Too Many Cooks

I figured this was an appropriate title of a blog entry the day after Thanksgiving even though the subject matter will have nothing to do with drumsticks, lumpy gravy, or green bean casserole. Hang with me. You'll see.

In Utah or Indy, it was pretty easy to know who were the medical experts in the field. I'm not putting either location down. It was just easier to identify. Although there were several hospitals, you knew where to go for cancer, eyes, orthopedics, etc. Now that we live in the medical mecca, there are just too many choices. Everyone is an expert and everyone has an opinion.

Last week I had a follow up appointment with my neurosurgeon. He looked at my films, did another exam and remarked that he strongly suggested I mull things over with my husband and consider surgery. Herniated discs typically resolve on their own within 6 weeks so so. I'm on week 9 and still there hasn't been much relief. I decided to schedule a second opinion at the multiple suggestions of my pain nurse practitioner and my therapist.

"Oh no, you definitely want to go to the Baptist. Lemme put it this way: one does not go to the local community hospital for spine surgery. You want to go where the sheiks of the middle east travel for orthopedics. You want the best when working on your spinal column." Proclaimed my therapist, obviously not doing the traditional non-directive, reflective work that I consider good psychotherapy.

My pain nurse worked there for 12 years and put in a few phone calls to get me prioritized on the list. Upon requesting a prior authorization from my primary care, she called and left me some rambling message about staying with my neurosurgeon as he has been excellent with my care and has not been quick to cut.

Last Tuesday I went in for my 4th round of spinal injections. The prior weekend I was beginning to notice other problems.

"Hey, would you hold my right foot? It feels cold." I said to my husband one night while sprawled out on the couch.

"Just your right foot?"

"Yes, it feels colder than my left. Is it colder?"

"No. Let me ask you this: why would your right foot be colder than your left? Is it really colder or are you just perceiving it to be cold?"

Sometimes its helpful to have a logical doctor type in the house. Another symptom has emerged and it isn't a good one. When I mentioned this to my neurosurgeon on Tuesday along with the increase of pain his response was to emergently admit me to the hospital and do the surgery the day before Thanksgiving. Well, I panicked and said no. Flashbacks of my knee surgery flooded my brain where I went through a similar situation. Instead he wrote me a prescription for narcotics and said to call the next day and get the surgery scheduled. After the injections he watched me carefully and asked if I was going to pass out on him again. Even the nurses remarked, "Hey! Its the fainting girl!" when I checked into the cath lab. Good times there.
I managed to stay upright and left the hospital in a cab while talking on the phone to my husband.

"Excuse me, miss, but I couldn't help but hearing you had some distressing news." Said the cab driver. "I realize its not my business and you didn't ask my opinion but I too have had back issues. You don't want to get the surgery there. No, let me give you the name of my surgeon. He is short on the bedside manners but he knows how to wield a knife."

The following day I went outside to take the recycling out when I ran into two of my neighbors.

"How's the back?"

"Yeah, I heard about your back. Is it better?"

"Oh, she had a walker and everything but I notice you aren't using it anymore."

"A walker? No kidding?"

Notice I haven't had a chance to get a word in edgewise.

"Have you done the injections? My niece had those injections and it helped."

"Yes, I've had 4 rounds and it still isn't better. My doctor thinks I should go to surgery." I said.

"Surgery? My God, well you know who you should see is Dr. so-and-so at the Brigham."

"Or, I could give you my doctor's name at the General."

"You know in Indy we knew who to see but living here in Medical Mecca, everyone has an opinion. I even got a suggestion from the cab driver yesterday."

"Oh, is that why he was outside of your house yesterday for such a long time?" Good God, I'm beginning to think that this one neighbor is the sole neighborhood watch.

Seeking clarification I called my primary care for her thoughts. After all, she was from here, did her residency here and was in the medical community. She gave her input that I should only see a neurosurgeon, not an orthopedist, even though the surgery was essentially the same. She also said I should just stay with the doc I was with as he had an amazing reputation despite his practice residing at the community hospital. Chances are, I would be guaranteed he would be doing the surgery not some resident. That was a huge benefit. I felt like my mind had been made up.

