He's sick, I'm scared, and I'm 3000 miles away. Help!

October 8, 2005 8:19 AM

On Tuesday, my boyfriend is having an anterior cervical fusion of C5 and C6 as a result of being on the weak end of a car-bicycle collision. He's in Los Angeles. I'm in Boston. I'm worried, and I have lots of questions. How can I help?

He was hit by the car two Thursdays ago, finally made it in to see a doctor (long story) last Monday, and in the intervening week has had four separate and unrelated doctors, including two non-surgeons with no interest in unnecessary surgery, look at him and go, "Oh, shit, it's a good thing you're not paralyzed." So we're pretty sure this is the right thing to do.

Flying out isn't really an option, due to the expense and my job, etc., nor is it particularly necessary; he has family and friends in the area who will be around to help. It's rational for me to stay in Boston and go about my life; it doesn't mean it's what I want to do. I've basically been put on internet research detail, but I feel so very helpless and useless at this. I've offered several times to come out (and have a packed duffel in the hallway by the door), but he is also being rational about this and discouraging it, on the grounds that there will already be lots of people there and I won't be able to help that much; it would be better for me to save the time and money and see him when he's recovered.

Complicating the issue (for me, anyway, although I'm not mentioning this to him as it's one more thing he doesn't need to worry about) is my crippling, bowel-clenching phobia (self link) of doctors, medicine, hospitals, needles, etc.etc.etc. that puts me nearly into a crying, shaking panic attack when I think about all of this too hard.

So now for the questions:

Medical:
- What can he expect in terms of aftermath and recovery time? He's 37 and in good overall health, non-smoker, slender build, very healthy diet.

- Has anyone here had this procedure done? What were your experiences (good and bad)?

- What's the best way to treat a surgical wound so it heals quickly and with minimal scarring? What's the best way to prevent infection? He's considering using something like this, on the grounds that it will seal out everything nasty and won't need to be fussed with for a week. Thoughts? Why would this be a bad idea?

- His doctor has had a single malpractice arbitration judgment against him, for $1.2 million in October of 2004, but says that he hasn't had any deaths. Is this a large enough settlement to be concerned about? I'm taking it with a grain of salt, as I know perfectly well that very good doctors often settle malpractice disputes just to settle without going to court, but I'll admit that the size concerns me.

Legal:
- Is there a maximum inheritable value above which point the estate goes to probate court regardless of the existance of a will, or as long as it's under the $1.5 million mark (for the estate tax) does the will take precedence? (No, I'm not this ghoulish, but he wants to be prepared for the worst.)

- He hasn't contacted a lawyer and is unwilling to sue (variety of reasons). He has health insurance that should be covering all of this, so will they just go after the car insurance and leave him out of it?

Personal:
- What concrete steps can I take to help him from all the way across the continent? As I said, I'm on internet research detail, as he has limited time he can sit/stand upright, so I'm answering and trying to anticipate his questions, but it's so...little.

- How do I get control of my head? I'm keeping busy, knitting him a scarf, cooking, going out with friends, not letting myself be too alone, but often when I am, bad scary things start going on inside my cranium. I want them to stop; they're not helping him and they're not helping me, but I can't. I know some fear is rational, but I know this isn't.

Random:
- He has an returning residency visa for New Zealand, and was planning to move there (permanently) before all this happened. Will this affect his application for an indefinite returning residency visa?

posted by fuzzbean to health (14 comments total)

May I suggest calling the surgeon's office? You might not be able to talk to the surgeon directly, but a lot of surgeons employ a nurse who can answer questions for people like you.

Remember that we doctors are just folks; we put our pants on one leg at a time. We want to help.

Some neck stiffness for a couple weeks after the operation isn't unusual. That's the worst thing that is to be routinely expected.

The big deal is that the operation is in the vicinity of the spinal cord; if it weren't, it wouldn't be necessary in the first place. The whole point is to stabilize the spinal column so that the cord isn't damaged; so you can be sure everyone's going to be very attentive to this. When you have vertebral fractures or misalignment, the OR is about the safest place you can be.

So stay cool and let the experts do their thing.

Also, I'd recommend against sealing the wound - you'll never get it sterile under one of those things. Just wash it daily with water and a mild soap to get the crusts off.
posted by ikkyu2 at 8:34 AM on October 8, 2005

1: Calm down. The chances are very good that nothing will go wrong.

2: Don't seal the incision. Sealing it will make it hard to check how it's healing, and won't let it drain. I had lumbar fusion (posterior) surgery 8 weeks ago, and all they did was staple the incision and tell me to wash it daily. When he took the staples out two weeks later, he taped it to keep the surface edges from pulling apart. Now all I have is a smooth pink line.

3: $1.2 million isn't a large settlement in the world of medical malpractice, especially for a spinal doc.
posted by jlkr at 8:55 AM on October 8, 2005

"What's the best way to treat a surgical wound so it heals quickly and with minimal scarring?"

