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October 1 – October17: My Recent Illness and Major Surgery - some personal observations on the UShealth care scene

During the above periodI was in the Intensive Care Unit (ICU) and Operating Room (OR) of two Bostonarea hospitals, had major colon surgery and now recovering at home. So far theoutcome and prognosis are the best that can be hoped for someone at my age. (Avery small cancerous bump in my colon at its very early stages missed even bythe biopsy during a colonoscopy was removed together with a section of theintestine) For someone who never had major surgery or been hospitalized forserious illness, the past 17 days has been quite an experience. Recorded beloware the events and observations I accumulated.

It all started on themorning of Oct. 1 when I observed significant bleeding during my morningconstitutional. I also feel faint due to the large blood loss. So, my wifedrove me to the nearest hospital which is not in my insurance/hospital network.There I received excellent emergency care – IV feeding, blood transfusion, lifesign monitoring every moment- and follow-up care. After three days in the ICU,the bleeding stopped. I had a colonoscopy, endoscopy, and a CAT scan of myentire gastrointestinal (GI) tract. They found a bump/tumor in my colon nearthe small intestine. Biopsy of the bump turns out to be negative but possiblypre-cancerous. All things considered, my own decision analysis (e.g., themortality rate of such colon removal surgery is 1%), doctor’s recommendation,and the consequences of postponement indicate that I should nevertheless proceedwith the surgery which was scheduled for 10/12. The hospital I was staying veryprofessionally, courteously, and seamlessly transferred all my medical data tomy own primary care physician, surgeon, and insurance network. The surgery wasuneventful and apparently successful. Thecomplete pathology on the bump afterit was removed found a very small section, missed by the earlier biopsyfrom the colonoscopy, has already turned cancerous. Thus, the decision tooperate is a correct one. Currently, no chemo or radiation therapy will becalled for.

I am now home andrecovering slowly after such trauma and major surgery. I am weak and painful tomove around. Complications from the surgery such as leaking from the two re-joiningsof the small intestine and the colon can still occur. We are keeping ourfingers crossed. For seven days during the above period I did not eat nor drinkand subsisted on IV feeding. Even now, I need to be careful and watch for any unusualsigns from my GI tract. In the normal course of recovery, doctors say that Ishould allow one month from now to full recovery at my age.

I thank all my friendswho learned about my illness and offering of help and concern. All thingsconsidered, I am still a lucky guy http://blog.sciencenet.cn/home.php?mod=space&uid=1565&do=blog&id=279300 (coloncancer is the second leading cause of death among American male and usually aresymptom free until too late)!

Now to some personalobservations:

1.      For persons withinsurance and can afford it, America certainly has the best medical care. AndBoston is the leading medical capital of the country. All the best doctors and teachinghospitals are here. No wonder many wealthy foreigners come here for treatment.

2.      As a student ofOperations Research, I was most impressed with the computerization of medicalservice from the viewpoints of efficiency, prevention of errors, informationprovided to patients, and coordination of care. Of course, all equipments arethe latest and first class.  I cannotimagine similar operations anywhere else in the world.

3.      The US health careunfortunately is also the most expensive. Everything the staff, nurse ordoctor, and the patient touched is “used-once-and-thrown-away”. This includesgloves, gowns, needles, tubes, cups, and things I may not even be aware of.Part of the reason is the fear of being sued for malpractice. Privately,doctors even admitted some of the tests they order aren’t even necessary exceptfor self-protection. For example, during most of my stay, I was wakened everynight a couple of times to have blood sample drawn. Finally, when things beganto turn around, I simply refused these bloods taking at night and the doctorsagreed once I assume the responsibilities myself.

4.     As Dr. Gawande pointedout in his best seller, medicine is animperfect science. http://www.goodreads.com/book/show/4477.Complications Biopsy can miss as it did in my case. Routine surgery caninvolve complications. I am glad my decision analysis background helps me inreaching confident major decisions (Remember the first rule of decision analysis - Good decision does not guarantee good outcomes. What you can be confident about is that you did the best possible -Man proposes, and God disposes)

5.      Surgery nowadays hasmany options from  OPEN to Minimally Invasive Surgery (MIS). We opted fora compromise which still involved an incision from which a section of theintestine can be removed and rejoined. It is difficult for me to visualize howsuch intricate and delicate steps can be performed via camera and a couple ofsmall holes (particularly the removal of cancerous tissues and organs from suchholes without contamination).

6.      Anesthesia andsurgery nowadays are very different than 68 year ago when I had my tonsils out.In the pre-operating room, I was told that they are going to feed me somethingto relax me first. Next thing I know I am waking up in the recovery room. Allthe anesthesiologists assured me that they are aware of the sensitivity ofAsians to anesthesia.

7.      But incisions aremajor trauma to the body. Five days after surgery, it is still painful for meto move, sleep, cough or laugh. I could use narcotic painkiller with the dangerof addiction.  Thus, the recovery withopen surgery is longer.

8.      The total of seven daysof no food or drink during my two stays is not as difficult as imagined. The IVfeeding does seem to keep hunger pain in check.

9.      There is nothing moreimportant than you spouse during these times. Children love you and areconcerned. But they are far away, have jobs, and other constraints. Your wifeof 52 years can drop everything, sleep by you bedside in hospital rooms, andattend to your every needs, No wonder they say that the first one to die in acouple is the lucky one.

1     Again, I am grateful to all of you for yourconcerns. I should be back to my old self in due time.