The Million Dollar Bone Mill

In an issue of the Santa Fe New Mexican last week there was an insert published by the National Union of Hospital and Health Care Employees, which is an affiliate of the larger AFSCME/AFL-CIO. The nurses and technicians at Christus St. Vincent Hospital in Santa Fe have been involved in protracted negotiations with hospital management over wages and conditions—safe staffing and experience—and as I write this union members are voting on the proposed contract.

The insert, as part of the union’s message to the public regarding the struggles of the nurses and technicians, includes a list of the salaries of “Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees” of Christus. The CEO, Alex Valdez, makes a whopping $457,064 (and $148,122 estimated fringe benefits). But lo and behold, the highest compensation by far on the list belongs to my old friend Dr. Samuel Chun, an orthopedic surgeon, whose makes $935,275. He’s not really my friend, but I did see him as often as I see many of my friends when I was referred to him for treatment of a bone spur on the lower part of my thumb. After shooting me up with cortisone a couple of times, which did nothing to alleviate the pain, he proceeded to remove the bone spur, which he did quite well, as he appears to be an excellent surgeon (although he forgot to take a look at a mass on my palm while he was doing the cutting). But then the trouble began, which should have been included in my Diary of a Bad Year, except that it would have made it the Diary of My Two and a Half Bad Years and I wouldn’t have been able to use J.M. Coetzee’s title.

I wasn’t blogging back then but I've always done my best venting by pen so I sent him a letter. He never answered, of course, but now that I’m blogging I’m going repeat some of what I said in the letter. You never know, maybe someone who is considering orthopedic surgery will read this posting and decide NOT to choose Chun and NOT to contribute to his $935,275 compensation package.

After my cast was removed Chun’s office sent me to a physical therapist who specializes in hands and arms. I didn’t get any better: my thumb hurt horribly and my shoulder froze. I was treated by the actual physical therapist only once; subsequently it was by her aides, and nothing helped. I figured it was time to go back to Chun with my troubles, but each time you go see him you have to wait at least at hour for a 10-minute visit, so I procrastinated. When I finally told him my tale of woe he asked me if I wanted him to cast my thumb again. I told him no, I wanted him to figure out why it was taking me so long to heal. He offered to shoot up my shoulder with more cortisone, and I told him no on that one, too.

He told me to come back in another month, which I did, still miserable. This time he said, I want to consult with my partner who specializes in shoulders. So I made an appointment with this other orthopod (I waited for an appointment and then I once again waited in the waiting room). This doc asked me some questions, checked out the lack of mobility in my arm and hand and said to me, I want to go consult with Chun. I’d been there for all of 10 minutes. He came back into the room and said, I just talked with Dr. Chun and I think you have RSD. I asked, what’s that, and he said, it’s a syndrome that can be treated at the pain clinic with a “sympathetic nerve block”, meaning a shot of anesthesia in the neck. I didn’t like the idea of a shot in my neck but I was pretty desperate for a diagnosis, so I took him at his word. Fortunately (or unfortunately) I had the presence of mind to ask the technician to spell out the name of this diagnosis, which was Reflex Sympathetic Dystrophy.

When I got home I did what anyone with a computer does these days: I went on the internet and looked up RSD. It was then I burst into tears. Reflex Sympathetic Dystrophy, or Complex Regional Pain Syndrome, is a chronic pain condition or “continuous, intense pain out of proportion to the severity of the injury.” It can start in your hand and spread to include the entire arm. There is no cure, and no definitive drug or treatment procedure, i.e., the sympathetic nerve block that Chun’s buddy was prepared to order. On one of the internet sites the words “some people can have unremitting pain and crippling and irreversible changes in spite of treatment” especially stood out.

That was the end of my relationship with Chun and his partner, who I suspect makes a six figure compensation as well. I found another orthopedic doc in Española who looked at my medical records and the RSD diagnosis and said to me, let’s not go there. So I didn’t, and with the help of a good physical therapist and many hours of evaluation by the new doc I eventually healed. In my letter to Chun I suggested that he spend some of the money he was making (at the time I had no idea how much that actually was) on a patient navigator who could follow the progress of everyone who makes his or her way through the maze of his assembly line practice. But that kind of practice works efficiently only when patients are in and out the door. Once it was obvious that I was a malingerer, he wasn’t interested.

So that’s the story. The solution is simple: Christus St. Vincent can pay Dr. Chun and his cohort a salary just like it pays the nurses and techs who work their butts off to take care of all of us before and after the surgeons stroll in with the scalpels. If they can do it at the Mayo Clinic, they can do it in Fanta Se.