my day as a patientPosted: May 18, 2012
MANILA, Philippines – It was something that I had given much thought but then again I didn’t really think much about it. This seeming contradiction is not really such.
While in college, I had broken my little finger during a basketball game. The finger basically bent at close to a 90-degree angle just below the joint. I guess I was in too much shock that it didn’t really hurt at all. I was first taken to the UP Infirmary. There I was told as everyone else had up to then been telling me that the finger had just been dislocated. I guess people just wanted me not to go into further shock by telling me this “white lie”.
From the infirmary, my roommate at the Molave Dormitory – Jay Millan and I took a jeep to the National Orthopedic Center. Upon reaching the ER reception, the doctors there immediately told me that “hmmm, bali ‘yan”. Without warning one of these doctors essentially just took my broken finger and bent it back in place. Now that was painful but that was apparently the best way to do it – with no warning.
I no longer recall how long it was but my right hand all the way up to just short of the elbow was encased in a plaster cast. The tips of the other fingers protruded a little from the cast giving my right hand some level of functionality. Having that cast was inconvenient, to say the least. I had to learn to use my left hand for many things that I would normally do with my “stronger” right hand. Eating was a challenge so I’m pretty sure I lost some weight over that period of time. It also happened that this period encompassed final exams. I was a able to still use my right hand a little to write but it was painfully slow and I had to be judicious in my use of words for essays. Thank God for multiple choice exams.
My hand and arm started itching really bad underneath that cast. There wasn’t much that you could do to reach all the itchy spots. When the cast was finally removed, the doctor and I discovered a ballpen cap lodged between the cast and my arm which I had forgotten about and was undoubtedly left behind when I used a ballpen with its cap on to scratch an itch.
Over time, I began to notice that the broken finger was not healing straight. The finger healed with a slight 5 to 10-degree angle to the right. As it wasn’t really bothering me at that time, I just let it be for over 20 years.
About 6 or so months ago, the finger started hurting. For some reason, it was also becoming a slight hindrance to things I wanted to use my hand for. Maybe I just began to notice it more because of the intermittent pain.
Working for a medical group, you are around doctors a lot. I would ask this and that doctor what could have happened with the crooked healing of the finger and what my options were. It appears that there was really nothing wrong with what the original orthopedic surgeon who set the cast did. It’s just that when the bone starts healing it looks for the path of least resistance which in this case happened to be one in which the bone turned slightly right.
After 20 or so years, I ran into a good friend of mine from college who it turns out worked at the University Physicians Medical Center (UPMC) – one of the medical facilities that our group operates. He had become a doctor and more than that, a hand specialist. When I asked him what could be done, he said the finger had to be broken again and re-set. He initially said he would do the surgery but he eventually backed (chickened?) out :-). Mahirap na daw kasi magkaibigan kami. I guess, a little performance anxiety.
He instead referred me to one of the best hand specialists in the Philippines who also happened to be practicing at UPMC. We set the date for the surgery and I didn’t really think much about it. I asked, of course, whether it would hurt? How much would it cost? That was pretty much it. I just took much of it in stride that I was rushing to get cleared by my primary doctor for the surgery on the day before the surgery itself, in between meetings.
The risk of having the surgery didn’t really hit me until late on the day before the surgery. I had to go to the Operating Room (OR) complex to give the pre-operating instructions to the head nurse. There she reminded me not to eat nor drink anything after midnight. When I asked why, she mentioned the risk of pulmonary aspiration. Pulmonary aspiration in this case means the entry of food and drink into the windpipe and/or lungs leading to death by asphyxiation. The risk of this happening is elevated when one is in a depressed state of consciousness such as being under general anesthesia which was going to be applied in my surgical procedure. I also remembered that this was going to be my first ever surgical operation.
So for me – last meal at 6 pm and last drink at 10 pm.
I arrived at the OR of UPMC really early, about 5:30 am. The surgery itself was scheduled at 7 am. The pre-operating procedures were expected to take about an hour. The process was smooth and very efficient. The only thing that I didn’t like was the insertion of the IV line. I hate this. I start thinking that I might inadvertently tear it out. It didn’t hurt as much as it used to. The assistant of the anesthesiologist told me that it shouldn’t be hurting after a while. Maybe I was also imagining that it hurt.
Then the anesthesiologist, who is also a friend of mine, showed up. His presence took away some of the “shakes” so to speak. He asked some questions, walked me through the process and shared a joke which helped as well.
I was wheeled into the OR just after 7 am. One nurse asked if I was ready. That remark didn’t really help. It got me thinking again. But then my friend/anesthesiologist and the surgeon came in and the last thing I remember was hearing – “we’re starting”.
I apparently woke up at 10:35 am or just over an hour after the operation was concluded. I didn’t feel a thing. I don’t remember telling the nurse so but apparently I asked her to give me another 30 minutes. Wala namang rush, it was just me wanting to actually (maybe foolishly) wanting to go back to work. At 10 minutes past 11 am, I was fully conscious. I got up, changed, did some final paperwork, thanked the OR staff and went up to my office on the floor above the OR.
I admit I was still feeling a little funny from the effects of the anesthesia. I ordered lunch, walked around the facility and upon the advice of my guardian/doctor went home after finishing lunch. I slept another couple of hours and when I woke up started making and fielding work-related phone calls and checking e-mail.
This is certainly a new model for healthcare, even surgical procedures in the Philippines. People give no thought to being confined at least overnight in a hospital for simple procedures that I underwent. Outpatient procedures now account for over 70% of surgical procedures in the United States most of them done in what are called Ambulatory Surgical Centers (ASC) of which UPMC is the first of its kind in the Philippines.
My procedure called corrective osteotomy with internal fixation ended costing me less than P12,000 at UPMC. The same procedure performed by the same doctors using the same equipment at Makati Med, St. Luke’s, Cardinal Santos, Medical City or Asian Hospital would have cost at least double. The reason is simple. Without the cost of maintaining what is called the “hotel component” of a hospital which includes the patient rooms, dietary services and other such items, an ASC such as UPMC can cost their procedures at a significant amount lower than these tertiary hospitals.
Three days after my surgery, the heavy bandage that covered my hand was removed and replaced by gauze and a net-like protective cover on just the finger that was operated on. I have always believed that this way of delivering healthcare would work in the Philippines after having seen it myself over the 10 years that I lived in the United States. Filipinos just need to adapt and get over the mental model of hospital confinement as a necessity for most surgical procedures. It is not and the good thing about that is that the out-pocket cost for the patient is a lot lower without the quality of care being compromised.
Kudos to my doctors – Doc Jotek, Doc Tammy, Doc Nick (all faculty members of the UP College of Medicine) and my nurses – Bedz, Rose and Jen.
Next week – the stitches will be removed and I expect my little finger to be as good as new :-).