I miss my left hand...

Dear Gentle reader: (I'm not sure if this phrase is trademarked or not, but I like to think my few readers are gentle...)

I miss my left hand. I miss the reliability of being able to type. But what is peculiar, is that I miss the things I used to do with it that I haven't done in a very long time; like sew, embroider, crochet,lace net darning, and other web-weaving skills I know. I can't really play guitar or piano well, but I always was very good at creating interesting melodies and haunting chords on both. When my hand gets better, well, I promise to take guitar lessons for real. In case this online bookkeeping and software support thing wears off in novelty and/or paychecks.

Oh my- you may not know what happened to my hand! Well, the night after my sister passed away, in grief and anger I swatted some dishes off my counter, and in the process, I punctured the palm of my left hand with the newly broken handle of my favorite coffee cup from White Castle. I'm talking about my left hand - the one I normally write with and is wholly responsible for the tab and CAPlock keys, which is extremely handy in my line of work.

I didn't simply puncture or cut it, no, I had managed to cut an artery in 2 places, destroy the median nerve juncture and sliced or partially sliced 3 of its branches, and the flexor tendons of my index finger and thumb(in part and/or in total). The cut was barely 3/4 inch long but nearly an inch deep. Apparently, I had hit a glass so hard that it broke off the handle of the cup and my swat-swing had such follow through, that the now broken, twisted, shard-knife of a handle, did all of that damage in the blink of an eye. I didn't even feel it. I was embarassed by my lack of control that for about 45 seconds ir so, I stood there, head tilted back, hands at my sides, trying to breathe through this grief/anger, brought on by a petty argument with my grown daughter. I had no idea for almost a minute that I was bleeding to death onto the floor. My daughter was disgusted with my temper and though she saw the blood, she left in all the disgust and huffiness of a 22 year old, who also couldn't face death or mourning. We both have come to terms with this and forgiven each other since.

However, my son (21 yrs old) came into the kitchen and made me aware that I was flooding the entire kitchen (all 30 sq ft if it) in my blood. It was quite a pumper and he saved my life I suppose, for I was in a kind of shock and not willing to realize what I'd done was serious, or just too sad to care at that moment. He got my companion, Randy and they took me to the hospital ER to get treatment.

This is where the true saga begins. Throughout it all, my friend Randy was in the room for all of these visits described below, except at Presbyterian, where only my son Alex was with me. So I do have witnesses.

At the ER of Presbyterian Dallas (it was the closest, and I really was bleeding quite badly), they got the bleeding stopped, and sewed my artery shut, but even after I and my son asked the pretty lady doctor about tendons and/or nerve damage, she said, "No, no tendons are cut, but maybe there might be some minor nerve damage." I asked her twice if she wanted to test for tendon cuts or damage and she declined, albeit, politely. I told her that my thumb and forefinger felt very strange and she asked me to wiggle my fingers. My other three fingers were unaffected, but it was clear to me that my index finger and thumb were damaged in some way. I said, "Look, they aren't moving at all and I can't feel them properly!?", to which she said, "I saw them move and they'll be fine. But you may want to have a hand surgeon look at it after you get back from Ky and to take the stitches out next week."

As if it was not urgent. I had volunteered in surgery at the world-famous Hand Hall surgery at Jewish Hospital for 6 years as a teen, and I had had tendon surgery years before back home in Louisville KY at Jewish Hospital, more than once in my late teens, so I knew what a real tendon examination looked like. Now I had explained throughout this visit that I was preparing to go to my only sister's funeral later that morning (it was 3 a.m. when we left the hospital), but that if tendons were cut, I could wait or not attend. My sister was being cremated, and I'm sure they would have given me a few extra days if needed to get there (I was driving from Texas to Kentucky). I know it's my sister and I loved her dearly, but I knew that if tendons are cut, you could possibly be damaged for life. Nerve damage is usually given some time before any surgery is performed so it's not quite as urgent as tendon damage but much more painful. Tendon injuries are also very painful, but that nerve thing - wow.

