Tag Archives: surgery

An Alternative to the Unacceptable

May 16, 2014 Michael Cox Leave a comment

Waiting on the bench in an 8’x10’ white-walled box was not exactly how I’d planned on spending my Friday afternoon—least of all in a gown that made me feel more naked than if I hadn’t been wearing anything at all.

I’d been having some back pain for the few months leading up to this appointment, and this was supposed to be the solution to my sleepless nights, spent tossing and turning—looking for sleep but nagged by a persistent tightness across my shoulders and my lower back. It was supposed to be an in-and-out, “here’s how you fix this,” with a laundry list of things that I should and shouldn’t do, followed by no more pain. Instead, I was told “we’re going to fuse your spine, and that should stop this from getting any worse.” What kind of a solution is that?! “Oh, no big deal, we’re just going to severely limit your mobility for the rest of your life by performing a surgery that will impact most of the rest of your senior year of high school with a flat-on-your-back recovery.” How about no, thank you.

Of course, I was very polite to the doctor at the time, as was my shell-shocked mother. Scoliosis runs in my family so it wasn’t exactly a huge surprise, but the severity of my scoliosis and the solution described by the doctor (and the urgency with which he described our next step of the recovery journey) caught both of us flat-footed. We said that we would call back in the coming weeks to set up a surgical consultation, but my mind was racing to find any other viable solution. Up until this point, to say that I was a firm believer in Western medicine would be an understatement: I used to laugh at all of those people who would go to accupuncture, who would rely on massage, who would change their spiritual lives to impact their physical selves. Well, at that point I was just praying for the chance to eat my words and find some alternative treatment plan that wouldn’t involve inserting surgical steel into the central support of my nervous system.

I started out with Google. After reading 20-30 pages of life-changing stories, I was no more ready to take the plunge than I was in the office. So I called up my aunt, who had worn a back brace for years in order to deal with her own scoliosis, but the outcome of that conversation led me no closer to believing in the all-powerful solution of major surgery. So when my sister woke up for work that evening, I talked to her, defeated, unsure of what to do. She had recently gone through a series of chiropractic visits to deal with a lasting whiplash injury after doing a 360° kickflip in a Camaro at 75 MPH on the freeway. So, of course, shetold me to give chiropractic a try. Considering how horrified I was at the prospect of becoming a cyborg at the ripe old age of 17, I thought “why not?” and set up my first appointment for later that same week.

I had brought my x-rays from the doctor’s visit with me to the chiropractor, and he outlined a plan that would free me of pain and arrest the progression of my spinal deterioriation. He could tell that I was skeptical (and terrified), but what did I have to lose other than some time and some money? If it worked, then I would be able to avoid some life-changing surgery. And if it didn’t, then I was no worse off than I was before. So, here we go on a whirlwind chiropractic adventure! Pop-crack-snap!

Ow, was my thought the following day, and after the next appointment just a week later. The chiropractor had shown me what he was going to be doing: how the different decompression techniques he was using would limit the pressure on my slightly bulging discs and alleviate the strain on my lower back that had been plaguing me for quite some time. He gave me some exercises (which I dutifully took to), some recommendations for maintaining better posture, and activities that I could do that would be beneficial for my spinal health, and my well-being overall. Once again, the skeptic in me couldn’t overpower how much sense he was making. I had horrible posture, thanks to my habits of gaming too much and studying too late. While I regularly ran and tried to lift weights, I had never targeted any areas that might actually help my back (like my core). So, I gave it all a try.

While the western medicine approach of throwing a few nuts and bolts at the problem would likely have been effective, it was lacking in some key areas. The doctor didn’t even talk to me about changing my habits to make things better—the first and only option was to make with the choppy-choppy. The chiropractor worked through my daily habits and routines to come up with a total life-routine makeover that would mitigate my pain, improve my well-being, and help me develop the habits that would keep my condition from getting any worse.

Within three months, my pain was receding and we could tell that the treatment was working. I continued some regular appointments, just to keep tabs on things, but within the year almost all of my pain was gone. I still have the curvature in my spine, but it hasn’t progressed in the last couple of years, and I’m hoping that it will keep me going until some other alternative medicines are available. (Nanites? Stem cell therapy? Who knows what the future holds!) Sure, trying to do a backwards somersault still hurts (and I was never good at those to begin with), but doing the things I love—like sleeping!—didn’t hurt any more, and I could run, jump, swim (until I got mono… but that’s an entirely different story), and play to my heart’s content.

