June 13, 2009

• A Stay at The Hospital Hotel

  Hospital Hotel Itinerary

  (Denial only goes so far….)

  

  “Welcome to the Hospital Hotel. You can check out any time you like. But you can never leave…”

  I’m going to spend my “vacation” at the “Hospital Hotel”. A Five Star residence hotel/hosptial called the USC University Hospital, located in East Los Angeles, CA. Although right up the street from USC County, or “County Genreral”, the old city hospital, USC University is a teaching hospital for the school, and is where my orthopaedist, a specialist who can perform my “hip revision”, works. I’m going in for a 3-5 day stay in order to replace or repair my ailing and ancient hip. It’s been over a year since I first met my Doctor, Dr. Longjohn, and even Joel was aware of my upcoming operation, even though he’s been gone a year now. Instead of using state disability funds right away, I schedule a three week vacation from work. My paycheck will continue to be direct deposited into my checking account on Thursday nights at midnight.
  I take my final work day on Monday 6/1 and spend Tuesday 6/2 stocking up on supplies for post op at my house. I stock up on food for about two weeks. First meals will be microwave “TV Dinners” and Top Ramen noodle dishes, easy to make and to eat. I also get chicken and hamburger, which I put in the freezer for meals later in the two or three week period. Liz and her boyfriend Spencer pick me up at my house at around 2:00pm. We have a liesurely lunch waterside at Old Tony’s on the Pier in Redondo Beach. Liz treats me, cause she didn’t get around to treating my on my birthday this year, a ritual since we met in 2004. After the meal, we head up to Simi Valley, where she lives. I will spend the evening with her at her place, and then we’ll drive in to checkin at the hospital at 6:00am the next day. The later evening is spent watching National Treasure: Book of Secrets on her Netflix enabled TV, and then we go to bed.

  Following is my “timeline” for this adventure, detailing my stay at “The Hospital Hotel”.

  6/3 WED.
  6:00 am: Check in at concierge. I first joke to my friend Liz, after we get to the hospital, that I’m spending my vacation at the “Hospital Hotel.” I’m given a “pager coaster” just like at the Claim Jumper restaurant, which will alert me when I’m ready to go upstairs for pre op prep.
  6:30 am: While perusing the newspaper in the richly appointed wating room, my “pager” begins to buzz and flash. About a half dozen patients are escorted to preop room.
  7:00-8:00 am: Pre op preparation. I fill out and sign innuberable forms and precautions. Administration of the epidural procedure for anaesthesia and pain control, in which I’d expressed an interest during preliminary check in procedures the week before. Liz tells me her goodbyes at this point, and we hug each other tightly. I have to bend over and accept insertion of the needle in my spinal column. It tickles. Before I know it,. the needle is in my back, and liquid heaven is being pumped in my system. Surgery scheduled for 9:30 am. I fill out and sign still more innuberable forms and precautions.
  9:30 am. Surgery delayed when doctor’s team needed for emergency heart transplant in another OR.
  11:00 am. Surgery rescheduled. By now all patients in my group, plus all patients in preop room when I arrived, around 20, have been moved into surgery except me.
  11:45 am. Doctor Longjohn, my orthopaedic surgeon, who will perform the “hip revision” operation, appears, apologizes for delays, and promises I’ll be in surgery by noon.
  12 noon: Surgery begins.
  3:00 pm: Surgery completed. No complications encountered at all. Top ball of thigh bone prosthesis replaced. Total socket replaced. New ball/socket is about 40mm larger in diameter than on the existing prothesis. Wound is sealed with stainless steel staples and is pretty much in exact place as previous wound from original hip replacement.
  3:30 pm: Check in room 635, a single with attached bathroom. Upgrade had been requested and delivered. The hospital is small, with 265 beds, and it’s a good thing I won’t be sharing my room. I’ll be staying from “3-5 days” with planned checkout for Sunday, 6/7, or perhaps even before. Prior to surgery, a nose swab detected a bacterial infection which causes my room to be semi quarantined. Entrants always have to wash their hands and wear antiseptic gowns and caps while in the room.

  6/4 THUR. through 6/6 SAT.
  Normal period of rest, recuperation, and physical therapy rehabilitation. I attempt to exhibit a dash of class and remain distinguished even in a somewhat less than classy and less than distinguished environment. I find that there are so many things to learn about healthcare through the nurse’s perspective, and meet a lot of nurses really quickly over the space of a few days. No matter how vehemently a certain nurse might believe in a method of treatment, another nurse will most certainly believe doing exactly the opposite. If both nurses are on suceeding shifts, they end up undoing the other’s ‘work’ while badmouthing.The same nurse who is able, as if by rote, to recite all rules, regulations, warnings, and precautions relating to your specific ailment, will most probably move your water pitcher or walker just out of your reach before they exit your hospital room. I’m told repeatedly that I’m on track for early dismissal based on my progress in physical therapy and in occupational therapy. All my nurses tell me I’m a model patient, and they wish they had more like me.

