Surgery cancelled due to doctor politics
Written by Daniel P. Malito on October 9, 2012
Last time, I gave you the last piece of writing before I underwent the knife once again. This time getting my ankle replaced, I spoke about all the old fears and concerns surfacing anew. Well, the surgery has been postponed, much to my chagrin. Postponed not because of any valid, medical reason, but because of medical politics, a subject that I have spoken on before.
Here’s how it went. I was preparing for surgery, both mentally and physically, and a week ago Wednesday I spent the entire day at the hospital undergoing pre-surgical testing. I was told that the pre-testing was mainly a formality, and the blood tests and x-rays were routine. Since I had done that type of screening before, I knew what to expect — no surprises. I knew no matter how early I showed up, it was going to take the majority of the day to complete. I settled in for the long haul, and made sure I took out a second mortgage to pay for the hospital parking garage.
After four hours worth of testing and visiting several different physicians, I only had one meeting left – the anesthesiologist. This was a new one on me, as meeting with an anesthesiologist was only necessary in certain cases. Well, I was that special case this time around.
You all know that last September/November I had a heart attack following a shoulder replacement surgery. Well, I also returned to the hospital a month and a half later to have an additional stent inserted. The official date for that last stent insertion was November 18, 2011.
Unbeknownst to me, the Heart association has set guidelines about surgery after a stent is installed, and the guideline says to wait one year after to perform any elective surgery. Now, there is a reason I put the word guideline in italics – it’s because the year waiting period is exactly that – a guide-line. The year waiting period isn’t written in stone and when there are extenuating circumstances, surgery can be performed safely before the one-year mark. To support this, my cardiologist has provided studies that show that once a stent-receiving patient hits the six-month mark, there is no discernable difference in waiting a full year before surgery. In other words, once six months has passed, surgery can take place as safely as if the patient waited ten years. Oh, and just in case any of you were wondering if my cardiologist is some quack, know that he is a Harvard Medical educated doctor who is under the tutelage of one of the most respected cardiologists in the world.
Because of this guideline, it was necessary for me to meet with an anesthesiologist to get approval for the surgery. So, after waiting two hours for her to show up, I finally got my meeting with this doctor. Now, keep in mind, going into this meeting, I had the approval of no less than five separate doctors for this surgery to take place. The head orthopedic surgeon of the hospital, my rheumatologist of 20 years, my ivy-league educated cardiologist, the hospital’s own general physician who’s job it was to clear patients for surgery, and my pain management doctor.
As soon as the meeting began, I should have known the surgery wasn’t going to happen. From the get-go, this doctor tried to pick apart every aspect of my M.I. event (myocardial infarction – a.k.a. heart attack). In fact, when she first glanced at my file she said “wow.” So, the meeting went on like that, with this doctor questioning everything from the manufacturer of my defibrillator device to the opinion of my cardiologist. She even called the mentor/partner of my heart doctor who, after reviewing my file, said that the surgery should be no problem. It was as if she was trying to find an excuse to cancel the surgery but was being stopped at every turn.
So, the meeting eventually concluded, and since the anesthesiologist couldn’t find any valid reason to postpone the procedure, the surgery was scheduled for five days later. Despite all of my instincts telling me that this woman did not want to touch me with a ten-foot pole, I drove home and began the final preparation for the surgery.
Those of you have never had major surgery may not know this, but in addition to preparing physically and logistically for a procedure and hospital stay, there is also a distinct set of mental preparations that one must go through before going under the knife. Think about it, if you were going into the hospital for a serious procedure that could, even if the chances were small, potentially kill you, how do you think that would affect your mental state? If you said greatly, you guessed correctly. You have to prepare yourself for the worst outcome of all, and that’s the result where you don’t end up coming out of that operating room alive. Sure, the chances are slim, but it’s a possibility, and you can’t simply ignore it. Or, at least, I can’t. Some people might be able to go into surgery without considering all the risks but that’s not me. In addition, you have to prepare yourself for the eventuality that once the surgeon gets in there, he or she may not be able to do everything that was promised. For instance, my anklebone not be in the right shape to support a joint replacement, so they will have to fuse the joint only, or leave half the surgery for a later date. As much as a doctor prepares and takes x-rays and CT-scans, there is always an element of the unknown. Getting your head into the right frame of mind takes time and practice. This mental preparation is what I spent the next two days doing. That is, until I got the call on Friday, two days after the pre-surgical testing.
As I was eating lunch, the phone rang. The caller ID said the name of the hospital, and I thought it was simply the surgical scheduler calling to inform me of the arrival time for the coming Monday. When I picked up and heard the voice of my general doctor, the one who does the per-surgical exams, I immediately knew what had happened. When you have been doing this as long as I have, you begin to be able to tell when something isn’t going exactly right, and this entire surgery stunk to high heaven ever since the meeting with the anesthesiologist.
Of course, I was informed that the anesthesiologist had decided she wouldn’t do the surgery until exactly a year after the stent. She had apparently consulted with other doctors, and decided it was the best course of action. Immediately I asked whom it was she had consulted with, since all five of my other doctors were on board with the surgery happening. I then asked who was going to pay for my gas to come back to the hospital for new pre-testing, and who was going to pay my second set of co-pays. It wasn’t as if the anesthesiologist had just heard about this surgery, she had the file for months. Of course, he had no answers for me at all, beyond to say there was nothing he could do.
In the end, it turned out that the doctor simply wanted to cover her butt in case something happened and I filed a lawsuit. It didn’t make a difference that I promised to sign a waiver, and that I wasn’t even going to be under general anesthesia. It didn’t matter that I was in severe pain, and that my ankle was causing my hips and other joints to be thrown out of place. The Hippocratic oath “first, do no harm” obviously was not at the top of the priority list any longer. The one doctor who didn’t know me at all got to make the final decision about my surgery. Medical politics at it’s finest.
So, it is with a heavy heart that I ask you all to wait with me until Thanksgiving week, of all times, to begin the replacement blog and to go ahead with the surgery. The important lesson for you to take away from this is that sometimes the patient’s needs do not come first, and you should prepare yourself for that eventuality, especially if you are chronically ill. The longer you spend dealing with doctors, the greater the chance you will have to endure something like this yourself. All I can say is that I feel your pain, and hopefully, most of your doctors will be like most of mine – putting the patient first at all costs.