Misadventures in Medicine, A Cautionary Tale

Pointless Protestations

When I walked into our house, Whiskey ran around like a deranged maniac, excitedly barking at my safe return. I gratefully hugged and kissed my youngest, soothing her anxiety. This had been hard on her too. My wonderful mother-in-law had just arrived from New Jersey to hold down the fort. She would stay, as long as I needed her, to help out around the house and take over the cooking. She is an excellent cook and I could soon anticipate some delicious Indian grub coming my way. My husband was returning the next day and my sweet son was also coming from Idaho to be with his poor invalid of a mother. My loving family was gathering around, ready to help and support me through the challenging days ahead. I was home.

The morning after my discharge, I wasted no time and called the University Medical Center's Neuro-spine Clinic and requested a follow up visit with my attending physician (well, not exactly a follow up visit, as I had yet to actually meet the man). I was not ready to concede defeat in the matter of the brace. I managed to get a timely appointment for two days later. My husband drove me and I showed up full of hope that my concerns would be fully addressed: The doctor would be able to answer my questions. He would be able to work with me to modify the treatment plan to fit my needs.

To my unexpected disappointment, even though my appointment was "with" the doctor, the person I saw was, in fact, another physician's assistant. I had been misled. It was a classic bait and switch scenario.

Ms. Neuro-spine PA did her best for me and I give her credit for that. I expressed a lot of frustration and even some anger during that visit, but she listened, remained patient, and kept her cool. The problem, from my perspective, was that a PA is not allowed to think too far outside the box or modify protocols without permission. The basic job of a PA is to carry out the physician's treatment plan.

Ms. Neuro-spine PA, seeming genuinely concerned, made a special effort to impress upon me the seriousness of my injury and the necessity of following the protocol to the letter. "We don't want the fracture fragments to shift and potentially cause injury to the nerves," she warned. "No we do not," I concurred. Among other things, she reviewed certain parts of the draconian treatment protocol with me as follows:

· The rigid brace is to be worn at all times while out of bed or if elevated beyond 30 degrees. (This means that you cannot actually lie in your recliner without your brace, even below 30 degrees of elevation, because it is impossible to log roll into and out of a brace in a recliner).

· You must shower with the brace on (I have many problems with this rule which I'll come back to).

· When lying in bed without the brace on, you should remain flat on your back at all times (This was news to me. No one had told me this before and it wasn't written in the discharge instructions. Speaking of discharge instructions, I was astounded to read that I was allowed to resume having sex as soon as I felt comfortable, which not only seemed like a terrible idea, but very contrary to the strict nature of the protocol).

· You can lie on your side only if wearing the brace (So, if you want to change position in the middle of the night you must either put the brace on or take it off. Seriously?).

The remaining parts of the protocol not discussed during that visit consisted of the following:

· You must log roll into and out of the brace (Scooting, shifting, and wiggling are strongly discouraged here).

· No bending, twisting, or lifting more than a gallon of milk. (This is the one rule I felt that I could actually follow.)

· No sitting for longer than one hour at a time.

· The brace should be worn as tightly as possible. (Who needs to breathe? Maybe I should invest in that fainting couch after all.)

The treatment protocol was completely impractical, something that sounded good on paper, but wouldn't actually work in reality.