Wednesday, November 7, 2012

Oh, and On That Election...

Naturally, I'm far from overjoyed by the results. 

The result that has the most direct impact on us is the passage of Proposition 30 (California).  That one is going to smack us in the pocketbook in a most unpleasant way.  It's also an indicator to me (as if I needed any more indicators!) that Californians are utterly committed to going the way of Greece.  They've got the pedal to the metal, and are heading for the cliff.  Except that I think with this election, they've actually done it: they've driven off the cliff.  I don't see much chance of a return to sanity for California after this.  The best that can be hoped for is that there will be a future opportunity to come back in and rebuild from the ashes.  We're going to be leaving within the next couple of years, and maybe much sooner.  This was the final straw for us, and I don't think we'll be alone.  I had so hoped that Californians would climb back in off the shelf on this one...

Obama's win I'm much less upset about.  First of all, unlike Proposition 30, I was expecting this one to go the wrong way.  Second (and thankfully), we still have a split Congress; the Republicans are still firmly in control of the House.  Gridlock will ensue, I hope.  There's one immediate concern, though: the fiscal cliff and what will or will not be done about it.  Anything at all could happen now, in the lame duck Congress.  I wouldn't put any compromise past the big-government Republicans.

In the longer term, I haven't quite reached the level of despair for our future at the national level that I have for California.  The situations really are quite different. 

In California, we have a progressive executive and an overwhelmingly progressive Assembly and Senate, with a ludicrously ineffective minority of conservatives – and the trend is for more progressive members.  The results for San Diego County elections were instructive: it looks like a long-time big-government conservative Representative (Bilbray) has lost to a progressive opponent (Peters), and it looks like our new city mayor will be a flaming progressive (Filner).   San Diego has long been the largest city in California with any semblance of a conservative government, but now that is crumbling before our eyes. 

At the Federal level, things are not quite so bleak.  We have a Senate with a tiny Democratic majority, and a House with a solid Republican majority.  Obama won't be able to pursue his progressive agenda without an effective opposition.  There will still be ballot box opportunities to get the Federal government back on track.  While it won't be good for our country, I do believe it's true that four more years of Obama-style progressivism will breed more, not fewer, conservative-leaning voters.  Hillary Clinton is the most likely Democratic candidate in 2016.  The Republicans have a huge field of quality candidates to choose from, and some of them are not big-government Republicans.  It remains to be seen, of course, whether the Republicans will be smart enough to choose a small-government candidate (like, say, Paul Ryan).  But my real point is that they will have a chance to do so.  So I haven't quite reached full on despair at the Federal level. 

I see no such possibilities for California.  I see an endless spiral, downward, for California.  Man, I really, really, hate to say that...

The Reason for Blog Silence...

I can tell from my email (and my mother's phone call) that some of you have been wondering why this blog hasn't been updated for the past few days.  Most of you, quite sensibly, couldn't care less.  If you're in the latter camp, please feel free to ignore the rest of this post...

My long-time readers will know that my wife (Debbie) competes in dog agility, and that she runs with one field spaniel (Miki) and one border collie (Race).  This past Sunday, she and Race were in Vista at a seminar teaching some of the finer points of running dog agility.  Like any agility training, both the dog and its handler were being trained.  In one practice run, Debbie was running flat out, and Race did something very undesirable: he ran behind her, from her left to her right.  He smashed at full speed into the lower bone (tibia) of her right leg when it was extended behind her.  Down she went, and she didn't get up on her own.

I wasn't there to see this.  The first I heard about it was a roughly 10:30 am call from a very tense-sounding Debbie, telling me that she'd hurt her knee and we needed to go to the ER.  At that point she was about 70 miles away from me.  So of course I went zooming up there, and found my girl sitting on a chair, knee wrapped tightly in about 4 miles of Ace bandage, with ice surrounding it.  It was obviously badly swollen.  Off we went to the ER at Palomar Medical Center in Escondido, a facility recommended by several other seminar attendees.

I won't bore you with all the details of our 10 hour ER “adventure”.  Most of it was waiting.  It took three hours to make it past triage and get into an examining room, where a doctor agreed that pain medication was in order.  After seven hours, she'd had a cursory exam, an X-ray, a CAT scan, and a thorough exam by the orthopedist on duty.

Debbie and I have lived through an ACL break before – mine.  We knew what those symptoms were like.  The symptoms Debbie was showing looked the same to us, so we were expecting to hear that she had a torn ACL and probably meniscus damage on top of it.  So when the orthopedist came back with a diagnosis of a fracture of the tibial plateau, we were quite surprised.  The more we heard from the orthopedist, the more dismayed we were.  For starters, he told us that while an ACL tear wasn't very likely, some meniscus damage was.  Then he told us what recovery would be like: three months without being able to put any load at all on her right leg.  That means a walker or crutches for that whole time.  She would be in physical therapy for range-of-motion and strength during that period, but inevitably her quads will atrophy significantly.  Then she starts two to four months of gradually increasing loads on her right leg, with physical therapy to build her strength back up.  He told us that if the surgery went well (about an 80% chance) then in about a year she'd be back to her previous condition.  If the surgery didn't go so well, she might never regain her full abilities, plus there may be early arthritis and even a debilitating disability.  On the other hand, if she skipped the surgery the odds were flipped: about a 20% chance of a good outcome, and an 80% chance of a bad one.  Yikes!

The worst part for me was noting that the orthopedist was very interested in Debbie's case – because her injury was a bit unusual (naturally).  I hate it when the doctor thinks my case is “interesting”, and it seems to happen way more often than you'd expect to both Debbie and me.

