Random Stew It seemed like a good idea at the time.


Be Careful What You Wish For

I recently wrote about the difficulties I had getting an appointment with an ENT to fix a broken nose. I finally was able to see an ENT six days after breaking my nose. He came into the examination room with Michael, a medical student functioning as his assistant.

After a bit of chitchat about how I broke it while training for a black belt test, the doc examines my nose and X-rays (yes, it's broke). He said the nasal bone had a broken piece that was crushed inward and needed to be pushed back up into place. He then asked me if I would like to schedule a surgical procedure to set my nose or if I wanted him to go ahead and try to set it right then.

fistofcashI hate to admit it but, as someone who is self-employed and carries a high-deductible on his health insurance policy, when he said "surgical procedure" I swear I heard the cha-ching of a cash register.

"Doc, if you can set it now, go ahead and do it," I said. "But you hear that 'if' loud and clear, right?"

The doctor assured me that he both heard and understood exactly what I was saying. He then shot some topical anesthetic up my nose and told me he'd be back in about 15 minutes.

Fifteen minutes later, the doctor is back and asks me if I'm ready. Like a fool, I said yes. Michael, the medical student, tells me he has a morbid excitement as he's never seen this procedure performed. In hindsight, I should have handed him my cellphone to video the next couple of minutes; I'm sure it would've gotten a million hits on YouTube.

fingernoseeyeThe doc quickly puts on a glove, squirts a lubricating gel on his finger and rams his finger up my nostril, pushing on the misplaced bone fragment with all his might.

Now I know that I only had a broken nose -- not a major injury. But, trust me, having someone jam their finger up your nose, pressing on a broken bone, is a very intense experience. He literally lifted me out of the chair by my nostril. Still, that didn't work. He quickly reaches over and grabs an instrument that resembles a reinforced, stainless steel coke spoon. He jams that up my nose and starts prying on the bone piece to pop it back into place.

It was toe-curling, testicle-shrinking pain.

As this is happening, I glance at Michael and he's actually cringing!

At the very peak of the pain -- as I'm about to attack the doctor to make him stop -- the misplaced bone pops back into place. Instant relief. In fact, I felt high from the sudden relief and the huge amount of adrenaline that I'm sure was pumping in my system.

The doc then packs some gauze and antibiotic ointment in my nostril. While the doc applies a hard shield over my nose, Michael starts gushing about how he couldn't believe what he had just witnessed and he'll be telling stories about me forever. I'm so glad I could impress him.

The doc gives me a prescription for a few Tylox and some Percocet. As I checkout of the doctor's office, I joke with Michael and the office staff. In my 'sudden pain relief' state, I didn't notice that I did not receive any care or follow-up instructions. I go get the prescriptions filled and am actually feeling pretty good about now, even posting my picture via mobile upload to Facebook.

painThat night, however, the pain begins again. And worsens. And worsens some more. Tylox is not making a dent in the pain, but it is making me almost comatose. All Wednesday night, Thursday, and Thursday night, the pressure and pain is horrible. Almost to the pain point I felt when the doc was setting my nose. I'm thinking I have a raging infection in my sinuses and call the doctor's office. Unfortunately, I miss their return call but their message says I cannot have an infection due to the antibiotic ointment and to just continue with the painkillers.

On Friday, I call the doctor's office again, looking for an appointment with him. Instead, they say I already have an appointment scheduled for Monday and instead write a prescription for more painkillers but say I must come pick it up. After two nights without sleep and constant use of painkillers, I can barely walk around the house so I must wait until the afternoon when my wife can pick up the prescription. When she goes to the doc's office, the doc's nurse -- his normal assistant who was not there on the day I went -- tells my wife that I should continue with sinus washes. Sinus washes? I was never told anything about that.

So, while my wife was having the prescription filled, I give myself a sinus wash. An hour later, a huge plug of gauze, blood, and slime comes sliding out of my nose (sorry, no pictures). Again, the pain relief was immediate. A couple of hours later, I do another sinus rinse. And again, another plug comes out of my nostril. Now the relief is complete and the pain is gone.

On Monday, I see the doc at my appointment and he commiserates for a moment about my suffering. I told him about the sinus washes and the plugs; he nods and says the plug was probably pressing directly on my nose break. As the gauze absorbed more blood and slime, it grew and pressed all the more on the break. He apologized profusely for the lack of post-procedure instructions.

