Didn't See That One Coming

When your dementia-addled hospital roommate shits on the floor because he'd rather not shit the bed, and then forgets to signal the nurse call light because of said dementia, well, that's an odor that lingers. I suppose I can't blame the guy, such are acts of self-preservation when faced with limited options. All day since I've been experiencing phantom whiffs of the experience; an unpleasant reminder of my two-and-half days at University of Michigan Hospital following my third pressure sore debridement surgery. I had already made up my mind that I was ready to go home the night before and was informed I was to be discharged earlier in the morning, but crazy-old-guy-losing-bowel-control is a moment that really drives home the desire to get the F out of Dodge. I'd also like to have this whole on-going ordeal come to a conclusion before...why even speculate?

The truly sad thing about the old guy is that in his brief moments of clarity he had been trying to convince various hospital staff members (and more likely himself) that he was ready to go home on his own instead of into a home for "rehab"--as his discharge planner so delicately put it. From my point of observation it was easy to see that none of these people believed going home was an option the old coot would get to explore. Shitting on the floor was more than enough nails to seal that coffin.

Today's lesson: Stay fit people and keep the mind sharp.

WTF? You're Still Here?: Familiarity Breeds Contempt

There was a time when things pressure sore were a lot easier to lampoon, but that ship is loaded for bear and untied from its moorings. The wind is blowing like stink and she's about to set sail. We had our fun I guess: this handy visual aide comes to mind. But that was back in the halcyon, autumnal days of aught-seven, when this sore was just a ragged, odorous, weeping, infected mess. I took the professional advice and followed the proper course of action. A corrective procedure here; a ten week course of antibiotics there; the New Year held promise of good tidings, but 'twas not to be. "We're very, very close. I can feel it." Give it a second go-round and we'll nip this thing in the bud. What's six more weeks, anyway? That was January. Yeah...Not so much. It's like this: They really should have stopped after Police Academy 2. Let's see: Mahoney is the comedian, Hightower is tall and strong, Tackleberry loves guns and Jones tricks people with sound effects. Oh, and Callahan has huge Js, but you never really get to see them. We get it! Guttenberg even called it quits after Four and yet they still kept plugging along. But what other ideas are there? And so back into the breech... So, No, Cube, even though I did not have to use my AK, today was most definitely not a good day.

Doctor's Day 2008. Who Knew?

So yeah, I guess tomorrow, March 30th, according to the University of Michigan Health System, is National Doctor's Day. And I guess the University of Michigan Department of Internal Medicine felt I should be aware of this because, well I don't know, maybe because I tend to spend a lot of time hanging out at the hospital. When I opened the promotional materials sent to me making me aware of Doctor's Day, I immediately asked myself, "How can I best join in recognizing the splendid efforts of the fine physicians at U-M on Doctor's Day?" The answer is simple. I can "Make a Difference Through a Unique Tribute" of a tax-deductible donation, as recommended in the enclosed fundraising form. The Department of Internal Medicine has conveniently chosen a few monetary levels at which I can express my gratitude: $50, $100, $500 or "Other."

Now, in the last few years, I have learned a few things about hospitals, insurance coverage, medical billing and the like, so I know that even though patient medical bills seem to be exorbitant hospitals still need to budget their resources and a little extra cash in the coffers always helps. But, milking me in the name of doctor appreciation, well, that strikes me as a bit disingenuous.

I am made aware that I can make my donation in the name of my favorite U-M Internal Medicine specialist. Oh, how nice, but I have so many more questions. Is my chosen doctor going to get a cut? Is there a tote board in the break room keeping a running total raised by each doctor? "Jim, your patients are really sending in the scratch. Keep up the good work." How will I choose which Internal Medicine doctor to recognize? The last time I was at the hospital for a stay, I saw eight different Internal Medicine doctors, and that's not counting the two Plastic Surgery residents or medical students who came in my room to poke around. For reals, Yo. Eight. Plus, I would like to think that my favorite Internal Medicine doctor is already aware of my satisfaction with their care. A showy, unnecessary display of gratitude on my part would just embarrass them; s/he isn't big on P.D.A. (I'm playing the pronoun game so as not to hurt the feelings of the other seven). And cash donations are so cold and impersonal. It's like giving a gift card at Christmas: "I like you, but not to the extent to know you well enough to buy you anything specific." How about if we all just sign one of those oversized Thank You cards? No?

