On Being a Complicated Patient

In August 2015 I became a “complicated patient.” Seems that getting a pacemaker implanted in your chest earns you that distinction. I’m only now learning what all that means. All along I thought I was a complicated patient but maybe I was just cumbersome, confused, and convoluted.

My pacemaker, whom I call “Jude,” because it was made by St. Jude Medical and because it is fun to get its attention by singing “Hey Jude” to it, is designed to make sure my heart rate does not go below 60 bpm. It does this by monitoring my heart rate and if it goes below that benchmark it delivers an electrical “stimulus” to the bottom chamber to tell it, “Hey, pick it up, move it, move it, move it!” At night, though, a computer (or maybe it is just somebody sitting with a computer on their couch in Olney, Maryland) tells it to allow my heart rate to slow to 55 bpm so I can have a more peaceful night’s sleep.

Oh, one other thing about Jude…specifically St. Jude. According to some followers of the Roman Catholic faith, St. Jude is the patron saint of lost causes. Though I’m not Roman Catholic and have no saints that I particularly care about, I do think it is rather an unfortunate thing for a medical device company to take the name of the patron saint of lost causes. Not exactly a confidence boosting brand, folks.

My July 2nd surgery started six weeks ago, though, because, as you know, I am a complicated patient. This means I had to see all my other doctors – Dr. A (primary care physician), Dr. S (cardiologist), Dr. Suess, Dr. Who, Dr. Dimento, and my in-home oral surgeon and epidemiologist spouse, Dr. Vargas – for clearance.

Now, you may be wondering, what was my surgery? I’m sorry, I cannot tell you. If I did, I would be in violation of HIPAA (Health Insurance Portability and Accountability Act) laws. Just to remove any sense of mystery for you though, let’s just call it a lateral whackalectomy.

Lateral whackalectomies are not something you should envy and you should definitely never wish to have one. They are relatively simple surgeries that do not take much time but they are “intense” enough (according to Dr. J-B, the anesthesiologist) that they prefer to knock you all the way out (and you’ll be glad they did). The biggest downside of the lateral whackalectomy is the recovery period. You do get access to narcotics (oxycodone) which I have so far avoided taking. (You may question that by the time you finish reading this post but, really, I’m only on arthritis strength Tylenol). Lateral whackalectomies sometimes have to be done in two surgeries (I was lucky, it appears mine only required the one) and they are known for their “uncomfortable” recoveries, which can take weeks.

So, how “uncomfortable” is “uncomfortable?” Let me put it this way…Dr. S (cardiologist who will eventually cut my chest open to service my pacemaker), when he learned I was having a lateral whackalectomy paused reading my notes, looked up at me sympathetically, and quietly said, “I’m so sorry.”

Having received clearance from Dr. A, Dr. S, Dr. Vargas on the home front, and clearance from Clarence on principle (see Airplane!), I was ready to go on Friday morning, July 2nd.

We arrived at the hospital, entered through the main entrance as directed, and proceeded to the first check in place just inside the hospital door. This check point functioned to make sure we were COVID-19 tested, vaccinated, masked-up, and socially distanced, verify whether we were in the right place and, apparently, to broadcast my medical condition to all present.

  • Desk Attendant: What’s your name?
  • Me: Tom Klaus.
  • Desk Attendant: Full name?
  • Me: Thomas William Klaus
  • Desk Attendant: What are you here for?
  • Me: Surgery.
  • Desk Attendant: Yeah…but what kind?
  • Me: (Surprised) What kind?
  • Desk Attendant: Yes, what kind?
  • Me: (whispered, because I actually know the meaning of HIPAA) A lateral whackalectomy.
  • Desk Attendant: What?!? I can’t hear you.
  • Me: (a little louder now) A lateral whackalectomy.
  • Desk Attendant: (turning to another desk at the far end of the lobby and yelling like a waitress to a short order cook at Waffle House): Thomas W. Klaus here for a lateral whackalectomy. Where do I send him?

After a bit of shuffling about in the lobby and more violation of my HIPAA rights, I was told that I was at the wrong building, despite my written instructions. I needed instead to go next door. We were happy to leave immediately.

We finally made it to the right building where we were greeted by a receptionist who asked me the first of two of the most unnerving questions I’ve ever heard on surgery days.

  • Receptionist: Do you have a living will and an Advance Directive?
  • Me: Yes. Do you think I’ll need them?
  • Receptionist: (Pause) Probably not…but we like to know you have them…just in case.
  • Me (gulping): Well, I not only have them, but I have them with me, you know…just in case.
  • Receptionist: Great! Do you mind if I scan them into our system?

