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Sunday, September 29, 2013

No Escaping the Scalpel

This is the third post documenting my experiences, living in Manhattan, after I missed one step on the way to the laundry room and broke a bone in my foot. First post was here: The Fractured Fifth - Manhattan Life with a Broken Foot


My mother read my blog.  Immediately I got a phone call.  "Scott, you can't do this anymore. It's crazy! I'll come into the city by bus and hail a cab for you!"

"But Mom, you live in New Jersey!  It's crazy to come into the city every week just to avoid paying for car service."

"Well, how much is car service?"

"It's twice as much.  I don't want to pay that."
"I will.  Just tell me how much it is."

"Thanks Mom, but let me look into it."

That was the conversation I had that led me to look up a highly rated car service on Yelp, GoGreenRide.  They might be $3-$5 more than a taxi, but it's a flat rate, they show up usually ten minutes early or more, and there's plenty of leg space.  Even better, you can see where exactly your driver is on a map on the web site.  There's an iOS and Android app that supposedly lets you request and track cars as well, but unfortunately their Android app needs some fixing.

The drivers are super-nice to their passengers, and they help me into the car each time.  They even offer you a complimentary bottle of water if you're thirsty.  There's an iPad that supposed to give you some level of internet access, but it's hard to use a touchscreen unless the car is stopped, and it's not very functional in general, unfortunately.  But you can still see yourself on a map, and use it to pay as well.

It looked like I surmounted yet another nasty obstacle to surviving in New York with my broken foot, and I was off to the podiatrist again.  I'm happy to see my mother is there for me if I need her, but I prefer to not be dependent on others when possible.

I recounted the prior cab-chasing incident to my podiatrist, telling him how I stepped on my bad foot unintentionally when I slipped from my crutches trying to hail a cab.  He did not appreciate hearing that, but we would see the following week how the healing was proceeding with the second of the biweekly X-rays I was scheduled to have.

I thought about how it'd feel if I needed surgery.  How all my efforts to heal as fast as possible would be wasted and the timeline would be reset, starting from whenever I could schedule the surgery.  I would have to wait another week to know for sure, but I was going to protect my foot vigilantly until then.

Every morning, I'd get out of bed, and Luna gladly took my spot as I literally hopped off to the shower.  This cat would mistake me for an overgrown rabbit if she had ever seen a rabbit.  Luna's never been outside of Manhattan since we adopted her as a kitten though.

Although I don't have to leave my apartment very much, I make sure to shave regularly, to stay in the habit of personal grooming.  I want to feel like a man, not a helpless, caged animal, barred from social interaction.

As you can see in the picture, my hair is fairly short.  I also managed to go to the local barbershop.  I was on crutches, and there were stairs, a closed door, and no handrails.  I stood outside the window and gestured at the barber toward the door with my glance.  He finally got the idea and opened up the door, then I managed to hop in while putting my hand against the wall.  I didn't know how to get back down.  I figured I would sit on the ground and scoot down the stairs, dragging the crutches with me.

I made an appointment online, but they told me, when I finally sat down and inquired, that they don't use that system, and any appointments I made didn't matter.  Fortunately I'd still get a haircut though. Someone came in after me, and the barber repeatedly asks him if he came in before I did.  I wasn't paying attention, more concerned with the stairs, but fortunately the new customer was honest and I was able to get my haircut.  My suggestion about installing a handrail was met with an awkward silence.

My haircut was done, and it was time to make my exit.  They showed concern and walked with me to the doorway, holding it open.  No suggestions were made about how to descend to the sidewalk, but I realized I felt again fairly comfortable hopping down the steps with my hand against the wall and the crutch on the step I was hopping onto.  Somewhat scary moment still, but I got through it.

This week, leading up to my second X-ray, would be all about healing as much as possible.  I believe without sleep, there is no healing.  I laid back on the sofa often, stretching my legs.  Luna jumped up and followed suit, tending to my injured foot.

One thing that dawned on me.  Aliona and I had concert tickets.  For an October 15th Placebo concert.  Ever since I met Aliona, I would have easily picked Placebo as her favorite band, and I certainly heard a lot of their music, quite often.  I definitely would have accompanied her to see them at any opportunity, but they, for some reason, would not tour in the US.  However, in the five years I've known Aliona, they finally announced a limited US tour, including New York City!  Aliona was ecstatic and we snatched up tickets.

But now I have a broken foot, and these seats are standing room only.  I look online for information about the venue's handicap accommodations.  There are next to no accommodations.  I see a Yelp review about a wheelchair-bound concert-goer and his caretaker being treated awfully, with next to no accommodations.  I wasn't going to fair much better, because there was no way I was going to be able to stand throughout a concert, let alone in the middle of a crowd.  I had to put my ticket up for sale, and Aliona is going alone.  We had a personal connection to Placebo, but she said she would rather go alone otherwise.  I understood, but this made me sad.

Being that I'm normally fairly hungry, Aliona feeds me with random healthy snacks, also protecting me from potential heart conditions that my father has had.  She has not broken stride during my foot ordeal.

This was a roasted vegetable souffle, accompanied by cucumbers, tiny pickles, and a dollop of hummus.  The fork was only needed for the souffle.  The rest was finger food and dip.

It was finally time for my third appointment with Dr. La Puma.  I ended up leaving with this prescription:

This was a prescription for tests required to clear me for general anesthesia.  My foot had gotten worse.  Another fracture had formed, probably from that day nearly two weeks before, when I slipped while trying to hail a cab.  My worst fears had been realized.  My initial thought was "How soon can I get the surgery?"  I needed that light at the end of the tunnel.  I didn't care how long the tunnel is.  I just needed to set my sights on something.  Otherwise, I'd have gone insane.

The doctor made some calls, and suggested he could do the surgery a week later, Thursday morning, at Interfaith Hospital in Brooklyn, where he did his residency.  He assured me the podiatry program there is stellar, and he'd be operating alongside his former mentor, so it'd be optimal.  He also volunteered that the anesthesiologists there are top notch.  At this point, I trust Dr. La Puma, but I didn't need any sense of doubt in my mind.  Despite the general unfavorable sentiment toward Interfaith Hospital, especially in the ER, I decided I would trust Dr. La Puma about this.  In such stark contrast to the orthopedic surgeon I dealt with before, with a warm demeanor and a careful, responsible approach to my care, what choice did I have?  I was further assured when the doctor actually gave me his personal cell number, in case I had any questions or concerns.  That's never happened to me before.  But then again, I've never had surgery before, past my wisdom teeth being removed, which I remained awake for.