Even though it took me weeks of going through the treatment before I truly began to accept that it could be worthwhile (and not merely a method of procrastinating the inevitable surgery), I eventually came to understand that non-conventional methods of treatment for chronic pain and illness can be effective. Growing up in the holy halls of western medicine, I never gave alternative treatments like accupuncture and chiropracture the time of day. What could any solution not founded in science offer me that studied, peer-reviewed, proven-to-work solutions couldn’t? Well, it turns out that this particular solution offered me more control in my life and an option to mitigate my pain while preventing further degeneration without the risks of major orthopedic surgery. Not too shabby!

Photo by Meggyn Watkins

Health

The Cost of Squeamishness

May 12, 2014 Meggyn Watkins Leave a comment

Damn, waking up in the morning is hard. And with this weird, non-stop buzzing noise.

There’s like… static… and voices? …I’m not in bed.

I’m face down. On a very hard, very cold floor.

My face is wet? Oh… it’s blood. My blood.

—

My mother was born with a heart defect. Just a small flutter in her heart… it was something she had lived with her entire life. Then, last summer, “atrial fibrillation” became a noun in our world, “stroke” was a concern, things like “end of life” documentation arrived, and I was signing papers about being her “medical advocate.”

It was terrifying. But open-heart surgery could not only avoid worst-case scenarios for the future, but also give her a better quality of life in the here-and-now.

I tried not to cry. I tried to be brave. I encouraged her to be optimistic, to sit down and talk through the pros and cons of pig versus bovine versus mechanical valve s, to consider whether she should go on the trip of a lifetime overseas before surgery and risk an atrial fibrillation attack away from hospitals or wait until after the surgery when she was possibly relearning how to live with a valve.

There was a lot of talk, a lot of anxiety, a lot of stress, and a lot of love.

…I wasn’t expecting a lot of debt from my own trip to the ER.

The day of my mom’s surgery, my sister and I woke up before dawn, picked my mom up, and brought her into the pre-surgery prep wing. The entire morning was ramping up to be pretty anticlimactic overall: my sister and I were treated to an hour and a half of sitting in the waiting room with mom, without mom, with paperwork, without anything to do except browse reddit and play mobile apps.

Finally, the monotony broke: a nurse at the hospital found us in the waiting room and invited us to come back to say goodbye before my mom went under!

She led us back to our Mom’s room and the other pre-op nurses ran to find us a couple chairs in the otherwise-empty room. The first nurse jovially chit-chatted with us, and then proceeded to shove the most massive catheter into my mother’s forearm. No warning.

As possibly the most squeamish person alive, it only took about 1.5 seconds for me to hit the floor.

I woke up on the floor next to my mother’s pre-op bed. Through the forest of swarming nurses’ appendages, I could just barely see her over the edge of the bed but she kept looking away from me. The nurses wheeled me away on a stretcher to the emergency room, as I deliriously screamed how sorry I was… over and over and over. At the time, I was terrified that my accident had stressed her out and caused her to undergo life-threatening surgery in a poor physical and mental state.

My sister stayed behind with our mom until she was wheeled into surgery, and then Sara joined me in the ER: laughingly, she reassured me that our mom was on so much morphine that she probably didn’t realize I was gone. I was glad to know I wasn’t going to be the cause of her hypothetical death, but seriously distraught that I didn’t have the opportunity to say goodbye. My mother was unconscious for the next 26 hours: I alternated between pacing the waiting room with tears in my eyes and curling up in an exhausted heap on the floor, as her initial surgery dragged to an interminable seven hours. The post-op offered no respite, as it devolved into eight hours of platelets platelets more platelets until I made the decision to sign the authorization papers for an emergency find-the-leaking-hole-in-her-heart surgery.

She made it through the night. A week later, she made it home. She was alive, and she was healthy. Everything was finally okay.

—

It was at this point when I stopped focusing all my energy on my mom and started considering my bank account. I entered this optimistic state of denial: the hospital wouldn’t possibly send me a bill for an ER visit they caused themselves! They know the nurse brought me to an off-limits area. I am definitely not liable for this.

Imagine my surprise and disappointment when the bill finally materialized in my mailbox: approximately $3000 for the hospital, $300 for the doctor, and $200 for various labs and tests. As a recent college grad sans-benefits, my measly $100-bucks-a-month health insurance wasn’t doing me any favors. My friends and family encouraged me to pursue litigation. So, I scoured the firms in my area, called some malpractice numbers, and waited for someone to deliver me from this obviously unfair burden. I’m definitely not a litigiously minded individual, but I just couldn’t afford that bill. So I waited. And waited. No one was calling me back.

Finally, a lawyer took pity on me. Not that he swooped in and won my case: he took just enough pity on me to spend 20 minutes explaining why the legal system was not on my side, and explained my alternative options. After drowning in anxiety for two weeks, the dose of transparency was a very welcome breath of fresh air.

