Surgery or the Twilight Zone

As I write this from the living room couch with my right leg strapped into the sling of the CPM machine with Sammy comfortable perched on my hip and the laptop on the other, I am truly thankful to be at home. It is early Wednesday morning and I have already completed 30 minutes of the 2 hour treatment. I have come to realize that I have been undergoing a whole change in my thought patterns. It has helped me get through the past 6 days. I had my concerns about this 2nd knee replacement from the beginning but I knew that it had to be done and that my insurance being Medicaid would be challenging at best. With the whole health care debate going on at present I will write a whole piece on my experiences and my feelings regarding it in another blog. For this installment I would like to write about my experience.

I have been too many hospitals in the metropolitan area and I have also had this procedure done on my left knee 6 months ago at another area hospital with a different surgeon. One of the first differences was that the 1st surgeon had very few Medicaid patients and so I was treated with respect and my questions were answered and my preferences heard. The 2nd surgeon 90 % of his practice is Medicaid, Medicare & workmen’s compensation. The difference in treatment as a patient was significant. In the first surgery I received the Cadillac of care and in the 2nd it was more like rent a wreck.

My experience this time was the large gaps in communication. I met the physician once, he was brusque, told me to lose weight and that he didn’t think I should have the procedure. I found it interesting that he was significantly more overweight than I was and that his 5 minute overview was not sufficient to determine whether I needed surgery or not. It was because the other surgeon had agreed to do the surgery was all he needed to go forward. It was with equal surprise that after the surgery the Surgeon informed me that I had worn through the cartiledge in my knee and wore a hole in the top of the femur which had to be repaired before the replacement could be placed. Imagine if I had listened to him and continued to damage the femur in my leg.

I did not hear from the hospital at all and on the day before surgery contacted them to see if it was still scheduled. They told me that I was to be there at 10 am and that surgery was scheduled for 12 noon. They also informed me that there was no needed be concerned as they were going to call me later that afternoon to let me know the schedule. The first hospital had a joint clinic in which you went in had your blood drawn and were given a tour of the facility. They introduced you to the Social worker who would be scheduling your rehab and answered any and all questions regarding your upcoming surgery.

Throughout my experience with the 2nd hospital, I was greeted by surprises. I had spoken to the surgeon about having a femoral artery block and he told me to just talk to the Anesthesiologist. On the day of surgery I was informed that the hospital didn’t provide that type of procedure. I was then rushed along so I could get into surgery. I was told that the epidural would be sufficient and that there was a small possibility of awakening during the procedure. Well, halfway through I awoke to the sound of a mallet hitting my leg. I remained awake through the rest of the procedure. When I reached the hospital floor the nurses were shocked that I had awakened during surgery.

My concerns about healthcare reform is that it has already become a system of the haves and the have not’s. It seems they cannot refuse you the basic requirements of a procedure but they can perform it in such a way as to treat the patient as a 2nd class citizen. The overall care was the same its just the concern for customer service doesn’t exist.

During the first night it seems that the epidural had worked its way out of my back and so I was experiencing a very high pain level of about 12 out of 10. Imagine my surprise when they decided to replace it at 1:30am in the hospital room with my roommate a curtain away. I was also informed that I would be transferred to the joint floor that morning but found myself having a femoral artery block placed, again in the hospital room and not being transferred until 6 pm that evening. This of course meant that the Social worker had not started on my transfer to Rehab on Friday so nothing could be done until Monday.

The most important difference with Medicaid is that you as the patient no longer need to be informed or decide what your medical treatment will be. I was informed throughout that it was decided that I would be going to CareOne and when I told them that no I would be going to Kessler they all seemed surprised and stated “well of course you can chose your rehab, especially if you have been there before”. I had requested to speak with the Social Worker at 9 am Monday morning and by 11 am I was beginning to get annoyed, wondering why I had not spoken with anyone. Finally I requested again to see her and she appeared at 11:30 and told me she was working on it. I stated I wanted to go to Kessler and she noted it and left, she reappeared with her supervisor to tell me that I was denied rehab because I now had a good knee so I didn’t need acute care. Since my coverage didn’t cover sub acute care I would be sent home and a visiting nurse would see me on Thursday. At 2 pm I prepared to go home, got dressed and packed my things to be told by 4 pm that they were 50 % sure that I would stay the night. By Tuesday morning at 9:30 am I was told I was going home, I made my arrangements and then proceeded to wait….. At 12 noon, I wanted to know why I couldn’t leave, well I had to wait to be signed out. My surgeon was in the hospital and he would come up between surgeries, by 2 pm I requested to sign myself out. This brought in a nursing manager who then worked for the next hour trying to get me out. It was just neglect and incompetency that held me up there.

At 3 pm the paperwork was finally done and I couldn’t get a wheelchair for 20 minutes so I started to walk to the elevators with a walker. It finally arrived at the elevator but it took me 30 minutes to just leave the building. God I hate hospitals!

I am home now instead of in a rehabilitation facility because my insurance doesn’t cover it. If I hadn’t been through this before going home would have been very scary. While my 2 daughters still live with me they are very rarely home. I knew what to expect at the facility so I can do some of the PT myself but having just had the knee replacement moving around it difficult. The visiting nurse will not be here until tomorrow so it will be 2 days without a bandage change. Of course I will change the bandage but the first time around I don’t think I would have.  I will manage to get through this but the circumstances and challenges have been constant and frustrating.