So now my nose is set and healing. In about 4-6 weeks total, I'll be able to start sparring again. Hopefully, I'll be a little more elusive when my opponent throws a big overhand right over my jab. If not, I know which of the two treatment options I'll choose.

Pain is only valuable once you know that you've learned from it. --Anonymous

And for those of you who say I should choose a more benign pasttime,

Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever. --Lance Armstrong


Of Broken Noses and Health Care Systems

As I wrote a couple of weeks ago, I've been training hard in preparation for a black belt test scheduled for this Saturday. Thursday night, I sparred with several visiting black belts who had graciously agreed to participate in my testing. Unfortunately, one of them caught me with a punch that broke my nose.

"Yet who would have thought the old man to have had so much blood in him?" - William Shakespeare, Macbeth, 5.1

So, Friday morning I call my doctor to see about getting my nose fixed. Unfortunately, my doctor was moving his office to a new location and could not see me. So I ask the receptionist if the doctor can just refer me to an ENT specialist.

"No, the doctor cannot give referrals without seeing the patient first. You'll need to go to Urgent Care."

"Can you make an appointment for me at one of your practice's other locations? With another doctor?"

"No, we've already booked up all the other doctors with referrals today. You'll need to go to Urgent Care."

Instead, I decide to call my insurance company to see if I can just make an appointment directly with a specialist, cutting out the middleman as it were. Yes, it turns out I can "self-refer" to a specialist as long as they are a participating provider.

So, I call the ENT and spend the next 30 minutes arguing discussing whether my insurance will allow self-referrals or not. Finally, they call my insurance company and find that I was indeed correct.

"Our first appointment for a non-referral is December 23.", I'm told.

"That's 11 days from now! I'm self-referring; what do you mean by non-referral?"

"You don't have a referral from your doctor."

"If I had a doctor's referral when could I be seen?"

"In 3-5 days, when your swelling subsides."

Arrrggghhhh... I feel the rabbit hole open up beneath me.

I give in and go to Urgent Care. After only two hours, I'm seen by a doctor. I tell him that all I want is a referral to an ENT. He says he can't give a referral without a diagnosis and he needs X-rays to ensure I have a broken nose. He ignores me as I volunteer to ensure a broken nose by punching myself in the nose.

So, I have X-rays and, yes, my nose is broken into 3 pieces (surprising given that I don't think it's that misshapen). The doctor says he will give me a referral to an ENT. Great, I think, I'm on my way.

The staff member charged with dismissing me tells me that I'll need to take my X-rays to the ENT when I see them. So, I ask if I can just have the X-rays right then to save a trip later.

"No, you must have an appointment with a specialist before we can release your X-rays." he says with a kind of sigh that tells me the he's been down this road before.

"But they're my X-rays! Why can't I have them? And once I have an appointment with an ENT, how are you to know whether I'm telling you the truth anyway?" I argue with him.

"I know. The system is screwed up isn't it? All I can tell you is that you need an appointment first."


I walk out of Urgent Care and call the ENT, hoping to get an appointment and immediately pick up my X-rays. The ENT has not received the referral from Urgent Care. I'm amazed that such things aren't automated, but apparently Urgent Care usually faxes referrals. The appointment manager at the ENT tells me that Urgent Care is usually prompt with referrals and since it's now late Friday afternoon, I should call back Monday morning for an appointment.

Monday morning comes...still no referral from Urgent Care. Monday noon comes...still no referral from Urgent Care. I call them and am told that they're running behind from the weekend and will fax the referral shortly. Monday mid-afternoon comes...still no referral. I call again and ask if I can pick up the referral in person to take the ENT. Of course not.

Tuesday morning comes...still no referral from Urgent Care. Tuesday noon comes...you guessed it, still no referral. Finally, the ENT staff has pity on me, calls Urgent Care, and has the referral faxed immediately. I wish they had done this yesterday.

So now I can make an appointment with an ENT. Unfortunately, the earliest opening they have is at 3:15pm on Wednesday at their office on the other side of town. Oh, and they'll be "working me in" so I may have to wait a while. Want to bet that they look at my nose, confirm that it's broken, and schedule another appointment to fix it?