Tuesday, January 31, 2023

On the mend


Yesterday's outpatient surgical procedure appears to have been successful.  I've got a new, relatively deep slice taken out of my left thigh, just below the groin, where the abscess was opened up and "washed out", so to speak.  It's going to be left to drain again, and the hope is that it'll seal itself up permanently.  Here's hoping!

It was intensely frustrating, as always, to have to deal with the hospital staff.  I'm sure they're doing their best as they see it, but almost without exception they won't look you in the eye, won't engage in any sort of human-to-human conversation, and maintain what I suppose they'd call a "professional distance".  Time was, I recall, when one was treated like a human being in hospital, and expected to treat the hospital staff in the same way.  Today... not so much.  It's abstract, remote, and not very "caring" from the patient's perspective.  One feels like a piece of meat on the slab in a butcher's shop.

Just as frustrating is the difficulty of digging information out of the system and the personnel.  I had some prior bloodwork done, but had never been informed of the results.  Yesterday morning I was informed that a major health indicator was "out of balance", and I needed to address it urgently - but nobody had called me as soon as it was discovered, days before the procedure, to alert me to it and give me an early opportunity to deal with it.  What's more, no follow-up treatment was suggested or offered.  Instead, I was told that I needed to fix it, without any further information or input.  Fortunately, I'm aware enough of my condition and potential treatments that I can do that:  but others, without that advantage, might be left floundering.  Why couldn't someone just have called, told me what the test revealed, and offered a suggestion or two as to a way forward?  Would that have been so difficult?  From the lack of effort, I can only suppose that yes, it would have been that difficult - at least, in their eyes.

To make matters more frustrating, my surgeon lectured me on what he considers to be the best short-term solution to the problem (which, perhaps inevitably from his perspective, would involve more surgery).  He completely failed to provide the other side of the argument, which is that the operation in question frequently results in complications, is of limited effect, and is fully successful in less than a third of cases - all facts I already knew.  Needless to say, I won't be following his suggestion.  I don't like being taken for a fool.

Sometimes the system is amusing.  I had my procedure under local anesthetic.  As part of the preparation for surgery, the anesthetist stopped by and informed me that I'd be fitted with a drip, so that if emergency anesthesia was needed (in case of complications), it could be administered without delay.  That was understandable:  but he also informed me he was going to give me a "pre-anesthesia" dose, something to relax and sedate me without knocking me unconscious, similar to what they give patients before a colonoscopy.  He was startled and upset when I refused that, saying I wanted only the local anesthetic.

"But... but... everybody gets the preliminary shot!"

"I don't want it.  It's only a little pain."

"Oh... well... I suppose it's your right to choose."

Yes, it is, and I exercised that right.  In the theater, the anesthetic technician was also surprised by my choice, and couldn't understand how anyone would want to "endure pain".  First of all, there wasn't much to endure, and second, I'm a combat veteran.  I've been shot, stabbed, bashed around and sundry other unpleasantries.  I know what real pain feels like.  Compared to those injuries, a little scalpel work is nothing to write home about.  The local anesthetic took care of 90% of it, and I sat through the rest.  That's all there is to it... but clearly, that wasn't the politically or anesthetically correct response!

Oh, well.  After more than 20 hospitalizations for this, that and the other, with stays ranging from a few hours to 40 days, I've grown accustomed to (but still intensely dislike) being no more than a digit in the system.  I suppose it's the inevitable result of more and more people seeking care from fewer and fewer doctors, nurses and medical facilities.  The torrent of illnesses, injuries and complaints overwhelms the system, effectively forcing it to become dehumanized in many ways.  I don't know how that can be fixed, except for those wealthy enough to have access to concierge medicine and private facilities.



EricW said...

Glad to see you up and about, Peter!

I’m astonished and deeply disappointed in our modern medical system. It seems to be following the path of wokeness, and most doctors today are either ignorant, brainwashed, or just in it for the money. A large part of it is that the system has broken, corrupted by big pharma and twisted by bureaucracy.

They really might as well be practicing witchcraft - recite a spell, wave the magic talisman and do a little dance.

Anonymous said...

When my Father entered hospice, he was against the morphine, haldol, or any of the other 'comfort' drugs they tried to give him. He was clear, lucid, totally aware, we had discussions of pros and cons, nope, I don't want it. When he was sick, Mom would try to get him to take a tylenol, and he refused. Just didn't like meds. Any of them. Ever.
As he slipped away, I had to FIGHT TOOTH AND NAIL with all of the nursing staff, my own sister, the chaplain, AND the doctor who kept trying to get one of us to administer that first dose (cuz we all agreed, Dad included, after that first mouthful, he would be in la la land until the end.) He expressly told me he did not want to go out that way.

