Insurance Bureaucracy and Narcotic Hoops

For the most part, I have to say that I'm very satisfied with how smoothly everything has gone with my health insurance in terms of my care for the cancer.  Group Health has done all the approval paperwork,  referrals, etc. and I haven't had to do anything.  The only quirky thing that's come up is with my medications.  

Now, one would think that if I had surgery at an authorized facility outside GH, it would be ok to get related medications at said facility, right?  Yeah, apparently not.  To give a little background, no one told me an exact discharge time from the hospital, and frankly, I was happily addicted to the little red nurse call button, so I hadn't really arranged a set time to be picked up by my sister.  Around 6pm or so, one of the nurses came in, went over my discharge papers and gave me the all clear to head home.  Oh yeah, and I wouldn't have any nursing care after 7pm.  BUMMER! It was at this time that I was told that I'd have to pick up my pain medication at a Group Health pharmacy, rather than get it from the in-house pharmacy at Virginia Mason.  I knew both the downtown and northgate clinics closed at 5, so the only way to get it would be at the main pharmacy.  After making a phone call, it was discovered that it closed at 7:30.  Under normal circumstances, it's maybe a 10 min drive from VM to GH, so I wasn't too worried about it.  Until....

I called my sister's place, and they were JUST getting dinner settled (with 3 kids, this is no small feat!) and she said she'd eat quickly and then come get me.  As I watched the clock tick closer and closer to 7:00, I started to get a little itchy.  I talked w/ the nurses who faxed my rx over to GH, and gave me the paper copy, in the hopes the pharmacy could have it ready to go when I presented the hard copy.  They had already called for the hospital transport to bring me downstairs, and by ten after seven, my sister had been waiting downstairs for almost 15 minutes, and I was still 3rd on the list to get a wheelchair escort.  Of course by this time, I was pretty mobile, packed and ready to go (although I was still stoned out of my mind and slow as molasses in January.)  Because of the absolute NECESSITY for me to have my pain meds (duh!), finally one of the nurses said screw it, and took me down herself.  She grabbed my bag and off we went to the elevator bay.  The most convenient patient pick up spot was closed for construction (ironically the same day as my surgery), so I can imagine how funny it looked for a nurse with a mission and a gym bag being following by a grinning, near drooling patient shuffling along in pink scottie dog jammie pants and flip flops, winding through the halls of the hospital.  We finally made it to one of the lesser known/daytime use only entrances and it was like walking onto 520 during rush hour.  Apparently I wasn't the only patient being released, and there was a whole host of cars waiting.  This explained why I had been waiting for over 45 minutes for someone to bring me down.

I got into my sister's car and off we went to GH as quickly as possible.  We arrived with just 5 minutes to spare, and I shuffled to the pharmacy in my flip flops and jammie pants, armed with the hard copy of my script.  After a few minutes, I was called to the window, slid my script under the glass, and expected to be handed my vicodin so I could go home to recover.  Now, keep in mind I was still less than 48 hours post-op, had just been released from the hospital, and here I am, standing at the pharmacy window, stoned out of my gourd.  The initial guy was cool, took my script and he acknowledged that the pills were waiting.  YAY!  Then he said that before they could give me the pills, a pharmacist would have to speak with me. Not yay. 

Now, you'd think on a Tuesday night, now 10 minutes past closing, I wouldn't have to wait.  But oh, dear friends, how wrong you would be!  There was one guy ahead of me, and another woman who came in just a minute before the pharmacy closed.  Oddly enough, both of them were helped and on their way out before me. After waiting several minutes, I began to lose my ability to stand upright, and thankfully the pharmacy window had a nice strong ledge for me to lean on.  Just imagine the sight: strange woman in jammie pants and flip flops, clearly stoned, with all kinds of recent needle marks up and down both arms (from IV's, people - I'm SO not a junkie! ), inpatient bracelets, barely able to stand, wanting to pick up narcotic pain medications.  Add to this, my doctor had written two different directions for the meds.  Yeah, that didn't set off any kind of warning bells! 

The pharmacist came to my window and, perplexed about the prescription's directions, began to quiz me about how I was told to take it.  By now, I'd been standing for nearly 20 minutes, and was getting dangerously close to just curling up on the floor for a nap.   She then wanted to give me a run down of how to take the pills, side effects, things to watch out for, don't drive while taking the pills, blah blah blah blah.  FINALLY she handed over the bottle, and I flip flopped my way back to the car, where I was whisked home, and got myself settled in for a few weeks of recovery.

