The Grateful Patient

26 years. 26 years I’ve been involved in healthcare. From my nascent days as a medical student to my current position as a solo, independent, private practice specialist. I’ve seen, heard and experienced many things. My dad used to say, “eyes and ears open, mouth shut”. I will confess – I’ve done better on the first part of that.

Some people know I’m a perfectionist. Certainly, my wife. my coworkers. my close friends. even some of the patients I care for. Is being a perfectionist a bad thing? Especially in the service industry? I’ll need

to be convinced that it’s a character “flaw”. Bottom line is, I’ve re-dedicated the rest of my career to the Golden Rule. And that comes with a cost. A cost I’m willing to pay.

Flip the script, and all the sudden I become the patient.

Roll back the tape to 2015. My team of 47 employees, coworkers and direct-reports decided it would “be fun” to train for a half marathon (Run Rocklin), traditionally held early April. So, I say “sure, that would be fun”. And I dutifully head to my neighborhood gym to start training. In the midst of my third workout, I feel a strain in my Achilles’ tendon. I stopped jogging, cooled down and redirected my plan.

“I really need better arch support” I said to myself. Sounded good. Yeah, that’s a good plan. So I grabbed my 15-year-old son (who was complaining of sore feet) and headed to a local shoe/foot insert store.

Two hours and ~ $1200 later, we’re set. We’ve got our new inserts, and we should be good. Right? What could go wrong?

Two days later, I head back to the gym. Newer shoes. Custom orthotic inserts and plenty of will power. I warm up gradually and set reasonable expectations. I’ve seen and heard of too many weekend warriors in their 40’s cause self-injury. I won’t be one of those goofballs.

Everything is going great. Nice and easy. Steady. Take your time. Set reasonable expectations. Follow the timeline and workout schedule you found online. You have 14 weeks to train. We’re still on pace. It’s all good. Warm up …

CRACK!!!!

Since I’ve had both Anterior Cruciate Ligaments (ACL) surgically replaced, and a meniscus in my left knee, I know the sound of soft tissue injury/rupture.

This sounds was 5 times louder. And reverberated through my skeleton.

I immediately felt crushing pain in my left foot 🦶. I stepped (fell) off the treadmill and crumpled towards the ground in a heap. My son was nowhere in sight in the gym. The person on the treadmill next to me twisted and asked, “are you OK”?

“Yes” I muttered. I’m OK. It was a total, complete and utter public-save-face-in-public lie. I was scared. I knew something had gone very wrong in my left foot. I had experienced significant pain before, but this was different.

After 10 minutes, I was able to rise to stand. I hobbled towards the stairs on the second floor of the gym and realized that I was going to need to take the elevator down. (Thankfully, Cal Fit Rocklin has an elevator in the middle of the main workout areas). I always took elevators for granted. *More on that later.

I texted my son and said, “are you ready to go”? We reconvened, and I drove home.

2049 days. January 15, 2015. August 24, 2020.

2049 days of fluctuation between low level ache, mild swelling, twinge and crushing, brain 🧠 consuming, overwhelming soul wrenching pain.

7 medical opinions

2 MRI’s

Countless plain films (x-rays)

$50,000 of shoes inserts

Another $50,000 of shoes

12 months of traditional PT

9 months of Bowen PT therapy

1 celebration of life for a parent

1.5 million milligrams of ibuprofen

1 professional divorce

3 new teammates

4 great gel ice packs

1 amazing wife

3 incredible kids

Millions on tears

2 years of crummy HMO cost- saving insurance

$150,000 of copays, deductible, share of costs

2 high school graduations

14 Southwest Airlines flights

2 Covid-19 mRNA vaccines

5 incredible co-workers

1 professional disgrace

1 sleazy business proposition

A seemingly never-ending pandemic 😷

Fast forward to August 24th, 2020.

Pasadena, California.

A crisp Monday morning. The San Gabriel mountains glisten with that picturesque fine beauty you have to see to believe. (Everyone thinks the LA basin is filled with smog and traffic). Once you’ve lived in Pasadena, you know the beauty of these mountains I’m talking about.

I picked an early morning appointment. The team would be fresh. Organized. Caffeinated. And ready to consider a new plan.

I got in the room. Put on the new fresh mask. Repeated the answers to all the questions on the form I just filled out. Confirm my pharmacy. And waited for him. And waited. Voices percolated softly under the door. A mutter. Not decipherable, but close. I pay attention to building design and flow like never before.

Surgical. Organized. Clean. Connected with computers. A few “stored” items, as with most clinics. Always out of room.

I waited.

He came in. Eye contact. No handshake. Pandemic. His medical assistant and 2 scribes followed. I said hello to them.

He asked my specialty. I said Allergy. He smiled.

His assistant pulled up my MRI from 20 months prior.

I fell backwards on the exam table. My head made a slight thud. Tears ran down my cheeks.

I found him.

The clinical team became confused, exchanged concerned glances. He was concentrated on my foot. And then the MRI. And then my foot. And the MRI.

Tears ran down my cheeks and poured on the cheap table exam paper.

He finally looked up. His hands left my foot. He saw the tears. He spoke. “Oh, I’m sorry. Did that hurt”?

I muscled up to a sit, quickly wiped the tears off my face and muttered “No. no. That didn’t hurt”.

He resumed his exam.

I found him.

But I couldn’t stop the tears. So many thoughts rushed through my mind. When? How long? What else do we need? Where? Oh sh!?. I gotta get my things in order.