That night my husband came home with more options. He had reached out to his program directors and attendings. They all had suggestions and offered to pull rank if needed to get me a consultation. They also agreed that time is of the essence as there is also a window of time that the surgery needs to happen before my nerves re-wire and think that this level of pain and sensation is the new normal. That deadline is 12 weeks on average. I didn't realize it, but my window is closing quicker than I thought. We decided to send the docs emails but aren't holding our breath.

I think its pretty safe to say that I'm on my way to the operating table. This Christmas could very realistically be: Ho, Ho, Ho, off to surgery you go!

Dr. Teeth

I have spent years of my life living in different states across this Nation. And while I think nothing of it to get a new primary care doctor when I move and establish care, I have always kept my same dentist back in Salt Lake. Why not? You only see them 2x a year and quite frankly, that's pretty easy to schedule in when you routinely go home to see family. My husband has the same mind frame I do, although we keep different dentists. "Routinely" has turned into "annually" in the past couple of years which sucks.

I've only had 2 dentists in my life. The first was Dr. Simonsen who talked about being a big helper and "mister toothy" and inevitably you got a prize at the end of the visit. I went to him (as well as my pediatrician) until I graduated college and was forced out of the practice. It made sense as I hung off of the exam chair that was made for pint sized people.

I tried one adult dentist who was on my plan when I paid out of pocket for insurance and was horrified that they, a) actually scraped my teeth, and b) never offered me fluoride to rinse with at the end. Horrified. To the point that I didn't consider him to be a real dentist. I wrote letters to both the dentist and the insurance plan about the sub par care I received. Dr. Simonsen never did either of those! Little did I know, that was adult dentistry.

So, I joined the rest of my maternal and paternal grandparents, parents, and other relatives into the practice of Dr. Sorbonne. It was comforting to have such a geeky guy with a squeaky clean image peering into my mouth. My hygienist was usually pregnant regardless of when you saw her and had a brood at home. She was happy, giggly, and could talk non-stop. This took the edge off of her ruthless flossing.

Typically our moms call the dentists the minute our plane tickets are booked for a trip home in hopes of a cancellation. I was fortunate enough to see my dentist last November when I took Edgar home before flying to Australia. When Ginny died around the 4th of July this year, I wasn't so lucky. However, I did see "The Jerry" and haven't cut or highlighted my hair since. Pathetic, I know. At any rate, J's dentist has been known to do special appointments like the morning of Christmas Eve just for J if that is the only time schedules will allow. However, last year nothing worked and as a result he hasn't seen a dentist in (gasp) 2 years. All of this gets compounded by my stupid back. I still can't sit so although J's vacation is in a few short weeks in the middle of December, the reality of me sitting on an airplane for 5 hours is impossible.

Believe it or not, we had foresight before all of this and in fact, J started asking his colleagues and mentors about dentists in the area about the time we moved here. One came highly recommended and he called. The wait time was 3 1/2 months out. I'm not kidding. But, he scheduled and finally I did too. After favorable reviews from my husband I was looking forward to going. How I was going to sit in that damn chair was beyond me, but I certainly knew that in this town rescheduling is NOT an option.

Luckily for me, the staff were considerate of the fact and I spent most of my 2+ hour reclining. I was escorted back through the busy office, offered a magazine, and the purple bib was clipped around my neck. Things seem really normal. Typical family photos line the wall so I can tell he has 2 daughters and 2 grand kids. Well, in walks my new dentist. Imagine Patrick Dempsey with salt and pepper wavy hair, looking appropriately messy, and it is quite obvious in his scrubs that he works out. Of course, he has a killer smile. He introduces himself to me.

"Ok, lets get this party started!" He says sitting down on the rolling stool and immediately turns on Jimi Hendrix. I'm not kidding.

The guy is doing things that I have never had a dentist do before like take measurements of my teeth, my bite, and my gum line. I finally ask what he's doing.

