Surgery in a Foreign Country: Check!

Alright! Got that over with! Thank you, everyone, for all of the supportive and encouraging comments and emails you have sent me. I was feeling pretty bad about the whole thing, and your thoughtful words and prayers sincerely helped. And I am working my way through your most excellent movie suggestions. Now it’s been five days since I had my knee surgery, and I’ve had some time to think about the whole experience. It was very, very different from the first time, and I haven’t decided which experience was better or worse.

First of all, the surgery in the States was an outpatient procedure. I didn’t have much preparation beyond being given a prescription for pain meds before hand. I went to the hospital in the morning, put on a gown, and was quickly put under. I woke up fully clothed(!) and as soon as the recovery nurses got me to stop shaking, I was wheeled out to the car to be driven home. I was already under the influence of unusually heavy narcotics, even by US standards, and pretty much stayed that way all week. I don’t remember a whole lot of pain. Or a whole lot of anything, I guess, but I do know that it was a lame, depressing time, perked up by visitors and plenty of ice cream. A few hours after I got home, a technician arrived with two contraptions, a CPM (stands for Continuous Passive Motion, a machine that moves the operated limb through a range of motion to prevent too many restrictions from forming during the healing process) and this cool wrap thing that circulated ice-cold water all around my leg from an ice chest reservoir– this was a great help, and anyone who stopped by was asked to dump out the cool water and refill with plenty of ice. This really helped with the swelling, and went a long way toward keeping me comfortable.

Despite the fact that the first surgery was considered an outpatient procedure, it actually lasted 4 hours! It was originally scheduled as a 2 hour operation, and I still have no idea what happened in there to make it take twice the usual time. I did get a call that night from a slightly concerned anesthesiologist to make sure I was OK after so much time “down under.”  Other than that, I never saw any medical staff until a week to 10 days later.

This time seemed like an absolute inversion of the first experience. I had to go in and spend the bulk of a day at the hospital two weeks before my surgery date, getting a physical that ensured that I was “fit for surgery,” which included blood work and cultures. I also met with the “physio” staff, and they pre-trained me on crutches, taught me my post-surgical exercises and let me know of the restrictions and rehab schedule that I should expect. After that, everything was totally quiet… I never got a confirmation call about my surgery appointment, or follow up questions about insurance after I dropped off that paperwork (this is going to be important later.)  It felt weird that no one called to make sure I remembered not to eat anything the night before, or just to make sure I was clear on the time.

I did show up on the right day and time. Oddly, as soon as I checked in, the receptionist asked me for £5000! I explained that I wasn’t a cash patient, but that I had turned in my insurance information two weeks ago. She said she’d look into it, and I was quickly taken to my hospital room, where both the surgeon and the anesthesiologist came by to chat with me and make sure I was clear on everything about the procedure, including the risks. This was a lot more conversation than I ever had with MDs in the US related to the surgery, although I had already spoken to my UK surgeon about all of it a couple times before this, as well. One odd thing was that I was waiting for a long time for it to be my turn– everyone had told me I should be going in much sooner, but the times kept changing. Then someone from finance came in. They had never called my insurance company, and wondered if I had an authorization number. (No. I don’t. You have my insurance info, I thought you would call them… I asked if you needed anything else several times…. Why are we having this conversation NOW?! I’m in a gown, I’m fasted, my husband is at work, I’m late for my surgery!!)  I had the most ridiculous exchange with this person several times, and then she said they don’t have a contract with our insurance company and wouldn’t proceed with the surgery until they could get payment. What?! I had really been doing a good job about keeping calm and brave about everything until this happened. I was completely livid. But I know better than to be nasty to people who could possibly help me. I pleaded my case to her, then called Jeff. He stopped what he was doing to call the insurance company and basically cajoled them into calling the hospital and telling them we were covered. I never heard back, and soon after, I was wheeled out to surgery– I didn’t ask anyone if it was resolved, I just wanted to get the thing done before anything else happened!

