Downtown Los Angeles is a cornucopia of interesting sights at 4:30am. Not quite the bustling metropolis of mid-day, the streets are quiet and there is an air of truce. Eager business leaders are donning their Armani as they walk to their place of business while ladies of the night in thigh-high boots, revealing short skirts and lipstick slightly smudged to one side appear to return to the facade of their daytime persona. It's an interesting mix and while I was naively not in fear of my safety, I was still comforted to see two policemen on Mt. Bikes crossing the street. It would be just typical to be carjacked in LA on the day I was supposed to get a new hip.
We arrived at the hospital at 4:50am. There was no one but a security guard in the lobby. There is no more eerie feeling than walking into a new hospital, which are generally characterized by bustling staff, overhead pages, and familiar sounds like elevator beeps, rolling gurneys and telephones ringing. St. Vincent's was completely silent which was an excellent opportunity for me to notice that the ceiling needed some work, the paint was old and the carpets needed cleaning. My confidence in this venture was plummeting.
We headed down to the outpatient check in. Again, empty. No sign of a single person. Were we in the right place? I started to think of my Devil Schmalzried image and that I was potentially the only patient that would be there today. It was surreal on so many levels. Being completely comfortable with hospitals and red lines you are not supposed to cross, I went exploring. Passing through two sets of double doors and signs that said "staff only", I found the short stay unit and a scene more fitting of a hospital. There were techs and nurses and surgical staff brimming about with signature white paper cups that indicated they contained coffee and a ringing phone or two. Half of these folks just got to work and the process of stocking and checking off boxes on safety checklists was in full swing. I felt better.
"May I help you?" asked a kind nurse despite the fact I was not where I was supposed to be.
"Is this where I check in for surgery?"
"Oh no, that's back here around the corner," leading me back the way I came.
Just then a very nice lady came rushing in, apologizing for being late and asking me to step in to her office. I still felt like the Thanksgiving turkey on a particular day in November, but decided that sometimes a little faith might work out to be a good thing.
She kindly introduced herself as Arlene. She appeared to be of Asian or Hispanic heritage yet she had no distinguishable accent. She explained the process of registering me for surgery, and went over everything in detail. She was professional and knowledgeable. I was feeling better.
"What do you think of Dr. Schmalzried?" I asked her.
"He's very nice. Always has a big smile and always acknowledges everyone in the hallway. People come from all over the country to see him."
It was a similar answer to the X-ray technician. Was this guy too good to be true? Did he make up socially what he lacked in surgical skill? I had no good evidence that this guy was anything but an excellent Physician with strong interpersonal skills. he was making it very difficult for me to back out.
"This is your consent. Sign here please. "
This is where I give Dr. Schmalzried and St. Vincent's Hosptial permission to saw off my femur and replace it with an unknown implant that they deem appropriate. Generally, in these surgeries, the company rep shows up with 3 or 4 tables of implants, parts, pieces and tools so that once they have opened you up and dismantled your wheel, they don't have to go running out of the room for a screwdriver.
I scribbled my name nonchalantly.
Arlene told me to take a seat and a nurse would be with me shortly. I left her office to return to the waiting room and saw a line of people waiting at the check-in desk. The place was filling up. By this time, there were more people in hallways and the TV's in the waiting room were on. It appears, I was just an eager beaver of sorts, and my fears of being the only entree on today's menu were obviously incorrect.
Minutes later, a Chinese nurse came through the first set of double doors and called my name. "Tori" is usually not butchered by Asians as it means "chicken" in their language. I found this fitting given the situation. "Hyangshee RN" led me to my room and handed me my paper surgical gown.
"You take everything off please, including underwear, and put in bag."
"Even my hair tie?"
"Everything please." she nodded and left the room.
There is something very unsettling about being anxious and being naked at the same time. One is exposed both physically and emotionally and the vulnerable feeling it creates conjures a very primal need to control something, anything. One wants to feel part of the process especially now that your identity is stripped and your future is slightly uncertain.
"Can I have my IV in my left arm please?
"Which leg getting fixed?" my nurse inquired.
"My right hip."
"IV go in right arm with right hip. You lay on left side." She gestured that my left arm would be inaccessible while in a left side-lying position. This made sense as she was leaving the room, but did not satiate my need for control.
When she returned, she brought with her TED hose. TED hose are white compression stockings that are useful in preventing blood clots. As the Standard of good nursing care is being adhered to, my confidence level is rising. In the meantime, two other potential hip victims enter the short stay area. One, is a relatively young gentlemen accompanied by his wife. I overheard him state that he was having bilateral hip replacements. He couldn't be more than 60. I also overheard him talking about how great it was going to be to get back to running. He and I had common interests. I wanted so badly to walk over in my little paper gown and recently pedicured toes and ask him who his surgeon was along with his diagnosis. However, I refrained. Not everyone is comfortable with naked strangers in paper gowns coming over to you and asking you about your health problems. He was probably as nervous as I was and we were the bobsy twins in our little paper gowns which I was coming to hate as nothing more than a means to denigrate my character.
