11 March 2007

I'm back

Although I'm flat on my back is just as descriptive.

Ankle surgery sucks.

SOP in America is to send you home pretty soon after you open your eyes after surgery, which also stinks.

Tuesday night around midnight I awoke — at home — to find that the pain block that they'd separately administered had been doing far more than I'd given it credit for doing. I'd taken the oxycodone, as the doctor had said to do, but it didn't seem to be touching the pain, which now felt a bit as though someone had inserted a frozen — or burning — plate of steel in my ankle. The pain did not let up, and it was exacerbated by my ankle being swollen against the split/cast.

We went in, and after a couple hours I was seen and got morphine in an IV. I told them that I didn't want to go home, that I wanted to keep the IV, but they assured me that the hydromorphone they were giving me was good stuff, and that together with the oxycodone I'd be just fine.

Not true. The next morning I was in pain again. It wasn't as bad as it had been the night before, but it was still a lot of pain, enough that I couldn't imagine enduring it for hours or days.

I called the doctor's nurse, who had a bedside manner akin to Nurse Ratchett. "Why didn't you have them admit you, if you were in so much pain?" she asked me.

It was my fault! I just hadn't realized it.

The pain the night before had also been my fault: even though I'd taken the painkiller as ordered, the ER PA suggested that what had happened was that I'd let the pain get out of hand, and that if you let it get out of hand, it's hard to rein in again.

This was the exact opposite information than I'd gotten from the Kaiser advice nurse, who had been alarmed that I'd taken 20 mgs of oxycodone in a couple hours. I was only supposed to take 10 mgs every four hours. The PA was quite a bit more laissez-faire. He thought I'd be fine up to 80 mgs.

So Wednesday morning I was indeed taking more and more and more drugs, enough to horrify the nurse. So what was I supposed to do?

I also got her test question wrong, about where was my pain on a scale from one to ten. I told her four — having a personal acquaintance with the fact that pain can actually climb to far higher spheres than most of us imagine possible.

Four, she sniffed. That's not so bad.

I began crying, and she then questioned how I could be crying with a pain level of just four.

Indeed. How could I be? After being so well taken care of, and with all the faith in the world that this primo care would continue, how could I have cried?

The ER on Tuesday night complained about orthopedic surgeons in general, saying that they under-medicated their patients and that about 30 percent of post-surgical send-homes like me ended up back in the ER needing more pain meds.

If I'd been in a civilized country, from Bolivia to Belgium to Botswanna, they wouldn't have sent me home in the first place.

Not that I'm bitter.

1 comment:

Fabella said...

I know you are in a narcotic fueled haze... but do you really want to get an operative ankle fracture in BOTSWANNA??!! You may have gotten an extra night in the hospital... but probably wouldn't have been operated on, and while they likely have lots of morphine to help with the pain... it would be easy to pick you out of a crowd since you would be limping for the rest of your life with your malreduced, unfixated fracture.

Or, perhaps you would get an operation, using a plate that some good-hearted American surgeon dug out of a dead person in the US and sterilized (a buddy of mine did that for his trips to Nepal - still better than nothing) and were operated on in a hospital surrounded by tropical diseases (not that the diseases that live in our hospitals are any less scary).

Now, in reality you would probably do fine anywhere. Most ankle fractures heal up well with or without surgery (we as orthopedists probably do too much ankle surgery partly to avoid lawsuits from people who have ankle pain after a fracture that has not been "fixed" perfectly). And staying overnight is not horrible (although by your data 70% of people don't need to stay overnight which would put that much more financial strain on even the almighty SINGLE PAYER if/when it comes to pass).

I'm just rattling your chain some...

Hope your feeling better now...