This is my space heater, or as I like to call it now, my $6,600 space heater a.k.a. my bone density testing device. Why? Because I tripped over it and broke my left arm on February 16th, which maxed out my $6,600 health insurance out-of-pocket limit for the year.
The heater was off, so I didn’t get burned in the literal sense though I did get burned financially. I also got a spiral fracture in my left humerus, which is the upper arm bone. As I waited for Aunt Donna to arrive and drive me to the hospital, I did some Googling and learned that 85% of humerus fractures can be fixed without surgery. However I was in the unlucky 15% and won a night in the hospital that I spent awake hoping I wouldn’t die during surgery the next day. Spoiler alert, I lived! They had to insert a plate and 8 screws to fix me, and they sealed up the 8-inch incision with 41 staples.
You can view the image of the incision and 41 staples that held my arm together here, or not, if you’re squeamish.
I’ve been recovering over the past 7 weeks, which is why it’s been so long between blog entries. I couldn’t comfortably type with my left hand until recently, and using the Windows speech recognition software to dictate an entry felt weird. It worked well enough to handle email, but blog entries seem to flow better if I’m typing, not talking. (Pro tip: if you leave speech recognition on and start listing to music, your computer will act like it’s possessed, opening random applications and making you convinced you’ve downloaded a horrible virus.)
The ER in real life is not like the ER on TV
When I arrived in the ER at 9:30pm on a Thursday night, guess what was playing on the TV? Chicago Med. That’s right, I arrived in the ER to watch a show set in the ER. So much for TV escapism. Also, my actual experience in the ER was nothing like the chaos I’ve seen on shows set in ERs. Yes, there was one woman moaning in pain in the waiting room, but everything was fairly calm and under control. No one was pushing gurneys in a hurry and yelling “Code Blue!” or anything like that. And when I was taken back to see a doctor I got my own room, not some area portioned off with curtains.
Nurses are awesome
The nurses at the hospital made my visit so much better than it would have been otherwise. When I was scared, vulnerable, and wounded, they took good care of me and helped me with embarrassing things without judgment, like the time I overfilled the bedpan and had to lie in my own piss for several minutes. (Peeing while you’re lying down feels unnatural, and even when you haven’t overfilled the pan it feels like you did.)
The ER nurse helped ease my mom’s mind by telling her I was going to be ok after she examined my arm and saw that I had good color and could still move all my fingers. The night nurse in the ortho wing let me borrow her personal phone charger when my phone, my only connection to the outside world, was down to 12%. Right before I was wheeled off to surgery, my nurse also offered to put my phone in the little safe where they keep the opioids since I didn’t want it to get stolen. I took her up on it, but as I was being wheeled to surgery I thought, “Shit, I hope the anesthesia doesn’t erase my memory of that conversation, because if it does I will NEVER find that phone again.” Another nurse poked a hole in my tissue box to hold my chapstick so it wouldn’t roll off the table. And when I was being discharged my nurse offered to get me a scrub top to wear outside because the weather had gotten drastically warmer since I’d arrived in the ER in a sweatshirt. Thank you, nurses!
An endless merry-go-round of people
During the two days in the hospital I met at least two dozen people who rotated in and out of my room, sometimes awakening me in the middle of the night, and often asking me to sign something that I did not read because I knew I needed to sign it for them to fix me and I needed to be fixed. This would have been a great time to run a real estate scam because I would have signed anything you put in front of me. Here are all the people I can remember meeting:
- The triage nurse at the ER who let me know my blood pressure was 168/95. DEAR GOD.
- The intake nurse who told me they couldn’t confirm my insurance, which momentarily freaked me out because I knew I had autopay enabled and had successfully used the credit card associated with the account at a Subway sandwich shop that afternoon. It turned out they’d misspelled my name, which caused a mismatch.
- The x-ray tech in the ER who said she wasn’t allowed to diagnose me for legal reasons, but let me see my x-ray which made it obvious that, yes, I had DEFINITELY broken my arm. Even without the x-ray I was 99% I’d broken it because when I moved my upper arm my lower arm remained totally still, which was unnatural and unsettling on a level that’s hard to describe.
- Mo, my wonderful ER nurse, who was able to use an ultrasound machine to find my vein and start a line with one stick.
- A med student who checked to make sure I hadn’t banged my head and had to take a moment to count on her fingers and try to remember which nerve I had injured that would cause numbness on the top of my thumb and index finger. Answer: the radial nerve. Thankfully I didn’t damage it too badly, otherwise I wouldn’t have been able to lift my hand up and down at my wrist, which would have caused a serious lifestyle change.
