An Efficient Arhroscopy

16Mar09
Epworth Hospital, Box Hill

The big black hands of her watch were out of proportion to the slender firm forearm of the physio. They showed 1:30, which meant I’d been there for 30 minutes, having arrived on time. She explained the likelihood that I’d be awoken around midnight as the anaesthetic wore off. Her advice was to take a couple of the painkillers before I went to bed tonight. Then she got into details about what I was to do for the next few days.
I was being prepared for an arthroscopy – needle-point keyhole surgery to remove the jagged torn edge of the meniscus on my left knee. I don’t know what caused it nor when it happened but the pain had bothered me for a few years. My regular physio was unable to relieve it so I chose to succumb to a surgical fix.

Today will be the first time I have ever been unconscious.

I’m impressed by the efficiency of this place. There are at least 30 people in the waiting room, all with appointments and all having earlier prepared at home, and mailed in a comprehensive profile of their medical history, as I had. Smart business transfer to their customers the responsibility to record and provide all their clerical data. These days this applies across all but the most backward interactions between suppliers and customers. In this case the supplier is the hospital, and the customer is me. Capturing my data this way reduces the hospital's cost, and also reduces its responsibility for the accuracy of the information. It assumes – quite validly – that I am truthful and have a good memory, so my medical history is correct.

I was checked in by a cheery and efficient Sri Lankan lady who processed the insurance aspects and payment of my share. It’s all convenient, efficient and painless. I subsequently learn there isn’t much pain at this place even though it’s a hospital. Perhaps painlessness is the best way to measure the efficiency of a hospital...

Back to the physio – I’m given instructions and a set of crutches. She says I’ll need them for the next 3 days. They’ll be collected from my home by the company to which the hospital outsources the supply. I simply call up to say I no longer need them, and supplier picks them up. All that efficiency for just $20.

I return to the waiting room.
Regardless of the venue, if I’m in a line, the other one always moves faster; and so it is here. By 2:00 I am one of only 3 people left. No problem, I’ve come prepared with The Economist that arrived this morning. The good stuff in it sustains me for another 30 minutes until my name is called and I’m guided to a small changing room. As instructed, I take off all my clothes, except underwear, and change into the hospital gown with the open back. My clothes and the man-bag into which my wallet, blackberry and various forms are placed, goes into a large paper bag that I’m told will go with my bed, so it won’t be lost or tampered with. More efficiency.

I’m pointed in the direction of a bathroom and invited to urinate. It’s a surprise there’s anything left because I’ve obediently have observed a complete fast since 7 am.

From the gowned waiting area I overhear a conversation between two men I can’t see. One is complaining about a new employment arrangement where they will get overtime penalty rates only after they’ve worked all their regular scheduled weekly hours.
“You can work a 20 hour shift early in your week’s schedule and not get anything extra.” complains one of them, “It isn’t worth it.”
There’s no response. The complainant goes on with more of the same. I tune out.

After a short wait and I’m guided into another room where there are several beds, with curtains for privacy. For about the 3rd time, I'm asked my name and date of birth. This handover procedure is obviously to ensure that the right surgeon gets the right patient (and vice versa). I wonder what disastrous mix up prompted this precaution. It’s all done in a friendly efficient manner.
Another nurse goes through the same name, birth date routine and proceeds to shave the targeted knee with a noisy and not very sharp electric razor that looks like an undersized sheep shearing device. An Asian woman arrives, introduces herself as the assistant to the anaesthetist. She too does the name and birth date thing, but adds an extra – she holds up the forms I signed earlier and asks me to confirm that the signature is mine. I deduce that I must soon be going under, and this is the last chance I’ll have to verify something visually. Then she wraps a wide band around my right bicep, explains that something is going to be attached, and takes my blood pressure.
“It’s 113 over 70. That’s good,” she says. It has been 110 over 70 since I was about 25.
Now the shaving nurse pours a cold brown antiseptic liquid over my balded knee and washes left and right, top and bottom. There’s a little friendly banter and good cheer. They leave me alone.
I reflect on how good everyone here is at their job; and how we are a nation of immigrants. Just as well – we probably don’t have enough capacity in Australia to find and train enough of these people to provide an acceptable level of service.
I’m very relaxed by the ambiance. Shortly, the shaving nurse is joined by another cheerful young Asian woman. They wheel my bed and me off down a long corridor. The view of the lights passing above reminds me of how this scene is treated in the movies. There’s an odd beeping sound, like a doorbell as we pass various doors to my right. Some system to ensure I get to the correct theatre?

