Health Care Reform Part 2

Surgery is getting closer, and, frankly, I’m a little scared. I hear these horror stories about doctors and nurses going to the bathroom and not washing their hands, or having sex on beds next to sedated patients, and then working on people’s bodies, giving out nasty infections that kill the people they’re trying to fix. This is my second time with this surgeon, and I’m still alive, so I tell myself not to worry. Of course, the nurses will be different this time, and who knows where they’ve been? One point added to health care reform for the icky hands crisis. [Health Care Reform People 24-Other Status Quo Group 22]

Op

My wife drops me off at the hospital at 7:30 AM with no ID, no credit cards, no nothing, except my loose-fitting clothes. If I were to somehow conk my head and get knocked out, would anyone know who I am? What if I forgot who I am? They’d put me on the news —“Can Anyone Identify This Man?” — and everyone watching would think that I normally wear loose-fitting clothes. There’s always a worry in my head, and this takes the place of icky hands germs for now. It’s better this way.

I haven’t had anything to eat or drink since 11 PM, so I tell the nurse that I don’t need to pee as she gets ready to put the IV needle in my arm. Immediately after the tubes go in, I start to re-think my decision not to try to pee. If I only had to wait half an hour or so, I would have been OK, but for some reason they’ve asked me to get there by 8:00 for a 10:00 operation. If I had known that surgery was over two hours away, I would have tried to pee. But now I’ve got to get the thought out of my head. The more I try not to think about peeing, the more I do. I finally give in at 9:30. The nurse helps me off the gurney and I take care of my business. As I find out later, this would be a near tragic mistake. [HCRPP 25 – OTHER 22]

My memories of a previous hernia surgery, 4 years ago, are overwhelmingly unpleasant with one triumphant exception—getting shaved. Two friendly nurses did the honors in the actual operating room. I had never had surgery before so it came as a pleasant surprise. Maybe my memory is a little rosier than the reality, but I recall them shaving me completely, both sides and smooth. The morphine kicked in as they finished, and I had sweet dreams until I woke up with awful pain and some mean nurse telling me I had fifteen minutes to leave the hospital. When the nurse finished sticking the IV tubes in me this time I knew what was coming, or so I thought. She left, and another nurse came over. Here it comes, right? Wrong. All she did was tell me, “The orderly will come over soon to shave you.” Huh? The nurses don’t look busy, so why can’t they do it? Is it because of some new union rule? Are any orderlies female? The only orderly I’m aware of is Jerry Lewis in “The Disorderly Orderly.” Mine turns out to be a guy with a runny nose who looks half-asleep. He bears a slight resemblance to a Dean Martin-era Jerry Lewis, but even if Jerry Lewis himself did the shaving it would be a big letdown. I didn’t spend all that time shampooing, dying, and brushing my hair to have some orderly shave it off. Adding insult to my injury, he does a poor job shaving, leaving me prickly and only half-shaved, looking like a sideways bearded guy with hair implants. Five points for HCRPP [30-22].

As I’m wheeled to the operating room, my gurney bumps into another one carrying a guy who looks to be in much worse shape. Maybe even dead. My nurse cuts off this guy, then mumbles something to me about how she should have let that guy go first. Now I feel a little guilt. [31-22] In the operating room, they ask me to move from the gurney I’m on to another one that looks the same. Five seconds later, I’m out.

When I wake up I’m in a morphine dreamworld. My recollections of the next half hour are a little hazy, but eventually I end up in the recovery room. Last time I went through this, I was given half an hour from regaining my consciousness to leave the hospital. I remember climbing off a gurney in the worse pain I’ve ever felt, with the morphine already wearing off (this is where mothers say, “it’s nothing compared to childbirth,” and I say, “childbirth is nothing compared to getting kicked in the balls,” knowing that they can’t possibly prove me wrong). This time I’m not as rushed, maybe because the hospital, Glendale Adventist, recently expanded. They have room to care for people now, a change for the better without reform. [31-25] I’m also more prepared this time around: when the nurse comes by and asks if I need anything, I speak up: “more morphine.” I get more morphine with a simple twist of some IV valve. Marianne Faithful and the Rolling Stones sing, “Here I lie in my hospital bed, Tell me, Sister Morphine, when are you coming around again.” Mick Jagger must have had hernia surgery. I’m sure he was shaven by a nurse. [31-28] [In a Facebook post that day, while still flying high, I had mistakenly credited Willy Wonka with inventing morphine. In fact, thanks go to Friedrich Sertürner, who made the discovery in 1804 in Paderborn, Germany. Way to go, Friedrich. If I’m ever in Paderborn, I’ll buy you a beer and a sausage.]