Fought. Almost physically. Stood guard in front of the bed (I'm big, they didn't even come in the room). They couldn't understand why I was so vehemently defending my fathers choice. They used argument after argument about how their way was better... couldn't fathom that someone didn't believe them, nor agree with them, nor simply wouldn't blindly follow their recommendations. Literally could not grasp why I was trying to protect my dying fathers wish to NOT be medicated for the process.
"But he won't even know if you give it to him at this point."
I came thhiiiissss close to punching that ladys lights out after she said that.
Should probably file for malpractice, but sadly, that IS how it works today. Fucked up, I know... why I have a half dozen outstanding problems I won't get addressed.

Eaton Rapids Joe said...

I always request that a copy of the blood work results be mailed to my home address. The printout has typical min-max expected values and flags results that falls outside of the expected.

It is very odd that I have to sign a HIPA form to release data to myself, but that is the America we now live in. We no longer have a unfettered right to our own health history.

libertyman said...

I am guessing there is a certain amount of age bias as well as weight bias being demonstrated in many cases. As you suspect, monetary incentives may override the best choices for medical care. A sad situation that is unlikely to get better, it seems.

coyoteken48 said...

Three weeks ago I went to St. Vincent Hospital down in Green Bay Wi. to get a stint after another stroke. My experience was the complete Opposite of yours. I was so very impresses with the quality of care I received from every level of staff from the nurse assistants up to the surgeon. I guess it's where you end up going. ---ken

Mind your own business said...

Check your bill from the anesthesiologist carefully. Chances are they will try to ding you for the pre-anesthesia dose that they never administered. Your choice cuts into their profit margins.

Part of what you are seeing is because most of the hospital staff you come in contact with never expect to see you again. You are just another piece on the assembly line. Unlike having a family doctor who knew and treated the entire family, year after year, these people don't even know if their jobs are secure or if they'll jump to another hospital across town or in another state.

TechieDude said...

BTW, that little something something they give you to relax before your colonoscopy is Fentanyl.

Only reason I know is I saw it on the bill. The wife saw that and lit up.

I had fentanyl patches during cancer therapy. They were, by far, the worst part. It took months to wean off of them - 12 micrograms at a time.

Ed Campbell said...

Glad that you are on the mend. I agree that the medical profession has gotten more distant and no longer treat a patient as a human being. The last procedure I went through it felt like I was a widget on an assembly line and the doctor was just there to do the procedure and then I should get out of the way as soon as possible so the doc could move onto the next widget. I don't know what is causing that distancing but it has certainly gotten more obvious to me in the past few years.

Anonymous said...

The source? Diverticulitis? Just a thought. MD. FACS retired

Charles Craig said...

It's different in the UK. I've had a lot of hospital time in the last 5 years and the vast majority of medical staff treated me like a person and not a thing. (I occasionally got rude receptionists). I've also dodged just about any painkiller I could dodge. Teeth extraction, fillings, gastroscopies, endoscopies, lumbar puncture, (only 1 of them I'm glad to say), 2 kidney punctures.. The list isn't endless but goes on a bit. I work on the theory these things go better if you're awake and can cooperate. Usually I'm out and limping down the road while people who have had the same procedure are still in the recovery room.

Anonymous said...

When you are an out patient you are a cog in their wheel. They have X# of rooms and X# of patients to get in and out with X# of operating rooms. Gotta keep the sick people moving. But the pre-shot keeps you from becoming a problem in the OR so that wheel doesn't get clogged. One reason nurses offer no solutions is that the Doc's doesn't usually want others explaining and the ability of someone to comprehend the explanation. My cleaning lady has a very marginal IQ and is on disability due to it but listening to her explanation of a health problem and what a nurse or doctor said leaves a lot to be desired. Sometimes it's not possible that what she 'thinks' they said that they really said that.

Beans said...

My wife and I both don't handle anesthesia very well and take 3-4 times longer to come out of it. Outpatient clinics hate us with a burning passion for that reason as they have to stay until we're ready to go home. 7am procedures with total anesthesia take us 12-14 hours to wake up. I'm worse than her as my heart rate slows down, respiratory goes way down, seriously almost to death levels. Good thing I avoid going in most times.

And my main issue is none of them listen. Like really listen. They don't care if wife is hypothyroid so that means everything is different, between temperature (runs 2 degrees lower than normal) to, yes, processing anesthesia (local, twilight and general.) And they don't read the huge list of meds we bring them, along with allergies. We can bring in every pill bottle and they still won't believe she's on three different pain meds for pain management, because nobody does that.

