OT-How to go in for sinus surgery and come out with Crutches

[Skier757]

How to go in for Sinus surgery and come out with Crutches.

Yesterday I went in for outpatient sinus surgery. I had a septoplasty with right endoscopic concha bullosa resection, and bi-lateral outer fracture turbinates. After the first time when asked about my procedure the nurses and I ended up saying, ‘septoplasty and a lot of other sinus stuff’.

The surgery could not have gone better. When I woke from the anesthesia I could breathe through my nose better than I had in years. Despite the trauma of surgery it was obvious my breathing passage was significantly improved. I had no real pain, other than a sore throat from the anesthesia tube. I had no nausea, and other than being woozy and light headed, I felt great. There was also very little bleeding or other drainage, and best of all, no nasal packing or splits.

The interesting part of the story comes when it was time to be discharged. As I was laying on the gurney recovering from the anesthesia, I noticed that my left calf was tender. There was pain developing just from the pressure of laying on the gurney. As I tried to flex my foot, the pain shot up my calf like a bad cramp. I had to use the restroom, the IV fluids I guess, and when I stood I could not walk without a significant limp. I hobbled to the restroom and back, and the discharge nurse looked at my leg. She decided that since she could not detect any significant swelling or heat there was nothing to prevent me from being discharged. She did give me a serious warning that if the pain did not go away in a few hours to call my surgeon as it could indicate a blood clot and that could be life threatening.

At home, I continued to feel great in general. I could breath, and I had no pain at all at the surgery site. I did have more bleeding, and the more I moved around the more I bled, so I settled onto the couch to watch TV, and write some forum postings. An hour later when I got up to use the restroom again, lots of fluids in recovery, the pain was worse in my calf. The pain was not super high on the pain scale, but the fact that my leg hurt more than my surgery site was alarming to me. I also never get leg pain or cramps and I am an avid bicycle rider. My instinct was to walk it off, but the more I tried to walk, the more I bled from the surgery site. So at 3:45 PM I decided to call my surgeon as directed by the surgery center, figuring he would be going home soon, and I wanted to consult before he left.

Of course this was a setup, what could the doctor say but to go to the ER. Without seeing me or my leg, and having no reason for my leg to be in pain, I guess there was nothing he could do in our defensive medicine, and lawsuit avoiding society but recommend that I immediately go to the ER to have the leg evaluated and an ultrasound performed to rule out a blood clot. Thus the adventure begins.

In Carlisle PA, our local hospital was bought out several years ago by a for profit hospital management company. The Carlisle Regional Medical Center, (CRMC), is the most profitable hospital in central PA, and apparently money is about all that matters to them. I arrived at the CRMC ER with a very unrealistic set of expectations. I thought that being a post surgery patient, with still bleeding surgery site, and a possible surgical complication, that they would take me back immediately and promptly and efficiently evaluate my situation. Wrong.

My step son drove me as I was not able to drive in the post anesthesia state, and we arrived at the CRMC ER at a little after 4:00 PM. Upon entering the ER, there is a nurse triage counter, but it is no longer staffed. Instead there are some torn out sheets of paper scattered on the counter with a pen, and a warning to leave the pen on the counter. You fill in your name, date of birth, social security number, phone numbers, and reason you are in the ER, and then leave the paper on the counter. I am not sure how CRMC thinks this meets HIPAA, but no matter. I filled in the sheet, and listed myself as a post surgery patient with leg pain, sent in by my surgeon.

Now I used to be a wilderness first responder, and I know the definition of Triage. However at CRMC, triage seems to mean calling out into the waiting room and asking who was there first, and letting the patients figure it out. Despite actively bleeding into my dressing under my nose, with a possible blot clot in my leg, I sat in the ER waiting room for 35 minutes before anyone even spoke to me. I sat there with several children who were so sick they had basins to throw up in. I moved as far away from the children as I could. Now CRMC is not a big inner city hospital, it is a small town hospital and there could not have been more than five parties waiting. Unfortunately CRMC only staffs one triage nurse, and she took 35 minutes to check in the two patients who were there ahead of me. Once she called my name, she asked why I was surprised my leg hurt if I had surgery on my leg. I sat there dumbfounded with a bloody dressing under my nose. I carefully explained that I had sinus surgery, and the pain in my leg was a possible complication. “Oh” she said, “OK”. I am not sure why they have you fill in forms, if they are not intending to read them. Well, she had read my social security number, as she already had all my insurance and billing information up on her computer. I was admitted to the ER thinking the worst was over, but the saga was only beginning.

