By David Martineau, MD

So much of what’s considered “normal” changes from week to week, day to day, or even minute to minute, as I discovered one afternoon. The back-story involves a patient I will unceremoniously call “Jane” who came to see me for wrist pain. Like so many patients I see (including a number that day), she had what I would consider a minor problem with major lack of coping skills. The degree of her complaints was only rivaled by the number of anti-depressants and anxiolytics she was taking. After talking with her, examining her wrist and reviewing her x-rays that she had from the ER the week before, I diagnosed her with De Quervain’s tenosynovitis. My biases led me to believe that treating her would succumb to failure. She reminded me of a previous patient with symptoms way out of proportion and, despite what I considered sound medical treatment, an outcome less than satisfactory. We discussed the pros and cons of various treatment options and Jane decided upon a steroid injection. My eardrums are still recovering.

Fast-forward 4 weeks, she returned in a similar amount of distress, somewhere between agony and incapacitated, clearly a 10/10 on the pain scale. She said the injection might have helped for an hour afterwards but her pain as since been significantly worse. She insisted I do something for her. I was convinced I had the correct diagnosis and discussed with her the option of surgery, despite what I considered better judgment. After leaving the exam room, I had reservations and convinced myself she would turn out poorly. I resolved her depression wouldn’t be cured with a first dorsal compartment release.

The day of surgery came and went without issue (though my partner on call that day was sure to let me know she paged him shortly before midnight asking if it was normal to feel pain in the wrist). When the time came to see her in the office for her first visit after surgery, my medical assistant assured me that Jane had called no less than 5 times in the previous week with concerns of pain, swelling, stiffness, soreness and “something’s not right” with her wrist.

I had my most “empathetic hat” on before going into the room only to find it wasn’t necessary. A smile greeted me when I entered as Jane expressed how extremely happy and grateful she was. When she finished, she couldn’t hold back tears of joy. I lost count of how many times she thanked me for giving her arm and her life back; being able to sleep and use it again. She admitted it was sore but SO much better than before surgery. It was the first time I can remember being speechless in an exam room.

Since then, she has referred me several friends and family members (all of which seem to have better coping skills and take fewer anti-depressants). Lesson learned: treat each person to the best of your abilities and the “normal” might surprise you.