Sunday, August 24, 2014

More on Dr. M.

It might be worth beginning with a few background facts:

  • Seventy-five percent of Vermont is forested, making it the fourth most forested state in the US. (If you can imagine that Vermont is one tenth the size of the entire UK - Scotland included - you might get the sense that that is a lot of trees!)
  • Vermont has the smallest carbon footprint of any state within the US.
  • Vermont is the only state in the US which does not use coal to generate electricity. 
  • Winter in Vermont tends to last around six months (mid-October through to April). 
The reason for mentioning these facts is to provide the context for my recent post-surgery conversation with Dr. M.

In Vermont, nearly every house has a large wood-pile neatly stacked in its yard because nearly every house is, at least partially, dependent upon burning wood for heat. Stacking wood is so ubiquitous at this time of the year that every conversation - in the farmer's market, in the general store - will include one person grinning broadly and commenting on how wood keeps you warm three times over: once when you chop down the tree, once when you stack the wood, and once when you burn it.

It took Dr. M. and me a little while to move our conversation around to wood. We were too busy defining the list of things I am not allowed to do since breaking my neck.

I began with my favorites:
'Can I start horse-riding again?'
'Not yet.'
When I sighed, he called up my x-rays on his computer screen and offered me a quick lesson in statistics.
'In a normal person, there might be a 15% chance of this part of the neck breaking in the instance of a fall.' He circled the section of the x-rays where shiny parallel lines depict some of the metal work I'll carry around with me for the rest of my life. 'Now with this kind of fusion, you'd need to factor in a 10% greater chance that the first three cervical vertebrae would fracture.'
He didn't need to say more. I'm not an expert on ratios, but I know that fracturing one of the first three cervical vertebrae is the kind of injury which landed Christopher Reeves, and many others, in a wheelchair. They were the lucky ones: breaking the top few vertebrae in your neck normally stops you being able to breathe as well.
'So not yet,' I echoed and Dr. M. smiled, apparently pleased at the readiness of my understanding.

'What about my bike?"
I love my bike. It's been my fast-moving, narrow-wheeled companion through four major relocations; carrying me up Cumbrian mountainsides, past Northumbrian coastlines, through Cambridge traffic, and, for a few short weeks, along Vermont roads.
'What kind of bike do you have?'
I leant forward in my chair, wrapped my hands around imaginary handlebars and, for a moment, felt the wind rushing through my hair.
'Don't sell it yet,' Dr. M. said, 'But you might want to think about replacing it in the spring.'
'Replace it with what?' Being told to replace my bike felt a little like hearing someone say I should replace my dog with a different breed.
Dr. M. sat up tall, old-lady-like, and lifted his hands to chest level.
'A sit-up-and-beg?' I scowled and, apparently less pleased by the direction of our conversation, he arranged his face into a more authoritative expression and quickly lowered his hands to his lap. 'Don't try and ride your bike this year. We'll know more in the spring.'

God loves a trier, although Dr. M. might not agree. My questions about yoga met with a shake of the head, the doctor made it very clear I shouldn't sign up for Iola's taekwon-do classes, there will be no cross country running for me this year, and rock-climbing is off the agenda. Furthermore, I should encourage the girls to help me with vacuuming, I shouldn't lift heavy pots off the stove, and it would be a good idea to have someone else carry the wet laundry up out of the basement.

The silence between us was not completely comfortable.

'Can I stack wood?' I asked, having exhausted every other physical activity I could imagine.
I'm not often at a loss for words, but he was meant to have said no, wasn't he? Six cords of wood had been delivered to us that week (a cord, properly stacked, occupies a volume of 128 cubic feet. We hadn't measured the volume of our 6 cords of wood, because we had not yet made any attempt to stack it).
'I'm not going to advise any patient to fail to prepare their family for the winter,' explained Dr. M.
'And I won't cause myself any damage?'
'You won't damage the work I've done on you.' Dr. M.'s blue eyes sparkled for a moment. 'And your body will tell you to stop stacking wood far sooner than I can.'

Of all the things of which I am afraid (and you might now want to add stairs and light switches to that list), hard work is not one. The next day I tackled those 6 cords of wood with all the anger and resentment I felt at being forbidden from riding a horse or a bike, at being unable to throw a round-house kick, or sit among a group of elderly women muttering namaste. I lifted and threw every ounce of fury at those pieces of wood, and I learnt that I love wood-stacking! It's like playing jenga with weights and, while it is not as satisfying as riding my bike, it burnt off some of the adrenaline which has been stagnating in me for nearly two months. In truth, I might even have smiled and sang while I worked.

Dr. M. was right, of course  - it's his job to be right. I have barely been able to get out of bed for the past few days and the constant pain I live with has taken on a whole new set of dimensions. But you should see my woodpile: even a Vermonter would deserve to feel proud!

Thursday, August 21, 2014

Follow-ups, or a taste for hospital drama.

I'd only met my surgeon - let's call him Dr. M. - once: he was in his operating scrubs with a white mask covering his mouth and his hands suspended in sterile awkwardness. We were only moments prior to a lengthy surgery on my neck and he acknowledged me with a rapid nod before beginning a roll-call of the people and equipment present in the operating theater. His eyes were very blue.

Following the operation, there was an endless stream of hospital staff. This is perhaps more typical of American hospitals than health care in the UK. There are, for example, regular visits by the surgeon's slightly more junior colleagues and the hospital doctors and the ward doctor; there are smartly dressed physician's assistants whose perceptions of their own seniority seem, sometimes, to be held primarily by themselves; there is a highly striated rank-and-file of nursing staff from ward managers and expert practitioners through to nursing assistants and trainees; there is a case manager who wears a smart suit and high heels and sounds like an accountant; and even the cleaning and auxiliary staff have a careful hierarchy within which each person has their own clearly defined place within the food chain organization. Even as an Englishwoman knowing few people in Vermont, I had little chance to become lonely, although my insurance company is now paying dearly for the company I kept: currently the expenses associated with my operation exceed $100,000.

But Dr. M and I were not scheduled to meet again until this Tuesday, and I was looking forward to our meeting. I wanted to say thank-you, and I had a long list of questions written out on the back of a hospital menu.

But first I needed to introduce myself to the plump middle-aged woman behind the reception desk. She directed me towards a younger woman with a smaller desk, who confirmed, with careful and laborious care, that my address, date of birth, and credit card numbers had not changed since the accident. I followed the signs to radiology, where another receptionist greeted me. I suspect she is paid slightly less than her front-of-house colleagues: she needed to talk about bra straps and menstrual cycles rather than credit card numbers and insurance coverage.

The radiologist was male. After all the 'Good-afternoon-welcome-to-the-spinal-institute-how-are-you-and-have-a-nice-day' pleasantries of the previous staff, his silence came as a surprise. Behind the beard and lead apron, here was a man who saw himself as a tortured artist. We spent an uncomfortable half-hour together, trying to stretch and bend my neck into positions which were the most aesthetically pleasing for his work, and I think I was a disappointment to him: when I said good-bye, he grunted and did not return my smile.

In another part of the hospital, a male nurse showed me into the surgeon's office. He was a nice man of many words. A few years ago he had an operation on his neck. He's still in pain every day. Lots of pain. When he rides his motor-bike, it hurts. He showed me how much he could move his head to the left and right, up and down. He told us he shouldn't have been our surgeon's nurse that day, but the other nurse and her stand-in were both absent. He didn't like working so hard because it made his neck hurt. He had to hurry away to another patient before I finished offering him my condolences.

Being left alone in a doctor's office is typical of most doctor visits in the US. From what I remember of the UK, the doctor is in the room when the patient knocks on the door. In the US, the patient sits in the room - once, when we were waiting to see the pediatrician, for more than an hour - and it is the doctor who knocks on the door.

Except when it isn't.

After twenty minutes, the physician's assistant knocked. She was extremely beautiful and well-dressed, making House M.D. seem like reality television. We talked about who I was, which was useful because she had thought I was someone else, and I read out my list from the back of the old menu card. When she asked if she might examine me, I felt suddenly self-conscious about my plaid shirt and shabby jeans. I've never been someone who dresses up for doctor's visits, but I felt poorly presented for the role of 'patient with a broken neck'. Fortunately, the examination was swift: she looked at my scar, tapped my arms and commented upon my lack of reflexes, and left the room.

Dr. M's eyes were as blue as I had remembered. He was happy with the radiologist's artwork and the evidence of his own handiwork. He was gracious when I thanked him and his eyes, which were very blue, only strayed towards the physician's assistant's legs occasionally while I was talking. Overall, it was all very positive news. My neck is healing as well as I am allowed to expect, the nerve damage seems to be lessening over time, and my mobility is excellent considering all things.

My next visit is in 6 weeks' time. In the meantime, I am going to watch a few hospital tv shows so that I better know what to wear and how to deal with frustrated artists.