Since when is it a requirement that a person has to pee before being discharged from the hospital? What about my surgery would have cut off my urine flow? I find out later that work was done in my testicle area, two inches below my incision, for some reason (maybe the doctor took a long look at me and decided I should not procreate). Still, the doctor would have to screw up pretty badly to damage my urinary system. Technically, the first request, coming about a half hour after my arrival in the recovery room, is to “go to the bathroom.” Because I’m genetically incapable of defecation (an evolutionary mutation, like in x-men, meaning all my waste is expelled through sweat and urine), I have only one choice. [When people say, “Hey Jim, why are you so fat?” I tell them it’s because I don’t have as many ways to rid myself of bodily wastes. I once offered my extraordinary story to the major talk shows, but they all declined. Your loss, Oprah.] [32-28, because of the pee rule, not my mutation]

The second request for pee comes an hour into recovery, and it’s more of a demand. I tell the nurse that I haven’t had anything to eat or drink in 14 hours, that I peed right before surgery, that I’m dry. I’m beginning to feel that I’d rather be home, and I ask the nurse to call my wife. She says she won’t call until I pee.

I give in at the next pee request, about 15 minutes later. Huge mistake. I climb out of bed with surprisingly little pain (thanks again, Friedrich), but a sudden wave of nausea and lightheadedness comes over me. I never throw up (remember, I can only expel waste in two ways) so the nausea stays with me as I drag the IV tower, and about ten feet of IV tube slack, to the bathroom. The nurse takes me as far as the toilet, then leaves. I know I’m dry, but I strain anyway, hoping that a mere drop of pee will save me. The next minute or so of my life is lost to me.

When I come to, 5 or 6 nurses are hovering above me. It takes me several seconds to get my bearings: namely, that I'm sprawled out on a cold recovery room bathroom floor with my head lodged beneath a toilet paper dispenser. A nurse slaps my face trying to revive me. Another mentions getting smelling salts. I don’t want smelling salts, so I desperately try to will myself to communicate my awareness. With awareness comes a sudden realization: I'm on display! A nurse opposite me is looking beneath my gown. And it's cold on this bathroom floor! Nurses get lessons in shrinkage, don’t they? At least I’m half-shaved—that helps my cause. Fortunately, to my knowledge, no photos of my privates have surfaced on the Internet—yet. [On Facebook I listed three women who could vouch for my manhood: my wife, Tinky, Betty White, and Julia Gillard, the new Prime Minister of Australia. Someone ratted me out, or maybe Tinky actually reads my posts. Now when I ask for something, like a foot rub, she says, “Why don’t you ask Julia Gillard for a foot rub?”]

Score five points for HCRPP for the collapse. The nurse said later that she assumed I would sit down to pee, but you should never assume a man in my condition would defy his instincts. I don’t think peeing like a girl would have prevented my black-out anyway, but maybe my head wouldn’t have cracked against the tile wall. Then again, the mighty crash that the nurses reported they heard, which alerted them to my fall, would not have been as mighty, and I could still be lying there. Score five points also for the OTHER group. At least one of the nurses, and probably all of them before I revived, peeked under my gown. That’s exciting, at least in retrospect. I get a tiny thrill; the nurses get to joke about me in the cafeteria later. It’s win-win, and a wash for the scoreboard. [37-33]

Still awkwardly splayed across a thankfully shiny clean floor [37-35], I keep reminding myself who I am and where I am, afraid I’ll lose consciousness again. The nurses look me over for bleeding and breaks, but find none. An orderly is called—the same Jerry Lewis imposter who half-shaved me earlier—and I’m lifted in a wheelchair and brought back to my bed. Please call my wife, I beg my nurse, but she stalls again: “We have to talk to your surgeon about your fall first.” How come my wife can’t wait with me? Are they afraid Tinky will sneak me out of the hospital? The surgeon has left the hospital for the day, but they reach him at home, and he tells them I’m free to leave—once I pee.