I passed her my paperwork and she gleefully scanned them into their system. A few minutes later we were led by Nurse J to the pre-op area. As per usual I had to strip down, put on one of those fine surgical gowns, and Nurse J got an IV started in me. Pretty cool, though, that Nurse J offered me a bit of lidocaine before trying to hit one of my veins with the IV. I had never had that option before and I liked it. I hope that is now part of nursing best practice.

Once he had me hooked up, Nurse J ran through all the screening questions. The first was the second most unnerving question you want to hear on surgery day: “What are we doing to you today?” Like having a pacemaker made by St. Jude Medical, it is not a question that initially inspires confidence. I looked at Nurse J and said, “Don’t you know?” Nurse J assured me he did but he wanted to make sure I knew and that we were in agreement. Now, really, I wouldn’t know?!? I’ve only been obsessing on it for the last two months when I first learned I needed surgery.

Nurse J was great and a lot of fun. He worked his way through the obligatory screening questions with grace and humor and helped me feel relaxed about the surgery. After Nurse J did the standard prep, he left the room for a bit. He barely got out of the room when I heard Clemencia laughing.

“Look at this sign!” she said between giggles. I couldn’t though because Nurse J had me so wired up I couldn’t turn to see it. “Take a picture and show it to me,” I asked. She did and here’s the sign that triggered her inner surgeon’s sense of humor.

  • Clemencia (giggling): Look at this…”Mark must be at or near incision site.” And it must be the physician’s initials. Where do you think the docs put their put initials when it’s hemorrhoids?
  • Me (trying to join in the humor of the moment, though it didn’t sound convincing): Oh no…what if it’s a vasectomy?
  • Clemencia (giggling even more): I can’t wait to see the doc make her initials for your lateral whackalectomy.

She was infinitely enjoying this more than I was.

About that time Nurse J came back in. He wanted to swap my fashionable cloth facemask for the standard hospital issue. I seized that moment to ask, “Where do you want me to put my chewing gum?” Nurse J froze, his smile dissipated, and he asked me sternly: “Gum? What gum?”

  • Me: My chewing gum.
  • Nurse J: You have chewing gum…in your mouth?
  • Me: Yes
  • Nurse J: You told me you had not eaten or drunk anything since before midnight last night.
  • Me: Yes, that’s true. But I like to chew gum.
  • Nurse J: When did you start chewing the gum?
  • Me: When I was a kid…Wrigley’s Juicy Fruit was always my favorite and sometimes Dubble Bubble.
  • Nurse J (continuing the inquisition): No, today. When did you start chewing gum today?
  • Me (as if I track such things): 10:03 AM, precisely.
  • Nurse J (moving into full nurse lecture mode): Look, the sugar in chewing gum can activate your digestive system. Because you haven’t eaten it will send your system into overdrive. When the surgeon cuts into you there could be an explosion that injures the whole surgical team and shuts down the OR for a whole week. (Okay, he didn’t really say that but I thought he might the way he was going on about it.)
  • Me: But, Nurse J, it was sugarless gum.

At that point Nurse J looked at me like I was a hopeless imbecile and left the room, returning only when it was time to finally get rid of me into the operating room.

Next up was my surgeon, Dr. B. She came in wearing a track suit and bounding about a little too much like Dr. Kylie Johnson on Mad TV. Fortunately, though, it was not my first meeting with Dr. B so it did not take me by surprise as it did Clemencia. To be fair, I did warn Clemencia that Dr. B was younger than our children…and possibly younger than our grandchildren would be, if we had any. I did my research on Dr. B prior to our first meeting for my diagnosis. I learned she is very accomplished and had received positive reviews from her surgical patients. Even better, I learned that her specialty was “minimally invasive surgery” on lateral whackalectomies. I felt confident she knew what she was doing.

Of course, my confidence was slightly shaken when her first question was Nurse J’s opening line: “Do you know what surgery we are doing today?” I really hoped she would know. She did, of course, and then went on to explain that she wouldn’t know if the lateral whackalectomy could be completed today. It might turn out that she’d only be able to do the first part today and I’d come back again in about six weeks for the sequel.

  • Me: When do you expect you’ll know?
  • Dr. B: Oh, not until I get inside. It just depends.
  • Me: Depends on what?
  • Dr. B: On what I find when I get inside.
  • Me: Ohhhhhh…….

