29 attempts to pick up 1 peanut

I have not been posting because even mine own ennui has become boring.  Not worth a groan, an utter waste of a moan.  An insult to adjectives, a baseball bat to the knees of my home-grown adverbs, really culled from your community gardens, picked wet with dew, the gourd mature yet not so large as to be tough, too seedy, but packaged under my name -- printed on squares of cellophane, attached with high tech red rubber bands.  Eggplant, cucumber, climbing the vine beans, I want them tender.

Surgery has been put off a bit, again, this time until June 18, something to do with giving more time to yet another humeral fracture to heal.  I don't know where they're coming from, these breaks.  Fred doesn't beat me about the upper arms. Marmy Fluffy Butt has stopped gnawing in an ill-advised attempt to strike tuna in my marrow, and terror in my heart.

I think a lot about dying.  That's right:  the height of ennui.  Fred even said, "I feel like I am just sitting in this chair waiting to die."

These are the dangers of days so hot and humid that we lose hope and our buttocks carve our cushy futures into the cheap styrofoam of way past cool paisley wing chairs and roll-about PETA-sanctioned pleather office furniture.

Between now and June 18, I need to have my right hip evaluated.  Maybe it'd be more accurate to say "located," because I swear it's gone off again, road-trippin'.  It was on my list of things to do, right after "everything else." However, it seems that during my ICU psychosis, I went on and on and on about how effing much my hip hurt.  To ShoulderGuy OrthoWizard, no less.  At a recent meeting, he intoned (and intoned is the only verb that works here), "I was very angry with you for not telling me about your hip."

Far be it from me to avoid repetitive testing that will clarify nothing, eat the stray orts of my checking account (influence of NYT Cross Word Omnibus) from among the other detritus seeding my dirt-strewn floors, or just shout out about insanity, frustration, pain, and crap like biofilm infection....

Good news?  The clonazepam is greatly helping quell the spaz attacks.  I am down to about one visit from the automatic shimmies a day.  The cost is worth it -- I feel very sedated.  Word is, though, that I'll adjust.  Even if I don't, even if I sort of slant-smile and fail to blink my way through religious services and medical appointments, that's fine with me.  God, or someone, finally took me seriously -- I cannot tolerate the dystonia, the jerks, the nadir of me.  Thank you, God, or someone.

There have been some supremely funny moments here at The Manor.  The telecommunications installer who couldn't stay because he was allergic to cats, forgot the protective cones to.... protect himself, and failed to bring the necessary equipment as detailed in the work order... which he'd love to go over with us but he was starting to itch and did I have any Benadryl?  The third instance in as many years of a person asking me if I knew their friend X, who was also in a wheelchair.  My 29 attempts to pick up a peanut off the floor using one of my new grabbers.  I mean, seriously, who keeps going after, say, the fifth time?

Oh, and the doctor whose name I did not recognize from his $1300 bill.  Something made me check his licensure status.  License?  What license?  Absolute giggles set in when I noticed that my insurance company paid his claim, in its entirety, without batting a corporate eye.

just a few of the available assistive devices.
29 attempts, people, to pick up a freaking peanut.

I'll try to write more, and better, soon.

sunday night check-in

i apologize for not "checking in" before now -- and hope to post something worth a read tomorrow or tuesday.  my legs are giving me fits, and the pain/fevers/chills from the infected shoulder make me a very uninteresting person, indeed.

saw the surgeon thursday, and remembered why he and his staff will always be heros to me.  what they are attempting to do for me is technically and medically difficult, something my go-to-guy doctor and i both tend to forget.  so it mattered to take a few minutes thursday to recognize that fact.

the down side of such emoting was the ensuing hug fest -- which rapidly degenerated into friendly shoulder pats that nearly made me scream.

there was one little bit of unexpected news.

dr. shoulderman was trying to walk me through the process and i was only half-listening, as this is not exactly new territory.  he'd gone over the ins-and-outs of the first surgery, talked about the need for a new infectious disease specialist, the PICC line, and 6 weeks or so or intravenous antibiotics.  (he briefly cradled his head in what might have been exasperation at the news that i was still taking oral doxicycline when surgery was 10 days away.  so shoot me... no one told me to stop and it just did not occur to me that it would screw up the culture sampling.  i stopped taking it thursday and pray that was soon enough for it to exit my tissues.)

he paused, and i entertained notions of actually going home and curling up under a few inches of soft flannel, as i just could not get warm.  i have even resorted to covering my feet, something that causes severe burning pain, as even my feet feel cold these days -- and this, after a decade of sleeping with them uncovered.  i also thought about trying to line up the roto-rooter treatment for my port, which, at the moment, will allow stuff to be administered but will not, in turn, surrender any blood for testing.  and, to be honest, there were some thoughts of stopping somewhere for lunch.  i was thinking taco bell when dr. shoulderman's voice took on a new tone...

