Monday, February 23, 2015

Waiting to Go Under the Knife (i.e. pray for my surgeon)

essentially me, but not for much longer

Note: I asked for prayers for my surgeon. It's really my anesthesiologist who needs prayers. Unless it's a cardiac surgeon, the surgeon may maim you or, in the case of a neurosurgeon, leave you in a state of paralysis or permanently diminished mental capacity, but it's your anesthesiologist who holds the power of your life or death in his or her hands. The worst my orthopedist can do is to render me lame. My literal life is in the hands of my anesthesiologist, which is why I don't want to become an anesthesiologist.

WARNING: If you're squeamish or easily sickened, skip the first paragraph or so.

I'm still alive, or at least the machines tracking my vital signs indicate I'm not dead yet. The Nazis controlling such matters do not want to give me any pain meds prior to surgery, so I'm suffering through pre-op with a throbbing foot and a migraine to boot. When I tossed my cookies -- no actual cookies, as I haven't eaten for over twenty-four hours and have drunk only what was forced down me --  but the gastric system has its way of producing just enough fluids, for awhile, anyway, to sufficiently gross out the pre-op staff so that they were motivated to at least administer anti-nausea meds. Even those meds are making me slightly loopy, but not loopy enough.

I wouldn't be in pre-op right now had my father not sort of pulled rank (false rank, as he has no actual clout here, but his name alone is enough to make staff members who don't know any better quake in their shoes), and he not thrown a minor conniption fit in the E.R. last night. I went there [by ambulance because my dad didn't want me to be triaged behind such patients as a teenager having an anxiety attack who arrived in an ambulance on the dollar of the State of California*** (your and my tax dollars hard at work) and have to wait for hours, as happened when I had the initial injury because I had a severe migraine and was dehydrated, and there's a limit to how much migraine medication can be taken in conjunction with narcotics, or whether narcotics should be taken at all in the presence of a migraine unless it's the most severe of migraines that will be alleviated by nothing else. 

My parents will pay in a big way for the ambulance ride, as I don't think even my dad will be able to convince the insurance carrier that the ambulance transport was medically necessary, but it was well worth the cost, even though it was about a two-minute ride. By the time the ambulance crew did everything they were required to do or for some reason thought was necessary, it would have been far quicker to have put me in a wheelchair and wheeled me there on the bike path with an umbrella covering me, as it was drizzling outside, but what's a few hundred dollars when all is said and done?  I'll pay the bill myself if anyone complains.

My dad  looked at my Xrays for the first time and more or less blew up at the attending orthopedist who has been covering for the guy who is supposed to actually be handling my case but who has had more pressing matters with which to deal than reviewing my Xrays, reading the radiologist's report, or examining my foot (this applies both to the attending and to the guy who's actually supposed to be the attending). 

It was an ugly exchange. My dad berated the attending orthopedist, who was irritated as hell for having been called in at 11:00 pm, for not having personally examined the Xrays. He told the guy I would have received better care from a physician's assistant, or, for that matter, could have read and interpreted the Xrays myself, which I actually did. The orthopedist, or at least the man who calls himself an orthopedist, told my dad he was some sort of world-acclaimed oncologist who thought because of his status in his own field that he knew everything about everyone else's field as well. My dad countered that in addition to being an oncologist and hematologist, he was also a board-certified E.R. and trauma specialist, and he at least knew enough to 1) look at an Xray of a patient (if an injury is serious enough to require an Xray, a doctor treating a patient needs to personally review the Xray, or even if he's too lazy to do that, at least read the #$%^!! radiologist's report when it becomes available); and 2) to know when he's in over his head and to call in someone with sufficient expertise in the field.

The orthopedist blew up at the notion that he, Dr. QRS, lacked sufficient expertise in his field to handle my case or any other.

My dad commented that both the Xray tech and I, the patient who happened to be a 2nd quarter medical school student, had correctly noted the fractures the Xray displayed.

"Great. Your daughter's a genius just like you think you  are. She'll be a fabulous addition to our program!" he muttered. (Note: I may not be a genius, but my father legitimately is one.)

The nursing staff knew a major fracas when they heard it, so they had in the meantime called in another orthopedist -- a young woman one year out of her second fellowship but regarded as highly competent, and who must have already been on the premises to have arrived so quickly. She pushed the curtain open, introduced herself,  announced that, with the patient's consent, she would be taking over the case. The previous orthopedist, who wasn't even technically managing my case but was covering for the doctor who was supposed to be in charge, semi-roared at her, "And who the hell do you think you are?"

