Tokuda Hospital: "I wish I knew how to quit you"

We haven't posted anything to this blog since April, but fear not: life has been plenty interesting. Just too interesting to have time to write about it. We've taken some fun trips around Bulgaria and to Prague (very pretty, very fun...post coming soon), but also taken quite a few trips to a place I wish I didn't know so well: Tokuda Hospital Sofia.
I've lost count exactly, but I think we've had visits on least 9 different days this month, including 2 overnight stays, for 3 different reasons. (That doesn't include several visits to other health care providers.)
In the beginning of May I slipped while hiking (LINK coming soon) and put a pretty nice 3-inch gash in my leg. After hiking down off the mountain my friend Brett drove me to the ER at Tokuda, where an eager and inexperienced but apparently competent medical student gave me 9 stitches. I ended up with contact dermatitis from an allergic reaction to the bandage (or maybe the tape?), which did fun things like cause an angry swollen red area around the original wound and cause an itchy rash all over my body, even on my arms. I've got the stitches out now, and it's healing, but I will definitely have a lovely scar from that one.

A week ago was our most difficult visit to Tokuda, by far. After what we thought was 12 weeks of pregnancy, we had a miscarriage. It was sad and awful, but I'll let Shannon write more about that if she wants to. Hospital stays rarely are pleasant, but that was not a fun night in the hospital. Hopefully we'll have better news on that front in the not-too-distant future.

This week I got another overnight stay at Tokuda that was planned, but more unpleasant in a darkly comic way than tragic way, which I suppose is the best you can hope for from hospital stays. Over spring break in Athens I discovered I had a hernia. Awesome. Some of you may remember I had a hernia fixed during college (best spring break ever) so now I'm a repeat offender.

I considered putting off the surgery until the fall, or at least until the summer in the US, but it was getting worse and really needed to be dealt with sooner rather than later. At least we have good health insurance. Surgery in Bulgaria it is! I tried to schedule an appointment for the surgery on the first day back from Prague, but I should have known from the lackadaisical way that the surgeon was scheduling me that "appointments" here don't quite mean the same as in the US. In general, if the doctor says you have a 3:00 appointment, that means he'll be around at 3, probably, and if you're there too you might get to see him, maybe, depending on who else is in line.
The administration at our school has been very supportive. I told my department chair about the surgery, afraid she would be upset I was missing so much school. Instead she was encouraging me to take more days off than I was planning. Thanks, Krassi. The registrar and assistant head of school both gave me their personal cell phones to call if I needed any help, and then the assistant head assigned her personal assistant (Milena) to be my translator for the day of surgery. Thanks Tanya, thanks Maria, and above all, thanks Milena! Every time we'd been to the doctor before it had been an exercise in frustration with our lack of sufficient Bulgarian language skills. The doctors often speak some English (especially the younger ones), but the nurses and receptionists often don't, making figuring out who to talk to and where to wait a real mystery. At the clinic outside the campus gate (where I went to deal with my contact dermatitis from the gaping leg wound) I ended up having the elderly American owner of the clinic translate for me while the even more elderly Bulgarian dermatologist examined me. Another time a 2nd doctor who spoke almost no English translated for the one seeing me who spoke no English. It's been exciting.
So I was very thankful for Milena, who I expected would only be needed for an hour or so while I checked in to the hospital. Shannon took the day off work too, just to be there for moral support. WEDNESDAY
We got to the assigned waiting room a little after 8 in the morning and found a seat in the crowd. After half an hour, Milena was concerned that maybe they'd forgotten us, so she went to the reception desk again. "Yes, we know you're here. Be patient."
Another half an hour passes, Milena checks again, and the response is the same. As our wait approached 2 hours, Milena inquired a little more insistently, and was told "Arm yourselves with patience." Excellent.
Around 11:30 they called me. Apparently they had been looking for me, and I had missed my window because they couldn't find me. If by "looking" they meant whispering my name into an empty janitorial closet, than maybe. In their defense, both Shannon and I were wearing very subtle orange and red shirts that blended in not-at-all with the green decor.
Now it was time to get admitted to the hospital, and get the show on the road. They took some blood samples (while not wearing latex gloves...they don't wear gloves when around bodily fluids nearly as much as I'm used to, or I think they ought to) and Milena helped me fill out some paperwork. I had come in for an appointment a week prior, hoping to get some of this taken care of, but apparently I was rushing things.
I tried to ask the surgeon about post-operative procedures, and Shannon tried to ask him about prescriptions he would write, so we could get that taken care of ahead of time and while we had an interpreter. We were brushed off with "Why put oil in the pan when the fish is still in the sea?" Nice.
So I went up to my private hospital room (my insurance hadn't approved that, but I think the hospital wanted me segregated from regular folks that spoke Bulgarian). It was very nice (as was Shannon's the week before). Tokuda Hospital is only a few years old, privately owned and financed by a Japanese company. It is clean and modern, and excellently equipped. From what I've been told, they were able to pick the best doctors from other area hospitals and they cater to ex-pats and wealthy Bulgarians able to afford the plush facilities. The facilities are very nice indeed, but the medical services are still provided by Bulgarians, and Bulgarians are not yet known for their service-oriented mentality. (Check out the link for "Medical Tourism in Bulgaria!" on the Tokuda website, in case you're looking for an exciting vacation.)

