The Surgeon patient or the Patient surgeon
In December 2010 after reaching the age of 70 and practicing for 38 years, the last few years being a part timer, I decided to I hung up my scalpel, concentrating more on travel and golf, traded the frigid winters of the Northeast to the Sizzling hot summers of Las Vegas and became a patient instead of being a care giver Surgeon, being called a Mister instead of a Doctor. My days of dealing with patients whose main life schedule revolved around doctor’s appointments, found myself doing just that in the early days of my retirement. The healthy strong as an ox, never really had a personal physician, taking care of myself, found me with all kinds of maladies, undergoing 7 surgeries in a space of 4 years, dealing with Ca of the prostate to benign tumor of the Laryngeal area. Too much hot sun in the summer required several trips to the Dermatologist and an Allergist found me allergic to a variety of substances, I never had. It’s a tribute to the Surgeon’s can do spirit, that we were able to manage multiple trips around the globe and a few surgical missions, timing those surgeries between trips. Interspersed with these was a marathon, angst ridden, month long malpractice trial which fortunately went my way. One can only mutter to one’s self, what a beginning for the rest of my life!
Transitioning from four decades of being a doctor to a patient is huge. I remember the early days of my practice in the suburbs of New Jersey, which was an hour away from New York, getting into town in a 2 way road with chicken coops close by, surrounded by farms and orchards, and a newly minted hospital with 120 bed. Transform that now to a bustling town of over 31,000, with an immediate area of over 200,000 residents in highly urbanized New Jersey with wall to wall houses. That road to town, now a 6 lane highway, gone were the chicken coops and most orchards replaced by subdivisions, and that little hospital have grown to around 300 beds in 2010 all computerized with 450 doctors. I still remembered being compensated with a bag of apples for saving the life of a migrant worker, a Jamaican apple picker, shot 7 times in the abdomen and back, for demanding that he be paid back the money owed him, by another worker. How about that oriental farmer who gave me a tray of fried rice after removing a large cancerous tumor in his arm, profusely thankful he was finally rid of a recurring problem. Those were fond memories of grateful patients, whose sincere gestures were worth more than the money they lack, certainly more than that Wall Street guy, arguing about his co-pay.
Though I still enjoyed taking care of patients, the hustle of dealing with insurance companies, the increasing practice regulations, the EMR with their bullet points, aggravated by back to back 16 inch snows and ice made me heed my children’s advice to quit and get closer to the West Coast, where they all live.
Las Vegas is not the Garden State of New Jersey and that’s evident as our plane prepared its descent, passing the Rocky Mountains, the Grand Canyon and barren deserts with patches of green, ultimately visualizing the iconic landmarks of Las Vegas, its casinos along Las Vegas Boulevard, as it landed and taxied on the tarmac, within 3 miles from the Strip. Everything in Las Vegas, with good traffic, is within a 15 minute drive from the Strip, served by 2 main highways and wide multilane tributaries leading to your own neighborhood, many times a short distance from the mountains surrounding the valley. The attraction of Las Vegas beside the dog days of summer is its weather, year round golf and of course, the Strip. Where else could you boast living in a city where you could walk to Caesar’s Palace, enjoy the fountains of Bellagio, ride the gondolas of Venice, eat gourmet foods in Paris, see the sites of New York in a roller coaster, go inside the pyramids of Luxor and in the evening have a choice of shows to watch and go to sleep in one of those luxury suites, which puts to shame a Trump Hotel’s best.
My introduction to Las Vegas medicine began with my Family Practitioner, an Internal Medicine Specialist in a big group, who came with a stethoscope around his neck and clutching a laptop computer to input my medical record. Accustomed to the touch-feely doctor patient relationship back East, I was a little disappointed that his stethoscope never left his neck, nor did his hands put down the computer. He sent me to a Cardiologist to follow up with my Cardiac Meds and a stress test. I can never even remember the face of the first Cardiologist I had, whose main contribution was to put his stethoscope on my chest, a Chinese American who left for the Midwest after the follow up for my Stress Test, which in itself was a little stressful . I was used to the Cardiologist administering the test right next to me, but this time, all I had was a PA. When I asked him whether the cardiologist was within the building and he answered no, he is either in another office or in the hospital. Alarmed, I asked him what he will do if something happened to me during the test, his answer wasn’t reassuring, you won’t have one, if you did, we’ll send you to the ER. Later on, I learned from an Internist Classmate of mine that she did have an MI during the Stress Test and had to argue with the PA to call an ambulance instead of driving to the ER. Even though he knew that I was a doctor, he made it a point to address me as Mister, and with a few exceptions, everybody seems to do the same, must be a reminder to make you behave like a patient, you are not in charge anymore.
It takes a lot of patience and tolerance, not to argue when you know that there is something amiss. My wife went to our Family Practitioner for a follow up mammography, which she does every few years in New Jersey, and when she came out I asked her where her mammography request was and she answered, none. She was told to just go to the x-ray department which she did and was out in a couple of minutes. When I asked whether there was any doctor checking the mammograms and the x-ray Tech answered none. I was used to a Radiologist reading the mammograms right there and then, checking and repeating the films if necessary, before the patient is allowed to leave and that was for everybody on the schedule. Suffice it to say, that nobody called to give the results of the mammogram, you are left to assume that it must be OK, or maybe they just plain forgot or a symptom of Las Vegas Medicine. When I had my surgery for my larynx, part of the workup was CT Scans from the neck to the groins and as a routine I get copies of the CD before leaving, and after a cursory look at it, it seemed OK to me. Months later when I visited my Family doctor, and news to both of us, the radiologist found something in the chest which he wanted to follow up, a few scans later it was concluded that it is probably a scar tissue. With a history of Ca of the prostate and a laryngeal tumor, how callous can one be, but that was the surgeon thinking. Have those close relationships and personal vigilance passed, have we become just numbers to a busy practitioner or a mega group? I don’t know, as I fumbled for the schedule of my appointments and lab tests, I seemed to have misplaced it. Senior moments!
A week ago, I had a follow up visit with my friendly Ophthalmologist, a son in law of my friend and we had a longer than usual conversation about the family and the present practice of medicine. Most of his surgical patients are in the high risk geriatric group, like cataracts which I had done already, those $2,500 per lens for far and near vision sure gets rid of the eyeglasses. He got a notice from Blue Cross Blue Shield, addressed to all ophthalmologist, that they would not pay for the Anesthesiologist for Cataract surgery anymore, probably giving the onus to the surgeon to give the anesthesia as well. Considering that it is but a 10 to 15 minute procedure, they probably thought, what could go wrong in that short period of time, the same could be true for the Gastroenterologist. Imagine what would happen when a multi-risk patient suffers a cardiac or respiratory problem, while in the middle of the surgery. Sometimes these corporate geniuses need to put themselves in the patient’s place for them to realize the dilemma they have created, to put better numbers in the bottom line. So folks brace yourselves, you might have to keep one eye open while you are having surgery, so you could check the monitors or hold the instruments in place while the doctor is resuscitating you. Now, don’t you feel good about being a well informed patient.
Honorio M. Cruz, MD, FACS