  One patient, “the screamer”, bellows loudly for nursing staff from his room. Another room seems to be filled with Mexican partygoers from 8-10pm each evening. I like to be left alone, (with the door closed) and only call a nurse if I need to go to the bathroom. I need her help to unhook whatever fluids are flowing into my veins from the IV pole so I can ambulate untethered into the bathroom. I can use the “pee cup” at my bedside, but prefer the “cleaner ” version of using the toilet whenever possible.

  I make an attempt to remember each nurse, technician, or doctor who enters my room (in order to take up time, and to get them all straight in my head.) There is Jennifer, the night nurse with the bubbly personality. Audrey, a  new hire nurse who seems to get a perplexed look on her face whenver confronted with a piece of medical apparatus. Nurse Kilyoung, who is matter of fact, opinionated, and loudly disagrees with all nursing procedures performed by others before him. Nurse Charles, who always seems to be distracted by something else, but is otherwise pretty professional, if not overwhelmingly giving of his help. My night nurses, Nurse Fil and Nurse Nannette, who always take the time to really help their patients, even though it seems they are totally alone in this endeavor during the evening hours and are continually being paged.

  I meet so many people, and am made to feel safe and  am given excellent care. One of my lab techs, Daniel Neyra, is from Peru, and has a last name similar to mine. On Friday evening my night nurse is Gina, from another wing and floor of the hosptial, who informed me I have “floating veins” and couldn’t find one in which to insert the IV tube, so had to call another nurse for help. The nurse who had never seen a digital thermometer before scared me a little. I’m sure they’ve been around for at least 20 years.Each time a lab tech comes to draw blood, I mention the “floating veins”. The tech will instruct me that he never has any problems at all, and then he will leave me with three balls of cotton taped to the various pricks from which he unsuccessfully tried to draw my blood.

  Since I usually eat only one full meal a day, I’m a bit hornswoggled by being sent meals three times each day, and at first treat this as an unwanted nuisance. (Like someone was forcing food down my throat at all times.) I might need pain medication or other nursing assistance, and seem to wait longer and longer for these important things to happen as the time wears on. However, the food service people always seem to be underfoot, taking orders for the next day’s meals, or arriving with new platters piled with food. After a while my appetite returns in full force, and I begin to look forward to the meal breaks as exciting distractions to otherwise boring routines. I decide that the two murder mysteries I brought along as reading matter are not interesting to me at all, and flip on the (non DVR equipped) basic cable TV from time to time, relishing finding shows on PBS dedicated to 40s swing music and the 60s pop group The Mamas and the Papas.

  6/7 SUN.
  7:30 am: During removal and redressing of the wound, I’m told by my doctors that I should be checking out later in the afternoon. I call Liz, who will be taking me home, with the good news. I let her know I’ll call her as soon as I know I’m being discharged for certain, since I don’t want her to have to wait around on “hospital time”, where a minute can stretch to a few hours in the seeming blink of an eye. My mental health is positive and high. My physical therapy is going strong, and I’m making vast improvements. I’m more than ready to go home, and have had quite the experience, taking mental notes on all that happened during my stay.
  9:45 am: Things begin to take a small turn for the worse, accellerating wildly an unpredictably. My nurse brings in some “antibiotics” on an IV drip. Perplexed, I ask why I’m again on an IV, since I’d been taking most medicines orally for the past couple of days. The nurse tells me I’ll have to wait for my doctor to explain.(Not a good sign when this happens on the medical shows on TV!)
  11:30am: My orthopaedist arrives to give me the latest prognosis. It seems that a staph infection (the coagulase negative staph aureus bacteria) was found in my blood, so I’ve been ordered to stay an additional 24-48 hours for observation, and will be taking intraveneous antibiotics twice a day.
  11:45am: I begin to get a bit depressed, call Liz to tell her about this latest delay, and begin to “wait”. Imperceptible cracks begin to form in my classy demeanor.

  6/8 MON.
  6:30 am: When the wound is undressed early in the morning, Dr. Longjohn’s assistants declare that there is still too much seepage of fluids. Besides the bacterial infection, this latest snafu draws some more anquish and anxiety from the patient.
   9:30am: I meet my latest nurse, Nurse Joycelyn, who wears a Nurse Betty Boop themed shirt/blouse and a Betty Boop watch. Our conversations center around a number of subjects, and one is how I began to watch my health when I turned 40, which is why I have a hip repIacement in the first place. I cause her to blush (which I’ve never seen a black person do before) when I tell her she doesn’t look a day over 25, and she confesses to being 43. Because of the gloves the nurses all wear when in my room, I can’t detect whether or not Nurse Joycelyn is wearing a ring, but I’m getting interested in somehow continuing our relationship after I leave, if the opportunity presents itself and it is at all possible.
  2:30 pm: In rapid succession, I meet Jack and Dr. Geisel from the Infectious Diseases department. Jack is an Asian American with a deadpan delivery, who tells me that I don’t have anything to worry about concerning the staph infection, which might already have been in my body. Because of the mix of biological parts, plus old and new prosthesis parts, nobody wants any complications with infection. Dr. Geisel seems to have come direct from Central Casting. With wild thinning white hair, erratic hand gestures, and an accent which sounds exactly like Dr. Ludwig Von Drake, he explains to me that the antibiotic program has been changed to another drug.
  7:00 pm: At shift change, I’m a bit disappointed that Nurse Jocyelyn doesn’t drop by to say goodbye. I’d written a list of URLs for my blog and websites earlier, and wanted to give them to her, so she could see my Betty Boop website.
  8:15 pm: Nurse Fil, the night nurse, gives me my nightly morphine injection, so I can go to sleep. Since Saturday, my evenings have been nice and restful. Sometimes I get strange fever dreams (and nightmares) from the pain drugs, but for the most part I’ve been sleeping better than I normally do at home!