"after 3-6 months, if all goes well, we will want to go in and remove the spacer, of course.  if it appears successful and we find no obvious evidence of infection, there are then two choices."

i think i probably smiled.  i didn't know i had choices!  this was great news!  i thought there was just the one option, the option we had bandied about for over a year -- the old reverse total shoulder replacement.  a woman with choice, a woman with options, now that's a happening woman.  i put taco bell and roto-rooting plans away, and tried to pay attention.

"we can put in a new prosthesis..." he said this in the most desultory way, as if it were something too awful to contemplate.  odd, i thought, since that is, of course, the best outcome -- a clean shoulder, a new bit of bionic wonder.

"i thought of you last week as we finished surgery on a gentleman in much the same situation. i put in a new prosthesis, the frozen sections looked good, it seems like he had beat the infection.  then eight days later, i get a call saying that something has grown in his cultures -- p. acnes.(this is the major suspect in my case, as well) -- and now he is back on the merry-go-round."

why, dr. shoulderman, that sounds suspiciously like a cautionary tale!

more sober talking, more somber scenarios in which it looks like i have beat the pathogens all to pieces when, behold!  the suckers were just lurking in the hope of reasserting themselves on some new implant.  there were dire descriptions of the state of my bones (no news there), and at the opportune moment, shoulderman shifted gears...

"and so it may very well be that at the time of the second surgery, i will have to assess the situation and consider leaving you with a flail shoulder."

the smile stayed on my face because i had not the least notion of what a flail shoulder was.  i knew the term flail chest from some EMT courses way back when -- and knew it to be a horrible trauma that basically unhinged the rib cage in folks who slam into the steering wheel in a car wreck.  inane smile still plastered on my face, i interrupted to make my inquiry into our brave new lexicon.

turns out that flail shoulder is the polite surgical term for no-freaking-shoulder-at-all.


in truth, this result had been mentioned before, but only in passing, and only, i thought, as a conversational oddity, a bit of ripley's believe it or not.  i remember, most specifically, my go-to-guy doctor whispering, several years back, "this is not going to end well."

dr. shoulderman, kind and handsome, talked on.  some people were able to train themselves to use scar tissue as a kind of new muscle, thereby allowing for some arm movement. i was particularly thrilled to hear that "some people can learn to bring their hand to the mouth."

unfortunately, even the most scintillating of conversations have to end (this one, as that one!).  but i've carried on the talk inside my head, a few minutes at a time, more if the fever spikes a good bit and my frustrations pop out.  i keep imagining what ifs that don't help one bit but are nonetheless all too probable.  how will i do x now, how will i do y?

within two days, fred was already able to think productive, forward-inclining thoughts.  yesterday, he even inquired about the possibility of an external bit of hardware with which i might regain control of my left arm, once it's been rendered flail.  i was dismissive, as it seems like dr. shoulderman would have brought that up right away in his extemporaneous powerpoint presentation.  fred, as usual, is a great point man, and a quick googling of "flail arm" turns up many examples of braces, hooks, and goth-inspired hardware that can be strapped on, and, if nothing else, used to make me look fierce, tough, and borderline biker.

Stanmore orthosis with hook:
Add a clutch and silvertone choker studded with Swarovski crystals for an easy day-to-evening look.

i don't know whether it is the stress of it all, suddenly, or what, but my left leg is now the fugly spitting image of the right one, and both are spasming to the beat of a whacked-out drummer.  i refuse to repeat the die hard description that one crps-er after another has ripped off and reiterated: "imagine being doused in gasoline, lit on fire, and then kept that way 24 hours a day, 7 days a week, and knowing it was never going to be put out..." it's... depressing.

dr. shoulderman is wonderfully cognizant of my crps, and though we rarely discuss it, he is well-informed, as every orthopedic surgeon should be.  he has been distressed by the obvious crps spread, and the condition of my arms, as surgery anywhere is never wise with crps on board, and repeated surgeries in an area of lots of rsd activity is what polite society calls a "no-no."  so he decided to order repeat regional blocks in an effort to prevent further spread.  it was comforting, reassuring -- he cited a recent study, and did so in depth, an impressive feat for a man whose brain must be chock full o'important stuff.

tomorrow will be a long and uncomfortable day.  it's off to the hospital we go, for testing, testing, testing, and -- i predict -- some arguing with the billing office.  they say i owe over $3000 from a few years back -- they didn't file with my insurance company until 18 months passed from the date-of-service, and by then, i had switched to a new insurance, and -- of course -- the former company refused to pay.  if they make this admission contingent on paying that bill?  i will be in a tough spot.

ah, and tomorrow they'll culture skin and nares for mrsa... i have cultured positive several times before, therefore spending my time in isolation, with a very frustrated fred having to wear those awful yellow paper gowns, and be gloved up.

maybe i can have them give me the roto-rooter port clean-up tomorrow.  if we have to spend the day, may as well check off as many chores as possible.

so that's what has me away from the blog... although my heart is always at the manor, safe in marlinspike hall.

And... we're off!

How is it that hearing exactly what I expected to hear from the surgeon could depress me?  What is the point of even having expectations if they don't shield you from the negative effects of your own neurotransmitters?  Hmm?                              

