Brain-Fried Noodle

Redwood Park

It’s post-op day 8, woo hoooo!  To all my patients who have had surgery, now I know what it’s like—a little bit.  What a fascinating experience, and I’m so grateful now that I can relate!

Some of you may know that I tore my ACL in November playing volleyball.  It only took me a few weeks to decide I wanted to have it repaired (reconstructed, actually), because I don’t ever want to wonder whether my knee is stable enough to do the things I want to do.  I have now officially embarked upon that journey of rehab, and so far so good. This post is my story so far.  Just wanted to share.

Pre-Op Eval

The 10 days prior to surgery were some of the busiest in recent memory, starting with a whirlwind weekend with the kids in San Francisco ending with us on a redeye back to Chicago and cabbing it straight the office where I borrowed my colleague’s clothes for the day.  Then back to back meetings, clinic days full of patients, a team-building seminar, a Grand Rounds presentation, Chinese New Year, a teaching session with my awesome medical students, a movie playdate, a confirmation retreat, and laundry.  I barely got enough sleep, and the eating was not great.  But at least I wasn’t sick/infected.

I got all kinds of useful advice from friends and colleagues:

Use the meds!  Opioids are great for post-op pain. Expect maximum pain and swelling at 48-72 hours.  Well the block lasted at least 48 hours so no pain then.  And since then it’s actually not that bad—like a giant toothache at the knee, with radiating soreness up the thigh and down the leg.  Tylenol alternating with Advil pretty much takes care of it.

ICE ICE ICE!! Oh, how I love my electric ice machine.  It’s a pad that wraps around my knee and circulates ice water drawn through tubing from a cooler.  Brilliant!

Take time off, at least 2 weeks!  Like a silly person, I’m going back to work tomorrow.  I was even sillier initially to think I could have surgery on a Thursday and go back to work Monday!  Lesson learned, but hopefully I will never need to apply this learning?

The Jitters

The night before surgery, I wrote in my journal an “In case I die” entry.  I told my sister where I left the book, so she would know where to look for the message to my kids in case something bad happened.  It’s a little embarrassing to admit, but I imagine I’m not the only mom who has ever felt this way.  It was pretty irrational, but hey, it was my first major surgery—anything could happen!  Sitting in the cart in pre-op, I got tearful (and still do now), thinking of how much I’d miss the kids, what they would have to go through, how everything would change, if I died.  But when the anesthesiologist asked, all I could articulate was, “I keep thinking about all the things I should have done for them this morning—packed their lunches…”  He had the perfect words: “It’s never enough.”  And with that I felt strangely reassured and absolved.

The MEDS!!

So here’s the most dissociating part of the experience.  In pre-op I was handed a little cup with five pills: two 500mg acetaminophen, one 75mg diclofenac, and two 300mg gabapentin.  That’s standard pre-emptive pain management, apparently.  Then for the femoral and sciatic nerve blocks, the anesthesiologists used bupivicaine and triamcinalone.  Once in the OR, they started clindamycin to prevent infection, and then midazolam, fentanyl, and propofol for the sleeping cocktail.  Of these nine medications, I had taken exactly three of them ever before.  It was a little alarming, even though I knew the indication and rationale for each drug.  I found my inner voices exclaiming at once, “Wow, this is totally routine, we have really got it all figured out,” and “HOLY SHIT ARE YOU KIDDING ME NINE MEDICATIONS SIX OF WHICH I HAVE NEVER HAD BEFORE AND YOU’RE JUST GIVING THEM ALL TO ME LIKE IT’S NO BIG DEAL I COULD TOTALLY DIE FROM THIS WHY ISN’T ANYBODY THE LEAST BIT BOTHERED!?!?”  And I did just fine, like everybody expected.  Fascinating.

new tongue out emoji


And whoa, the meds…  Apparently it’s a known side effect of propofol to shiver when waking up from it.  That was uncomfortable, but even more so was the inability to pee for about 40 minutes, despite having a bladder that felt like it could burst at any minute (I know that could not happen, but literally, you could have bounced a coin off of my lower abdomen it was so full).  Thank God for the experienced nurse who offered me hot tea—what a relief!  And finally the nerve blocks—amazing.  I could flex my hip normally, so I lifted my braced left leg into the car while standing on the right; but lower than that I had neither sensation nor motor control for a full 24 hours.  It.  Was.  Dead.  The foot/ankle came back first, with that creepy, stinging, tingly sensation.  Then slowly, begrudgingly, the thigh returned.  The muscle twitches throughout came mostly at night, as if waking from anesthesia is, of course, a nocturnal activity.

I felt pretty clear-headed after about an hour in recovery, fully coherent and articulate.  But man, I could not really focus or hold attention for long at all.  I had all kinds of articles saved to read those first two days lying in the recliner, but it was just not happening.  My mood was great and I had long periods of alertness.  And then I just wanted to sleep–deeply.  My body was not only unresponsive in the left lower extremity; it felt limp and weak kind of everywhere, my mind included.  Hence the title: Brain-Fried Noodle.