  6/9 TUES.
  7:00 am. I meet with Dr. Longjohn, and his assistants, Drs. Luke and Jackson. The last dressing, which should be clean as a baby’s bottom, is still filled with blood and a sickly yellow fluid. The doc gives me a worst case scenario having me go under the knife again in order to undergo exploratory examination, and further clean these fluids from the open wound. Although I try not to  show it, my depression deepens. A best case scenario involves dermabond, a super glue for skin. I can’t leave hospital observation until my wound is clean.
  10:00 am. In my daily phone call to work, I upgrade my metaphor of the hospital as hotel to a jail.
  10:30 am: Dr. Luke applies the dermabond to my wound area. If there is no seepage found in 24 hours, then I should be allowed to go home on Wednesday, fully a week after I checked in.
  12:00 noon: Procedure to install ‘Picc” line in my arm for intraveneous fluid delivery after my discharge. The entire procedure is done in my hospital room. First I’m given an ultrasound in my right upper arm to find a good vein, then a local anasthesia is applied to my arm, and the picc line inserted in the vein until it gets pretty close to my heart itself.
  12:30 pm: Chest Xray. The machine is rolled into my hosptial room and looks like a small forklift. The plate is situated behind my back, and the Xray aimed at my chest while I’m still in my hospital bed.
  1:30 pm: In the midst of one of my numerous naps, my remote, which controls lighting, the TV, and calls the nursing station, aquires a life of it’s own, and begins to call the nurse repeatedly. I keep apologizing, and telling the nurse I think the remote is broken.(Cue Twilight Zone theme music here.)
  2:15 pm: While I’m taking a bathroom break, the remote calls the nursing station again. I call from the toilet that I can’t turn it off, since I’m otherwise indisposed. After getting back in my bed, I turn on the TV (with the remote), but can’t adjust sound levels, or even get any sound. Using the phone, I call the nurse’s station (the remote won’t let me!) and let them know I need a new remote. When an orderly appears to check it out, she slaps the remote up against the side of the bed frame, and then aims it at the TV. Sound suddenly comes on, and it seems to be “fixed”.
  3:00 pm: The theme on Oprah is medical misdiagnoses. A chef almost had his tounge and lower mandible removed, and a gal had her lasik surgery almost applied to the wrong eye, which would have blinded her. Glad the remote is finally working, I shut offf the program quite quickly.
  9:00 pm: During a telephone call with Liz, I tell her not to even mention that there is any possibility of my being released from the hospital, in order not to jinx anything.

  6/10 WED.
  6:30 am: Dr. Luke removes dressing, and inspects dermabond around wound area. No seepage detected. I’m told I will be released within a few hours, as soon as Dr. Longjohn reviews Dr. Luke’s assessment.
  7:15 am: Breakfast comes a little late this morning. I eat my meal, read my newspaper, and regale anyone within earshot about my impending release.(Which begins to sound like Chicken Little proclaiming that the sky is falling after a while.) Most of the people to whom I talk are orderlies or cleaning crew.
  11:00 am: A representative from “social services” drops by. She is assigned to “longtime patients”, one of which I have become since I’ve been in the hospital for over a week. During her interrogation, she asks when a good time for release might be. I answer by saying “three or four hours ago.” She explainst that I could be discharged the same day, if provisions can be found for delivery of the antibiotic medicine to my house for uninterrupted coverage. The social services gal is short, a bit pudgy, and really seems concerned when I tell her I understand I’m not the “engineer driving the train” but if the bacterial infection is at bay, and the medicine on it’s way to my house, I’d really like to get out of there as I’m beginning to go stir crazy. She goes, to return a few moments later to tell me she’s conferred with my doctor, and I will definitely be released today. Optimum time is to be 2:30pm. I have time to call Liz, arrange for her to pick up my “hip kit” from a local medical supply house, and should be out of the hospital immediately following my evening antibiotics treatment, which will be moved up an hour, to 5:00pm.
  2:00 pm: I stare at the clock hand for an hour.
  4:30 pm: Liz comes by, is given the latest delays, and leaves to pick up the hip kit. She’ll eat dinner while I’m having the antibiotics treatment, and then return when the treatment is over to take me home.
  5:00 pm: Nurse Charles hooks me up to the antibiotics drip one last time.
  6:00 pm: Liz arrives with the needed supplies. Discharge procedure begun with Nurse Charles.
  7:00 pm: Release (er, discharge) from hospital.
  8:00pm-10:00pm: Filling of prescriptions written during hospital stay.

  • 2:42 pm
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