Doctors make terrible patients
"Doctors are the worst patients," my surgeon said to me in our pre-op discussion.
"I know," I answered.
"No, you really are. You're going to have to follow directions. I want you to get on the carousel and take the ride. The problem with people like you is you try to do too much too fast. Listen to instructions, and follow the rules."
I recently had the experience of becoming a surgical patient. After years of hip pain from arthritis, and encouragement that turned into annoying nudging from family and friends, I had the total hip replacement. I knew I wouldn't handle this well. I don't do "disabled" well, and I absolutely don't do "patient" well.
I spoke with my insurance carrier prior to the surgery to make sure there would be no surprises. I was told that if I did it at an outpatient surgery center, there would be no out-of-pocket expenses and no deductibles.
"What about physical therapy? The anesthesiologist? Nurse home visits?"
The well-mannered gentleman on the other end of the line put me on hold for each question and researched it. It took over an hour. "You have a very good insurance plan. There are no out-of-pocket expenses and no deductibles, as long as you do it in the out-patient center. All services rendered in your house are fully covered. There is no co-pay for physical therapy up to forty visits for the calendar year."
That sounded pretty good, so I scheduled it at the surgicenter. I went in at 6:30 am and was home by 4:00 pm. I even walked up the stairs to my bedroom that night, aided by the handrails, and had a walker at the foot of the stairs and another at the top of the landing. I felt like I was ninety years old.
By the next morning, all the anesthesia and local pain medicine had worn off, and I had the most excruciating pain I have ever experienced. I was forced to take the narcotics. The instructions said one to two tablets every four hours, so, of course, I started with a half tablet. Not riding the carousel.
I had a hematoma on my butt that felt like I was sitting on a two inch metal pipe, which took two weeks to resolve. I had to force myself to eat food in the morning so I could take the aspirin intended to prevent a blood clot. The meds made me sick to my stomach. The pain made me sick to my stomach. I had to get up and walk the living room with the walker every hour, which made me sick to my stomach. I soon found I could eat mini cream cheese and cinnamon muffins for breakfast (and snacks) and I continued to lose weight. Well, I could see the weight loss, but the scale, if I could have stood on it, was sure to have said something different. The titanium and cobalt/nickel weighs a pound and a half more than my bone did (so said my surgeon) and the swelling from the procedure and the aspirin-induced bruising had to have added another pound or two at least.
I was cleared to drive at two weeks and two days, but I probably wasn't supposed to be vacuuming the house. And I could drive to the supermarket, but why did they have to put the bread all the way at the other end of the store? And who needs such HUGE stores, anyway? Only in America... But there I was, not riding the carousel.
The hospital system sent me updates on bills. The physical therapy and nurse visits had been entered as "hospice", which had not been approved, so it showed that I owed $2,700. There was a charge for lab work the day of the procedure, of which I have no recollection, for which it said I owed $342. The surgery center was charging me $300. The anesthesiologist's bill was still being processed, and was for the exact same amount as the surgeon's, another error. At least the surgeon's bill, while only a fraction of it was covered, showed that I owed nothing.
Three phone calls to the insurance company to rectify; another two hours. No, I am not a hospice patient (thank God!) I am a post-operative patient who fully expects to get well and walk again. And run. And play tennis. And... climb trees. Well, maybe not, I haven't done that since I was a kid, but my surgeon did say I would ultimately be able to rappel and rock climb again, although he thought I was nuts to have ever engaged in such activity.
After forever on the phone, everything was settled except the surgicenter's fee. I explained that I made my decision to come home after eight hours based on the conversation with the lovely gentleman. They said they would look into it.
Two hours before Kol Nidre service, the beginning of Yom Kippur, I received a call from the insurance company. They had pulled up the recording of the conversation and reviewed it. Yes, indeed, I had been told I would have no out-of-pocket expenses, and, lo and behold! They were going to honor that. The insurance company was going to pay the surgicenter. I owed nothing. I hope the poor guy didn't lose his job over that.
There are so many things I used to take for granted. Walking, for starts, standing, reaching into the dishwasher, being able to cross my legs, put on socks and shoes-- not to mention jeans. It was a month before I could wear anything other than sweats. My cat loved the little gadgets I had to use to put my pants on every morning, and she took it on as her job to assist me in my daily dressing. That is, after she rested assured she would continue to get fed and have her human around to care for her. She refused food for the first two days. If you've met my cat... you know how extreme that is.
Both in-home and out-patient PT, or physical therapy, is provided by trained individuals who surely take a course in torture tactics toward the end of their curriculum. They save it for last, in case the student chooses not to complete the program. Once they graduate, they are sworn to secrecy regarding this part of their training. It's actually part of the graduation ceremony. Really.
