Well, before too much time goes by, and I slide back into not blogging, I should do my best to bring you up to date with our life in Georgetown. It has been an endless series of doctor's visits since we have been here, but we seem to be making headway. In my last blog, I left you with us struggling to determine just what to do with Barbara's wrist fracture unable to heal after her first surgery. We had found a confident and well credentialed young gun surgeon, who seems to have a good understanding of the problems Barbara faced in getting her wrist repaired, and we had nearly decided to do it. After several days of discussion, some with him and some by ourselves, a go decision was made.
We let him select the hospital as he wanted to operate with his regular team, and expected to discharge her that afternoon. The morning we went for surgery, things got off to a poor start. We were to be at the hospital at 6:00 AM for a surgery that would start at 8:00 AM. We were, but we seemed to be the only ones who were. No one at the day surgery reception desk, and no one except other patients waiting. Finally a nurse came out and called someone's name. They left, but shortly another nurse came and the process was repeated.
After about fifteen minutes of this we were down to two couples, two patients I assumed. A nurse came out and called the other couple, and asked if we were scheduled for surgery. We told her yes, and she suggested we follow her along and she would get us to the right place. The other patient was in a wheelchair, which the nurse wheeled at a very brisk pace, and left us behind. Finally she turned a corner and when we got there, she was nowhere in sight. I finally saw a sign pointing to Pre-Op and we went in the door. We were immediately stopped by another nurse asking who we were, and when we identified ourselves she kindly showed us to the pre-op cubicle where we belonged.
During the flurry of activity taking vital signs and the like, we noticed a needle on the floor. We told the nurse and she seemed unconcerned. Since Barbara, by now had only hospital socks on, I kicked the needle over under a chair. Two more comments to the staff went with no attention. I thought sharps were supposed to be carefully attended in a hospital environment!
Shortly Barbara's surgeon came in and covered some more details and options with us. The possibility of total fusion was discussed and discarded by Barbara as she felt it would be the end of her career as an artist. Partial fusion was discussed and after careful consideration of the outcomes, she approved if there was no other alternative. The surgeon estimated the surgery to be 2 1/2 to 3 hours.
I went to the surgical waiting area and tried to read, but after the first hour I gave that up as a bad job. After about three hours, the surgeon called me from the OR and said he was down to his last real option short of partial fusion. He was hopeful, but less than optimistic he said. After about another hour and a half, he said in a second call that partial fusion was the required course open to him. I approved and he said it should be about 2 more hours and he would see me after the surgery. Finally, after a total of eight and a half hours he came out and said the delay was because they had discovered that near the end of the surgery, Barbara had been burned by a hot instrument, and she had second to third degree burns on her finger and the back of her hand. Moreover, because she had been on a block for so long, he wanted her to stay in the hospital overnight for pain management by the anesthesiologists and to observe her burns and have them treated by the wound team.
Since much of the hospital was being renovated, it would take a while to get Barbara and appropriate room, so I went to get coffee. When I got back to surgical waiting room, they gave me Barbara's room number and suggested I go up there to wait for her. When I got to her room, I was surprised to find the Director of Nursing waiting for me. That struck me as strange. She tried to pass this off as a visit to a spouse who must be stressed, but it soon became clear she was there to apologize for the burn (and likely to assess my frame of mind regarding legalities).
I must say, the room looked like the hospital was in bad need of rehabilitation, as there were areas of the walls where paint was off, many water stains on the ceiling and the like. More on this later. After some time she seemed ill at ease and I wondered why. Finally, after a bit more than a half hour, Barbara arrived attended by two nurses. Although still partially sedated, it was clear she was in significant distress. She had a “pain ball” which is a sort of portable, self sustaining nerve block device, injecting pain killers directly into the nerve site involved in the surgery. She commented several times that her arm felt like a log attached to her. Now the Director of Nursing's presence took on a somewhat different view. She was definitely there to try to protect the hospital’s interests.
Since it was very late in the day (probably 7:30 PM) and we had been on the move since about 5:00 AM, we decided I should go home and get some sleep and return early the next morning. Since traffic in the morning rush hour would be very bad, we agreed I would be back by about 9:00 AM.
When I entered her room in the morning, I found my wife crying uncontrollably. Let me say right here that Barbara is no sissy. She has had both physical and emotional pain for much of her life and she bears it very well. When I could finally understand her, I got that she had not had her pain managed for most of the night. Now recall that the reason she was admitted to the hospital, post surgery was for pain management. She said she had asked for pain control in the middle of the night, and they gave her a Vicodin and made her wait an hour and then gave her a second one. No call to the anesthesiologist was made until about 6:00 AM and he came at once and reset her “pain ball”. Relief was just starting to take effect at around 9:00 AM.
While sitting in the room waiting for the pain to subside, Barbara pointed out to me the unclean conditions in the room. I asked for the Director of Nursing to come up and she did so promptly. I pointed out several cleanliness deficiencies to her and she agreed and called for the head of housekeeping.
The anesthesiologist counselled repeatedly it was best to not let the pain get ahead of you. The anesthesiologists decided that her pain ball tube had moved away from the nerve that needed the medication and they should remove it and install a new one. This required them to move her to pre-op and they did so and accomplished the procedure without consequence, and said she could be discharged.
We came home to our apartment and she was on a great deal of pain medication. The next few days were spent running for prescriptions, getting meals, cleaning up, and trying to keep her comfortable. Dr. MacKay checked in frequently by telephone to follow her progress and after about seven days we went to the office for him to check on her. He was concerned about the continuing pain, but wanted her to start trying to move her fingers, which were still terribly swollen. He was also concerned about the burns on her hand. They were weeping and inflamed and looked very sore. She did not complain too much about the burns, but much more about the surgical site. What we didn’t realize then was that her course of healing would be long and trying and most importantly emotionally difficult.
For several weeks the pain in the burned fingers was a serious problem, but finally it yielded to the ointments we were applying daily. While that sounds easy, with her cast nearly covering the burn site, it was a challenging exercise. In addition to the burn, the swelling from the surgery caused extensive pain. She had a rod about ¼” in diameter coming out between her index and middle finger on her left hand, and two wires which were crossed in her wrist in order to hold everything together while healing took place. Of course, with three holes in her skin where these existed, infection was a constant threat. As you can imagine she was nearly constantly uncomfortable and a good night’s sleep was a treasured occurrance. In addition to these other items, substantial pain medications were involved and so that was another complicating factor. It seemed that trips to the pharmacy for drugs and potions was a daily occurrance.
After several follow up appointments with the surgeon, it was beginning to become clear that there was little, if any healing going on. In an attempt to improve that situation, Dr. MacKay wanted her to wear a bone growth stimulator ten hours a day. It is a rather small device, worn over the cast, which supplies small but continuous electromagnetic pulses to the fracture site. This has been proven to be helpful in stimulating bone growth in about 40-50% of patients. In the next couple of weeks, he removed first one wire from her wrist, then the other, and finally to rod that was between her index and middle finger. This gave her some relief of the annoyance and constant concern for bumping them, but did not indicate any real improvement in healing. X-rays and CAT scans were not encouraging with regard to having the fusion heal properly.
During this time, we were asked by the hospital not to take any action against them, but rather to sit with them when Barbara was better and discuss how they could “make it right” with us.
