lotus10’s AchillesBlog

Day of surgery

Posted in Uncategorized by lotus10 on the July 22, 2010

Pre-op procedures were fairly seamless. I filled out a form about my past medical/surgical/anesthesia history, faxed it, and waited until 4pm the day before to hear about my OR time. I was told 1:30pm, and to not drink or eat after midnight. I tried to argue - I should have known better - surely over 12 hours of fasting is a bit of an overkill? (Even babies can have clear liquids up to 4 hours before anesthesia - but I didn’t say that) But got shot down, and resigned myself to it. Luckily it was over 90 degrees that week, so there was very little appetite.

At 9am I got a call asking if I could come in a little earlier, because the surgeon is able to move up his schedule. It wasn’t a problem, I got to pre-op, registration, and things were moving quite smoothly. When the anesthesiologist came in was the first time I had to divulge that I am a physician. When in my work we meet families who, straight up, upon meeting them for the first time, tell you “I’m a doctor at U of…” or “My father is a head of …. Hospital”, it’s seriously off-putting. Same thing when they tell you “I’m a litigation lawyer” or “I work in malpractice” right away, before you can even talk. It’s like, so we should treat your baby differently? But maybe when it comes to your child, you go into that mode, to protect your own. Most doctors I know, even at their kids’ pediatrician visit, try to refrain from blurting out that they’re in medicine at all.

Then a resident came in. Also there was an ortho resident getting my consent. Now the date was July 2. Although many residencies start in the last week of June, we all chuckle, nudge, nudge, to each other about being hospitalized in July… when your doctors are brand new doctors, 2 months out of medical school. In fact, my friends told me, “request for no resident! only attendings!” I just couldn’t. We’ve all been there - I’ve had my first spinal tap, my first intubation, my first central line - so what if I was someone’s “first”? But luckily I fell asleep during the sciatic nerve block, and next thing I knew I was post-op.

I’d had high hopes that I would stay awake during the procedure and even see it on some screen, but looking back, I don’t think I would have enjoyed it. I was blissfully asleep on versed and propofol, and when I woke up my leg was in a cast very similar to the pre-op cast. I had to prove I could urinate, could walk up and down the hallway, drink water. My surgeon came in and told me that everything went well. I had meant to ask him, “was it way up there? was it all shredded?” but in my versed state, forgot to ask. He also said he talked to me before surgery… but I didn’t remember this part at all. Why would they talk to you when you’re all drugged up already for surgery?

I was getting my stuff together, when the nurse asked me if someone was coming to pick me up. I said no, I’m taking a cab home, and she freaked out. She said she cannot, cannot, discharge me to a cab! She had to see me being handed over to someone. I told her, yeah, the cabdriver, but that was not good enough. So reluctantly I called the unit where I work, asked my colleague to meet me at the hospital entrance. (if you’ve noticed, I am fiercely independent.) There was probably some eye rolling on both sides, like, “what is she thinking?” But happily I got my Norco tablets and was released from the hospital.

Upon their insistence, I gave in and decided to stay at a colleague’s place a few blocks from the hospital. (Yes, I’m lucky to work with very, very caring and nurturing people, and they know I’m stubborn.) It was 90+++++ degrees out, the long weekend was coming up. My leg was still numb, the World Cup was on, and I was rather content… until about midnight, when the throbbing began. I woke up wondering “WTF is going on???” and realized my block is wearing off. Which brought some relief, because, well, they didn’t completely damage the nerve! But then the throbbing came on and got stronger and stronger, it was like my heart was beating in the leg - thump thump, thump thump. I’ve had a ruptured appendicitis before and then I thought a drum was beating in my abdomen. Very similar. I took half a Norco tablet, then another, wondering if this is how Michael Jackson died?

Up to surgery

Posted in Uncategorized by lotus10 on the July 22, 2010

I’m not really sure why my pictures aren’t coming up???

The day after I went to the ER, I was scheduled to be on call at the hospital. My work involves the ICU, I attend high risk deliveries and the unit can have 80-90 babies at a time… I don’t know what I was thinking, but I took a cab, hopped on up the elevators, thinking I can do this. My co-workers thought differently though, and we had to call in another colleague to come in for the night. That was the first time I cried in all of this, I just felt so terrible, an inconvenience to others.

