Of course, the journey was not completely over. True, I no longer had to be driving to and from places or waiting for filled prescriptions. But the story isn’t quite over…

I have not had any additional issues that have needed addressed by a professional since my appointment on December 1st, so this last post about my “journey” will be odds and bits or different things, out of context of the actual travel of this journey, that I thought I’d share. When I say, “have not had any additional issues”, I mean issues needing medical care. I get what I label as “ghost toothaches” from time to time. It feels just like a toothache feels, but it’s usually mild and lasts less than 15 seconds. I’ve only had one instance where I felt that sensation and while still mild, it lasted for several minutes. I was able to work through the sensation of pain without help, but I also knew that I would pop a couple of OTC pain relievers if it didn’t go away on its own.

I am writing this post several weeks earlier than the day on which it will be scheduled to post. I’d given myself 5 days between posts once I started writing them so that I would have the opportunity to sit down and write them without feeling pressure to get them done. Nonetheless, the entire journey I shared in these posts happened over the period of many weeks from the day I fell to the day of my last appointment. Now it was just waiting for all of the paperwork associated with the injury from the hospital, the surgeon and the insurance company to see where things stood.

Let’s start here: The total hospital bill at St. Luke’s Bethlehem, from the moment I was moved into a room in the emergency room area until I exited my hospital room, was a whopping $106,432.71. No, that is not a typo. It does include the surgery, a billing for post-op recovery area, every little pill or shot I was given, every prick of my finger to check my blood sugar, etc. But still, over $100,000 for less than 48 hours’ stay? The number astounds me. Now, granted, there is a negotiated rate with my particular insurance on what they pay for each and every item, and the insurance did not pay nearly that amount. And, of course, with Medicare, I am responsible for 20% of the approved costs, but the EOB only shows right now that my share using Medicare insurance totaled $266. (These billings did not show up as entered until December). I do have a secondary medical insurance that I carry, so I’m hopeful it will pick up much of my 20% co-pays for all of this. I’m not happy that, on the EOB, that I can’t see each item’s individual billable and payable amount, just the total, and I’d be interested in knowing how much the surgery cost versus the hospital room versus the medications, etc. I’m just not yet able to wrap my head around it, all in all, being billable at that incredible total.

Just over a week from my hospital release date, I received a printed card from the unit I was on during my hospital stay. It was generic in the way that it basically said, “Thank you for letting us take care of you during your stay” and it was hand-signed “8th floor unit staff”. I have to say that, with the exception of one staff member, I felt really coddled the entire time I was there. The one member I’ve excepted was not in any way rude, but the rest of the staff really felt like they went above and beyond to make me feel like my well-being was their #1 priority, and the lack of that feeling was obvious with that one staff member. I can still think back to being in the hospital and how cared for I felt. When you’re used to taking care of yourself and no one is around to provide any sympathy or nurturing, those simple events that are routinely a part of their jobs were the best part of my stay (if one can find a good part of a hospital stay!).

While most of us lay people will have to fake our way through reading this, that nice thing about this hospital’s network of allowing patients to access their records means that I can see my surgeon’s notes. They read as this:

Procedure and Technique:

The patient was greeted at the bedside in the prep and hold area. All risk, benefits, alternatives to open reduction internal fixation of bilateral mandible fractures, closed reduction maxillomandibular fixation and surgical extraction of any necessary teeth discussed in detail.  All questions answered. Patient is amendable to treatment and signed informed consent.

The patient was brought in the operating room and placed in a supine position on the operating room table. A time out was performed with surgical, nursing, and anesthesia staff verifying patient procedure and laterality. Anesthesia placed appropriate monitors and intubated patient nasotracheally without issue. The patients lower jaw and neck were prepared with chlorhexidine solution and dried. The patient was draped in the usual sterile fashion.

A throat pack was moistened and placed in the oropharynx. 1% lidocaine 1:100,000 epinephrine was used to anesthetize bilateral inferior alveolar nerve, lingual nerve, buccal nerve, superior alveolar nerve, greater palatine nerve. Injections were reinforced with 0.5% marcaine 1:200,000 epinephrine.

