Chapter 7:

This Is Getting To Be A Real Pain In The Neck

The next step of my adventure led to an Eye and Ear Hospital at a local health system.  It was a teaching facility that is a well-known part of a local university.  I’ve developed the opinion that if you are a complicated patient, then the teaching setting is usually the best place for care.  This is for a couple of reasons.  First, resources are at an abundance.  Resources refers to equipment, clinicians, and time.   When you have an appointment at a University location you will assuredly first see a physician who is doing a fellowship.  They will be responsible for gathering information and presenting it to the teaching doctor.  They will discuss things, and then at this point the teaching physician will come in the room and repeat the examination process.  He or she will then give you their thoughts and plan of care.  Sometimes you will even be assessed by a Physician’s Assistant or Certified Registered Nurse Practitioner (CRNP).  You’re essentially getting double or triple the time with clinicians compared to a local independent community hospital or clinic.   That doesn’t necessarily mean that the community doctors are not good.  It just means that physicians practicing in a university setting have a lot of help, and it allows them to provide better care.  Moreover, many of the offices are equipped with diagnostic equipment and blood drawing capabilities.  Therefore, you get one stop shopping.  A lot of care can be provided in one location.  If the offices don’t have the equipment, then quite often they are located within a hospital or facility which does have the resources.  A second reason teaching facilities are better for complicated patients is experience.  Years ago, for the most part you picked your doctors by location.  You went to practitioners you were close to or could get to easily.  Today it’s a lot different.  Mainly because of the options available in two key areas.  Specialized physicians are much more available as well as transportation assistance to their offices. Many health systems have reached out to communities with the building of outpatient clinics and diagnostic centers.  The more complicated care is referred to the system’s hub at the teaching locations.  If you are a complicated case these are the people you want to help you.  They have vastly more experience with the more complex, less common cases.

I remember that my appointment was later in the morning on a Friday in early May.  This ended up being a marathon day.  The doctor was late, so it was at least an hour past my scheduled time when I got in the exam room.  A nurse took all my vital statistics, and then a fellow was the first provider to pay me a visit.  He took a detailed history and did a thorough examination.  I didn’t have a huge history, but the forehead was a rare occurrence, so it made things a little more involved.  The physician was next up to visit me.  After examining me, he told me to head to another floor of the facility where I would have a CT Scan.  I followed his instructions, and after about another hour wait I was getting the scan.  CT Scans are quite fast.  Even if you are receiving contrast material.  You do need an IV to introduce the dye, but overall its only like a 20-minute event from IV insertion to scan completion.  By the time I was finished and headed back up to the doctor’s office it was like 6:00 PM.  This is a perfect example of the advantage of the University setting.  All in one building you have the physician’s office, and all the needed diagnostic tools.  The ability to have testing done spur of the moment on a physician’s request is such a great advantage.  In this instance my doctor ordered the results “stat”, hence they were available to him immediately upon radiologist reading.  I was soon back in the exam room waiting for the results.  There was a lot of conversation with the doctor when he presented, but I vividly remember his comments as to what the swelling may be.  He remarked: “I think you’re a 41-year-old man with something in his neck that shouldn’t be there, and it needs to be removed.”  The list of things it could be was too big, and not enough information was known to narrow it down to a diagnosis of any type.  I inquired if a biopsy might be done.  He said if I wanted one he would certainly order it, but biopsies in this area still have a 25% chance of false negative results.  Because of this fact, he wasn’t going to put me through the aggravation of sticking a needle in my neck.  It was going to still be the same plan of care regardless of the results.  And that was going to be: excise the irregularity from my neck.  Therefore, I agreed to moving forward with surgery.  It was scheduled for about three weeks later which took me to very early June.

My boss wasn’t at all in favor of the surgery option at first.  The trunk of your main facial nerve exits your cervical vertebrae in the back base of your skull, passes by and below your ear, and through your parotid gland.  It then branches off in small arms feeding to all the different areas of your face, and making it function.  Her concern was that my facial nerve would be cut during surgery resulting in either temporary or permanent facial paralysis.  She was in favor of waiting a bit longer to see if the swelling dissipated in any way or presented other symptoms giving clue as to what might be causing it.  I totally understood her position, and I certainly was leery of having damage done to my facial nerve.  Over the ensuing few weeks we talked about this several times.  Eventually she conceded that because it was going to continue to be such a diagnostic problem, she agreed surgery had to be the best option.  It was comforting to have her approval going into this situation.  Especially because this was going to be a bit more complicated procedure than my previous year’s.  I was now heading into my second summer of dealing with head and neck surgery.   At least it was a short wait for the surgery date.

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