19 Days Pre-Op – Physical Exam with Surgeon’s Office and pre-admittance testing and interview at Mass General.


My wife and I had a very busy and productive four hours in Boston this past Thursday. If anyone had told me the amount of work and preparation that went into preparing for knee replacement surgery I would have never believed them! What follows is a description of that days events.

Pre-op appointment at the surgeon’s office:

We met with the surgeon’s nurse practitioner for a thorough exam, interview and briefing. The first thing I should do is let you know that I don’t take a whole lot seriously and if there is any chance at humor I will take it. I love when people buy into that attitude and embrace the silliness. This NP did not embrace my humor! That in no way stopped me but it made it somewhat less fun!

We were led into an exam room and she left for a moment or two. That’s when I spotted a sample of the artificial knee joint on the counter. I‘m not real good about boundaries either and pick the pieces up and started playing with them. I was most surprised by the larger of the two halves being as heavy as it was. I guess it makes sense as they can’t be made out of recycled cans and are meant to be durable but definitely much, much more heavy duty than I would have expected. Feeling like an old school Soviet Spy I whipped out my Blackberry and snapped a picture that I am pasting below.

When the NP came back in we then went through about a forty-five minute question and answer period with a very basic physical exam in the midst of it.  She was real good about answering our questions than ran the gamut from insurance related questions, actual surgery questions to the rehab and recovery period.

We were most concerned about the release from the hospital and my ability to go directly home. Due to where we live once in our home I am blessed because everything is on one floor. The downside is that to get into that single level I have to navigate a total of forty-eight stairs. As it turns out even before surgery the Surgeon’s office assigns a rehab case manager to me who will do a pre-surgery phone interview with me that will cover issues and concerns such as these. She is in charge of coordinating my in-hospital physical and occupational therapy and those same efforts after release from the hospital. If it is determined that I cannot access or egress from our home safely then there may be cause to put me in a rehab facility for a few days after surgery.

I did learn that my surgery is scheduled for 2PM on August 10th and that I am scheduled to arrive at the hospital two hours before the surgery time. While in some ways I would have preferred an earlier surgery time this will likely work better for us. We are travelling south from New Hampshire into Boston and the morning rush hour and traffic backups may have added just a bit too much stress.

I also learned that my surgeon uses the most up to date knee replacement technique that includes the use of computers to align things appropriately. I thought that this was pretty cool as in my own research I had watched this type of knee replacement surgery on Youtube. I’m including a couple of sample links below:

http://www.youtube.com/watch?v=zk2P35GaPPc

http://www.youtube.com/watch?v=8WL5oghOUSQ

The NP also asked a ton of personal health related questions to make sure that all pertinent information is gathered that could be of importance to the surgery procedure itself. This was a bit tedious as I had just been through a complete pre-op physical with my general practitioner the day before and had been inundated with similar questions.

After all of this Deb and I were then sent on our way across the street to Mass General for my scheduled appointments there.

Pre-op tests at Mass General:

Let me just get this out of the way early on- so far I love Mass General. It is huge and can seem to be intimidating but so far we have had nothing but excellent experiences with the hospital and staff. I am most hopeful that at the end of this journal I will still be espousing my love for this hospital.

Deb and I found the pre-admission testing area and registered there. Immediately I was handed a clipboard with a medical history questionnaire that was four pages long. This was now to be my third time in two days that I would have to answer these same types of questions!

I was taken in within minutes by a robust black woman who matched my irreverent humor pattern to a tee! Every humorous shot I could fire at her was returned with an even larger volley. The thirty or so minutes I spent with her actually teetered on flat out fun!

The first stop in the circuit with her was the EKG. Nothing too exciting there in terms of the procedure. She did make note of the fact that my resting heart rate was about 105. I explained to her that for years I had been tachycardic, (heart beat over 100), and she was satisfied with that.  She also said my blood pressure was a little high but I explained that Dr. GP had just adjusted my blood pressure meds the day before.

The next step with her was a urine test. The good news is that I had been up all night studying for it, (insert cymbal crash here). She said do you think you can produce a little urine for me?” Fact was I had to pee like a race horse at that moment! I asked her how many ounces she was looking for and she told me that she only needed “a splash” and I was welcome to do what I wanted with the rest!

