In order to understand what follows, one must know that within seconds, I can go to the garage and find thank you notes written to me in the past 40 years, when I practiced medicine.  These notes were handwritten, a word that has almost been extirpated from the English language, now that we have the noun/verb e-mail.


It surprised me that day in Eugene.  I headed out for a 5 k run, a daily occurrence, and 200 meters into it, I got a sharp pain in my right patella.  It wasn’t too bad, but it bothered me, for I have never had problems with my knees.  For sixty-five years, they have climbed mountains, hiked Alaska, carried 65 kg down the middle of a Canadian river, walked thousands of kilometers, skied tens of thousands, pedaled a hundred thousand, bent as I drove more than a million, and been my friends.

I finished the run, but the knee hurt.  I took some anti-inflammatories and walked 3 km to dinner and then back.  I shouldn’t have done it, but I refused to believe my knee was betraying me.  I walked, but neither my knee nor the rest of me was happy.

The next two days, I didn’t run, but I still walked to dinner.  I was a little better.  OK, I thought, this is good.  I hiked 16 km with 300 meters elevation gain with virtually no pain.  I was happy.  I drove back to Tucson and ran 5 k again.  I was fine, until I returned home after the second day’s running.  The pain was back.

I stopped running.  For a half century I have run on a regular basis.  I think perhaps 5 times I have had to stop for some time, never for knee pain.  For the next three weeks I walked and walked, took anti-inflammatories, and my knee improved.  I was going to Uganda for the eclipse, and I did not want a bad knee to hurt the trip.

Shortly before I left, I decided to test my knee by running a few steps on it.  I am capable of remarkable denial and irrational thinking.

The third day of the test, all was going so well that I ran 60 steps three times.  I did fine.  I wish I hadn’t done a fourth.  The pain was back, and I was soon on my way to Uganda with tight connections and a bad leg.  Fortunately, I did well on the trip, because I was sitting in a vehicle most of the time.  But one day, we walked in a rain forest up and down hills.  The pain was back.  When I arrived in Houston on the way home, I took an escalator rather than the stairs.  I NEVER take escalators voluntarily.

Before I went to Uganda, I did have the good sense to make an appointment for after the trip with an orthopedist whom I have known for 30 years.  I figured I would not need the appointment; I thought I would get better.  Suddenly, I was really glad I made it.  My knee was stable and not swollen, but all sorts of things went through my head.  Could I have torn something?  Do I need an MRI or surgery?  Will I ever run again? What is going on?  A former physician, these thoughts and others went through my mind.

The orthopedist entered the room and asked if I had been hiking.  Well, sort of, until recently, I replied.  He listened to me carefully, nodding like he had seen this before.  He had me lie down and put my knee into full extension.  I had done this, but I did not have long enough arms to do what he was able to do.

OUCH!  He found the spot I had been searching for.  “Patellofemoral syndrome,” he said, rather nonchalantly.  “I’ll inject it and give you some Sulindac.”  Wow, that was quick.  He injected, without saying whether it would hurt, because he knew it wouldn’t, said he was done, and told me what to do.  From start to finish, the entire procedure took 10 minutes.  Maybe.  The pain was gone.

The physician is an elder.  He has been practicing for as long as I did plus an additional 20 years since I quit.  He has seen this condition many times.  I wish we could capture his experience and use it in the medical community.  He did something simple to him, an everyday procedure, but to me his reassurance was immense.  I never felt I did much of that as a neurologist.

But then I thought about that feeling a little more.  Early one morning, a quarter century ago, the same orthopedist called me and said he thought he was having a stroke.  He had horrible dizziness and asked if I could see him soon.  I told him to come into the office right then.  I practiced in reverse order.  If I and the patient were both ready, I saw the patient, and the paperwork came later.  Patient care came before paperwork, if I had the choice.  It drove my receptionist crazy, but I wouldn’t have done it any differently.

I knew what the orthopedist had before I had hung up the phone: positional vertigo.  I confirmed it in the office, reassured him, and was fortunate in retrospect that he didn’t need vertigo exercises, which hadn’t yet been invented.  He had no stroke, didn’t need a CT scan, and MRI wasn’t around then.  I had seen this condition a lot.

He was reassured.  I doubt he remembers that day, but you know, unless I tell him thank you for what he did, he will never know how much I appreciated what he did for me.  I will remember this day, and I will make sure he will, too.  I’m not completely sure what I will do this holiday season.  But I know I will handwrite a thank you note.  No e-mail.  The verb is “to handwrite,”  archaic today, which while sad, enhances the strength of the verb.  Oh, does it enhance the strength.

If the orthopedist is like me, he will save it.  Perhaps it may make his day, as he made mine.


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