“All gowned up!” Yes, I was bored and texting pictures to my husband.

Coming out of the anesthesia was really rough, for some reason. I got pretty ill, and was so out of it but conscious enough to know I was scared. And I had a whole lot more pain than I had expected. The two nurses in the recovery room were SO nice. They were really concerned, and super kind. I was throwing up and one of them was rubbing my back while the other, a young male nurse kept saying “Well done, well done. Yeah. That’s it. Yeah, well done….”  This is very funny to me in retrospect. But I appreciated them both so much, and never saw them again after I was taken back to my room. I would seriously hug them both if I ran into them in town.

So, this was the point at which I was sent home after my surgery in the US, but I still had another 24 hours in the hospital. This was partly because I had a femoral nerve block, and I couldn’t get around at all. Most of the nurses were really nice, and I have never been called Luv, Darlin’, and My Dear Girl so much in my life! Being served tea throughout the day was also nice. Then the anesthesiologist stopped by a couple times to talk to me about my pain, and everyone discouraged me from having anything for my pain beyond Tylenol and Ibuprofen (these doses were even less than what I was given after my c-section, amounts considered safe to use while breastfeeding.)  My surgeon came by and declared the operation a success, detailed the findings and procedure, and proudly announced that it only took 55 minutes.

The next day, I really wanted to get home, but no one seemed in much of a hurry to get me out of my hospital bed. My physiotherapist came by several times, for a little bit of work at a time, and asked the staff to supplement my meds, since my muscles were so inhibited by the pain. It sounded like he has often had to rally for more pain control for patients, so he could even get them to move. After the fourth visit, he had gotten me walking and even seen me hobble up and down a few stairs. No one really seemed to be clear on the discharge requirements. I was relating what my MD had said to me about leaving to the nurses, and it was news to them. The lack of protocol and communication seemed strange to me. Finally, it seemed like no one cared if I stayed, so I asked if we could go… “Sure, if you’d like.”  Then no one said anything about how we should leave, if we needed to sign papers, or anything. Someone mentioned finding a wheelchair down the hall. Finally, an older nurse that had really been invested in my care offered to help us out, and she brought a wheel chair and wheeled me to the door. I crutch-hobbled to the curb and waited for Jeff to come by with the car, and that was that!

I left with a prescription for Tylenol and Ibuprofen, a PT appointment for one week later, some bandages, and an exercises and precautions paper. I asked about ice (it was never used in the hospital) and they said “Sure, use it if you want.”  We have, and I quickly asked Jeff to go on base to get Tylenol + Codeine, since I had a lot of pain, and couldn’t do the post-op things I was supposed to (weight bearing, exercises) with the level of discomfort I had. He actually found it at a local drug store, not requiring a prescription, but with lots of strong warnings about addiction on the box. It was especially wonderful to get back from the hospital, and to be home. Our living room is really nice, and I love the view out our big bay windows. Jeff had put four flower arrangements around the room, and it’s a great place to be. (I appreciate this even more now, because of my previous hospital experience, when I didn’t have a home to go to when I was discharged.)

My view from the couch…

Several days later, I am still basically living on our couch. I sleep here and hang out here all day, but have recently graduated to going to the dining room to eat (exciting!)  Today was my first day alone, since Jeff had to go back to work. My daughter’s school found a family nearby that is willing to come by and walk Amelia to school in the mornings, and Jeff has arranged his schedule so he can pick her up in the afternoon. It’s a huge relief to have the neighbors’ help, and I only just met them this morning. I am hoping we can see them socially when this is over! I am feeling better and better, and hope to be able to resume my normal duties in another week. Jeff has been doing all of the cooking, cleaning, and care taking around here, and has been really, really nice about it all. Bless him. We are still keeping fingers crossed that we don’t get a bill in the mail for £5000. Gulp.

And so, we have muddled through another foreign experience, and come out just fine. Oddly, my 30 hours in the hospital provided more social interaction than I have had in the last three months. I guess this is one way to get to know your new town!