Also, in case anyone had any lingering doubts, yes, pain is, indeed, subjective.

I recall this scenario having unfolded every time I've received the "we need to operate" response from ShoulderMan, a scenario that is now over the half-dozen mark.  By the time we are back home at The Manor, my pain levels rise to an obscene point, approaching the landmark "ten."  It honestly seems to hurt worse just because my excellent surgeon has opined that yes, surgery does look necessary.  That's nuts, makes no sense, and yet, is true.

We are going to proceed with the usual futility first, though:  Yes, another aspiration of the shoulder under fluoroscopy!  The eighth one.  May it be productive, because the first seven were not... Then, in 2 weeks, I will go back to hear how nothing continues to grow in the lab, and to finalize the scheduling for surgery.

At least I have an excellent excuse for bailing on the Wheelchair Negotiations for today.  The man handling my case is an idiot.  No, really, he is.  He also lies with excessive ease.  I don't know whether we are going to take our relationship to the next level of actually acquiring the new lightweight and speedy transport.

But, as I am trying to convince myself -- let that go until tomorrow.  I am spoiling for a fight, for anything that might distract me from the prospect of major surgery during the holidays, PICC lines and vancomycin (can't use the bleepety-bleep-bleep port installed in my chest wall for the post-op antibiotics), surgical cement spacers, and the subsequent surgery or surgeries to try and put in another prosthetic shoulder.

It's a darned good thing that The Nutcracker is such a piece of crap, both as music and as ballet -- because I am going to miss seeing it performed again this year!

That was supposed to be funny.

Fred has that deer caught in the headlights stare going on. Bless his heart, bless his bones.

The only good thing thus far today?  My surgeon just got back from Haiti, where things are, of course, really bad -- though he said things were more settled than they were immediately following the major quake, at least.  They desperately need orthopedic supplies -- crutches, walkers, canes, splints, slings, etc. -- and we have at our disposal an entire closet dedicated to the storage of such supplies.  It feels good to be able to put the stuff to some use, or it will, once Fred, Bianca, Sven, and I go over each item and refurbish things as best we can.  So that is one good thing for the day...

I just feel like weeping:  Therefore, let's post some cat videos!  If sending my orthopedic closet collection to Haiti and uploading a bunch of cute cat action doesn't dry my tears, what will?

First, we have Buddy in a Box.  Unfortunately, most of the footage of Buddy in a Box consists of no sign of Buddy but minute after minute of a mysteriously wiggling box.  Since he is more interested in me, for some reason, than his Bodacious Box, you lucked out this time, Beloved Readers!

Isn't it amazing how HUGE he has gotten, this freakishly large kitten that turned out to be a Maine Coon? Fred and I peer helplessly at one another and cry, "Who knew?" several times each day.

Next we have the Old Married Couple Series.  These are three videos of Dobby and Buddy, who suddenly have decided to promulgate peace, love, and understanding instead of trying to wipe each other from the face of the planet.  Okay, so Buddy is something of a recidivist, as he goes for Dobby's throat in the second video -- but he gets over the impulse and is soon right back to being a perversely large kitten, and all cuddly again in the third take.

As usual, please ignore the audio.  Seriously, it's embarrassing.

More Close Encounters of the "Bob" Kind

Has enough time passed since the jubilant signing of the Health Care Reform Bill and its necessity of 20 pens that we can settle down and speak the truth?

Like... what a terrible disappointment it is that the public option was sacrificed, when it alone would have made this true reform?

Like... how despicable conservative obstructionists have been? How heartless, and cruel? How manipulative and disrespectful of their own followers, that they have, essentially, abused free speech by inciting to riot, by screaming "fire, fire, fire" in the cramped and dark theatre that is the U.S.A.?

Like... how uninformed and illogical many citizens are, and how driven by out-of-control emotion -- fuming, frustrated anger that has all the hallmarks of a two-year-old's temper tantrum, except that two-year-olds don't usually wield the weapons of bigotry?

And (having taken a quick look at today's news headlines) like... how if the Democrats could adopt just a tiny bit of right-wing anality, the bill would not be subject to a re-vote on the basis of parliamentary mistakes? Just because you have succeeded in doing, in a marginal way, what is minimally moral, does not mean that you should fail at following the rules for governance. Yes, I am a nerd, and often a wonk. Yes, I am frequently appointed to be the Ball Buster Rule Diviner -- often seen as a curse, due to the thankless nature of the work, but that role is necessary to success. I haven't yet scoped out who the House Parliamentarian is... but 30 lashes with a limp noodle might be appropriate.

So I ran across this Emperor Bob person/persona on Twitter, then briefly visited his blog, Emperors Rants and Observations, where he can be found addressing the Various Issues of the Day, from campaign finance reform and climate change to the health care reform initiative and Alaskan politics. He's keen.

Oh, Faithful Readers:
I am so tired this morning.

