The week before last I went into the hospital in El Paso, TX for spinal fusion surgery. It seems like much longer ago. The operation was something I had wanted and pursued for months: finding a neurosurgeon, consulting on different treatment options, and even getting a second opinion. Had it not been for the pandemic I would have acted sooner, because the pain and left leg/foot numbness that started within a year of my 2018 back surgery was becoming unbearable.
By all accounts the procedure went well, although letting the fusion heal successfully over the coming weeks and months will be key. Although proximity and access to U.S. medical care has been a major plus for us at this post, the hospital “care” experience for me from start to finish was less than I expected and a rude re-introduction to many aspects of the U.S. healthcare system (especially after Australia!). Less than two weeks later, the whole thing already feels like a surreal dream.
About a week and a half before I went into the hospital, I went in person to pre-register and fill out paperwork. I had tired of calling and being transferred around, told I could register over the phone, no, I could do it the morning of surgery, no, I would need to come in person two days before surgery to register, and then being repeatedly disconnected. Knowing I would be acting for my boss during the five days preceding my surgery with no ability to take time off, I figured it would be better to register on my own timeline than try to muddle through all the hospital’s mixed messaging.
It still took more than half a dozen phone calls to get my specific surgery time slot and pre-surgical instructions, which, as I explained to the hospital staff, I needed earlier than the day beforehand due to fasting, needing to cease certain auto-immune medication, and potentially needing to pull in another acting if I needed to be there in the middle of the night before my boss returned to post.
In fact, to get this mysteriously difficult information I had to prevail upon my neurosurgeon’s office for help; standing right in front of someone, in person, at the hospital, could not garner me this information. Because why would anyone need to know when to arrive at the hospital for surgery more than a day in advance, especially when traveling from another country for the operation?
The easiest way for me to explain this to them was just to say that I needed permission to be off my post and that there were logistics around my international travel that involved other people and couldn’t be planned the day beforehand. Even though we are talking about seven miles here, I am technically correct. The border is closed (which for U.S. diplomats is not a big issue but we do need to plan extra time for snags), and there are medical clearance issues to leave and return to your country of assignment for a hospitalization. My nightmare scenario was arriving for surgery and finding out they had told me something wrong and my operation – and all my carefully planned leave – needed to be postponed.
So I was none too pleased when the hospital called me the afternoon before my surgery – as I had specifically asked them not to do – and asked me to come an additional three hours earlier, and contradicted the previous guidance about when I had to cease water intake.
“Oh, cause ya’ll gonna be travelin’ from New Mexico then?” the nurse drawled to me on the phone.
“No ma’am,” I replied flatly. “From the U.S. Consulate General Ciudad Juárez. In Mexico.”
“Oh,” she ventured. “Isn’t the border closed?” I rolled my eyes very hard and rubbed my temple.
Needless to say, I showed up very close to my original time the next morning. And unfortunately for me, this level of professionalism and communication was par for the course with what I experienced during the four days of my subsequent hospitalization, too.
Here is a quick two-minute animated video that does an awesome job explaining the procedure I had and how it works.
We arrived and I took a few minutes in the parking lot to release some work emails from my phone’s draft folder, put away my Global Entry card, and clear my mind. I felt ready.
We went inside and I was rushed by a harried nurse into a pre-operating room. She made V sit in the waiting area as I went about donning a gown and signing forms. She constantly tried to hurry me, and I didn’t let it animate me; by my watch, I had graciously arrived 25 minutes early. When I needed the bathroom, I went. When I wanted to text someone, I did. And if it weren’t for V pestering other nurses to come back and see me, he would have been forgotten at reception by that same nurse who had promised him he would get to see me before I went under.
My neurosurgeon came in and put my mind at ease; in his easygoing way, he said it was good we came when his office had advised and not three hours prior because things were running a bit behind. I met the thoracic surgeon, and had a long talk with the anesthesiologist. I’ve been hospitalized and under general anesthesia seven or eight times and I usually struggle with poor physiological reactions to anesthesia and pain medicine, so I wanted to make him aware and discuss some options. A nurse started an IV, put compression and anti-skid socks on me, and wrapped my hair into a blue cap. V hugged me.
I was texting my best friend K from high school because I realized I had forgotten to tell her about my surgery. She asked when it would be as three people burst in and announced it was time to go. I texted back, “Now,” with a heart emoji and handed my phone to V.