Finally I got to meet my anesthesiologist, Dr. J-B. She reviewed my checkered anesthesiology history with me. She asked about the recovery and long term welfare of the nurses and security guards that were in harm’s way when I was last “put under” for my pacemaker implantation in Philadelphia. I have no memory of it but apparently, I was not at all pleasant and have much greater strength than I ever knew. After she heard the story and read my records from that surgery, her eyes widened and she assured me: “Not to worry. We are going to put you out…way out…and intubate you to make sure you aren’t moving around during surgery. But don’t worry, you won’t remember a thing.”

“That’s what you think,” I said with an evil smile and a chortle. (Okay, I really don’t remember a thing from Friday).

Before she left and turned me over to the nurse anesthetist, she quizzed me on my unnatural body parts:

  • Dr. J-B: Do you have any artificial or metal parts in your body?
  • Me: Yes, I do.
  • Dr. J-B: What are they?
  • Me (somewhat surprised she didn’t seem to know): Well, my pacemaker of course.
  • Dr. J-B: What about dentures?
  • Me: No.
  • Dr. J-B: What about lenses? You had cataract surgery, right?
  • Me: Oh, yeah, I forgot about that. I guess the new lens in my life eye qualifies right?
  • Dr. J-B: Right.
  • Me: No, left.
  • Dr. J-B: Left what?
  • Me: Left eye, the new lens is in my left eye.
  • Dr. J-B (sighing): Yes, left eye. Anything else?
  • Me: Only the chip in my brain.
  • Dr. J-B (looking quite surprised because she thought she knew all about me already): Chip? What chip?
  • Me: The one that Johns Hopkins put in to make me believe that lacrosse is a sport worthy of NCAA status and television coverage.
  • Dr. J-B: Very funny, Mr. Klaus.
  • Me: Yes, but not as funny as lacrosse as a “sport.”

By that time it was time to be wheeled away to the OR. I never saw Dr. B (surgeon) again, though I assume she was there. The last thing I remember was being wheeled into the OR, looking around at all of the nasty looking devices laying about on (presumably) sterile tables, and wondering if they were really going to need all of them for my lateral whackalectomy. Apparently they did.


Epilogue

We were warned that a lateral whackalectomy did not take long. In fact, it did not. I was back in recovery before Clemencia had much time to start a new knitting project or listen to a Spanish language podcast as part of her course preparation. When she realized I was already in recovery, she made her way there before anyone had a chance to retrieve her officially. She was just anxious to see if they were planning to offer to send my lateral whacka home with me in a jar. She wanted to be there before I had a chance to say anything stupid.

I’ve been home for the past few days in recovery now. Honestly, the recovery is not pleasant, but it isn’t horrible either. I can’t lift anything over 10 pounds for a couple of weeks which means I cannot play golf (as if I really had time to play golf anyway). Recently I’ve been playing every Saturday I can with my son, Jake. To help me feel better for having to miss golf with him the day after my surgery, he sent me this text from the course.

It is unfortunate that Jake began his note as he did because it makes golfing sound far more nefarious (or a few may say “more interesting”) than it is. Just to be clear “the ladies at Gunpowder” refers to the women who work the front desk and check-in golfers. Now, turn off your imagination.

So, the surgery took place and I’ve been resting at home for the past few days. The recovery is not pleasant, but it isn’t horrible either. I’ve had a bit of fun writing this post as it helps keep my mind off the “discomfort” and reminds me how fortunate I am.

I am fortunate to have good health insurance that allows me to obtain excellent care. I have enjoyed good health through most of my life and have had little reason to use my health insurance. Despite my bit of fun at their expense, the docs and nurses were outstanding (well, that first desk attendant needs a bit more training on HIPAA). I’m fortunate that Dr. L, a doctor I see routinely each year picked upon on the fact that my lateral whacka might not be normal. He sent me right away to Dr. B a specialist for her opinion and biopsy. It was not cancerous, but it did need to be addressed. It was caught early enough to have avoided more serious problems and even multiple surgeries. My most serious surgeries have been simple when compared to those experienced by some people I know. In all, I’m a lucky guy to have good insurance, good doctors, and overall good outcomes related to my health care. In a better world, we’d all be so lucky.

Author: The Driveler

Tom Klaus is the Driveler. On March 16, 2020, the first day of the Novel Coronavirus shelter-in-place order for his state, he started writing a daily blog to keep himself from stressing too much about the pandemic situation. He thought the daily blogging would last for only a couple of week but it stretched on to 77 consecutive days. Then he continued writing daily for a while after that as well. At some point the blog became The Daily Drivel...mostly because he was mostly writing the stream of consciousness drivel that was pouring out of his head, running down his face, and, sometimes, out of his mouth. In November 2020 he launched The Daily Drivel as a free-standing website/blog.

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