Saturday, September 27, 2014
It finally happened. After years of sitting at John’s bedside through multiple serious bike crashes, I had one of my own. I’ve had plenty of time to build up a ridiculous amount of smugness about why he crashes and I don’t. “John is reckless; Staci is cautious. John rides like an airplane engine on a shopping cart; Staci uses her head.”
I was mountain biking in Cherokee Park. A storm front was moving in so the temperature and humidity were dropping and it was breezy. I felt so good! Like Rose and Jack on the bow of the Titanic. I was queen of my body and that trail. I passed a real mountain bike racer and I said to myself, “Yeah, I’m a racer too.” Twenty seconds later, my front wheel hit a stick in the trail. My wheel went left and my body went right. My right hip hit the trail and a bolt of lightning lit up my hip socket. I pulled myself to the trail side and checked around. Nothing else hit, no skin lost, no head trauma, nothing. I stood up. Left leg works…right leg does not. Time to go to the hospital.
Now for the observations:
1. Thank goodness for the kindness of strangers. A woman and man found me trying to stand up unsuccessfully. They and a lone mountain biker helped me up a 100-yard grassy slope to the road. The real mountain bike racer came back and wanted to fetch his car and take me to the ED. I waved him on. No sense screwing up two perfectly good rides.
2. It can be fun when you don’t look like the typical person with your diagnosis. After the lightening bolt of pain subsided, my hip really didn’t hurt that badly. I could even move it around some, especially if I was in charge of the moving. The ED doctor wanted to do an x-ray but I don’t think he expected to find anything. It was amusing to watch John and three ED docs look at the x-ray in another room and then look through the window at me with surprise. I already had my answer when the radiology tech said I needed a chest x-ray. All the ED staff were kind to me before and after they knew I had a broken hip.
3. Anyone who touches pee, poop, vomit, sputum or blood without making an eww face is an angel to be thanked at every opportunity. During my first hospital day, I could only lift up on a bedpan to pee. The CNAs, RNs and John assisted with me kindness. I teach medical students, medicine residents and palliative medicine fellows that they must be present with any misdeed the human body, mind or soul can manifest and not make an eww face.
4. Pick good people to care for you and then trust them to do so. John’s orthopedic surgeon is in his list of favorite contacts. She is smart, talented, experienced, compassionate, and a “master of the obvious.” She answered John’s call from the ED, looked at the x-rays and recommended a surgeon who was trained in doing a total hip replacement from the front rather than the back. This meant no cutting through my butt muscles and a faster recovery time.
5. I wanted a surgeon who was smart and a good human being. I was pleased to hear multiple physicians affirm that I had picked the right surgeon for my problem. But the deal was sealed when two former OR nurses who had worked with him said he treats everyone with respect, equality and kindness.
6. Healthcare workers freak out when you talk about end of life care preferences. I told one of my nurses if I had a catastrophic complication related to my hip fracture or surgery that necessitated total care or permanent artificial nutrition/hydration, my goals of medical care would change to comfort only. I would want to be allowed to die naturally. Her body shivered and she said I shouldn’t talk about such things. Hip fractures are not benign. If you are an older woman, you have almost a 1 in 10 chance of dying in the first month. Talking about death in this situation is practical. I was able to use a wheelchair independently on my second hospital day so I visited with the RN in charge of palliative services a few floors below my room. I told her my predicament. She knows I have a completed living will declining life prolonging care in certain scenarios. John is my healthcare surrogate. She said she would be available to support John in carrying out my EOL care preferences if the need arose.
7. Sweet words matter. I care for actively dying people. When I am at their bedside, I tell them things that I would want to hear in the hours and days before death. “I am here… You are safe… You are surrounded by people who love, care for and honor you… I will be here as long as you need me.” I don’t know if these words help; dying people can’t tell me. My anesthesiologist said similar things to me when he was putting me to sleep. I will keep saying my words.
8. Take your pain meds after surgery. I thought I was superhuman since my broken hip seemed nearly painless. I refused the RN’s offer of medication. I treat pain crises often. Until I had my own, I did not comprehend how trapped inside your miserable body you feel. I did not escape until hours later when the opioids kicked in. (Editor’s note: Please note that she did not call them narcotics.)
9. Take your laxatives. Pooping is imperative.
Disclosures: The only thing I promote is good palliative care for people who seek my advice. I did have free and easy access to many physician colleagues for their expert opinions. As the perks of being a physician dwindle, I will happily claim this one.
Staci Mandrola is a wife, mother, grandmother and palliative medicine physician who practices in Louisville, KY. Her husband John writes at Dr John M, where this post was originally published. Reprinted with permission. Copyright © 2014 John Mandrola