"Well, I'm pretty anal I guess, so I do this with every patient. But lets say you are in a car accident, God forbid. I can completely reconstruct your teeth to where they were. For example I know that your overbite is exactly 3 millimeters over your bottom teeth. Your mid line is perfect, and your gums are 2 to 3 millimeters, which is awesome. Any more than that and we know there's a problem." By now Jimi is over and on pops the Grateful Dead. "Bet you never had a dentist who liked to rock out to Hendrix while you were in the chair."

I couldn't answer him as he now was holding my tongue with gauze and examining the floor of my mouth. Again, a first for me. The guy even palpated my salivary glands and examined my jaw movement.

"Guess I'm just stuck in the 60's." I have to say it was a lot better than listening to the elevator music I was used to in dentists offices or the inappropriate Christmas station blaring in the waiting room. Its not even Thanksgiving yet, people! Come on!

He even gave me the name of his back surgeon in the area and spent a considerable time talking to me about his own back adventures. Turns out he also had the L5/S1 mess and hasn't had a problem since the surgery in '84. He also talked about how he loves dentistry, but hates being late which he apparently is due to how he's crammed back to back with patients. The guy was personable. Someone you'd like to go have a beer with.

The rest of the visit went according to plan. The hygienist cleaned and polished my teeth. She flossed (gently) and gave me a toothbrush. I even got molds for a new night guard so I don't keep mashing and grinding away my little to no enamel I have left on my molars. (J thinks is oh so sexy with my night guard, by the way. Ha ha.) I shattered 3 of them in my life. While I was sleeping and they were in my mouth. Not kidding. Its gotten better with me not working though.

Besides the psychedelic rock, the rippling hair, and the minuscule measurements of my teeth, the only other thing that struck me was the sticker shock of my bite guard. I remember my parents talking to me about how expensive orthodontics were, but holy cow. Maybe its just the town I live in or perhaps I've been in the dark ages for so long, but I wasn't expecting it to cost the same amount of a pedigree Scottie puppy with papers and genetic testing. Not kidding. Thank God they do payment plans.

At least I didn't get a parking ticket on a two hour meter when I only had enough change for one hour and I was there closer to three. That was a major bonus.

Traffic

As a landlord, I can completely appreciate the availability of my tenants to give access to such people like electricians, handymen, plumbers, and the like to solve whatever problem may be occurring at said residence. As a tenant, I get the inconvenience just to get things fixed. "Could you be home between the hours of 8-4? We'll fit you in." Gee, let me just take a day of paid time off to do this, no problem. Knock on wood, my house has been in great shape with really responsible tenants whom I wish would live there forever and ever and ever until I want to come back. However, I digress. I just had to get that little magical thinking/superstition thing out of the way.

I believe my landlord is quite grateful I've been laid up. I can give 24/7 access to the house and it is not a true inconvenience for me whatsoever...I mean not in the traditional sense. This week has been a zoo.

First, we had the oil dudes show up. Now, I had never in my entire life heard of actual oil STILL being used to heat houses until I moved here. It was like someone telling me that they use the back fat of a pig or whale to heat the house. I suppose I thought that the method went extinct somewhere when the EPA was created. Not so much. Just move to the East where all things historical reign. I could almost charge admission to families visiting the area and show them the large oil tank in my basement and the 5x6 bright red oil shut off valve in my kitchen. They could make the stop after visiting Paul Revere's house. The problem with my money making scheme, its not so novel around these parts. Just about every house in the neighborhood has oil tanks and there is free enterprise among oil providing companies in the area. Its not like the electric company where you only have one choice. Good hell.

So, the oil dudes show up. They are trying to figure out the leak in our bathroom radiator. I, myself, would have called a plumber to do this, but my landlord assured me these were the right guys to call. At 5:00 on Wednesday some burly dude with a handlebar mustache and a wrench large enough to clobber Col. Mustard in the library, rings my doorbell. There were no introductions made or identification shown. Just a: "I'm here about a problem." For all I know he was the singing barbershop quartet hit man, but I let him into my house like a stupid trusting soul and showed him to my bathroom. It took maybe 5 minutes for him to work his magic and he was out the door. Edgar didn't even get a chance to smell the dude. He did let me know there was a small flood in the basement, to which I said I would let my landlord know.