We waited.
And waited.
Hung around my hospital "suite" and chatted. Shannon, Milena, and I actually had some good group bonding, although I'd wish I'd brought cards.

A nurse told me to shave all my bits. I had anticipated this, so had shaved at home the night before, where I could use my electric clippers.
Nope, I need to shave more. She hands me a disposable razor and says to shave basically everywhere my shorts cover. Suck. There are parts of your body that should never see a razor.

After about 2 hours, I got to go play health insurance games. We have very good health insurance, with global coverage, and for large expenses they will directly pay the provider instead of having to get reimbursed. I'd set it up ahead of time, so Tokuda already had an approval of payment for their bill, in advance (2150 leva for the surgery and hospital stay, about $1,350 with current exchange rates). The hernia repair surgery involves opening you up and placing some kind of mesh or fabric across the hole where your intestines are squirting out, and closing you up again. The procedure hasn't changed much in over 100 years. For some reason, Tokuda wanted me to pay for the plastic patch separately, because "we are different companies. We have to buy the patch from a different company, so it would be better if you paid them directly."
No, it wouldn't. It might be better for YOU, the hospital, to not have to bill somebody else for the parts you're putting inside me, but it would definitely not be better for me to have to bill some random Bulgarian company for a product that my insurance company already agreed to pay YOU for. They seemed peeved that I refused, and thought maybe I just didn't understand the request. I understood just fine, and after several higher levels of management tried to "explain" it to me, they eventually relented. Now I got to pay (in advance) my co-pay and deductible. I don't know why, but I had to do this at the Tokuda Bank (on the hospital first floor, right next to the Tokuda travel agency). For Shannon's hospitalization a week prior, we paid at the registration desk, with a debit card. Now we had to pay with cash, at the bank, and get charged 1 lev fee for paying at the bank. I started arguing with the bank, asking why I was being charged to pay, and they were trying to close and were upset that I was getting huffy over a minuscule fee, and poor Milena is trying to explain that I didn't really care about 1 lev, but just didn't want them tacking on random fees for no reason...whatever. I gave up, paid, and went back to my room.
To wait.

A nurse came by to see if I had shaved properly. They don't really do "privacy" here, so figured the nurse wouldn't follow me into the bathroom. Milena turned around, and I dropped trou to show the nurse. Apparently Milena didn't really know what I was doing, and got a full butt-shot.
Sorry Milena.

