Exit Appendix, Stage Right

by Norman Clothier, M.D.

Last week, for the first time, I needed to use the facilities. I mean I really needed to use the facilities. In fact, over a period of 36 hours, I used the ultrasound machine, the CT scanner, the operating room, the recovery room and a medical/surgical hospital room.

That's right. Last week I became an inpatient at my own hospital facility. I had an emergent appendectomy.

I'm sure many an article or text has been written about the classic doctor-becomes-the-patient scenario. I want to share a few slightly different insights into my initial and — hopefully final — hospital stay. Some of these may be unique to us as family physicians, and most have changed my perspective on a few hospital and treatment issues.

The first is that it sure is nice to be a V.I.P. in the facility. I believe that I benefited from knowing all the nurses because I admit my own patients. I was admitted by my friend, The Surgeon, and I must say I was pleased not to be admitted by a hospitalist whom I had never met. I have recently discovered that some family practice privileges may be in jeopardy at another Metroplex hospital because of views held by the Joint Commission on Accreditation of Healthcare Organizations on the family-physician-versus-hospitalist issue. Some of our core privileges may be lost because some have chosen to stop making rounds on their own hospital patients. I am pleased that my own doctor could have rounded on me at any given time while I was in the big house. In fact, I was with myself the entire time.

The nurses really bent over backward to please me. In fact, all four who failed to start my I.V. line until the sixth try were very polite and caring. While writhing in pain and awaiting pain medicine, it is annoying, to say the least, to experience progressively more pain with each subsequent stick to the hand. Perhaps I gained a little more compassion for those in pain and an understanding of the frustrations of delays. I also learned that the huge bureaucratic push to the 1-to-10 pain scale may actually add more pain to the situation than simply the edema of the appendix. How many times must one answer whether the pain is “an eight” or a “nine” before medications can simply be administered as ordered? I certainly never felt like pausing to draw a sad face or point out which expression best fit my McBurney's point sensation.

I also learned not to label myself as “odd” too quickly. Knowing what I know of laparoscopic-with- possible-conversion-to-open procedures, I declined to allow blood products on my consent form. At the time, I felt confident that my surgeon would not accidentally (or intentionally) dissect my aorta. However, it soon became clear that I had crossed the hospital the wrong way. Suddenly, everywhere I looked there were full-sized paper signs emblazoned with bold letters in huge type: PATIENT REFUSES BLOOD PRODUCTS! Flashing through my mind, I imagined hushed conversations about what could be wrong with me, or perhaps what mind-control cult had taken charge of me. I thought an ethics consult might be forthcoming and perhaps I'd be placed on “DNR” status, with haunting wails of “You should have agreed to the blood” spewing forth as the room grew darker and darker. I had become noncompliant. Oh, the horror of it all!

I also found that I have more friends than I realized. After my 3 a.m. surgery, a seemingly endless stream of well-wishers came through to observe my predicament. While very kind, it was also exhausting. Listening to various people in the hall trying to divide my practice and possessions, and talking about my “placement” was also a bit disheartening.

Although I have not yet received my bills, I also feel sure that, despite all of the gripes and complaints over time, I’ll certainly be glad that I have insurance.

Additionally, I served as proof again why God blessed women with the ability to have babies, while men stand by talking about how easy labor must be compared to kidney stones. My wife is expecting our eighth baby. If in a reversal of roles, I gave birth, we'd have a single child.

Finally, I learned that appendicitis really, really hurts. Next time I have it, I'm going in sooner, and I'll start my own I.V.