Ok, now keep in mind, I don't have health insurance. They are not motivated at all to do anything beyond stopping me from bleeding to death, but I have a sneaky suspicion if I had Blue Cross, they would have taken steps to prevent permanent damage to the hand of a woman who works for herself on the keyboard as a software analyst and bookkeper. But not without the health insurance. It seems like to me that if I had no health insurance more care would have been taken to prevent me from becoming a welfare case, and instead, caring for the long-term effects, and allowing me to find some way of repaying them. But that is certainly not the focus of care for the uninsured. Treat 'em and street 'em. That's what we have. If you have no insurance then your long term prognosis is not an issue. Or that you may be a positive contributing member of society and could be waylaid by such an injury, and become - in a worst case scenario - the very sort of homeless, unemployed blood-sucking leech that "they" hate treating. If I had insurance, I'm certain that I would have been examined further, and all that damage would have been seen, and treated right away.

How do I know this? Because, while I was in extraordinary pain and truly suffered all the way through my sister's funeral, and while I was in Louisville KY, my hand turned blue, the pain became unbelievably unbearable despite the token amount of darvocet I'd received, and on the advice of a physician friend of my uncle's, on Tuesday, July 21st, I was seen at Jewish Hospital Hand ER. Yep, that's right, an ER just for hand injuries. Nobody better at hand injuries in the whole country. World class surgeons. And they were shocked that the tendons cut were missed by the ER staff physician at Presby Dallas. And they said I should have this operated on in the next 72 hours or the possibilty of loss of use was about 90% certain. They offered to schedule this surgery for the next morning, and we'd work out how I was to pay for it later. They were very concerned that the tendon damage was severe and that the arterial flow of blood had been compromised in some way.

The caveat was that they would require a committment from me that I would stay in Louisville for 8-10 weeks of post-op care as they did not feel comfortable with someone else handling that part. They did not care that my blood pressure was a little high (they'd treat that symptomatically for the duration) or that I was still a smoker despite my recent efforts to quit. In fact, while he recommended that I quit as soon as I was able to give the nerves a better healing factor, that this wasn't an obstacle to my surgery, either. And I admitted to them, that I suspected my blood sugars were no longer being controlled by diet, but had not taken the money to go get that treated either as if yet, and he said they'd deal with that too, if it was a problem. In other words, all I had to do was agree to stay there for 2+ months. I have never regretted a health decision like this in my life. But I chose to leave anyway.

I was in a rental car (my car had no A/C, I couldn't afford to get it fixed) and the logistics of staying in Louisville were all too overwhelming for me to accept in 20 minutes or less. So, I opted to go home to Dallas. Jewish wrote up a diagnosis and gave me my X-rays, a nice splint, and a small prescription for more darvocet (enough to get me home and seen, they thought, left the stitches I had in place, and I left, thinking I could find the right kind of surgeon in Dallas. After all, it's not exactly a podunk township, it's a major metropolitan area, right? But Jewish could not recommend one surgeon for me to see. They explained to me in detail what kind of surgeon I'd need, and what kind of surgery I could expect, but they could not recommend anyone. They'd never heard of that kind of surgeon in Dallas. With great misgivings, I left for home. I am afraid I will regret this decision for the rest of my life now. I turned down world class surgeons for the mess I'm in now.

I came home and called the 'hand' surgeon on my discharge sheet from Presby Dallas, Dr H. Boulas. He was quite frank with me. Honest but brutal. Funny, cause I'd seen him last year when I'd had insurance for a sprained wrist and shoulder, so I wasn't a new or unknown patient, yet now I couldn't receive his services. Without insurance or as his receptioniist put it, "several thousand dollars, up front," he would not consider it. I asked him about removing the stitches. She relayed my question and came back with a flat no. My physician friend in Ky was quite concerned about a possible infection from the stitches being in so long but they were not. I asked Dr. Boulas' receptionist what my options were, and she said UT Southwestern Medical school. She gave me a number. I called it and after much waiting I was finally able to speak to a receptionist, who took in the entire story and medical history and then explained to me that they only have one hand surgeon, and she was booked until September. And she then said, if you don't have insurance anyway, it won't matter, you'd still have to go to Parkland (the county hospital). Through the ER. ~shudder~

So I went to the ER at Parkland Hospital Dallas on Friday, July 24. I had run out of the darvocet Jewish had given me (15) the day before. So in agony (nerve damage is really, really painful), I waited. 10 hours later, at 6 p.m., someone came out to the waiting room, and took me to get X-rays. I explained I didn't need additional X-rays, I'd brought mine that were less than 3 days old, and there were no bones broken. They said I have to get them here anyway, they wouldn't use mine. I just thought, "I'm gonna have to pay for these too, even though there was no need for them."