The longest walk EVER

Before you read the rest of this story, you must click this link (http://www.youtube.com/watch?v=2dQ5c5SIYnc ) and allow it to be your background music as you go with me on my journey!  And feel free to hit repeat so you can truly revel in the awesomeness of this song!

Another glorious part of my doctor's post-op schedule/regimen is to walk as much as I'm able (willing?).  Even in a medicated state, laying in bed for hours on end is boring. Even with facebook and cable.  However, it is rather tricky to just get up and walk when you're hooked up to about 463 different machines by an additional 572 wires, hoses and cables.  After 20 minutes (or what seemed like anyways), I was unburdened from all my technology, including my beloved leg warmers.  Now the real work began! I never knew how challenging it could be to sit up on my own, and swing my legs around to the edge of the bed.  Oh yeah, did I mention that anesthesia, morphine and vicodin combined make any kind of ambulation that much more fun with dizziness.  And being laid out on your back for the better part of a day is gonna do screwy things to your blood pressure if you get up too fast.  For several minutes I hung on grimly and determined to the bed rail, with my entire focus being standing on my own two feet (clothed in fashionable yellow foot socks with safety tread).  Once I felt my feet touch the floor, I knew that one way or another I was going to stand and walk come hell or high water.  With a granite grip on my IV pole, and a herculean effort, I finally stood, wobbled, scared the hell out of the nurse & tech waiting to catch me, and finally stabilized in a near upright position.  It was glorious!  Choirs of angels came down from the heavens, and cherubim peaked out from the fluorescent light fixtures playing harps.  Or perhaps the uber drug combo combined with the reflection of the city skyline from the window for a seriously awesome hallucination?  Naw...let's stick with reality. ;)

I'm sure most of you dear readers have never had a hysterectomy, or major lower abdominal surgery, but I can tell you it's a crazy bizarre feeling to have all your organs, especially your intestines, shift around in new ways.  My belly felt like it was hanging with tension.  I guess if you wanted to really understand, imagine a half filled water balloon being dangled in mid air by it's top.  Even though I wasn't feeling any pain, I was afraid to stand fully up to my proper 5'6" height.  All in all a very curious feeling.

My first walk was low/no pressure, and the nurse said it was up to me to decide how far I wanted to go. Once I'd made it to the door of my room, I scanned either end of the hall and realized there weren't any real halfway points since the nurses station was one door down from me.  I set my goal on the emergency exit door at the shorter end of the hall.  For those few minutes, the entire scope of my world was oriented on two things: placing my palm on that door, and making sure I didn't trip over the catheter hanging down my leg. I know, TMI and Ewwww!  Step by painfully slow step, I did the old lady hag shuffle down the hall, with the nurse ready to grab my free arm in case I started to go down.  With the passing of each room, I glanced in to see what other patients were experiencing, and  for the most part they were either empty or had people sleeping.  As touching the emergency exit door became more and more of a reality, it suddenly occurred to me that although my end goal was in sight, I was going to have to make the return trip back to my room.  Damn, why didn't I think of that ahead of time!  DOH!  *forehead smack*

Finally, I reached the end of the hall, slapped my palm on the door (secretly hoping to set off some secret alarm!), shuffled around a 180, and looked down a hallway that had easily grown exponentially longer than when I first started my journey.  On a side note, the song running through my head through all this was The Greatest Adventure (of which you are currently listening to if you followed my instructions at the beginning of this entry.  If you haven't, then you're a poopstick and need to click it now, and start reading again from the beginning.)  The walk back to my room was surprisingly uneventful - no face plants or tripping over the catheter.  The worst part of the whole walk was at the end when, weak, exhausted and only wanting to crawl back into bed (even with my legwarmers),  I had to feebly hang on to my sweet blessed IV pole while the nurse straightened up my bed.  Finally she was finished and with the same herculean effort it took to stand up, I slowly eased my way back into a blissful prone position.  Another 20 minutes to hook me back up to all my equipment, and I was able to get back to my woodstock-like drug haze.

On Catheters and the Morning After

What do hospitals and the military have in common?  Both have strict schedules.  VERY strict schedules.  Especially for post-op patients.  And my doctor, being a military man is VERY particular about his patients and their post-op care, even more so than other doctors (according to the RN gossip mill!) Overall, things post-op were going very well, I has happily drugged out of my gourd on anesthesia, morphine, and vicodin.  Then, as time went by, things took a dark and ugly turn.  With every shift change, the new staff would come in and introduce themselves.  With the nightshift, I knew would come a challenge:  My own personal Nurse Ratchett*.  Now, don't get me wrong, I think she's an amazing nurse, and actually, towards the end of her shift, we were joking around.  However, it was her charge to make sure my vitals were taken every 2 hours by the tech.  Oh yeah, and one of the post-op tools is to use this funky breathing machine where you inhale slowly, and have to get the little blue doo-hickey between the blue arrows and the other blue thingamabob up to a certain measured level (the purpose of this is to help patients use their lower lungs to keep pneumonia from setting in.)  As with the vitals, I had to do 10 reps of this every 2 hours. All night long.  And Nurse R wasn't about to let me just sleep in my drug haze either!  Now, for the most part, I was in/out on Facebook and Frontierville, so these 2 hour checks weren't too bad.  Until 6am.

I don't remember the 4am check, but I knew when Nurse R woke me up at 6am, I had been sleeping for a good stretch of time.  Oh yeah, and I f'uckin' HATE mornings.  Ask anyone!  My mom will testify with her hand on a bible, torah, quran, *insert sacred text here*, that at no point in my life have I EVER done well with mornings.  To the point where she should pour water on my face to get me up, and ice cubes down my jammies because I refused to get out of bed.  With that in mind, I'm sure you can imagine how much I loved being woken up at 6am after everything that had happened the day before.  Add to this - Nurse R informed me it was time to take out my catheter, per MD orders (damn him and his post-op schedule!).

Let me first say, that having a catheter in when you're stoned out of your gourd in bed is AWESOME!  Never get the urge to go, and you can just lay there and enjoy the buzz without the hassles or inconvenience of going to the bathroom. The downside of catheters (and maybe this is just a woman thing), is that walking w/ a catheter is just weird!  I don't know how you guys do it - stuff dangling between your legs. Can you say, AWKWARD!  Maybe it's because I was a first-timer, but seriously guys, WTH!??!  It's just cumbersome and bizarre!!

Ok, enough of a tangent.  So Nurse R comes in at 6am, with her happy cheery its-the-end-of-my-shift-so-don't-give-me-any-shit way, and announces that it's time to take out the catheter.  Honestly, the process itself isn't a big deal and didn't hurt at all (yay for short urethras!)  Having it done at 6am when I'm at my peak grumpiness = not a good situation.  Of course I announced my displeasure and in very mom-like fashion, was promptly told to stop whining.  It was epic awesomeness.  Seriously, Nurse N even gave me the mommy glare. And yes, I totally deserved it, because in my completely stoned and narcotic addled brain, the only way I could articulate my displeasure was to whine.  Like a 3 year old being dragged away from her bowl of ice cream at the circus as she's about to get an elephant ride.  After being told to, in essence, shut my pie hole, the grown up in me woke up and took hold and realized that I hate whiners above all, and here I was on the verge of an epic toddler meltdown.  After that, things went smoothly, it only took a few minutes and I was allowed to go back to sleep to the gentle whirring of my leg warmer's motor gently squeezing my right calf....


*Just to clarify, I think she's an awesome nurse - extremely capable, professional, efficient, and clearly knows what she's doing (which, to me inspires a lot of trust and confidence).  But she's also very strong willed (like me) and  has a take-charge authoritative presence, which as mom will testify on a pile of sacred texts is not always the best mix with my personality.  Add to this a shit-ton of narcotics, and I think my perception of her is probably a little skewed. Like I said, we actually ended up joking around a bit - I'm sure she'd be a kick to shoot back a few whiskeys with! LOL!

A GoLytely Addendum

As I'm sure you can imagine, I made sure to comment to my doctor the horrors and sadistic awfulness of a colon cleanse.  In his wonderful way of straight faced humor, he told me that GoLytely was named and invented by a famous intestinal neurosurgeon named Dr. Crapper.  Yes.  Dr. Crapper from Great Britain.  I swear I'm not making this up!  He's some british lord and descended from the inventor of the modern toilet.  Hence, why we call it the Crapper.  Oh the things you learn in pre op!

The First Meal and the Worst Legwarmers EVER!