I don't do stairs well these days, but I decided that I should venture down the rickety timbers to check it out. And, well, since I was going down there I may as well throw a load of laundry in at the same time. Down I go to find that yes, there were some small standing puddles of water and damp concrete, but it didn't stop me from throwing my load of towels into the washer. I did curse my overestimation of my abilities as I hobbled back up the stairs one at a time.

Later that night I let my landlord know who looked discouraged and exhausted from a long days work. It seems a lot longer now because of daylight savings and it gets dark at 4:00. What the hell? I have reached the conclusion that just about everyone in New England must have Seasonal Affective Disorder. How could you not thinking that you are a slave to your company working until dark every night not seeing the light of day? To add to my vision I like to think that the cafeteria at work only serves gruel. She also mentioned the fire marshal is going to stop by as well on Friday.

Sure enough bright and early two very good looking gentlemen in tight tee shirts with "Watertown Fire" embroidered across their chests ring my doorbell Friday morning. Edgar is going nuts and I'm regretting my post-wake up wardrobe selection of a Rush Pike '94 tee shirt, flannel pj bottoms, and hospital socks.

"Oh hey, lil doggie. Weez here about checkin tha fuhrnace fourh fiah code." The first guy said in perfect South Boston drawl.

"Ok, sure, come on in." Once again letting strangers into the house. Edgar is rooing and standing firmly behind me like a fierce protector. "Don't mind him. He's all talk."

The two guys follow me into my very messy house to the basement door. Again, 5 minutes later they emerge to have Edgar still grumbling and pacing.

"Hey, remembah tha one cohl abou' tha' dawhg?" The first guy says to the other and they both start to laugh. "Yeah, it waz so funny. Ourh captain reached dohwn to pet it and it bit him in tha crawtch."

Both are wiping their eyes with laughter in the middle of my kitchen that looks like a tornado hit it.

"Yeah, he had ta goh get a tentus shaut an' everythingh."

"Hey, yous not from ahround hereh, are ya?" The second guy says after regaining his composure. I wasn't aware we were having a chit chat visit and began to wonder if there were kittens in trees these guys had to go rescue or something.

"No, I'm originally from the West. We just moved here a couple of months ago."

"Whll, hey! Welcome to tha neighbahood. Its really nice hereh. Its just yous an' yah huzband?" He looked at my left hand. Well, that was a good sign I thought. Maybe he was checking me out, all bed-head, morning breath, and all. (At least this is what I'm telling myself to boost my ego.)

"Yup, and Edgar." I gesture to my black mop of a dog who is still protesting these strange men in his house.

"Ehdgah. What a ghreat name. Like tha poet? I'z read a lot a him in college. Mahjohd in English lit." Oh good God, the fireman is a scholar. I was expecting him to launch into "The Raven," at any minute.

"No, no, he just looked like an Edgar."

"Hey, youh gettin caught up on tha Sopranos?" Motioning to the tv, paused on Uncle Junior's face.

"Yeah, yeah, I should be studying." It was only at this moment did I notice the bright red huge firetruck parked outside my house. How I missed this earlier I'll never know.

"Noh kiddin? What cha studyin'?" The guy picked up one of my text books.

"Getting my masters in organizational development and psychology."

"Wow. Good luck tuh yah then." He puts it back down on the table. I'm beginning to wonder how busy this department really is as they took the one fire truck from the station leaving the rest of the crew just to go check a furnace and if perhaps I should offer them tea for our visit since it doesn't seem to end.

"Wells, it waz a pleasure." The poet fire dude hands me some signed document indicating everything is up to snuff. I almost expected them to imitate the SNL skit of Mark Wahlberg and say, "Say hi tuh yah mutha fohr me." But instead I got a handshake.

The Good, The Bad, and The Ugly

Its been an eventful week. For one, I went back to the neurosurgeon for more spinal injections. That visit went something like this:

"So do you hurt here?" Dr. presses sharply on my back. "As in, does it aggravate the pain?"

"Well that certainly doesn't feel good." I'm wincing.

"Yes, but does it aggravate it?"

