One urologist’s painful lesson on the importance of self-care

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One night, I found myself sleeping on the couch in the surgeon lounge at the hospital at 1 AM while I waited for my turn to do a case. The following morning, I awoke with some pain just superior and medial to my left scapula. Bothersome, yes, but nothing terrible and I’ve had back pain for years so, like any good surgeon, I ignored it. A bit of ibuprofen and it improved.

A month later, I awoke with 10/10 searing pain going down the back of my left arm towards my middle finger. Thirty minutes later, I had pins and needles on that same dermatome and 30 minutes following that, I lost feeling. I had a robotic prostatectomy scheduled later that morning; tough to operate if you can’t feel your hand, so I went to the ER.

Turns out I had herniated my C6/7 disc with impingement of the nerve root. Steroids, physical therapy, and time didn’t help and the pain just wouldn’t go away. I tried to get an epidural shot and my insurance company put up numerous roadblocks (let’s just say we should be united against insurance companies placing profits before people). When I started losing some strength in my triceps (innervated mostly by C7 it turns out), we went to surgery.

I have no idea what happened. I haven’t had any trauma recently, I don’t do crazy lifting, I’m just a boring 45-year-old small-town urologist who works long hours and doesn’t have a primary care doctor.

While I was waiting in the ER that night, I was NPO (for no other reason than I was in so much pain I hadn’t bothered eating breakfast) and was talking to the ER doctor trying to make light of my situation (Is sarcasm considered a mature defensive mechanism? I doubt it), and I asked her to include a cholesterol panel with my other labs. I was having blood drawn and I was going to meet my deductible anyways, so why not? I was curious.

Turns out, it wasn’t very good. My BMI is 25. I exercise once or twice a week. Who’d have thought my cholesterol wasn’t perfect? The rest of me is.

And that made me think. According to the AUA’s Annual Survey, the average age of a urologist is 56 and almost 30% of us are over 65. If we as a specialty are going to survive and take care of an ever-aging population, we need to first take care of ourselves, both physically and mentally.

Physically, the easy solution is to get a primary care doctor regardless of your age, which I did. Turns out there were a couple simple things I could do to improve my over heath. If you don’t think you have time for a visit to a primary care doctor, here is a link to a wonderful chart put out by the United States Preventive Services Task Force (yes, these are the people who hate PSA screening and are ignoring the fact that the incidence of metastatic prostate cancer is on the rise ever since we decreased PSA screening), which shows by age and gender what you should be at a minimum screened for with links to the data behind their recommendations.

Mentally, we all know there are numerous barriers to health care providers seeking mental health care, but for those people with questions, options do exist. Your primary care doctor can point you in the right direction after a few simple, well-validated surveys. Another option is just to read a book. I recently read The Doctor is Burned Out: A Physician’s Guide to Recovery by Jeff Moody, MD and am better off for it.

And in case you’re curious, no, I didn’t do that robotic prostatectomy the morning after my first ER trip. One of the toughest phone calls I’ve ever had to make was to explain to my patient how since I had ignored my own health, one of my partners was going to have to cover the patient’s case.

Don’t be me; take care of yourself, because you can’t take care of patients if you don’t.