It's been six and a half weeks. I am having a hard time breaking the habit of eating mini cream cheese muffins, and it's finally it's starting to show. I still resemble Frankenstein when I walk, and while I no longer need the cane in the house, I do take it if I'm to walk more than a few feet outside. I actually clipped my toenails six days ago, which was a major cause for celebration, but there are so many things I still cannot do. I can squat down in the kitchen, but when I tried to reach to the back of the cabinet, my hip screamed at me, and it took several minutes to get back up. I can take a shower AND put on make-up AND blow-dry my hair without having to sit and rest for ten minutes between each activity. I can bend over and change my cat's water bowl all by myself.
But I am not nearly back to normal. I can't run, can't drive more than twenty minutes without pain, I can only walk a half mile before my groin is on fire. But I am so much better than I was. And I "know", even if I am so impatient with the process, that by all rights, I can expect to return to better than before activity. It's just taking it's sweet time.
I am tasting what it's like to be disabled. To see my loving cat in front of me and not be able to pick her up. To have an itch on my foot and not be able to scratch it. To need someone to take out the trash for me. To be unable to carry a plate of food it to the table.
There is so much I take for granted every day. That I can breathe without wheezing, walk without getting short of breath, get up the stairs without a chair lift. I can drive my car-- that I have a car. That I am generally in excellent health, arthritis not withstanding. And that I have health insurance.
Yes, it took me many hours on the phone, both before and after the surgery to get it all sorted out, but with the exception of the "hip chair" that my surgeon wanted me to get, everything was covered 100%. Of course, I pay a hefty price for that insurance. This year for the first time, they lost money on me instead of the other way around.
I did not ride the carousel, not entirely. That was the doctor part of me. My surgeon said no vitamin supplements, but I took milk thistle (since I live on Tylenol), and glucosamine; I knew there was no interference. He insisted I use the mupirocin ointment, not the cream, in my nose for five days before the surgery, but I knew it was to prevent MRSA and I knew the original studies were done with the cream, which I had in the house. I used the cream anyway. I had no choice but to be on my feet much more than I was supposed to. It's really hard to get a physician to follow all the rules.
I have a new empathy for patients with disabilities. I was always sympathetic, but it was a theoretical sympathy. Now I have lived the frustration and the pain, and I imagine how much worse it would be if it were not temporary. There is something to be said about "walking a mile in someone else's shoes". Especially if they cannot walk.
Unfortunately, I already knew, from working on the other end of the stethoscope, how ornery and difficult insurance companies are, but I found the frustration is magnified by pain and fatigue on the patient's side.
I hope I never lose my gratitude for all the things I can do, all the things I do know, and all that I have, like caring people in my life, health insurance, and money in the bank. Of all these, my greatest gratitude is to my friends and family. Special thanks to all who helped me through these past weeks.
"I know," I answered.
"No, you really are. You're going to have to follow directions. I want you to get on the carousel and take the ride. The problem with people like you is you try to do too much too fast. Listen to instructions, and follow the rules."
I recently had the experience of becoming a surgical patient. After years of hip pain from arthritis, and encouragement that turned into annoying nudging from family and friends, I had the total hip replacement. I knew I wouldn't handle this well. I don't do "disabled" well, and I absolutely don't do "patient" well.
I spoke with my insurance carrier prior to the surgery to make sure there would be no surprises. I was told that if I did it at an outpatient surgery center, there would be no out-of-pocket expenses and no deductibles.
"What about physical therapy? The anesthesiologist? Nurse home visits?"
The well-mannered gentleman on the other end of the line put me on hold for each question and researched it. It took over an hour. "You have a very good insurance plan. There are no out-of-pocket expenses and no deductibles, as long as you do it in the out-patient center. All services rendered in your house are fully covered. There is no co-pay for physical therapy up to forty visits for the calendar year."
That sounded pretty good, so I scheduled it at the surgicenter. I went in at 6:30 am and was home by 4:00 pm. I even walked up the stairs to my bedroom that night, aided by the handrails, and had a walker at the foot of the stairs and another at the top of the landing. I felt like I was ninety years old.
By the next morning, all the anesthesia and local pain medicine had worn off, and I had the most excruciating pain I have ever experienced. I was forced to take the narcotics. The instructions said one to two tablets every four hours, so, of course, I started with a half tablet. Not riding the carousel.
I had a hematoma on my butt that felt like I was sitting on a two inch metal pipe, which took two weeks to resolve. I had to force myself to eat food in the morning so I could take the aspirin intended to prevent a blood clot. The meds made me sick to my stomach. The pain made me sick to my stomach. I had to get up and walk the living room with the walker every hour, which made me sick to my stomach. I soon found I could eat mini cream cheese and cinnamon muffins for breakfast (and snacks) and I continued to lose weight. Well, I could see the weight loss, but the scale, if I could have stood on it, was sure to have said something different. The titanium and cobalt/nickel weighs a pound and a half more than my bone did (so said my surgeon) and the swelling from the procedure and the aspirin-induced bruising had to have added another pound or two at least.
I was cleared to drive at two weeks and two days, but I probably wasn't supposed to be vacuuming the house. And I could drive to the supermarket, but why did they have to put the bread all the way at the other end of the store? And who needs such HUGE stores, anyway? Only in America... But there I was, not riding the carousel.