Turned out later that they didn't even use those X-rays, the doctors used mine after all, cause they were with me in the room when I was finally seen at 10 p.m. Now it was Friday night, and I was being put behind all the gunshots, car accidents and drug ODs by then, but I'd tried to beat the rush by coming hours earlier. It didn't help.

At 7:15 p.m., they told me to come to the back because they finally had a place for me. Not in a treatment area exactly, but in the "ortho" room, where they put casts on. I was in such pain and exhausted by then, that I was getting a little testy. At 9:45 p.m., Dr. Justin Heller, a plastic surgery resident training a rotating lady resident from Brazil, came to my 'room'. From the top, I told him the whole story, showed him the write-up that Jewish did, and since he could not locate my new X-rays, he used mine from Jewish Hospital, apologizing that I would have to pay for the new ones anyway. He did the expected tests, and seemed to be leaning towards me having surgery right away, maybe eveb that very night, but about midnight, he admitted he would have to call in his superior to get the ok and a second opinion from him. He seemed very nervous about this decision, but left to go make the call. The nurse had brought me single pain pill, a 30 mg codeine pill about 11 p.m. Dr. Heller told me that the other Dr. was coming in, but that he was not happy about it. He started to explain, then trailed off. About 12:30 a.m., Dr. Alex Nyugen, plastic surgeon came in. He was completely rude to me as if I had personally picked this moment to wake him up. Why was I here so late, he asked accusingly, why did I wait so long? I explained, or started to, that I'd been there since Friday morning, but he never really heard my answer.

He re-examined my very painful hand and seemed to be much more rough in his manipulations than necessary. I was in tears, but he was unmoved. My friend was getting angry at this treatment, but I stayed him from saying anything. Then they all three had a conference just outside my room. I could hear how angry he was at the junior resident. Then he came back into the room and said he didn't believe any tendons were cut, that I only had nerve damage. And then he said he wouldn't operate on me at all anyway, unless I could prove that I had quit smoking for a month, cold turkey, no [atches, no gum, nothing. I was shocked. I had certainly reduced my smoking to less than 5 cigarettes a day since this happened, and that in fact just before my sister passed away I had quit for a week. I had finished a program with Chantix ( a medication for smoking cessation), that I'd saved up to get. But I'd not been strong in the face of my sister's death and all the smokers of Ky in my family.

I told him I would do my level best, but I could not imagine that Jewish Hospital's diagnosis couldn't be that far off and that he must be mistaken. He was quite pissed about that and grabbed my hand and wiggled it around some more, making me cry out again,and yes, my thumb wiggled a bit, as it had before with Dr. Heller's exam, but only in a small way and only in one direction. It was all flexor tendon damage not adductor tendons...just as Jewish had said and I had the audacity to repeat - out loud. Dr. Nyugen then ceased talking to me at all. He barked at the other two Drs. to give me a new plaster splint, which they did nervously, and poorly. They were supposed to support the thumb in a particular way, but they did the forming of it over the sink instead of over the thumb and the padding was put on by the Brazilian woman, who apparently had never applied a band-aid, let alone a cast. I think she appreciated the tips I gave her for the padding and how to wrap an Ace bandage. But it did not fit at all and caused unbearable pain since the thumb part was twisted out and downward in a very awkward way. I took it off before I got to the car. I couldn't bear it. And they left the stitches in too.

