6 pm. Checking in at Encompass. Initial impressions very favorable. I’m sharing a room and I have the window. Abbie, the nurse, checked me in. Dora, a care assistant helped. Dora’s deaf but communicates with her smart phone. Food looked unappetizing, though what I took for a Sloppy Joe turned out to be Pulled Pork and wasn’t bad. The green beans, however, were nasty. Abbie explained that they’re not known for their food and that I can also order out.
A normal post-surgery day at MGH. I wrote and sent out a status update yesterday. At 7:30, the medical team came by. They are familiar with my case but are not following in detail. It seems that I’m no longer interesting. I was a bit chilly but slept until 8:40 when the nurse came by to give me meds, after which I slept deeply until 9:15 when two Patient Care Assistants (PCAs) got me cleaned up and out of bed and into the recliner.
SLC stopped by to change the dressing on the right leg and install the brace.
The decision on rehab is pending, but our first choice of Whittier was turned down because of lack of beds. So I’m to go to Encompass Framingham. As of the time of writing it’s showing on the BCBS as pending June 23-29. The leg pain is pretty bad. I think it got a bit better overnight when I called for pain meds. Meghan stopped by with 30 mg oral morphine. It’ll take some time to kick in. I’ve not had hallucinations since switching. It’s hard to say if it’s more or less effective than oxycodone since the pain is in the ball of the foot on the right leg, and I still don’t have the ability to distinguish touch down there. It is worrisome. We’ll see what Encompass will do with it.
MGH appears well run, which is not to say that there are times when I have been dissatisfied. Above all, of course, is the need to ensure safety of the patients and freedom from obstacles to that purpose. The parts of the organization that I come into direct contact with are the nursing staff, the facilities in the ward, and the people that maintain those facilities. There are also the doctoring teams, and at the top, the superstar specialists and surgeons. In some ways, running a hospital must be like managing a sports team, a rock star, or an airline. They all have a clientele that is willing to repeatedly spend a lot of money to receive their services, and they must maintain their reputation for excellence. It costs a lot of money to maintain these services and reputation. The bottom line, however, must be that safety is essential, while the budget for safety and the financial benefit is impossible to measure. Back to the nursing team then, I am somewhat surprised that, unlike most major hospitals in the Boston area, MGH does not have a nurse’s union and it appears that management actively discourages it. An entry in Wikipedia reads as follows:
The vast majority of MGH’s thousands of registered nurses are not represented by a union. While sister hospitals in the Mass General Brigham (MGB) systems […] have nurses represented by the Massachusetts Nursing Authority, MGH nurses have historically voted against unionization.”
The entry goes on to notes that 88% of physicians voted in 2025 to unionize, but that Nurse Practitioner and Physicians Assistants are predominantly non-unionized. Reading some additional articles it seems that the board fears reputational loss, which in turn lessens the ability to attract top-rated staff, and overall loss of management control – both of which I understand. What I do miss, however, is the apparent lack of specialized training and a reliance on on-the-job training. This latter method, although essential part of training, carries the risk of instilling sub-optimal practices simply because they are easier to use. It also encourages the acceptance of work-arounds leaving the obstacles in place. For example, the nurses frequently complain about the new suction pumps used with the Jackson-Pratt bulb drains that pull liquids from the site of the surgery. In my case, I have two bulbs and sets of tubing that work with a single suction pump. The new pumps apparently have more features than the old pumps, but they set off alarms multiple times a day. The alarm is particularly discordant, and seems to have based on the sound made by a vuvuzela. This is obviously an annoyance to the patient, but it is also a distraction to the nurses who may be engaged in other tasks requiring their concentration.
It seems that the pumps were introduced using a train-the-trainer. Nurses also do not have any channels for expressing their frustration with the device. I was also disappointed when I mentioned the applicability of safety management systems in healthcare to Nick, my nurse for the day. He had never heard of the work of Jim Reason in this area. This was a change from my experience as a cancer patient at Brighham and Women’s 20 years ago. There, the physician team and nursing team did know about him, and his work developing the famous swiss-cheese model. Pushing further, I asked him if he had read anything by fellow Bostonian, Atul Gawande. Nick just asked if he was born here? (He wasn’t. He was born in Brooklyn, NY). Bottom line, I think that I would like nurses to recognize their calling and the role that they play in healthcare. As I’ve said many times since I’ve been here, I’d like the person asking about “where does it hurt?” and “what’s my pain level?” to actually have experienced pain themselves.
I’ve been reading up on my surgeon, Santiago Lozano-Calderon. SLC as I’ve referred to him here, or ‘Santy’ as members of his team call him. I see that the orthopaedic oncology area in which he works incudes the evaluation and treatment of primary benign and malignant tumors of bone and soft tissue, as well as metastatic bone disease. It’s an area where we don’t have all the answers and difficult to make precise diagnoses. It is eminently reasonable, that six weeks after my first appointment with him, I still don’t have a diagnosis.
