My Experience being the Patient:
What I learned having My Appendix removed during Residency
Most of us are healthy during the years of medical school and residency, with few needs for medical care. Because of this, we often have very little experience being the patient in medicine. And it is a different viewpoint, once you are the patient and not the medical provider. This is the story of my own experience with medical care – when I developed appendicitis during my intern year!
To start, my appendicitis followed a pretty classical presentation. The story starts on a Friday/Saturday night – due to some extra vacation days, I had a nice 4 day weekend. My wife and I went down to the nearby casino and enjoyed our Friday with a few adult beverages and going to town at the buffet I was able to get comped for the night. Saturday night, we went to a banquet – with a big steak dinner and a few more adult beverages. By Sunday I was worn out! And I noticed I had developed a little generalized abdominal discomfort – not really pain – but just felt different. After a couple big meals and a few too many adult beverages, I chalked it up to a bit of over-indulgence.
Monday morning, the abdominal discomfort continued to be present, but I otherwise felt normal. By lunchtime, I noticed I wasn’t very hungry but nothing else was amiss. Then that afternoon, while writing some progress notes I suddenly noted a very peculiar feeling. A new twinge of sharp abdominal pain, directly in my RLQ!
“That’s weird” – I thought, simultaneously remembering that I’d been having some generalized abdominal discomfort for about 2 days, that now was suddenly more pronounced/localized to the RLQ – a classic sign of appendicitis.
I arrived home about 430pm and joked with my wife I had developed appendicitis and would go into surgery in the morning. She had made dinner, and despite not feeling that hungry, ate fairly normally (real smart, being an anesthesia intern and eating a full meal while being concerned I had a semi-emergent operative condition). I kept joking about needing surgery tomorrow, but I think I really didn’t expect anything more than a normal day in the morning.
Things changed about midnight, when I was awoken by more RLQ abdominal pain and now some definitive nausea. At that moment I knew I probably really did have appendicitis, and would need to head in to the ER. Lucky for me, I was at a community-sized hospital and one of the favorite ER attendings was just starting her 2am – 10am shift. I told her my story and she took me to the trauma bay, gave me a quick abdominal exam, and went through my history/symptoms. She was convinced as well, so at that point, I was checked in as an actual patient and given a quick trip to the CT scanner.
“Impression: Findings consistent with acute appendicitis”
By this time I was given a bit of pain medicine and admitted to the hospital. The OR there was unusually busy that night, so I was put off until the AM (a more and more common practice now anyway).
My surgery would go fine. The surgeon kept me the following night and I went home postoperative day #1. I was back to work on POD #4.
Here are a few things I learned during my hospital stay and appendicitis experience:
1. Because my surgery was slated for first thing in the morning, but before the normal 730AM starts, it wasn’t immediately clear who would perform the operation. Having been through the surgery month as an intern, and it being a community hospital, it quickly got around that a resident was in need of appendectomy. As such I had 3 different surgeons come in and offer to do the operation. The funny part is I’d never seen a surgeon WANT to be around a medical trainee before (Just joking surgeons)!
The true takeaway is that when I was sick I had a lot of different people offer to cover shifts, surgeons offer to watch out for me, and generally, people were extremely willing to take care of one of their own (I even got a private room!). There’s actually a lot of evidence VIP style care leads to worse outcomes – but boy did it feel nice!
2. It’s nearly impossible to sleep in a hospital. I was a healthy patient, with a routine operation, staying overnight only as a precaution. Yet the amount of traffic in and out of even my private room, the noises, IVs, labs, etc etc make it impossible to get any decent sleep. It’s also fairly dang uncomfortable just simply being in a hospital, even when you aren’t even that sick. I’ve been more apt to offer sleep assistance when patients request since then – even if it’s just a little melatonin!
3. Treating pain! As I mentioned, being in a hospital tied to IVs and being post-op is a pretty uncomfortable experience. Because of the opioid epidemic, I feel we tend to undertreat acute pain, worrying about long-term issues. After being in the hospital and having an operation, I am very quick to treat acute pain more aggressively. It’s no fun being in the hospital and especially worse to be in pain!
However, on the same topic, I went home on Wednesday morning with 15 Norco 5/325s. I was back to work Saturday morning. Once discharged and at home, my pain post-op was pretty minimal and certainly required minimal narcotics. While I think treating acute pain is warranted aggressively is warranted, I can say that in my case there was not much need for additional pain medicine once home and a prescription for any more narcotic pain medications would have been overkill.
4. Holy cow medical care is expensive! I was covered via a HSA/High deductible plan via the residency department. My final cost was about $3000 out-of-pocket – not exactly cheap on a resident budget! However, the total bill the hospital sent to the insurance company? $34,000!!!! For an ER visit, appy, and one-night hospital stay. This highlighted even a young, healthy male the importance of having some form of insurance. And regardless of your political opinion – we should continue to make sure people have the ability to purchase health insurance.
5. My experience was very positive! BUT I think a large part of it was because I knew exactly what was going on at all times. Being in the medical field, even a physician at the hospital I was being cared for at, made me very comfortable with each step of the process. I had a good idea of my diagnosis even before the ER and knew they’d probably want a CT to confirm. Then, I knew I’d be headed off to surgery sometime shortly thereafter. I already knew the difference between a “lap-appy” and an “open appy” (I even CHOOSE to have done lap, as some of the surgeons there routinely offer open-appys, unless you know to ask). I knew what it’d be like before and after surgery. Basically, I was just along for a ride I already knew well.
This is not most patients. Most patients have no idea how a hospital works, what to expect, or what physicians do in the operating room. I was grateful to have that knowledge, as it alleviated much of the nervousness one would normally have. And that more than anything made my experience a positive one!
What other perks are there to being in medicine while having a health issue? Have you ever been a patient? Lend your thoughts in the comments or consider writing up your own story.
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