I hobbled back to an exam room, was told to undress again and put another hospital gown on. I was also told not more to drink or eat until I saw the DR. Now I had not eaten since midnight the night before, and was trying to re-hydrate, so this was not welcome news. I was also due to take my first pain pill shortly. Eventually I disregarded that directive. An RN came in about 20 minutes later and examined my legs, and said that he felt it was unlikely that I had a blood clot, but that they would need to do an ultrasound to know for sure. Unfortunately it turns out that CRMC does not keep radiologist or ultrasound technicians on the clock in the evening, it was just barely 5:00 PM, and they would have to call one in. So we waited. At 6:15 PM, with no one having every checked in on us, and we were in a closed room with no window, no one would even know if I was dead in there. I needed to use the rest room and had no idea where it was. I also desperately needed to rinse my sinuses and had not brought my simply saline with me. I rang for the nurse. After ten minutes with no response to my calling for the nurse, my wife who had thankfully arrived with fluids and a snack, went and found the rest room for me. I hobbled to the rest room and back, and only when I returned, I guess at the report of an open backed hospital patient roaming the floor, a nurse came by and asked. “Did you need something?” I said ten minutes ago I did…… I was getting really frustrated. I pointed to a chart on the wall that listed wait times for various tests, and all diagnostic imaging services listed a one hour wait. I pointed out that I had already been there for two and a half hours, and the nurse stated, those wait times are from the time you see the ER Dr, and I had not seen the Dr yet, and there was only one working that night and it would still be a while. I complained some more. First I was freezing and shaking in the cold room in just a gown and one thread bare blanket. I also suggested perhaps I should leave and go to a larger and better staffed ER, and reminded them that I was a post surgery patient send in by my surgeon with a possible complication. That seemed to get things rolling. Suddenly they had plenty of warm blankets for me, where they had been while I had been shivering I would like to know. At 7:00 PM the ER Dr finally arrived in my exam room. He was mystified by my leg pain, but decided that I needed an ultrasound. Really, I though we knew that when I arrived at 4:00 PM. Well, no one had called the ultrasound technician yet, because the Dr had to order that. So I had to wait another 30 minutes while she drove in from home.

Finally I got the ultrasound I came in for three and a half hours before. It turns out that even if they found a blood clot in my calf, they would not have treated it as they do not consider it a threat until it is in my thigh. If anyone had told me that in the beginning, since the pain was only in my calf, I would have stayed home. Of course she found no blood clots. But that was not the end, no, of course there was no radiologist in the hospital at night, so she had to “Send” the study out to be read, that would take another 30 to 45 minutes.

After 30 more minutes in my cold ER exam room, the ER Dr came back and said he had not received the reading yet, but he trusted the Ultrasound technicians judgment that there was no clot. He could not explain the pain, but felt it must have been the position I was in for the surgery or something that pressed on my leg during the operation, or some other yet undiagnosed mystery. He was not done though. He was finally determined to treat me. He suggested an injection and asked if I was allergic to aspirin products. I pointed out that I had surgery that morning, bloody dressing under my nose; I could not have any aspirin products. ‘Oh’ he says. How about pain medications. I point out the pills already on the counter from my surgeon. ‘Oh’. Well you need crutches. It really seemed that I was not going to be able to leave unless I let him sell me something, so now I have a brand new set of very nice aluminum crutches. I fumbled and stumbled with my shiny new crutches and made my way out of the ER over four hours after I arrived. I don’t think that I will ever use them again.

So that is how you go in for sinus surgery, and come out in the evening with crutches.