Dr. La Puma was suggesting that my primary care doctor should be able to handle all these tests and could give me the clearance himself.  I knew I just had gotten some of these tests done, but not the chest X-ray and EKG.  The key was to get cleared by early next week, in time to do the surgery.  He didn't expect a problem, because I was about to get surgery by the orthopedic surgeon, although I knew that surgeon didn't do much medical investigation at all past just asking me some basic questions about my medical history.  I appreciated Dr. La Puma giving a crap about whether or not general anesthesia would had adverse effects on me.  My mission was to do whatever it takes to figure this crap out and get the surgery done.  I wanted to be free from unipedal hell.

Dr. La Puma gave me a new cast, but decided against cutting a hole for the bone stimulator.  Any new bone growth may very well need to be trimmed away anyway, and puffiness had formed around the bone stimulator hole, so the cast was applied tightly, without a hole, to push the inflammation back down, removing the puffiness, resulting in some mild but expected pain.

When I got home, I called my parents and told them about the surgery in Brooklyn.  It's not a hospital my mother felt comfortable going to directly, so she suggested she'd stay on my couch.  For two nights, because Aliona is generally ultra-busy, and since she's retired, why not?  I mentioned that the apartment's small and the couch might not be comfortable, but she would hear none of it.  She'd have reading material to keep her busy during the surgery, and well, it's good to have someone there for you.

While I love Manhattan, and can interact with a ton of people here, it can be a lonely place when it comes to having family and friends standing by at the hospital for you, because they normally live in more affordable places.  The people you meet in Manhattan, at least in my line of work, are only interested in their own ambitions, and the friends and families they already have.  Zack might be an exception, but he's got a lot of good friends, so our interaction so far has been limited.  It's a good thing New Jersey is not far away.

The new cast had not been the most comfortable, with slight burning sensation in the heel, but I could ignore the discomfort.  I went to sleep, and woke up with my foot absolutely on fire.  I tried to go back to sleep, but it was not happening.  I figured maybe a lack of blood, due to the tightness, was causing the pain.  The pain was similar to what you feel when you put frozen hands under hot water.  I left the bedroom and sat down, letting the blood rush down into my foot.  I felt some relief, but then the pain returned.

It was 2:39am.  I did not want to call the doctor the very first night after he gave me his number, but already I felt I had little choice.  I decided to text him about it, then got to doing some internet research while wincing.  I knew it was easy to misdiagnose symptoms, but after searching for "tight cast" and "burning", I came across the notion of "compartment syndrome".  Apparently if swelling is restricted by a tight cast, extreme pain, followed by necrosis can occur.  I was willing to bet it was not that, but it's enough to convince me to cut off the cast.  I texted the doctor who had not responded yet that I was cutting off the cast.  I grabbed my kitchen shears.

Instant relief.  I looked at my foot and saw sores having formed in a couple places, right around where the pain was.  Apparently the cast was digging into my skin.

I put the oversized cam boot onto my bare foot as tight as possible, so I'd have some form of protection in the meantime.  I got a text later the next morning from Dr. La Puma that I did the right thing, and he invited me to stop in to get a new cast.  I worried about the cast causing more pain, but I figured, worst case scenario, I could cut the cast off again just as quickly.  This wouldn't be an official appointment, as it was just replacing the cast, but unfortunately, I still would have to pay for car service to get there.  I decided to try looking into getting at least one of the other appointments I needed done that same day.  My primary care doctor would be in that day but not Friday, so it would help speed things along if I could get maybe everything done that day.

That morning, I washed my entire right foot, thoroughly, for the first time in weeks.  I'm normally very sensitive to my personal hygiene, so I went over the foot at least three times with soap, gently but thoroughly.  I looked at my right calf.  I knew to expect atrophy.  I saw it happening.  I looked away, promising myself of how hard I'd work to get back into running form.  I wanted to run past Battery Park again, seeing Lady Liberty at night.  But first, the leg would get skinnier.  The timer had been reset.  The clock was not even running yet, and wouldn't be until after the surgery, assuming I could get cleared for it.  I did not want to think about it.

I learned that my primary care doctor did not have the ability to do either the X-ray or the EKG.  With my broken foot, it was going to be a pain to visit two specialists and then my primary care doctor to get clearance.  It would be expensive too, because I would need car service to each.  I couldn't go to another primary care doctor who could do both (I found one nearby who took Cigna), because my insurance wouldn't allow me to switch primary care doctors more than once a month.  I checked with the hospital near me, with the foot surgeon I previously ran away from.  I could trust them at least with an EKG and chest X-ray.  The woman that answered told me a cardiologist would be needed to do the EKG, and I was likely needing clearance from the cardiologist.  I couldn't get an appointment until Tuesday morning next week.  I made the appointment, but would have preferred to get it done earlier.

I decided to try an urgent care medical facility.  If they had a cardiologist on staff, I'd be golden.  The one I went to before didn't have a cardiologist, but I called CityMD at Union Square and was elated when they informed me they had a cardiologist and could do everything.  It would be an expensive $100 copay for urgent care, but it'd be worth it to get everything done that day.  I would go first to the podiatrist for the new cast, then to CityMD, then home.  I canceled the hospital cardiologist appointment and made the three GoGreenRide reservations I'd need.

Just before it was time to leave for my two stop trip, I decided to call up CityMD just to double-confirm they could do everything.  Nope, they don't have a cardiologist.  What they told me before was a complete lie, and my previous appointment was down the drain.  That day, despite my best efforts to get everything done with, I was only able to get a new cast.  To be locked back in the foot prison, that seemed I'd be unable to escape from.

At least Dr. La Puma made absolutely sure it would be comfortable.  I worried that it felt tight again, but then I felt a lot of padding in there.  Not once did I feel any pain from the new cast.  I was relieved to know conclusively that a soft cast can and should be generally pain-free.  As a nice bonus, the inflammation from the bone stimulator hole, which would have been undesirable during surgery, had disappeared.