So here's my thing: If I do send some greenbacks your way U-M, can you guys get cracking on figuring out a more effective method of encouraging tissue growth around my wounded ass bone? I'm not complaining and I'm definitely not a doctor, but it just seems the traditional method of lie-around-and-wait-and-see is really time-intensive. I'm just asking because I had a couple things I wanted to do this...7 months ago.

The Michigan Difference

The last few years, the university has touted "The Michigan Difference" as their main message in all of their advertising and so all of the publicity media have the same general look. The Health System advertising is the most prominent: atmospheric, instrumental version of the Michigan fight song playing in the background, shots of diverse doctors and nurses at work, a montage of patients with horrific scars overcoming adversity, someone doing science, someone writing something important on glass, a voice-over extolling how awesome it all is, ends with "The Michigan Difference." The Doctor's Day materials are no different and are of the highest quality. It's a presentation that subtly says, "We're not cutting corners on this, and you're going to give us a lot of money." Their print shop uses great card stock, it even smells professional. I read the spiel about Doctor's Day 2008 and looking back over the front of the donation form--an assemblage of images of U-M doctors in varied types of work--something caught my eye. The doctor in the middle of the frame is holding a Foley catheter. And. He. Looks. Mesmerized.

Um, Why?

"Hey Bob, we're putting together the promo for Doctor's Day 2008 and were wondering if you'd like to be in the photo collage on the front of the fundraising form?"

"What's Doctor's Day? Never heard of it."

"Just this thing the hospital is doing to raise money."

"Yeah?"

"Yeah."

"And why me?"

"Oh, we heard you're doing some really some cool stuff with your research and the Department wants to showcase you."

"Wow. That's really nice. What do you need me to do?"

"Just hold this out in front of you like so...and sort of look towards it and not at the camera."

"This?"

"Yep."

"...But this is a catheter."

"Yeah, I know. Try to look at it with interest--"

"My research is in nanotechnology and--"

"I know and we're real proud of what you're doing...Now really focus your gaze."

"But this is a catheter."

"Yes, but nanotechnology is hard to photograph and get you in the picture."

"What if I look up from a microscope or something?"

"We already did that."

"We did?"

"Just hold it up a little higher, but don't look so much at me."

"Can I hold something like a--"

"Like what, Bob?"

"How 'bout an artificial heart?"

"That's been done too."

"By who?"

"Uh, that kind of goofy looking guy."

"Ted?"

"Yeah, him. And he's Surgery anyway, and this is for Internal Medicine--"

"Well, I'm not a Urologist!"

"Well I know that, but come on. This fits our theme."

"How does this fit our theme?"

"I don't know, 'Our doctor's are passionate about medcine, even the mundane things'."

"When's the last time anyone saw a doctor place a catheter?!"

"I don't know--"

"Can't you just take my picture?"

"You have to be doing something."

"Seriously?"

"Look, I still need to get a shot of Johnson and some old lady before lunch."

"But this is a catheter!"

"Dude. Do you want to be in the picture or not?"

"...I guess."

"Good. Now try to look really interested in the cathe--...You're still looking into the camera, Bob."

Do Not Taunt Happy Serratia marcescens*

Does this bacterial culture look like trouble?

How about now?**

If a person is already mainlining copious amounts of antibiotic medication and they happen to get the former in to their bloodstream, it will start posturing like the latter. At least that is what happened to me a few weeks ago. With an immune system already suppressed by several weeks of antibiotic treatment, the body doesn't take well antibiotic-resistant micro-organisms. My new friend Serratia marcescens fit that bill. My body's reaction was a persistent two-day fever that peaked at 102.7 degrees Fahrenheit. That was enough for mom to shuttle me off to the Emergency Room and another three-day stay at the hospital. The length of the stay was determined by the length of time it took to culture and identify the bacteria that grew out of several samples of my blood. The hot zone in this instance turned out to be the PICC line in my left arm that was placed to dose the IV antibiotics that were supposed to get me healthy after my most recent surgery. Somewhere in the two and a half weeks after the surgery, the bacteria got into the line and reared its ugly head. Treatment of the fever consisted of knocking back the occasional Tylenol, and alternating between a cold washcloth on the forehead and shivering through fever chills; treating the infection consisted of ten-days worth of a couple different oral antibiotics to kill off Mr. Graham-negative stain, as S. marcescens is sometimes known.