My internist and I, recognizing an infection flaring in my left shoulder, decided that I should return to my poor orthopedic surgeon. Um, poor in the sense that the man has operated on me eight times since 2005, replacing shoulders, removing shoulders, putting in antibiotic spacers, taking them out, and so on, but has not managed to get any of the bacterial specimens to grow in the laboratory environment. Without identifying the offending bug, the correct antibiotics cannot be applied to the situation.

And now the pain is getting worse on the right side, and... {whisperofdenial} my left hip. Both of those joints have "hardware" implanted, thus making them attractive breeding grounds for germs. But we won't think about that today.

So, Fred loaded me and my super-duper powerchair into Ruby, the Honda CR-V, and we sped off to see said surgeon.

You are a fool if you believe that being without health insurance does not affect the standard of the care you receive, even in the form of advice.

ShoulderMan opined that he wanted another "aspiration under fluoroscopy," which would be the fifth or sixth time we tried that particular trick. It is painful, not particularly dangerous, and expensive. But, for me, the overriding factor was that it has never produced a piece of useful data.

If samples of purulent pus taken directly from my humerus during surgery and rushed to the awaiting petri dishes in a sophisticated hospital lab also cannot produce the identification of the offending organism, why do we keep pretending that these painful and expensive aspirations are in any way superior?

I reminded ShoulderMan that since I had last seen him, I had been priced out of my health insurance -- my Faithful Readers know well that I just could not swing $1513 a month for premiums, plus the $5000 more in deductible, and all of that on top of the thousands not covered. I live on private disability insurance due to the combined effects of CRPS in all my limbs (and now, face), avascular necrosis, lupus, Addison's disease, aortic insufficiency and so on, ad infinitem, ad nauseum.

Believe me, I tried to stay insured. It took the help of my state's Insurance Commissioner for me to have coverage to begin with, once COBRA expired. But BCBS eventually was demanding 97% of my income... and I dare you to criticize me for folding, at that point.

ShoulderMan said: "I don't get it. You ought to have MEDICARE."

{we have had this exact conversation already several times over and over again, not to be repetitive or fall into a déjà-vu sort of iterative redundancy}

Moi: "Yes, Dear ShoulderMan, I ought to. {actually, i tried to pull off an oughtn't i? but couldn't spit it out.} However, I fail to qualify because most of my working years were spent in university systems that did not pay into Social Security but rather into poorly funded and criminally operated pension funds. I lack ONE work credit, in the amount of $830, toward eligibility."

ShoulderMan replied, with a fair amount of dripping condemnation in his voice: "Well, why don't you do some work for a week, maybe tutor some local college kids, and turn that in?"

Moi: "Hmm, wow, I never thought of that." Okay, that's a lie. What I really said was:

"I have been informed by my Disability Insurer that to do so would mean the loss of my disability income, and it would be well over two years before any substantive replacement from governmental sources would kick in."

ShoulderMan muttered: "Oh, well... Okay. So I think we need to get this aspiration done and consult with a new Infectious Disease doctor, maybe over at Charity Hospital. This is the kind of thing that cannot be ignored..."

And he promptly exited, stage left.

His minion, PA Bob, then did something that reduced me to tears. Yep, here I go again, even crying into my laptop.

He came over to me, handed me the official pink and yellow copies of codes for the visit, so that I could check out and pay (which I obviously was prepared to do). As he walked into the crowded hallway, he said, loudly:

"Why, wasn't that nice of Dr. ShoulderMan. Look, he marked the box for 'No Charge' so that you don't have to pay for this consult."

Dr. ShoulderMan, who moves at roughly the speed of light, was long gone and already ensconced in the next exam room, so Bob was not making points with him... Leaving me, once again, to wonder why Bobs, in particular, are so intent on confusing me! For a succinct treatment of my history with Bobs, read this.

I've never engaged in a political dialogue with either PA Bob or his boss, having intimated from various remarks that they are both ultra-conservative and that ShoulderMan may, in fact, be an Evangelical (I intend that to reference the Conservative Evangelical Movement, à la George W. Bush).

Aside: Here is one of the fairest succinct explanations of Evangelicalism that I've run across. It comes from an address by conservative EPPC Senior Fellow Wilfred McClay* entitled American Culture and the Presidency, delivered either in Fall 2004 or early 2005.

As a faith that revolves around the experience of individual transformation, it inevitably exists in tension with settled ways, established social hierarchies, customary usages, and entrenched institutional forms. Because evangelicalism places such powerful emphasis upon the individual act of conversion, and insists upon the individual's ability to have a personal and unmediated relationship to the Deity and to the Holy Scriptures, it fits well with the American tendency to treat all existing institutions, even the church itself, as if their existence and authority were provisional and subordinate, merely serving as a vehicle for the proclamation of the Gospel and the achievement of a richer and more vibrant individual faith.

Anyway, there is nothing abstract in the nature of how being an uninsured (and uninsurable) citizen impacts my life. It truly may contribute to my death, as I have spent the first few working hours of this day on the phone with the aforementioned Charity Hospital -- and the helpful pickings are, let's say, slim. The clinic system there may eventually help me, but there are no appointments to be had anytime soon.