Surprisingly, during my unplanned visit, I got greeted by most of the people in the office.  Another doctor walked up to me and said "The man with the blog!"  Apparently Dr. La Puma really liked my first two blog posts, and the other doctor read the first.  My blog was definitely good for their business, but I promise you, the first two posts were very objective.  Maybe they were making a point to seem friendlier because of the good PR.  I'd like to believe otherwise, because I was treated plenty well before they knew about it.  As a litmus test, if Dr. La Puma only gives you his personal cell after you write a blog post about him, I agree that it's suspicious.

Anyway was home again, and I needed clearance somehow.  I learned from Dr. La Puma that a cardiologist wasn't needed to give clearance.  My primary care doctor could do it.  But I needed the EKG, and was able to make an appointment to get an EKG done by a cardiologist in the same building as my primary care doctor. 

I told the woman I spoke to at the cardiology office that I would need a referral.  She told me I wouldn't need a referral, but I insisted that, whatever information she was going with, it was wrong or incomplete, and I absolutely needed a referral.  After nearly crying into the phone, she finally agreed to confirm with the insurance company herself.  I couldn't believe how hard I had to fight to convince people I needed referrals.  Why is it so hard with Cigna?

I still don't know for sure if I'll have to involve my primary care doctor's office for more than a referral and medical records, or if the cardiologist can give me the clearance.  I'll find out later.  I double-confirmed that I can still do the radiology visit at the hospital near me, without an appointment or referral, and it seems I can, so I'll be doing that first thing in the morning.  Then I need that sent over to whoever gives me clearance.  I guess I'll have them send the X-rays to the cardiologist and the primary care doctor, just in case.  Who knows? 

I let my workplace know the new development.  With their condolences, they took the time-sensitive projects off my plate for now, and suggested I probably would need to take off the day after surgery as well.  That's not what I wanted to hear, but probably true.  At least I finally get to use that oxycodone I paid for when I was about to get the surgery done the first time.  I learned to expect them to make me feel sleepy, sleeping through the pain, rather than simply not feeling it, which I would have preferred.

I did call into work for a technical presentation someone was giving to the company, where I was the resident expert.  This presentation had been delayed a number of times, before I broke my foot, but they were finally able to visit now that I was out.  I did the best I could asking questions over the speaker, but it felt awkward.  I was this disembodied voice occasionally interrupting the proceedings.

On top of that, there were numerous company events that I would have loved to go to.  Even a presentation, complete with breakfast, going on at the New York Stock Exchange on Wall St, normally less than 10 minutes walk from where I live, I did not consider going to.  I wanted to, but I did not want to pay for car service.  I pictured trying to eat food while on crutches.  I pictured trying to find a handicap entrance of some sort.  Dodging people.  No way.  There were probably six other events I would have loved to go to that month.  I felt like I was wasting my time in New York.  People don't pay crazy rent to stay in their small apartments.  I felt so sad.

The weekend finally came, and it was bittersweet.  No matter how much I rested, it wouldn't put me any closer to having my foot back.  Aliona was busy studying for an exam she was taking the next morning, so I occupied my time that Friday night watching a 2004 Sci-Fi series on Netflix, "4400".  I've seen better, but it lets me stop thinking about other things.  I can just watch one episode after another, with the cat on my legs.  I wondered what happened to my ambition.  I moved mountains making movies.  I had an idea for an internet project that I wanted to work on.  I was working on it before, but I totally forgot about it after I broke my foot.  Maybe it's time to get back to it?  For now, it's too late.  The surgery is approaching, so I'm not going to be doing anything requiring my brain until afterward.

On Saturday, Aliona suggested we go to the italian restaurant beneath us for brunch.  I would be able to roll right up to an outdoor table on my knee walker, no stairs to worry about.  It would be awesome to go to a restaurant again.

We both had something off the brunch menu, giving us plenty of bloody maries.  The place is known for its pizza, so we got this pizza for dessert, wrapping a lot of it up to take home.  It took my mind off things.

On the way back from the restaurant, I rode the knee walker down a slight decline.  The ground was shaky, and I felt unsafe.  I'm planning to ride the knee walker to the hospital and back for my X-ray, so this makes me now worry about its stability.  A doorman brazenly asked me, "How much longer?"  I reply "At least two months."  "Ouch."  Sigh.

Later that night, I noticed a bump forming on my left foot.  My good foot.

I immediately worried about anything wrong happening to my good foot.  After looking on the internet, I found it looked like a "bunionette", a deformity in the bone that juts out from the end of the metatarsal.  But it didn't feel like bone.  The skin was tough, but the bump was malleable.  I figured it's just a callus that formed from so much balancing on my left foot.  The edge of my foot has to press into the ground so much.  I decided to try balancing on my left foot as little as possible.  Fortunately, the bump looked significantly smaller the next morning.  A large bump couldn't be a good thing, so I'll try to avoid irritating it.  One more thing to worry about.  I'll ask the podiatrist about it later.

I suggested Aliona make use of the weather, and go for a nice walk.  She returned with... a bagel!  She loves me :)  It was a splendid, fresh, sesame bagel with salmon lox cream cheese.  So good.  Thumbs up to Long Island Bagel.  It's probably a good thing I can't get to it very easily on my own.  Otherwise I might drown my sorrows in these things.

 And with that, tomorrow, my mission is, to get cleared for surgery.  Wish me luck.

Sunday, September 22, 2013

I Used to Dream of Flying

This is the second post documenting my experiences, living in Manhattan, after I missed one step on the way to the laundry room and broke a bone in my foot. First post was here: The Fractured Fifth - Manhattan Life with a Broken Foot 

I started getting used to my crutches slowly but surely around the apartment.  I would still roll around with my office chair whenever possible, but when I needed to stand, often it was easier to just use the cane, as sometimes it was difficult to navigate my small apartment with crutches.  Crutches would be for the outdoors, when I needed to go outside.  My friend Zack stopped by to enjoy sushi with me and Aliona.  He also helped move some things out of the way, which were difficult to navigate around with my computer chair.

I began to take not only anti-inflammatory drugs such as tylenol regularly, but also vitamin supplements, including my normal multivitamin, plus calcium/vitamin D tablets.  None are likely necessary, but I'm doing whatever it takes to heal faster.

The shower stool arrived.  It was SO much easier to get into the bathtub.  Also, I was able to sit on a stool rather than on the floor of the tub.  I felt before like an animal at the bottom of his cage.  With the stool, I was able to sit up, and lean into the shower water when I chose.