Side note. The only thing CRMC seems to be good at is collecting money. While initially waiting for the one triage nurse to learn some efficiency, there were two billing clerks who repeatedly walked through the waiting room waving a check someone had written and looking for the person to get them to correct something on the check. This was a bad sign. More billing clerks than medical staff. It turns out they had one triage nurse on duty. One ER doctor on duty. No ultrasound or radiology staff on duty. But they had at least four admission and billing clerks on duty. If nothing else they were going to get your money. When I paid my bill, I was required to sign three times, essentially signing away all rights in any billing dispute. One form had a line that really defines everything that is wrong with medicine in this country. If you have no health insurance, CRMC will give you a 61% discount if you pay cash. That’s right sixty one percent discounts for cash. So they are admitting they are over billing insurance patients at least 61%. Amazing. I can tell you this is the last time I will cross the threshold of the CRMC under my own power.

Final post script. Today, the day after my surgery and ER odyssey. My bleeding is under control and I was able to walk in my yard without increasing the bleeding. After fifteen minutes of walking, the pain in my calf has started to subside. It is still greater than the pain from the surgery, but clearly, my first instinct to just walk it off was right, and I have learned to listen to my heart, and not trust in the ER.

[rosacer]

I'm happy your calf pain is gone and your bleeding under control. What an odyssey it seems the ER's are very similar all around the world

Thake care and all the best!

[WearyOne]

Wow, what a horrible experience! And I can't believe they just leave those forms out there with personal information that anyone could just walk by and pick up.

My family's experience with our closest ER has fortunately been much better than this. I actually have no complaints about wait times or how each of our personal situations was handled. I know this is the exception, though.

Glad to hear you're on the mend from the surgery and that whatever was wrong with your leg is getting better!

[Janknitz]

Holy smoke!

I would copy your post and send it to the CEO of the hospital.

[profoundapena]

Well, having been to this emergency room three times, I would say that both times I was fairly pleased with the service I got. It is a beautiful new facility. The first time was the worst--I was there a total of 11 hours and felt largely ignored, but when I passed out one time, I called out for the nurse and they all came running. The place is very high tech adn they can monitor your vitals from their terminals. I spent a lot of time watching and it appeared that two doctors were on duty and many nurses. They did spend a lot of time sitting and talking, but they could have been reviewing data online. The second time I cut off the tip of my fingertip and was afraid I would wait forever, but they called me very quickly and the nurse said that if I agreed to it, she would patch me up (I had been bleeding for hours and was worried I'd pass out). I agreed and she used this plastic stuff to replace the tip of my finger and it stopped bleeding. The doctor then made a brief appearance and I was on my way. The third time I had terrible foot pain for weeks and the doctor said to keep it elevated and put ice on it. Meanwhile I waited in a private room with TV and was content. I was out in 2 hours. I had gout, brought on by medication. I went in during a weekday, during the day, on a Sunday at 10 pm, and on another weekday at 8 am. Overall, they treated me much faster and better than the hospitals in BAltimore ever did. One time I waited in the ER in a Baltimore for 9 hours for a specialist to be called for a consult. My mother was gradually losing feeling below the waist, and I was panicked. She needed emergency surgery, which they eventually performed at 7 pm on a Friday. So it's all relative, bad service.

I would encourage you to complain to the proper authorities, because your treatment sounds outrageous.

[boston]

Last june I went to the ER in severe pain, the admitting nurses cell phone rang, and she told me to just wait while she answerd it and had about a 3 minute conversation, and it was NOT important, she was right in front of me, I could hear everything.
I was already in pain, and then I was mad as heck after that.

[dsm]

Skier757

Wow what a story. How discouraging !. Sorry it went so poorly.

My last hospital trip was for a torn shoulder ligament after cartwheeling off my bike.
Went very well even though it did drag on for a couple of hrs getting the x-rays done.

Hope you get over this ok & no more complications - who needs that on top
of sinus surgery

Cheers

DSM

[dave21]

Wow, sorry you went through this!

I remember when I has an operation 15 years ago (pre-CPAP) they didn't really want to operate unless they really thought they had to, and in the end it came to operating. I remember the doctors saying that any kind of operation is a trauma to the body, you can also get blood clots as well, the body just doesn't like any kind of trauma. Most are okay but some aren't.

Thanks
Dave