Dr Asshole-Alex Nyugen left, and Dr. Heller came back to tell me I now had an appointment with the Ortho clinic there for August 13th, to determine if I really needed surgery. I couldn't believe my ears. Then he wrote a prescription for 30 more of the little codiene tablets. I asked him about neurontin or something for the nerve pain and he said the clinic would have to do that. Then he wrote the prescription on the wrong paper form. The next day, while I literally rolled aroubd and rocked myself in agony, my friend Randy went back to the hospital to explain they had written a narcotic script on the wrong form and that no pharmacy would fill it. It took him 9 hours at the ER to get them to correct their mistake. And then they wrote it for 40 Tylenol#3s, which is less effective for me. I guess the 10 extra pills was to make up for that boo-boo. At any rate at every 4 hours for pain, they would not have lasted til the appointment anyway. Idiots, even I can count.

Then I called the Patient Advocates on Monday. They did see some reason to my argument and moved my appointment up to Thursday July 30. The clinic dr. scheduled the surgery for Aug 7th. They left the stitches in too. By now, the stitches were driving me crazy with additional pain, so I took them out myself in Saturday, and the little wound finished closing nicely before Aug 7th. I tried again to explain why they should do it sooner and though they again agreed with Jewish's diagnosis now, I would simply have to wait. Then they tried to delay my surgery again the next day because my sugar test came back kind of high (250, right after eating, tricksy for their part). They said if I did not have a full-scale diabetes plan in place and meds by the next Tuesday afternoon, they would delay the surgery again. I didn't officially have diabetes as of yet, but told my endocrinologist I must have it so she (for $300) wrote me a note saying I was on a plan and gave me a prescription for metformin. That made the clinic happy, so we were back on for surgery on Friday August 7th.

I had the out-patient surgery, and pleased to meet the pleasant chief surgeon and attending physician, Dr. Sean Bidic. However, as soon as I came out into the recovery room, with a snotty, moralistic attitude, Dr. Del Puerto, a resident of UT Southwestern Medical school(? - thought they only had one?), told me that I could just count on having to have a second surgery for the tendons cut and damaged in my thumb, because I HAD WAITED TOO LONG TO GET THIS SURGERY DONE AND IT HAD SCARRED ALREADY! HE SAID I SHOULD HAVE KNOWN BETTER AND HAD IT DONE SOONER BECAUSE NOW THEY MAY NOT BE ABLE TO REPAIR IT TO FULL FUNCTIONALITY! I made him repeat that statement 3 times. He did so thinking I was too drugged or something and didn't understand him or his South American accent (Brazilian/Portugese again, I think). I was not that drugged up.

In fact I was pretty damn straight.

I am so angry now, and I really look forward to my surgery followup visit this coming Thursday, Aug 20th (seemed a long tme to wait). The new cast is also amateurishly made and has been quite irritating. I hope they remove it. I have many more stitches now and the scar is over 3.5 to 4 inches long. They have waited 2 weeks to even look at it and it will cost me more money I don't have. I don't know if I have a lawsuit or not, but for the first time in my life, I want to. I wanted to be a hand surgeon or any kind of surgeon, when I volunteered all those years ago. But I don't I have the necessary coldness or ineptitude to be a surgeon in this day and age. I can't wait to see what they'll blame me for next.
Will I, Havoth, haveth more surgery? Who knows? I might get a witch doctor. Or do it myself. I could wing it. It's cheap and might be more effective.
- Havoth

Wakes? Who pays for those???

Wakes? Who pays for those??? I read Anne Moore's little and small minded essay, Harry and Louise Must Die on who should die already in Salon.com today. In this article where she says "hey let em die-it's cheaper", and to demonstrate her point about how it's better to just die at home,she has this blithe, romantic memory of her Irish-Catholic wakes as a younger (and possibly, softer-hearted, less selfish brat). Here's an excerpt if you don't want to read the whole article, some of which I do agree with to an extent, but that's not how it feels, Ms Moore. Maybe...maybe in your pampered, well-insured life. Ms Moore writes:

"Hospice focuses on comforting the terminally ill patient and family, at a health facility or at home, the last six months of life. If a terminally ill person in hospice stops breathing, they die. If their heart stops, they die. If they stop eating, they'll die within weeks...
If a terminally ill person who's hospitalized stops breathing, they're intubated. If their heart stops, they're resuscitated. Death is prevented, life is extended -- but the person is still terminally ill with cancer, or kidney disease, or heart disease or diseases of the brain....Why should we care which path people take? Well, it comes out of our pockets. Medicare is funded by Social Security payroll taxes, and 75 percent of those who die each year are 65 or older, enrolled in Medicare. If we died more gently, we'd cut spending."

