Saturday, November 5, 2011

Surgical strike Pt 3

Report on arthroscopy:

I rode to surgery in a C-class Benz; my driver is one of the owners of the company that manages the surgery centre (and others in the Bay Area). The place is a freaking assembly line, but I suppose that’s pretty much the case for all such organizations these days: maximize the ROI, keep the product coming through, cut and move on to the next one.

My procedure was scheduled for 0745 and I wasn’t the first on my surgeon’s list. The recovery room holds 17 beds and I imagine there are times when they’re all full.

Successive cohorts of nurses asked me the same questions about history and meds I’d been asked twice before. They had me initial both knees, just to show I was knowledgeable about what was going to happen (ordinarily they have you initial the limb in question to ward off lawsuits, but in this case it was both). AJ, MD, stopped by for 37 seconds, gowned, masked and capped for one of his other gigs, and that was the last I saw of him.

Conversation with the anesthesiologist—he’d assumed we were going general and was surprised when I said I wanted local and AJ, MD, had approved. He had to check, but we did go local with heavy sedation. So, in the end, I still didn’t know what went on in the OR.

I woke up in recovery at 0840 and within two hours I was back in the Benz on my way home. Knees bandaged, but no real pain.

The driver helped me up to my flat and I spent the next few hours reading, dozing and icing. Turns out I didn’t need the crutches—although I’m sure it made the nurses feel good that they taught me how to use them. My discharge says I can bear weight, so I’m doing it. 


Haven't really needed the Vicodin. I took one tab yesterday because, you know, I could; but nothing since.

Whatever they gave me still made me a little nauseated, but by early afternoon that was over.

I’ve spent the weekend so far in my flat, but I’m walking about pretty normally, and I reckon tomorrow it’s time to get down the stairs & see how I manage the clutch.

The nurses said they’d call to check on me today, but it’s gone 1830 and nothing. I will say that this is the first time I’ve had no follow-up (and usually it’s been from the surgeon), but I’m not surprised. I’m not a sports star and I expect they figure that if I were in trouble I’d have called.

I get the pressure bandage removed officially (I’ve already pulled it off, just to see what’s there—gauze with a splash of blood on the interior side) on Monday and my first PT session on Friday. Don't see AJ, MD, until first week in December.

Glad to get this behind me.







Friday, November 4, 2011

Surgical strike Pt 2

Okay, ready for arthroscopy.

Turned down the opportunity to rent (at my own expense—insurance companies won’t reimburse) a cold therapy unit. 1) The description of how it works kind of scared me. 2) I don’t know how I’d haul it up two flights of stairs while on crutches. 3) I have plenty of ice bags and bags of ice and I know how to use both.

Finally (after several calls) connected with the driver who’s hauling me to and from Burlingame. Not feeling overwhelmed by competence here; but he’s a practice employee, so it’s on him to get me there on time. He’s picking me up at 0530 for a 0630 arrival at the centre.

Gave the same health/prescription information to the surgical centre nurse that I gave to the surgical nurse last week. They may be testing me to see if I'm sticking to my story.

Procedure scheduled for 0745. I’m hoping to be on my way home by noon.

Seriously looking forward to not having to deal with any work nonsense until Monday. There’s less pain involved in surgery on both knees than in what’s going on there.



Thursday, November 3, 2011

Surgical strike

Some time tomorrow, I’ll be in a surgical centre, having arthroscopy to repair torn menisci on both knees.

Imagine my joy. I live in a third-floor walk-up.

But it has to be done, and as long as that’s the case, better get them both fixed at once to minimize the time spent hors de combat. Also—better to have the procedure while I’m still covered by the best health insurance I’ve ever had. It’s about an hour of actual cutting time and then the sharp pain I’ve been having for the last few months goes away. (Okay—after a weekend of icing and six weeks of physical therapy.)

But I have a few observations about the process.

First of all—what is it about surgeons that sends them off the scale of arrogance? You don’t find rheumatologists, obstetricians or endocrinologists swanning around with quite the air of godhood that surgeons exude. I mean, we’re talking the same aggressive egos you find in cops. I’ve come up against around ten surgeons (in their professional capacity) in my time. Two were actually decent human beings; the rest were either complete or borderline jerks.

This one, Arrogant Jerk, M.D., is one of the worst. Here’s what I mean:

I wasn’t all that impressed with his interpersonal skills on my first visit, but I did get the sense that he knows his orthopedic onions. Plus, he’s part of a sports medicine practice that treats players from the major professional teams around here, and those guys have real bone and joint problems that need to be fixed. The way you’d fix a racehorse, on account of it’s got to be in the best shape possible and a lot of money is at stake.

But their surgical centre is in Burlingame, about 30 miles up US 101 and I balked at trying to find someone who could schlep me up there and back. So at our second meeting, when we went through the options, I asked him who he would have do the procedure if it had to be done in the South Bay, since I didn’t have anyone who could drive me up to their facility so far away.

