Surgery Time Out for the Future

What are your outcomes: surgery, treatment, grieving?

Surgery recommendations have been a part of my life for the past year. While I have felt halt and lame, my goal is to be hale and hearty and live fully, not merely breathe longer.

Preparation for surgery may include tests and data that require lifestyle change to address any number of things — weight loss, what’s causing a deficit in a variety of blood tests, and other health issues identified before surgery.

I have been on this journey for almost three years. I needed to lose ten pounds, which I did. Unfortunately, my height has recently dropped as well, so my BMI calculation went up with the loss in height.

I had anemia, which answered the question, in part, where the fatigue was coming from. The anemia was caused by unidentified bleeding ulcers, which needed treatment and now preventive management. I chose the more conservative treatment, not surgery.

An irregular heart rhythm required pacemaker surgery.

Finally, a month ago, I had a total knee replacement. Joint replacement and rehab is a painful process.

Timeout During Surgery

Most healthcare practices require a timeout during surgery. The team affirms the patient by two identifiers and states which body part—the left knee—is going to be operated on. This surgical timeout prevents mistakes like the wrong patient receiving the wrong procedure.

Identifying health challenges has been a painful process, both personally and institutionally. But the point of surgery is to live a better, more fulfilling, and longer life. I have to remind myself of that when the leg hurts and is stiff and I hobble from one place to the other.

A year before surgery, I worked to strengthen my legs and arms, which now helps me push off a piece of furniture to stand and has helped me meet my physical therapy goals. I want to get back to that regimen to strengthen my other leg and avoid surgery.

I used to work in medical care before I retired, and I had a nurse manager who came from England. She would often shake her head and say that in the National Health Service there, someone who was frail and of advanced age would not be subjected to continued end-of-life interventions, including surgeries. The culture would advise the person to live out their remaining time with purpose and prepare what they needed to prepare.

The average age of care for all causes in my former hospital system, a tertiary care center (which means advanced treatments for diseases) was 65. Most patients for total joint replacement are Medicare-age.

Medicare is the tail that wags the dog, meaning many private insurance companies follow Medicare standards of reimbursement in their contracts with different healthcare providers, no matter the age of the patient. Medicare is a primary source of reimbursement for many hospitals. Medical care (and Medicare) expenses are large in the last year of life — $80,000 on average from all healthcare payers.

I want to limit unnecessary spending

As someone who used to be charged with reducing Medicare spending by identifying areas for efficiency, I know these expenses, in particular, were of concern.

So, I do not want unnecessary interventions that merely extend life. But I am all up for improving the quality of life, and that requires time out.

My pacemaker implant took six weeks of recovery time, and my knee will take at least three months to recover. So far, I have “lost” eighteen weeks of this year to reduced activity and more time indoors. I knew that downtime was coming up, and luckily, I love to read, write, and watch documentaries. Still, I get stir-crazy.

Joint replacement is a common procedure for those in my age bracket. So are other tweaks.

Time out for grieving might be a part of aging. Time out for all sorts of recovery is part of aging. Mental health and addiction treatment can require time outs, whether for ourselves or loved ones.

We can be future-oriented while saying goodbye, in some fashion, to how we were. Who we will be has learned some new things, the hard way, through experience in this last quarter of life.

But I often think of that sentimental television ad, the one with the grandparent with open arms fading out and the advertisement for some unremembered product coming on with the admonishment, “Be there for your grandchildren.”

I could add “your friends, your family, yourself.”

Take the time out.

Sharon Johnson is a grandmother who walks by the river.