Unbelievably, three times (like Peter's crowing cocks), I was told to go to the Emergency Room!

I have avoided a close rereading of what Obama signed, and what Congress is continuing to work through, precisely because I am not yet convinced of the permanence of any change -- but clearly, I am going to have to dedicate time to it today.

Because if there is no fairly immediate help for me in the legislation, I am close to abandoning all hope. I cannot continue with daily fevers up to 101, the attendant sweats, chills, and pain -- on top of my usual severe pain from CRPS and AVN -- I cannot sit in waiting rooms for hours, especially now that my left hip may have joined with the Infected Skeletal Alliance.

Oh, boo-hoo! What a sob fest this post has turned into! But I am going to leave it as is, if only for its potential to serve as a shaming mirror the next time I decide to whine.

The saving grace here is this YouTube video from Emperor Bob, an amazingly calm rant to which I will return with frequency... Thanks, Bob! [Correction -- a correction which blows the whole Bob Phenomenon to hell, but maybe you won't notice -- that is not Bob on the video. No, the star of that show is one "old fart rants," who has quite the head of steam built up over on YouTube!]






*Wilfred McClay is the 2009-2010 William E. Simon Distinguished Visiting Professor at the School of Public Policy. He is the SunTrust Bank Chair of Excellence in Humanities at the University of Tennessee at Chattanooga, where he is also professor of history, since 1999. He is Senior Scholar at the Woodrow Wilson International Center for Scholars in Washington, DC, Senior Fellow at the Ethics and Public Policy Center, and has served since 2002 on the National Council on the Humanities.

Major sigh, and where is the ibuprofen? "The SunTrust Bank Chair of Excellence in Humanities"?

In High Cuss (Dungeon and Dudgeon)

I am angry with myself. I've been exceedingly dumb.

Because I knew and didn't go in. I vacillated. I hemmed, hawed, and poled down the longest stretch of inland water, that mighty, rolling African river.

Fred has great pictures of Lake Tana, where the Blue Nile begins.

Ethiopia Travel hawks its ware: "1 lake, 37 Islands, 14th century Monasterys and the blue Nile Falls!"

"1 lake, 37 Islands, 14th century Monasterys and the blue Nile Falls!"

"1 lake, 37 Islands, 14th century Monasterys and the blue Nile Falls!"

We just got back from the first post op visit chez ShoulderMan. The first visit is with his Physician's Assistant, and usually consists of two views of the shoulder in x-ray, and having the nurse remove either the staples or the stitches. Having been through this six times now, it is usually a ho-hum deal, with the exciting pay-off of finally being able to take a shower!

Last night there was a minor explosion from the suture line. (Sorry, I don't intend to gross you out. Really.) I was changing the dressing and lightly touched on an area that was red and well, hmmm, there was, as I said, an explosion.

The PA said to be ready to go back in. That he was calling the surgeon. That likely they'd have to go in and do a wash, maybe remove the prosthesis, go back to the freaking spacer. I know he was just trying to prepare me for any eventuality. He also opined that maybe I could use a little more time with the Zyvox. (I vigorously supported that thought.)

The pain is worse, and I have lost all the range of motion gained early after the last surgery.

Fred --in shock, I think -- drove us home in high cuss. "High cuss" is my attempt to graft something new off of "high dudgeon," about which Michael Quinion of World Wide Words fields this query:

[Q] From L Crary Myers: I have seen others attempt to answer this, but apparently maddeningly little is known. You always seem to manage to find something interesting, however — so, here is the question: from whence the phrase in high dudgeon? Thank you, and I am an avid fan of your site.

[A] “Maddeningly little is known” is unfortunately a fair summary. I’ll try to add a little more, but it is one of a distressingly large group of words for which we have no idea of their origins. The group includes a couple of others also ending in -udgeon: bludgeon and curmudgeon.

Dudgeon means a state of anger, resentment, or offence and often turns up as in dudgeon or in high dudgeon The Oxford English Dictionary can’t give its source, though it’s sure it’s not from the Welsh word dygen, meaning malice or resentment, which has been suggested in the past. It does point to endugine, a word recorded just once, in 1638, with the same sense, which might have given us a clue, but doesn’t help at all.

It also records another sense of the word, itself mysterious, for a kind of wood used by turners, especially the handles of knives or daggers. It has been suggested it was another name for boxwood. It appears in Shakespeare’s Macbeth: “I see thee still, / And on thy blade and dudgeon gouts of blood, / Which was not so before.” Later the word was used for a dagger whose handle was made of this wood.

It just might be that a state of anger or resentment could have led to the grabbing of a dudgeon knife with intent to redress a slight, but there’s no evidence whatever of the connection.

It's embarrassing to admit, but I am one of those who have said "high dungeon," when, of course, "high dudgeon" was what I meant. Or would have meant, if I had known better.

Better to author a new phrase than mangle an old one, so "high cuss," it is.