My bed started to roll. My neurosurgeon walked with me to the operating theatre. I made a joke but he didn’t smile, instead resting his hand on my shin in a gesture of comfort. I tried to look around the room, startled by the amount of space, equipment, and people standing ready. I saw a nurse and the anesthesiologist appear over me. The nurse took my right wrist and said something. A plastic mask went over my mouth and nose. The anesthesiologist said, “You’re going to feel a little woozy,” and almost immediately I started feeling carsick. I closed my eyes and thought of V. That morning we had joked about this umbrella cockatoo named Pickles whose antics we love to follow on Instagram, and I pictured Pickles dancing and flapping his wings.
“Now the good stuff,” said the anesthesiologist. I wondered for a moment what would happen if I just tried to stay awake, and that’s the last thing I remember. The next thing I knew, someone told me I was in recovery. ￼
I tried to look around, but could only see the foot of my bed. I was too sleepy and drifted off again and again. I don’t feel dizzy, I thought, relieved. I could not keep my eyes open for anything.
I was aware at some point of my bed rolling again, and a woman I couldn’t see told me she had my purse and was taking away my pillbox because I wasn’t allowed to self-administer my own medication in the hospital. I mumbled “OK” and slipped back under. I remember becoming increasingly dizzy and slipping in and out, and a nurse asking me if I wanted a Diet Shasta.￼ “Yes!” I smiled.
Surprisingly soon afterwards I was standing with a walker at the bathroom sink (how do I always get up so soon after back surgery??), dizzy and hyperaware of my five-inch abdominal incision as I tried not to vomit into the sink.
The rest of the afternoon passed in a blur. I found out later that although V had been promised he could see me in recovery, he was ignored until the last minute and then turned away until COVID-19 limited visiting hours (from 4-6 pm) began a few hours later. He made a split-second decision to take my wallet and overnight bag with him and run some errands in El Paso, but gave the nurse my purse so I would have access to my phones. But I lay beached on the mattress, head slowly spinning, and what personal things I had across the room in a wardrobe may as well have been on the moon. And that’s how the nurse went through my purse and captured all my vitamins and supplements that I would not have taken without permission, but it irked me that they were taken out of my purse at a time when I was unable to have an adult discussion about it.
V arrived during visiting hours and unpacked my things just as I was really starting to feel awake and better. He set up my phones and chargers, and placed my iPad, sleeping mask, and chapstick on my night tray. He put my toiletries in the bathroom where I could reach them, and took out my toothbrush. He sat with me, and comforted me. My dinner arrived, and my head started to clear. He cut my steak and vegetables for me and fed them to me like a small child. Before he left, he arranged everything I wanted on my night tray where I could reach and gave me a hug.
In the following two days, I tried to get used to being there. V visited every day during visiting hours. The anesthesia started to leave my system, and my teeth constantly chattered. My eyes were blurry and I couldn’t look much at my phone, even with my glasses on. I experienced some complications, and had more pain and difficulty getting up as the hours went on instead of less. After the second day I began refusing pain medication, and of course, everything started to get better; being allergic to morphine typically means I get something 10x stronger that messes me up and keeps me from being able to function and make decisions.
I complained about the way my purse was ransacked and my pillbox taken away while I was drugged to multiple nurses who ignored me, until my awesome nurse J said that was handled wrongly and five minutes later came back with it. We had a talk about why patients should not self-medicate in the hospital, which I concurred with (I had only brought them, and their original bottles, to back up what I filled out on my Rx list). He apologized and let me keep everything, and in return I never touched them.
I started to get mixed messaging from different nurses, the physical therapists, and the patient care director about everything from whether my doctor was going to visit me, to what type of physical therapy I should have and when it would start, to how many nights my insurance would authorize me to stay. I can’t emphasize how many conversations it took, with how many different people across three days, and how much confusion, stress, and unpleasantness on each of these issues I experienced. My neurosurgeon apparently doesn’t do rounds on his own patients, but the doctor he has arrangements with never introduced himself to me (that I remember) and so I never was sure who he was until the last day when he appeared at my bed at 4 a.m. and I wasn’t sure if I was dreaming.
Some hospital personnel were proactive, kind, and attentive, and some were not. One physical therapist was cruel to me about not doing what I “needed to do” when I refused to sit up during a full vertigo attack, without even getting to know me at all or asking me what was happening. During one visiting period V arrived to find me sobbing from pain and holding my bladder, my call button pressed, with no water to drink and my IV sitting disconnected from three hours prior by a distracted nurse, and immediately set about putting things in order.
