Wednesday, 18 April 2007

Surgery

Dorian's asleep on the couch. This is a pretty rare event. He had an operation on Monday to repair an inguinal hernia and he's now off work on sick leave. I have his permission to blog about it by the way.

For the operation he was given the choice of waiting indefinitely or of going to the Broadmeadows Health Centre to have it done within about eight weeks I think it was. (We stopped our health insurance when amassing money for the house deposit, and unfortunately the hernia was diagnosed shortly afterward.) He chose Broadmeadows and soon, as you would.

Next time either of us has to have an operation or something we will know to ask a lot of questions before. This clinic turns out to be a day-only place and it closes at 5.30pm. Dorian had his operation, under general anaesthesia, at about 2pm and I had to help him get dressed and into a wheelchair and into our little car shortly before 4pm. He was a bit spacked out on morphine but still, every time I drove across a join or bump in the Ring Road he grimaced and winced. I made it to the chemist's in time to get the painkiller prescriptions filled and then it was straight into bed for several hours. He didn't really look right till about 10pm, by right I mean in a fit sort of state to be going home.

As far as I know the operation was done properly and so forth but I think it's a bit rough to bundle people out onto the street when they're still very sore and groggy. More to the point, we had no idea at all that this was the plan if he took the Broadmeadows option as we just assumed that the clinic would keep him under supervision and give pain relief etc as long as necessary - didn't know it closed in the afternoon. I appreciate that hernia operations are fairly routine but this sort of haste is necessary how? He's not been suffering, on the scale of how these things go, but still, you know, there are two tiers to the health system, absolutely no question. On the lower tier you take a few chances.

Now he's getting better but today still seems to be in a fair bit of discomfort. I hope he will soon be able to ease off on the pills, which can't be good for you.

31 comments:

Ampersand Duck said...

Poor Dorian! I hope he feels a lot better very soon.

Pavlov's Cat said...

Yes, me too.

I'm sure it won't make either you or him feel any better, but in my experience this kind of thing is more or less the norm. High turnover of patients= more money.

I did a lot of fetching several different people after day-surgery procedures last year and this year, and on most of those occasions it really took two people to get the victim, erm, patient, erm, client from the surgery to the car, they were so out of it. In the case of my friend R, they told me I had to stay with her for six hours, which was the first that either she or I had heard of it. You're exactly right about the moral of the story -- ask lots and lots and lots of questions beforehand.

lucy tartan said...

Well, thanks both of you. I'm fine & Dorian is not too bad.

High turnover of patients is okay, really. Nothing wrong with trying to do things efficiently. The slightly iffy part is that the surgeon gave him the option of going to Broadmeadows in a way that implied there was something a bit undesirable about that but he didn't say what. At the time we assumed this was simply because it was notorious Broady (sorry David) but I think now it was the long distance, which to us was an unknown unknown factor. I don't imagine a surgeon would do a less meticulous job on a public patient but I do think he'd make stuff a bit clearer to a privately funded one.

Something I wondered at the clinic: Are female surgeons called Mr?

Francis Xavier Holden said...

Some people think a hernia op is sort of funny. I don't. I've had one. Good luck and don't laugh or cough.

There really isn't any excuse for not having full information. The surgeon should have provided it either in interview, by paper or by directing you to a web site.


Opps I just looked up Northern Health site, http://www.nh.org.au, I assume thats who runs the day surgery and their "Information for Patients & Families" page is blank. Bad. You should let them know about your exerience. Politely.

Check out the Victorian Patient Charter while you are on the Northern site.


There is some info here on day surgery:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Day_surgery_and_anaesthesia?Open

Meredith said...

I have a friend who was sent home on the day of her mastectomy operation. But interestingly she was a private patient. I think our general attitudes toward surgery are getting lax - we tend to think they're not as serious anymore - but then hospitals are getting grimmer, too, so you wouldn't want to spend time in them anyway.

Dorian said...

FX that is so true about the laughing and coughing. I don't know if the morphine played a part but Southpark on Monday night was the funniest episode ever and I had to change the channel to avoid bursting something. So if anyone taped it? It had a World of Warcraft thing happening.

pk said...

Best of luck Dorian.

It's always been my kneejerk reaction to defend public health (I spent quite a few years working in A&E) but I think this is a pretty unacceptable situation.