On the bright side, given that Bob didn't tell me to stay NPO, surgery cannot happen tomorrow.
There's that, at least.

We're going to brew some coffee, start the day over. We bought a bag of $3 coffee at the local ALbrecht DIscount which, go figure, brews something almost divine, it is so straightforward, pure. The coffee, not ALbrecht DIscount.
**********************************************************************************************
Ah, some good news from the fantastically tall and exceedingly kind Bob the PA! He phoned the surgeon who wants to watch and wait, wait and see.

***Now Friday (saw Bob on Tuesday): Sadly, we have achieved pus, that purulent exudate, itself. Very localised pain, and a sitting-behind-the-eyes steady fever.

I'm cleaning up the evidence, wrapping gauze hither and yon, taping tape-to-tape, swabbing, dabbing, daubing, staunching. I'm possibly going nuts. I just might grab my dudgeon knife in a vain attempt to redress this slight.

To all medicos in the Monday-to-Friday world: Don't leave people hanging over the weekend. Not when they're leaking purulent exudate!

Bob pretty much said surgery is the only answer... unless the Zyvox kicks in.
So pray that the Zyvox kicks in.

photo credit

I'm just sayin'

I'm home!*

The Good Doctor ShoulderMan worked his magic on Monday, gifting me with a new left shoulder. He had to do some rearranging but he made it work.

But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé) -- well.

Well, on the "deep tissue" stain, we finally found bacteria waving back at us, all gram-positive-y, upbeat, and downright defiant. But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé)-- Wait one freaking minute! (The fog of anesthesia?)

As of Day 2, there was, natch, no growth on culture! My Infectious Disease Dood's eyes are bugging out. Bless his bones, he cannot decide when, and how much, to lie to me -- in his mind, I think, he sees this as "managing" the patient.

Because, you see, I refused insertion of a PICC line. They thought I was just posturing, joshing, when I made the declaration before surgery. But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé) -- arg! Sorry about that, and je vous prie de bien vouloir m'excuser, too -- covering all my bases.

So, Infectious Disease Dood decides that I need Zyvox, a ridiculously expensive antibiotic that just happens to have serious interaction issues with 3 of my meds, as well as some nasty side effects all on its own. The deciding factor? Insurance coverage, as the $1500/week cost doesn't fit my very tired budget. Anyway... Fred and I think it was all a plot. As in, ID Dood was expecting BCBS -- Bull Crap Bull Skeet of Tête-de-Hergé -- to refuse coverage.

I was held hostage, told I could not leave the hospital without either the Zyvox or a PICC line with trusty i.v. med balls full of vancomycin.

[I know that it's overkill for the vanco hyperlink to refer back to this blog, but it astonished me, upon searching, to find out how much vancomycin has occupied my life and mind, and what it has come to signify. Allow me that rare {raspy cough} professorial moment of recommending a read of Macbeth, Act 5, Scene 5. Wunnerful wunnerful commentary --

Life's but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

I'm just sayin'.]

Fools! They didn't know with whom they were messing. Once Fred, all bleary-eyed and pooped, arrived... well, we were hell-bent on leaving the hearsepital. At that point, ID Dood and His ID Minions began weaving tangled webs.

Case managers arrived. All nurses with decision-making capacity suddenly were off the floor, scarfing down lunch. And didn't I wish to order lunch? And, uh-oh, the medication you must take before eating hasn't come up from pharmacy. Let's get a blood sugar and another set of vitals! And then they sneak in: They'll be up to put in the line in about 2 hours, no need to go down to Interventional Radiology, how great is that? [I despise the huge, cold, scary room down in IR.]

They promise a nirvana-inducing insertion, complete with a soundtrack. And lest I scoff, they cite:

PICC the Music and Travel to the Port of Relaxation: Preliminary Results of the Effects of Music on Perceived Pain and Anxiety During the Placement of Ports and PICCs
Journal of Radiology Nursing, Volume 26, Issue 2, Pages 61-62
C. McDaniel, M. Burkett, M. Cormier, J. Duvallm, S. Davis, L. East, G. Gilmer, N. Mahaffey, M. Moran

Giggle.

We left. Politely. Give me a call when you all figure out the antibiotic situation, okay?

Amazingly, BCBS of Tête de Hergé decided to fork over the money and my pharmacist, who inexplicably informs me that "[i]t's like déja-vu," promises that I'll have these ridiculous little white tablets by noon the next day.

My BCBS policy, for which I pay $1328/month [Remember: my (private) disability income is a whopping $1996.20. Without that luxurious twenty extra cents, all would be lost!] -- My policy dictates that I pay for medications and then receive reimbursement of whatever they think arbitrarily fair.

So what a hoot it was to have Discover Card's Fraud Unit calling me, all breathless. Did I know that a $3030.00 charge was just made at the nearby Huge Grocery Chain? That was for a mere 14 days worth, ID Dood suggesting I buy the Zyvox in 2 wk lots, in case I need to stop it for some reason or other. Anyway, to the inquiry about the charge:

"Yep!" said I.