I also received the latex and plastic foot cast cover as well, which keeps my cast dry without the need for a trash bag and packing tape.  It has been sometimes difficult to get the thing over my cast without straining something in my foot or unraveling the bandages forming my cast, but it certainly felt far more civilized and sane.

I made a point, on Sunday, to enjoy some time on the rooftop of my apartment complex.  It was quite an ordeal getting to a good spot using crutches, and when I finally collapsed into a seat in the corner, I noticed I was downwind from a smoker a couple chairs over.  I had to move, being allergic to cigarette smoke, finding another nice shady spot.  That's the smoker on the left.  Eventually I noticed the smoke from someone else on the rooftop, but he was far enough away for me to ignore.

On the way back to the elevator, the security guard helped open the door for me, suggesting I take longer strides with my crutches.  That advice proved invaluable later, for when I went outdoors and would have to travel on crutches for much longer distances.

Monday morning, I woke up early, unable to sleep due to needing weird positioning of my imprisoned foot for it to be comfortable.  I sleep normally on my stomach, so the foot naturally rests on the toes, which is not comfortable.  Aliona was still asleep and I was on the sofa, eating breakfast around 8-9am, and I heard unusual noise at the front door, like maintenance is being done in the hallway.  Shockingly, I saw light begin to stream in from the front door.  Someone was entering my apartment.  I grabbed the cane and limped over.  The guy quickly saw me and exited, then rang the doorbell.  He explained that my apartment is supposed to be vacant, and he was going to confirm whether or not I should be there.  I knew there's no way this is the case, but I worried about how many places I'd have to physically go, foot and all, and how distracting this will be in order to clear it up.  Fortunately, I got a very apologetic phone call from the building manager who provided the wrong apartment number.

A couple hours later, I was cheered up when my bone stimulator arrived!  I learned that they retail for about $5000 each, and the insurance covers it in full:

While the guy was showing me how to use it, I asked him how to return the thing when I'm healed.  He said I keep it.  I imagined perhaps I could sell the thing, which he confirmed is done on eBay, despite it not being allowed, as it requires a prescription.  On eBay, it looks like you can get the same model new for a couple hundred at most.  Anyway, he told me, as Dr. La Puma suggested, that I should optimally use it twice a day, but if I can't be bothered, once was almost as good.  I knew that there would be no way in hell I'd miss any opportunity to use it if it was going to speed up my recovery for even a day.

I have to put some strap on my foot, then a conductive gel on my skin.  I insert the thing that delivers ultrasonic waves into my foot, then seal up the enclosure and press the big orange button.  Then I sit for 20 minutes per session, twice a day.  It can sense when it's not directly on the skin.  If I place it poorly, it beeps at me a lot until I fix it.  The hole on the cast was getting stretched a bit, so this was a problem for the first week.  During one session using this thing, I counted the number of sessions I'd have with this thing over the course of the next two months, at least.  About 120 sessions with 40 hours of my life stuck on the couch, waiting for this thing to beep.  I can't believe I have to deal with this crap.

While I wait each 20 minutes, Luna likes to watch me while sitting on the case I store the bone stimulator in.  She prefers I throw around her toys for her to chase, but sitting on new things is her next most favorite thing to do.

Monday, early afternoon, I went to my new PCP for a "general checkup", just so I'd have a PCP who could give me a referral when I needed it.  Getting a taxi at 1:30pm wasn't so bad once I went a block away to a busier street.  It was shaky getting in, though, and I felt bad when my crutches hit the taxi awkwardly.  I arrived and entered the office, happy I read beforehand on the internet how to use crutches on stairs.  These 3 steps had a handrail.  The web site also explained how to use crutches on stairs with no handrail, but I find that concept terrifying.  I was told to fill out some initial information on a tablet PC.  I had no way of carrying the tablet PC back to my seat.  Eventually I was able to convey this to them and they carried it over, and then back when I was done.

It was my turn, and they held the door open, guiding me to a door not far down the hallway.  The assistant took some basic measurements and readings from me and asked me some questions, then explained I'd have to go pretty far down the hallway to see the doctor.  After I settle into the new room, the assistant explains the doctor wants me to go one more door over to his office.  I finally saw the doctor, and then he immediately apologized, saying he would have come to me if he knew about my foot.  If only doctors read the patient history that takes so much effort to fill out every time you see a new doctor.  They rarely do.  "Broken foot" was certainly something I prominently recorded on the tablet PC as a "reason for my visit".

I learned my new PCP is a pulmonologist, which hopefully won't be relevant to me until my dying breath, but he was courteous and certainly knowledgeable.  I realized I probably should have brought the X-rays, but he said anyway, because I'm relatively young, he would recommend that I get surgery right away.  I explained what I heard from the foot specialists, how they both suggested it may heal fine on its own, describing the fracture as still mostly aligned and with no tissue damage.  He relented, seemingly ambivalent.  He had someone draw some blood, and I was on my way.  It was still fairly early in the afternoon, so I had no problem getting a cab, which I only really appreciated later.

When I got home, I was notified that my knee walker had arrived.  I was elated, as everyone on the internet was raving about how much better it was than crutches.  It lets you carry things in a basket, and scoot around freely.  Stairs are still a problem, but I wasn't going to be needing to deal with stairs around home.  Fortunately, the staff was nice enough, again, to bring it to my door.  This could be very well owed to a sense of guilt from the earlier incident.

I was warned in the Amazon reviews that the assembly was not complex but the instructions were abysmal.  I have confidence in myself to figure it out, but was pretty unsure at various junctions.  Luna meanwhile played with the packaging.

When I got the thing assembled, Luna was in heaven.  Once again, Luna was an obstruction.  While the kneepad is certainly too small for me to safely sit on, it's the perfect size for Luna.  She likes the basket too sometimes.

Later that afternoon I got an email from my boss.  After affirmation from me that I could work full-time, aside from my Wednesday podiatrist appointments, five projects were piled onto me!  Modestly complex projects, but five of them were plenty.  I felt a bit worried, not having worked so heavily remotely before, but I'd make it work, and I needed something to make the time go quickly.  The deadlines wouldn't be unreasonable at all.  I had my work, and I could do it from home, so I was grateful.