AND THEN Ms Moore goes on to say..."When I was a little girl, I went with my family to a lot of wakes. Most of my very large family -- I have 50 first cousins -- lived within a few hours drive, from D.C. to Boston. French, Irish, Catholic: There were a lot of us, and some of us died. For three days and nights, we waked the dead. The coffin was open, and there was a stepped platform beside it, so little tykes like me could view the dead. I was never afraid: I thought the dead looked regal, laid out in their finest clothes, on a bed of off-white satin." - article link here too.

--Wow. Off-white satin...mmm how dreamy, romantic.

OK - but how to determine who is just terminally ill and who isn't just being a social burden - robbed of their economic contribution because of the LACK OF HEALTHCARE? [Dear Reader: A side note - I will be discussing this topic more in the near future]

Why don't we just kill all the undesirables in our beautiful, capitalistic society, where we talk and talk about healthcare costs, but no one questions even the price of an aspirin given in an emergency room. Why is that aspirin 400% more costly than the ones I buy at the store? If I had known it would be that expensive I'd make sure I carried some aspirin around with me so I could just eat one of my own. How come we can't control or even sometimes find out what healthcare costs??? Hospitals for profit are just as evil as prisons for profit, in my opinion. It encourages the rising costs (and the demand/need). Our government participates in this bullshit profiteering from misery, just as they have learned to do so well at war-profiteering. But I digressed, again, gentle reader.

SO, I posted this letter at www.Salon.com in response:

A little rant here about the idiot doctors who took 9 years to kill my 50 year old sister July 14th, a few weeks ago. The fact is that she probably would have been ok to begin with if she'd had healthcare or insurance. But after the first of many surgeries to cut bits of her intestines out that after what was supposed to be a "simple" hernia operation, turned into a 9 year odyssey of pain, humiliation, surgeries, cruel speculation on the doctors' part and their criticism of her body's inability to perform as they'd hoped, it took her ability and joy of working (she'd been many things but at the last a CNA, helping other old people into the good night). It left her as an expensive burden to the state, who got tired of paying to fix her and though she was on medicare and SSI, threatened her with a $89,000 hospital bill in June that would "ruin" her credit (she had none by then having lost her 5 acres and home years before because they f**ked up and she could no longer work), but they succeeded in scaring her into believing that this bill would be used to throw her out of her Sec 8 housing (no doubt needed by somebody else economically ruined by lack of healthcare) and told her that the bill would be "paid for by Hospice" (I'd really like to see that check they wrote), if she would agree to sign up with Hospice, who would helpfully setup a hospital bed in her Sec 8 house where she could be fretted over by her 19 year and 21 year old daughters, and her grieving, lovable husband who at 67 had no real education/career or contribution to society and no real reason to exist in this world other than he loved my sister (the country mouse in our family). Then as I (the city mouse), living in Dallas, was finding out about this, she was given enough liquid morphine to mess her head up and I couldn't get through to her that there was nothing that those people could take from her (she was, as they they say, 'judgment proof' having nothing left to lose) and then *poof!*, she died in her sleep a few weeks later [added for emphasis]. Of what did she die, you ask? Lack of healthcare? Ignorance in backwater Ky? Lungs gave out? Intestinal failure? NOPE- Hospice says she "must have a had an aneurysm - of course there was no autopsy. In fact Hospice helpfully had my sister cremated within 6 hours of her death. She didn't have life insurance. It had been cancelled long ago with her work ability and then she was too sick to get any. I nor anyone else in our families had the mucho bucks to have her embalmed or preserved long enough to have a wake. Was in fact told, no funeral home in the state of Ky (!?!) had a refrigerator to hold her long enough for me to try to raise the funds to have a modest wake/service before I could travel there from here in Texas.

[WTF? --not in my posting but geez...I would have liked to have seen her again. But it was more efficient to just burn her at no cost to the family, of course. I'm surprised they let us have the ashes back.]

That little romantic remembrance of wakes, made me wonder if we are gonna kill the poor quicker, can they at least provide better funerary services? Surely it can't really COST that much, can it?