I had the impression that with limited visiting hours due to COVID-19, some of the hospital personnel spent a lot more time socializing and goofing off than proactively taking care of patients. For patients in more pain, or less demanding about being taken to the toilet or for walks, it was a very lonely and disconcerting experience. I also should not have had to call multiple times at 3am asking the nurses to be quiet or close my door because my room was directly across from the nurses’ station and their boisterous socializing was keeping me awake. As difficult as their jobs are and particularly at this time, the behavior I witnessed was not on par with basic professionalism, let alone standards of nursing.
On the last day I demanded – and received – something I felt I needed in order to be well enough to leave, after asking directly and repeatedly about discharge criteria and getting the runaround. Finally in the late morning I was well enough to be up and around on my own. I ate breakfast in a chair, unobserved.
After my IV machine was beeping and my call button ignored for someone to come and turn it off, the half dozen nurses sitting down socializing at the station looked surprised when I appeared in my own doorway, IV stand in tow, asking pointedly for the beeping to be turned off.
Once I was mobile, it was another ball game! I asked for waterproofing of my stomach incision and I took a shower. No one had cleaned my skin or brushed my hair in four days, and the limited time I could spend standing at the sink was sufficient only to brush my teeth and wash my face. Had I not asked for a clean gown on the third morning, I surely would have stayed in the same gown for the duration. Very, very different from Australia where they kept me clean and did not let me feel like an animal.
I blow-dried my hair and put on street clothes and makeup. I strolled all around the halls for two hours with my walker observing everyone and what they did, feeling a strange bittersweet feeling: sad that almost everyone on the wing had been discharged but me, frustration that I had been so flummoxed looking for people from my bed whose offices were mere yards from my room, wonder that the same boulevard I frequently drive on was visible from the windows in the hallway, triumph that I was going to blow this popsicle stand and be gone as soon as V was off work and could pick me up later that day.
When V arrived during visiting hours to pick me up, nurses fluttered around, helpful, solicitous. I made it a point to say goodbye to the ones who had been truly kind to me, including a wonderful older lady named A who grew up in Ciudad Juárez and talked to me about her family. V brought the Tiguan because I thought it would be easier to get into than climbing up into the 4Runner, and the seats in the Tiguan are very firm and upright.
I held a bed pillow against my stomach for stability as we made our way through an unfortunate two-hour Friday traffic jam the seven miles home. Besides a ridiculous wait on the U.S. side to cross, watching umpteen vehicles approach the border informally across the dirt tracks along the fence used by Border Patrol and cutting across the duty-free parking lot to avoid the line we were in, a major intersection in Juárez that has been under construction for months was additionally fouled up by accidents and closure of a U-turn lane. The impact was we sat for at least an extra hour, had to off-road through bumpy dirt, and prevail on other drivers to let us merge in areas where no actual road existed. And of course, no police or traffic cops to be found.
On one occasion we were even muscled out of the way by threatening individuals with fake police lights who rolled down their windows to give us hard looks, all while inches away from other cars on all sides. Very, very uncomfortable and especially while in such a medically vulnerable position. The last thing I wanted was to get in a collision with another driver or have to call the roving mobile patrol. I doubted that had I needed to get out of the car I could have stood and conversed with anyone for more than 60 seconds before having a medical emergency.
We finally, blessedly arrived home and I needed the walker to get into the house and up to bed. In the nine days since I came home, I have been getting stronger every day. I can now go up and down the stairs by myself, my surgical incision is healing, I can shower and make food by myself, and I can stand and walk for limited periods of time. I can’t do any bending or twisting, so I have a claw I can use to pick up low items or things I drop. I need help to throw things away under the sink, to wash my clothes, and even to get water, as I cannot lift more than five lbs. I am really careful about getting in and out of bed. I don’t use pain medication and I don’t feel I need it. However, I certainly don’t feel 100%; even the simple acts of walking up the stairs or blow-drying my hair can exhaust me, despite the fact that before my surgery I regularly walked 30 miles per week.
In a week or so I will have a checkup with my neurosurgeon, and in about 10 days I will start three weeks of telework before physically returning to the office. Probably around the end of the month I will start physical therapy, but I’ll have to see. The most important thing now is not to damage the fusion so it can heal with the vertebrae and become bone. Unfortunately for now it means no driving, limited car rides, no bending or chores, and just very limited activity in general.
I am grateful to be at home with V, that he is working from home and available to supervise me recovering safely (especially as we have a two-story house with lots of tile), and that we are in a position where we have support and everything we need. In addition, as of today I have lost 43 lbs in 2021 so far! My progress towards having the awesome year I hoped for last December is coming true, bit by bit.