There was a tremendous pause. It was absolutely KILLING the woman on the other end of the line to not be told WHAT I had bought. So she rephrased the question, and, on cue, reiterated the pregnant pause.

"That's right!" I crowed. Her frustration was now palpable.

Why not give her something to liven up the day? Let her imagine an elegant late dinner of lobster and caviar, un petit souper à la parisienne [or A Family of Sans-Culottes refreshing, after the fatigues of the day]. Just a little casse-croûte thrown together by a retired French prof whose purchase habits extended to extravagances of generic yogurt and diet cola. Okay, okay -- I also splurge on almonds and good coffee.

By the time the credit card gods were appeased, the antibacterial troops put all in a ducky row, my clothes 'n sundries put away, urgent emails answered, ablutions completed, phone calls returned? I truly felt like shit. I was febrile to the tune of 101 degrees, sweating, and hurting like the proverbial Dickens ["Fan the sinking flame of hilarity with the wing of friendship; and pass the rosy wine!" -- ummm, any excuse for passing on my favorite Dickens quote].

Alas, poor Yorrick (sic), a quick and easy search about the origin of the phrase "hurts like the dickens" reveals the following:

Posted by James Briggs on December 18, 2001

In Reply to: Re: Hurts like the dickens posted by R. Berg on December 18, 2001

: : My son said this at supper tonight........."It hurt like the Dickens". We wondered if any one knows the origin? I have also heard "scared the dickens out of me". Any enlightenment would be appreciated.

: From the archives, here's a response to the same question.

: Posted by ESC on January 12, 2001:

: "Dickens" is a euphemism for "devil" as in "'what the dickens,'.an
expression common centuries before Charles Dickens was born, having been used by
Shakespeare in 'The Merry Wives of Windsor'." "Morris Dictionary of Word and
Phrase Origins" by William and Mary Morris (HarperCollins, New York, 1977,
1988).

It may be an altered pronunciation of "devilkin"

En tout cas... since then, it's been a topsy-turvy time but anything beats being in the hearsepital. And, thank goodness, we only have to visit ID DoodLand once a week versus the usual three or four times.

My MDVIP Go-To-Guy? He opined in an email: "I'm glad it's over and done with. We are all a bit skeptical that this will take care of everything but please try and keep positive thoughts and prayers as we all are trying to do." I have noticed that since his switch to MDVIP, he communicates much more freely and makes frequent reference to prayer, saying that I am being kept in prayer. At first, I was somewhat taken aback. Now? I am thoroughly appreciative and almost virginal in the prose with which I write him.

However, I will visit Holy Ruin on the first person to suggest removal of this prosthesis.

I'm just sayin'.

*******************************************************************************************

*graphic of huge mouth courtesy of BENBENEK BLOG -- from an entry which consists of the following:

I’m just sayin’…
I’m pretty tired of people using the phrase “I’m just sayin’…”

Palin trumps Jackson and Grader Boob wishes me well

In case any readers or passing trolls are wondering, the reason for the frenetic posting today is that surgery is tomorrow.

I am nervous.

I really should not be, given that this will be the... give me a minute... the seventh surgery done by this particular operator, since 2005. The sixth since we began this mucked-up odyssey against infection last summer.

He's talented, famous, and more importantly, he practices good medicine.

Still, despite the wrongheadedness of it, I feel like I have been primarily... lucky.

Last August, I ended up in ICU on a vent. Then again in April of this year. And through all of this, we have been unable to identify the offending organism.

I am worn down, exhausted, in a world of pain, able to do less-and-less. I am full of self-pity.

Anyway. I just got an email from Brother-Unit Grader Boob. He claims that he is taking his "organizational scheme from Governor Palin," as in:

"Before I continue with my resignation, I'd like to thank the American troops who are fighting abroad to give me the freedom to quit."

He goes on to note that, "[w]ell, at least she interrupted the Michael Jackson death watch."

Truly. Isn't it a frightening glimpse into American culture, that this woman should prove to be the newsmaker to shift a dead, mentally-ill, drug-addicted, worldwide pop icon from center stage?

Anyway, Grader Boob and I have communicated through, and hidden behind, sporting events our entire lives. I remember watching bowl games with him, snug and secure in my big brother's presence, while my family and country went about the process of disintegration. He's been an awesome brother, and I would do anything for him. You know... like if he were reading this and all, it would be nice for him to know that, trust in that.

Ahem. Anyway, he has already left Wimbledon behind (fourth set now, Roddick kicking booty in hopes of tying the match at 2 sets all) and is getting his head into Le Tour de France. Grader Boob was an accomplished cyclist. I say was because:

"Right now, I'm watching the le Tour prerace show and I look over at my cycling shorts and realize that to squeeze into them would be truly an eyesore."

He closes by telling me about the class he is teaching: "[A]pparently, they're still at the stage where they like to mutter smart ass answers under their breaths, not at all concerned about offering up a more insightful response. Hopefully, that will change as they delve into the readings. Hope springs eternal!"