Some confusion this morning. My mouth was very dry. As I write this two hours later I’m still confused. My eyes drift in and out of focus making it hard to read and type, and words move on the page. Random auditory hallucinations. I open my eyes and what I see doesn’t match my mental images. Items are the same but in different places. My mind decides that there is some task I need to do with the device I’m holding and I open my eyes and I’m not holding anything. I don’t feel warm or anything like that, I’m not agitated, I’m just confused. I call for the nurse (I find that if I have more than one thing, then its best to say something like “Good morning: I need two things: <pause>” And then number them, otherwise the operator will just cut me off after the first request. Also, it helps me remember why I called the nurse in the first place. It didn’t make any difference this time though, after I asked the operator for a fresh pitcher of water, either she failed to pass on the message or the nurse forgot it. It was good to get her in here though, because one of the things I’d asked for were the “Dude Wipes” by the window, and as I was using them I realized that I’d shat myself, so we had to go over the routine of rolling to one side, wipe wipe wipe, pull out the potty pad, put the scrunched up edge of a new one under my back, roll back over to the other side, wipe wipe wipe, pull out and flatten the scrunched up potty pad, and roll back. The nurse, Emma, is very long suffering. I can’t imagine Mo doing this without complaint.
The nurse this morning was Nick. He came in around 8 am to give me my meds. Pain level 4 so we agreed I could reduce the oxycodone dosage. Went to get pills – came back – put pills in a cup and handed the cup to me. The only problem was that he gave me an empty cup. This is a classic slip. It turned out that after having measured the pills he threw the cup away. The nurse’s vigilance suffers from rushing and the patient must provide a line of defense against inadvertent mistakes. When I told Nick that he hadn’t given me the pills he swore that he had. I held my ground and eventually he looked in the trash he saw what he had done. He had to go get another nurse to sign on to him reissuing the medication.
Busy day. Moved from bed to recliner around 9:15, where I stayed most of the day.
Yesterday, a medical tech (Mark?) stopped by to fit a metal brace to the right leg so that they have an approximate fitting for the fight leg when they remove the wraps. They didn’t say when that would be.
Maureen and Miranda came in a bit earlier. I expected them around 12:30 but they got here at 11:30. Nick, the nurse, said they were going to get me down for an ultrasound in the morning, but noon came and went and they said couldn’t do it, but would push for the next day. In the event, they actually came at 4 pm just as Maureen and Miranda were leaving. I don’t expect they’ll see anything as it’s the right leg that is a concern for blood clots, and they can’t check for that because of the bandages. I expect they’ll do that another day.
I turned the TV on shortly before noon and figured out that the hospital remote would take a 2.5 mm audio cable to connect it to the Bose headphones. It was a good move and a great match for the US versus Australia which they won 2-nil. Later I watched Scotland vs. Morocco. Midfielder Ismael Saibari scored lightening goal 1 minute 40 seconds after the kick-off to leaving the score 1:nil at half-time. Morocco was the better side – they have a definite height advantage and some of the players are very fast on their feet. It was then that they took me down for the ultrasound so I didn’t see the second half, but even at that time, given the mediocre performance of the Scots in in their previous match, I was doubtful if they could turn it around or even squeak a draw. And so it was. It was the final minutes before I made it back into the ward (50+ minutes later. 3 minutes for the procedure two floors down in the same building, 47+ minutes waiting time!)
I’m still getting hallucinations when I close my eyes, both auditory, and presence. This latter type of hallucination is when you fell that one or more people are in the room with you. I will try cutting down the oxycodone to 15 mg and keep it there for tonight. If it goes ok I’ll try cutting it down a further 5 mg.
When they got home, Maureen and Miranda facetimed me so that I could walk them through setting up the trellis for the indeterminate tomatoes. It worked out pretty well I think. The tomatoes look well established and have grown a lot. Miranda gave me a video tour of the rest of the garden.
Remove cover from brassicas and spray with BT to protect from cabbage moth.
Fertilize onions and garlic.
Keep cutting out garlic scapes.
Examine and pinch out peppers
Chelsea chop the Rosinweed (Silphinium integrifolium) and New England Aster (Symphotrichum novae-angliae). Remove ⅓ to ½ above leaf node.
Fertilize eggplant and tomatoes. (NOT peppers)
General thoughts: Today was a good day. I’ve been here since last Thursday and of course there’s fatigue with it all and wishing I was able to go home, but I must admit that there’s a certain enjoyment that I get from being cossetted in this way. Today though, I also got enjoyment from the walk through the garden, seeing it thriving despite my absence and the brutal drought. For all this, of course I must thank Maureen, and also Miranda for supporting her. I can never repay them.