I saw notification from a project manager of one of the projects that I was required at a meeting that fell right during my podiatrist appointment.  She explained that just this meeting couldn't be moved.  I didn't want to push my appointment to another day.  The podiatrist appointments were my key to getting out of this broken foot hell, so I figured that perhaps I could move the appointment 2 hours later and it still should end before rush hour.  I reluctantly agreed to try to move the appointment, and I was able to.

Got more more instant message from a project manager working on a project I hadn't been assigned.  She said "I hear we'll be working together!"  What?  Soon another email arrives from my boss, saying that I get to work on that sixth project too.  It seemed simple enough, so I welcomed that as an easy brownie point.

On Wednesday, I had my meeting.  I rushed off to a taxi to get to the podiatrist afterward, hoping to get out of my 3pm appointment sooner rather than later.  I told the taxi the address, and despite me yelling "Stop!" he drove almost a block further, which seemed not a big deal to a cab driver.  Unless you can guide a cab driver precisely, you'll rarely end up exactly where you say, and that only registered in my mind then, when every step was a significant effort.  Fortunately I got up to the office no problem, and soon was treated to another whirlpool foot bath and this time, a new "sono" treatment, which I believe works similarly to the bone stimulator.  A machine was hooked up to conductive pads that were applied to my foot.

I honestly don't know if the foot bath or this sono treatment was actually useful, or was just to make me feel psychologically content, but I was going to trust the doc and was also just happy not to have to limp around on crutches for a while.  I was, however, starting to worry about the time.  They seemed to let me sit in "therapy" for longer than I needed to be, and I feared it was getting too close to 4pm, when I figured the rush hour traffic would start to kill my chances of getting a taxi.  I was on crutches now, and did not want to have to painfully navigate the subway system again, risking more injury to my foot.  I wanted to tell them to hurry it up, but I didn't want to interfere with anything that could help my foot heal faster.

Afterward, Dr. La Puma applies a new cast.  He cuts a wider hole in my cast to help with the difficulties with the bone stimulator beeping.  It felt less comfortable than the last soft cast.  I figure since the soft cast is manually constructed, the fit varies significantly.

I was good to go, but it was already past 4pm.  I tried to get a taxi after, on crutches, traversing a "long block", which, in Manhattan, is three times longer than the "short blocks" that are north and south.  The taxis are mostly on the north-south roads (avenues), so it only makes sense to traverse the long blocks, and the next avenue always seems to have more taxis.  The available taxis have a lit up sign above their roof, and during rush hour, very few if any of them are lit up.  That was certainly the case in the ultra-crowded midtown, slightly after 4pm.

I tried at the second avenue for a while to hail a cab, to no avail.  I notice someone walk slightly in front of me and start trying to hail a cab.  I was pretty sure he was unaware that someone on crutches behind him was desperately trying to hail a cab, and had been for a while.  It would have taken a lot of effort to get his attention and state my case, but I didn't think I was going to find a cab anyway on that avenue, so I decide to head down another long block.  Following the security guard's advice, I was taking rather long strides, but I'm getting so exhausted.  I wondered if I needed to make my crutches higher, but would that reduce my stability?  I feared how easy it would be for me to slip somehow on crutches--to have something go horribly wrong--but I was forced to deal with them for the time being.

Eventually I reach the third avenue and saw so many taxis, and some of them were still lit up.  I tried desperately to get the attention of some of them, but they just ignored me.  I shouted into the open window of a lit-up taxi as it drove by helpless me, but that only served to startle some unsuspecting pedestrians.  Trying to wave at a taxi, I accidentally slipped and stepped on my bad foot.  I thought seriously about limping out into the middle of 4 lanes of traffic, stepping in front of any taxi with their light on.  They move slowly enough.  Surely they wouldn't run me over?  I certainly would have gone for the subway at that point, but I made the wrong choice, and I no longer had the strength to get to a subway station.  I feared my best option was to sit on the ground and weep until rush hour ended.

I made one last, desperate wave at a taxi on the far side of the intersection.  I could have sworn he made some sort of gesture of recognition.  The light changed and, yes, he pulled up and I got in!  I tried to explain where I lived in the Financial District.  He didn't recognize many of the street names.  He recognized an intersection about 3 blocks away, and I used hand gestures to communicate where exactly I lived.  He nodded and I dozed off.

A while later, I was relieved to see he was driving the right way.  He asked me whether to take exit 1 or 2.  I wasn't sure, but suggested exit 2, the Brooklyn Bridge exit, was a safe bet, maybe at worst slightly slower.  He still didn't know where I lived though.  Even "turn right here and go 3 blocks" didn't work.  I got out at the intersection 3 blocks away and had to fight my way slightly uphill, 6 steps at a time.  I was so tired.  People who have to use crutches a lot build up their upper body strength, but I was new at this.

Eventually I saw my building.  I weakly made my way in, panting heavily.  Just one more hallway from the elevator.  A neighbor I've never met realized "that guy on crutches lives next to me" and asked if I needed help.  People generally want to help the crippled, and it's nice that so many good samaritans are ready and waiting, but I didn't need help anymore.  My advice is to help people on crutches hail taxi cabs.  There's an app, "Uber", made for hailing cabs electronically, but due to politics, it doesn't work in Manhattan.  Only the more expensive options are available, including car service which would run $30 more.

I fell into my chair, tired and sweaty.  The cat crawled on top and comforts me, as I was left to worry about whether or not I'll need surgery now that I had stepped on my bad foot.

I get back to work, with the cat on my lap.  We moved some chairs around, so I can get around easier, but one chair was still quite a bit in the way.  By putting it on the table next to my work laptop, it turned out to be the perfect hangout for the furball to snooze her life away, occasionally checking up on me.

I have always loved beer, at least since my college days, and had a sizable (22oz) one in the fridge, which I was really needing at the time.  At the end of the work day, I embraced this bottle, which apparently contained "maca root", and despite the beer being very obscure and hard to drink a lot of, I got through it, and felt much better.  But my coordination was off.  3 times my knee slipped off the pad of the knee walker, and the third time, I accidentally stepped a bit on my bad foot again!  This started to send me into a downward spiral emotionally for the rest of the night, but thankfully, strong beer helps me sleep fast.