- An ER doctor who I can’t remember doing much other than tell me an ortho consult was on the way.
- The ortho consult with arm tattoos who let me know I would need surgery and put a temporary fiberglass splint on my arm to prevent further damage. (Is it more acceptable to have arm tattoos if you’re an ortho doctor than in other specialties? They were nice tattoos, but I have to wonder if a neurosurgeon could get away with that.)
- One of two nurses who wheeled me halfway across the hospital to the ortho wing. Thankfully we didn’t have to get in the elevator, though she was happy to tell me an elevator horror story.
- The other nurse who wheeled me to ortho who let me know they had the nicest rooms in all of the hospital, possibly because it used to be the maternity ward.
- Lisa, the night nurse, who lent me her phone charger.
- My other ortho nurses, Callie, Joanne, and…Joelle? I think it was Joelle. It definitely started with a “J.”
- My surgeon, who woke me up at 7am to have a discussion about my medical status, which is not the most lucid time to be talking about your medical status. He did however assuage my fears that I was going to die during surgery, which was something I was concerned about enough that I gave my mother the password to my computer. He said someone my age usually has a good heart and lungs, which are the major risk factors in surgery. He also assured me the plate they were putting in my arm would not set off metal detectors and it would still be safe to have an MRI in the future if I needed one.
- A silent med student who was with my surgeon.
- My anesthesiologist who asked me questions like, “Do you have any loose teeth?”
- Two guys who helped move me onto the surgery table.
- A surgery nurse who I remember asking whether they should intubate me before or after moving me to the surgery table. Considering this is the last thing I remember before surgery, I’m fairly certain they intubated me before moving me. The next thing I remember is being in the recovery room in the middle of a conversation I couldn’t remember starting.
- A few other people in the surgery room that I didn’t technically meet but helped during the operation. It made me feel strangely important to think all these people in the surgery room had gathered together just for me. I’m so special!
- The surgeon’s PA who woke me up at 7am to ask if I felt well enough to switch from IV painkillers to pills. The pain pump I had didn’t seem to be doing much anyway, so I said yes.
- Katie, a PA, who recommended I schedule a bone density test after I was discharged because it’s usually only older people who break their humerus.
- A social worker who stopped by to make sure I wasn’t in an abusive relationship and that I hadn’t fallen because of drug or alcohol use.
- A discharge nurse who scheduled me for a follow-up appointment with the Healthy Transitions clinic because I had not yet established a primary care physician in Indianapolis after my move six months ago.
- A physical therapist who put a belt around me that he held as we went for a stroll around the ortho wing and I walked up and down half a flight of stairs to prove I wasn’t a fall risk. I was taller and weighed more than him, so I’m not exactly sure what he could have done if I did fall other than act as a cushion between me and the floor.
- The occupational therapist who taught me how to put a bra on one-handed. It’s not as hard as I thought it would be! (Also if you search for “one handed bra” on YouTube, amusingly most of the videos are about how to take one off.) She also taught me pendulum exercises I had to do for several weeks after surgery which were really tedious but unfortunately necessary.
- The guys who brought me meals which I got to order off a menu via phone, which was kind of fun even though it was just mediocre cafeteria food.
- The janitor that emptied my waste baskets.
So, I encountered at least 27 people at the hospital in a little less than 48 hours. I also didn’t get much sleep because they had to take my vitals every 4 hours, so it’s possible I might have forgotten some people. You don’t get a full night’s sleep at the hospital, just a succession of naps. Even though I was only at the hospital for 44 hours, it felt like forever and a day.
I am cyborg
After surgery, I had so many things connected to me that I felt like a cyborg. I had one of those nose things on that gave me oxygen, though thankfully I was able to take that off after an hour. I had a pulse-ox thingy on my right hand that connected to a machine on the left side of the bed. I had an IV connected to my right arm giving me antibiotics, pain meds, and fluids. I had a pain pump control button that I kept on my lap next to the remote control for the TV. There was a phone that stayed on the left side of the bed near my knees. Oh, and every time the nurses gave me drugs they’d have to scan the bar code on my paper wristband first, like they were scanning a head of lettuce at the grocery store. The drugs cost a lot more than lettuce though.