What he explained was that, thankfully, the half-inch lightning-bolt scar newly gracing my browline could not be considered “disfigurement.” That was the good news. The bad news was that, without disfigurement, there was no way that I would be awarded a settlement large enough for a lawyer’s cut to be worth his or her time (not including the thousands it would cost to hire an expert witness to testify about nurses’ standard of care). The numbers simply didn’t crunch.

He did encourage me to keep looking for lawyers. My friends even suggested finding a pro bono lawyer just to get the bill waived. Or maybe someone appointed to me through my local community. But by this point, I was so overwhelmed and disheartened, I just couldn’t bother. In the space of two weeks, I received three or four new copies of my bill. You know: just in case I had forgotten. Thanks, hospital!

With yet more encouragement from friends and family, I looked into the last-ditch attempt the lawyer had suggested on the phone—only to be used if I could not find any other legal representation. I called the hospital’s main line and asked for the Risk Management department. This is how I met Tim.

Tim was so kind… so sympathetic… so absolutely impotent. For three weeks, I was talking with Tim every few days or so, with him updating my files and forwarding my messages to the Billing office, awaiting the verdict that never seemed to come. Finally, frustrated, but not wanting to sacrifice the “pity me” persona that I’d developed with Tim, I asked if perhaps I could call this mysterious Beatrix woman from Billing who never seemed to receive Tim’s messages on my behalf.

Magically, everything changed.

Later that afternoon, Beatrix called me. Something, something, something, no indication of malpractice in my records, something, something, 20% discount. “Hold up,” I said. “I appreciate any discount possible… But, obviously there is no indication of malpractice in my records: my doctors in the ER were wonderful. You know it was my mother’s nurse who did this to me, right?”

Nope, she had no idea. Thanks for passing along the story, Tim.

My BFF from Billing called me back the very next morning: the hospital wasn’t admitting fault, but Beatrix verbally tiptoed her way through an explanation that the hospital bill would be waived ($0 owed), the physician bill would be discounted 50% ($150 owed), and the lab costs were the only things I had to pay in full ($200 owed).

In the end, the check I wrote was only 10% of the cost of my original bill (not including the price of the tears, sweat, and undiluted stress that emanated from me during those months). But finally, there were no more Tims to fight, no more Beatrixes to convince. And my faith in the goodness of human nature was not completely destroyed.

Photo by Sara Slattery

Health

The ER: It’s nothing like on TV

October 21, 2013 Jennifer Dorsey 2 Comments

Just under 130 million people visit ERs every year, complaining about everything from earaches to broken bones to severe pain. I, myself, have visited the ER more times that I would like to admit, due to some chronic illnesses that love to become acute at the worst of times, combined with a tendency to twist joints in directions they are not meant to go.

Photo by Meaghan Morrison

If you’ve never been to the ER, it’s good to know what to expect in advance, because the stress of the situation can easily overwhelm you.

Bring your ID and insurance card: While paperwork is often the last thing you want to think about when dealing with a health crisis, it’s important that you have the necessary documents so that the hospital can easily get you into its system. Without them, it can be a nightmare in the following weeks to play middle man between the hospital and your insurance company—trust me, I’ve been there. That’s why it’s one of the first things you’ll be asked for: while you’ll never be denied care, insurance or not, having all of your information up-front will save enormous headaches down the road. Usually, registration is quick, and in big emergencies where you can’t really chat with the hospital staff, they’ll get it from a family member or friend as soon as possible. I keep my ID and insurance card with me at all times in my wallet, and I make sure at least one other person can access it: in college, my roommate and I had copies of everything organized and accessible—it saved the day at least once.

Know your medical history: The first thing you will do after registering in the ER is go through triage, whether you arrive by ambulance or walk through the front door. This is a short process in which a nurse or nurse practitioner will measure your vitals (blood pressure, pulse, oxygen levels, and temperature), find out what symptoms you are experiencing (always be as descriptive and honest as possible—unlike hospitals on TV, they aren’t likely to spend hours and thousands of dollars worth of tests figuring out what you are hiding: drugs, drinking, sex, all of it is important), ask for your pain levels (scale of 1-10), and get your medical history. This will include information like what medication you take, including any vitamins, your drug and alcohol use (again, be honest!), medical conditions, and any past surgeries. If you are female, you will also be asked if there is any chance you could be pregnant and when your last menstrual cycle was (it’s as awkward as it sounds at first, and often I forget—I hate this part). All of this information is key to helping with diagnosis, so it’s important to keep it handy. If you have a few things you need help remembering, keep a list on your phone or somewhere else handy so that the stress of being sick doesn’t cause you to forget the dose of your daily medication or the name of that surgery you had years ago.

