From my point of view as a patient, the systemic failures during my recent surgery were widespread and serious. Some lapses were funny, in a Keystone Cops kind of way, most were not. When I shared the muddles and anxiety these lapses caused, I was surprised at the reactions:
“All hospitals are the same. It’s just going to get worse.”
“There’s nothing you can do about it, so stop complaining.”
“You’re going to be okay and that’s the important thing. All the rest is behind you.”
I do not share these attitudes. As a patient, a citizen, a former professor, and a writer, I am drawn to telling the story about my recent operation and hospital stay during which my care was often inexcusably lacking in focus and effectiveness.
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On April 3rd, I became one of the 200,000 American women per year who have surgery for pelvic organ prolapse. The urogynecological surgeon, Dr. K., diagnosed Grade III uterine prolapse, cystocele, and rectocele; Grade III vaginal vault prolapse; and gaping vaginal introitus.
After the diagnosis, a friend who had had similar surgery loaned me books which gave me hope that I might avoid surgery. I did the exercises and followed the suggestions in the books but the symptoms failed to improve. I dithered about seeing Dr. K. again, but my primary care physician, Dr. D., tipped the scales when he said, “Do it now before you become too old for surgery.” I’m 73.
I told Dr. K. that I was ready to follow his recommendations: transvaginal hysterectomy, enterocele repair, suburethral sling urethropexy procedure, anterior and posterior colporrhaphy perineoplasty, and a sacrospinous vaginal vault suspension procedure. After reading this, my husband remarked, “easier done than said.”
This was my first major surgery and I was daunted by the long list of procedures, but Dr. K and Dr. D. both said I’d probably be home the next day, and after a couple of recovery weeks I might still be sore, but could go about my daily life. Though skeptical of my doctors’ sunny predictions , I was ready to proceed.
Another concern was that I would be cut off from Dr. B., the holistic doctor who has been my most effective health care provider over the past 25 years. Both Dr. D. and Dr. K. are open to what are often disdainfully referred to as “alternative treatments,” but hospitals do not integrate this kind of care.
Pre-op instructions were simple:
See primary care physician within 14 days of surgery, and have a chest x-ray, blood work, and an EKG. Check with your GP about your regular medications.
Do not eat or drink after midnight the night prior to surgery.
If you develop a cold, rash, etc. tell the surgeon.
Take off all jewelry and body piercing items.
The intake at Mt. Sinai hospital was crisp and efficient. I was checked in and given a wrist band with a round identity chip on it. I later found out that it would enable the staff to scan my wristband to make sure they were working with the right person. My husband was given a transponder. They would beep him at pertinent points, and let him know when the surgery was over. So far I was impressed by their clever use of technology.
I was then sent to a registration cubicle where I signed forms and an intake clerk typed my information into a computer. I felt at ease; Mt. Sinai had gone digital and my information would be instantly available to everyone from then on.
My belongings were sealed in plastic bags with a scanning code so they couldn’t get lost. I got my hospital garb, and then I was escorted to the surgical waiting area. During my two hours there, an assisting Fellow, a nurse, and the anesthesiologist gathered the same information that the intake clerk had collected. I asked the Fellow why and he said, “I know. It’s crazy. They want us to take down the same information by hand.” My brain was frowning.
The doctor came to the waiting area to be sure I understood what he would do. Since they were going to put a sling on my bladder and make other repairs, they would check the next day to see whether I could void the bladder. If I could, great; otherwise I’d have to go home with a Foley catheter He assured me that 85% of women could void their bladders, so not to worry.
I was as ready as I would ever be.
I was bundled onto a rolling stretcher and went barreling down the hall. The orderly clicked on the Operating Room Door button, and it swung open automatically as he shouted, “Patient Incoming! Patient incoming!”
Everyone looked at me; Dr. K., the Fellow, the nurse, another doctor, the anesthesiologist, and a couple of other people arranging stuff.
I’m claustrophobic, and when the anesthesiologist put a mask over my face I started to panic, but repeated “OOOOOOOOOOOOOHM” to myself. They put pressure sleeves on my legs and an IV needle in my arm. Dr. K. put his hand firmly on my thigh, almost as if he were resting on a table, and I calmed down. He was there, watching.
I woke up in the Recovery Room. A male nurse was chirping “Good morning, time to wake up! Everything went well! You can wake up now!” He busied himself taking vitals, and rearranging things. “We’ve got to get you ready to go home! As soon as you fully wake up, you can go home!”
“What? I’m not going home today.”
“Oh yes you are! Everything went great and you can go home!”
“That’s not what my doctor said. You’d better ask him about that.” I was alarmed at the prospect of going home right away, but couldn’t stay awake. Luckily, my husband was there and repeatedly insisted that the nurse check with the doctor, who confirmed that I was to stay overnight.
When I next woke up, I was in a bed in the Orthopedic Ward rather than the Gynecology Ward where I belonged. When my husband asked why, he was told that the same recovery room nurse who had been ready to send me home had also given my place in the Gynecology Ward to someone else.
I was in a lot of pain. The nurse gave me Percocet. No change. She gave me a second Percocet. No change. Dr. K visited and asked me about my pain level on a scale of 1 to 10.
“Twelve” I said.
He prescribed an anti-cramping medicine and left for his next surgery, but the pain did not subside.
I was chilled and shaking, my teeth chattering. I told the nurse the pain was a combination of the worst menstrual cramps and a baby stuck in the birth canal. A nurse’s aide came to take my blood pressure, and when she saw 194 over 135 (I could see it, too), she cried out “Oh mercy! I’ve got to tell the doctor,” and steamed out of the room.
My husband began asking about a morphine drip. Both Dr. D and Dr. K had said that morphine would be provided as needed, but no one was available to approve it. Dr. K and his assistants were in the OR and the Resident was nowhere to be found. My husband watched me suffer needlessly while the nurses and staff went about their business for the next hour seemingly unconcerned.
Eventually, a nurse was dispatched to the operating room to get Dr. K’s permission for a morphine drip. Twenty-five minutes later she returned and said that Dr. K had approved it, and that the morphine had been ordered from the pharmacy. My husband sat down next to my bed as we waited for the morphine.
Half an hour later the nurse passed through on her way to the other patient in the room and my husband called out “How long will it be? Is there no sense of urgency about this?”?
“Sir, the pharmacy is backed up and you’ll just have to wait.”
“Can’t someone go down and get the medication?”
“It’s not magic sir,” she snapped, then turned on her heel and left.
From start to finish, it took over three hours to tame my pain.
Having read about the advances in pain management these days, including clinics devoted to nothing else, I wonder why there is not a post-operative pain management team at Mt. Sinai. This would efficiently deal with post-operative suffering, and free up medical and nursing staff to deal with things they are authorized and trained to do.
I also wonder why the digital records resident in the intake clerk’s computer could not be distributed to other parties participating in my case. At the very least, the record of allergies, medications, past surgeries, and so on could have been printed out and pinned to my hospital gown, saving at least half an hour of further interviewing. (That suggestion made Dr. K. laugh.)
The snafus in my care affected my recovery. My blood pressure spiked, my nervous system was in chaos, and I lost my confidence in one of the most famous hospitals in the world. I felt helpless in a system which had already tried to send me home too early, put me in the Orthopedic Ward, and failed to control post-operative pain. What else would go wrong? My husband and I had to make decisions we were unprepared to make, and had to watch keenly for other errors which might be invisible to us.
I told my husband, “There’s no reason for you to sit there and watch me sleep.” He needed dinner, some fresh air, and a good night’s sleep. He had suffered too.
Thus ended day one.