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• W4214551536 abstract "FigureThis 21-year-old young man has come back to the office to review the results of his recent laboratory studies. I had left a voice mail message on his cellphone, informing him that all results were within normal limits. Perhaps he didn't pick up the message; maybe there was a glitch. In any event, here he is, dressed in the same worn T-shirt, the same soiled work pants, the same steel-toed black leather boots, the same ball cap cocked back on his head. I saw him 2 weeks ago. He had come in with complaints of numbness and tingling in his hands and feet of several months duration. He worked in a machine shop for the previous year and a half. For the most part he was on his feet all day, setting up jigs to form custom pieces used in the construction of commercial aircraft. Sometimes he used chemicals to clean the metallic parts; sometimes he wore a mask when performing these tasks, and sometimes he didn't. His medical record showed that he had been seen for irritant dermatitis of the hands 6 months ago, presumed to be secondary to exposure to chemicals in the workplace. Otherwise, with the exception of arthroscopic knee surgery for a meniscus tear 5 years ago and periodic migraine headaches, he had been in good health. The initial physical examination demonstrated good bilateral motor strength in the upper and lower extremities with no focal neurologic signs or sensory deficits; there was no clinical evidence of arthritis. I discussed his symptom complex at length and elected to order a couple of laboratory tests to screen for inflammatory conditions. “We'll check a few parameters,” I said. “Most likely they will come back normal.” And they did. “How have you been doing in the meantime?” I ask him. He shrugs his shoulders. “Nothing much has changed. Still get the tightness in my hands and feet.” “Have you been going to work in the meantime?” “Pretty much,” he says. “And how has work been going?” “About the same,” he says. “I'm pretty beat by the end of the day.” “How do you spend your evenings and weekends?” “I usually go home to dinner, maybe watch a little TV, then hit the hay. Weekends I work on the ambulance crew as an EMT.” “How long have you been doing that?” “Maybe a year or so.” “How do you like it?” “It's okay. We went out on a call a month ago—motor vehicle accident—turned out to be a friend of mine from high school—dead on arrival, nothing we could do.” “That must have been hard to take. Did you talk to anyone about it?” “Just the guys on the crew—that's about it.” We sit in silence for a few moments. Then I ask: “How do you feel about your job? Think you'll stick it out for a while? What do you see yourself doing in 2 years, 3 years, 5 years?” He thinks a moment. “I don't know—it's hard.” He bites his lower lip, strokes it with his teeth. “I look at some of the older guys, workers who have been there for 25, 30 years. They're in their 50s, shuffling around, bent over, always achy, in some sort of pain. I look at them and say to myself, ‘God, is that going to be me in another 15, 20 years?’ I don't know, I just don't know....” His words trail off into a whisper. “Perhaps you need to do some soul-searching, maybe consider a career change,” I say. “It certainly wouldn't hurt to look around.” “I've thought about it, but the place I work, it's a small shop, family owned. My boss is actually a cousin of mine. He's 10 years older than me, give or take. He kind of got me the job, so I feel like I owe it to him to stick around for a while at least.” “I understand your dilemma,” I say. “But in the end it's your life, no one else's.” Gradually, he nods his head. “I guess you're right. I guess I've got some thinking to do.” I offer him my hand. “Come back and see us if your symptoms worsen or persist,” I say. “If you need to talk, our door is always open.” There are many things in medical practice that we can't fix. Hearts have their reasons, of which reason knows not. Sometimes reassurance and a listening ear are the most we have to offer." @default.
• W4214551536 created "2022-03-02" @default.
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• W4214551536 date "2021-02-01" @default.
• W4214551536 modified "2023-10-17" @default.
• W4214551536 title "Back to the future" @default.
• W4214551536 doi "https://doi.org/10.1097/01.jaa.0000731548.02061.61" @default.
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