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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.

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