El Communicado Non Comprehendo Part III

(A View of an Orthopedist’s Office from the Inside Window Looking Out)

By the time I was nearly an octogenarian I had assumed new environments would not often be part of my life. I had been in my home community for decades and was used to its attendant communication challenges. My high school teaching days were long past, which made the memories of overcoming generation gap challenges more amusing than challenging. I had lived at Pheasant Run Airport for 40+ years and dealt with hundreds of people visiting and attending events, so I felt adept at relating to folks from many different areas.

Then, during the pandemic, I found myself in the middle of a medical environment that I could not have predicted would ever happen. My husband Chuck, a victim of a bad aircraft accident in 1979, had been a patient of Dr. Patrick Hergenroeder’s, an orthopedist, for a couple of years. After Chuck died in 2008, the doctor did arthroscopic carpal tunnel surgery on my hands and also did conservative treatment for my arthritis.

In 2017 Patrick and I began dating, and when his receptionist in his Geneva clinic became ill, he asked if I would take over her one-day a week duties. At first, I was aghast at the idea, as visions of a computer full of data ran through my mind. Quickly he told me all work in that office was done on a TYPEWRITER.  Although my own computer no longer intimidates me, I am still not prepared to work on a strange one. Plus, Patrick explained to me that all scheduling and almost all phone calls were handled in his Chagrin Falls office and I would be mostly working with folders in dealing with patients.

Very much an individualist in how he organizes his practice, he does not go from one treatment room to the other with a rolling computer. He refers to the folders, makes written notes, and after each patient leaves, speaks on a Dictaphone, which gets transcribed at his Chagrin office.

Learning how to set up the folders and interpret insurance cards required that I make two trips to Pat’s Chagrin office, where his long-time receptionist, Sue Hawkins, spent a few hours with me. That office itself was a bit overwhelming since it houses Patrick’s 47 years of orthopedic records, numbering thousands of patients’ folders, many of whom had more than one surgery. There are additional files in the Geneva office although not as many as Chagrin because Geneva practice is “only” 22 years old. He has done over 30,000 surgeries and in recent years practices at Ashtabula County Medical Center.

Being behind the window of a doctor’s office is a much different experience than being a patient looking in. For one thing, my “assignment” began during the height of COVID, and Pat built a Plexiglas barrier at the patient window. Paperwork is slid under the window. Knowing that my hearing is damaged, he got a little microphone/speaker and threaded it from outside the window to an inside plug. He did not like the cord showing across the long desk and was determined to hide it behind the heavy desk, but there was no moving it.  I told him to give up the idea of hiding the cord.

Not one to give something up when Plan A doesn’t work, he sat on the floor with his feet against the wall, having remembered that the wall was drywall, not plaster. The cord dropped out of sight as he pushed on the drywall. It was a lesson that I would learn about him repeatedly from his descriptions of surgeries. One of his statements about x-rays, MRIs and CT scans is that they are never perfect, and “you don’t really know what’s inside a surgery site until it is opened up.” I have learned that what sets him apart from many other orthopedic surgeons is the ability to make unexpected adaptations when finding an “uh-oh” inside a patient.

Dr. Patrick Hergenroeder many years ago earned a diploma in hand surgery and now considers it his favorite specialty. Shown here is the hand of a man who had Dupuytren’s syndrome, a condition in which the fingers grow fibrous tissue that interferes with movement.  Left untreated, the hand becomes claw-like. The surgery took 2 1/2 hours because of the need to scrape away all the offending tissue.

In addition, many ortho doctors specialize in a specific part or a few parts of the body; there is the knee/ hip specialist, the shoulder/collarbone specialist, and sometimes the back specialist. Pat has diplomas in a dozen different orthopedic areas, each one having its own anatomy, set of terms, and required procedures. He seems especially fond of working on hands because he is fascinated with details, and the human hand is one of the body’s most intricate structures.

Between that first day working in the office 2 ½ years ago and now, I would discover many things about human nature that were new to me. Certainly, most adults are aware of the obesity problem now rampant in our country, but being in an orthopedist’s office was still an eye-opener for me. Most of the patients are 60+ years old, and having slim people come through is a rarity, except for ones that have had accidents of some type.

We have a Patient Medical History form that each new person to the office fills out. Listed are varieties of conditions, which include “obesity.” I was rather surprised that most people who fit the description are willing to check it off. Also, almost always checked off are various heart issues, high blood pressure, diabetes, and lung problems. As Pat says, “Obesity is the mother of almost all ailments.”

