At a picnic in the summer of '98 my abdomen began to feel distended and swollen. It was also rigid in a strange way, as if my stomach had been replaced by a large rock. The next morning when I awoke it was worse: A pinching pain just above my navel and a visible bump in the same place, as if something had tried to poke through from my innards and gotten stuck. It was a hernia, and a bad one from the look and feel of it. I called my doctor that same morning and thus began an odyssey that would terminate with my deliverance into the hands of what I've now come to think of as the Meat Mechanics. You might know them as surgeons.
Most of us have had a discomfiting experience with our HMO, probably more than once. Those few of us who don't belong to an HMO have doubtless read about them and the often-tragic results of the shoddy care they too often provide. If we're lucky, though, we have no knowledge or experience with an HMO's Ninth Circle, the outpatient surgical center (OSC). Outpatient means exactly what it sounds like: you're out the door as quickly as they can move you. These facilities have existed for many years, but recently they have become almost mechanized. This machine shop atmosphere has bred a new type of surgeon (a chilly stratum of an already cold profession) who in my very unfortunate experience seems to view the human body the same way Mr. Goodwrench views the average Buick.
I went to my doctor, who touched the bump, pronounced "Oh my, yeah, that's real!" then recommended a surgeon, who later poked and prodded me while scratching his chin in a thoughtful manner. "You've got yourself an umbilical hernia there," he said, causing the word "mechanic" to pass through my mind for the first time. I was told the hernia would require surgery, and soon. A volleyball match ensued between my surgeon and my HMO, with an elusive authorization number acting as the ball being spiked back and forth over the net of my life as, somewhere beneath a graveyard in Prague, Franz Kafka rolled over and yelled "For pete's zake, pe'foam ze zurgery!"
Finally a date was set. I was given the usual pre-surgery warnings: no aspirin, no booze, etc, but with a little twist I hadn't expected: I would have to find a ride home or else the surgery would not be performed as scheduled because I would be going home the same day. Having been healthy and accident-free since before I was no longer covered by my parents' insurance, I had assumed that, this being an invasive procedure (i.e., my body would be cut open with a knife), I would be in the hospital at least one night. I was wrong, and furthermore there would be no hospital, but rather the medically glorified office building that is the OCS. How was I to get home? My grandmother seemed the only option, but the idea of her septuagenarian spine trying to walk my drug-leadened, post-operative body out to her car was not reassuring.
I thought back to my childhood, when I had my tonsils removed. Though fearful of being away from home, being very, very close to the people who knew how to save my life had been most reassuring. I would get no such comfort now. My mind turned to the children who might be having surgery the same day as me, and I wondered how they would deal with it. My own waiting brought dread. Most disturbing to my sleep was the apprehension I felt at the slip-shod way all of the preparations were being handled, and what that foretold of the surgery itself. My dreams filled with cries of "Flatlined! Flatlined!" or, worse still, "Oops!"
On the big day I reported to the OSC, was led to a phalanx of partitioned prep cubicles and told to undress, slip into a surgical gown, lie down on the bed and "relax". I was offered a magazine, which I accepted. My blood pressure was taken. I was given a pill, to help me "relax". I was briefed by the anesthesiologist, who asked a couple of quick questions, failed to adequately respond to my worries (chief among them the chance of waking up during the surgery because of a tolerance for drugs, one built up from four years of taking Xannax for panic attacks), and then explained how I was to be knocked out. Next came the surgeon, who said, "How are you? We'll be getting to you soon." I remember thinking to myself, "Did he say 'to you', or 'to your car'?" Again the word "mechanic" flickered across my consciousness.
I waited, and waited, and in the meantime was given a shot of something stronger than the pill. Several times some anonymous person in O.R. green would whisk open the curtain to my cubicle, glance at me, then swing it closed again. The curtain opened one last time as my bed and I were unceremoniously yanked out of the cubicle and shoved down a hallway. I mentioned to one of the orderlies that I didn't think the drugs were strong enough, I didn't feel like I was going to fall asleep, and was ignored. I once more mentioned the Xannax issue. Again, I was ignored. Once in the operating room I was pulled from the bed onto the operating table. I was gassed and fell unconscious. Then I woke up. Oh God in heaven, did I ever wake up.