For me, going to the hospital is becoming such old hat that I'm starting to not care what the diagnoses are anymore, and mostly just focused on when they will let me go home. It becomes a dance of how can I answer these doctors' questions so that I'm properly diagnosed, but yet don't set off too many alarm bells that will keep me here more than a day? It's the same type of attitude that keeps me from seeking medical attention in the first place and that will probably be my ultimate downfall:
“Tell me sir, how did you get your legs cut off?”
“Uh, I think I was hit by a train.”
“And when exactly did this happen?”
“I think it was Tuesday?...Monday or Tuesday.”
“Tuesday! You realize today is Friday?!”
“Um yeah. Well, you know, 'Lost' was on last night and it was a new episode and I wanted to see it on a big TV.”
“You've lost an insane amount of blood.”
“Well, I can't really feel it, so I figured...”

In summation, a week after I left the hospital I saw my infectious disease doctor and he decided to have me finish out the course of medication I was on when I left the hospital and then to stay off of any further antibiotics. The good news was the bone biopsy that was done in January didn't reveal any further bone infection and the wound site of my pressure sore seems to be healing up properly this time around.

*I was all set to recount this episode but then the day after I left the hospital I found out Deep Purple was playing a command performance at the Kremlin and then things got a little crazy around here.

**The amount of time I spent in MS Paint trying to get this image to look just right probably far outweighs the amusement value of the intended sight gag.

The Real Reason This Little Piggy Went, "Wee, Wee, Wee!"

I've covered this territory before (see My Left Toe), but this time I decided to make it a multimedia experience.

In the interim between my first visit to the podiatrist and my most recent sojourn, about a year after the first visit my right big toenail needed some attention. Similar to what happened to the toenail on my left foot, somewhere along the way I split the skin away from the outside of the nail. During the second visit the right side of the nail also needed some attention. When I went to get the toe looked at, the podiatrist did his usual straddling-the-thin-line-between-medicine-and-torture-routine and removed significant chunks of both sides of the toenail.

As the toenail grew back in, the outiside of the nail came back ingrown and about 15 degrees to the right off verticle. All of this took place over the course of about a year, as toenails grow at a rate on par with continental drift. At one point, I ended up snagging the outside edge of the nail on the thin side of the footrest on my shower chair and separated a portion of the nail from the nailbed underneath. Of course, I can't feel any of this so it was quickly out-of-sight, out-of-mind. On occassion, the side of the nail would bleed a little bit and then scab over but it wasn't showing any signs of swelling or infection and I continued to let it go. One time I even considered doing a little home podiatry, but realized I didn't have the right tools or dexterity to pull off the task.

While I was hospitalized after my most recent surgery, one of the nurses made a comment that I should get the toenail checked out. So while I'm currently laid up, I finally decided to get the nail taken care of - kill two birds with one stone. This time I got a little video footage of the experience. Unfortunately, I wasn't quick enough on the draw to capture the very beginning of the procedure.

I'm debating whether or not to upload this on YouTube. I'm sure the creepy, foot-fetish video enthusiasts would love it though...Not that there's anything wrong with that.

Been There, Done That

I'm heading back into University of Michigan Hospital tomorrow (Wednesday 1/16) for another surgery in an attempt to get the pressure sore I've been dealing with these last five months to heal properly. Those who've been following along are already aware that the procedure I'm undergoing tomorrow will be a repeat of the one I had back in October. Although highly less than ideal, as I was anticipating as recently as December that at this point in time the wound would be ready to be closed. Upon closer examination, my surgeon determined that the underlying bone might still contain some residual myelitis infection. Thus, he will be opening the sore back up and performing another bone biopsy. This procedure and the subsequent healing period will be a setback of at least another six weeks of convalescence. Thanks to everyone who has and continue to send words of encouragement.

Lather, Rinse, and...Repeat.

SONOFABITCH!
That was the sound my brain made. My brain made that sound because Dr. Rees, the plastic surgeon overseeing the continuing care of my pressure sore had just ended a sentence with the phrase, “debride it again.” This was in direct contradiction to what his physician assistant. Mr. De-Hong, had concluded not three minutes earlier before stepping out of the exam room. The exam room that I was in, side-lying on an exam table with my left ass check exposed. Three minutes prior, my brain wasn't making all sorts of ruckus trashing the joint because, at that point in time, Mr. De-Hong had finished telling me what I wanted to hear. That conversation went pretty much as follows:

De-Hong: Hello Dan, how are you?

Me: Pretty good.
De-Hong: Has your pressure sore gotten any better?
Me: I think so. It's definitely gotten a lot smaller in the last month.
De-Hong: Let me take a look. [Exams the sore] Yes, this is much better. I think we can can schedule the flap surgery, now. Let me consult wish Dr. Rees.

