Well, the hernia is done, and the overall experience at the Shouldice a good one. It really is a well-oiled machine:
- Day 1 Pre-op: Check-in, blood work, ECG, consent forms, accounts office (for semi-private, to be reimbursed later), doctor examination and ok for surgery. X marks the spot. A later quick meeting with the surgeon who will actually do the operation to walk me through the risks etc, show me where the incision will be. And a late afternoon information session to walk all the patients through the upcoming days. And given it is a private hospital, some marketing on add-on massage therapy for the area around the incision post-op. To further go through with final preparations, small groups of 5 meet with the nurse to go through the following days routine and address any last issues or questions. Given the importance of repetition to communications, they certainly apply that, along with some good handouts to reinforce the messages.
- Day 2: Operation: Early start when one is shaved and then taken down with the others for that particular slot. Large pre-op waiting room with about 10 beds. One gets one’s meds (local anesthesia) to calm one down and then about 30 minutes later, one walks in – being supported on both sides given the meds – and set up for the operation. While one can feel a fair amount of pushing and pulling, no pain, some quiet background music and little repartee among the medical team. I was hardly alert in any case to pay much attention. Then after some 45 minutes or so, into a wheelchair, back up to one’s room, change into relaxed clothing, and I drifted in and out of sleep for the balance of the day. In contrast to subsequent days, operation day is largely a day a bed rest, as one’s body needs it. Usual post-op check at the end of the day to ensure all ok.
- Day 3: Post-op recovery: The worst day for pain, and one has to be careful how one moves. But a good design feature is requiring patients to get up and about for meals, wifi, lounges and the like, as there is no entertainment in the rooms. Getting up is the most painful part, as is coughing, sneeing and laughing. The morning begins with the removal of half of the staples (8 in my case) and my first look at my scar – longer than I expected, about 4 inches. A number of us hobble along the corridors (the ‘Shouldice Shuffle’ as one friend calls it), the walking wounded. A short group exercise class, mainly stretching and easy movements. Those one day further along, of course, walk more normally. Manage about 6000 steps.
- Day 4: Removal: Like all hospitals, patients fit into the routine, I am wakened from sound sleep to be asked if I need pain medication, as well as the routine temperature check. Sigh… The remaining staples are removed, as is the bandage. Uneventful. About 48 hours after the operation. . More walking today and less pain, apart from getting up. Usual short group exercise session. About 14,000 steps. Accounts settled.
- Day 5: Discharge: Allowed to go home. Still some pain and discomfort, but able to walk more quickly, with the pain more than manageable.
Overall, a much better experience than standard hospitals. A few other observations:
- First, more women than I expected, about 20-25 percent of patients my week. And more younger patients as well, perhaps 10-15 percent.
- Secondly, while I know the Shouldice is like an assembly line, the care can be characterized as more professional than warm or caring. Tone is cooler than I had expected, or maybe I am spoiled with the warmth of the cancer care I have received in Ottawa (and doubt that general surgery in Ottawa would have been warm). But they clearly have the complete process and procedure down pat, and it appears incredibly efficient from a patient perspective. This also applies to the doctors. The doctor who first examined me appeared more interested in the computer monitor than me as he mumbled through my medical history, the surgeon who operated on me was much better, making eye contact and engaging more as he walked me through the risks and flagged other issues (e.g., my red blood cell counts being lower than normal).
- Thirdly, this is one of the rare cases of medical tourism to Canada from the US, given the lower cost charged (around $5k for one hernia) and short waiting period (it took only 6 weeks from time of application to surgery in my case). There were a large number of US patients here this week, the furthest one coming from Alaska.
- Fourthly, the design of rooms, services, and processes to get people up and moving works. We all have to go to the restaurant to eat rather than eat in our rooms, save for operation day. Wifi only works in the common areas. TV is only available in a few lounges. Sort daily exercise class has almost 100 percent participation. Rooms are for sleeping and resting, little else. A major benefit of this is the chance to compare notes with other patients, learning from those who have already had the operation to know what is ahead, sharing one’s knowledge with those further behind in the ‘assembly line’. A fair amount of black humour helps, and we all compare notes.
- Fifth, nice lounges, lots of natural light, beautiful park like setting and decent food make a difference.
- Sixth, one last note on their written materiel, all of which is very well done, with one bit of advice that perfectly balances information with humour in discussing resumption of sexual activity: ‘when the ecstasy exceeds the agony’. Never seen anything quite as clear – and meaningful – elsewhere.
I finally managed to read Jan Wong’s Red China Blues, her account as a student during the last days of the Cultural Revolution, and subsequent stint as Globe and Mail correspondent during the Tiananmen uprising and massacre. Much of her story is that of her personal growth and coming to terms with the reality of China and the Chinese government; starting off as an idealistic Maoist and ending as a disillusioned cynic of the corruption and inequality in contemporary China. A very good and interesting read, and helpful in understanding contemporary China, what has changed, and what has not.
Today, we drive back to Ottawa. Fortunately, the timing dovetails with reading week, so we will have the kids with us in the car, more good family time.