I smiled. I found him. Tears still flowed. So much pain. So much anguish. So much frustration. So many sleepless nights. So much sadness. So much feeling alone and scared.

I wiped the final wave of tears away. Pull yourself together, Miller. You gotta set up this plan. It’s go time.

I found him.

The exam lasted almost 45 minutes.

Some of my previous exams lasted 45 seconds. One ------- didn’t touch my foot. # 6 (medical opinion). Seriously - he’s a foot surgeon who didn’t touch me. I could make up excuses about the pandemic and weird protocols and all that. But he’s a surgeon. What surgeon doesn’t touch their patient or do an exam? Such a disgrace. It’s buffoons like this that PAIN MY SOUL as a clinician. These practitioners should get free employment retraining. He looked at my foot, used fancy words (all of which I understood) and sold me $300 of durable medical equipment. Just like many of the other scheisters. Pure snake oil. No bedside manner. Not a whiff of care. Get to the next patient (in less than 15 minutes0. Gotta pay the bills. My copay had covered his 2 minutes. Such a disgrace.

And then there was #7.

I found him.

It took me 15 months after #6. I had to dig deep. I understood how the system worked. I wasn’t going to get anywhere with an HMO. Hence #6. $300 of snake oil.

When I started digging for #7, I decided I was willing to spend weeks or months to find him or her. It didn’t matter. # 4 was AMZING. Local. Professional. Thoughtful. Patient. Organized. Great listener. Open to shared decision making. But once she saw my 1st MRI and the absolute CHAOS erupting in my mid-foot, she challenged me to get another opinion. So for # 7, there was a “profile”. Mid-career. Young enough to take on a challenge. Old and experienced enough to have seen some gruesome stuff in their career. Willing to tackle a really tough case. Not afraid of a challenge.

Location didn’t matter. I’d seen all the options within 50 miles. I was willing to expand my radius to … 100, 500, maybe 1000 miles (I even considered 2,500 reasonable at one point). I knew where some of the options were: San Francisco, Los Angeles, Denver, Baton Rouge, LA.

I had done my research. He was well trained. Well educated. Mid-career – 20+ years of experience. Young enough to be bold, curious and willing. Old enough to have seen gnarly cases that wouldn’t scare him off. And not worried about liability or the remote possibility of a bad outcome. There’s too much fear in healthcare. Looking over our shoulders. CYA. I was done with that. Ready for a bold new path.

His name is Kenneth Jung, MD. He’s a year younger than me. Impeccably educated and trained. He’s a team doctor for professional athletes in the LA basin. But those are only his paper credentials. I’ve seen great paper credentials and been disappointed or left wanting much more.

He’s humble. He doesn’t use medical jargon, even though I speak that language. He gives eye contact on entering the room. He says “good morning”. He smiles and occasionally laughs. He’s laser sharp with clinical skills but doesn’t establish a “vertical relationship”. He’s everything a picky, perfectionist, highly experienced consumer/patient wants and needs.

And then there’s “the team”. All the people who support him. Vanessa. Bill. Dilu. KJ. Judy. Juan. Keenan. Alfonso. So many more. These are all the faces “behind the scenes”. Beyond the scrubs and white coat. Beyond the diplomas, degrees and licenses. These are the people SCRAMBLING to make HIM look good and polished. I know these people. I hear these people. I see these people. I’ve hired these people. And trained and crafted many, too. Their lunches get cut short, because of that urgent phone call. That prescription with high priority. A patient with extreme need. In essence, they are who make Dr. Jung even better. They fill in the gaps. They smooth out the wrinkles. They answer the phone calls, speak to over controlling pharmacists, insurance companies and other tertiary “interlopers” in the process. To these people, I CANNOT thank you enough. Your unwavering dedication to good patient outcomes keeps your boss fresh, alert and focused for the BEST OUTCOME possible. And your teamwork is ESSENTIAL and NOTICED.

On December 2nd, a planned ~ 2-hour surgery became a 4 ½ hour complex “reset”. I couldn’t keep taking ibuprofen every day of my life. I wanted to walk to the mailbox without pain. I wanted to join my wife and daughter occasionally when they walked our dog. Maybe someday I’ll even hike a beautiful trail again. Or start training for that Ironman I longed for at 45. Who knows?

The foot that looked like a gutted fish is healing. The swelling is going down. The hardware and screws and pins and staples and plates and bone islands and settling into their new home with their new neighbors. The tendons and ligaments are finding their new alignment and anchors - no longer overstretched and misplaced. There will be plenty more X-rays, range of motion checks, dermatome (nerve zone) exams, and 80+ weeks of physical therapy. There will be copays, deductibles, insurance schemes, and phone calls and hassles.

And when I see his team, I’ll always try to catch their eye. I’ll say good morning. I’ll wink and laugh and smile. And I’ll try to tell a funny joke or bring simple gift cards to keep the team aware of my deep and real love.

He knows he’s my HERO. I’ve told him as much. He tried to laugh it off, because that’s his style. He’s too modest. Too humble. Which makes him even more my hero. And he clearly knows, and follows, the Golden Rule.

Through all the mumbo jumbo, insurance BS, bureaucracy, pandemic, rules, restrictions, delays and the like – he powered this ship through the storm and didn’t panic at the battering. He stayed the course. He gave it his best shot. He went above and beyond our plan. And that’s what I asked him for.

And for this. I am forever THE GRATEFUL PATIENT.