As recovery continued, and the anesthesia began to wear off, I was beginning to become more conscious than not (although, let's be honest, the conscious bits weren't really totally self aware moments).  One of the nurses showed me how to use the bed remote control with that lovely red button that would call someone to my room right away (oh I miss that button now!!)  I made sure to have my laptop and cell charger all set up before my family left (I mean really, you all didn't think I'd actually be mindlessly "resting" did you!?!?), so as the nurse started to explain how just one push of a button controls the tv, I looked at her, indicated towards my pile of technology on the table, and said, "Yeah, I think I've got this one."  She chuckled and left me to it.  I was given the land line (yes, a land line. corded.  with actual lit buttons.), and a menu and told to order whatever I wanted. Well of course after the wonders and joy of the GoLytley, my brain was saying it was time for some foodage, but the narcotics kept any actual appetite away.  After spending the better part of an hour staring at the menu, trying to decide what to order (yes, a medicated Grace, is an easily distractable and ADD Grace.) I decided on the fruit/cheese plate and the fish n chips, as the nurse said to get whatever I want.  When the food arrived, it smelling divine, and I made some attempts to begin eating, but it's really hard to do when one arm has an IV, the other an O2 monitor, plus the nc up my nose.  As I'm meandering through the meal, one of the nurses comes in, and says I might have a hard time w/ the food I ordered because of upset stomach.  Now mind you, this was the same nurse who said I could have anything I wanted.  Umm....HELLO!?!?  I would have just gotten a salad if that was the case! After being told that, my joy at the fish and chips dwindled at the prospect of possible vomiting which generally involves the use of abdominal muscles, which at that time I was pretty sure would hurt like the devil if I even attempted to engaged them. In the end, my iron stomach held up just fine, but I still only managed about half of the meal, which was surprisingly good for hospital food.

Now to my legwarmers.  Two of the main concerns post-op are the development of pneumonia and blood clots.  Given the profound lack of mobility from all the monitors, surgery & meds, medical science has devised a device that may or may not violate the geneva conventions on cruel & unusual punishments.  It consists of electronically inflating fleece wraps that go around your calves.  First one inflates (like a blood pressure cuff), then deflates, followed a minute or so later by the other one.  Now, the "theory" is that they keep clots from forming, but really I think it's to overheat patients and generally irritate us.  The most wonderful part - unless we're actually walking, the legwarmers stay on.  24-7.  I'm secretly convinced that these vile devices are used to motivate patients to get up and walking as quickly as possible.  On one of the vitals checks, I told the CNA that I was feeling really hot.  She responds with, "Oh, you're having hot flashes."  Umm no, heifer, it's not hot flashes, I'm BAKING!  So we did some investigating.  Not only did I have two thermal blankets, a sheet, and my fleece leg warmers, but the room temp was set to 75.  Seriously, I think a hot yoga session is cooler than I was.  She chuckled and started removing my eskimo layers and set the room temp down to 65.  I still felt hot, but damn it was a hell of a lot betterer!

Coming soon.....the Catheter Tales...

Home again, home again, jiggety jog!

Well, it's all done - made it through the surgery and back home resting. To put everyone at ease, the surgery was a snap.  They were able to do the laproscopic procedure, and once they got in there with the scope, they didn't find any cancer in my abdomen, and it didn't appear to have spread outside of the uterus.  The next step is to wait and see what the pathology report says, which could be radiation or chemo if it appears to be advanced.  But I'm gonna cross that bridge when I get to it and focus on getting physically healed, and plant my victory flag on the top of Mt. Cancer.

So now to fill you all in on the fun times of my post-op experience! When I first woke up, I was in a lovely medicated haze (as I'm sure you can remember!).  I was being wheeled to my room from the recovery area by this awesome big fuzzy black guy (I wish I could describe him better, but I was drugged and didn't have my contacts in, so well, that's how he appeared to me).  The whole way, he was singing (damned if I can remember what).  Needless to say, I felt obligated to join in, even though my voice was shot to hell from the intubation.  I also recall saying a cheery LOUD hello to everyone we passed.  I felt it was very important to acknowledge every fuzzy person I saw.  Needless to say, I startled more than a few interns, made one nurse almost drop her coffee, and enjoyed myself immensely singing and giggling the whole way there.

Once I was comfortably ensconced in my room, it was wonderful to have mom there.  I'm pretty sure there's nothing more wonderful or powerful than a hug from mom.  I could tell she was relieved to see her baby girl conscious (sort of), and otherwise doing well.  I'm not sure how much longer it took for my sister and niece to arrive, but no matter how screwy we are as a family, I felt amazingly loved and taken care of.  Now the almost bestest part - the rice crispy treat from starbucks.  My sister mercifully thought I could use a treat, and starbucks was it (thankfully she took my advice on the awfulness of the hospitals coffee).  Can I just tell you how AMAZING that crispy treat tasted?  It took me a solid 4-5 hours to get it down, but the taste and texture were the most divine thing to hit my tongue.  Ever.  Until I noticed my niece eating swedish fish.  Oh the joys, the wonders of the delicousness of the gummy treat!  Unfortunately, my family had to leave, which was actually ok, because I was ready to slip back into a lovely medicated sleep.

Up next....the joys of scheduled meds & catheters!  But for now, time for another vicodin nap!