A Minor Surgery

Just the other day I finally got to see the surgeon for a minor surgery that I needed done. The procedure here in Canada (national health insurance covers all citizens and permanent residents)  is that one needs to first see a General Practitioner, GP (generally a family physician) who will then refer the patient to a Specialist if required. In most cases, however, even where the need for a specialist is obvious (e.g. major fractures almost invariably require surgery), the specialist cannot treat a patient without a letter of referral from a GP. Thus arise the inevitable delays in getting prompt treatment: a GP visit is first required, and that takes time to book, whose function is absolutely not to treat the patient (beyond a suggestion for painkillers or something equally ineffectual by the sympathetic GP), but simply to acquire that letter of referral. Then a specialist visit is required, which generally takes even more time as specialists’ calendars are booked months in advance. The purpose of this first specialist visit is then to verify for himself or herself that the GPs diagnosis is indeed accurate and that this particular specialist’s treatment is required (Crafty rascals, those GP chaps!). Still no treatment is provided beyond perhaps the psychosomatic relief that the patient may feel in finally being able to articulate for the first time to someone who knows and cares—so far it has been like talking to the hand, so to speak. Then comes the second visit to go over the special procedures (to continue with our surgical example, say, the surgical operation). Finally a date is set for the surgery into the surgeon’s calendar, which as noted above, is heavily booked, permitting the said appointment to occur weeks or months later. In sum, a fractured bone could take anywhere from a few weeks to months before any actual therapy is even begun to be effected.

One has to bear in mind the time taken off work for the various doctor’s appointments (one is lucky to be seen within the hour after the actual appointment time, which is generally due to heavy overbooking by the receptionists to ensure that—even factoring in cancellations—that every minute, nay, every second, of the doctor’s time is fully booked in the billable hours of the day). There is the possible need for assistance if the fractured bone in question impedes general mobility—say a broken leg—will inevitably requires one to secure the assistance of a relative or friend to assist along during the doctor’s visits. Even if the fractured bone—say a broken finger—does not condemn its suffering owner to such abject dependence, the business of travelling about back and forth between GP, Specialist and other hospital visits is at the very least a cruel inconvenience. I cannot imagine anyone with a broken bone (of whatever functionality), joyously looking forward to the difficulty of movement—the travelling about, and the endless waiting among other ailing souls, tattered magazines, and the sharp disinfectant with all its unpleasant associations—which would tax even a perfectly healthy and fit person, and far more a person who is in considerable pain! But these costs, not to mention the fact that the poor bone is still as broken as ever, and possibly creaking even more ominously with each tweak of the wear and tear of endless days until the great day: the day of surgery and repair. And then the whole healing process begins, with possibly further follow-up visits, time off work, abstinence from even an occasional consoling scotch, but at least one is generally thankful that at least some form of therapy has been effected, and one fishes out one’s stiff upper lip to wear for occasions such as these, and hopes for the best.

This brings me back to the minor surgery I needed. Apparently a cyst had formed above my wrist, and had recently become especially inflamed causing pain and declining mobility in the fingers of my left hand. Now, this is no major medical condition for which discoverer’s names are assigned and immortalized; it is so common that even as late as the seventies, it was called the ‘Bible cyst’ so named from the recommended homegrown treatment: one generally hammered down the cyst back into the wrist, and the Family Bible (a staple in every God-fearing household) was generally a handy hammer, and perhaps more effectual than another comparable volume for its divine interventions as well. However, recent medical wisdom exposed what must have been obvious from the start: that such a violent mashing of a liquid-filled cyst would forcibly disperse the liquid through the tissues and tendons causing recurrence of the cyst, and possibly infection or some such undesirable consequence. Therefore, it is recommended that a quick incision be made, the offending cyst permanently & safely excised, and the incision closed—in other words, a minor surgery.

At the hospital, I am misdirected three times (to three different wings of the hospital), and finally end up where I started at the counter which I had initially taken was the correct place, the Day Surgery Unit. Paperwork done, duly ticketed, taped and stamped, I was put in a consulting room adorned with diplomas and degrees extolling the professional excellence of a certain Karen Armstrong M.D., Ph.D, and a Fellow (doubtless a jolly good one) of the Royal College of Surgeons, and a few other impressive sounding memberships to similarly august organizations. A pleasant young man in his twenties, possibly stepping out of a GAP commercial, walked in, introduced himself as Dr. Fernando Spencer in an endearing Spanish accent, which recalls, perhaps, an audio-book reader of Harlequinn romances. After a couple of preliminary questions, scanning my requisite GP letter of referral, X-Rays and Ultrasound scan (done on different days, in different parts of the city), he confessed to me that some mistake had occurred, and I really needed to see someone else. At least he had the courtesy to sound apologetic: in an I-am-sorry-for-your-lousy-luck-but-hey-its-not-my-fault sort of way.

My previous visits to the GP at a drop-in clinic, to the Radiologist for X-Rays, and the Ultrasound Clinic for the scans, had been characterized by an immense sense of haste in terms of “face time” with them. These people had absolutely super busy schedules from which they were squeezing in a few minutes to do you the super big favour of a consultation. They generally zipped in to the consulting room, scribbled away comments to a few rapid-fire questions, interrupted you if you exceeded the word limit of 10 words-per-comment, and had you packing out of the consulting room within the next few minutes. Everything about the demeanour conveyed impatience, other (more important) preoccupations, and an overall sense of deep urgency like the world was coming to an end in the next few hours, and you have the temerity to prey on the doctor’s precious time with unnecessary questions about your puny affliction. As the specialist was somehow perceived to be upper in the pecking order of medical professionals—at least that did seem implied by the long waiting lists and the royal letters of referral required to be even granted an audience with them—I was conditioned to expect an even more hasty visit with even more perfunctory examination. It was therefore with well-conditioned resignation that I accepted my Syssiphian fate that all this time and effort, all these months of pain and weakened use of my left hand had been for nothing. I would have to go back to square one and re-start the whole process, hoping for an eventual therapy.

Dr. Fernando Spencer, quickly disappeared with my file, I thought permanently; after all he had performed his function in this consultation, which happened to be that a mistake was made in getting this patient to him when obviously another special kind of specialist was intended. Surprisingly, he returned, explained my next steps to me if I wanted to continue in this quest of getting my cyst removed. Pausing significantly, he added, that was, if indeed a cyst removal was necessary in the first place. He reasonably observed that a measure of mobility had returned to my fingers, the pain had dulled (and perhaps I had become more accustomed to pain as well as gingerly using the troublesome wrist to avoid further agitation), and that it might subside in time with the nightly application of a warm, soaked hand-towel. This time, he took my hand, applied some pressure to the bump, seemed to examine it with his clinical fingers, and simulated something of a doctor-patient conversation with me. After he had outlined some of the risks associated with surgery, not to mention the fact that I would have to wait a few more months to see the correct specialist, I considered the hot-towel therapy as perhaps the best option. In fact, my mother, a veritable font of home-grown remedies (it was from her that I got the ‘Bible cyst’ story), had suggested that to me when I first incurred the inflammation.

I should end with an apology for possible typos, and other mechanical errors in this piece. You see, I am at a slight disadvantage these days: the fingers on my left hand are not as agile as they used to be. And my wrist is wrapped in a thick hot hand-towel, which sometimes encroaches on to my keyboard. The surgery was not merely minor, it was irrelevant.


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