"Um, yes? I mean it doesn't make the shooters come." I'm getting frustrated with this whole subjective pain scale anyway.

"Aggravation?" As if repeating it 3x will make it better.

"Yes."

Dr. decides to inject only 2 of the 3 sites that hurt. I don't get it.

"Could we do all three?" I ask as he's swabbing betadine all over my lower back and pelvis.

"No. I'm concerned about the level of steroids you've had already. That level messes up a lot of body functions."

"Yes, but it hurts and I just want to feel better. What happens if I come back for my follow up and I'm still hurting. Are we then doing surgery?"

"Are you pushing for surgery because if you are, then I'm not going to do it." (Did you catch the I'm-in-charge-and-you-can't-make-me line?)

"No, I can't see why anyone would push towards surgery. I just want to feel better. I don't care how it happens. Would we do more injections?"

"I see that you are emotional right now and frustrated. Medicine is an art and a science. Now my intuition, or the art part, is telling me only to do 2 of the 3 sites."

I could have pointed out that we were both arguing from emotional sides, but I decided to let it go. Later after the awful, awful sadistic injections, I was instructed to go sit in the waiting room of the cath lab. Since I cannot sit, I stood. In the waiting room there was a family who was waiting for their 87 year old mother who apparently had a heart attack and went down in front of a few family members. I stood there listening to their stories, trying not to be intrusive, when a nurse came by and said, "Honey, are you ok? You don't look so well." I couldn't respond because I passed out. Yup, I went down in front of the startled family thus re traumatizing them. The staff put me on a gurney, gave me juice and crackers, took my vital signs and asked where my responsible adult was who was taking me to and from the appointment. I responded that my husband could not get time off work so I just took a cab. Let me tell you the kind of lecture that followed. It was all very embarrassing. They made me lie there for awhile and then had me stand and then followed me out to the cab. Way too much drama and I still have a big question mark as to my plan of action with my back.

The second thing that happened was that I made it to school this weekend. Administration was highly accommodating and put a couch in the classroom for me. I had a great time. Exhausting, but great. The next class is about Self as Practitioner. There are a lot of assessments and understanding of styles and impact of it. It seems to be highly introspective so you could see my confusion when one of the assignments is for all 13 of us to work on a business plan for a consulting agency. Ummm, is it me or does that not meet the learning objectives? Somehow I became the mouthpiece for the class leading this revolution. The same thing happened 10 years ago when I was at Tulane and they took away choice of our professors when registering for classes. I was the voice for that one too. How is it that I end up in these stupid roles?

The third thing that happened was this morning and standing in line for 40 minutes in my pajamas to vote. The line wrapped around the school and I truly believe that history will be made today. It won't be the outcome that is historic for me, although it will be noteworthy that a minority (either racial or gender) will be in office, but it will be the record turn out. I've always had a passion for getting out the vote, or GOTV as they call it in poli sci circles. It makes me proud to see people actually caring. It also made me wish I kept my status in Indiana to vote there by absentee. However, even though it would have been legal, I wouldn't have felt very ethical about doing it.

And the fourth thing that will happen today is visiting the perinatal psychiatrists. Who would even dream that there is a speciality out there like this? Its a complete dream come true like believing in unicorns or something. I suppose living in the mecca of advancing medicine is like living in Oz and having little green men running around everywhere. If you dream it, it exists. Now, while it is a dream come true, I will not be visiting Glinda today but more like her sister. I have experienced zero compassion from them. Originally I had an appointment in early October, but J canceled it as I was in the hospital. They rescheduled it and then canceled only to reschedule to today. When I realized that J could not make it and getting down there for me would be a feat I tried to reschedule. They told me that if I couldn't make it they would never see me and deny rescheduling me ever. Even as I explained the circumstances of the rescheduling they were rigid beyond belief. I was within policy of the 24 hours and yet no leeway. Oh yeah, we're off to a raging great start with a therapeutic alliance that needs to happen between psychiatrists and patients. But, I will make it there and stand with my walker for my one hour intake assuming that they are on time, that is. I'll make sure my point is made. For their sakes, I hope I don't pass out.