It's bad when she's just day-surgerying, but actual stays at the hospital? They'll maybe give her half of her meds, totally off schedule, and then bitch when she's in pain. To the point that I bring in her meds and give them to her if they screw up scheduling too much, including pain meds.

As to allergies, the last surgeries we told everyone, from the doctors' offices to Intake to Pre-Surgery to Surgery Prep that my wife is deathly allergic to Steri-strips (those little surgical bandages they use instead of staples or stitches, that cause skin lesions and skin infections and total skin breakdown within an hour of being placed on her, seen it with my own eyes.) So, of course, nobody listens when we tell them this, when we hand the list of meds and allergies to them (we carry 10-12 copies of said list and hand it out to everyone we can) and, so, of course, the last two surgeries she had they applied... Steri-Strips. Next to last surgery wasn't bad, just an invasive biopsy. But the last, here I am in the recovery room where they're showing me how to clean and dress the wounds (which they got wrong, by the way, trained medical people got it WRONG) and, lo and behold, there were two Steri-Strips. Which I pointed at and did my best Invasion of the Body Snatchers imitation, well, basically getting louder and louder saying, "Is that a Steri-Strip? She's deathly allergic to Steri-Strips. Get it off, get it off NOW!" and increasing until someone finally did so, while you could visibly see the skin rot away.

Don't listen, don't do things right, don't do this, don't do that.

Getting lectured about being rotund by a staff of highly trained rotund medicos was the last straw.

And, of course, everyone and his/her/its brother, sister, whatever, dog, cat, bigfoot all trying to push the clotshot at every turn.

Bah. I am a better diagnostician than most doctors. I am a better nurse than most nurses. I am definitely a better physical therapist and nutritionist than what you find in the current medical system.

James said...

Had a left knee replacement at the end of 2019. They gave me a big time pain killer during the surgery and I refused all pain killers after that. They told me I could go home the day of the surgery if I showed a certain level of mobility, you better believe I did that. The pain killers were pushed hard but I had a serious back injury when I was thirteen and pain is just background noise. I want to know what is going on. I worked in medicine the last twenty-six years of my working life and there is a level of risk with ANY drug and you should always minimize what you take where possible. If the odds on a bad side effect is tiny, it is still real and you don't get a do over.

TRX said...

> Steri-Strips
It only took about two days for one to fall off of me, taking patches of skin with it. It left a big scar.

Jim said...

My experience is different from yours. I recently had an aortic valve replacement and the staff at the hospital all treated me very well. I'm now undergoing rehab and the staff is the same.

Aesop said...

I can't tell you how it is for outpatient facilities, but in-hospital, it goes like this:

The cold comfort you received can be blamed on decades of entitled @$$hole patients, and worse, family (95% of all negative interactions are by well-meaning white night idiot visitors behaving like Beans, above, except without the knowledge or medical information he brings to the equation. List of patient's meds and allergies? Printed out? God love you!), who should have been booted out the door, but instead getting the run of the place.

I do everything necessary, but minimize interactions to the maximum extent, not only because of the necessities of time management (I've usually got 4 patients ranging from waste-of-my-time to critical, and the least sick get the least of my time and effort, necessarily) because overall, people are @$$holes, and doubly so and twice as entitled when they're sick, as if that's suddenly okay in the hospital. (A few punches in the nose and roundhouse b****slaps would stem that problem right quick, as would discharge out the door on the spot, but all of that's unfortunately against hospital policy.)

And when it comes to patient treatment, the Golden Rule applies: You're nice, I'm nice. You're not: you're about to get a bootcamp flashback courtesy of years as a Marine NCO.

I have outright fired patients a dozen times or more in my career. ("You don't want to co-operate with the plan of care, and you think yelling at everyone is going to fix that? Surprise, not so much. You're fired. Maybe someone else will come help you. I'm done with you. And you're running out of nurses to piss off here. Good luck with that plan." And then went to the charge nurse, and informed them I was no longer caring for Mr. @$$hole. They could move him to another zone, or discharge him, but I was done. Yes, really. BTDTGTTS, with oak leaf clusters.)

The brighter, slightly teachable ones get The Lecture:
"Hey, didja ever act like this much of a human rectum at a restaurant? And didja notice afterwards that your food tasted just like spit?!? So maybe think long and hard about all the rest of your behavior while you're here. You have the right to remain silent. Everything else you say from this point on can and will be used against you. Really not kidding about that."