It’s getting late and all the other recovery room patients have left. The nurses seem anxious to leave. I convince them to give me some apple juice by promising not to throw up (I don’t bother telling them about my mutation). I also convince them that the presence of my wife will help me pee, and they finally call her. Tinky’s arrival pays immediate dividends. “No Vicodin,” she demands. It didn’t work last time, and I’m in no condition to remember that. Instead she asks for Darvocet, and over the next several days my pain is about 80% less severe than after my prior hernia surgery. There’s at least enough flexibility in the health care system to get me proper pain relief, so we now have a tie ballgame: 37 for HCRPP and 37 for OTHER.

Tinky’s arrival and the economics of two recovery nurses for one patient add to the urgency of the situation at hand. As the sun sets outside, my nurse pulls open the curtain to my room and announces, “Plan B for pee-pee. Let’s get this party started!” She holds a plastic urinal and plops down on the bed next to me. I swing my legs over the side of the bed and put my thing in the “urinal.” The nurse holds on to my shoulders in case I get lightheaded again. The pressure is on, and I feel more than a little weird, with my wife sitting across from me, and a nurse looking at my you-know-what, watching for even a tiny drop of urine so that we can all call it a day. No luck. The nurse states the obvious: “You probably feel a lot of pressure.” Yes in fact I do. She tries looking away, but I still can’t produce. She calls on the other nurse to run water in a nearby sink. No luck. “Performance anxiety,” I tell the nurses. My nurse leaves: “I’ll give you another half hour, then we’ll try Plan C — C for catheter.” Damn.

Would they really keep me overnight if I can’t urinate? What if my genetic inability to expel bodily waste has spread to my urethra? Could I be trapped at this hospital forever? I’ll bust out if I have to. The nurses make plans to transfer me out of the recovery room. I’ve been there for about six hours and they’re about to close. I don’t have high hopes for a catheter. I place my trust instead on apple juice—lots of it. It looks like pee and smells like apples, the best of both worlds. My trust is rewarded, and with only a couple lights left on in the recovery center, and only a few minutes to spare, I perform at last. A few drops is all it takes and a wheelchair is called. Jerry Lewis, Jr. has gone home, so my nurse wheels me to a parking lot. I am triumphant. I’ll give the OTHER group two points for a speedy post-pee release. [37-39]

Post-Op

Pain has a purpose. With Darvocet I’m moving around the house as if I had the surgery weeks ago, instead of a few hours. With Vicodin I couldn’t move for two days. The downside of Darvocet is that I pay for the mobility with more pain the next day. The easy solution is more Darvocet. I can see why people get hooked. The trauma of the surgery is visible from an inch above the incision to three inches to the side, and all the way down to the testicles. I won’t gross you out with the particulars. I’m also bruised on my back, my side, and my right foot from my bathroom collapse. Strangely enough, my head, which bore the brunt of the fall, is fine. I think I have foam padding inside my skull. Probably another evolutionary mutation. (My knees also don’t pop up when whacked by a doctor). (Also I have to pee a lot at night, but I think that’s normal for guys my age).

By the time I see the surgeon for a follow-up a week later, the loose blood in my system is starting to get absorbed and expelled by my body, and the soreness is confined to the surgical area (except for my foot). I’m able to walk more than ten feet in an hour without the help of pain killers. The surgeon says I’m progressing normally. What’s better is that I take a chance and get to his office half an hour early—and he sees me within ten minutes. Even with an HMO, it appears I’m able to get decent care. The surgeon says that I can even come back, for free, if I have any questions or complications. [37-41] I now wish I had asked why he operated in my scrotum, but I assumed there was a good reason. I’m normally a very skeptical person, but not with doctors.

A week later a complication does emerge—right under my belly skin. I haven’t been able to lie down on my front, which is useful for a certain activity, since the surgery. After climbing in bed, and tossing and turning as usual, I turn from one side to the other and feel a jolt of pain in my side. My fingers feel a string of some sort stretching from the incision area straight up my body into the belly area for about 3 ½ inches (I just measured it). I immediately jump to conclusions…maybe a nurse’s friendship bracelet fell inside my body during surgery…maybe the surgeon inserted a caterpillar in my urethra as a prank…maybe I have a blood infection, maybe tetanus. I decide the latter is the most likely. When I was about ten years old, my parents stupidly allowed me, my brother, and my friends to build a 3-story treehouse in a backyard tree. I stepped on a rusty nail and didn’t bother telling anyone until a line of infection had spread across my foot and upwards toward my ankle.

Tinky feels the string, too, and makes a mark on my skin. We check it the next day to see if it’s longer. It isn’t, but it’s become thicker and harder. I figure this is something the surgeon should know about, and I make an appointment. This time the wait is long, at least an hour in real time and two hours in what-it-feels-like time, and I’m the last patient to be seen for the day. I don’t feel very welcome. When the surgeon finally sees me, he brings with him a different young female doctor. I wish I were a doctor. That’s the life man. He asks me to show him the problem, and I have a difficult decision to make—do I show the whole area, so that the female doctor will see my naughty bits? Would that be too obvious? I’m a wimp in these situations so I only show the minimum. Another regret. The surgeon feels the string but claims that it is not related to the surgery. I say, “But it wasn’t there before, and it stretches out from the incision scar.” He seems offended. I should have added, “And what were you doing to my testicles, dammit!” He admits that the “string” may in fact be related to the surgery, but concludes the exam with these scary words: “I don’t know what it is. Let’s hope it goes away.” He then tells me that I’m welcome to come back, free of charge, if I have any more questions or concerns. Thanks, but what’s the point?

Many doctors seem to think their competency is being challenged when a patient asks a question. Maybe they can’t remember back to pre-doctor days, when they were trusting, concerned patients. I’m not blaming the surgeon for whatever is wrong; I just want an explanation, or at least a promise that he will follow through and look for an explanation. A week later the string is still there and I call my primary doctor. He tells me that the string is probably a result of the surgery and that the surgeon is really the expert on this matter. Yes, of course, but I had to ask. Overall, post-surgery follow-up is a big disappointment, mostly because something unusual has gone wrong. [41-41] My hernia ordeal would have ended in a tie if not for one final indignity. As I was leaving the surgeon’s office after the “I don’t know” diagnosis, I passed by the check-in counter. There, next to the sign-in sheet, was a copy of Highlights. Seriously. And I’ve only ever seen adults in the waiting room. Final tally: Health Care Reform People 42 and Status Quo “Other” Group 41.

Conclusion

Before I was mistakenly identified as PPO people at my surgeon’s office, I never considered the possibility that my family was treated with less respect because we’re in an HMO. I understood that we had to fill out extra forms and see certain doctors, but I could live with that. Now that I know better, my wife’s employer is in the process of removing the PPO option. Maybe it’s less painful to give up something that I wasn’t using in the first place.

Health care reform is a big, ugly, messy, boring issue. My guess is that if Congress fixes something, another problem will pop up. If Highlights gets banned, maybe kids won’t hate going to the doctor’s office so much, and take less care of themselves. Let’s hope on balance things get better. For all I know they may have passed a health care law already. They never mention things like that on Family Guy, and I haven’t overheard anyone talking about it at In-N-Out. None of the PTA Moms has brought it up lately. For a while they were talking about some oil spill. Now they’re back to talking about the economy. Next I’m thinking they’ll be talking about Big Foot sightings in the neighborhood. But that’s just a guess.

Soon after the surgery, lying in the recovery room and enjoying the morphine high, I tried to talk to the President about health care reform. He said, “Jim, I’m a busy man. I don’t have time to talk about your hernia. I only took this call because Joe Biden tells me you’re the only person genetically incapable of defecating. That’s pretty cool.” There’s a chance I just imagined this. It’s hard to tell. Maybe I was really talking to the orderly. If the President would listen, I would tell him what everyone knows but doesn’t want to say for fear of offending voters, that people basically want more healthcare than they’re willing to pay for. Every year what they’ll accept as the minimum level of care gets higher and more costly. Democracy is awesome and all that, but it has a growing problem: voters, or rather those people who politicians fear could vote, want more for less. Fifty years ago, my grandfather would have learned to live with his hernia, and no nurses would have seen his shrinkage.