The Pain

Those first two days were fantastic in terms of pain—none whatsoever (thank you, bupivicaine)!  And I was on the ice machine 24/7.  Since then two pain patterns have emerged.  First, the deep ache from having the joint capsule invaded and a tunnel drilled through bone.  That’s the giant toothache, almost like a deep itch that wants to get scratched from the inside.  The second is a hypersensitivity of the skin where all the bruising is.  It’s swollen, tender, and oh-so colorful!  And it zings every time I pull on my compression sock, from the ankle to halfway up the thigh.  That’s what makes me stop and breathe deeply for several seconds.  I figured out today that I’m probably not drinking enough water, which likely contributes to my pain.  It’s so ironic, as my primary advice to patients for almost any ailment is to hydrate first.  Well, this is me trying to walk the talk.  I’m so happy not to have needed opioids (so far), and everything should continue to improve as the tissues heal.  HYDRATE!


The Rehab

I swear, I think I have lost 50% of my quad on the left.  My physical therapist thinks I’m progressing well, and I’m happy with where I am.  This will be a long road and I must monitor my expectations.  First, prevent further atrophy while tissues recover initially.  Then weight bearing, stability.  Then strength, coordination, and eventually back to sport.  Patience, diligence, persistence.  I’m told PT should make me cry, it’s so painful.  Well, it’s definitely making me sweat!


*sigh*  We really can’t do anything well alone in life, huh?  All the advice, all the well wishes, all the texts and messages right before and right after surgery—every single one held me up a little higher.  And my mom, who insisted on coming despite my denying the need—now I get it.   And thank God for her.  Thank you, Ma!  Last week would have been quite hellish for us all if not for you!  The hubs and kids have been pretty great, too, accommodating my crutches, ice machine, and constant occupation of the chaise side of the sofa.  Every day they come home and ask how I am and how they can help.  I’ve tried to do what I can—sort laundry, rinse/cut vegetables, instruct our amazing sitter on recipes, pay bills, make sure our DVD machine doesn’t die from under-use…  But there is no substitute for a wide and strong support network, and mine is as dense as they get.  Thank you, all my friends and family, for all of it.

* * *

Huh…  I thought I could accomplish so much more in 8 days off!  I fantasized about all kinds of blog posts, reading, correspondence, de-cluttering.  Hey, I said fantasy, didn’t I?  Oh well, time flies like an arrow, fruit flies like a banana.  Things don’t usually turn out the way you plan.  Maybe it will be good to slow down for a while, reorganize, reprioritize, focus… For now I gotta get that second set of exercises in tonight and get to bed on time—and hydrate—work tomorrow!

Onward, friends, hope you are all well!

No Substitute for Time


NaBloPoMo 2017: Field Notes From a Life in Medicine

Day 3

How much time do you spend with your doctor each time you see them?  Is it enough?  If they had more time to spend with you, how would you use it?  Would it be better?

I’m too tired and it’s too late tonight to discuss the myriad factors that erode the patient-physician relationship, and thus our medical system in general.  But time comes to mind often for me, and I wonder if patients are as frustrated about it as I am.

Where I work now, I pretty much have as much time as I want with people.  It’s a sweet gig.  I can ask them about their work, their families, their interests.  I have time to listen to the answers, and even connect those with my observations about their health.  The most interesting parts of my interviews are the social history.  What do they spend their days doing at work?  What problems do they solve, who do they interact with, and what brings them meaning at the place where they spend the majority of waking weekday hours?  Then what do they do for fun, what’s life like outside of work?  I get to know my patients as individual, whole people, which I love, and that makes me look forward to every day at work with joy.

But time is not just good for me, for my professional fulfillment.   It’s good for patients, too.  When I spend time asking the important questions, putting together pieces of a person’s symptom puzzle, and do a directed exam, I’m more likely to come to a correct diagnosis and make an appropriate and specific care plan.  When I take the time to explain my rationale, decision process, and possible outcomes and follow up, my patients are more likely to feel seen, heard, and reassured.  They are more likely to stick with the plan and contact me if things change.  The next time they need help, they are more likely to call me and we have another chance to know each other better.

When the physician-patient relationship flourishes, we’re all healthier.

I love this article on The Health Care Blog, which essentially validates the time I take to talk to my patients.  My favorite line:  “More information about the value of a physician-patient encounter will always be found in the content of their communication than in what they ultimately do. The difference in… physicians’ behaviors will not be found in any database, electronic medical record, or machine-learning algorithm. I have yet to see data on the contextual information from a history of the present illness in any data set or quality improvement initiative.”

You may also be interested in this article, describing the origin of the 15 minute clinic visit, and why it really doesn’t make sense.

What do you think about physicians and patients advocating together to change this aspect of our flawed medical system? I know it’s complicated, requiring a hard look at our billing and compensation processes, as well as our productivity-driven, fee-for-service medical culture.  I still think it’s worth pursuing.  There is no substitute for time.  We must protect and defend it; our health depends on it.