She extended her hand and said, "If memory serves me correctly,  I just introduced myself, and I believe we've also met previously on numerous occasions, but, for the record, once more, I'm Dr. XYZ. I'm pleased to meet you once again." Dr. QRS kept his arms folded, ignoring her extended hand. My prayer is that Dr. QRS doesn't get relegated to med-school faculty or even clerkship rotation supervision, because I'm sunk if I'm ever under his authority. I offer my praise to God, Karma, and everything else in the universe that orthopedics has never been my specialty of choice, because if it had been, my options would be to change specialties or risk being bounced from the program by an attending supervisor who clearly has it in for me.

I gave her my oral consent and told her I'd sign any needed forms indicating such. Dr. QRS gave my dad a prominent display of his middle finger as he practically tore the dividing curtain from its moorings, storming out. 

Cutting to the chase, the new orthopedist viewed the Xrays, agreed that I should have been admitted at the time of the injury and that traction probably should have been the treatment until surgery was possible. I spent last night with my leg in the air and some mechanism applying force to the bones in my foot. 

I'm now awaiting surgery. It's a heavy day in the O.R. Life-threatening emergencies take the numero uno priority, followed by diabetics, followed by children. Routine cases such as myself take the few remaining spots. Were I not related to someone at least semi-important, I would not have gotten even one of the very last slots.  If (God forbid) enough traffic accidents happen between now and the end of the day, I won't even get one of those slots. If all goes as planned, I'll go into surgery at 2:30.

*** I'm a child of privilege, and I readily acknowledge it. As such, I'm slow to criticize those whose health care is provided by the state, as there but for an accident of birth or but the grace of God go I. Still, I think it's too easy for a family whose medical care is entirely free to pick up a phone and dial 911 for an ambulance when they could easily load their fifteen-year-old daughter into a car and drive her themselves to the nearest hospital. I believe -- albeit without a whole lot of evidence to back up my belief -- that it was an attempt to circumvent triage and a lengthy ER wait, that they chose ambulance transportation rather than transporting their daughter themselves to the ER that motivated them to rely upon 911 and the ambulance service. 

The mother told the triage nurse that what she thought was wrong with her daughter was a gall bladder attack, which turned out not to be the case. (Those curtains in the ER may prevent other patients from seeing what happens, but they're far from soundproof.)  In most cases, even a gall bladder attack wouldn't merit an ambulance ride for an otherwise healthy fifteen-year-old.

If a family receiving public health benefits were charged a co-pay of fifty or even twenty-five dollars for an ambulance ride, they might consider driving their child to the hospital themselves. I know they have access to motor vehicles, as evidenced by the roughly fifteen relatives who found their way into the ER to take up all the available chairs (so that one was not available to elevate my foot while I waited to be seen) to offer profuse sympathy while the girl hyperventilated, probably causing her to hyperventilated all the more. 

Every so often, a nurse would make his or her way over to the spot where the girl's entourage had set up camp and would tell her to cut it out with the hyperventilation and to breathe normally. One nurse even told the family and friends that they were making things worse by enabling the girl in her belief that her situation was more serious than it actually was. A family member threatened to report the nurse to the higher-ups.

Even if the parents themselves lacked possession of a car, at least one of those concerned friends or relatives could have driven mija to the hospital. A twenty-five- to fifty-dollar co-pay would likely have eliminated the ambulance ride and would probably have prevented the fifteen-year-old hyperventilator from being treated before I was. If I sound a bit bitter, it's because I am.



  1. Good luck Alexis.

    Orthopaedic (note the variant spelling -we still use diphthongs!) surgeons are generally regarded as being one step above gorillas in the surgical world. If you REALLY need one ,try to find one with a resemblance to a Homo Sapiens and with a spark of empathy. Most treat the Xrays rather than the patient. After extensive orthopaedic surgery I mentioned to my surgeon ,whose resident I had been in a previous life, that the after effect of this operation was instant middle age. His response ." I'm not interested in the psychological aspects of orthopaedics". He can not recognize me at social occasions despite,as I said , my having served as a resident on his unit.

    Thankfully you have people going in to bat for you.

  2. I wish you a speedy surgical recovery and subsequent healing. I'm glad that you weren't entirely alone during this situation, and that your dad came to the rescue. I am sorry I didn't see this earlier.

    1. PS: Maybe you can get some type of extra credit for this?

  3. Get well soon! Your blog is like a new season of ER. Your dad rocks.