Pat has operated successfully on many obese people, and only in extremes does he turn them away with “Sorry, you must lose some weight before I can fix you.” One man who came through was bent over at an 80- degree angle to the floor and had a huge gut that hung down three or four feet. Pat told him he would not survive back surgery and would never walk again if by chance he were to survive it.

I knew that there would possibly be many interesting, offbeat people come through the office. It didn’t take long to learn that if a married couple came through and the man was the patient, he  typically had long ago assigned his wife to take care of his medical records. Sometimes the married men can’t even find their insurance cards. Men also tend to know less about medical terms than women do. I had to look straight down at my desk to hide laughter when a 31-year-old man couldn’t find “hernia repair” on the medical history sheet and asked if it was anything like a hysterectomy.

A good number of Amish people are Pat’s patients, some of whom work at the cabinet company in Middlefield and sustain hand injuries. Working at many trades and doing agricultural work make them more prone to injuries also. One man, although not Amish, owns a lumber company and had jammed his hand in the space between his truck bed and the tailgate when it dropped down. His hand looked like one solid, mashed mess; three months later, after Pat repaired the fingers, all of them worked and his hand looked normal.

It is also rather amazing to see the offbeat things people can come through a doctor’s office to have treated. Sometimes their problems are obviously embarrassing to explain so they make up stories about the causes. One young man came through with a perfectly lined up row of infected puncture marks, obviously needle marks from injected drugs, inside his forearm. He said they were spider bites. Yes! And that spider must have had a tiny ruler to line the bites up like that.

A teenager, obviously a nail biter, had an infected index finger with a tip that looked like a wilted red tulip. Pat worked on the infection to get the worst cleaned out and told her to meet him at the hospital’s emergency room in a week for a check-up. As he was driving into the hospital’s lot, he saw her on the sidewalk going rapidly away. He opened his car window and yelled, “Young lady, where are you going?” She yelled back, “Doc, I just can’t DO this anymore.” She knew he would have to remove more tissue. He never saw her again.

Occasionally a prospective patient comes in who has difficulty filling out the forms. One section on the medical history sheet asks for names of medications being used; it didn’t take me long to realize that pharmaceutical companies must have different systems for naming their products than most businesses do, and one requirement is that names must be long. It is rare to find a prescription drug name of fewer than three syllables, and most take full advantage of the lesser used letters of the alphabet, such as Q, X and Z, maybe because there are so many different drugs. One ointment for various skin conditions has a name of two words and nine syllables, as if anyone can easily remember that. It made me wonder what would have been wrong with just calling it “Itchnomor.”

Because hand injuries are a major part of Pat’s practice, sometimes, if a dominant hand is bandaged, I fill in the patient’s form. This worked fine until a Hispanic -speaking man came through. I do not know any Spanish but was lucky to find that another man in the room knew the language and could help me with the words.

Other than these general unfamiliar experiences that came my way in the office, there have been quite a few patients who earned a special place in my memory, so I will describe them individually. Patient names used in this section are pseudonyms, whereas names of the clinic’s staff are real.

not Tatianna

Tatianna –The Walking (not very far), Talking (a lot) Charm Bracelet:

Admittedly, it took me a long time to get used to the idea of tattoos on women, and I have struggled to get more tolerant. Tatianna came in with a knee problem, 19 pages of medical history (printed on both sides of each sheet), and more tattoos and body piercings than I’ve seen on any five other women combined. It was winter, and she was wearing shorts, apparently to show off her body art.

Because she had been limping so badly on the way in, I greeted her in the waiting room and sat opposite her to explain the paperwork she would need. She had multiple piercings in her eyebrows, on every inch of flesh on her outer ears, three “hoops” through her nostrils, and more on her tongue than I could count.  She had little skin that was not tattooed. Some of the piercings were circles/hoops from which dangling charms were hung, and they swung from side to side with every move.

Her medical history sheet listed many conditions, procedures and medications that she’d endured; she began a long diatribe about all of them to make sure I understood that she had been ill most of her life. Earlier Pat had explained to me to me the harmful effects of tattoo ink and the worse ones about body piercings. It took great effort on my part to not launch into a health talk with Tatiana, even though it was too late to do anything positive.

