Saturday, July 8, 2017

Bite Me

Today I had round one of my dental reconstruction.  I had no real idea or any information about Vanderbilt when I came here and like Nashville I chose to ignore the flags of caution and allow myself my own experiences to make my own decisions about both.  And I have mixed feelings about both and as Vanderbilt is the largest employer in the area and in turn my encounters with many in the area have been mixed as well I had doubts.  But I knew that I wanted a woman Dentist and someone not "from" here.  And while she Asian she is from Missouri but there is nothing Southern about her which I appreciate and in turn my Oral Surgeon is from the Princess Bride I can say nothing but I did not kill his father.

As for the rest of them only one other I met whom I have seen only one time since is the perfect stereotype of adorable Southern Boy you would take home to Mother and she would be relieved.  Sadly I wished I had seen him today but alas I met two nice Interns and that was the end of it.  I have no idea who operated on me, who was in the room and know nothing.  And on some level that is a good thing given how the day started out.  And the number of flags thrown down that day would have brought a stop to any game on any field but I progressed.

My first encounter was at the check in desk.  No one was there but I asked in another section if they knew if I was in the right place and she said to ask at the desk out front.  By the time I and my Nurse Practioner (whom I hired from a private agency) arrived the woman was there but not taking inquiries.  And finally she acknowledged us and to say in an abrupt manner would be insufficient as she then informed us we were in the wrong place, lectured me about a phone call and message she had left with said instructions. then demanded payment (which I had given credit info the day before) and then promptly gave us wrong directions which the NP knew as she facility and had been with many clients previously.  So a quick pit stop to the wrong location and we arrived.

And then another Nurse was there asked who I was and told us my procedure was scheduled for 3 hours and I should be done by 11 or 12 at the latest.  I told my NP that she was to "move the car" but in reality the nonsense that someone sits there the entire procedure is absurd so I informed her be back by 11:30.  She was but I wasn't.  But I shall explain later.

I was taken to pre op and asked all the questions that I had submitted on a form the day before.  So let's back track here.  I was scheduled for this surgery for at least a month.  Then the day before I get two emails from Patient Coordinators, one with the form and the instructions to fill it out and email it back or just provide basic answers to the questions.  And I found out why as the document is not one you can edit or revise or electrically sign so you just sort of answer them in a generic response.  Mine did have the big caveat:  I AM AFRAID OF GENERAL ANESTHESIA.    

The other was an urgent response to another provider whose main goal was to get paid.  She ran it through immediately and of course abruptly, the constant manner of Vanderbilt staff, discontinued the conversation.

I had asked repeatedly to have a face to face meeting, to review pre op, to get a detailed itemized billing and in turn any restrictions or requirements I should follow prior to surgery.  This includes the outdated NPO bullshit that says no fluids after 12.   I get the no food especially if being intubated by mouth but in dental surgery is nostril intubation general anesthesia was administered.  So basically I followed the National Association of Anesthesiologists and had a black coffee and water at 5 am.   I then made sure that I took a long walk and eliminated any excess waste and the humidity and sweat took care of the rest.

So when I arrived the Nurse that had demanded payment stopped the pre op went to look at my file as that was more important that giving a shit about the water drinking and my own fear and found I had paid.  It proceeded with another rant on my part  that I was appalled at the lack of communication and response as well as overall treatment  that I am a deadbeat/liar/incompetent and such when I walk in takes a toll; which should explain why I have White Coat Syndrome with an immensely high blood pressure that rarely levels unless I have time to calm down.  Remember this is the same crew who called the Cops on me when I blew up over the incorrect treatment plan the first time and said "what do I need to do get a gun a blow my head off to get help here?"  That is because Vanderbilt is the largest trauma center (much like Harborview in Seattle and my experience there is well documented) and as a result their energy is spent in ER, which is not surprising given the guns here. So hence the cops four days later when I could have harmed myself and others in the interim not an issue but 7 am arriving at my home uncalled not stressful in the least.

She apologized and in turn finished the procedure.  She was a typical Nurse and again I have no comment to lend to that but 26 year olds are not my favorite.  And she won no fans when I told her about my BP she said I need to get a Physician to help me monitor it.  I go, "Yeah that should do it!" Thanks I will keep to staying out of hospitals unless absolutely necessary, go work out and now that I am going to have teeth eat healthy and be happy having functioning teeth and get out of Nashville. My favorite question was "does someone hurt or threaten you at home?'  Well that was what led to the blow up with the first coordinator about being married or having a partner and me hiring a Nurse so who is doing that?  I responded, "No school is out so I don't expect that until about September when I return to work as in my 20 years Teaching I have never encountered Students with such violent outbursts."  She did not respond to that.

Then came the Nurse Anesthesiologist who was administering my GA.  This guy was everything I hate in Nashville, the old white Southern guy whose condescending patronizing manner was in high gear.  I did not admit to drinking the coffee as I knew the reaction about the water was a tipping point and he heard little about my research regarding the the Anesthesiologist society and that they said clear fluid was fine within 2 hours despite that that it was actually 3 hours earlier followed by  a 30 minute walk after. And again in this heat I  had urinated and  was feeling  pretty dehydrated at the moment.   But the manner of speech, his manner towards me told me he dismissed anything I had to say.  And to be this dehydrated prior to GA  means you are in a state that requires more fluid during surgery and is in fact more dangerous but whatever.  He was clearly not believing any of my responses about anything.