I had abdominal surgery earlier this year and the scarring and color was GREATLY reduced with Neosporin Antibiotic Ointment. The nurses, doctor and even my home health care nurse after surgery, all "crowed about it." I also used Vitamin E oil, as pure as you can find, from the local pharmacy. I used both of these multiple times per day, and must say the results were "as advertised!" Six months later all I have are faint, pinkish, scars and I can tell they will be completely diminished at the one year point.

As far as covering the wound, I'd went with what my post-op nurses told me - keep the bandage/dressing on for the first week, then just the daily cleaning, showering and Neosporin routine. Good luck to you both!
posted by thebarron at 9:03 AM on October 8, 2005

I had abdominal surgery earlier this year and the scarring and color was GREATLY reduced with Neosporin Antibiotic Ointment. The nurses, doctor and even my home health care nurse after surgery, all "crowed about it." I also used Vitamin E oil, as pure as you can find, from the local pharmacy. I used both of these multiple times per day, and must say the results were "as advertised!" Six months later all I have are faint, pinkish, scars and I can tell they will be completely diminished at the one year point.

As far as covering the wound, I'd went with what my post-op nurses told me - keep the bandage/dressing on for the first week, then just the daily cleaning, showering and Neosporin routine. Good luck to you both!
posted by thebarron at 9:43 AM on October 8, 2005

I've been through significant other health situations. It's hard, whether you're on site or not.

In the meantime, I think that the best thing you can do is seek treatment for your medical phobia. Cognitive behavior therapy can do great stuff in a short time. I wish you (both) well!
posted by Carol Anne at 10:40 AM on October 8, 2005

fuck that rationality shit, GO! I did not spend as much time at the hospital as I wanted to when a loved one of mine was there and I have come to see my privileging of a 'rational' response as factuallly incorrect (it was a denial response, not an actual rational response) and one of the greatest mistakes I ever made.

Not what you asked for, but my two cents. Spend them as you will.
posted by mwhybark at 10:51 AM on October 8, 2005

I have to go with mywhybark here, you sound agonized over not being there, no matter what he says would like you there, and the rest is just details. You are not "being rational" : you are rationalizing.

Best wishes for a happy outcome for you both,,,
posted by Rumple at 11:11 AM on October 8, 2005

Bicycle content: I ride (regularly) with a gentleman who had a similar operation and he is fine, no ill effects. Chances are this will turn out very well. It's not like falling off a log, but it is a pretty common procedure. Best to you both.
posted by fixedgear at 12:02 PM on October 8, 2005

RN input here-

I understand that this is VERY difficult for you, and want you to know that you are not alone in feeling this way. You are so far away and there's nothing you can do to help other than offer emotional support and send silly gifts- but doing that is important for everyone's morale. It's also normal for you to be thinking about worst case scenarios. Write down all of your questions, even the ones you are embarrassed to ask, and call the doctor's office and talk. As ikkyu2 said, it's part of the job. Someone will take the time to answer all your questions and most likely they've heard it all before.



As for getting this out of your head, well, it's going to be there. The question is not how to get your thoughts out of there but rather how to channel them in a more positive direction. A friend of mine aften says, "what are the opportunities for growth here?" and sometimes I just want to smack her upside the head, but she has a point. Do you pray? This might be a time to work on your relationship with whatever you believe God to be, or about channeling your thoughts in the direction of sending healing loving thoughts to your friend. I have a piece of jewelry that I wear in times of trouble- it reminds me that I have been in this place before and that I am strong and can get through it again. The time will pass and everything will be fine. Use this time constructively and you will emerge a better stronger person and partner and friend, and someday you will be able to use your experience to help someone else get through their troubles.
posted by puddinghead at 3:14 PM on October 8, 2005

I meant OFTEN, of course. And I wanted to add my best wishes and thoughts to you and to your friend.
posted by puddinghead at 5:48 PM on October 8, 2005

For you:

Stay busy. Do stuff. Be with friends and family. Whatever it takes to distract you. Especially since you recognize your own phobia.

Medical:
He'll likely have to do rehab. You haven't said, why they're fusing the spine. I'll assume some bone material is damaged? What did they tell you about the length of his rehab?

I used to work with post surgical patients. Keep in mind, doctors want successes in orthopedics. They generally don't want to operate, unless they know the outcome will be well.

Much malpratice is settled out of court. The size is what was agreed between Lawyers and Insurance companies. Priced high enough that everyone got paid. Keep that in mind.

Legal:
Was it just this week? He probably feels overwhelmed. Ask if you can be involved by helping him cover his ass legally, just in case. A good friend (who is that kind of lawyer) believes that if the "be safe" is just to keep good records. Ask if there is any paperwork, any phone calls you can do (and this will give you helpful stuff to do, rather than fret.)

Getting control of your head:.
It's good you know the fear isn't rational. Somewhere you must have had an awful experience with medicine. Think about how many babies are born each day! Look around...every person around you managed to be delivered. The accident was far more serious than the surgery.