A 15 blade was used to make an incision on the height of the edentulous ridge with mesial and distal releases. A full thickness mucoperiosteal flap was reflected. The fracture was visualized, mobilized and debrided using a rongeur and bone file. The fracture was reduced and secured using a 1.25mm Synthes plate with four 8 mm screws. The flap was irrigated with normal saline and closed with 3-0 chromic gut sutures. Attention was then directed to the left subcondylar fracture. A bovie electrocautery was used to make an incision in the left buccal mucosa to expose the ascending ramus of the left mandible. A full thickness mucoperiosteal flap was elevated and the dissection was carried up the coronoid process, the temporalis tendon was released and the dissection was carried to the posterior border of the left ramus. The sigmoid notch was identified and the subcondylar fracture was identified, there appeared to be a callus and the segments were not mobile, the bone was smoothed using a rasp and the site was irrigated with normal saline and closed with 3-0 chromic gut sutures.

The throat pack was removed and the oral cavity suctioned.

Sterile drapes were removed and the face cleansed with normal saline and dried. All sponge and needle counts were correct and verified with the nursing staff. No complications encountered. 

I was present for the entire procedure and A qualified resident physician was not available.

Signed by: Rhonda R. Rohloff, DMD

And, as of this writing, I am still sans dentures. I’m doing what I’ve done for many, many months now – putting in my top denture to go out in public or if I’m going to be chewing something I can’t just gum to masticate. I just feel like I need to put this whole fiasco far back in the rearview mirror before I take on another series of appointments, etc.

I did have a moment of clarity (out of nowhere) when I wondered to myself why dental professionals didn’t use a topical product like Anbesol on the gums to cause a temporary numbing sensation before stabbing the patient with a Novocain needle. Someday maybe I’ll run into an appropriate professional to ask…

One last, in the scheme of things, truly a small thing – – – the beeping battery in one smoke detector that I came home from the hospital to is, in fact, still beeping. It requires me to get up on the top step of my stepladder and it makes me very nervous. I mean, do I need another fall so soon? I hardly notice it anymore, and I’ll get my beloved brother to take care of it next time he visits (as well as the light over my kitchen sink because that bulb has since burned out) because he’s tall enough to reach these from the middle step!

As Forrest Gump said (only three times in the film, believe it or not), “And that’s all I’ve got to say about that!”

I am not a fan of Novocain shots. Well, actually, I’m not a fan of any kind of shot or situations where a needle pierces my skin (which is why I am tattoo-free). But I can handle the quick prick of a vaccine needle or one inserted to draw blood for various testing. I have donated a pint of my blood 15 times over the past few years, and while that can sometimes be a little more painful, once the needle is inserted and blood is flowing freely, I don’t think about it anymore. But Novocain? I know that I automatically close my eyes when a hand moves within my vision which I know is headed for my mouth. I don’t think I’ve ever seen the shape/mechanics of the equipment that provides the shot, but in my imagination, it’s like a miniature caulking gun with a big trigger.

So, eyes automatically close, and I feel the pressure against my inner mouth as the hand of the doctor moves in. My body automatically tenses from knees to neck in anticipation, and when the shot hits, I let out a groan of displeasure. (This is pretty much my normal routine when getting Novocain.) A moment later, when the sensation of pain has subsided, I relax, almost telling myself how proud I was to have made it through. And then, ping, the needle hits me again! I grabbed the ends of the armrests with my hands and let out a louder groan. I hadn’t seen that coming and I wasn’t happy about it. And then, ping, ping, ping, ping – another 4 shots administered with less than 10 seconds between and each one now causing me to lift up my butt from the chair and each groan getting successfully louder and more intense in sound. And in between each shot, from #2 through #5, Dr. Kim acknowledges my discomfort by saying, each time, “I know, sweetheart”. It was a good thing my mouth was open with his hand and his device of torture filling it, because there was a not-so-ladylike response I’d have had to fight to hold in had I had the option to say it.

His hand and torture tool finally leave my mouth, and I suspect that I was glaring at him by then. However, I just let him do what he had to do as quickly as possible so I could get out of there before I lost my cool. Once he was done sewing me up and leaving a large tail of thread in the front of my mouth, he set me up for another appointment and told me I had prescriptions for more of the same antibiotic and mouthwash at my pharmacy. Well, since I still had the mouthwash, and since a visit to my PCP on November 3rd indicated that my sinuses were quite red (this may have been the result of the surgery), she had sent a prescription for 2 weeks of the same antibiotic (for which, if you’ve been paying attention, already know that I had to wait 20 minutes longer after I pulled up to the drive-thru window at the pharmacy). I simply chose not to pick them up after this oral visit.

A few days later, sharing the details of this visit with my bestie, I first became aware of the feelings I associated with his repetitive comments of “I know, sweetheart”. Honestly, as I thought about it, I felt very much like he was being condescending and patronizing towards me. I was able to think of alternative variations of statements if he was attempting to calm me. As I said to my bestie, I wasn’t offended in a sexual way by the repeated use of the word sweetheart, but thought that, not only was it not at all appropriate in this kind of setting, it also could feel a little creepy to a younger patient who would feel uncomfortable having a stranger repeating a personal term of endearment. I realized that I would like to share those feelings with him, not in a way to criticize him but to help him. However, of course, I was not even in the room without his assistant present, and I didn’t want to embarrass him by saying anything in front of her. I thought I’d have another opportunity when I went back for my follow-up visit.

In between that visit and the next one scheduled, I developed another, new problem on my lower left jaw. It felt like something was sticking up from my jaw, near the front of the sutures. It felt like a piece of a toothpick, maybe a third of the length of one and half the width. It didn’t hurt and it wasn’t terribly sharp. I still wasn’t chewing on that side of my mouth, so I wasn’t worried about it breaking off. But still – we’re now a month past the surgery and I’m still having issues?

When I went back on December 1st, I had a different dentist. If he gave me his name, my brain didn’t retain it. I knew he was a different person because, while also of Asian race, he was taller and wore glasses. I actually took charge of this appointment in terms of how I wanted and expected to be treated. I explained my low tolerance for pain in general, my intense dislike of Novocain, and that I needed to know what was going on each step of the way to avoid anxiety and an unpleasant experience. He explained to me that there was a fragmented piece of bone that was sticking part way out of my gum which was dead and not attached to anything that mattered. He said that I would only need one shot of Novocain and that the process would be simply to grab the piece of the bone above the flesh and “wiggle” it out. I asked if I needed to have Novocain and his response was to the effect of “I wouldn’t get it, but I have a moderate pain level.” I asked him to give me a moment or two to think about it. When I’d thought about it, I had one more question and asked him how long it would take, in his opinion. He told me that it should only take a few seconds and so I elected to forego having the Novocain shot. And so he began.

I felt his hand in my mouth although I couldn’t feel the wiggling. Before 10 seconds were up, he removed his hand from my mouth and I asked, “Is that it?” It wasn’t… of course it wasn’t! He said that the bone was pretty tight within the flesh of my gum and he had gotten some movement, but he didn’t want to wiggle too hard and rip the skin. He went back in the second time, and again, seconds later, he pulled his hand out again. I made eye contact with him and he told me that one more tug was all he needed. Well, I was at a disadvantage, so I had to let him continue. Next thing I knew, he was showing me this tiny little piece of bone that had been causing all of the trouble. It was over, and I did it without Novocain! He told me there was the tiniest little hole that needed to heal, but it should be completely healed within about 3 days. No additional antibiotic prescription needed (thus, no more waits at the pharmacy to get it filled). He suggested a salt-water rinse after I ate for a couple of days but I didn’t need any further follow-up unless I had any problems.

I walked out the doors to my car and was overwhelmed with a sense of relief that, unless something else developed, it was finally over! No more schlepping to and from Bethlehem! No more sitting in the drive-thru at the pharmacy only to be told, when it was finally my turn, that the prescription wouldn’t be ready for another 20 minutes! It was finally time to be hopeful that full healing would come, and that my Medicare plan would cover replacing my lower denture which no longer even fit the profile of my lower jaw, much less stay in place with adhesive! The relief was almost palpable! The journey was over!