But after schlepping all the way to the hospital, I decided I might as well sleep in the extra call room, and try to see an ortho first thing in the morning. A colleague had given me names of people to see, one who was kind enough to email me immediately and tell me to page him the next day so he could see me in between cases.

I wasn’t about to take him up on it, though; I mean, that’s taking advantage of my being a doctor, right? But the next morning, I looked up all the orthos at the hospital - what is up with all their specialities - hand, shoulder, joint replacements, etc etc? And started calling one after another, only to be told there was no appointment for 2 weeks?! I told them “I tore my Achilles!” but didn’t seem to get anywhere. Finally, at noon, the surrounding co-workers told me to page that guy. I resisted until one of them said, “my god, we doctors should get SOMETHING out of being doctors, you’d do the same for one of us!” and I gave in.

But let me tell you, we were all pretty clueless as to what would be done to my Achilles. Most said, “there’s no way they’d operate!” because “I was not a professional athlete”. I was quite eager to get surgery and get this thing re-attached surgically, but my audience (residents, hospitalists, attendings) tried hard to convince me that any surgery is fraught with risk, so stay away! Until one colleague, married to an ortho herself, texted him and he wrote back, “of course they’d operate, why wouldn’t they operate”. In his words, if you’re young, healthy and active, surgery is the way to go. And the room was abuzz again with discussion and telling me not to get surgery because I had a “better chance of winning the Nobel prize than the Wimbledon”. Seriously.

Sure enough he called right away and got me in between his OR cases at about 4pm. I told him how the injury occurred, and he said he’d have to see for himself, because “sometimes ER can be wrong”. After a brief exam and a couple of my “FOR THE LOVE OF GOD” and “HOLY MOTHER OF#*$&@)_”, he told me it was indeed a tear. My question “is it partial? is it complete” didn’t seem to have much weight, and he quoted the re-rupture rates, surgery complications, the logistics of surgery (regional block, outpatient surgery).

“Well let’s just do it!” I said, and hobbled home again, in a cast. I waited for 4 more days. There was no pain, but sometimes I swear, I could feel something - must be the gastroc - DANGLING.

3 weeks post-op now; but first, how it happened

Posted in Uncategorized by lotus10 on the July 22, 2010

I tore my left tendon on 6/25 playing tennis.  I exercise regularly, but had started taking lessons for a few weeks, loved it, and that night there was a "tennis party" at the club.  I’d thought it sounded too cheesy for a Friday night, but went anyway.  An hour into it, I served, turned, and heard it, the famous pop.  And felt the snap.  I tumbled forward; the pro told me to ice my leg, but in my mind I knew it was more than a "pulled muscle".  It didn’t hurt, and I could walk on it.  I even drove home, filled the car with gas.  By the next morning, I knew I’d torn it.  I am a physician myself - I’d studied orthopedic injuries enough back in medical school, I knew this was surgical.

So I packed a bag full of sets of clothes, a laptop,  hopped down the stairs to the street, called a cab, and went to the nearest hospital (not where I work).  Being a patient in the ER is agonizing.  After I told the triage nurse "I think I tore my Achilles", while to me it was an emergency, I saw a guy seen rapidly for a "chest pain" and rationally, of course that’s an emergency!  but I felt myself sigh and then felt terrible for feeling frustrated to wait,  I mean, this guy is probably having a heart attack!

When I was finally seen, though, first by the PA (physician assistant), she ordered an x-ray.  I tried to tell her, "um this isn’t a fracture" but she insisted, saying "just in case" and I was dreading having to put up my leg onto the x-ray machine.  Then the ER attending came in and shooed the x-ray tech away.  By exam, he said, this was an Achilles tear.  I said, fine, let’s do the surgery, I’ve packed my bags.  But he told me that this was not urgent - and put me in the immobilizing cast and crutches.  I did ask him, "but how do you know for sure?  Shouldn’t we get an ultrasound? MRI?" and he took pictures on his iPhone and showed me.  I hope these show up here.

I was told to see an ortho within a week.