Most of the time, he told us, tibial plateau fractures occur on the outside of the leg.  Debbie's fracture was on the inside.  He then told us that because of the nature of her fracture, he thought it was a good candidate for a relatively new technique called “balloon osteoplasty” (see explanatory video below).  As he explained it, this technique stood a good chance of making the best possible reconstruction of Debbie's tibial plateau.  The better the quality of the reconstruction, the better the chances were for a complete recovery.  He gave us the option of going for conventional surgery right then (Sunday night), or of waiting for Tuesday, both for a hole in his schedule and to have time to get the equipment brought in (this technique requires gear that isn't normally part of the operating room's inventory).  We opted for the balloon osteopathy and waiting for Tuesday.

The more we spoke with this orthopedist (whose name I won't publish until we know the outcome), the more we liked the guy.  In addition to being easy to talk with, straightforward, and unhesitating in answering our questions, he also had an appealingly quirky sense of humor.  We also noted the deferential way the ER staff treated him – and when I had a private moment with an assistant ER doctor, I asked why.  The answer I got was, basically, “Dr. X is a god.  He walks 5 or 6 feet above the water.  Everybody here loves him because he does such a great job on his patients!”  That's a positive endorsement in my book!

So the surgery was scheduled for 8:30 on Tuesday morning, and the hospital staff figured they'd wheel Debbie down to the OR for prep around 6:30 am.  So I arrived at Debbie's side at 6 am to be sure I was there to see her off into surgery.  6:30 came and went; no word.  8:30 came and went, no word.  Finally at around 9:00 am, one of the floor nurses got in touch with someone in the OR who knew what was happening: the special gear the orthopedist needed for the balloon osteopathy hadn't yet arrived.  He was shuffling his schedule to keep a spot open for her, and as soon as the gear arrived she'd be slotted in.  Dang.

Finally, just after lunch, the trolley and a couple of runners showed up to send her down to the OR.  I sat with her through prep, which mostly meant paperwork and endless rechecks of vital signs, administration of antibiotics, etc.  But this experience was far more harrowing than we expected.  In the little curtained off area right next to us, an elderly gentleman was coming out of anesthesia after his own surgery.  We found out later that he was a dementia victim, very confused all the time, with significant mental impairment.  But all we knew at the moment was the horrifying, heart-rending, and very loud moans and groans that he was emitting.  If you didn't have the nurse there to tell you what was going on, you'd imagine he was having his fingers pulled out one by one, or something along those lines.  Debbie, already frightened by the whole process, was very uncomfortable in the teeth of this poor man's agony.  It didn't matter what the nurse told her; it was so awful (for all of us, even the nurse) that added to her pre-existing fear it was nearly overwhelming.  Finally, and mercifully, they wheeled Debbie into the OR for the surgery.  It was 1:30 pm, and the surgery was scheduled to take 2 hours.

Off I went to the waiting room, to ... wait.  I couldn't do anything that required any real thought.  I ended up watching a TV for an hour or so; a strange experience as it was tuned into a Spanish-langauge station (and I don't speak Spanish at all) talking about the U.S. election.  It was easily the most palatable election coverage I'd run into yet, not least because I couldn't understand any of it.

At almost exactly 3:30 pm, Debbie's surgeon came walking out into the waiting room to talk with me.  The first thing I noted was his demeanor: this was one very happy man.  I shortly found out why – the surgery could hardly have gone any better.  First of all, the balloon osteopathy worked a treat, and her reconstructed tibial plateau was “perfect”.  I like perfect.  Then he went on to say that he couldn't see any meniscus damage, and that her ACL was (as expected) intact.  Debbie's got some hardware in her leg now: a big surgical steel plate and three titanium screws.  But the most important thing: her surgical outcome was better than we had even hoped for, and she's got an excellent chance at a complete recovery.  Whew!

It was an hour after that before I could see her again, in the OR recovery area.  We were there for two hours before they would release her to her room.  But finally, at about 6:30 pm, we were on the way back to her room.  We had one very bad experience as the two people who transported her back to her room transferred her from the gurney to her bed.  They slid her off the gurney into the bed in a manner that suggested they were unaware that her knee was injured.  The result was some immediate and extremely bad pain for Debbie.  She was out, unconcious, briefly; then back with us and telling us all (very explicitly and descriptively) just how bad her pain was and how willing she'd be to execute the people who had done this to her.  Prior to this, she was in no pain at all.  Making it even worse: in the confusion around her transfer from OR to the floor, there were no orders for pain medications in the computer record for her.  The floor nurses were sympathetic, but couldn't actually administer any pain medication until they had orders (really, that means until a doctor says it's ok).  That took around 15 minutes, which seemed like a very long and hell-like eternity to Debbie.  They finally did get the pain meds into her, and she finally got some relief.

For the next few hours, Debbie faded in and out of consciousness.  Often, she woke up very confused about why she was in the hospital; she had no memory of having been injured.  I stayed with her until around 11 pm, and another friend of hers was with her for a while as well.  Around 10 pm she finally fell asleep; fitfully at first, but finally into a full-on snore-o-rama.  So I went home to take care of the animals and get some sleep myself.

This morning (the day after surgery), I got a phone call at 5:30 am from a perfectly lucid Debbie.  I don't have the words to convey just how good it was to hear her normal self back with me.  Even better: she wanted coffee - a nice big cup of Starbucks latte, with an extra shot.  That's my girl!

And today she's doing much, much better.  She's finally got the word about the excellent surgical outcome.  While she still professes a desire to execute the two people who caused her pain last night, one senses that it's more pro forma at this point than it is for real.  She had a little physical therapy today, ate a little food, and had some nice visits from friends.  Her room is full of flowers and cards; there's no longer any space for more.  She must have gotten a dozen calls from friends today.  She's still got some pain, but the floor staff is doing a good job keeping it under control.  We can see a recovery in her future...

Explanatory video about balloon osteoplasty: