Surviving Surgery with Humor and Patient Advocacy
Have you had surgery?
Introduction – Surgery is Fun
On Wednesday, June 19th, I have an appointment with my neck surgeon. According to my latest MRI and x-ray, not only has my neck fused from C2 to C7, but there's also a bunch of new damage and issues at C7. According to pain management, these issues could potentially lead to brain issues for me. So, despite my hope of delaying surgery until I have better health insurance, life seems to have other ideas. Once again, I start the process of determining whether having surgery will raise my current quality of life to a level worth the expense and energy of surgery.
If I do have another neck surgery, this would be my 3rd (I think 12th overall) neck surgery since 2005. Now, I’m not sure how many surgeries constitute receiving the title of “surgery expert,” but my name must at least be in contention for such an award. With that in mind, I thought I would share my thoughts and experiences obtained from having so many surgeries. However, to make it more interesting for you, the reader, while providing me with an opportunity to become more articulate, I will add a tongue-in-cheek element that is not normally found in a post like this. After all, if you can’t have some fun while contemplating the ridiculousness that is our healthcare system, are you really a chronic patient?
Surgical Resume – I don’t think AI will be able to read this resume.
If I’m going to present myself as a “surgery expert,” I should probably begin by proving it. Now I could practice some body positivity and post a naked photo of myself and maybe offer up a pony if you can circle all my surgical scars. However, I’m guessing some of you are currently counting the change in your pockets in the hopes of offering me enough money to convince me to NOT post a naked photo of myself. Fair enough! Here is a list of some of the surgeries I’ve had during my lifetime:
Had my tonsils removed during my Kid Era.
Had a benign blood tumor removed from my right wrist during the last of my Teenage Era.
Had 10 screws/plate inserted into my left wrist the night I thought I could fly while rock climbing, but gravity proved me wrong.
Left hip is resurfaced, right hip is replaced. Let’s call this my Hip Era.
Currently have 8 screws and 2 plates in my neck from 2 surgeries with the probability of more on the way being high.
Had a Bankart Shoulder Repair surgery on my left shoulder during my Stupid Freak Skiing Accident Era.
This is not a complete list of my surgeries. If you require a complete list of my surgical history before accepting I might know what I am talking about, then I’m going to include that naked photo of myself but not offer up a chance to win a pony. You have been warned!
Worst Case Scenario – There is no pain in death though.
Let’s shift gears from a threat of my nudity and discuss Informed Consent for a moment. According to Professor Google, Informed Consent is defined as “permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.” That is the adult definition, full of strong action words and top-tier college English classes. In surgery world, this is where the doctor tells you about all the worst-case scenarios that could happen if you elect to have said surgery. However, since the surgeon wants to breed confidence in their ability to raise your quality of life, they might try to blow off or trivialize these scenarios almost to the point of absurdity. Yes, you could die, but statistically, there is a better chance a purple-colored lizard will marry your sister on Tuesday following a full moon. Surgery world absurdity.
I’ve got jokes in the hope of making this post a more enjoyable read for you. Informed Consent is important and should be a serious part of every surgery. That said, I think we need to modify the process of informed consent. It should be framed regarding possible consequences of life as it relates to “quality of life” and not just in the frame of said surgery.
WAIT, WHAT! Do you need some help translating my nonsense? Like life, there are no guarantees when it comes to surgery. Even the simplest of surgeries can have life-altering consequences. But it’s important to remember that so can eating at Taco Bell or flying Spirit Airlines. Even my simple brain knows that if I elect to have a third neck surgery, there is a chance I could end up paralyzed if something goes wrong or even something worse happening to me; my surgeon would be working around my spine, after all. That’s not informed consent, that is just logic. What I’m trying to argue for is informed consent should be more about what my life will be like if I don’t have a third neck surgery. At what point can I expect brain issues because of the damage in my neck, how much worse could my pain get, how much more range of motion could I lose, at what point will I be a danger to other drivers, or at what point will I likely require some kind of help with getting dressed, eating, or showering? In my head, these are the true patient-centered questions that should be answered before I can obtain the “knowledge of the possible consequences” or Informed Consent of having a third neck surgery.
Surgery is an Opportunity – Why is surgery only used to add drama on a TV show?
About a year after healing from my left knee scope, my right knee decided it wanted some surgical attention. While waiting in the examination room to discuss my right knee with my surgeon, the patient in the room next to me became hysterical because the doctor proposed scoping one of their knees as an option to help with their pain. When I say hysterical, I mean there was yelling, crying, and utter disbelief that they needed surgery. They were so loud I could hear every word they said despite being in another room. Their hysteria lasted for more than an hour; mind you, they were in a surgeon’s office asking for help from a surgeon! The good news for me was the surgeon and his staff kept offering me drinks and snacks from their breakroom because of the delay.
I’ve thought about this experience often because their response caused me so much confusion. As a culture and society, we are taught that surgery is something to be feared, avoided, a tool of last resort. We have demonized surgery to the point where a grown adult was so scared of a simple arthroscopic scope they became hysterical to the point of needing constant attention. If they were truly in that much pain that seeing a surgeon made sense, a simple arthroscopic scope surgery should be something to be grateful for. It is a chance for pain relief, a chance to quit limping, and most importantly, a chance for a higher quality of life.