Dr. Rees entered the room and examined the state of the wound. His concern was that, although the wound has filled in quite well and has stayed clean, by poking around in it with his finger, he was able to determine that there isn't yet sufficient tissue growth over the bone that was exposed by surgery to debride the sore back in October. In addition, he could feel that there was still some residual infection in that bone. My mother asked how he could determine that about the bone simply by touch; did it feel “squishy?” He responded that, “Yes. I guess that is a good word for it.”

We asked several more questions about the time table from this point forward. I confirmed what I thought I was hearing, that they would be opening the wound back up, cleaning out the remaining damaged bone and starting me back on another six week course of IV antibiotics. At which point in time, then they would be able to go ahead with the flap surgery to close the wound completely. That all sounded to me like the past two months and ten days of lying around doing Jack had gotten me all of right back to where I already had been. I stated how frustrated that I've been dealing with this since August and now this seems like a step in the wrong direction. Dr. Rees countered with something about how if they attempted to close the wound now there was a fifty percent chance it would break down into a sore again and then we'd be starting all over from square one. Despite the fact that he went on to talk about how debriding the wound now would allow them to close it in six weeks, I had already heard all I needed to know. Plus, it was hard to concentrate on Dr. Rees with the din, blue streak of obscenities my brain continued spewing. At the end of his remarks, I was able to focus long enough to hear Dr. Rees conclude his remarks about pressure sores with, “You have no idea.” As in, “You have how bad these sores can get,” and, “You have no idea how long they can take to heal.”

Well, far be it for me to dispute his medical expertise, but I'm pretty confident at this point that I have an idea. In fact, I think I have an excellent idea. Sure, he sees these things every day and therefor has an excellent gage on what constitutes the varying levels of just how severe these sores can be. And yes, my sore pales in comparison to people that lose toes and legs because of severe complications. But when he starts throwing around numbers like “six weeks” as if they're just some drop in the calendar bucket, then I know he can't really comprehend what this is like. I should have asked him, “Do you have any idea how many times Scrubs is televised during the day?* No? I didn't think so. You have no idea because you spend your day doing cool things like seeing patients, performing stomach staples, and generally getting to leave the house. I know the answer because despite reading books, watching movies, surfing the Internet, and doing my best to avoid watching mind-numbing TV, I'm still lying on the couch for upwards of ten hours a day with Shit to do and have been doing so since August. When you casually talk about prescribing another six week course of antibiotics, you may have read about the potential side effects, but do you know that Vancomycin dries my eyeballs out so that my contacts are always blurry and then they wrinkle up and painfully get stuck in the corners of my eyes? No? Of course not.”

But there's really no point in asking those questions because there isn't any better course of action. So, on January 16th –and it's the 16th because that's the next open surgery slot—I will go in to have the same surgery performed that I already had done back in October. I'll get discharged on the 17th, and then it will be the beginning of the next week until the orders come through to start the IV antibiotics. Six weeks from then will be the first week of March. Will I immediately be scheduled for my flap surgery? I doubt it, so I'm going to estimate that happens in the middle of that month. I already know the rehab protocol coming out of that surgery is at least two solid weeks of bed rest before even limited sitting is allowed. Now it's April, barring no setbacks.

'Tis the season.

*On an average weekday, Scrubs is on 8 times, on 3 different networks. In my opinion it really went downhill after about Season 4, just about the time Zach Braff's head got fat. They've been phoning it in for about two years now.

Beauty Isn't Necesarily Subcutaneous

Back in October I posted a photo of an image of the Virgin Mary that miraculously appeared in an unlikely location on my person. Then I remembered I'm not Catholic and don't believe in such things. For a few days I surmised that, although highly unlikely, someone had secretly been after me with a hatchet and if it was indeed a hatchet wound I should seek medical attention. When I went to the doctor's office it was explained to me that this abscess was in fact a horrific pressure sore. I guess the visage of mother Mary was just an optcal illusion caused by the camera flash.

Fast forward three months: monotonous hours of side-lying in front of the TV, debridment surgery, eight weeks of IV antibiotics, and now wunder-ointments. The result is evident here.

Progress.

Update: For all the heretics, if you squint it's there.

