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!