Nothing’s black and white

I had a slight setback today.

But maybe it’s not a setback. I can’t tell.

We tend to think of medicine as clearly defined. Either you’re sick or you’re not. Either you’re better or you’re worse.

But the reality is much more complicated. The human body doesn’t operate in absolutes, even though our minds tend to. And those two things can be difficult to reconcile.

I thought about this as I visited the hand doctor at Hopkins Bayview this morning. It was the first time I’d seen him in about six weeks, and I was expecting it to be routine. It started out that way. The X-ray tech said the images of my hands looked good. Then the PA saw me flex my fingers (I can fully bend each of them without pain) and said they appeared well ahead of schedule relative to my injuries, which were multiple fractures in multiple fingers.

But the doctor had a slightly different take. He thinks the middle finger on my right hand isn’t healing quite right. He showed me the X-rays up close, which was the first time I had seen them in that detail. Before, viewing them from a distance. I thought the fractures were in a straight line across the finger bone (called a transverse fracture). That’s how we tend to think of a bone breaking. But as I learned today, that kind of fracture is very rare in fingers. What I have are oblique fractures, which go diagonally across the bone. This type of fracture is much more common in fingers.

(I also found out that my right pinkie finger was indeed fractured. During previous visits, the verdict was that it was not broken. The initial diagnosis in the ER, meanwhile, was a fracture. X-rays might be literally black and white, but figuratively they are not.)

I thought that all those fractures had more or less healed. But the X-rays showed small, dark lines were the fractures had occurred. The bones are healing, but they are not quite healed.

And that’s where the uncertainty lies. The doctor says the break closest to the tip of the middle finger doesn’t appear to be progressing quite as well as it should. The others are fine, but that one is lagging.

I’ve noticed since at least my last visit to the hand doctor that the fingertip is now a little crooked, veering a bit toward the ring finger. Sometimes broken fingers heal a little crooked, and that’s perfectly normal. In this case, the fracture is causing the finger to be crooked.

I thought I was done with wearing finger splints, but today’s visit means that I’m not. During my appointment at the physical therapist on Friday morning, I’ll be getting a new splint to wear on that one finger at night.

In a month, I’ll be back at the doctor for more X-rays. If the bone still shows troublesome signs. graft surgery might be the next-best option. I thought I was well beyond the point where I might have to have a hand operation, but as I’ve been finding out, health problems are often not that easy. If the bone were to heal incorrectly, I could be stuck with chronic finger pain the rest of my life.

A Philadelphia sports fan with a chronically painful middle finger … no, I don’t want to be that.

Maybe the bone will heal OK. Maybe it’s just taking longer than would be expected. Maybe this new splint will help things along. That’s a lot maybes, but they’re all possible.  As I’ve found out, doctors — really good ones, like mine — look at these problems through a lens heavily tinted by caution. I’m constantly finding out that I know less and less when it comes to health, but I do know that’s the best approach.

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