Thursday, April 20, 2017

Your gallbladder was rotten

As you probably know from my blog post A rough few days, I discovered back in early March  that I had a rather large gallstone (1.8 cm). I had had a lot of rather excruciating pain, but the doctor in Beijing told me it could wait until July when I was finished working for the summer. I questioned this because this was the second really bad attack in three weeks and both had lasted days not the minutes or hours that I had read about. He assured me that it would be okay.
Nonetheless, I started speaking to my family and coworkers getting their thoughts on things in order to help me make a decision on what to do. Several people made some really good points. Among them: 1) "you don't want to wait and have it become an emergent situation and then have no choice on where you have it done." 2) "Gallbladder surgery is routine, but things do go wrong. If you're in a hospital in Beijing your family might not be able to find you" (because taxi drivers don't speak English and my family doesn't know their way around at all, but this one got me also thinking about the delay as my family tried to get an emergency visa to even enter the country). And one of the biggest deciding factors, 3) "As a Chinese [person], I would choose to have surgery in the States if I could." Thus, I decided to have surgery in the US and to have it sooner rather than later.
Having made the decision to have surgery, I now needed to figure out how to schedule surgery in a country I'm not currently in and get everything squeezed into two weeks because that was really all the time I could afford to take off from work. This is the point where I was really blessed (or used a concept the Chinese call guanxi). I have a brother-in-law who is a hospital administrator at a hospital not only close to my parents' house, but also where my Dad used to work and in-network for my health insurance (Thank you so much to my friend M who convinced me it was worth the extra cost to upgrade my insurance from worldwide excluding the US to truly worldwide - her main argument, if you need treatment for something you'll be able to go home for it). My awesome brother-in-law got  everything set-up for me. He found a surgeon who was willing to take my case with only minimal information coming out of China. The surgeon was also willing to schedule my surgery before he even met with me.
Thus, I departed Beijing on Friday evening the 7th of April (after having worked that day) and thanks to a beneficial time difference arrived at the airport closest to my parents on Friday evening (needless to say it was a LONG day). I met with the surgeon at 9 am on Monday and had my pre-op appointment at 11. My surgery was scheduled for Tuesday the 11th and my return ticket was for Thursday morning the 20th.
Of course things simply could not go that smoothly. Monday afternoon (before I'd even gotten the call telling me what time the surgery was scheduled for) I received a phone call from the financial department at the hospital telling me my preauthorization had not yet been granted. I asked her what I should do next and she said the procedure hadn't been cancelled, but I should call the office of my provider doing the procedure. Having not scheduled anything myself I wasn't sure who to call so I called my good ole brother-in-law. Super brother-in-law directed me me to a woman named Christina.
Over the next few days, Christina, a woman I've never met, practically became my best friend. To make an incredibly long story a bit shorter Christina harassed the US side of my insurance company for days, the surgery got postponed 3 times (from Tuesday to Thursday at 6:30 then Thursday at 6:30 then Thursday at 10:30 and finally to Thursday at 12:30), and I called and emailed the Shanghai office all night long Wednesday night to Thursday morning. Thursday morning at 7:30 I called the Shanghai office and was told it had been approved. Unfortunately, even when I checked in at 12:30 the hospital had not yet received the preauthorization and I had to sign a waiver. My surgery ended up not starting until about 2:45 and from something the surgeon said at my follow-up appointment it appears he did get notice it had been approved prior to starting the procedure.
Everything went really well. I woke up thinking I was in China and my first memory is someone telling me I wasn't in China and my replying, "I understand what you're saying about me not being in China, but I can't shake the feeling that there's where I am." I don't know if that conversation started with them asking me where I was or not. They asked me a bit later after several other conversations and actions had transpired where I was and I correctly identified both the hospital and the city. I suspect that is what started the previous conversation.
Several other things happened when I woke up including me having both my hands tightly clenched. They told me to unclench my hands, but I refused. They then proceeded to put the blood pressure cuff on my leg and a pulse ox monitor on my ear. Oh I did not like having that on my ear (remember my actions are all while coming out of general anesthesia)! I asked them what I had on my ear and after they explained I said, "well then if I unclench one hand will you take it off my ear?" "Yes." "Fine, which hand do you want unclenched?" They indicated the left. I unclenched it an spread my fingers wide. "There, it's unclenched."  They removed the pulse ox monitor from my ear, but didn't have to put one on my finger because there actually was already a thin disposable one there.
I declined all pain meds. I was in far less pain than many times before my surgery ( I estimated my post-op pain at 4 and at the doctor's office before my diagnosis I had estimated it at an 8.) i met my goals for release very quickly (pain control, eat with no nausea and pee). When I was in the PACU (post anesthesia care unit) one of the first things I asked was for the time. It was 4:45. By 7:45 I had eaten, gone to the bathroom twice, proven I was steady on my feet, asked for my IV removed (they hadn't done it yet) and was pacing my room in the day hospital. My nurse and the new nurse (it was shift change) came in and founding me pacing. They immediately began trying to get me discharged and by 8:03 I was dressed with discharge papers in hand waiting for my parents to return from dinner (and possibly a bit of shopping). I walked out of the hospital (having twice declined a wheelchair) on no pain meds and only wishing for a throat lozenge (the nurses said they'd find me one, but forgot) at 8:15 pm. In China they said I'd have to stay in the hospital for a week!
I got to go to church the following Sunday, which was Easter, and my sisters and their families all came over. I had an awesome time, but may have slightly overdone it, especially with the 5 inch wedges and running around the yard with the Easter egg hunt. After everyone left, I took three ibuprofen and fell asleep on the couch for about 3.5 hours before getting up and going to bed. I had to take Monday easy.
On Wednesday I saw my surgeon for my post-op follow-up. It was a couple of weeks earlier than usual, but necessary because I had a 7:25 am flight on Thursday. When I saw him he told me my gallbladder had been rotten and he couldn't believe it hadn't come out sooner (in the PACU a resident told me it had been really inflamed and that it was surprising it hadn't caused me a lot more pain). The pathology report showed in addition to cholethiasis (gallstones) I had both chronic and acute choleocystitis (inflammation of the gallbladder). I had feared I might be being a wimp pushing to have my surgery done now instead of waiting for summer, but clearly it couldn't have waited.

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