I also had a wound-vac attached to my surgery bandage. The bandage was made of a purple, spongy material and covered in plastic similar to saran-wrap. The wound-vac was a little machine the size of a Walkman (if you’re old enough to remember those) attached to the bandage via a tube that created negative pressure on the wound, that evidently promotes healing. However, no matter how many times I got up after surgery I kept forgetting this thing was attached to me until, THUD, it fell to the floor. This happened at least 20 times. It is a testament to the designers that this thing never broke, because I did my best to destroy it.
I was supposed to keep it attached to the wound for a week after surgery, however it got slightly wet when I took a much needed shower even with a garbage bag taped over my arm. This caused some of the plastic wrap to peel, which caused the vacuum to start buzzing more and more often until I felt like I was sleeping next to a snoring computer. We finally got authorization to turn it off on the fifth day and got it replaced with a dry dressing.
My mom is a saint
Before I left the hospital the nurses asked me, “So, you have an independent lifestyle?” Normally being an independent woman is seen in a positive light, but in this case I could tell is was NOT the preferred answer. Once you break your arm you will no longer have an independent lifestyle. My mom stepped up and took care of me during the weeks afterwards, spending the night several times, and making me lots of sandwiches. She did my laundry twice and made my bed. She twisted ice cube trays and opened jars and did all the other things I used to take for granted. She washed my hair in my teeny, tiny, bathroom, which was rather traumatic for both of us. She also drove me to 7 different medical appointments in the span of 4 weeks because I didn’t have enough strength to turn the steering wheel. So, my mom is a saint, basically. Afterwards we both had a lot more appreciation for home health aids.
Oh, and remember that valet trash service at my old apartment that I made fun of? That really would have come in handy this month.
Swelling and pain
Unexpectedly, the swelling after surgery annoyed me more than the pain. I had pills for the pain, but there wasn’t that much I could do about the swelling. The only recommendation was to keep my arm elevated above my heart, but there was no comfortable way to do that unless I was lying down, and even then it only did so much. I had no idea my knuckles could bulge that much.
I was also unaware that bruising could start appearing as many as three days after the surgery. That’s why I started to freak out Monday night when a bright red bruise started to appear on the underside of my arm. I thought it might be an infection. Thankfully, Aunt Donna came over to talk me down while my mom made the drive back up to my apartment. It turned out just to be a bruise.
I had kept my arm bent at a 90-degree angle on the armrest of the recliner during the time the blood settled, which caused the bruise to have a clearly delineated edge that left my inner arm completely bruise-free. It was weird.
Other odds and ends
- When I talked to my surgeon before the operation, I considered asking him to cut off any excess arm flesh in an impromptu brachioplasty while he was in there, but decided not to because 1) I doubt he would have and 2) It wouldn’t match my right arm, so why bother?
- When I got home, I was paranoid about tripping over things, so I picked up every item that was on the floor. I’m still vigilant about this, moving every stray item onto tables, counters, and shelves.
- I have a deep appreciation for the joy of sleeping on my side. I had to sleep on my back for two and a half weeks after the break and it’s not the most natural or comfortable sleeping position for me.
- Showers are amazing!
- I finally learned my blood type: O negative. This means I’m a universal donor, but that I can only accept O negative blood for transfusions.
- A day or so after I came home, my mom and I were watching a movie and at one point a character slipped and fell and I immediately exclaimed, “Oh my God! I hope she didn’t break her arm!” I also saw an ad where a couple ended up in the ER after a car wreck and felt more empathy for them that I usually feel for people in commercials.
- I felt a little disappointed I hadn’t taken more advantage of the free movies available on the hospital’s media system.
- Strangely, the second most painful part of this experience was removing the bandage the first time. That glue STICKS and hurt my poor, delicate, arm skin.
- I feel fortunate that I work for myself so there was no problem getting time off to go to all my medical appointments. My clients were all very understanding, which I appreciated, and thankfully I didn’t have any hard deadlines at that time that couldn’t be pushed.
- If you ever feel down about your life, hang out in the OrthoIndy waiting room for half an hour. On my first visit I saw at least 3 people in wheelchairs, including a woman who’d broken her femur and pelvis when her dog yanked her off the front porch by his leash. On the second visit, I met a man who’d fallen out of a tree and broken almost every bone on the left side of his body. He now had more metal inside him than a silverware drawer. You think you have problems? These people have problems. My broken arm did not seem like much by comparison.
- Power windows in my car would be nice to have right now. Even after 7 weeks, it’s painful to roll down the window with my left hand.
- It was interesting to reflect on the fact that my sudden hospital visit had a much larger impact on my cat’s life than the election of Donald Trump did. I’m still upset about the election, but it’s good to remind myself of the scale of the universe and that some things that matter a lot to me might not matter a lot to other creatures, like my cat, and vice versa.
