Friday, May 26, 2017

Surgery #9: When American Healthcare slapped me in my polite Canadian face

You know that saying about the best laid plans, right?

I felt like I was an expert surgical patient the morning of my surgery. I was cool. I was calm. I was prepared with an arsenal of post-surgery weapons, including digestive cookies for nausea, a metal-free hair tie,  a list of questions for my Anesthetist, and a host of meditation techniques to calm my nerves and ease my pain post surgery. I had essentially been preparing for this surgery for a year, exercising both physically and mentally, as well as undergoing surgeries #7 and #8 which were prerequisites to this cartilage implantation surgery

So when the nice lady behind the Registration desk at the University of Pennsylvania Hospital informed me that I was at the wrong hospital, I felt a bit...well...panicked.

As my mom, Ev, and I hopped in another uber to take us to the Pennsylvania Hospital (no "University"), I looked anxiously at my watch. It was 9am - the exact time that I was scheduled to check in. The Uber driver informed us that we were about 40 blocks away from my Pennsylvania Hospital. He also informed us that traffic was not flowing on this Monday morning. I attempted to remain calm in the backseat; however, the drive was anything but relaxing. The streets of Philadelphia were out of control. It was UPENN graduation, so we dodged thousands of joyful grads in their caps and gowns and waited patiently for proud parents to cross the street. I felt like screaming, "Congratulations on such an impressive achievement... but get the F&*$ out of our way!" Like a video game, our route was foiled with obstacle after obstacle including garbage trucks, front-end loaders, and blocked streets. The three of us remained silent, anxiously watching the time tick. Thinking, "what's the worst that could happen?" it dawned on me that they could cancel or postpone my surgery. Yikes.

We finally arrived almost an hour and a half late to Pennsylvania Hospital. At that point I was in full blown panic mode. They quickly whisked me away to prepare for my surgery. Unlike my last surgeries at the surgery centre, where they carefully hung my clothing in my fabulous PennMed garment bag and delivered a nice dose of Versed to calm my nerves and make me forget, they carelessly threw my clothes in a plastic bag and instructed me to climb up into a stretcher. Off I went, panicked and choking back tears. This was not the plan. Where's my Versed?!

Once I was rolled onto the surgery floor, I was "stored" in the pre-op room, where the Anesthetists prepare their patients and patients meet with their Surgeon to discuss the surgery. I met with my surgeon who informed me that it would take at least 5 hours to transplant a new meniscus and implant my cartilage into my lesions. 5 hours? No one mentioned a 5 hour surgery! Again, I felt unprepared..and..where the eff is my Versed? I met with my Anesthetist, a quiet, elderly looking man, who probably had 40 years experience under his belt. I requested a post surgical nerve block, an injection that numbs the knee for hours to help ease pain after surgery. Trying to regain control, I took charge of the conversation, asserting, "How many nerve blocks have you performed?" The Anesthetist kinda glared at me and huffed, "It's not rocket science." Perhaps I pissed off my old guy because when I woke up 6 hours later, I was in excruciating pain, and it was apparent that the nerve block did not work. Shit sticks. I had lost control again.

The next 24 hours were rough. I was admitted to a private room with a fantastic nurse who shared my name. Kirsten tried everything to get my pain under control. I was injected with Dilaudid, Percocet, Gabapentin, and muscle relaxants - you name it, I got it. Nothing eased my pain. Mom and Ev took turns holding my hand and helping me breathe through the tears. When pain became intolerable, I began snapping my fingers, which is a strange pain reaction, but indicated to my "team" that things were bad. They finally decided to equip me with a PCA, a device that delivers Dilaudid on demand, with a push of a button. I pushed my little button all night long and finally was able to settle down for a few hours. There was a cot in my room, so thankfully, my Mom stayed the night and Ev went back to the condo to stay with the pets.

