American College of Physicians: Internal Medicine — Doctors for Adults ®

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The hospitalized hospitalist

James S. Newman, FACPBy James S. Newman, FACP

From the November ACP Hospitalist, copyright © 2008 by the American College of Physicians

After years of waddling down the hospital hallways making my appointed rounds, I decided it was time for a hip replacement. I had put it off as long as I could. Everyone said that I was too young for a THA but I was sure feeling old. My surgeon asked if I was ready. We discussed options—resurfacing, total hip, alloy, ceramic. Did I have a preference? I could not believe it when I heard myself say, “Whatever you think is best.”

The morning of admission started early. 5:45 a.m. check-in—ungodly surgeon’s hours. I stood in the registration line with dozens of other people waiting to enter the medical machine. I felt my independence and identity dissolve as the two plastic armbands snapped on my wrist. My name is N-E-W-M-A-N, J-A-M-E-S. Birthday 4-21-59. No known drug allergies. I would repeat this over and over in the days to come. The last time I had an armband it was for a water park.

The next step was changing into the gown. “Take off all your clothes, including your underpants, and put them in this plastic bag,” ordered the nurse. Arm-banded and underpants-less, I knew I was no longer a physician; I was now a patient. In the preoperative area, the staff intermittently called me “doctor” but I knew it was just pretense. When a nurse came and gave me a hemi-torso shave there was no MD about it. I was a plucked chicken.

I would be having spinal anesthesia with a nerve block. As the fentanyl and Versed went in my IV I wondered why I didn’t get the countdown from 100. I thought I’d try … I came to in the post anesthesia care unit. I pulled the covers over my head. They asked what I was doing, and I told them I was keeping the sand flies off me. It seemed reasonable at the time. I guess they thought I was delirious. For the next two hours I enjoyed the best hallucinations since The Grateful Dead at Red Rocks. I’d be walking though a forest, then the blood pressure cuff would constrict, bringing me back to the PACU.

Another time I was riding a horse through Yosemite, then the cuff roused me again. It was a pleasant few hours. Being a guy, one of my greatest fears was urinary retention. I remembered my first I-and-O cath, but it was no big deal because my spinal was still working, the same for the second. As my sensation returned I swore it would be the last. I lay in my bed supine with a urinal in place, straining and fretting, envisioning all the patients I’d sent out on routine I-and-O. I have never been so glad to urinate.

Finally up in my room, the stalwart nurse settled me into my bed. She wondered if I needed pain medication. I wanted my PCA. I was ready to start clicking that little button. But there was only oxycodone ordered! I said I’d take it but not before I had some senna and Colace. I told her I did not want to have to be disimpacted. “Don’t worry,” was the nurse’s response, “I won’t be on shift then anyway.” I thought of all those times I had asked postoperative patients if they had passed gas. I always said the same corny line, “We like patients to pass gas in the hospital, unless it’s in the elevator.” The flatulent joke was on me this time.

Day 1 post-op, it was time for my shot of LMWH. The nurse asked who would be giving this at home. My wife, I told her. (That lasted about one day till my dear spouse pointed out that first, I was a doctor, and second, my hands had not been operated on. So much for the pity card.) It was nearing time for discharge. I could have left on day 2, but neither my wife nor my mother was ready to take a difficult patient like me home. I was just another placement problem. Would I need a social work consult?

I had been though delirium and retention, sluggish bowels and DVT prophylaxis. I did not think I’d acquired MRSA, C. diff, or VRE. No atelectasis, bed sores, atrial fibrillation or fever. And best of all, the correct hip had been operated on. All in all, it was a successful run though a modern American hospital.

I wondered if I had learned anything about being a patient, or about myself. Had my horizons broadened and my world perspective altered? Would I be a better healer? Possibly.

I cut off my armbands, put on my underpants, and enjoyed that “new hip” smell.

Jamie Newman, FACP, is a hospitalist at the Mayo Clinic and editorial advisor to ACP Hospitalist.

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