He also promises that "I'll be thinking of you tomorrow, sending good thoughts up into the heavens and some semi-articulate prayers towards {Tête de Hergé}."

I couldn't be more blessed.

Mr. Pus? Mr. Frank Pus?

We were off to see the surgeon yesterday afternoon.

For reasons all his own, Fred chose to remain in the crowded waiting room, trying to read midst all the noise of the television, the chitchat, and the cell phone tag being played -- continually -- despite signs forbiding their use.

I am grateful to have been worked in. Okay? Very grateful.

Still, if only sleek competence might join that terrific availability!

The appointment was at 3 pm. I was called back at 3:50 and was stashed in one of the cast rooms (orthopedic surgeon). Then someone needed a cast, so I was switched to an open exam room. Unfortunately, when I was swapped out, my paperwork did not follow me.

Yup. They "lost" me.

Luckily, I had a good book to read -- an André Dubus novel. Even more fortuitous? I had water and pain medication -- some of that soon-to-be-banned Percocet. My surgeon is much sought out, and he had not planned on needing to see me, so I didn't start to feel uncomfortable in my little room until about... 4:45. The door suddenly opened and one of the doc's assistants poked his head in, said he was looking for the doc, then disappeared. A few minutes later, his nurse threw the door open (does no one knock?), made "Aha!" noises of discovery, and slammed my paperwork into the file holder on the door. As she was walking away, she called back to me, asking whether I "had my films."

Errrr. Well, I was returning the x-rays we took for the expert to peruse back on June 9, but got the sense those were not the ones about which she was asking. So I powered up my chair and chased after her.

Yes, an order for 2 views of the shoulder had been given, and no, it hadn't been done.

And just my luck to get the pissed-off x-ray tech who is alarmed by the look of what she develops, thinks it has to be because the x-ray (not my bones) is bad, and repeats, repeats, repeats the most painfully posed view of all. Finally, I ask her if she gets that there is no real bone in there, constituting a proper shoulder, to which she replies, "But you haven't had your surgery yet, honey. This is your pre-op visit."

Who was it who then fairly yelled something sort of obscene, but not entirely?

It took her 6 exposures to get her 2 views done, and it was well after 5:30 before I got back to my cell. At this point? I am having spasms in my legs and back, and my temp is doing its late-afternoon spike-thing. And I am hungry.

I had many questions and arguments I wished to present -- but by the time the obviously fatigued surgeon and I finally met? I didn't care that much about anything beyond getting home. The pain was out-of-control and the x-ray tech had done nothing but aggravate things.

Still, we managed to cover a few things. I won zero, nada, zip in terms of concessions I was seeking -- like No PICC line, no vanco, no to any iv antibiotics unless and until a pathogen is grown out of the cultures and a sensitivity test results.

Apparently, I am to change my mindset. We're suddenly going more for medicine as an art form than medicine as founded on scientific principles. He wants to go ahead and put in a total prosthesis, even in the presence of infection. Thus far, on this side: there was a hemi put in in 2002 -- a surgical failure; then in December 2008, he had to remove it as well as several inches of humerus, giving the lame excuse that it "exploded" with pus; in April 2009, he was sure things had cleared up (despite my fevers, sweats, and pain), but found more infection, and therefore inserted a second spacer. For the past one year+, everyone has been careful to tell me that a prosthesis could not and would not be put in when there was the least little doubt about continued infection.

Ah, but things changed. (don't ask me how, i dunno) As of yesterday, we are going to proceed and just hope for the best, by God.

I told him about the running joke here at Marlinspike Hall, deep, deep in the Tête de Hergé, wherein one of us (usually La Bonne et Belle Bianca Castafiore) pretends to page "Mr. Pus, Mr. Frank Pus!" -- and he didn't laugh.

His eyes widened, though.

Anyway, I told him that if there was frank pus, or any really overt signs of infection, I would not be comfortable receiving the prosthesis. His head went up-and-down but I am not convinced he really heard me.

Oh -- and it turns out that my acromion is fractured. That seems to have captured his attention more than anything. And would you believe that I forgot to ask him what he needed to do about that? I was so tired.

Based on the fact that this is not my first go 'round with an infected joint, I can assure him, you, and anyone who would care to listen, that this freaking spacer is definitely serving as a culture dish. It is the fever, the sweats, the increasing instead of decreasing pain upon which I base my wacky-wacky opinion.

Believe it or not, we never even got around to discussing what happened post op last time -- those annoying episodes of respiratory arrest. Three of them in 8 hours, the last not even remembered -- they just intubated and hooked me up to a vent. The theory back then was that I had pneumonia that went unspotted before surgery... So I guess the only relevant advice might be to not get pneumonia ahead of time, this time.

How was Fred when I was finally done? Testy. And let's just leave it at that.

Tomorrow, preop labs and ridiculous interviews at the hearsepital.

Anyway... not the greatest appointment just prior to surgery. I suppose I wasn't the best patient and clearly, he and his staff were in just-back-from-vacation mode.

I trust him. It will be okay. Right? Right.