So for good or umm...ill:


===============
Sir

An acquaintance told of the lack of information supplied when her husband was recently admitted to to the Broadmeadow Health Service for a hernia repair. They were particularly concerned that the patient was released within 2 hours of the procedure and that his wife was expected to take care of her still very groggy husband with both inadequate notice and expertise.

Now it might be the way of the future and costs control to have friends and relatives play a greater role in direct care, particularly with day only procedures, but it is more than a little disturbing to hear that the people upon whom this most directly impacts are receiving inadequate pre-admission information.

Perhaps it could be impressed upon the admitting specialists that they should outline the most likely scenarios with respect to a patient's condition at the time of discharge and expectations of their family/friends when they go home. One would have thought that this sort of basic information would be communicated at the time the surgery is recommended.

Nevertheless, it is with more than a little surprise that I find the Northern Health website category 'Information for Patients & families' to be blank.

It speaks ill of a service when neither the staff nor the facility's website provide basic advice about the expected practical consequences of a surgical procedure. I therefore urge you to review the standards required of staff in pre-admission consultations and consider recommendations that serve to make informed consent actually informed.

Your sincerely


Paul K
cc Vic dept. health
======================

I guess bureaucracies are less likely to react/respond to complaints that don't supply them with the intimate details (name etc) - so they can grab records to better defend themselves - but still, these things probably end up in the inbox of someone of import so it's worth bringing up as a general concern.

I found it easiest for some patients to understand who the hell I was if I told them I was a 'mister sister' so maybe the female surgeons would be happy about 'mister' just to reduce confusion? (that's a very english title. I don't know we do that much if at all in NSW)

Scrivener said...

That sounds like a terrible experience. You and Dorian should certainly have been given much more information. Glad Dorian's alright.

Mindy said...

Hope they told you to get some anti inflammatories as well. They neglected to tell me that when I went home post caesar so I suffered for two days before a midwife sent hubby to the chemist post haste, and then magically the pain went away. Apparently Voltaren are pretty good (although as I was b/feeding I couldn't take them). Might be worth checking with the doc if they haven't been recommended.

Hope Dorian is feeling better soon, surgery of any type is no fun.

lucy tartan said...

PK, David and Mindy, cheers: I'll tell D about the antinflammatories. PK, the health centre sent D a packet of information about what would happen before the operation. What nobody mentioned, though, was that he'd be sent off before us nonmedical people thought he was ready. I don't know, maybe he was.

It's not like being sent home on the day of a mastectomy though. That's shocking.

elsewhere said...

Hear, hear -- to pretty well all of the above.

Get well, Dorian.

Kate said...

Glad Dorian's on the mend. I don't want to focus on what happened to Dorian specifically because I've got no idea why they didn't tell you about the post-surgery procedure. Day surgery certainly has it's downsides, and I don't doubt that cost is an issue, but a factor that doesn't get much of a mention (and which is important in the decision-making of going home time) is infection control. Although you feel like crap immediately after surgery, and you feel like you should be under strict observation (and sometimes you should) you are much less likely to get an infection at home (assuming appropriate wound care) than you are in the hospital. It does place a burden on family and friends to care for the patient, but the outcome can be better than if you stay in over night.

Francis Xavier Holden said...

What Kate said is not only true but important.

Also most people do prefer day surgery and to get home "as quickly as possible"

But there is no excuse for lack of info re how the patient might be: dopey [more than usual ;-)], physically uncoordinated, [more than usual], nauesous [more than...], grumpy [more..], sleepy [you get the picture], and generally "not well".

The provision of info is not just a civilised curtesy, but a safety and health issue for carer and caree.

Being adequately doped up at home is important after an op. [for some it is important at any time].

Despite the surprisingly common view that pain is good for you - it isn't.

boynton said...

Best wishes, carer and caree.

Pavlov's Cat said...

I agree with Kate and FXH that it is better psychologically, and perhaps these days epidemiologically (is that a word? And does it mean what I think it does?) as well, to go home early.

But as someone who in 2001 was sent home after four days in the wake of major abdominal surgery, an operation that not so long ago they routinely kept you in hospital for 6-8 days after (my, this is an elegant sentence, n'est-ce pas?) -- and as a private patient (I got fed up) with (I got lucky) a private room -- I think it was at least 24 hours too soon, maybe 36.