Residency:
Ask him if you can check anything for him, sign forms, talk to someone.

In other words:
Be a good supportive girlfriend (which you're already doing). Find some stuff to keep you occupied. He's had at least a second opinion, it's very likely that the surgery is necessary...and I used to see lots of people who had some form of spinal surgery.

Oh, and everyone here is hoping that this go well.
posted by filmgeek at 6:23 PM on October 8, 2005

I have done the anesthesia for these surgeries many times over the past 15 years and I have to say that it is all extremely safe. Assuming the patient is young and healthy the biggest danger is of course injury to the spinal cord. The anesthesiologist and surgeon work together to minimize the risk and I encourage your boyfriend to read some and learn about the surgery preop and have any questions thought out ahead of time; then ask them. I have talked to many people who were afraid of something before their surgery but felt they would be thought foolish if they asked about it and thus their fears were never allayed. Of course this is a big operation and it is reasonable to be concerned, but in reality the riskiest time for a patient is walking around with an undiagnosed cervical spine injury.

As far as scarring goes, it is usually minimal after this surgery because the skin on the neck is not under a lot of tension and tends to have a lot of little wrinkles that help hide the scar. The best way to minimize scarring is to keep the area clean and follow instructions. The bandages you linked to seem relatively harmless compared to some of the home remedies I have seen patients use (garlic and honey seem to be popular, and both can lead to nasty infections) but I would still not use anything without asking your surgeon or his nurse about it. Many factors affect the degree of scarring after a surgical incision, and if someone happens to get a nasty scar, it can always be revised later by a plastic surgeon.

A single malpractice award may or may not be significant (but probably isn't for reason mentioned above. Since your boyfriend has family and friends in the area, perhaps some of them have ties to the medical community and can make some inquiries as to the surgeon's reputation among his colleagues.

My final thoughts are that if you cannot visit for the surgery, find out how long he will be out of work, school, whatever and think about visiting toward the end of this period, perhaps coordinating with his family. If his convalescence will be more than a week or so, people tend to tire out/drift away and a reinforcement of caregivers is a big help. In the end, though, that decision is between the two of you. Good luck to both of you.
posted by TedW at 7:08 PM on October 8, 2005

Thanks to all for the input and kind wishes and luck; I'm distracting myself as I can. I'll post an update on Tuesday evening (unless I'm flying out to LA, in which case not so much).

Does anyone know what the expected follow-up is in terms of post-release rehab and activity? Right now he's scheduled for a post-op follow-up on Nov. 3; apparently after that visit, if all is fusing as it should be, he's free to go about his business. Rehab hasn't been mentioned, and I haven't seen it commonly referred to in my net diggings. What I've seen is mostly, go home, wear the collar, and walk around as much as you can. Helpful, that.

How often do people go into this *without* pain and come out with it? (As of right now he doesn't hurt much at all; it's making him question the wisdom of this all over again.)

ikkyu2: I haven't spoken with his surgeon but I have spoken with an orthopedist's office at Beth Israel in Boston; he was very reassuring. Our concern is still the unpredictable outcomes; no reason to expect them but...what if? (Yeah, I know, I know.)

mrwhybark and rumple: Two cents appreciated, but he's told me pretty firmly that he doesn't feel that I should come out. I've made it clear that he can change his mind at any point (and am toting around a packed duffel), but he's discouraging it strongly. My other (unstated) reason for reluctance is my awareness of my own weakness when it comes to this; it won't do him a damn bit of good for me to come out and spend all the time in the hospital coiled up inside myself keeping myself together. I'm really not good at hospitals.

filmgeek: He's got a tear to the ligamentum flavum and a post-traumatic disc bulge at c5/c6, a partial tear of the posterior longitudinal ligament, and a fracture of the superior articular process of C6. We've both had some reasonably traumatic medical experiences, both personally and with close relatives (ie, his mom died after being infected with MRSA by a careless surgeon, after *almost* dying in the OR, again from his carelessness), which makes us very...wary of the medical profession in general (no offense intended to the people who've commented here; I very much appreciate your input and viewpoints).

TedW: His surgeon comes highly recommended (he found him through a wife of an employee of a friend; the wife had worked for the doctor in question, I believe, and apparently other doctors refer their staff to him for surgery). We've researched the procedure extensively and have a pretty good handle on what's going to happen during the surgery; it's post-surgical recovery and rehab we're now worried about--and there's a lot less I can find on that online.

Again, any input is welcome; if anyone is interested in seeing the MRIs or x-rays I can be reached at my username at gmail. Thanks to everyone for the kind wishes. I'll let you know what happens...hopefully it'll be him flying over here in mid-November once all this is past us.
posted by fuzzbean at 10:53 PM on October 9, 2005

Alive, awake, coherent. Surgeon said it went perfectly and was totally necessary.

Marginally less frightened.
posted by fuzzbean at 8:42 PM on October 11, 2005