March 22, 2024
Dear Interested Readers,
The Shortest Friday Letter Ever
As directed, my wife and I arrived at 9:15 at the Dartmouth same-day surgical unit last Monday. The process was very smooth. I was given a hospital gown, little booties, and a paper hat. My wife left with my clothes and I was introduced to various nurses and doctors who quickly prepared me for what would happen. I signed a few papers. I was told that I would be intubated and lying face down during the surgery. Two IVs were started. I was told that propofol would perhaps sting a little, and it did. The comment about the sting of propofol was the last thing I remembered until I woke up in the Post Anesthesia Care Unit late in the afternoon.
The header for this short letter shows the scene that greeted me when I woke up. I was eager to move on to “my room.” That didn’t happen for over 24 hours. The delay had nothing to do with my condition. My vital signs were quite stable, and I felt pretty good presumably because of some residual benefit from my anesthesia. I hit bottom on day three when I was discharged.
My nurse, a very pleasant and competent professional who was “traveling” from her home in Richmond, Virginia, informed me that the hospital was always full. Delays in getting a bed were typical. All of my nurses were excellent and all of them were “travelers.” One was from Greenville, South Carolina, my father’s hometown. I was surprised to discover that one nurse was “traveling” from Colombia in South America. She was excellent. Another travel nurse was from Memphis. There were others but I lost track of who was my nurse and who was “covering.” They all had at least four patients. The nurses work three or four 12-hour shifts a week. All had some difficulty finding housing. One travel nurse was doubly traveling. He had found an apartment in Concord over sixty miles away. New Hampshire has a very significant shortage of affordable housing. It is hard to find even a one-bedroom apartment or studio at any price.
I don’t do well with anesthesia. I have had two general anesthesias, and both times now I have had my misery prolonged by urinary retention and a sluggish return to normal bowel function. I also had drains that needed monitoring. Finally, late on Tuesday, I was taken to a semi-private room. I would have preferred a single room, but I thought any room was preferable to more time in the PACU, which was like being hospitalized in a subway station. The PACU is a large open ward with a central nursing station. The only thing that made it different from some of the large open wards where I had worked during my training was that every nurse had a large mobile computer workstation that they pushed from bed to bed. Paper medical records are a thing of the past.
The hospital is a huge place, and riding around on my back on a gurney always leaves me wondering where I was. Shortly after I arrived in my new room, my roommate was wheeled in. Eavesdropping on conversations he had with his wife, I surmised that he had just had his second knee replacement. My roommate must have been partially deaf because he played his television loudly all night long. The only time he spoke to me was to say a brief goodbye the next day when he was discharged, He had been behind his curtain the whole time.
My discharge process was completed at about 4 PM on Wednesday. It seemed to occur simultaneously with the nadir of my experience. Setting aside my complaints about bed shortages, what was important to me was that all of my care team was very focused on making me as comfortable as possible. My surgeon and his team were excellent. Before I was discharged he sat down with me and explained all the technical issues he had encountered. He told me that because of my lumbar scoliosis, my vertebrae were very dense and he had to really work hard to get the screws in place.
I have confidence in the fact that the extensive surgery that included screws, rods, and bone grafts will improve my function and has already relieved much of my pain. It is ironic that ten years ago my wife had almost the same surgery done at the New England Baptist Hospital. My surgeon knew me from hearing me speak at meetings at the Beth Israel. He had previously done surgery for many Atrius patients after we moved most of our tertiary admissions to the BI, and he knew my wife’s surgeon because the BI spine service began to do some of its work at the New England Baptist. These connections plus his personable style and willingness to describe everything in great detail gave me a sense that I was in good hands.
I think my hospital experience was typical. I left with the distinct impression that I had just experienced the issues of workforce shortages and reduced bed capacity that plague our entire system of care, and this explains some of the burnout and moral injury that our professionals endure every day. I don’t think any of the professionals who cared for me were delighted with the circumstances that formed the framework within which they had to work, I will be returning to these subjects as I process my experience. I know there are more challenges to come as I work my way through PT.
As icing on the cake, the day after my surgery, we got a letter from Blue Cross saying that they were not paying because I had not been through an attempt to improve myself with PT, but I had. I had seen a private physical therapist in my town for several months who was highly recommended but would not submit bills to insurance companies. I saw him frequently through the fall in an attempt to conservatively manage my pain. When we called the surgeon’s office to report the problem, we were reassured that we need not worry. We were told that Blue Cross frequently denies legitimate claims, but they always pay in the end.
My experience is a reminder that we are all vulnerable to the issues of access, workforce instability, and the ripple effects of larger social issues like inadequate workforce housing.
Weird Weather Update
The ice Is out just in time for more cold weather and the forecast for a foot of snow this weekend. I hope that wherever you are it will look more like spring.
Be well,
Gene
