Monday, March 1, 2010

So frustrating ...

For a brief period of time in the mid-1990s, when my surgically-repaired back was as good as it was ever going to be, I worked as a worker's compensation case management nurse for nearly two years. I was hired because I myself was an injured worker, having been injured on April 25, 1989 at Soledad Prison. I destroyed my back one night while keeping an inmate from flopping off a gurney onto the floor. I should have let him flop—when we arrived at the hospital, the ER physician quickly determined the inmate had been faking his seizures. I'd just completed an 8-hour shift with two inmates having uncontrolled seizures. Part of the treatment standard was to put their mattresses on the floor so they couldn't hurt themselves. But I'd have to squat or kneel every time I needed to re-medicate one of those men. At the end of my shift, and as the medical crew declined into a skeleton crew consisting of LVNs only, it was decided to transfer the seizing inmates to Salinas. I took what was thought to be the most unstable one.

Long story short, by the end of that 14-hour workday, my back was destroyed and my career as a bedside nurse was over.
It took eight months (and three physicians) to get a proper diagnosis and 10 months to have the first surgery. From April 1989 to early 1995, my life was consumed by surgeries, recoveries from surgeries, physical therapy. I honestly don't have a good sense of what was happening in the world at that time.
While I was working in worker's comp case management, I came to a conclusion about injured workers. They either are or they are not, and the ones who are not injured are the most troublesome. I had several clients who just did not act right, who claimed they were unable to do certain things after their "accident." We had a plague of deli workers at Nob Hill grocery store who "fell" and injured their backs. It was nearly impossible to get those people back to work. I had another client who claimed he could not raise his arm over his head following a shoulder dislocation and repair by a physician in Santa Cruz. I talked the carrier into a repeat surgery, this time by a doctor associated with the SF 49ers, thinking this injured worker would be impressed by this doctor's results with football players. Well, the guy had the surgery and claimed he was no better. I felt he was bogus, and he was surveilled and found to be repairing cars while drawing temporary total disability pay.
My back injury is long settled, and I am supposed to have lifetime care on my back. Sounds good, and when I get that treatment, it's great because I don't see a bill. But every since the worker's compensation overhaul we've had here in California—something I supported and voted for—it's been hell to get treatment.
Right now what is happening to me is a consequence of a two-level low lumbar fusion. The vertebra immediately above the fusion are not designed to bear the weight they do, nor are they designed to function like the lowest two vertebra. I'm having what is called facet disease, and according to my doctor, it's coming right on time, 15+ years after the fusion (fusion was in 1992). The treatment is pain medication and something called a rhizotomy, which is simply locating the offending nerves that are causing the pain and zapping them with an electrical current. Then I'm good to go, the pain is less, and I don't need to take as much pain medication orally.
After waiting three months for approval, I got a notice in the mail that the procedure was denied because my doctor had failed to document in specific ways how I improve after a procedure. It's not enough that he says it's so anymore. So I dashed off an e-mail and described what I do when a rhizotomy is working, and how I feel when it's not working, and the impact on my life.
And for some reason, the worker's comp carrier thinks I should not be having narcotic medications to treat pain. Huh? It's prehistoric thinking like that which will drive patients to do maladaptive things ... drink, acquire and abuse street drugs. I honestly don't know what to do if my doctor stops prescribing pain meds for me. I am very responsible with them; I don't mix alcohol with them, and I take them when I need them, or try to put off taking them.
So in a nutshell, when a neurotomy is on board and working, I can walk up to a mile and sit at my desk for hours, working. I can take the light rail to work and enjoy the three-block walk from the station to the job. I can do light housework and not be in immediate pain.
The consequences of not having the procedure: I do not sleep well, I wake in the middle of the night in severe pain and it takes up to two hours for the medication to work. I have my daughter drive me to work on those days I need to work onsite. I cannot work more than 4 hours, and need to take a pain med while at work because the chairs are so crummy.
I need an attorney to take on the fight and remind State Fund that we agreed on this years ago and they need to hold up their end of the bargain.
If I have to wait another three months for this, I may well be driven to drink.


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