Jody’s Jaw Journey – Epilogue

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!”