The hospital system sent me updates on bills. The physical therapy and nurse visits had been entered as "hospice", which had not been approved, so it showed that I owed $2,700. There was a charge for lab work the day of the procedure, of which I have no recollection, for which it said I owed $342. The surgery center was charging me $300. The anesthesiologist's bill was still being processed, and was for the exact same amount as the surgeon's, another error. At least the surgeon's bill, while only a fraction of it was covered, showed that I owed nothing.
Three phone calls to the insurance company to rectify; another two hours. No, I am not a hospice patient (thank God!) I am a post-operative patient who fully expects to get well and walk again. And run. And play tennis. And... climb trees. Well, maybe not, I haven't done that since I was a kid, but my surgeon did say I would ultimately be able to rappel and rock climb again, although he thought I was nuts to have ever engaged in such activity.
After forever on the phone, everything was settled except the surgicenter's fee. I explained that I made my decision to come home after eight hours based on the conversation with the lovely gentleman. They said they would look into it.
Two hours before Kol Nidre service, the beginning of Yom Kippur, I received a call from the insurance company. They had pulled up the recording of the conversation and reviewed it. Yes, indeed, I had been told I would have no out-of-pocket expenses, and, lo and behold! They were going to honor that. The insurance company was going to pay the surgicenter. I owed nothing. I hope the poor guy didn't lose his job over that.
There are so many things I used to take for granted. Walking, for starts, standing, reaching into the dishwasher, being able to cross my legs, put on socks and shoes-- not to mention jeans. It was a month before I could wear anything other than sweats. My cat loved the little gadgets I had to use to put my pants on every morning, and she took it on as her job to assist me in my daily dressing. That is, after she rested assured she would continue to get fed and have her human around to care for her. She refused food for the first two days. If you've met my cat... you know how extreme that is.
Both in-home and out-patient PT, or physical therapy, is provided by trained individuals who surely take a course in torture tactics toward the end of their curriculum. They save it for last, in case the student chooses not to complete the program. Once they graduate, they are sworn to secrecy regarding this part of their training. It's actually part of the graduation ceremony. Really.
It's been six and a half weeks. I am having a hard time breaking the habit of eating mini cream cheese muffins, and it's finally it's starting to show. I still resemble Frankenstein when I walk, and while I no longer need the cane in the house, I do take it if I'm to walk more than a few feet outside. I actually clipped my toenails six days ago, which was a major cause for celebration, but there are so many things I still cannot do. I can squat down in the kitchen, but when I tried to reach to the back of the cabinet, my hip screamed at me, and it took several minutes to get back up. I can take a shower AND put on make-up AND blow-dry my hair without having to sit and rest for ten minutes between each activity. I can bend over and change my cat's water bowl all by myself.
But I am not nearly back to normal. I can't run, can't drive more than twenty minutes without pain, I can only walk a half mile before my groin is on fire. But I am so much better than I was. And I "know", even if I am so impatient with the process, that by all rights, I can expect to return to better than before activity. It's just taking it's sweet time.
I am tasting what it's like to be disabled. To see my loving cat in front of me and not be able to pick her up. To have an itch on my foot and not be able to scratch it. To need someone to take out the trash for me. To be unable to carry a plate of food it to the table.
There is so much I take for granted every day. That I can breathe without wheezing, walk without getting short of breath, get up the stairs without a chair lift. I can drive my car-- that I have a car. That I am generally in excellent health, arthritis not withstanding. And that I have health insurance.
Yes, it took me many hours on the phone, both before and after the surgery to get it all sorted out, but with the exception of the "hip chair" that my surgeon wanted me to get, everything was covered 100%. Of course, I pay a hefty price for that insurance. This year for the first time, they lost money on me instead of the other way around.
I did not ride the carousel, not entirely. That was the doctor part of me. My surgeon said no vitamin supplements, but I took milk thistle (since I live on Tylenol), and glucosamine; I knew there was no interference. He insisted I use the mupirocin ointment, not the cream, in my nose for five days before the surgery, but I knew it was to prevent MRSA and I knew the original studies were done with the cream, which I had in the house. I used the cream anyway. I had no choice but to be on my feet much more than I was supposed to. It's really hard to get a physician to follow all the rules.
I have a new empathy for patients with disabilities. I was always sympathetic, but it was a theoretical sympathy. Now I have lived the frustration and the pain, and I imagine how much worse it would be if it were not temporary. There is something to be said about "walking a mile in someone else's shoes". Especially if they cannot walk.
Unfortunately, I already knew, from working on the other end of the stethoscope, how ornery and difficult insurance companies are, but I found the frustration is magnified by pain and fatigue on the patient's side.
I hope I never lose my gratitude for all the things I can do, all the things I do know, and all that I have, like caring people in my life, health insurance, and money in the bank. Of all these, my greatest gratitude is to my friends and family. Special thanks to all who helped me through these past weeks.
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