I think of the time years ago in Perth, when I accompanied Timo all the way to the door of the theatre for the last operation he had on his hand. He had been so brave through all the operations he had in Thailand.
I recall the feeling of tenderness in my heart for him when we took him to the Mongkut hospital in Bangkok for one of those procedures. It was a military hospital that excelled at orthopaedic surgery, supposedly because they’d treated many injuries from landmines during and after the Vietnam War. That gave them opportunities to increase their knowledge of this type of surgery, and to hone their skills.
Timo’s visit coincided with a border skirmish on the Lao border, so there were a few injured soldiers, silent and in their blooded battle fatigues, waiting on gurneys. Tim waited on his in this line. “My brave little soldier", I thought. When his turn came, a perspex window was lifted and he was slid across a stainless steel counter into the antiseptic theatre area. Then the window was lowered.
He came out a couple of long hours later, so small and sweet and innocent with a tube from his nose.
That was about 7 or 8 years before the last operation in Perth. We were all pleased that the Perth operation would be the last for along time; maybe forever, which is how it turned out. And I remember being there as he came to. He half opened his sleepy eyes and reached up his arms, one heavily bandaged, to cuddle Papa. My soul swelled with love and a happy sense of responsibility for this wonderful young boy; our son. The memory of it prompts the same feeling.
We stop, and I rejoin the present.
I’m left in a small ante room outside what I assume is the theatre. There’s a view to some trees outside and I enjoy watching them wave in the breeze. It seems a good place to do a meditation so that’s what I do. Don’t know how long it took but I was interrupted by a woman who introduces herself as the anaesthetist. She too is a bright and friendly Asian, and exudes competence. “Usually,” she says “I have to go through a book of questions, but your case is only a couple of pages. You’re healthy and strong.”
She’s referring to the forms I filled in and mailed last week. They’ve efficiently moved from my desk at home to her clipboard outside the theatre. Her comments make me feel “healthier than the average bear!”
She explains what will happen, emphasising that nothing untoward ever does and that she’ll be monitoring me at all times. She tells me the name of a painkiller that will be fed in with the anaesthetic.
While this is going on woman wearing a blue wimple on her head appears from inside the theatre. She looks like a nun, and her accent tells me she’s South African. I suppress an urge to call her sister. She’s the assistant surgeon and asks me some other questions. I deduce that they are designed to cross check all that’s been answered before, just to make sure they haven’t missed or confused anything. I feel her draw the shape of an arrow above my shin, pointing to the knee that I’m here to have fixed. Then she leaves me alone.
The surgeon comes in, all cheery and hearty and says almost the same things everyone else has, but with a certain extra and comforting gravitas. I know now that I have to leave the bandage on for three days and then not remove the small waterproof plaster that’ll be left. He’ll remove that when I see him for the follow-up appointment. He makes a joke about the arrow. I feel pretty good about everything, and the anaesthetist returns. She sticks a needle in the back of my left hand explaining that I’ll soon feel like I’ve had a couple of glasses of wine, then I’ll wake up in the recovery area.
And that’s what happens.

I don’t remember anything and I wake up in another room, where another 5 or 6 people are waking up too. I’m not fully conscious yet. That comes slowly and in waves, perhaps aided by the comforting words from another pleasant Asian nurse. I feel neither pain nor even the slightest discomfort, in head or knee. There’s a plate of small sandwiches a glass of water and cup of tea. They disappear fairly quickly, although I don’t recall what they were.

Nor do I remember getting dressed, but soon I’m sitting in a wheelchair with my paper bag. I check that my wallet, notebook and instructions are still in the man-bag.
I’m dressed and ready to go and the nurse says Nena is on the way.
A friendly porter arrives to push my wheelchair. I recognise his voice as the complaining half of the earlier conversation about lousy overtime pay. He wheels me to the car. I hope he’s still on ordinary time.
It’s easy to get in the car and soon I’m home and the hunger gets me. Nena’s cooked the usual delicious Monday evening leftovers which tonight are lamb chops a la George Foreman, her incomparable potato salad and some veggies.
She has to go out, so I eat in a happy solitude, watching a live league game on television. I treat myself to ice cream. But no vino – I want to take those painkillers the physio assured me would deliver uninterrupted sleep.
The game finishes and I turn off the TV. I sit, following the physio’s instructions, with my feet up and open my laptop. Back to work, checking emails and working on a report I’ve promised to complete tomorrow.
Efficient use of my time I tell myself.
It's been a long day.