Captain Ahab is on a mission to avenge the loss of his leg. Over the course of a year, his crew hunts sperm whales and harvests the oil in huge barrels in the hold of his ship Pequod. The ship travels all over the world and finally ends up in the equator in the Pacific Ocean, Moby Dick’s home area. Despite many bad omens, including breaking of navigation instruments and a typhoon, Ahab is determined to pursue the great white whale. Moby Dick eventually attacks the Pequod, and even while the ship is sinking, Ahab tries to throw his harpoon at the whale. Instead, the harpoon rope strangles Ahab and leads to his drowning. All of the crew die except the Ishmael, the narrator. In short, Ahab and his crew suffered workplace injuries.
Let’s see what we can learn from this story in terms of workplace safety. These are the elements of worker safety to explore:
1. The environment
2. The worker
3. Extenuating circumstances
Environment: Most of us recognize certain occupations with higher levels of risk, such as construction work, whaling and open sea fishing, or firefighting, but we may not appreciate the risks of those who have sedentary jobs. Like Captain Ahab, it’s easy to be in denial about the risk of our work until something bad happens. A common injury of those who have desk jobs is repetitive strain injury (RSI). Anybody who uses their hands regularly to type, or click a mouse, or perform other repetitive tasks is at risk. RSI is not a medical diagnosis per se, but carpal tunnel syndrome (CTS) is one common form of RSI. Fine motor movements performed day after day can lead to damage of muscles, tendons, and then inflammation of nearby nerves. In the past, I would see patients in their 60’s and 70’s with pain at the base of their thumbs, but more recently I saw patients in their 30’s with thumb pain due to texting constantly. It’s not unusual to see young mothers with inflammation of the tendons of their wrists from lifting their baby constantly with their thumbs outstretched. Your body does not differentiate if you are using your hands for something work-related or fun. I have seen people with injuries from playing computer games or from knitting constantly or playing a musical instrument. In addition, poor posture while at work can lead to back and neck problems. While I worked at Kaiser, I spent 15 years seeing patients in the Spine Clinic. I was amazed to see young people in their 40’s with neck problems leading to pain, numbness and weakness of their arms. Invariably, this was due to looking downward toward their laptop computers resulting in compression of the cervical discs. Neck surgery was often required so these patients would not have further loss of arm strength. Be sure your work and leisure time environment is conducive to your health.
The Worker: There may be underlying medical or situational factors contributing to a higher risk for a work injury. These include not exercising regularly; not taking frequent breaks; having inadequate sleep; having poor posture; having an unhealthy or stressful lifestyle; drinking excessively or taking medicines that lead to being less alert; having excess weight; or having underlying arthritis or diabetes. (The latter increases the risk of tendon injuries.) The main culprit in most jobs, though, is overuse. We often don’t appreciate the risk that we are subjected to. No matter how fit you perceive yourself, there is always a level where your body’s capacity can be exceeded. I recall a 19-year-old patient who came to see me in Spine Clinic because of low back pain. He was built like a gorilla, but the repetitive work of replacing tires all day as a Costco tire installer was too much strain even for his back. Captain Ahab was another one who failed to appreciate his risk of a second injury even after he lost a leg in his same workplace environment.
Extenuating Circumstances: There are often extenuating circumstances when something happens to trigger a specific injury. A former colleague of mine injured her back when she tried to lift and move her desktop computer on her own. This activity was out of her scope of practice, and she did not ask for assistance. You may be asked to cut up some fruit and vegetables for a workplace party. Anyone should know how to use a knife, right? Well, one would think so, until you cut yourself. I recall as a medical intern accidentally sticking myself with the needle after I drew blood from a jaundiced patient, but I was too embarrassed to report this. This was before HIV was identified, but like Captain Ahab, I minimized the risk of the event.
Prevention: Here are a few tips to help prevent workplace injuries.
1. Ask for workplace accommodation even if you think your problem is minor. A better office chair that allows you to maintain good posture may help you be more productive. A teacher who is provided a microphone so she doesn’t have to strain her voice will be a more effective instructor.
2. Position your keyboard, mouse, and monitor so that you don’t strain or stretch to work effectively. For more information about an ergonomic workstation, go to Kaiser Permanente’s Office Ergonomics page.
3. Take breaks and stretch regularly. I love my yoga class I take at the PJCC!
4. Learn to use some keyboard shortcuts if you don’t do so already. This will help you avoid using your mouse frequently, and may even save you time. For keyboard shortcuts, go to Keyboard Shortcuts for Windows or Mac shortcuts.
5. If you are beginning to experience any hint of injury, rest from the activity that is causing the problem. Another option is to use your non-dominant hand which, by the way, also may help you prevent Alzheimer’s. If typing is an integral part of your job, think about voice activated software.
Summary: Please be aware of how you interact in your work or leisure time environment so that you don’t harm yourself or others. You likely have loved ones who care and depend upon your well-being. Don’t end up like Captain Ahab!
Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.
Editing acknowledgement: Ellen Saliman
Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider