American Pie: Mediland - Part The Second
...Now, time spent in the hospital is just a brief period between the pre-op and post-op activities that take place all over town, and in your home, conducted by contractors. If medical practice continues this trend, it’s only a matter of time before the actual surgery will be done on your kitchen table!...
John Merchant, heading into hospital for a knee joint replacement, brings a wry and witty insight into the ways of modern US medicine.
Here I am, back again in Mediland. A little over two years ago I was writing about the experiences I incurred while having a knee joint replacement, and now I’m just about to enter the twilight world of pre-op once more to get the other knee fixed. As much as the right knee replacement experience was very different to my only other bout with surgery, 50 years before in England, so this little adventure also is full of revelations.
The way the pre-op phase is conducted today is, I guess, just one more attempt to make medicine more profitable in America. There was a time when you would be admitted to hospital three or even four days before surgery so that you could have the tests and preparatory procedures that preface the actual operation. During those few days the hospital would have to feed, heat or cool you, change and wash your clothes and bed linens etc.
Now, time spent in the hospital is just a brief period between the pre-op and post-op activities that take place all over town, and in your home, conducted by contractors. If medical practice continues this trend, it’s only a matter of time before the actual surgery will be done on your kitchen table! What goes around comes around it would seem.
In a way, I suppose it’s better to spend as little time as possible in hospital, but three days for a major surgical procedure is getting just a little skimpy. Aside from that, you experience some loss of identity in the pre-op phase. You’re neither fish nor fowl, neither in-patient nor outpatient. For the past 48 hours I’ve been wearing one of those hospital wrist bands so I don’t forget who I am, with admonitions from the nurse not to take it off under ANY circumstances.
My pink plastic bracelet attracts curious glances in public, and I can see by some of their expressions that the curious are wondering if I’m a criminal out on bail, or perhaps an escapee from a drug rehabilitation clinic. I find myself self-consciously tucking it under my watch. When I get into the shower it’s always a surprise to discover something still adorning my body, and my immediate instinct is to try to remove it. Nursey would not be pleased.
I entered this twilight world about a month ago when I had my first appointment with the surgeon. Like most orthopods, he’s a hearty, muscular, outdoorsy kind of guy, and it’s not hard to imagine him with a saw or chisel in his hand. After he and I agreed that it was time for a new knee, it was then off to the cardiac shop to have my EKG. Apparently the EKG confirmed I had a heart beat, so two weeks later I had my final interview with the surgeon before the big day.
This was followed by a visit to the hospital to be documented and tested, and to receive my wrist- band. I was also asked to sign a sheaf of papers to say they could whatever they wanted with me, and to give them the right to distribute my most intimate secrets all over America if they so chose. This was Tuesday, and my surgery was scheduled for the following Monday. They would call me on Friday to let me know what time to be there.
Feeling that I was making some progress towards full status as a patient, I returned home to find three telephone messages waiting. One was from the hospital, one from the surgeon’s office and one from the cardiac shop, all telling me that though initially they had concluded I had a heart beat, they now thought it was suspect. If I didn’t present myself for another EKG no later than the following day I would be stuck off the operating schedule, would go to jail and would not collect $200.
You can imagine my feelings. From having climbed to the top of the pre-op pinnacle I was now facing relegation, or worse still, perhaps even an early demise. So near and yet so far. Fortunately for me, it turned out that the suspect heart trace was merely a glitch in the fax machine the cardiac shop had used to fax the EKG to the hospital.
So much for modern technology. Wouldn’t you think that if the contractors to the pre-op world were scattered all over the county, they’d have a more precise way to communicate life or death data?
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