Monday, May 21, 2012

Mysteries of the Surgical World

Dear George,
I don’t know why, but we seem to be spending more time at the doctor’s office than we used to.  Katja’s sort of banged up right now.  She had a successful left knee replacement several years ago, but now her right knee is acting up.  I went along with her to see her knee surgeon, Dr. P, and he said the time has arrived.  Dr. P is a gray-haired, grandfatherly sort with a warm, reassuring manner.  He told Katja that she was a great candidate for knee surgery and that it would dramatically improve her quality of life.  Katja was all for it.  As he did last time, Dr. P asked for Katja’s permission to pray before and after her surgery, and he recommended that her circle of family and friends pray during the operation too.  Katja said that was good, though I didn’t know if she’ll really arrange it.  I myself am wary of surgeons who rely too much on prayer to produce positive outcomes, but what do I know?  Katja also has a lot of pain in her left shoulder from a fall two years ago, and steroid shots no longer seem to help.  Dr. P has stopped doing shoulders, but he referred her to his colleague, Dr. N, who is an expert in upper body renovations.

Later we talked to a doctor friend who wasn’t enthused about shoulder surgery.  He said it’s more complicated, is done less frequently, and is less reliable than knee replacements.  He advised Katja to explore the alternatives.  Then another friend told us that her mom, a registered nurse, had gone to a conference on shoulder surgery and promptly cancelled her plan to have such an operation herself.  That was food for thought.

Katja did go ahead and make an appointment with Dr. N, the shoulder surgeon.  We arrived early and I spent some time looking through the “Senior Citizen’s Guide” from the rack in the waiting room.  There was an interesting article on hearing loss that began with the question, “Do you feel that people mumble and do not speak clearly?”  I doubt that I have any kind of hearing loss, but I’ve definitely noticed that people mumble more  nowadays.  I’m not sure why that is, though it could be related to the Republican-dominated Congress and/or the decline of American civilization (both of which have been causing people to mumble more).  Then I ran across a blurb on home health care that said that Certified Home Health Care Aides cost $33 an hour while Uncertified Home Health Aides cost $18 an hour.  I asked Katja which she would prefer, and she said Certified.  I thought that Uncertified Aides looked like a better bargain, because I couldn’t imagine how Certified Aides could be twice as good.   If it comes to it, we’ll probably hire separate home helpers. 

Just about then, Dr. N’s assistant called us into an examination room.  He looked over Katja’s past records, asked a few questions, and went off to see if he could find an old MRI.  Katja put on a hospital gown with an open back.  Then a junior doctor came in, asked some more questions, and put Katja through a series of range of motion exercises with her left arm and shoulder.  She did pretty well.  Since Dr. N hadn’t yet arrived, Katja wondered why the junior doctor had examined her.  I said I thought it was like having both Uncertified and Certified Health Aides.  The junior doctor did the real work so the Big Doctor wouldn’t have to waste his time.  Dr. N did arrive shortly, accompanied by the Junior Doctor and a female physical therapist whose only function seemed to be to act as a chaperone.  Dr. N was friendly and jovial.  He asked Katja about her recent trip to Italy and recounted that he was just back from giving a conference paper in Milan.  They exchanged a few minutes of Italy talk (probably about $25 worth at a rate of $300 per hour).  Then Dr. N repeated the same range of motion exercises that the junior doctor had already done and looked over her X-rays.

Like Dr. P had said about her knee, Dr. N said that Katja was an outstanding candidate for shoulder surgery.  He explained how they would make a 3-inch incision in the front of her shoulder, attach a metal ball to the end of her arm bone, scrape out the arthritis, and glue in a plastic lining in her shoulder socket.  According to Dr. N, the procedure is 99% successful, produces dramatic pain reduction and very high satisfaction among patients, and will have her driving in a week and playing tennis in a month.  Dr. N didn’t see any point in more steroid injections, and there was nothing that Katja’s personal trainer could do to help (quote: “You have to watch out for these personal trainers”).  I said I was worried because Katja had developed a blog clot from her first knee replacement, then a life-threatening infection from another hospitalization.  Dr. N said no problem.  He was very confident and optimistic, certainly moreso than our other consultants. He didn’t mention anything about praying before or during the surgery, which I regarded as a point in his favor.  Katja was very enthusiastic afterwards.  I guess if I had all that pain I’d be eager too.  The whole idea makes me nervous though.  I’ll probably go ahead and pray even if Dr. N doesn’t encourage it.

G-mail Comments
-Vicki L (5-22):  Hi D,  Enjoyed your blog as always. Re. your commentary on mumbling - I'm in agreement. While I see lots of clients I've thrown my training out the window. Mostly I tell them that their depression is a solid indicator of their mental health; the world is a horrifying place and anyone who can't see that is in serious trouble. They mostly go away happy in their depression or at least proud of it. Love, Sis

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