At this point it was 4:30 in the afternoon. I thought I would have my surgery around 10 in the morning. I had not had anything to eat or drink since midnight (so as to not interfere with the anesthesia). I was surly. And hungry. And very thirsty.
Around 5 pm the doctor came by to say that they wanted me to see a cardiologist and anesthesiologist for consultations, and that I wouldn't be able to do that anytime soon, so the surgery would have to be post-poned. Suck. BUT CAN I EAT NOW? I didn't really care what else happened that day, as long as I could finally eat and drink.
I enjoyed the fine food at the 9th floor roof-top cafeteria with a lovely view of the city and Mt. Vitosha (nice job, Tokuda hospital architects!) before embarking on more waiting.
The cardiologist looked at my completely normal EKG and seemed confused why I was seeing her at all. (I had told the doctors that I have sometimes had an abnormal heart rhythm, but a cardiologist in Bozeman had evaluated it and not found any problems, and it didn't bother me. Still, they were concerned.) After the cardiologist dismissed me, I got to wait some more to see the anesthesiologist.
The nurse came by to take us to meet the anesthesiologist, and a random old lady came along. Milena was apparently so competent and professional in her translating duties that the nurse put this random old lady patient in her care, told Milena the code to run the staff elevator, and sent us off. Really! The nurse just handed a stranger (and her medical charts) off to Milena and gave her the elevator passcode.
At the office off the intensive care unit where we were supposed to meet the anesthesiologist, the staff seemed utterly confused. "Who? The anesthesiologist? He's busy. He will be busy for a long time."
We waited.
Maybe 30 minutes later, we were sent back to the room after it became clear that were not going to see the anesthesiologist.
We waited some more.
Time to go back down (with the random old lady again) to meet the anesthesiologist.
This time he was there, and spoke fine English (but was still brusque and unhelpful).
"What kind of anesthesia do you want?" he asked gruffly.
"Um, I don't know. What do you recommend?"
"You can do general, or regional [spinal tap]. "
"What's the difference?"
"With regional you're awake. Some people don't like that."
[I knew that.]
"Thanks. Are there any medical reasons I might choose one over the other? Is one riskier? "
All anesthesia is risky.
[Thanks. I knew that too.]
"What do you recommend?"
"It depends on the anesthesiologist. Some prefer one over the other."
[Well YOU'RE the anesthesiologist. Recommend something!]
"When _I_ had a hernia surgery, I had regional. But I talked too much, so they put me under."
[Not helpful.]
"Is there any difference in side effects?"
[unhelpful shrug.]
"OK, I guess I'll do the spinal tap, as that is what my surgeon recommended."
"Great."

After taking the old lady back to our floor, and writing a note that side "I'm leaving the hospital of my own choosing and will be back by 7:30 am" I broke free.
FREEDOM!
We'd only been there 12 hours, to NOT have surgery. I went home and went for a run (my last for a while), and got a little sleep before heading back to the hospital.

THURSDAY
Arrive at 7:30. Check in. Go to room.
Wait.
Watch some BBC News.
Wait.
Watch Deutsche Welle.
Wait.
Nurse tells me I need to shave still more. Sweet. Razor burn is the best, especially in your private bits.
So I shave more.
Then wait.
Try to snooze.
Wait.
Around 11am they take pity and give me an IV saline solution, so at least I'm not so dehydrated like the day before. Thanks for that.
"Your surgery will be around 1 pm."
Wait.
At 2:30 pm, it's go time.

I'd never seen an operating room before, because in previous operations I'd been given general anesthesia. This one was puke green, from floor to ceiling. Weird.
They had a boom box playing a standard Bulgarian party/dance mix. Really? In the OR?
Thankfully, there was one English-speaking nurse.
"What anesthesia do you want?"
[really? I thought we went over this yesterday!]
"Um, spinal tap, I guess."
"Have they explained the risks to you?"
"No. Actually, they haven't."
"Sometimes this causes headaches."
[hmm. That's not so bad.]
"OK, sounds fine. Let's do it."
I had to curl up in the fetal position on the operating table as she manually pressed and counted each vertebra. Usher (and Lil John) came on the boom box. Do-dinh, dee-do. "Yeah."

The whole scene started to freak me out a little. I visualized the nurse probing my spine was actually a lovely masseuse giving me a massage on a beach in Thailand. Umbrella drink in hand. That's better.
Ow, shot into the spine.
It didn't really hurt (not any more than a regular shot), but there's a reptilian part of our brain that is very defensive of the spinal cord, and it kind of causes everyone you mention it to to shudder a little bit. Me too.
Do-dinh, dee-do. "Yeah."