When I informed him that I had Bell's Palsy 15 years ago and residual paralysis next to my right nostril, my upper lip and right forehead was all that remains but quite obvious to those in in the "know."  And Medical people or former Bell's see it right away.   But instead he kept asking if I had a droopy eye. I said no, he repeated the question so as soon as I get that angry I respond a question with one so I go, "No, but is it drooping now? Is there something I am not seeing?"  Then he was obsessed with my cane that I brought in case I was dizzy post surgery and needed to walk with rather than rely on the Nurse and sure enough given the bum's rush I did use it and later at home getting off the couch, so it was needed.   And I said no it is not something I use on a regular basis. Did you not hear me I went for a 30 min walk and wouldn't that be noted in my med records about my cane/walk?

But he was an asshole and then his boss came in a, real Doctor, however he was equally patronizing and dismissing  with regards to my analogy that I think Bus Drivers are the real heroes compared to Pilots (the one he used to brag about their role in surgery and he really needed to be brought down a peg)   as they have to deal with just as many crazy people and get us all there safely every hour on the hour.  And in Seattle I lived with many Drivers being assaulted, stabbed and one killed. The old duffer then hauled me out like the fuckwit he was cutting me off telling me it was time to get the implants in.  But it wasn't.

I found out when I came out of anesthesia that they went out to my NP and informed her that I would be another hour that they were backlogged and she heard them tell a patient that was scheduled that he would have to come back in an hour and half.  How was that no fluids thing working for him I wonder? Another they told to reschedule for another day.  Gee got that scheduling thing down well don't they. So people take time from work arrange for someone to care from them which means more days off and they yet questioned why I hired someone and wanted a pre-surgery consult.  One worked the other didn't.  The one in my control and yet Vanderbilt had real problems with my need for control.  I see why.

When I came out they had to hustle me out as clearly they needed the room and apparently shut down at 3.  Which may explain why I was dazed and confused and needed time to recover but no instead I was given the bum's rush.  In the process I was left exposed without covering by a doorway, a bizarre ice pack that did not even remotely cover what I needed as it was utterly useless (even my NP thought it was odd)  and given a small list for post op and instructions to call on Monday for my follow up.  I see I am doing all the work here and had I not hired a professional I would have been utterly without any true support as how is a layman to know what to do? Sure tell a friend to take a day off of work and then say its only a half a day.. but not.  What I loved was that I was told to have someone 24 hours to help me.  Really? Then should I not be admitted if that was the case?  I said we will take care of when we get home and exchanged a glance.

So when I reviewed the inadequate post op compared to the ones I collected online from other O/M's I followed the ones that had detail and information that I found useful.  I guess Vanderbilt is aware that 40% of the population is illiterate so they keep it simple.  I mean only 33% of the population is educated and in turn probably all work in the Surgery and the School in leadership gigs and the rest are well the "others' whom I encountered in my "odd"essey.

The NP dropped me as she had scheduled another patient at 3 but I was fine with that as I needed to get my bearings and get that GA out of my system.  I tried some fluids then a broth then the projectile vomiting happened and that ended that.  Cleaning vomit, doing laundry after surgery is not a job for a Nurse but a Maid at that point.  I emptied garbage and in turn did dishes.  I was Martha Stewart on Hydrocodone.   This Juice Cleanse was now in hindsight was a good idea.  I have yet to start it so that might be wishful drinking.

So I also reviewed the take home pack which included Ginger Ale and Sprite. Why I paid for that is beyond me as I don't drink Sprite and I had ample Ginger Ale in my home in anticipation.  I bet the mark up was a good one on that.  Then some gauze and a spoon for reasons I am unclear.  But my favorite thing in the pack was a HAZMAT envelope with a set of teeth.  Were these my temps that I was to wear post surgery? Really?  I had mine with me and had properly wrapped them and put them away in a proper container but these were just sitting there without fluid or any proper care and this is what I am to use? Really?

I immediately emailed my Dentist to ask about this and her assistant read it got back to me immediately by phone (funny how many are able to contact me by my land line which I prefer so who is the one with literacy issues) that this was bizarre and she had forwarded my email onto the O/M office but they were already gone for the day (it was 3:17 pm) so not to expect anything until Monday.  I asked about care or what should I do with it and she said to bring it to my follow up appointment that I will be making myself as I know they won't.   We did laugh as I said if these are for me I am going to pass on them thanks as they are a bio hazard!

The reality is that I got more online about my procedure pre and post than I did from Vanderbilt.  And while I am pleased with my Dentist and my Surgeon the communication at that place was appalling. And the complaints about this issue is well noted on almost every site and review.  This is where the ACA was supposed to kick into gear with electronic messaging and records but that would require Vanderbilt to give a shit.  They care about research.  The reality is that since Tennessee elected to not extend Medicaid they treat only the few insured in the area and in turn the few Insurers that exist in the area.   So while mine is Dental and I pay out of pocket for this procedure my exposure to the Hospital side is very typical of a facility that has now largely a Teaching facility and trauma one.  But the issues here in the medical tourism capital as we house two other national Hospital and Insurers is ironic if you actually live here.  I call myself an interim resident and I don't think in all frankness it is different anywhere else.  I left Seattle as I could not get the care I wanted and needed at an affordable price and this is half of what I would pay so I guess you get what you pay for.  But by all when it is said and done this will hit 20K but thanks to Trump it is all tax deductible.

But I have round two next year and this worries me, it worries me a lot. But at least I know now what to expect and none of it good but the final result I suspect will make me realize that no pain no gain. But with Vanderbilt they are no different or better than the rest and that is the state of care in America. 

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