- Another interesting effect of my hospitalization is that it forced me take my head out of Twitter and stop obsessing about the news and the fate of the world for awhile. I still got bits of information, but it reminded me that I don’t have to drown in the news if I don’t choose to. It also made me aware that there are probably plenty of folks who form opinions on brief snippets of news and aren’t aware of every little detail of what happens because they have more important shit to do in their own lives, like recover from a broken arm.
Thanks, Obama! (No, seriously, thank you.)
I know it’s ironic that I had a major medical incident so shortly after writing about the benefits of the Affordable Care Act. I swear it was not planned, and I definitely do not recommend breaking a bone. Obviously I’m ecstatic that the Republican efforts to repeal the ACA have failed so spectacularly and so quickly. It took all of two seconds for me to trip over my space heater, but it drastically changed the course of the next few months of my life, and the contents of my bank account, though not as drastically if I’d been uninsured.
At this point, my hospital bills and follow-up appointments have cost $64,965.30. Simply by having insurance, the billed price got knocked down to $29,032.02 because the insurance company has pricing agreements with the providers. That’s a 55% discount! I only have to pay $6,600 plus $4,779 of premiums for the year, so $11,379 total. Without insurance, the hospital would have given me a 40% discount and they’re responsible for most of the billings, so if I were uninsured I’d probably owe about $39,000. Which I don’t have. I could set up a payment plan, but even if I paid $1000 a month, which is basically a mortgage payment, it would still take over 3 years to pay off. Maybe it’s just me, but I don’t think I should have to declare bankruptcy because I tripped over my space heater. I know there are Republicans who would disagree with me about this, but thankfully they lost.
My insurance plan doesn’t have any out-of-network coverage, so even though I was 99% sure everything at the hospital would be in-network, I did fear that some out-of-network radiologist might have looked at my x-ray for 30 seconds and was going to charge me $500 for it. Thankfully, that didn’t happen, and I was able to confirm it on my insurance company’s web site, which has great user design. Good job, Anthem!
Unfortunately, this means I will not be buying a new car this year. I’m kind of bummed about that, but there’s also a part of me that’s happy I don’t have to shop for a car because most people would agree that’s a terrible, stressful experience.
And now that I’ve maxed out my out-of-pocket limit in just the second month of the year, I can get any tests that have been recommended for me without extra cost! Woo-hoo! And I’ve had so many medical expenses this year that I’ll probably meet the threshold to deduct some of them from my taxes. Woo-hoo?
Abnormally low bone density
I got a bone density test two weeks after I fell. I thought it was just a formality and it would come back normal, but it turns out I do have abnormally low bone density. My z-score was -2.1, which means it was -2.1 standard deviations from the center of a bell curve. If you took statistics, you’ll know that means I’m in the bottom 3% of bone density results for people my age.
I’ve started taking calcium and Vitamin D supplements daily, and I’m making an effort to do more weight-bearing exercise, like walking. I’ve also started taking an injectable drug called Forteo, which in a bizarre coincidence is the same drug my dad worked on when he was a SAS programmer at Eli Lilly back in the late 90’s. I’d called him simply to ask if there was a history of osteoporosis in our family I didn’t know about (there isn’t), but when I mentioned Forteo my dad was able to talk about osteoblasts and osteoclasts and other stuff that made it clear he knew way more about this than I did. Of course, it also made me remember the reason my dad had moved on to another project was because the mice on Forteo had gotten bone cancer. Uh-oh! They eventually determined the risk in humans was extremely low, so it went on the market over 10 years ago and there haven’t been a spike in bone cancer among users, so I feel ok taking it. They do limit you to only 2 years of usage in your life though. Unfortunately this is one of those drugs that is really expensive (My first Tier 4 drug!) and whose price has skyrocketed over the years for probably no other reason than to make more profits, so we’re waiting to hear if the insurance company will authorize it. Right now I’m using a sample injector the doctor gave me which lasts a month.
Ultimately, breaking my arm might have prevented me from getting osteoporosis later in life. So even though this has been the most physically traumatic thing to happen to my body, it might have prevented me from breaking my hip 30 years from now. I’ll try to focus on the good things like that which have come out of this experience and think less about the financial cost and all the pain and suffering I endured. Even if it’s expensive, I’m truly grateful for modern medical science. If I lived on a prairie in the 1800’s I could have been permanently disabled or killed because of this. Instead they were able to patch me up and send me on my way. That is something worth typing about, with two hands.