Apparently the universe was not done giving me the āslow downā messages with simply a detached retina and sore knee that canāt be assessed, let alone fixed, until after my retina heals. So, ā¦ at least eight weeks.
The night of my surgery, I stumbled in the bathroom twice in succession, heard a loud pop both times in my right knee (the sore one), felt excruciating pain, and to cut to the chase, had to be taken to the hospital in an ambulance. I feel oddly embarrassed by this. I think prior to this week Iāve been in the ER only a handful of times in my life, usually for someone else, but only once before in an ambulance.
The 911 response team was wonderful. They immediately gave me IV pain meds that took the edge off. āThey wonāt stop the painā, the paramedic said. āTheyāll just make you care less.ā The EMTs apologized for the fact that they actually had to get me on the gurney and into the ambulance and to the hospital. And all this was going to hurtā¦ A lotā¦ It did.
Ambulance maintenance clearly does not include shocks. I felt every bump along the way. The EMT gave me a little more pain medication in route.
Apparently fentanyl derivatives make me very talkative. The EMT kept asking me questions and I kept answering them. I babbled the whole way. It only occurred to me later that this was a distraction strategy – keeping my mind on something other than the pain. He asked about my career – directing forensics at St. Olaf College immediately after earning my PhD, helping create the precursors to what become the School of Public Health at UNR, serving as the Kansas Health Foundation Distinguished Chair in Strategic Communication and starting the Wichita State University Hunger Awareness Initiative, teaching judges around the world, traveling with my children, my amazing partner Andrew, and on and on. I donāt think Iāve ever told anyone so much of the story of my life in one 20 minute moment. And through it all, I reaffirmed for myself how wonderful my life is except for this weird momentā¦ and, you know, some other weird moments,ā¦ but those are different stories. Apparently even when Iām on drugs I recognize how privileged and blessed I am.
We picked the hospital we did because it was in my insurance network and Iād had a very positive experience there earlier in the week when my retina partially detached (see parts 1&2 in this series). Andrew also called in advance to make sure they had people available to address my injuries. They told us they had people on call who could take care of me, if necessary.
We and the hospital staff differed vastly in our understandings of what ācareā meant. For us that meant figure out whatās going on with my knee and get a plan to fix it. For them it meant āIf it aināt broke we donāt fix itā, a literal quotation from my attending physician. They did, however give me great IV pain meds, so I was able to relax a bit.
Andrew followed the ambulance in his car. At the hospital the ambulance went in one entrance and the EMTs directed Andrew to park in a nearby lot. āTheyāll let you in back as soon as you get in. Donāt worry weāll take good care of her.ā And they did. āļøāļøāļøāļøāļø to the 911 response team. The ER staff were a mixed bag. I asked for Andrew from the time I got into a bed in the ER. They made him wait an hour and a half in the waiting room until they allowed him back with me.
When we got to the hospital Andrew called my daughter Alyssa. I hadnāt been able to reach her. Alyssa came immediately and they let her back with me.
They did a really nifty set of x-rays in the bed. I didnāt have to move my sore knee much or turn my head. It was pretty snappy. I knew that I hadnāt broken anything. I hadnāt actually fallen. So it had to be soft tissue damage. But x-rays are the ER go to.
What I should have remembered from Alyssaās experience shredding her knee was that emergency rooms, although they tell you they have orthopedic specialists and surgeons on call, donāt call them to the ER except to set bones. When I say I should have remembered that ERs donāt treat soft tissue injuries, what I mean is that 10 years ago when Alyssa destroyed her knee, severing her ACL, MCL, tore meniscus, and severely bruised her knee, they sent her home with no wrap, no brace, and no crutches because her leg wasnāt broken. When we went to the doctor the next day and found out the extent of her injuries, I was livid. I assumed Alyssaās experience was just bad care. I didnāt realize it was ER practice not to do anything with soft tissue injuries.
With Alyssaās insistence, they did finally decide to give me pain meds, the sling that I wear from my thigh to my ankle, and a pair of crutches. They then wished me the best of luck in finding a referral as they didnāt have one to give me. Not sure how any of that means orthopedic surgeons on callā¦ or careā¦ But there you goā¦
Reflections:
1. Iām really not sure what I should have done when I hurt myself that badly at night. The pain was unbearable. I definitely needed some serious pain meds and I am not clear what the alternative to the ER might have been.
2. I need a clear understanding of what services are provided in the ER. Maybe we all do. Itās important to know that they donāt deal with soft tissue injuries, no matter how painful they are. In the words of my attending physician āWe treat blood and bones.ā Neither were my issue. In the ER, they x-ray. Because the same ER had done CT scans with and without contrast and ultrasounds earlier in the week, I expected more.
3. Itās very important to have an advocate. My daughter made things happen quickly once she arrived.
4. In all situations, assertiveness and perseverance are important in getting your needs met. It was very difficult to get the health providers to come down to my level so I could actually see them. Since having had my retina reattachment surgery earlier that day I could not lift my head nor could I lie anywhere but on my right side, eyes parallel to the floor. I repeatedly asked the same doctor and nurse to sit down so I could see them when they talked to me. That actually helped them stop treating me like I wasnāt really a person and facilitated communication. Iām glad I was assertive about that.
5. It helps to have a professional that you can call for back up support. I am incredibly grateful to one of my ex students who is a well respected doctor and has worked in the Las Vegas medical community. She talked with me on the phone while I was in the ER, clarified my expectations, and helped me strategize.
6. Even though I didnāt get what I hoped for, a diagnosis and a plan for treatment for my knee, I did get what I actually needed in that moment. I got pain medication, a brace, and crutches. Thatās a lot to be thankful for.
Deborah's Deliberations 