And there were a lot of things they hadn't told me, like that the main side effect of the analgesia they'd given me was nausea and vomiting. I thought I had some hideous complication. (On the up side, I lost ten pounds in six days. Sweet.)

And the friend I fetched from major, generally-anaesthetised dental day surgery late last year was barely able to stand up. She's someone who could haemorrhage for Australia, so the following six hours in her company were a bit tense. Particularly as -- still way out of it -- she insisted on drinking two vodka martinis and half a bottle of wine once we got back to her place.

(/rant)

Francis Xavier Holden said...

epidemiologically (is that a word? And does it mean what I think it does?)

Not exactly - but we get the drift.


Particularly as -- still way out of it -- she insisted on drinking two vodka martinis and half a bottle of wine once we got back to her place.

That's close to teetotaller at our place.

Armagnac Esq. said...

Since I waited over 15 months for an operation on my knee where they didn't even perform the operation and left the ligament that they didn't see in the MRI sitting there sewed me up and my knee still isn't as good as it was before the op now 2 years later... since then, I'm paid up and i'm not getting out.

It's tough, shoit, et al. It shouldn't be that way. You are right, the vague sense that you are being treated like a human being is NOT too much to ask.

While I'm here, tell Dorian to get better!

Armagnac Esq. said...

Since I waited over 15 months for an operation on my knee where they didn't even perform the operation and left the ligament that they didn't see in the MRI sitting there sewed me up and my knee still isn't as good as it was before the op now 2 years later... since then, I'm paid up and i'm not getting out.

It's tough, shoit, et al. It shouldn't be that way. You are right, the vague sense that you are being treated like a human being is NOT too much to ask.

While I'm here, tell Dorian to get better!

Ariel said...

Best wishes to you and Dorian. I've been really lucky, I think - every time I've been in hospital (always public) I've had a pretty okay experience in terms of not going home until I'm well enough. The worst thing I've experienced was the food, really. But your experience does sound pretty ghastly.

Actually, the one awful thing that happened to me was when I went in under a general anaesthetic to have some tests done (aged 17), and woke up literally screaming - they'd found something and operated while they were there, which I had no idea would happen. The pain was so much worse for being unexpected. Being unprepared for what will happen to you can be deeply unsettling.

worldpeace and a speedboat said...

it's rather borderline to say the least that someone should be out the door 2 hours after abdominal surgery. sure, on one hand you should have asked questions, but your surgeon should have given you a LOT more information as standard.

I would also have thought that an operation like that would be scheduled first thing in the morning to allow for, at least, a proper recovery time frame.

as people have been saying, there are benefits to going home as soon as you can - where you feel comfortable is the best place to recover. but the emphasis is on *recover*.

there are too many people who think that if they've been discharged, they're completely recovered. they resume normal duties and wonder why their stitches bleed or open, why they get inflammation and infection, why they are sore as buggery, why they collapse after hanging out the washing two days after having a caesarian.

all very well to be home on the same day, or the next day, but if your doctor doesn't make it clear what is and isn't appropriate, then don't let them discharge you (hard in a day-stay situation, eh?).

I suggest some polite but firm letter writing.

seepi said...

Hospitals are now only for the very very sick.

Times have changed, and not for the better.

Ten years ago having a caesarian meant a week in hospital, and any birth about 3 days. Now it is 3 days for a caesar (which is major ab surgery), and 1 night for the others.

And we are supposed to be in a time of fantastic economy...

After my recent week in hospital, in a shared room with 4 people (ratio of annoying nutters over 50%), I have upped my health cover.

Something needs to be done.

hc said...

But the service your partner got, Laura, given that you were not insured was pretty good, right!

A few years ago I had a burst appendix one afternoon which nearly killed me. I admitted myself to Austin because it was closest and was treated as a public patient. Treated pretty well since I am still alive.

Foolishly, afterwards, when they asked me if I had private health insurance I said yes. Of course I then discovered the difference - they send you lots of bills.

Still they kick you out quick - the cost of a day in a hospital bed is huge and people need it who are really needy.

lucy tartan said...

Overall hc, yes, I would certainly say it was very good treatment, as far as I can say that given it's not me who is still out of action. Just those two things: sent away a little too soon (and WP&AS says what we thought, that if the operation could have been done earlier in the day than mid afternoon it might've helped) and the whole process could've been explained more clearly so we knew what was going to happen. It wouldn't have cost any more to do that.