If Regranex Was A Drug, I'd Sell It By The Gram

I recently started a new phase of treatment for my pressure sore. As the IV antibiotics I've been infusing to fight my osteomyelitis infection now seems to be doing the trick, my doctor prescribed for me to have a medication called Regranex applied to the wound once a day. Regranex is a special gel used in the treatment of pressure sores. The active ingredient is a growth hormone designed to encourage macrophage production and enhance tissue growth (although I'm still not hitting the long ball as I would like). Essentially, it mimics the body's own ability to promote wound healing. 

This treatment is necessary because after my initial surgery to clean out the sore and have a bone biopsy performed, the cavity of the sore was left wide open. Simply closing the wound up at that point in time would have been counterproductive because, not only did the infection remain in the ischial bone beneath the wound, but without any tissue covering the exposed bone, closing the wound over would have left me with a potential sink hole of sorts in that same spot. The skin in that area even more susceptible to breakdown than before the sore occurred in the first place. In order for the wound to finally heal properly it must fill in from the inside out. The Regranex is supposed to aid in the tissue growth to complete that process.

What makes the Regranex an interesting medication, in the context of the various aspects of my medical care, is its cost. Each tube of Regranex is measured out at 15 grams. Pharmacies will not stock Regranex, even though it is dosed in such small quantities, because that 15 gm tube is sold at an average price of over $520 according to some Internet sleuthing I performed. Suddenly, the insurance change that increased my co-pays from $5 to $10 doesn't seem like such a big deal. Per dose that checks in at a sum of approximately $38 per gram. I thought that sounded kind of expensive, but just how expensive? What else costs about $38 a gram?

Well, gold is highly valuable in some circles. On a recent day gold was trading for $801 per ounce and one once is equal to 28.3 grams. Do a little arithmetic and we find that gold trades for just over $28 a gram—score a point for Regranex. Oil is getting a lot of press these days; something about it being a limited resource by which the Western world fuels itself. When I last checked oil traded at about $94 a barrel. Now oil isn't actually sold in barrels, but as a unit of measure the size of a barrel of crude oil is 42 U.S. gallons. If that barrel was full of water it would weigh almost 350 pounds. Sixteen ounces to a pound, 28 grams to an ounce; a tube of Regranex approximately the size of a barrel of oil would sell for over $5.9 million, although I suspect in such a quantity Walgreen's might cut me a bulk rate deal.

What about illicit drugs? I've heard illegal drugs are quite expensive. According to Wikipedia cocaine can be bought for between $30-$120 a gram. The farther down the chain you are, apparently the more expensive cocaine becomes. I guess when it comes to blow, it's all about who you know (caveat emptor: find out how many times your coke has been cut, but be subtle about it). Drugs are bad, m'kay, but let me just mention that I found myself a little disappointed by the fact I had to refer to Wikipedia to find out my cocaine information. It's like having to look up how to launder money in the dictionary—not the best way to confirm one's street credibility. I don't know how this happened either. I'm not saying I have any inclination to know or associate with cocaine users or dealers, but I went to college, I know people who lived in fraternity houses, I have even used the bathroom in a Miami nightclub; the price of an eight ball is just experiential knowledge I feel I should have gained somewhere along the way. I saw Traffic—this never would have happened had I grown up in West Bloomfield. 

I have three refills on this prescription too, if there was a better market for its healing powers I should be able trade my three tubes of Regranex for something cool or useful, like an RPG, but I digress. I'm sure there are other, more relevant products I could use to provide a better cost analysis comparison to belabor this point, but I got lazy. I present this information to simply illustrate the fact that Regranex is expensive.

Oh, and to the FBI agents monitoring my recent web searches: I'm not really looking to buy cocaine or a RPG. Just wanted to clear that up. Thanks.

Word to your mother.

No Payment Due...That's Nice.

The bill for my hospital stay came in the mail sometime last week. I've been through this enough times that I'm no longer surprised at how much medical procedures cost, but I do still find it interesting at how much my insurance is charged for various aspects of my care. Case in point, here is page two of the bill for my pressure sore surgery:

(click to enlarge)

I kind of got a kick out of the fact that there are two different rates for the time spent in surgery. The first 30 minutes are apparently billed at a set amount of $1396, and then each subsequent minute is billed in addition to that. I now know that I was in the operating room for a total of 98 minutes. The additional 68 minutes clocked in at $2108, which by my calculations breaks down to $31 per minute. That initial half-hour, on a per minute basis, comes in at $45 and some change. Damn, I didn't know I was getting a discount.