The wait: ERs are notorious for their wait times. This is most common in big-city ERs where life-threatening traumas are more commonly experienced. I’ve experienced wait times as short as ten minutes and as long as five hours. It’s a toss-up as to when these times will be the worst, but I’ve found that nighttime is definitely the longest wait. There’s less staff on call, tests take longer, and there are more accidents coming in.. In the end, your wait depends not only on how many people are there but also how ill you are in relation to the other patients. If you are having a long wait and your symptoms change, make sure you let the triage nurse know immediately.

Getting care: Once you are seen, don’t expect there to be a private room: it’s often simply a curtained-off area. This can be extremely awkward at times, because you can hear everything around you. Sometimes it’s difficult to overhear, especially if someone is very sick around you. Other times, you’ll hear the wackiest conversations: I once heard someone find out that they were pregnant with their mother there, and her reaction was hilarious. In the ER, people watching is one of the few forms of entertainment available.

A different nurse will probably take your vitals again, will likely take some blood, and will ask you many of the same questions you were asked in triage. They are required to do this: it’s annoying, especially when you’re stressed and worried, but it ensures that they are getting the right information. Depending on your symptoms and complaints, they may also put you on an IV immediately. An IV is a tube inserted into a vein, most often in the arm where blood is taken, which facilitates getting fluid into your body (often saline) and medications for pain or nausea. It only takes a minute to insert and, though it’s super uncomfortable, it no longer hurts once it’s in.

After the nurse has seen you, a doctor will follow. Sometimes this wait can also be a bit lengthy, depending on how many people that doctor is covering. He will again ask you about your symptoms and conditions, and may have more extensive questions than you have experienced previously. Depending on your situation, he will then likely order medications or tests to figure out what is going on. Those tests can vary from blood work or urine analysis to an ultrasound, X-ray, or CT scan. Every trip of mine has varied because it really depends on what the issue is. The worst by far for me was when I was in a severe amount of abdominal pain. Seven hours later, I had gone through three rounds of blood work, an ultrasound, a CT scan, and an EKG. Other times, I simply had one test and was out within an hour or two. No matter what, they try to get these done as quickly as possible, but there can be a long wait even when you are in a room.

Leaving the ER: Once the doctor has the results, he or she will either order more tests or, if they’ve found a diagnosis, will get you the right medication or care. Remember that the ERs are for acute care (for sudden and often moderate to severe issues). I’ve always left the ER with a prescription for pain medication or other temporary treatment, with the direction to follow-up with my doctor as soon as possible. Usually, once the major issue is solved, my regular doctors are able to get a better idea of what is wrong and find a long-term solution so that I can avoid acute issues down the road.

If the condition is serious enough, it may warrant admittance to the hospital. I’ve been admitted three times in my life: once right after an emergency surgery, and twice when I spent six days in the hospital before solutions were found and solved by surgeries. Those were expensive, scary, and extreme cases, and I am definitely an exception to the rule: in reality, only about 13% of ER visits result in hospital admissions. Likely, admittance would occur for something like heart trouble, breathing issues that can’t be resolved, severe pain that can’t be managed, dangerous blood pressure, or serious infections. Hospital admissions are expensive and the beds are in high demand, so it requires sound medical necessity. However, if a doctor wants you to be admitted, know that it is in your best interest and they will aim to have you better as soon as possible. It’s always been worth it for me!

Otherwise, it’s back home you go! You will be discharged by your nurse, which, like everything else, can take anywhere from ten minutes to an hour, in my experience. Discharging includes home care instructions, information on your diagnosis, and any prescriptions you might need. Be sure to also request records of any tests you received, so that you can show them to your primary doctor and have them added to your medical file.

ERs are overwhelming places. Sometimes fear of them will keep people from going at all. However, if it could be a medical emergency, you need to make sure you get it checked. It’s never silly to go if you are unsure of a severe pain or of a mystery symptom that concerns you, especially if your doctor is unreachable. And if it’s a critical emergency, never hesitate to call 911 and get an ambulance, as it is always the safest and fastest way to get to the nearest hospital. I’ve arrived at the hospital by ambulance and by my own transportation: sometimes, it was out of my control entirely as I wasn’t the one calling the shots, but other times when I could make my own decisions, I never hesitated to go by ambulance if it was my best bet. Don’t be afraid to call one, despite the possible expense, because it can make all the difference in your situation—some counties even cover the cost of an ambulance for this very reason (mine does!).

Hopefully, you will never need this advice. But if one day you do, you now know how to be prepared and make it just a little bit easier.