For the Love of Femur Fractures

I love femur fractures.

I hate methamphetamines.

In medical school, I learned a lot about human anatomy. We spent our entire first year dissecting a cadaver and learning the names and functions of each part, including the skeleton. The femur is the longest bone in the body; its curved, slender shape reflecting both the elegance and intimidation of an archer’s bow. It is my favorite bone, the way the Tyrannosaurus Rex is my favorite dinosaur. Both are the biggest and baddest of their kind.

On the other hand, most of what I know about methamphetamines – a.k.a. “meth” – I learned from watching Breaking Bad. With all due respect to that television show’s creator Vince Gilligan, a drama series is no substitute for a real education. In school, I studied neurochemistry, pharmacology, psychiatric illness, and drug addiction, but it was all so esoteric. There was nothing to cut into, hold, smell, or saw like there was with a cadaveric femur.

In my life, I have had broken bones. I know the searing and enduring pain involved. I have heard the crunching sound a fracture makes and realized with nauseating assurance that this hurt isn’t going to pass quickly. I have suffered with the understanding that “I’m not going to be able to ski for months!”

I’ve never even seen meth. As an orthopaedic surgeon, I see the scars, disease, and damage inflicted by N-methyl-1-phenylpropan-2-amine almost every day. Yet, my disconnectedness from the drug itself has me questioning my credibility as someone who treats its effects. I am reminded of a scene from the movie, Training Day.  In this film, Denzel Washington plays a character who is a corrupt narcotics agent tasked with teaching a young police officer (Ethan Hawke) what it takes to be successful in that area of law enforcement. The elder, experienced Denzel tells the young, impressionable Hawke, “To be truly effective, a good narcotics agent must know and love narcotics. In fact, a good narcotics agent should have narcotics in his blood.” Is this level of commitment required to become a healer of methamphetamine abuse?

Thankfully not. If such first-hand knowledge was necessary to practice medicine, every oncologist would need to have cancer. In the case of this film, Denzel is manipulating his subordinate with malicious intent and therefore his training philosophy is suspect.

Nevertheless, the character has a point. Aren’t doctors supposed to be empathetic? The definition of empathy is: “the ability to understand and share the feelings of another.” I have had many musculoskeletal injuries. In fact, my personal experiences with sports injuries inspired me to pursue a career in orthopaedic surgery. I can truly relate to someone who has a broken bone. But how can I give my methamphetamine intoxicated or addicted patient the same compassion when I have no idea what it is like to be high on meth? To crave meth? To need meth so badly that I would steal from my family, lose my job, break the law, and become homeless for it? Doesn’t he deserve a physician who has more insight into his disease the way a former athlete does for his patients’ sports injuries? My job is to alleviate pain and the meth user’s pain is no less real than it is for the guy with the broken leg.

Sports injuries and femur fractures happen to healthy athletes. That is (or was) me.

Methamphetamine related disease happens to… well, meth users. Not me. Not anyone I know, really.

Femur fractures are easy to fix and they essentially always heal. I know how to do it and have a hospital at my beck and call to provide me the support and materials with which to do so.

Meth addiction has no good treatment and its prognosis is crap.

When I fix a femur, I feel like a hero. When I’m finished, I admire the x-ray of the reconstructed bone and the beauty of the body’s restored architecture. Everyone working with me is smiling and happy; satisfied at a job well done.

When I am debriding rotting flesh from the limb of a methamphetamine user, I am fatalistic, grumpy, and none of us really wants to be there.

I would never discharge a patient with a femur fracture without crutches.

I usually discharge meth addicts with nothing but antibiotics and (ironically and reflexively) a prescription for narcotics.

I recently took care of a patient who came to the ER complaining of knee pain. What we didn’t do was give him some ice and a cortisone shot and wish him luck. What we did was figure out what was causing the pain – in this case metastatic cancer – and treated it aggressively because it was serious and life threatening.

Meth addicts are typically patched up and sent on their way. Then we wish them luck with their serious and life-threatening disease.

This sounds cynical and defeatist. Maybe it is. But it is the current state of medical treatment of this epidemic in most places I have worked. It isn’t this way because we don’t care. I work with incredibly compassionate and non-judgmental people who strive tirelessly to ease suffering and eradicate disease. But with meth, we just don’t know what to do.

And we don’t like that feeling.

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