I became paranoid about making sure my knee was securely on the knee walker before using it.  It's not like a bicycle, where you don't have to look to make sure where the seat is.  I found that even without beer, I sometimes would not place my knee well, so I had to check each and every time.  The knee walker does not turn around well, so much of its usage involves carefully rolling backwards and trying to steer, then awkwardly turning the thing around while maintaining my balance.  Hopping from the knee walker to the sofa also can be difficult with the armrest in the way.

I now worry about what I'll hear at my next podiatrist appointment.  Did my two accidental steps screw up my foot even worse?  Or perhaps I didn't put enough pressure on my foot, and with rest, time, and the bone stimulator, my fracture will look better?  I got an email from work, telling me that my desk has moved to a different location that I like a lot.  I was surprised that they didn't give the seat to someone who had been there longer, but they apparently like me, and informed me the seat will be ready and waiting for me when I get back.  I imagined cutting off my foot, and using a prosthetic, but when this is all said and done, I'll look back on this ordeal as an obstacle I overcame.  Everything would be back to normal, yet I would appreciate having two feet.  Still, if my fracture looks worse at my next appointment, I'll be very motivated to opt for surgery, so I can at least have a fairly guaranteed recovery schedule.

I really have to emphasize how much Aliona has stepped up during these trying times.  So many healthy, fun meals prepared for me, and also dealing with many of the menial house chores that I used to handle.  Outside of a computer, I feel pretty useless, and will surely feel that way for some time.  I really cannot wait to be able to simply walk again.  In my dreams, I still can walk, and it seems so easy.  I used to dream of flying.

Friday, September 13, 2013

The Fractured Fifth

I walk at New York speed.  I'm adept at weaving through crowds of tourists, smartphone users, panhandlers, and hand-holding couples in Times Square subway station, and getting to the front of the crowd, getting to where I need to go before anyone gets in my way.  I race up the stairs, skipping steps, reaching the sweet bliss of the sidewalk's freedom.

That was before the accident.  I know there are much nastier stories of nastier accidents, but this story is about such a tiny misstep that lead to one of the last hassles a New Yorker wants to deal with in life -- a loss of mobility.  What was my misstep?  Just that... I missed a step... on a staircase, on the way to the laundry room.  It hurt, but I was still able to walk.  I decided to mostly stay off the foot and get some sleep.  The next morning (Monday), my foot was rather swollen, and it was apparent I'd miss work, and I'd have to see a doctor.

I just started a new job 3 weeks ago, as a technical manager at an agency.  I had yet to use my new insurance, Cigna's "Network" plan, which requires referrals.  I did not see a primary care physician (PCP), who generally is responsible for issuing referrals.  I instead went to an urgent care medical office.  Urgent care medical offices serve as an immensely comfortable option in Manhattan, allowing for walk-in doctor appointments.  Cigna charges me $100 per urgent care visit, which I'll note is the worst of any insurance I've had with my previous jobs.  I put on shoes with good support, limped into a taxi, and went to "Medhattan", normally an 8 minute walk away from my small apartment, downtown in the Financial District.  Dr. Leslie Miller was very caring and attentive, and after looking at the X-rays, had a very sad look on her face...

This is a fracture of the fifth... the fifth metatarsal.  To me it was just a number.  But I learned what it really meant later.  For now, I got a referral for an orthopedist near my apartment.  I got an appointment at 8:15am the next day.  I was sold a $24 cane, for the time being, which I hoped my insurance would cover.  Cigna told me they only cover equipment sold through in-network providers.  I argued I needed some way to safely leave the office.  The Cigna rep told me to just file a claim and wish for the best.  What?  Really?

The cane gave me some meager means to protect my foot.  I did my best to learn to use it.  I found that I could hold the top to my hip for stability, and the closer the bottom was to the side of my foot, the more pressure it relieved.  I learned to slow my walk enough where I could use the cane most effectively.  Frustrating, given the pace I was used to.  My prized mobility, for however long, was long gone.

I showed up and eventually saw the orthopedic surgeon.  He looked at the X-rays and quickly presented two options... surgery, with 5-6 weeks healing, or no surgery, which would take over 3 months.  I quickly decided on the surgery, and he agreed.  Then I found out I'd be put under for the surgery.  This I was very uncomfortable with.  I always hated the notion of losing consciousness, entrusting your well-being to strangers, but I figured if it happened, I'd be in much worse shape, with a heart attack or stroke, and would be begging for relief.  This was far from that, and I felt my skin go cold, still nodding my head reluctantly.

My surgery was scheduled for the next morning, at 6.  I was shuttled off to an assistant who took more X-rays, and then another that quickly went through a lot of critical information that I needed to know in preparation for the surgery.  I stopped her often as I furiously took notes, trying to organize the simple steps of preparation in a short list.  On my way home, I stopped in a pharmacy for oxycodone, a powerful narcotic to alleviate the awful pain I'd have afterward.  While waiting for my prescription, an elderly lady asks me for my seat.  By habit, I got up, thinking I'd be okay balancing on my good foot, but quickly I realized I should impose on the girl in the one other seat.  She quickly reassured me and let me sit.  I knew I had to get used to leaning on the many samaritans of New York.

I went home and waited.  Time passed, and I ruminated over my first surgery.  I went out for a "last walk" before surgery, in case I didn't wake up.  I know it was irrational and unlikely, but, it happens, doesn't it?  I like bagels.  I limped a couple blocks to the one good bagel place close by, Long Island Bagel, buying a cinnamon raisin bagel, with pumpkin cream cheese.  I like trying new things.  Never tried pumpkin cream cheese before.  It was like pumpkin cheesecake.  On the way back from my walk, I picked up flowers for my fiancee, Aliona.  I wanted something fresh and attention-grabbing.

I wondered what the real problem was.  One of my friends on Facebook suggested in jest that I film the surgery, with filmmaking as one of my hobbies.  I realized that if I was allowed to film the surgery (a quick google search told me this would be next to impossible), I would be a lot more comfortable with it.  Why was that?  Lack of trust.

Normally, if I choose a doctor, I'd check reviews online.  I'd learn something about him.  I hadn't.  I was entrusting my future mobility to this stranger.  I thought of how I was rushed through the paperwork.  I remembered an error in the X-ray form that the radiologist corrected.  I thought about how little was explained to me by the doctor, and how little I knew about him.