I was shocked when they removed my PCA the next morning, just as my pain was becoming controlled. My new nurse, Andrea, informed me that the PCA delayed my discharge and I had to be discharged by 6pm that evening. Say Wha??? That was the moment that the American Healthcare system slapped me in my unknowing polite little Canadian face. As I struggled, once again, to get my pain under control with injection after injection of medications, Mom and Ev met with the billing agent and a member of the Orthopedic Team who explained that my 5 hour surgery was coded as an "Outpatient procedure," which included a maximum of 24 hours in hospital, if needed. Anything extra was billed. An extra night in the hospital could cost up to $10,000. The medical team agreed to prepare a case for me, stating that I was in "intractable pain," however, they could not guarantee that my insurance would cover the cost. Frustrated and upset, I decided to go home, and requested that my Nurse numb me up with meds, so that I could transfer into an Uber and get back to our condo. I was very scared, as my pain was still a 10 out of 10. Again, I felt like I had lost control.

Surprisingly, the transfer home was better than I expected. Mom and Ev were so calm and cool, and I had a really great porter who helped me into my Uber without increasing my pain. I made it home, got into bed, and got absolutely baked on prescription pain meds for the next 3 days.

My memories of Wednesday, Thursday, and Friday are mostly a blur, to be honest. I required assistance to do everything, including going to the bathroom and getting dressed. Evan informed me that at one point while assisting me to the bathroom I questioned, "Why are we here?" Unsure of how deep and profound I was going with this, Ev responded, "Like on Earth? Like in Philadelphia?" and I responded, "No, like why are we in the bathroom?" I didn't really realize how stoned I was until my television began switching languages mid program. I turned to my Mom and asked, "Why is the TV switching languages?" I could tell by her concerned look that it was time to sober up from this "trip."

So that brings us today. It's been 12 days since my surgery. My pain is under control and I've drastically reduced the amount of medication I am taking. My Television is no longer switching languages, I can follow the plot of a 30 minute sitcom, I can go to the bathroom by myself, and I am orientated to place. Haha! The five of us (Dundee and Biloxi too!) are still in our little dark 800 square foot condo in downtown Philadelphia. We fly back to Canada on Sunday. My surgeon reports that my surgery went well and I now have the daunting responsibility of ensuring that my knee does not bear my weight for 8 weeks. I've been here before and I know that I can do it. I spend my days on a machine called a Continuous Passive Motion (CPM - AKA Constant Pain Maker), which slowly bends my knee, increasing it's flexion each day. It's uncomfortable and was, initially, quite painful, but it gives me a purpose to my day. My Physical Therapist has also provided me with a list of exercises to get my knee flexion (bend) to 90 degrees as soon as possible. I'm nervous about flying home, and fitting behind the seat, as I can only currently bend my knee to 30 degrees.

Overall, the surgery experience and post op was not as I had planned. But now that my pain is under control and I'm gaining independence (today I put on my underwear ALL. BY. MYSELF! #winning). I feel pretty upbeat, positive, and motivated to ensure that this surgery is a success. I'm relieved that the surgery portion of the experience is over. My Mom and Ev have been so awesome. If I so much as adjust my pillow in the night, my Mom immediately becomes alert and ready, "What do you need sweetie?" Although Evan is still working full time, he takes the time to arrange garbage bags, stools, and footrests to shower me every few days. I'm so lucky to have such a fantastic support system. I'm prepared for the fact that flying home on Sunday will be challenging. It's going to be a stressful day for Ev, Mom, Dundee, and Biloxi (#lindsaycircus). I hope that my pain is controlled and I'm relatively comfortable during the 2 flights back to Saskatoon. I can't wait to see my family and friends and settle in at Candle Lake for the summer.

Cheers Friends! I'm comin' for you Timmies - start steeping the tea!

Is there a knee under there or they did they remove that?
The view from my couch. If you look up...way can see sky.

Resume the position on the CPM - Constant Pain Machine

Off to my Dr appointment - doing our best with an office chair on wheels and a cutting board

This guy is really stinking up our condo, but he's such a good buddy

The animals are restless and have resorted to staring competitions.

I reached 30 degrees! Whoohoo!

The Lindsay Circus on the road.

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