Well hey, as long as this thing is on sale is there anything else you guys can patch up? I took a broomball stick across the bridge of my nose my freshman year and my nose just hasn't been the same since. It's not that noticeable, I know, but there's a bump there on the right side...No, no my right...that wasn't there before. Can you clean that up? I mean, this is plastic surgery. Right?

The moral of the story is, if you only have half an hour on your schedule to squeeze that next operation in, it's going to cost you more to come back and have them finish up later. Might as well bite the bullet and be late to that next appointment.

If I Could Feel It, It'd Be A Pain In The Ass

At 7:30am tomorrow (Wednesday), or today depending on when you read this, I'm having surgery at UM Hospital on this pressure sore I've been dealing with for the past 6 weeks. The procedure I'm undergoing is to have an infected portion of the ischial tuberosity (consult diagram or local medical student) removed and the tissue around it cleaned up. The bone needs to be removed so the infection doesn't spread through the pelvis. Unfortunately, this surgery won't actually close up the wound, but in fact make it bigger. The wound needs to heal from the inside out, so I'm expecting about six weeks of post-opt antibiotic treatments, continued daily cleaning, packing and dressing of the sore --all while spending as much time off of my ass as possible. Then depending on the state of the wound, a possible second surgery to finally close up the wound. At that point, I will require 24-hour bed rest until the site "gets all better."

I should be at the hospital until Thursday, maybe Friday.

Good bye Fall. Hello Christmas.

Don't click here.

X Marks the Spot

There's an old saying that states, "Opinions are like assholes; everyone has one." I'm in the minority of people that have two. Assholes, not opinions. Well, one asshole, one hole in my ass...I guess it's more of a crater than a hole.

The medical term for the sore is ischial pressure ulcer, grade IV. What makes people in wheelchairs particularly susceptible to getting pressure sores is the fact that paralysis prevents most people from sensing when an injury to the skin occurs. The poor blood circulation in the area caused by continuously being seated accelerates the speed of the tissue breaking down, hinders new tissue growth, and adds to why these types of sores are so difficult to get healed up. The location of my sore has also been extremely problematic in contributing to it's breakdown as well as it's protracted recovery time. The red X on the attractive Moroccan girl in this picture, me captured rudely ogling her cake, is an approximation of where my sore is located, if she were me.







(Click for a better view)

It started as an irritated patch of skin then through a combination insufficient cushioning and the neglect of out-of-sight,-out-of-mind the skin broke down and a sore opened up. For about a week it was a superficial skin abrasion. At the end of two weeks it was about the size of a quarter and I scheduled a doctor appointment. The doctor discovered that some of the tissue inside the sore had started to die and after cleaning it out and giving me instructions on how to dress it, encouraged me to stay off of it as much as possible - not the easiest set of medical advice to follow in my situation. My bad, it turns out, and when I saw the doctor again ten days later, the sore had deteriorated significantly, was now a centimeter deep in one spot and there was more necrotic tissue. A third visit, the next week, showed more deterioration of tissue and the depth of the sore had increased as well. The hope in treating it was to keep it from getting to the point where surgery was necessary to help it heal properly.

Well, to make a long story short, the month of days spent mostly lying on my side so as to not put unnecessary pressure on the sore, multiple wound dressing changes, way too much TV, and no social life helped to decreased the circumference of the sore, but a MRI scan revealed osteomyelitis in the ischial bone underlying the sore. In layman's terms, a bad infection in the bone that, while localized for the time being, if it were to spread further would be real bad. So, in a week and a half I'm scheduled for surgery to remove the infection. That will be followed up by more lying around doing nothing as the sore attempts to heal properly. I'm looking at mid-November by the time I'm back to full steam.

Wheelchairgate: An Update

Today is August 15th, 2007 and today authorization was finally given for the repairs to be made to my long-defunct wheelchair wheel. Henceforth, my wheel is officially now in the process of being fixed. It only took nine weeks to get to this point. Why does it take nine weeks to get a piece of paper faxed to a doctor, signed by the doctor, and faxed back to where it originated? As an outsider to the process, I can only make inferences based on observation and information collected post-fact, but my conclusion is that it takes a delicate combination of ineptitude, negligence, irrational bureaucratic protocol, and a lack of accountability on the part of those involved. Here’s a recap:

On June 12th, I took my malfunctioning wheel to Michigan Wheelchair Seating for repairs. Unable to repair the wheel in-house, I was informed by the repair technician that the wheel needed to be sent back to the manufacturer for repairs. The wheel would be sent out the next day and I should have it back within three weeks. I was loaned a power wheelchair for the time being. The information given to me by the technician seemed plausible and operating under the assumption that it was true I did nothing more about my wheel and went about my business for the next two weeks. Yes, it is true that the repairs would be done by the wheel manufacturer, but the timetable given to me by the technician was completely erroneous. In addition he left out a major detail that no work on the wheel would be started until the necessity of the repairs was confirmed by my doctor and authorization of payment for the repairs was confirmed by my insurance.