OTOH, patients who come in without an attitude or a chip on their shoulder are a constant blessing, and remind those of us in the healing arts of why we entered the field. Especially when they can manage to say "Thank you." Yeah, it's really that easy to get on our good side. If I had my way, we'd run one line for decent folks, and another one for d**kheads, and manage each as appropriate.

The System is overwhelmed by people going to the hospital for things that could and should be taken care of at the doctor's office or Urgent Care, along with primary care MDs expected to spend no more than 2.3 minutes per patient, just to break even financially. That, and half of everyone either uninsured, or sucking on Uncle's teat for healthcare, and using the hospital as the Primary Care clinic for every sore toe and sniffle.

So thanks for dealing with this at outpatient level. Glad you made it through the system hopefully better off, and wishing you the best on your recovery.

FeralFerret said...

It is no longer "patient care" in today's medical system. It Is "health care" which has the one goal of maximizing profits for the large medical service providers. Obamacare made it next to impossible to stay in practice/business for any providers unwilling to sell out to the big companies. I have had several conversations with my regular doctor and my chiropractor both before and after Obamacare regarding this. My chiropractor has managed to stay independent, but my doctor and his partner both sold out to the big medical corporation and became employees.

These companies strongly encourage their employee doctors to pass the patient around through their system of providers as much as possible. They are repeatedly pulling that crap on my wife and neither of us tend to cooperate with it.

Remember, "A patient cured is a patient lost."

Yes, many of the nurses and doctors completely ignore the information you give them regarding meds, symptoms, and allergies. Sorry Aesop, but not all of them are as conscientious as you are.

BobF said...

Very good to hear of the outcome. Mine was calf and not as large. I shudder at yours' location. Ugh. Hang in there -- it's downhill now.

PresbyPoet said...

The 16th, fell and ruptured my rotator cuff. Called the Kaiser advise nurse, scheduled a video chat with a doc same day. She was concerned i broke something. I told her I couldn't raise my dominant right arm. So went in and got X-Ray, negative. Not good she could not examine the arm, and see my classic rotator cuff symptoms.

A good thing, I can check test results on-line. Saw before the doc called that it was negative. This is a good thing. Also get lab tests just as fast as the doc.

A bad thing. No follow up. Called advise nurse, they are the ones who schedule, except for when they have to leave a msg with a doc who has no time. In this case, was not able to have an MRI until the 29th. Better than Canadian/English medical care, but too long. At least I have a nice description of how the supraspinatus is torn full thickness. Also, the MRI caught a "minor" bone break.

So I am in a sling for weeks, then PT? The older we get, the more things fall off. Better a torn rotator cuff than a broken hip. Can still walk. Still type. Still drive?

Practicing gratitude is important. My version of the serenity prayer:
Bless those who need to be blessed.
Curse those who need to be cursed.
Have the wisdom to know the difference.

MrGarabaldi said...

Hey Peter;

Glad you are back home and on the mend!!

deb harvey said...

distinct lack of nuns
formerly Christian hospitals being bought by consortia
hospitals here bought by huge consortium in texas
doctors are treated like inconvenient obstructions and that no doubt filters down to all employees

Beans said...

I would say Aesop is right, but he's not.

My wife almost died because some idiot nurse was going to give her a huge as amount of insulin right before a surgery. Fortunately we caught it before it happened.

Another time my wife almost died because she sat in the ER waiting room for 8 hours waiting to be seen while her gall bladder was going septic.

Another time my wife almost kicked the bucket because the doctors and nurses thought the reason she was screaming that her head hurt was because her blood sugar was highly elevated. Until she projectile vomited all over the nurses' station because of the deep brain bleed she had.

Then there's the time she was in for an infection because the nurse put steri-strips on her spinal incision site and it developed into an infection and had to be cut out.

Then there's the time she spent 9 months fighting to get heard that something was wrong and it wasn't until her digestive system shut down did someone finally acknowledge that her thyroid was dead.

Then there's all the times they missed her meals, or sent up the wrong meal, or no meal at all. And then bitched at me because I brought food for her.

Like the time she gained 100lbs of water weight because her protein levels were so low while in the hospital. Because the food was so bad and restrictive that she was becoming malnourished.

Or the time they snowed her to keep her on a respirator. Nor did they follow proper procedures for taking her off the respirator.

My experience? Screw the highly trained medical personnel. Trust them about as much as your average Democratic Party politician.

John T. Block said...

Hearing the same story from many actual practitioners, the system is not far from vapor-locking itself out of business. The Patriot Nurse channel offers training in herbal treatments and prevention of illness, to avoid overdependance on a failing g system...