Thursday, June 5, 2014, 17:33 PM

Hi Dr. Mroczek,

Thank you for performing surgery on me. I wish I could have seen you work since I enjoy watching live surgery on television, but I have no reason to think you did less than an excellent job. Your anesthesiologist and your other staff seemed very competent and professional and answered all my questions. Rachel told me that after the surgery you told her that you were pleased with the results and hadn't needed to do any cutting into bones, but that you had found uric acid crystals which are associated with gout.

Since the sedative I had been given causes amnesia, I only vaguely remember having spoken with you later that day. We had a very poor connection and I couldn't discern much of what you were saying. But I did remember that you didn't seem concerned about my recovery.

Post-surgical care in the hospital presented some problems, unfortunately. I was taken to a "Step Down" unit, which I was told was halfway between intensive care and normal care. This meant I was hooked up by a blizzard of cables to a maze of monitors which restricted my movements. I accidentally pulled out various cables over the next few hours, which triggered a lot of disconcerting alarms which were mostly ignored by the staff until I beeped them.

As you know, they had forbidden us to bring our CPAP machine with us. The hospital's machine didn't arrive until 1:30 AM. Jay, the respiratory therapist, is a very nice person, but he had trouble operating the machine, growing increasingly frustrated and muttering "Stupid!" under his breath. A few minutes after I had started to use it, the machine started screeching and Jay had to come back to figure out how to make it stop. He learned that the screeching indicated that there were leakages around the mask. I explained that when I was home there were always leakages, but that the only metric that mattered was the pressure inside the mask since leakages can easily be compensated by increased air pressure. My CPAP machine correctly measures only the internal pressure and never screeches. Jay said that I probably had a more advanced model. He said that the hospital's CPAP machine was probably 20 years old and cost around $20,000 — which would explain why they were reluctant to adopt newer technology. After a few more attempts to use this archaic device, sleep became utterly impossible, and I decided that I would have to try to sleep without it.

After another few hours being strangled and entangled by the cables every time I dared move, I noticed that my right knee was becoming painful again after a week of being pain free. It got so bad that I asked for a painkiller, which seemed to help a little. I got almost 3 hours of sleep that night.

In the morning several of the team visited me. A bit later in the day, Eileen Lydon, an N.P. from the rheumatology department dropped by and made heroic efforts to help reduce my pain, including placing herself in a very uncomfortable position to spare me from having to reposition myself. She injected prednisone directly into the knee and placed a prednisone patch on it. At some point the pain was so great that I found myself bursting into tears for the first time since childhood. Annie Lu, your N.P., dropped by and I told her that I needed to speak with you because I believed you would agree that it was medically inadvisable for me to spend another painful sleepless night there.

Some time later, Annie returned to say that you wouldn't talk to me and that I had to stay in the hospital. "It's non-negotiable," she added sympathetically. I couldn't believe that this level of pain and deprivation of sleep was simply not going to be addressed by anybody in charge. I made the only choice that would preserve my sanity — checking out of the hospital to find other medical resources.

As you know, hospitals insist on wheel-chairing you to the street when you are dismissed. Unfortunately, this prevents people like me from finding out whether they are capable of walking a few hundred feet. They wheel-chaired me out of the hospital and into the street, where I was practically lifted into a livery service vehicle. It was only when I got out, in front of my apartment building, that I learned that when I tried to stand up my knees would begin to buckle.

I had never experienced buckling before and wasn't expecting anything like this. I was able to struggle my way to the doorway, but then asked Rachel to bring down a chair for me to rest for 15 minutes and catch my breath before tackling the flight of stairs to my apartment. This was a mistake. When I tried to get up my knees buckled completely and I was unable to stand. A friendly neighbor even tried lifting me up, but I would just collapse back into the chair. After an hour of not knowing what to do, Rachel and I reluctantly decided we'd have to call an ambulance. I have been to the Beth Israel emergency department several times over the last decade so we went there around 5:30 PM. My problem naturally seemed very low priority to them, so we waited a long time. Around 10:00 PM they agreed to have another ambulance crew carry back me into my apartment. I told them I weighed 250 pounds and that it would be difficult to lift me.

They said the ambulance would arrive between 1:45 AM and 2:00 AM. When it did arrive, around 3:00 AM, the technician asked me how much I weighed and then said, "My crew can't handle that weight. We'll have to schedule a different ambulance." This other crew arrived after shortly after 7:00 AM. I had been able to get some sleep, but Rachel hadn't. After getting home, we fell into a deep sleep and didn't wake up until 5:30 PM, which is why I was unable to compose this report yesterday.

RECOMMENDATIONS:

1) I am a 67 years old and don't need to be blind-folded like a jittery horse that can't negotiate city traffic. Allow for the possibility that some of your patients are grown-ups who have a desire, and perhaps even a right, to see what is being done to them.

2) I understand that giving medicines that cause amnesia reduces the possibility of frivolous lawsuits, but they also reduce the patient's ability to understand post-operative instructions.

3) Hospital gowns are not fit to sleep in. They don't hug the body, so whenever the patient tries to move, he has to rearrange the gown all over again. Let people wear their own pajamas.

4) I understand the theory behind Step Down units, but I don't think you've worked out the technology yet. Incessant alarms going off all night that no one cares to stop is a form of torture, whether in a hospital or in a prison. People who feel they have a right to have a say in what is being done to them will never accept a de facto "strangle and entangle" policy.

5) We were glad to learn that Rachel could call me for free, but not so happy to learn that if I called her we would be charged unpredictable and astronomically high rates. Pressure the phone company to stop abusing your patients.

Dean Hannotte