On that Thursday, the day after I came home, I did a more thorough reading of the seemingly too many pages included in my discharge packet. On one page, I was told to schedule a follow-up appointment with the surgeon for the week after. On a different page, I was told to wait a week and then schedule a follow-up appointment with the surgeon. My pain was so minimal that I was willing to wait a week before scheduling that appointment. Meanwhile, on Friday morning, just 2 days post-surgery, this was the face that looked back at me from the bathroom mirror:

Man, I thought the bruising I experienced from the fall was ugly enough, but it was no match for the bruising I got from the surgery! This was much more bruising and much darker, but it did not last as long as the previous bruising had. Meanwhile, ever grateful that no one would look at me like I was crazy, I donned my mask whenever there was a chance I would see someone (even in the communal lobby when I went to check the mail). I did manage to make an appointment with my mechanic, who was crazy busy as it was, and learned that the check engine light was on because I needed to replace a camshaft solenoid (whatever that is!) to the tune, with tax, of almost $165. When it comes to vehicles, it’s been my experience that anything maintenance is always going to be costly, so I actually was almost pleasantly surprised at that cost only being that much.

On the Wednesday that marked a week since I’d left the hospital, I called to schedule my follow-up appointment. While I suspected I had gotten dissolvable stitches, I could still feel them in some places. I also had a place on the left side of my lower jaw that felt like the stitches had come apart and when my tongue ran over that space, I could tell that it felt different than the rest of my jaw. When the person answered my call, I explained that I was calling to schedule a follow-up appointment with my surgeon. The response I got was something to the effect that they normally don’t schedule follow-ups for the surgeons. I explained that I had paperwork from the hospital stating in two places that I needed to follow up with the surgeon, and that I had concerns about the stitches that hadn’t dissolved and the potential hole in my flesh where the stitches did not hold the spot together.

I finally got a scheduled appointment by phone for 3:30 PM on Friday, November 18th. About an hour later, I got a confirmation text of the scheduled appointment – same date but at 3:40 PM. It’s become obvious to me that the right hand doesn’t know what the left hand is doing from having two different sets of instructions for when to schedule a follow-up appointment, but I decided I’d stick with the 3:30 PM time because I don’t mind being early somewhere, but I get anxiety if I’m not there a few minutes early, never mind late. It was supposed to be another 45-minute drive, so I left home at 2:30 PM. Since I was heading to the same town as the hospital, I did feel like that much of my driving felt a little bit more familiar. My GPS got me to the address on Eighth Street with about 7 minutes to spare (again, construction, one-way streets and school buses). I pulled up, to the address but was concerned, because the numbered building was merely a duplex house with no signage. I pulled out my paperwork and realized that it was I who had erred, that I’d let the GPS default to Eighth Street but the address I wanted was on Eighth Avenue. I corrected the information in my GPS and it reported back to me that I was 8 minutes away (so I would arrive at 3:31 PM). Of course, the GPS does not take into account the traffic, road construction and school bus continual stops. At 3:35 PM, I started calling the main phone number, wanting to alert someone that I was just a few minutes out but was on my way. I kept getting the message telling me to leave a message for a return call. After getting that same message three times, I dialed the main number and tried a different option from the menu and managed to get a live person. I was informed that I was already late, and I needed to get there before 3:45 or I would lose my appointment time. (It was another not rude but certainly not nice person I spoke to – perhaps that’s a qualification that employees have to have before they can be considered for a job?)

I got there at 3:41 PM and registered. Because I’m a bit anal-retentive, I had extra copies of every piece of paperwork I had been given since entering the hospital, so I save them time and cost by needing to make their own copies. I didn’t have a very long wait before I was called to go into an exam room.

Less than 10 minutes later, a man of obvious Asian heritage entered my room and introduced himself as Dr. Kim. I was expecting to see my surgeon but agreed to allow him to look inside my mouth. There was, indeed, a place on the top of my left jaw that had pulled apart and he said that what I could feel was a bit of a metal plate that was used to help connect my jaw. I obviously couldn’t see it, but I was pretty sure it was about a 1″ length that hadn’t closed correctly. Dr. Kim said he would give me Novocain and re-stitch it for me. And then the real fun (hear that word with sarcasm) started.