Aliona saw my obvious discomfort, and the tears I tried to hide, and looked up reviews for the doctor.  She said firmly, "Choose another doctor!  His reviews are awful!"  I looked at them and instantly I knew, "No way".  Instead of reporting in to the pre-op room, I cancelled the surgery.

I looked on for another foot doctor that my insurance supported, who seemed good.  I found one, Dr. Vito La Puma, with 10 great reviews.  His description on Zocdoc mentioned he was a chief resident, which I knew was an impressive thing, thanks to many episodes of Grey's Anatomy.  I figured I'd need to get some sort of referral or some exception from Cigna, since I didn't have a PCP yet, so I scheduled an appointment through Zocdoc at 4pm that day.

The next day was all about cracking the code.  Finding a loophole.  I talked to Dr. La Puma, who confirmed I indeed needed a referral before 4pm.  I tried three approaches.  I explained the situation to Cigna.  There was absolutely no flexibility.  No matter how long it took, I would need to see a PCP.  I realized an unmentioned possibility of shelling out another $100 for an urgent care doctor again, but I didn't feel I should be forced to do so, since I already saw one.  The second possibility was to find an available PCP.  I looked all over the Cigna list and Zocdoc, which lists open appointments.  But no one listed by Cigna appeared in Zocdoc.  Would I have to call each one?  The reviews I was finding on Cigna-listed doctors were rather bad.  I could temporarily choose a bad PCP, but would they even be available?  Probably not.  I did find one PCP with good reviews, also listed on Zocdoc.  I had to call a few offices to find out which office he still worked in.  Eventually I made an appointment for 5 days later, but I called his office to try to get a referral just for now, and I'd come in later.  They agreed at first, but refused quickly when they realized I wasn't a patient there yet.  I realized maybe I could try the urgent care doctor again.  Even though they usually only refer patients to their handful of lackluster options, I pressed and was granted a "blank referral".

I had no idea what a "blank referral" was.  Should I write something in it?  Should I just give them the blank form?  Later, I realized that they did write "orthopedist" and the purpose of the referral on it.  Just not exactly who it was for.  Dr. La Puma's office readily agreed it'd be fine.  But Medhattan's fax machine was flaky, so I had to limp over there to get the referral myself.  On the way, the NYPD blocked off the street right near Medhattan... some event for families of war veterans I thought.  I asked them to let me just cross that one street, trying to explain that I had a broken foot.  No exceptions.  So I had to limp a couple blocks extra.

Finally when I got to Medhattan, an apologetic lady told me it was closed, due to the event the NYPD were tending to.  I insisted that I was just there to pick up a referral, and she was nice enough to get it for me.  I limped around for a few more blocks until I found a taxi.  The taxi driver asked me "Why the stick?" referring to my cane.  I told him I missed a step.  He shook his head, saying he does that himself, and hurt himself missing 5 or 6 steps once.  I told him he needs an eye doctor more than a foot doctor, and he laughed.  I allowed myself to laugh a little at my own joke too.  I needed it.

Traffic was miserable and I accidentally gave him the address of the PCP, which was also on 45th street, but on the east side.  Oops.  So I caned my way humiliatingly crosstown, through a rush of midtown foot traffic, like a rock a river flows around.

Dr. La Puma's office was in "Foot Care of New York".  I was greeted by an ultra-perky assistant who smiled and gave me minimal paperwork.  Zocdoc was also great, by the way, letting me fill out most of my paperwork electronically.  Learning to appreciate them a lot.  I just had to sign 2-3 things, including a privacy notice, but they got my thorough notes on my medical history from what I submitted to them online.

I was led in, to sit in a chair, and the assistant told me she was preparing a medicated, cold "whirlpool bath", to help with the swelling.  The chair had my feet raised, and I got a good look at my ailing foot.

I remembered my soccer games from when I was little.  I was never very good, but man, did my foot know how to kick that ball hard.  I remembered how I ran around Central Park on a whim, and wherever else I wanted throughout my life, just exploring.  I was quite a runner.  How much miles I covered during my college days, walking across large fields of grass, rushing to exams as I pursued my engineering degree.  And what did I do for my loyal foot?  I carelessly rushed down a flight of stairs, and left it to the mercy of a broken healthcare system and an unforgiving urban environment.  But things are finally getting better.  My poor, suffering foot, that the world seemed against, was actually going to be pampered.  I felt my eyes tear up again, but unlike the night before, these were happy tears.

This bath felt so good.  The cool water swirled around my foot.  Afterward, she gently toweled my foot dry, and led me over for a third set of X-rays.  Every doctor seems to have their own type of X-rays that they're comfortable with.

Dr. La Puma walks in, and we discuss my foot.  He says some good things and some bad things.  The bone has minimal displacement, which helps it heal without surgery.  However, the fifth metatarsal, he explains, is the worst possible metatarsal you can break in your foot.  It's attached to a bone in the leg that pulls on it, every step.  But it's not like I got to choose.  Also, it's a mid-shaft fracture, which is less stable, and with less blood flow.  But, more good news... he could provide me with a "bone stimulator", which is a little device that sends imperceptible current into the area, promoting bone healing.  "Steroids for bones", he calls it.  Also a surprise.  He tells me, if the leg does heal non-surgically, it would likely take around the same time with surgery.  It's just less guaranteed.

After a quick confirmation by him, I state that I'm fine passing on the surgery, at least for now.  I felt no pain, as long as I was meticulous and careful.  I had received email from my employer that they were accepting of me working from home.  I figured, I had as good a chance as anyone, now that I finally had the medical care I needed, for my foot to heal naturally.  The doctor wants to see me every week to monitor progress, and if effective healing wasn't happening, we'd go to the surgery option.

He admitted that while he was a resident, he would have jumped at the surgical option, but since then, he's learned to be more understanding and humane.  This reminded me of the ultra-competitive surgeon-residents depicted in Grey's Anatomy.  I asked him about his "chief residency", and he quickly admitted he was quite proud of it.  One time opportunity and it was quite competitive.  He explained he was an "attending" now, and I joked about him having "dreamy eyes", like the attending physician in Grey's Anatomy nicknamed "McDreamy".  We shared a laugh as he finished up my "soft cast" and his assistant returned with a "cam boot".  I was warned, that when I showered, to do whatever it took to keep the soft cast dry, such as a plastic bag and tape.  Otherwise I'd have to come in to get it replaced.