Just then, a new face entered my "room" which was really just a space designated by curtains.
"Hi, I am Debbie. I am the Physician's Assistant for Dr. Schmalzried."
She was pleasant, calm. She wore a white coat with her name embroidered in blue letters and her hair casually swept back from her face. She seemed kind and apologized for being rushed. Her morning was off to a swift start but she still brought a soothing feeling to my fickle psyche. She asked me my name and birthdate which is standard for making sure you have the right patient and then asked me the reason for my visit.
" Total Hip Replacement." I stated.
"Which hip?" she inquired.
"My right hip," I responded.
She wrote "yes" on my right hip with her sharpie and her initials, DC. I thought a big target sign with big, loud red circles representing "bullseye" would be much more fun. Or a snappy quotation like, "measure twice, cut once," or "Don't "F" it up," might be kind of entertaining. Not knowing my surgical team, I feared they would not find this at all funny and they were the last people I wanted to offend in my particular situation.
When a surgical team prepares a patient for a procedure, there a few key preparations that have to take place. A surgical procedure of this magnitude requires the patient to be intubated so that the anesthesiologist can control the airway. Obviously to do this, the patient must be sedated or "gorked" for a more interesting term. The medicines that are given for this type of surgery have a side effect of knocking out one's respiratory drive, meaning it's possible to stop breathing during the procedure. Rather than tempt fate and wait for this to happen about the time Dr. Schmalzried is halfway through sawing off the neck of my femur, the anesthesiologist does it up front as a protective measure. That way, there is already a tube in place to drive massive amounts of oxygen into my lung fields at my time of greatest need. I am all for it.
Then there is the subject of the southern region. A catheter is inserted into the bladder and drains into a bag. In the interest of keeping the surgical site clean, this is a brilliant solution to keeping me from peeing all over the table in my sedated state. And even if my bladder was empty, this handy little contraption means I don't have to get out of bed to pee directly following my surgery. I can't imagine anything worse than trying to stand up with all kinds of anesthesia in my system and make my way to the bathroom on a post-operative leg. One very important thing to remember with hip replacements: there are no "do-overs" and risking a fall so early in the game is not in one's best interest.
Finally, the surgical site is prepared. If the patient is a particularly hairy beast, the surgical team shaves the area and then applies an antiseptic, antibacterial agent that kills any potential organisms that my find opportunity in an open wound. Because the hip is so close to the genitals, these are not spared the shaving. The other added bonus is the catheter must be introduced to the urethra and a forested landing strip is a hotbed for bacteria to hide in. Having prepared patients for heart catheterization as a registered nurse, I was skilled in the art of groin shaving. I was not excited by the prospect of some surgical tech performing this duty without me being awake to tell them how to do it, so I did it myself. Plus, generally, they only shave one side, and I did not want to risk falling over later.
My personal pre-surgical prep involved two beauty treatments. One, having my toes painted and two, de-forestation of the old country. I decided to farm the toes out to a professional. I got the Spa Pedicure a few days before driving to LA which did wonders not only for my toes which were now a deep, dark red, but also my anxiety. Foot massages seem to rub away the fear of death, labor and delivery. I had this done prior to having both of my daughters and now it seemed like a good ritual to stick with. My pedicurist combines as a therapist which is really like getting a twofer or a BOGO.
Once at peace with my feet, I confronted the second task of deforestation on my own. This is probably not the forum to discuss shaving vs. waxing. We all know waxing is more effective over time, but much to my dismay, they don't make a do-it-yourself, Brazilian home-waxing kit and the idea of hot wax in a very important and highly sensitive area in unskilled hands seemed slightly irresponsible. I picked up my trusty razor instead. However, this too, had its risks and would require great concentration and focus on my part. Another very important thing to note is that after my surgery, I would be on blood-thinners to prevent clotting or a nasty little condition called deep vein thrombosis, so any cuts or lacerations would have potentially catastrophic results. This would not be a task I would take lightly. Again, I looked for ways to infuse my sick sense of humor. Shape of an "S"? Colored Magenta? More sharpie notes? Naaaahhhh. I did not know my surgical tech and was already robbing him/her of the opportunity to shave their own animal characters. I figured I'd just go with the hairless cat look. Shaving was probably doled out to the rookie in the room and I didn't want my wazoo in the hands of a rookie. They were being paid good money to find my urethra winking at them on the surgical table. That was all the winking that needed to go on.
Nurse Hyangshee returned to my room and began putting my TED hose on. She started with the right leg, and then tied the remaining sock around my right ankle. Hmmm, I thought. Usually, they put the sock on the unaffected leg and save the other one for after the procedure. She brought her IV supplies to my left side. Now, I was really confused.