Once the staff was informed I was staying, they started coming in to see me. My blood sugar was checked and was high (not surprising considering all of the sugar from the juice). Someone came in with needles and told me they were going to give me two needles in my belly. One was a shot of insulin and the other was a liquid blood thinner to help protect me from getting any post-surgery blood clots. I wasn’t happy about getting a shot of insulin, since I manage my blood sugar well with oral medication, but hey, if you were going to give me a shot in my belly anyhow, now is the right time to do it.

Another person came in with the cup of 3 Tylenol and a larger styrofoam cup with a lid and a straw. Eeech! The larger cup had thickened water in it. I got the pills down and handed that cup back to the attendant. I (nicely) said something about not being able to enjoy the thickened water and also, I didn’t think a straw was a good idea since I had stitches across my entire lower jaw.

About 2 hours after that, just after lunch, an attendant came in to tell me that they were going to start me on a painkiller. Now, I hadn’t asked for one, even though, when asked, I did say my pain was pretty constant at a 6 level, even with the Tylenol, but trust me, I wasn’t going to turn it down. She told me that I would be taking oxycodone, with which I was quite familiar. Oxycodone is what I was prescribed after I’d had my teeth removed prior to getting dentures, and it basically replaced what used to be called Tylenol 3, which was Tylenol with codeine. I didn’t want it for pain as much as I wanted it to knock me out and give me some real rest. The good news, in addition to that, was that I was now allowed to have non-thickened liquids (I may have said aloud, “Thank you, Jesus”). I immediately asked for a large cup filled first with ice, to the brim, and then filled with water, no straw needed. I guzzled so much of it that it gave me a case of brain freeze, and yes, I’d do it again!

Shortly after that, another attendant came in with a little cup of what looked like mouthwash and a plastic bin. I was supposed to gently swish it from side to side over my lower gums and then very gently spit it out. I was told I would have to repeat the process after I ate dinner. Not a biggie to me.

The rest of the afternoon was pretty uneventful. I was offered assistance with a sponge bath, but I declined. I’d taken a shower on Monday morning and didn’t think I’d gotten that dirty, plus I had a shower in the bathroom and was perfectly capable of bathing myself if I needed to. (Also, I know they are professionals, but I have body issues and prefer not to expose my body unless absolutely necessary). Meanwhile, I kept watching the clock, wondering when Dr. Rohloff was going to show up and let me know how the surgery went and what I needed to do and what I could expect in the next few weeks. There was a TV in my room, for which I had the remote, but I watch so little TV anymore that I wasn’t really interested in it. The pain pill didn’t make me drowsy, nor do much for the pain, but I got my Kindle out and would read a couple of chapters, then turn it off and close my eyes for a bit.

The three Tylenol tablets were dispensed every 8 hours, the pain pill was dispensed every 5 hours, my blood sugar was checked every 8 hours, and I received two liquid blood thinner shots that day, though I can’t remember how far apart they were. Donna, next door, was still coughing, but not as often and with a much drier cough, meaning not much of the continuous hacking. No one ever looked inside of my mouth or asked me if I had any issues. While the staff was amazingly kind and caring, I honestly could have been a patient with absolutely no recent surgery because no one seemed concerned about the fact that I had just had surgery other than to give me blood thinners and dietary restrictions!

Meanwhile, I spent much of the day awaiting a visit from my surgeon to talk to me about the surgery and anything good and/or bad associated with it. I didn’t totally give up on a visit until after 9 PM. By that time, I was back in the chair instead of on the bed, finding it much more comfortable once I realized it had a footrest like a recliner. I also had a pretty view out of my 8th floor window, at least until sundown. I sat there, feet propped up and blanket wrapped around my bare legs, dozing off at times and at times just resting. This was my view:

It was around 10 PM when my next dose of a pain pill was brought in. I actually turned it down and said that it wasn’t having any kind of effect on the pain, so I didn’t see the point of taking it. The (cute and charming) male nurse said that he could double the dose, since it was just a 5 mg. pill, and he nudged me into understanding that I had nothing to lose by trying it. So I agreed to the double dose.