Finally my foot had some protection.  I felt the healing process was finally starting.  The security guard at the door commented on my exposed toe, warning me about people stepping on it in the subway.  I just wanted to fall into a taxi and be taken home where I can finally relax and play with my cat.  But, it was rush hour.  No taxis to be found.  "Bike taxis" kept offering their service, but I didn't trust them, and heard they charge a lot.  I opted for the subway, knowing New York is pretty good with offering seats to the disabled.

Was I disabled?  I'm used to my former New Jersey life.  You had to do a lot to get a handicap license plate.  But on a subway, yes, anyone with an injured foot certainly qualifies.  So I had no problem sitting down.  It took me a while to get to Grand Central.  On the way, another cane-wielder limped by, at a faster pace, telling me "There ought-a be a CANE LANE!"  Already him, the security guard, and the taxi driver are trying to cheer me up.  New York can be unforgiving in many ways, but everyone's in it together.  That's New York.

This is me with my cam boot and cane, in my apartment.  I spend some time figuring out how to order crutches through my insurance.  I'm also, at some point, supposed to be visited by a man with the "bone stimulator".  I call up Foot Care of NY, asking when it supposed to arrive.  She said she'd check on it, and I joke that my bone really needs to be stimul... err... I cut myself off and realize how horrible that joke was sounding.  She was very understanding.  Oops.

I spent some time thinking about how to modify the apartment to better accommodate me.  I could use my office chair to roll around if openings were wider.  I shifted things about, but the problem was, Luna the cat kept jumping in my chair at every opportunity...

The next morning, it was time for my first shower with the cast.  I took out the packing tape and a trash bag.  I hoped, if the tape was tight enough, I wouldn't have to make my hairy leg suffer.

Getting in the tub was difficult, but I realized I could push the rubber foot of the cane safely into the bottom of the tub then jump in.  There has to be a safer way, however.  While in the shower, Luna took her time investigating my cam boot.  "Get outta ma friggin' boot, cat!"  She didn't listen.

 I don't think the doctor required me to wear the boot around the apartment, and it's rather heavy on my foot, but I want all the protection I can get.  I spent more time online investigating other things that might help.  Quickly I ordered:

Something better than a bag and tape, to cover my cast with:

A stool to sit on when in the shower:

A "knee walker", that will be so much better than crutches, usable outdoors, and unlike the chair, can roll over the bathroom and kitchen thresholds (useful, no?):

I don't know if I can get insurance to cover any of it, but I ordered all of it.  I don't know if I'd be too embarrassed to zip around on a scooter-thing on the streets.  But I remember once when I saw a girl on crutches try to enter a frozen yogurt shop.  There was a very slight downward slope leading into the store.  She tried to go down the slope on crutches and just didn't feel comfortable.  Do I want to deal with that?  Or could I survive just hiding in my apartment building for 2-3 months, only coming out when I need to jump in a taxi?  Just one missed step, and now this!

But first thing's first.  Fortunately, we had a good supply of frozen meals in the kitchen to hold me over while getting life sorted.  I had time to sync up with work too, and they're so far very reasonable with accommodating me.  They delivered my laptop home, so I should be able to work on some projects.  Maybe not the time-sensitive ones, but I'm planning on doing quality work still.  Now to deal with my most pressing matter.  I need to heal, and that requires rest.  But I can't rest until Luna is dealt with.

Totally not a real strangle, don't worry.  We love Luna.  I feel bad that I'm the one who plays with Luna, throwing little toys around for her to chase, and I can't really do that much right now.  Maybe with the knee walker.  Luna's a trooper though.

My crutches were supposed to be delivered at 6am.  I checked with the medical equipment store to make sure the crutches would be delivered to my door, and not just to my building's doorman.  I pass the time reading up on instructions for how to use crutches.  I realize most cane users don't use the cane to bear their full weight like I was.  Or so I assume, because it's quite painful on the hand, eventually, and awkward.  I realize that most likely, after using a cane to do so much -- even hopping in the shower stall -- crutches would be much easier.

6am passes, and I happen to review my email.  I see an email saying that my crutches were delivered to the doorman.  The doorman was fortunately willing and able to bring them to my door for me.

After I got my crutches, I try to sit back down to see how they work.  Luna is of course in my chair.  I shoo her away with my new crutches.

The last time I had my height measured at a doctor's office, I was measured at 5 feet, 11.96 inches.  I argued they mistaken, and surely were adjusting something wrong.  I've been over 6'1" throughout my life.  Could it be at the age of 36, I shrank?  I thought that happened later in life.  I figured it was inaccurate, but whatever my height was, I needed to figure it out to adjust the crutches, which had "pin holes" labeled by height.

I read enough warnings to know the things at the top are not supposed to touch your arm pits.  My initial tests went well and I was able to hop around the room.  I was thinking that maybe I should cancel the knee walker.  This didn't seem so bad, and I was less self-conscious of crutches.  But then I realized the feet of the crutches were supposed to rest six inches in front of me, and the height should be adjusted for that, which accommodated longer strides.

I readjusted and tested a bit in my small apartment.  I did feel I was able to move a lot farther each stride.  I had a bunch of wobbly moments.  Turning was very awkward.  I suppose I could have adjusted the height for indoor and outdoor use, but then I'd worry about being used to the shorter stride, which could be dangerous.  I decided then to not cancel the knee walker.

It was time to go back to sleep.  I believe in the importance of sleep, for healing, and thought that if I'm going to have any chance at healing without surgery, I needed to have plenty of sleep.

I slept very well, and at 11am I received a call from the supplier that was supposed to deliver the bone stimulator.  He seemed unaware of details, and said he might have to check X-rays, but I told him my doctor had cut a hole in my cast exactly where the bone stimulator should be applied, so he didn't have to worry about that, but then proceeded to explain that I'd need to come in to pick up the equipment.  No house call?  I thought about trying to use the crutches to go somewhere else random, or trying to direct a taxi there.  I told him I barely knew how to use my crutches and how I wasn't expecting to have to leave my home.  Silence, then... "Okay, where do you live?"  Phew... he's supposed to stop by on Monday.  Time is often measured with obstacles.  I hadn't taken a shower yet today, so that's 4 showers from now.

My boss called and we're going to figure out everything I'll be working on in the upcoming months.  They're rather supportive.  All I need to do is heal.  Will post a sequel when I get more material.  Long road ahead.