June 25th I called Wheelchair Seating to find out if there was any information on when I would get my wheel back. The receptionist seemed confused about what I was asking and wanted to know who I spoke to about my wheel repair. I gave her the name of the technician who took my wheel in for repairs and asked to have him call me back. He never did.

On July 2nd I placed another call to Wheelchair Seating again inquiring about the repair of my wheel and this time spent the majority of a fifteen minute phone call on hold as the receptionist looked up my file. I was told that the paperwork was being processed and that my information was in the system. Still operating under the assumption that the manufacturer was in possession of my wheel and performing repairs again I asked when I would be getting the wheel back. I was told by the receptionist that she didn’t know when it would be finished. I asked if she could have someone call the manufacturer and find out when they would be returning the wheel. This also did not happen.

After the Fourth of July holiday week in which I knew nothing would be done on my wheel, I called Wheelchair Seating again on July 10th. At this point in time it was approaching a month since I had dropped off my wheel for repairs and now I was expecting to have my wheel returned to me. This time I was passed on to another person’s voice mail account to which I left a message explaining what had happened up until that point and that I was expecting to hear when I would be getting my wheel back. The person never returned my call.

I called back again the following week and was shuffled to the same voice mail account as during my previous call. Again, I explained the situation (as I knew it to be true) and asked for an update on the progress of my wheel repair. For a second time the person responsible for that voice mail account did not return my call.

The week of July 24th I placed yet another call to Wheelchair Seating, but instead of being shuttled off to another anonymous voice mail account I asked to speak to a personal contact I had there from my time in Michigan’s out-patient physical therapy program. My former physical therapist had taken a position at Wheelchair Seating performing wheelchair fitting evaluations and although she was not responsible for any of the repairs being done to my wheel, I called her to see if she could find out what was happening. Par for the course, I did not speak with her directly, but instead had to leave her a voice mail explaining that the three-week timeframe I was given had stretched to six and I was still in the dark about the status of my wheel repair. Two hours later I checked the messages on my phone and I had a message from the person at Wheelchair Seating responsible for confirming the authorizations for all repairs. The information she had for me was not good.

When I called the authorizations person back that afternoon, fuming over the impending news that nothing had happened with my wheel repair yet—which it had not—it was explained to me that she was still waiting for my doctor to sign the referral confirming the necessity of the repairs and equipment I needed. Wondering why they would need my doctor to sign off the work order, I told her this was a repair and not a new equipment order. She explained that the repairs I needed were not covered under warranty and that anytime insurance needs to be billed the doctor must sign off on the repairs. Why wasn’t I notified of this and when did the doctor get the referral that needed to be signed? After a long pause and much paper shuffling she informed me the referral was faxed to the doctor’s office on June 19th. There really wasn’t a date she could give me that would justify any of this delay, but when she came back with the 19th I immediately realized this was a full week after I had brought the wheel to Wheelchair Seating. A week’s delay in getting the necessary paperwork together is ridiculous; especially in conjunction with the new information I was just given concerning their protocol of needing a doctor’s referral to bill my insurance. In my mind it seems once the problem is diagnosed, sending the referral to the doctor should be the first thing that gets done and there is no reason it should be done any more than a day later. In fact, the buildings that house Wheelchair Seating and my doctor’s office are literally within a mile of one another. I could physically walk the referral request to the doctor’s office from Wheelchair Seating in less time and it takes two people to help me walk.