By contrast, my appointment that day consisted of me explaining my pain, the doctor asking me to walk from one side of the room to another, then asking if I wanted to have my right knee scoped the following Thursday. I responded with an enthusiastic yes because I only had one class that Friday, which meant I wouldn’t have to miss that much school. This was my opportunity to reduce pain so I could get back to road biking, mountain biking, and studying for my second degree in accounting. It wasn’t something to be feared; this was the very definition of an opportunity. Everyone should think of surgery as an opportunity; if they do, I’m guessing they would be surprised at the results that could be obtained.
Surgical Recovery – No, you do not need Dilaudid for both before and after surgery.
Last fall—well, I think it was last fall and not last night—I was scrolling on Twitter (I refuse to call it X or whatever nonsense Musk is trying now) and came across a post from a patient concerning a possible neck surgery. Naturally, I was curious because of my own experience with neck surgery. I’m now going to break the unwritten patient code of conduct: never criticize a fellow patient.
This patient was upset that their surgeon would not prescribe Dilaudid for both before and after their surgery. They were so mad and in shock that canceling their surgery was the “right” option in their patient opinion. According to the post, this was just another example of doctors not caring if patients live or die. That it was pure evil to not prescribe Dilaudid. I’m not sure which surprised me more, her post or the 15 some responses that agreed with their Dilaudid assessment. This is just crap. Crap on many levels.
If you are not familiar, Dilaudid is two to eight times more potent than morphine. It is designed for short-term pain relief and is used after other pain relief options have not worked for a patient. If you can post on Twitter while engaging multiple other users, I feel comfortable stating that you do NOT need Dilaudid. Based on my surgical history, even if you develop side effects after surgery, you still do NOT need Dilaudid. Dilaudid is for soldiers who have been shot multiple times, car wreck victims who almost had an arm or leg severed off, or even someone who has fallen off a cliff while rock climbing and has a compound fracture that morphine hasn’t helped reduce the pain (I would have to check my medical records, but I think there is a chance I received Dilaudid the night I fell). It is not designed for a patient who ruptured their C6/C7 disk and needs four screws and a plate to correct (I speak from my experience from rupturing my C6/C7 disk—the pain is unbelievable, but not to the point where I couldn’t post on Twitter if I choose too).
Since I stayed at a Holiday Inn last night (should I give up on writing humor?), I’m going to offer an alternative theory for that Twitter post. Worst case: the author of that post was a drug addict who was trying to use their condition to get a fix. More than likely, I’m willing to bet they are a product of a culture that has demonized surgery to the point that they were unnecessarily terrified of having neck surgery. They didn’t need Dilaudid for pain; they wanted Dilaudid for a security blanket to counter the fear associated with needing surgery of this type. I say unnecessarily terrified because the surgery to replace a ruptured disk is something like 60 years old, and many, if not most, surgeons would perform it as an outpatient procedure. It’s health insurance companies that say that because it deals with our spine, the patient should stay the night in the hospital just as a precaution. I know—a health insurance policy that makes logical sense. Who knew, right?!
Surgery is designed to end a patient’s need for powerful pain relief drugs like Dilaudid. A surgeon’s goal is to make it so we can live our lives with an occasional Tylenol or Advil, not increase our reliance on powerful opioids. Yes, surgeons can be unbelievably arrogant, which can make for a bad first impression. However, we tend to forget that a surgeon’s goal is to ensure they never see us again, whereas a primary care doctor or rheumatologist’s goal is to create a working relationship with us patients because management of our lives is a major part of the care they provide.
Now this most definitely falls under the category of a humble brag: I went skiing roughly six weeks after my total hip replacement surgery. Although my surgeon and the patient advocacy world would most likely give me all the credit for skiing that soon after my surgery, I could not have gone skiing without his skill and dedication to the care in health care. In my head, it’s understandable for a surgeon to be arrogant if their patient can ski six weeks after a total joint replacement surgery.
Conclusion – It is about damn time!
I opened this adventure into surgery with the phrase “surgery is fun” for a reason and not just to grab your attention. For me, the second after my surgeon removes the stitches is comparable to the joy of going hiking, skiing on a bluebird day, learning a new skill or hobby like photography, or even reading a good book. It’s a time for exploration, for adventure, for learning what I’m truly capable of now that I have a joint that works correctly instead of a pain that affects my life negatively on a daily basis. To put it another way, it’s an opportunity (are you annoyed with my use of this word yet? ) to explore options for a higher quality of life.
It is important to remember and accept that opportunity is not a positive or negative noun; it’s a collection of both. Being a chronic patient is exhausting. Often, the road to surgery can take several years, which is a long time to battle with pain and adds to the exhaustion. This exhaustion can make surgery and recovery seem like summiting Everest, which is the last thing one wants to do when exhausted. However, all this means is your path to a higher quality of life might be skiing 12 weeks after surgery instead of six like I did. Exhaustion is a human-caused problem, which is great news for you as a patient because it means that there is a human-centered solution. Speaking from experience, searching for that human-centered solution can be fun too.
Obi-Wan Kenobi once said, “many of the truths we cling to depend greatly on our own point of view.” The good news is we can change our own point of view with education, active listening, and a willingness to keep an open mind. Yes, surgery does involve putting a great amount of trust into a stranger with a white coat. Not an easy task, which does involve operating in a state of vulnerability rarely needed in any other aspect of life. This is why emphasizing the goal of surgery is so important. It is one of the only tools in health care that is designed to be an opportunity to graduate from health care to achieve a higher quality of life. It is an opportunity to end the need for Dilaudid, to end the pain of the bad joint, or to fix a part of us that is broken and needs fixing. Most importantly, from what I understand chicks dig scars!
P.S. If you like this post, please check out my last post: From Snakes to the ER
My Hip Era