The Emotional Cost of my New Bionic Knee

I filed a formal complaint against the Presbyterian Española Hospital last week. A surgeon there gave me a bionic knee that will allow me to irrigate, hike, cross-country ski, and maybe downhill for a few more years. For that I’m truly grateful. But in order to get that new knee I had to participate in the medical industrial complex that is, as so many of us have experienced, diving deeper and deeper into disfunction and chaos that leaves the patient confused, ill-treated, and feeling abandoned. My story is illustrative of this defenestration, but may also provide some insight on how better to prevent that fall from happening to others.

There is no exact time at a hospital; there’s only “waiting.” Arriving at 8 am I waited until 3 pm for surgery. First, the anesthesiologist gave me a nerve block, which is an injection that targets a nerve or group of nerves to provide pain relief. Secondly, she gave me a spinal anesthesia block, which numbs the lower half of the body. I don’t remember anything after that (they also give you versed, a great drug that induces sleepiness, decreases anxiety, and provides amnesia about what just happened to your body) and she also gave me general anesthesia, meaning you’re not conscious during surgery. The actual surgery lasts only an hour or so but then you wait in recovery for someone to come get you and take you to your room in the hospital. A one-night stay is normal for my kind of surgery.

The first indication that the nerve block hadn’t worked came around eight o’clock that night when all the other meds in my body dissipated and I started writhing around on the bed at level 9 on the pain scale (10 is torture). First the nurse administered Tylenol (yes, this is the first drug they give you post-surgery); then oxycodone; then two doses of morphine; then a call to the doctor for permission to use tramadol (I’d never even heard of that one), until three hours later the pain abated and I dropped off into something I called the night’s wrestle: intermittent pain mixed with exhausted sleep.

I’ve had two previous orthopedic surgeries: a meniscus repair and a rotator cuff repair, in which I distinctly remember two days of nerve block pain relief at home before it became obvious it was time to take the oral oxycodone. I wasn’t in need of validation that the nerve block hadn’t worked but I got it anyway the next morning when the doctor came in for a brief visit: “Have you forgiven me?” The good news was that the surgery was successful. Then I waited a few hours and the physical therapy people came in and that‘s when I noticed I couldn’t bend my foot at the ankle. As I pointed this out, there was a brief silence and then someone said “foot drop,” and someone else said, it’ll probably come back, but by then I was imaging walking down the street with my foot dragging along the ground like Ratso Rizzo. When I got home I looked up “foot drop, caused by an injured nerve during hip or knee replacement surgery.”

So there I was: a nerve block that didn’t work on my knee but froze my ankle (it may have been two different blocks). After waiting another couple of hours I found out another alarming fact: Mountain Home Health, a company that provides home health care and physical therapy to Taos County residents, no longer serves El Valle (they were bought out). I’d based my decision to do my rehab at home because of these services. Because I live alone, now I have to find someone to take me to physical therapy, an hour away. It was too late to change plans, so home I went with a friend caregiver and others lined up for the first 10 days.

Around 10 o’clock that first night home the pain arrived again at level 9 and I woke up my friend with my moans and cries. She didn’t know how much oxycodone I could safely take. The good news was that I’d made sure I had some pills on hand left over from a previous prescription so that we didn’t have to stop and fill a prescription in Española on our way home from the hospital. My son would pick it up at my regular pharmacy in Santa Fe the next day on his way up from Albuquerque.

I’d already taken 10 milligrams in hourly succession and the pain wasn’t touched. My care giver called the hospital. Someone actually answered but when she identified who I was they told her because I wasn’t covered under their Presbyterian insurance (secondary insurance, as Medicare was primary) I needed to call my insurer to speak to a medical professional. No one answered the phone, of course. No nurse ever answered a nurse hot line number,either. In desperation we called 911, saying “I don’t know if this is an emergency or not but . . .” They sent out the EMTs from Peñasco, who were very kind but unable to administer pain medication (only paramedics can). They did get a doctor on the phone, however, who said we could safely increase the dose of oxycodone to a certain level. Just as we were trying to decide whether to have the EMTs take me to the emergency room, the pain started to abate and we sent them on their way.

The next day, Friday, I called the hospital to try to get some advice on pain relief. When you call the hospital you only get through to a main switchboard. There is no direct number to a clinic, a nurse, a physician’s assistant, or a doctor. You leave a message with whomever answers the phone and request that it gets delivered to the right person. The person who answered my call said she would send it to the clinic with an “asap” note on it. No one ever called me back. Then my son called to say that the pharmacy was “out of oxycodone” and because it was Friday night there was no one to call to ask for a prescription to a different pharmacy.

I had enough leftover oxycodone to make it through the weekend. I called the hospital on Monday and told them to get a new prescription sent to a pharmacy in Española that I could get when I went down for my first PT appointment on Tuesday. There was no Rx at that pharmacy on Tuesday. I called the hospital again and a nurse called me back saying the prescription had been sent to my primary pharmacy in Santa Fe. I told the nurse, “No, I requested that it be sent to the pharmacy near the hospital.” She said she’d ask them to send it to the correct pharmacy. Finally, on Thursday, when I went down for another PT appointment, the Rx was at the local pharmacy: six days after my surgery.

If I review what happened, step by step, each one becomes an indicator of the systemic problems that need to be addressed in not only the specific facility where I experienced them but in the larger medical industrial complex. Let’s break them down into bullet points:

• Pain management is crucial. If a nerve block doesn’t work or isn’t sufficient to help reduce post-surgical pain patients should remain at the hospital until a pain protocol is established.

• Communication between health care providers and patients is crucial, particularly for pain management. A hotline for post-surgery advice could provide the information needed to manage medications at home.

• Communication between health care providers and patients is crucial at all times, not just for pain management. With no direct access to the orthopedic clinic, a nurse, a PA, or a doctor a patient has to hope that messages are delivered in a timely fashion—or even at all!

• If it’s after business hours or the weekend a patient has no way to request a transfer from the prescribing physician. Pharmacies should be allowed to transfer opioid prescriptions to sister stores if they are out of stock.

• Case managers need to be assigned at the outset. She or he could help the patient navigate all the issues raised above: pain management (delayed hospital release); communication with medical staff; and prescription oversight.

I don’t have the qualifications to assess why these remedies aren’t enacted: I’m just aware of the anecdotal evidence supplied by those who’ve suffered in similar situations: insurance bullying; lack of staffing, from doctors down to MA’s (medial assistants); bureaucratic “efficiency” that makes things less efficient (never getting to speak t a person); opioid restrictions that increase patient pain; or there are just too many of us old people getting new knees and hips and shoulders. Think New Mexico’s latest publication, "How to Solve New Mexico’s Health care Worker Shortage” attributes the problems to the high cost of malpractice insurance that discourages doctors from practicing in New Mexico.

At a follow-up appointment at the orthopedic clinic when I told this story to the attending medic, he told me this was not the first time he’d heard these complaints (and he had a record of all the phone calls I’d made to the hospital), especially the one about not being able to speak directly to a medical professional when questions and situations arise that need immediate attention. So I walked down the hall to the administration office and filed my complaint. It will be sent to the Presbyterian headquarters in Albuquerque and then someone will “give me a call.” I’m not holding my breath.