So there was one week’s delay accounted for, but what the hell was going on in the intervening five weeks? The authorizations person at Wheelchair Seating couldn’t answer that question, but she was pretty sure my doctor was on vacation for part of that time. I told her someone over there should have called his office to find out what the hold up was and someone should have called me to let me know they were waiting on my doctor to sign the referral. None of this happened. For five weeks my wheel sat in their shop and collected dust. The technician who took it from me probably walked by it every day and not once did he think to himself, Man, that sure has been sitting here a long time. I wonder if I should find out what is holding up this repair? Or, if he did have those thoughts he didn’t get very far in acting on those notions. Not one single person at Wheelchair Seating took any initiative to find out what was going on with the referral, nor did they take any initiative in contacting me to fill me in on what was going on, or more appropriately, not going on. Had I not called and gotten someone completely uninvolved with this repair order poking around in my favor, I would probably still be none-the-wiser. She apologized for the communications breakdown and asked that I call my doctor’s office and see if I could get them moving faster. Her rationale was sound in asking me to do that, but it was also a bullshit way—whether intentional or not—of absolving herself of some of the responsibility for resolving this fiasco. But I made the call, because I also knew it was going to be up to me to get everyone involved on the same page from now on. Before I concluded that call, she asked me that once I talked to my doctor to call her back in a week to see where everything was at. Right, a week; because what’s one more week when six have already been wasted? I wanted to punch her.

When I called my doctor’s office and finally got a hold of his administrative assistant, I was informed that yes, it was true he was indeed on vacation and wouldn’t be back in the office until August 9th, which was the following week. When I asked whether or not the referral script had come through like I had been told it had, after much paper shuffling I was told that they did actually have the script. Why my doctor did not sign the referral before he left on vacation—you know, tie up loose ends like everyone else in the world does before going on vacation (he had ample time: at least three weeks by my calculations)—remains a complete mystery. I have my suspicions and those start with his assistant and her organization skills, but no way to prove them. I asked if anyone else, one of the other doctors, maybe his Physician’s Assistant, would sign off on the referral. It was not for a new equipment order, just a repair; it seemed logical to me that whoever was covering for my doctor would do that, especially considering the circumstances. The administrative assistant told me she would ask the Physician’s Assistant and get back to me that afternoon. She didn’t. I called the next morning to see if my request had been considered, she said she would ask the Physician’s Assistant, if I could hold. I waited on hold and after a few minutes she came back on the line and explained that, for whatever reason, the Physician’s Assistant didn’t feel comfortable doing that. So, I was again told the doctor would get to it when he got back in the office on Thursday the 9th. Fine, I said and hung up. In my mind it was, Fine. Fuck you guys, this whole thing is preposterous!

In the interim of all this wheelchair fiasco, I have developed a pressure sore on the back of my thigh. Pressure sores aren’t good and I’m pretty sure it came about from one of the activities I do at physical therapy. I’d like to be able to attribute it to not having my wheelchair in working order, just so as I can focus all my problems and blame around one central issue and group of people. Realistically, the sore and the wheelchair are unrelated, but coincidentally the state of the sore put me in my doctor’s office the day after he was supposed to have been back from vacation. My morning appointment time put me in the examination room with the Physician’s Assistant and not my doctor and led to this conversation:
“How are you Dan? It’s been a while since I’ve seen you.”
“Well, the reason I’m here is because of this sore, but I’m also still waiting on the doctor to sign the referral for my wheelchair repair.”
“Oh, that’s right. Yeah, with Medicare cases, as a Resident, I’m not allowed to sign off on the doctor’s refer—“
I cut her off, “I’m not on Medicare. I have private health insurance.”
“Oh. I can probably sign it then. Let me go check,” and she hurried out of the exam room. A new reason for me to want to kill; she made her decision to not sign off on the referral based on misinformation, easily verifiable misinformation. When she re-entered the exam room, she said, “The doctor already has the referral. He’ll sign it today.”

That was last Friday. I know from discussions with the authorizations person at Wheelchair Seating on Tuesday of this week that the referral actually came through on Monday, but really, what is another day at this point anyway?

What pisses me off about this whole ordeal is that the people I’m dealing with work on a daily basis with clients and in an industry of providing necessary services. Wheelchairs by their nature, with very few exceptions, are not luxury items. It’s not as if I took Grandpa’s old pocket watch down to the jeweler and asked the guy to clean and refurbish it “whenever you get the chance.” I’m not cruising around in this wheelchair because it’s a good way to pick up chicks; I need this wheel repaired and I needed it repaired six weeks ago! If there are going to be delays in the repair beyond what Wheelchair Seating can control, I can understand that, but this whole fiasco was caused by a breakdown within their own well-worn system and the fact that nobody lifted a finger in my favor speaks volumes about the quality of service they care to provide.

So, once again I have learned a lesson the hard way. And what I have learned is that these people can’t be expected to provide quality service even though that is the job they have chosen to do. The question is will they learn anything when I no longer take my business to them?