As the world came into focus and was audible again I felt two nurses shaking me hard and heard them yelling "Come on, Mr. Anderson! Wake up! Time to get dressed and go! Come on…up, up, up." I was in the "post-op room". In the background a child was screaming in what sounded like quite literal agony. This child would be left shrieking for at least fifteen horrible minutes before it was merely wheeled away into a room where it could not be heard - this answered any questions I had about kids and surgery, to put it mildly. During those fifteen minutes I was given a swig or two of 7-Up, was asked if I was in pain ("YES!") and given extra morphine. This was a good thing, because I wouldn't be allowed to stay in the "post op room" for very long. It was full, with at least eight and perhaps as many as ten other post-surgical patients, all of whom were getting the bum's rush because the spaces were needed for still more surgical patients. And so on, and so on, precisely like a manufacturing floor. It was then that the term Meat Mechanics was born in my mind. It was the only term that fit the ordeal, and the ordeal was far from over.
Since I was meat, it was necessary to process and prepare me for delivery as quickly as possible. Therefore a nurse whose name I do not remember but whose words I'll never forget proceeded to dress me while - I kid you not - offering a running commentary on the fragrance wafting from my feet and my general physical condition, in that order. Ignoring my yelps of pain as the morphine wore off (albeit with merciful slowness), and offering no more of it, she badgered me into my underwear, pants and shirt, sat me down on a wheelchair and rolled me at a fast clip into the lobby of the OSC. My suturing had been completed less than an hour earlier.
My grandmother was late, but not because she was careless. Having helped my grandfather through several surgeries and been through a few of her own over the years, she expected that, despite being an "outpatient", I would be placed in a recuperation room for at least a few hours. Ten minutes after being wheeled into the lobby, the desk nurse briskly inquired where my "ride" was and when I slurred that I didn't know she walked away frowning. Twenty minutes or so later she stalked up again, this time visibly annoyed. "You DO have a ride home, don't you?" I answered in the affirmative, and was told rather abruptly that this waiting would not do, no, not at all. I was then asked my grandmother's phone number. I could bearly think, what with the drugs and the pain, but finally managed to cough it up. My grandmother was called, and when she arrived was shocked to see me already dressed and in the lobby, and said so. The desk nurse explained in a monotone that "it was policy that patients be picked up promptly." She was handed a prescription for a variety of medications. She asked if there was a pharmacy on the premises. The answer was no. She would have to get the prescriptions on our way home.
The desk nurse left my grandmother to deal with me, but we were lucky in that another nurse saw the difficulty she was having and offered to help. Together they pushed me out to her car. As she helped me get into ti, each movement I made felt like someone was twisting a white-hot knife into my belly. I recalled something told to me by a security guard once, of how he would rather be punched than slapped and shot than stabbed. When I had asked why, he had explained that all four had happened to him and that slapping and stabbing were much more painful. Now I understood all too well what he had meant.
My grandmother somehow managed to get me into the car, but not before having to shout "Robbie, be careful!" at least ten times. She drove to a pharmacy and went inside. I waited in the car for an hour, sweating, half-hallucinating and in almost unbearable pain. By the time she got back I felt as if I had done something terribly wrong and was now being punished, but what I'd done I simply couldn't remember. As we drove to my apartment she turned on the air conditioning, the blessed cooling of which balanced my temperature to the point that I fell into exhausted sleep.
Then I had to wake up again. "Robbie we're here. Can you get up those steps by yourself?" Did I fail to mention the fact that I live on the second floor of my apartment complex? A strange omission, that, because getting up to my room was the final interrogation of this, my own private Spanish Inquisition. It took just over a half-hour to climb twenty steps. Each time I lifted a leg I got that knife in the belly all over again.
I belabor my pain for a very simple reason. It was talking to me, warning me. And it is, like the pitiful screams of that anonymous child, the most compelling evidence I can present to prove beyond all rational doubt that my surgery and post-operative handling should never have been performed in the manner they were, and neither should anyone else's. These houses of pain that HMOs have set up must not be allowed to operate as they do. Even though my surgery was successful, I felt in the end the way a Confederate or Union field hospital patient must have felt during the Civil War, like I had survived a horrendous ordeal of pain and screams and misery. Just two problems: I was a civilian, and it was 1998.
I think it beggars the whole point of industrialized progress to question whether a patient's dignity and comfort should be as important as the outcome of their surgical procedure. Of course it's as important. The fact that certain unqualified bureaucrats seem to think it is not is nothing short of an outrage. And if you don't believe me, just go outside right now and intentionally lift up something the wrong way, something entirely too heavy. Proof shall be forthcoming.