It brought back thoughts of my years at Riverside when I didn’t hesitate to point out to kids the dangers of smoking, illicit drugs, junk food, dating hazards, anabolic steroids, even sunburn. By no means did I limit my “sermons” to their bad study habits or careless schoolwork, but with Tatiana being an adult, I forced myself to recognize she had “rights” as an adult.

It would have been interesting to know what ran through Pat’s mind when she was called into a consult room, but he can maintain a deadpan look better than anyone I know. I also wondered if she had ended up getting an x-ray and what Cindy Storm, the x-ray technician, would think when Tatiana jangled up onto the table, or maybe an x-ray was not possible because of all her metal. Later I learned this patient had sent even Pat beyond his tolerance level and he got her out of the office quickly after a Lidocaine shot in her knee. After all, what difference would one more needle into that body make?

Cecelia – Noah’s Ark in a Wheelchair

Cecelia had aroused my curiosity several months before she came it to the office. She had made three appointments, all of which she had called and cancelled, in a very whiney voice, about an hour before she was due. Each phone cancellation included long descriptions of her ailments. When her name showed up on our appointment sheet a fourth time, I fully expected another cancellation but then looked out onto the ramp just as she arrived, being wheeled in by a young fellow (in my description anyone under 40).

The man had a decidedly difficult time pushing her up the slight incline of the ramp because she was huge and he wasn’t burly. Kinky, light gray hair came down over her back and shoulders and reached almost to her elbows. It was loaded with barrettes, clip- on bows and trinkets of every type imaginable: tiny plastic dogs of many breeds, along with all sorts of wild animals, and trees, flowers and hearts scattered in for good measure. The doo-dads were in rows extending from her crown to the hair ends. She wore a blouse of immense size and a full skirt that reached to her feet.

When I asked her to update paperwork, she said the young man would do it, and I asked if he was her son, trying to ascertain if he was knowledgeable enough to have her history.  He responded, “Oh, no; we’re not related; we are together.” Not wanting to pursue what “together” might mean,  I gave him the questionnaires.

As I was getting both Tatiana and Cecelia processed, I wondered how long their adornments must have taken to fix in place –  all day each time they were going somewhere? Cecelia probably didn’t go out much, but Tatiana seemed to have spent most of her life in doctors’ care. Did the stuff they wore get removed each night? That is another question best not answered. Imagine sleeping with all that metal attached to one’s body.

(At the opposite end of the extreme approaches to living one’s life the above women represent, there are three heart-warming patients’ stories that stand out from the past two years).

not Barbara and Jenny

Barbara –How To Grow Old Gracefully – Barbara had been a patient of Pat’s for several years and had been treated for a variety of issues. In mid-2021 her daughter Jenny pushed her mother’s wheelchair up the ramp, and the sight of Barbara’s injuries was heartbreaking. Her face was bruised with lacerations, and she had two black eyes. Her arm, knees and ankle were wrapped. I believe she had originally been treated in an emergency room, so the day in the office was a follow-up. Her head was bent down and she seemed barely awake; her file listed her age as 84. Jenny explained to me that her mom had fallen face-first onto concrete steps that went upward from a sliding glass door in their home, where they lived together.

Barbara was fighting infections from her injuries, and their first trip was the beginning of several over a few weeks, so I had the opportunity to talk with Jenny about her mom. She had been married several times and currently had a “boyfriend” in his 90s who lived nearby and visited them almost every day. Jenny liked the guy a lot, her only complaint being that he always came to visit right after lighting his trash pile so he hauled ashes onto their carpet.

In the process of discussing her mom’s past, I told Jenny I had noticed she herself was wearing what looked like an engagement ring. She responded, “Oh, yes; I have been engaged to a great fellow for 27 years. He loves my mom as much as I do.” I responded that there was no sense in rushing into marriage.

Barbara’s skin was transparent and had the tissue paper look; it was difficult to imagine how her injuries could be treated adequately, but over successive visits, she gradually grew talkative and lively and spoke of how good she was feeling. Her broken arm and ankle healed infection- free. One day she came in with a walker, and on her final check-up day, she came up the ramp with only a cane, sporting a perfect hairdo tied back with a bow and giving everyone a huge smile.