Kate (the other one) said...

Oh poorn Dorian.

And on top of all the moving house/renovating stuff too!

(I have spent exactly one night in hospital and suffice to say I don't want to ever be in there again, though of course I know that's impossible.)

Kate said...

seepi I spent only one night in hospital after I had a baby - because I asked to go home. I was in a birth centre (someone else there went home the same day, again by request) and was offered a second night. It was Christmas Day, and I just wanted to be home in my own space. I certainly wasn't rushed out the door. I had follow up home visits and phone calls for a week afterwards from people who I'm sure would rather have been home with their own families. They never made me feel I was imposing on them though and they made sure I was supported by family and the maternal and child health nurse. Proper care isn't only measured by time in hospital. In the midst of an unplanned for (by government) baby boom, I think I got better care than many I know who went private.

I felt much the same (although I was much groggier) after (private) day surgery to have wisdom teeth removed. Then I was also bundled out before closing time and into the care of my mother & housemate. Fortunately my mum insisted on proper instructions before she would take me home. The private nursing staff weren't forthcoming apparently (I don't remember).

seepi said...

BAZ BINGO!!!!!!

- Kate if you wanted to go home early that is great. But if others don't feel ready to go home, and are guilt tripped into it with the old 'other people need your bed' that is not so good.

Private patients get to stay a week incidentally 'so their breastfeeding can be established'. Hmm - no need to establish breastfeeding for public patients then.

sooz said...

Private patients don't get a week, those who deliver vaginally get 3 days, a c-section gets 5 and there are incentives to leave early (like nights in a hotel). Public and private patients alike are entitled to stay in hospital (even if they are pushed to leave) after birth if they are clear and assertive with practitions that they require this and can justify their request, like lacking support at home, or feeling unwell or scared or unable to care for themselves. Milk coming in is not sufficient reason to stay in eiter system (though of course it would be ideal!)

I am not agreeing that people should leave hospitals or clinics before it is safe to do so, but I think we have come to rely on medical practitioners to know and understand our subjective experiences of illness and return us to full wellness with much greater ease than they reasonably can. The same procedure can effect one person very differently than another, one person copes with pain or incapacity better than another or has a better support network than another.

It is also difficult for a doctor, who knows the kind of pain and suffering being experienced by someone awaiting care to not put pressure on a patient to really question whether they require that hospital bed for another day. It can be hard when we feel so much less than 100% to see when we are well enough to deal with ourselves and let someone even sicker have our bed. When every health service has a waiting list and is strapped for resources there will always be pressure to move people on as quickly as possible. The constant contact with very sick people inevitably leads doctors to have a different scale of wellness than us regular people.

The provision of information is mandatory and if a service is weak in this area they definitely require feedback. Slipping up is not excusable, but common I am sure. I agree with other commenters that polite but helpful feedback will ensure others don't get the crappy experience you did.

I too had a scary experience of being discharged whilst dangerously incapacitated, but when I had the same procedure done with different practitiioners previously I was fine within an hour of treatment. I guess you just never know what's going to happen.

I hope D is getting much better.

Stephanie Trigg said...

Female surgeons? Mine was *invariably* referred to, by receptionists, radiologists and nurses (but not the oncologist) as Miss...

Anonymous said...

I spent four days in hospital after my inguinal hernia op (note to self: calling it a linguinal hernia doesn't work with wikipedia). That was a bit alarming because the doctor admitted that they put me in just before lunch and the previous op ran late so they didn't get to eat but kept going - on me. Don't these people know anything about blood sugar and concentration?

I guess one of the good tricks is to try and wangle the early morning entry.

I reckon public hospitals are good on most things, but not the bit when you leave. They end up providing individualised bits of information like meds regimes and exercises and pain management to a) friends who are preoccupied with moving you around and/or b) you when you are stoned out of your gourd. And they don't write it down because the info is not standard...

It is a recipe for many bad things. Imagine if you didn't speak English on top of all the other problems. Are they going to wait for a Swahili interpreter as they push you towards the door?

- barista

seepi said...

I still don't understand why women in private hospitals stay 5 days after a Caesar, and in the same hospital's public ward, only 3 days.

Us public patients must be tougher I guess.

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