do it over again, what would you have done differently? Would you have planned more or less time off?
Alex: I would have cancelled my own patients and gotten the surgery earlier. I went through a very uncomfortable three weeks just so I wouldn’t inconvenience my own patients. We need to realize that we’re humans too, and we need to put our personal health first to be able to help others. I get that now.
Julie: I would have asked more questions and read more, but most of all, back in 2019 when my right shoulder started hurting, I would have stretched religiously and warmed up. I need to acknowledge that my body has served me loyally while I abused it over my lifetime and more than 25 years of stress as a surgeon. If I could go back to May, I would have taken two or maybe even four weeks off and focused on intensive stretching and daily physical therapy instead of returning to a full clinic while typing with a horrifically tense arm and shoulder.
Thank you, Alex, for sharing your story with all of us. On behalf of your readers, we send you healing and positive energy and wish you a supersonic recovery. Yes, we’re all human. We’re still connected, and we will struggle together. Thankfully, I’m beginning to find my former self, the one with greater sense of well-being, by taking it one day at a time.
Dr. Wei is division chief of pediatric otolaryngology/audiology at Nemours Children’s Hospital and director of the Resident and Faculty Wellbeing Program at Nemours Children’s. She is also an associate editor on the ENTtoday editorial advisory board.