After having seen many patients come into the office with their obviously weary, impatient family caregivers, I had to compliment Jenny for the loving care she always exhibited toward her mother. Jenny had been cheerful and upbeat from the first day on. Pat later told me that he had said to Jenny as they left, “Your mother could not have made this recovery without her loving daughter.” Jenny was teary-eyed as they walked out.

not Sarah

Sarah – An Example of a Brave Teenager

Pat had treated an Amish man from the Windsor/Orwell area; one day he called the office about a girl in his community who had some sort of leg problem. He told Pat that Sarah’s leg left leg was “off to the side so she can’t walk on it.” An appointment was made.

The 15-year-old was accompanied by her mom and dad, who had rented a van to make the trip. The mother was carrying a 5-week -old baby, and she told me that Sarah was the middle child of nine. Both Sarah and her mother were petite, and the father was well over six feet tall.

Sarah’s foot was nearly at a right angle to her other leg; she was skilled with crutches enough to make it obvious they had been lengthy companions. X-rays showed that the ball of Sarah’s hip was very much out of place. Pat’s first inclination was to refer Sarah to a specialist in juvenile orthopedics in Cleveland, but when he posed that idea to the family, the father responded, “CLEVELAND. We can’t go to CLEVELAND.”

Pat settled him down and told them he would make some phone calls and do research, although from his x-rays, he had a good idea of the problem. Further consultation determined that Sarah had been a victim of abnormal growth plate problems at puberty and the hip ball had been forced out of place. After telling the family he would do more research and get back to them, he spent hours studying this rare condition and determined how he could operate on her.

Sarah ended up with a 2” incision and a leg that gradually began turning into its correct position. After several months of recuperation, on her final visit, the entire staff at the clinic gathered in the hall as Sarah gleefully walked a steady, straight line; she would have skipped had the hall been long enough.


Danny– A Stoic Little Boy

Early last fall the same Amish fellow who had called Pat about Sarah called about a 5-year- old in his neighborhood who had fallen while playing; he said, “We think his arm is broken.” The “we” in his statement was no doubt the consensus of numerous parents’ observations. It was about 5:30 pm on a Friday; Pat asked if a ride could be gotten to bring the boy and said he would wait at his office if so and see what he could do.

Although Pat’s patients are nearly all adults, he recognizes the limits of the Amish community and knew that had the father and child gone to a hospital’s emergency room, it would have meant an over the weekend stay because of limited staff, which would have created a huge hospital bill with nothing accomplished until Monday.

Meanwhile, he set up the x-ray room; the father and the little boy arrived within an hour. It was a simple greenstick break; Pat moved the bones manually into place and took the child into the “cast” room and set it. He remembered that he had two very old child-sized slings in storage and got one, which fit Danny

“Danny’s” exay

perfectly. There was not so much as a murmur or complaint from the little guy throughout the procedure. When his dad lifted him off the table and gave him back the drink he had hadn’t finished on the way up, he marched quietly out of the office holding his dad’s hand with his good arm. Pat took his picture on the way out.

After hearing this story, I was eager to see Danny when he and his dad came back for a check-up the following week. I went out to the waiting room and asked the boy how his arm was. No response, but the father said he seemed fine. Nothing I could say to the child elicited anything but a slight smile. Pat later told me he had not heard a word from him either because the family spoke only German at home.

The day they came back for another check, I couldn’t resist watching from the door. Danny looked up at his doctor with complete fascination and no fear whatsoever. I told his dad on the way out that he was absolutely the cutest little boy I had ever seen. I could not help comparing his behavior to numerous children I had witnessed in other doctors’ offices – ones that were restless, complaining and out of control.

In watching both Danny and Sarah, I formed the conclusion that the Amish have both admirable faith and a stoic attitude, one formed by people who live simply and close to the earth. Certainly, the loving discipline they exhibit with their children is worthy of emulation.

It has been a pleasure for me to work in the Geneva clinic with such personalized, well-rounded care for patients. Pat’s Chagrin Falls clinic operates in much the same fashion.   Also present in his clinics are physical therapy departments for follow-up care. Head of the PT department is Shawn Segulin, an affable, patient man of great skill and knowledge. Rounding out the caring dedication for getting Pat’s patients well are therapists Cassidy Defranco and Logan Leichtman.

Gretchen Reed

There isn’t a day in the office that doesn’t present something interesting to ponder. We don’t get a large number of young people as patients, but one day a young man with a broken arm was watching me type. He said, “I heard the noise and realized I hadn’t seen a typewriter anywhere but in my grandmother’s house years ago.” I just smiled at him and said, “Mine makes perfect sense, then, doesn’t it?”

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