" I thought you said IV goes in right arm with right hip."
She did a double take.
"Which hip you fix?"
"Uh, my right one. See? PA-DC marked it for me."
Realizing her error, Nurse H went back to the foot of my bed and removed the TED hose from my right leg.
"Very sorry." she said. She replaced the sock on my left leg and tied the remaining sock around my left ankle. She proceeded to start my IV in my right arm.
"What just happened?" asked my attentive husband.
"They almost replaced the wrong hip."
"Oh. That's just great."
Yeah. Confidence back to zero. But PA-DC saved the day. Had she not written "Yes" in black letters, I would have found my perfect, last-minute reason to back out. There are a number of times in the process where double checks take place to make sure the right procedure happens on the correct side of the body. This was a perfect example of how bad things could happen to good people. It was also a perfect example of how a hospital has identified the potential for tragic circumstances and instigated measures to avoid them from happening. The error was caught which meant that this place was meeting the Standard of Care. Of course, my husband saw it differently and the lack of color in his face told the story.
I told him, "Don't worry honey. 'Close' only counts in horseshoes and hand grenades."
Healthy people with healthy veins have valves that assist blood flow back to the heart. It is not uncommon to hit one of these valves when starting an IV. Blood can be drawn but it is near impossible to advance the catheter. However, there is a nifty little trick where you push saline through the catheter, creating flow, that thus opens the valve and allows the catheter to slip in to the vein.
Nurse Hyangshee hit a valve. After drawing my blood and unable to advance the catheter, I could tell she was getting ready to pull it out.
"Wait." I exclaimed. I told her the trick and showed her how to push the saline while pushing the catheter. It worked beautifully.
"Hey, that's a good trick!" She smiled.
Global crisis narrowly averted, she turned out to be okay. Nursing is a hard job and much harder in a different language. It was clear that she cared about her patients and utilized strategies to do a good job. She would not be with me for my surgery, but my IV was in, sock on the right foot (or in this case the "left") and I was ready to"break a leg."
In walked nurse Mary.
"name and birthdate?"
Just by looking at her, I could tell Mary had been around the nursing block once or twice. She was stern, direct, and didn't smile much. For all of my questions, she had answers and didn't mince words. I liked that about her, so I put her on the spot.
"What do you think of Dr. Schmalzried?"
"I like him. He's very nice and people come from all over to see him."
I was beginning to think that this was a company line, but then she said something that most nurses would not divulge, and she said it unprompted.
"If I needed this done, I'd have him do it."
Confidence back up to a 10.
Just then Dr. Warnicht walked in and introduced herself as my anesthesiologist. She had a strong British accent. I was afraid that after all the medicine I was about to get, I'd wake up speaking British English. My husband rolled his eyes.
"Any questions Mrs. Robinson?"
"Please do not call me Mrs. Robinson."
(this brought a chuckle out of nurse Mary. Clearly, she's seen "The Graduate")
"Sorry.......(still trying to figure out what she was missing....) any questions then?"
"Yes, are there any benzodiazepines in my future?"
This elicited a chuckle from Dr. Warnicht.
"Yes, how do you know about those?"
"I am a nurse."
"Well, then we'll get right started with a little Versed."
They started rolling me out of the Short Stay area. I looked at my husband and smiled and I gave him a sealed envelope. I told him not to open it and that I wanted it back. It was all so melodramatic but I didn't want to leave him in a lurch. I gave him a big kiss and told him I loved him. You never know when your last moment on Earth might be and this carried a slightly better chance than going to the grocery store.
Inside the envelope were specific instructions of what to do in case I coded on the table. It pretty much covered my wishes for organ donation and to pull the plug sooner than later. It talked all about my plans for the kids and where to find the secret stash of money he knows nothing of. This gesture was the final "t" to be crossed or the final "i" to be dotted. They rolled me into the surgery suite and into my operating room where tables and tables were filled with all kinds of boxes with the company name of my implant all over them. The surgical table was state-of-the-art as was all the equipment. There were people everywhere bustling about, wheeling in more state-of-the-art equipment. They brought my gurney to a stop right next to the surgical table where I would soon be relinquishing my paper gown in exchange for a surgical blue drape.
But first, Dr. Warnicht put in an epidural. I rolled on my side while she numbed my back and gained access to my epidural space with a needle the size of a shish-ka-bob skewer. This would be where they infused the good stuff. She gained access almost right away. My confidence level was rising rapidly. They rolled me on my back, put my arms straight out, and just as I was about to give them my musical request.....the lights went out.
4 hours later, consciousness returned between recovery and St. Vincent's sixth floor. My new hip was installed, and my husband handed back my unopened envelope.
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