And then, I slept. Sitting up in the chair with my feet propped up, a light blanket covering my legs, I slept. I slept for about 4 hours without waking for any reason, and when I woke up, I felt like a different person! I stayed in that position, still resting but not sleeping. When the (cute and charming) nurse checked in on me about 4 AM, I gave him a thumbs up sign and said, “Thank you. I slept.” He asked if I needed anything else, and I told him that I would love to have a cup of coffee but I doubt that the kitchen had any ready that early. He said he could get me coffee and asked me if I wanted 6 oz., 10 oz. or 12 oz. Of course, I went for the 12 oz. size, with 3 creamers. Oh my gosh, one sip and I wondered if I could get some coffee upon entering heaven, because it was heavenly good! When the nutritionist came in around 6:30 AM, I asked for 2 cups of coffee (thinking they would be small) and a bowl of grits. Now, suddenly, I couldn’t have grits, however! I ended up ordering oatmeal, and it was as bad as the coffee was good. It was very sticky, and the texture felt like it was only half-cooked. I took two bites, pushed it away, and prepared my two fairly large cups of coffee to enjoy, which I did. Meanwhile, with the uncertainty of discharge, I had to order lunch and dinner at the same time. Now being able to have regular liquids, I ordered some chicken broth, but when I asked, was told I could have neither crackers nor a plain piece of bread to put into it to add some texture. I was going to have the baked tilapia but was told that it would still need to be pureed. Seriously, tilapia is a very flaky fish and falls apart with the least amount of pressure to its flesh, but they still had to puree it? No thanks. (Fortunately, I would not be staying for lunch or dinner!)

About 10 AM, a person I wasn’t familiar with (which made me assume he was a doctor) came in with a bunch of paperwork, which was passed on to me with the statement that these were all of the papers needed for my discharge. I wasn’t surprised by being discharged. I’d already gathered up most of my belongings in preparation. I got out of the hospital gown and into my own clothes, then sat down to read all of the discharge paperwork. I was expecting someone would be coming to get me – with the standard wheelchair – to take me down to the lobby. I read the paperwork again, including the fact that I needed to be out by noon to avoid an additional day’s charges. 11:30 AM came and I’m still in the room, bag packed and ready to go. At 11:40 AM I stripped the bed and pillows of linens (hospitality training never fully dies, I guess) and at 11:50 AM, I grabbed my bag and left the room.

I found the elevator, took one to the first floor, and ended up in the main lobby of the hospital. I asked at the desk how I could get over to the emergency room area because that was where I was parked. Guess what? You can’t get there from the main lobby except by going outside and going around the building to the ER entrance. Fortunately, because of the size of the hospital and its parking lot, there were courtesy drivers to take people where they needed to go because the main parking lot was across the street, so I requested one. Mr. John took me around the building (it took 4 minutes driving time, so I’m glad I didn’t opt to hoof it!) and I breathed a sigh of relief when I saw my car. I tipped Mr. John $3.00 and went to my car, unlocked it, threw my things inside and climbed into the driver’s seat. At that point, my mind repeated the words, “Be it ever so humble, there’s no place like home.”

The check engine light, of course, came on and stayed on and all I could do was hope that I would make it to the drugstore to pick up prescriptions (pain pills and mouthwash) and home. My mechanic’s garage is just a little over a mile from home, and if worse came to worse, I could get towed there using my AAA, so I just wanted to make it home. Thankfully, mid-day traffic wasn’t too bad and I was at the drugstore about 45 minutes later. I waited at the drive-thru window. When it was my turn, guess what happened? If you’ve been paying attention, you probably guessed that I was told the pick-up wasn’t ready yet and I should wait about 20 minutes.

I got my prescriptions after the wait, got home, grabbed my belongings and walked in the door. Belongings got dropped on the floor of my bedroom, coat hung on the doorknob of the front door, shoes kicked off and slippers acquired, a large glass filled with Brita ice cubes and cold Brita water was also acquired. and my butt hit the recliner. The rest of Wednesday and all of Thursday was resting, doing a little bit of reading, watching some movies (in pieces on Amazon Prime) and napping if I could. By Thursday morning, I was able to treat the pain with Tylenol and only took the pain meds at bedtime for Thursday and Friday to make sure I was able to sleep, and even weaned myself back to two doses of Tylenol, one when I got up and one mid-afternoon.

I assumed the worst was over… (and you know what assume does, right?)