The nurse tells me the headaches usually come on the 3rd day after surgery and last until the 5th or 7th day.
You did NOT tell me that the headaches would last 3-5 DAYS! That would have been helpful knowledge before you jabbed me in the spine.
They strapped me into the operating table, arms to the side. That's not a good feeling. On the plus side, if I wriggled and turned i could just make out my heart rate monitor. Laying flat on the table (with a little sedative in me, I think), my resting pulse was a steady 56 bpm. That seems healthy. There's one good thing.

During the surgery, they had a sheet blocking me from seeing anything, so being awake wasn't very interesting. What was interesting was that my feet and especially my butt felt really HOT, like I was sitting on a hot plate. This is apparently another side effect of the spinal tap that they didn't mention. Oh that and after the surgery I COULD NOT FEEL OR MOVE MY LEGS.
Perhaps this should have been obvious to me, but it was very disconcerting. They look like my legs, but I don't have any control over them, and when I poke them I don't feel anything. This lasted for about 2-3 hours after the surgery. I guess that must be what paralysis feels like. Ick. Not a happy feeling.
As they wheeled me out of the OR, I still had hot legs, but now I was shivering uncontrollably from being cold on top. No one seemed concerned about this, so it must be normal, but I sure didn't feel OK.
I was happy and much relieved when Shannon came to the hospital room where I was recovering. She even brought food (yay!) that I couldn't eat yet. Just having her there made everything a little better.
Not much pain. This is good.
An hour or two passed, and I gradually got more feeling in my legs, and more pain from my incision.
Pain manageable, but increasing. Was I really not on any pain medication? This is not how they would do it in the US. There they would give you lots of good stuff to start (like codeine), then wean you off the smack after a day or two. Not here. Here you have to beg for tylenol.

About 6:30, I thought I would see if I could stand up. Sitting up hurt, but I felt pretty with it. I started to stand, then had a wave of pain/nausea/i-don't-know-what, basically passing out and slumping to the floor. Luckily Shannon caught enough of me that I didn't smack my head.
Shivering, sweating, intensely hot skin.
OK. Not doing as well as I thought. Back in bed.
At 7 I got to sip some water (finally!) and at 9 I tried to eat (YAY!). After some pleading with the nurse (and looking up the word for "pain" in my Bulgarian dictionary: "болка") I got a shot of some unknown pain killer in the butt. Nothing morphine-like, but it helped.

Shannon had to leave, and I watched some more crappy TV before drifting off to sleep.

FRIDAY
The bright morning light fills the room before 6. All the pain meds have worn off, but I feel pretty ok. I can stand. I can get myself to the toilet to pee. Eventually I got up the nerve to take an amble down the hall and back (s...l...o..w...l...y). The surgeon told me he would be around to see me by 7:30.
I wait.
Play with the internet on my phone.
8:00
I wait.
Watch a Russian news program (in English) on cable. Interesting.
8:30.
I wait.
9:30 - A whole gaggle of doctors and nurses pile into my room, poking and prodding, inspecting.
I can go home. :)
"Any instructions for food or drink?"
No, live your life.
"Alcohol?"
"What is that?"
"Wine, beer."
"How much do you drink?"
I don't know, maybe 5 or 6 a week, tops. [that's actually a lot more than I usually drink]
Don't change your life for me.
Really? I just had anesthesia and surgery and you're NOT telling me to not drink?
Ok, bye!

Made it home for lunch. Tried to nap, but I was too antsy.
Took a walk around campus. Feeling much better than I expected -- much, much better than I did for my previous hernia surgery, when they used the supposedly superior laparoscopic method. I'm taking some mild painkillers (extra-strength Advil, basically), but nothing too bad.
The walk might have been too far (1/2 mile). Tired. Sore. Sleep some more.

This evening I wandered over to a friend's house that was having a birthday party full of drinking games (the "Beer Olympics"). I did not partake, but I helped "judge." In one game they had to chug a beer, put their forehead on a bat, spin around 8 times, then run. They generally also fall down. Apparently, it is impossible not to laugh at your friends when they fall down, even when that laughing causes excruciating pain. I kept trying not to watch, or watch and not laugh, but I couldn't, even though each hearty laugh tore at my insides. Whew. Good times, but it's time to go home.

So that's my week. That's my month.
No more trips to the hospital, I hope.