The best part of my interaction with her came during the blood draw. I have done this in the past with other ladies who were about to take my blood and it worked like a charm here too. As I was sitting there and she was preparing to draw the blood I just softly said “Sometimes I pass out!” Well the look on her face was great and she immediately got all flustered and said “really?” I confessed that it was just a joke and started laughing at her reaction.

In return for my efforts she got all sassy with me telling me that it’s not funny that when taking my blood she “ought to miss.” Not one to let it go I pointed out that the pressure was now on her because if she did miss it would look like she had done so on purpose! That was met by her boasting how she never misses. She even showed me a clipboard with a list that looked to be over fifty patients long that she had drawn blood from that day without missing. I again reminded her that the pressure was on her not to miss

Well don’t ya know- she missed! I have to tell you I was just laughing and laughing. She became so flustered and could not stop repeating that she never misses and that I made it happen because of my messing with her head! Now I told her that the real pressure was on and that she’d better not miss a second time. I swear she actually started sweating profusely. She even pointed that out to me as she was mopping her brow.

She tried again- and missed again!  Now this was too much for me and I laughed harder and harder and she protested harder and harder relative to her previously excellent track record. Again the clip board came out as a visual representation of her excellence in action prior to meeting me on this day. Fact of the matter is she asserted that she was done with me and someone else was going to take my blood. I told her that I was going to tell everyone else that she missed seven times. She said I’d better not- but I did. She had one of the other ladies come over to draw my blood and she got it on the first attempt. All the more funny for me and the more frustrating for her.

When the blood work was done she had to go and bring Deb in for the next steps and she just gave Deb a look and without even knowing the circumstance Deb just looked at her and said “I’m sorry.” She then went on a rant to Deb telling her that I had better take Deb out to dinner and that she admired Deb’s necklace and that I should have to buy Deb the matching earrings and ring as well.

The side lesson related to this delightful woman was that in our conversations I learned that she had just finished a year-long battle with breast cancer and its terrible treatment regimen. Most recently she had been diagnosed as Cancer free. With all this she was still a joy of a person with a wonderful disposition. So what in the world do I have to complain about regarding knee replacement surgery?

Pre-op nurse intake interview at Mass General:

This was pretty uneventful. The bottom line is that for the fourth time in two days I had to answer a “gazillion” questions about my health history. Same questions- same answers. I’m pretty well convinced that you have to answer these same questions at every stage as everyone in the medical community needs to “cover their arse”  due to the litigious reality that is our society.

The one thing that I did learn from her is related to the anesthesia type that I may receive for surgery. As it stands now I will have a “nerve block with conscious sedation.” Bottom line is that in this type of anesthesia they do not have to put me completely out and intubate me, (put a breathing tube in). This is supposedly safer and allows for less complications and quicker recovery.  Some useful links that I have found:

http://www.nysora.com/peripheral_nerve_blocks/ultrasound-guided_techniques/3108-us_guided_continuous_femoral_block.html

http://www.marshfieldclinic.org/patients/?page=cattails_2006_julaug_painblock

The bottom line is that in theory I may be somewhat awake during the two hour surgery but there will likely be no memory

Pre-op anesthesia nurse intake interview at Mass General:

You’ve guessed it- fifth time in two days with the same health history questions!  This nurse was very helpful with all types of information. At all steps during the day discussions had occurred with at all stations on this day as to the meds I take – and the supplements I take and what and when to stop taking before surgery. Turns out something as mundane as fish oil has to be stopped a week before surgery. Same goes for baby aspirin as both thin out the blood. No alcohol based products can be used on my body the day of surgery- things like lotion and cologne are a no-no!

To the important practical side of life she provided great insight as well. I explained how I was more worried about Deb on surgery day than for myself. She then stepped us through what Deb could anticipate on that day, the right places to go, best places to park, timing of the day…. It was also good to hear that the family surgical waiting room has a full time staff person there who receives real-time updates from the operating room that they will share with her. The most important thing she provided to Deb and I was assurance that she would not be alone or forgotten in the process. She explained that the vast majority of Mass General patients are not from Boston and a lot are not even from the United States so the staff is acutely sensitive to helping family members during this process.

After this last step we were free to go home. It was about a four hour process but not too bad considering all that was accomplished. Time to pay the $9 parking and head home.

This post was ridiculously long- apologies. Stand by for next update posts.

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About onemanoneview

Rode hard and put away wet.
This entry was posted in faith, family, medical, Uncategorized and tagged , , . Bookmark the permalink.

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