He visibly stepped back—what? I wasn’t going to automatically sign up with him? WTF? He professed to know of no one, but then asked if I could make it to Palo Alto…because he has privileges other places… Well, yes, okay, I could do that. Alright, then—he’d make a special exception and perform my surgery there and then scoot up to Milbrae (he lied about where the centre is to make it seem less onerous to me) to open up the factory line.

Only when I finally reached his surgical coordinator, she said AJ, MD, already was scheduled for that time in Burlingame and “he can’t be in two places at once”. Well, if he’s the god he thinks he is, I don’t see why he couldn’t manage that, but never mind.

(Also never mind the fact that they tell you in person and on their web site that you won’t know when your procedure is actually scheduled until 24 hours before, so I’m not understanding how he could already have that precise time blocked more than a month away.)

However—and here you could hear the sound of something sour in her mouth and something sharp up her butt—the centre will send…a car to pick me up and take me home. She said it wonderingly, as though she couldn’t believe this was happening. AJ, MD, had decided he didn’t want to do the surgery at Stanford, he wanted to do it at their centre, so they’ll supply a car service.

Now, ordinarily medical professionals won’t let you go home alone after any procedure that involves anesthesia because they want to think that there’s someone around you in case you suddenly get sick or a blood clot or something. They don’t look too closely at who it is who’s carting you about, but this is unusual enough that when I mentioned it to the surgical nurse last week, she couldn’t believe it.

(And here’s where I wonder what’s up with this? I mean, I understand that AJ, MD, gets a cut out of the surgery centre’s exorbitant fees, which he’d miss if he did the arthroscopy at another facility. So that’s maybe $10K-15K for the centre on top of his $3K-5K fee. And in the face of that, $200 for a car service is like a couple of extra aspirins tacked on to the bill. But why would he be so focused on not losing my little procedure? Does he have some kind of quota to fill—no Bas Bleu knees = no quarterly bonus? With all the 49ers and Giants and what not—does he really need my insurance company’s $20K total?)

The other thing I’ve pushed hard for is for him to do it under local anesthesia. I hate general anesthesia, it always makes me sick. And redheads need more of it than other people on account of we’ve got some wild-ass enzyme that makes us more sensitive to pain and that just leads to me being even more nauseated after it’s all over.

AJ, MD, was fine with that (although I believe I heard him warn me that being awake didn’t mean I could supervise), but his surgical nurse said that I’d have to get the final word on that from the anesthesiologist when he calls me tonight to discuss the whole thing.

Both the surgeon and nurse were fairly confident that I’ll be back on my feet by Monday. (Although I didn’t mention to him that my car has a manual transmission. I’ll just have to see how that goes.) AJ, MD, actually said this isn’t as difficult a procedure as repairing a torn rotator cuff, which I’ve already had done. (But of course, you generally aren’t walking around on your arms after shoulder surgery, so I’m not sure how the weight-bearing thing will affect me.) The nurse just thought I might still be kind of tired on Monday.

I’ve been stockpiling ice to use over the weekend, I have a stack of library books & a bunch of videos queued up in the DVR. As for the surgery, I’ll be interested to see if they find any matchbox cars or maybe Jimmy Hoffa in there.

Now, my one concern is: should I wash down the post-op painkillers with red or white wine? The tablets are white, if that has any bearing. Perhaps a crisp Pinot Grigio?





Wednesday, November 2, 2011

Post-Halloween "treat"

I’m not looking forward to this holiday season at my current place of employment.

Here’s what I found between the color & black-&-white printers this morning, obviously left over from some Halloween party yesterday afternoon:



Leaving aside the fact that I find even fresh pumpkin pie repugnant, isn’t leaving a custard-based dessert substance out overnight a health hazard?



Tuesday, November 1, 2011

Scary season

Since we’re still in the cusp-of-eternity period (it being el Día de los Muertos), I figure it’s okay to report that in Saint Louis, if you want to get treats you have to tell a joke.

It would be hard to make that work around here, because the treat-giver would need to be able to take in jokes in Farsi, Hindi, Urdu, Spanish, Mandarin and Vietnamese.

But it’s a nice idea.

Monday, October 31, 2011

Christmas in October

Ugh—it’s 1744 on Halloween & I’ve just seen my first Christmas TV commercial.

No, not for a salad shooter, so not completely official. But it was a Chex Mix with red & green bits, & had that dingy-dongy “Carol of the Bells” music in the background.

Not primordial ooze. Maybe

All Souls. Día de los muertos. Samhain. Halloween. All Saints.

The hours from 31 October through 2 November are just chock full of us looking over our shoulders at mortality, whistling in the dark, building bonfires to push back the night, dressing up as someone or something we aren’t, communing with the departed & generally displaying our defiance at the Last Unknown.

Night is taking over day & we have to convince ourselves that we’re somehow going to trick the Almighty into bringing back the light or even into skipping over us when sending the Angel of Death on his appointed rounds.

But this is also a time for, well, for just plain being weird. & for concocting strange—really strange things—with pumpkins.

For example: