Adding Insult To Injury; Painful OT

Several months ago my finger got injured and then infected during the height of he COVID-19 lockdown. It was the worst possible time to have a serious injury. X-rays showed that it developed septic arthritis in the PIP joint but they could not tell how serious the soft tissue damage was. My GP, hoping it would heal on its own had gone to doing telemedicine only tried to look at it as best as she could on video chat, prescribing several rounds of antibiotics.  She was afraid to send me to the ER even though that’s the usual procedure, because of my high risk of catching the Corona virus. When it remained swollen and was becoming stiff she then recommended I see a hand specialist. I was sent to the wrong place that as it turned out had no doctor on site, so I scheduled with a different clinic that sounded as though they knew what they were doing.

The first doctor blithely looked over my finger, then forced it closed, and said he didn’t think the tendon was fully severed but might be partially, and said when asked what he thought was causing it not to be able to bend “I’m not God, honey, I won’t know unless I open it up and it’s been 4 weeks so why not go to physical therapy for a month and then re-evaluate.” There was a huge lump on the top of my finger that looked like hypertrophy but it wasn’t, and that seemed to be what the obstruction was, at least in part. I followed his advice and set up twice a week appointments for hand therapy. I didn’t have alot of pain at that point, but I can’t say I saw much improvement. It just simply would not close no matter what I did. After about 2 weeks there was still alot of swelling. I noticed that when it was wrapped it went down but a little while after I took the wrapping off it puffed right back up again. The therapist who was working with me (I’ll call her E) noticed it too. Both of us had the growing feeling that something in there was still broken. I didn’t have alot of confidence in the first doctor, so I asked to be switched to another one who had really good reviews. He turned out to be great; had a good bedside manner, and also seemed technically good. He ordered an MRI and said there was alot of inflammation throughout the finger but he couldn’t really see clearly enough to see everything inside, so since physical therapy really wasn’t showing an improvement after several weeks he scheduled surgery.

First try ended up being a no-go. Being at an outpatient surgery center next to the office, the anesthesiologist got cold feet 5 minutes before I was to go into the OR because of my Dysautonomia. He said that they really didn’t have the equipment in case something went wrong, so said I’d have to have it done at the hospital.

Things here in Georgia were just starting to open back up, so all hospitals were requiring people scheduled for surgery to have a COVID test within 72 hours of their procedure. I had to have a friend from a distance away take me since medical transportation told me they don’t do drive-throughs.

The day of the test I thought, no problem. Easy-peasey. Just a swab in the nose and it’s all done. I had had swabs of my throat before and they weren’t too bad, but boy was I wrong! When we drove up through the testing station a man who was a doctor connected with Gwinnet Hospital dressed in a full Hazmat suit approached the car. “Which one of you is being tested? he asked. I told him it was me. He came around to the passenger’s side and told me to look up at the ceiling. He pulled out a long swab about a foot long, and stuck it up my nose and back towards the back of my head. It had to have gone in about 6 inches from what I could see. It felt like I had no skin in that area and almost as if he hit a raw nerve ending. It hurt like HELL! After counting to 5 he pulled it out. I thought he was done, but then pulled out another swab and took a sample from the other nostril. I felt as though I might faint. Things got swimmy and I got somewhat disoriented for a few minutes.

The day of surgery my aid and I arrived at the hospital in a van spewing fumes. It was one of the subcontractors arranged by the transportation broker. The hospital was pretty fast and got me into the back without much of a wait. There two nurses greeted me, asked me a bunch of medical history questions and one of them went to start an IV. I didn’t realize until she couldn’t find a vein that she was in training. At that point I can always tell because I never have problems with getting an IV in the first time if the person knows what they’re doing. She probably tried 2 times in some of the worst areas, then the senior nurse told her to use some lidocaine. That worked, saving my poor wrist and hand on the left side from further agony.

The surgeon was running late, but came in carrying what looked like mini trunks which I can only assume he used to carry his tools. I spoke with him about the procedure details and then the anesthesiologist. Because of my Autonomic Dysfunction they wanted to avoid putting me under general anesthesia but I did not want just a local because I didn’t think I could handle being conscious while my finger was being cut upon, so they did sedation. I was a little worried I’d wake up in the middle since that had happened when I had a colonoscopy at Emory, but luckily I stayed out the whole time and was not aware of anything until the operation was done and I was all stitched up. I awoke in the recovery room and they were transferring me back to the room where I had been prepped.

The surgeon came in and explained to me that he had found a tendon that was 50% severed, so in addition to removing the big lump of tissue on the top of my finger and scar tissue underneath, he had to sew up the tendon which had been engulfed in scar tissue and had been pulling it open further and further over time. Chances are the earlier physical therapy and exercises at home had just been fraying the edges more and more, so it was a good thing I had surgery when I did, as it might have eventually snapped completely, as tendons cannot heal on their own. Though my body did its damnedest to try all it did was result in a tangled mess of tissue that served only as an impedance.

It is 6 weeks now since my surgery and the splint came off last week. Overall OT has been going well; no problems… until last week. I had a rather jarring experience and have been researching what to do and came across an OT blog called My OT Spot about how OTs should handle when a patient refuses. In the blog post the writer gave examples of reasons why patients refuse a treatment. Having just come home from my appointment it struck me that she left out one very important reason…when the pain induced is intolerable. I’m posting this in my blog first since I think it’s fitting to my topic of horrors in the US healthcare system, but then posted it in her comment section.

Here it is below;

You left out one very important reason patients refuse; excruciating, intolerable pain. I go to a hand clinic for OT after having surgery to repair a 50% severed tendon in my index finger and to clean out scar tissue that was binding it up from being able to close. This clinic has several locations but only one has infrared, so I go to that one on Tuesdays, and the other on Thursdays. The therapist I see on Thursdays is very gentle and respectful, but the one at the other office is overly rough and impervious to when she’s going too far with something. Everybody knows it, too and half-joking; half serious talk about it while they’re in there! Last week she went to do the scar massage that is usually done with the hands, but instead pulled out this hard plastic tool and started digging really hard into the base of my finger and the knuckle on the palm. She was digging in HARD. This was not “uncomfortable”, “slightly painful”, “tender” , “sore” or anything like that. It was absolutely unbearable; I’m talking about 20 on the pain scale, no exaggeration! My whole body was trembling and retracting involuntarily and I started to lose consciousness. Only then did she stop. I left very shaken up, and thought, this can’t be legit. Either she must be badly trained or some sort of sadist. I left there saying to myself, never again.

Then she happened to show up at my other appointment as a floater to help out my other one and she must have charted something because the gentler one said to her she didn’t want me doing anything too aggressive. I thought that resolved it, but today she tried it again. I very clearly said “No, don’t use that. I can’t take it. Use your hands.” She kept arguing and insisting and actually said to me “It’s GOING to HAPPEN.” I have read the ethics standards for OTs and it clearly says they are not to force things on a patient. And I have read that they are not to coerce in addition. I felt like she really might fight me if I tried to leave the room. It’s hard to know what to say to something like that. I just explained to her rationally that it did not seem to be worth all that pain, as my finger got rock hard afterwards and felt bruised for days. She didn’t apologize for hurting me nor take any responsibility for trying another option, but instead acted like it had to be done and there was no other way. She was taking that drill sergeant stance you used as an example in your article. None of that was making me feel any more convinced nor at ease. I felt assaulted and cornered. She seemed to see it as a battle of wills when in fact it was not. I have not refused anything else they’ve asked me to do there but don’t want to injure myself further by subjecting myself to something that really has almost no studies proving it’s safe and effective and for which I was able to find no set standards of care. She was not able to tell me which protocol she was using (upon my later reading it appears to be either Graston or Gua Sha) nor offer any alternative ways to address scar tissue instead, and she could not really tell me how deep the internal part of the scar went that necessitated such drastic aggressive treatment. Her answer was that you can feel it when the thing goes over it. I asked her to show me with her fingers how deep it goes. When she did at less than 1/4 inch it seemed not so urgent after all for her to be in such a rush to go to these aggressive lengths. She tried to scare me further by telling me “it’s soft now but it will get hard, it can stick to and restrict your joint and you won’t be able to move it.” I am already having ultrasound and infrared and doing all sorts of exercises. It just struck me as very creepy just how hell bent she was to do this one thing, as if she was intent on doing it BECAUSE it was unbearably painful, not merely in spite of it. Now she is going to call my main one, “E” that I see on Thursday to try to coerce her to be more aggressive. Up until now I’ve had mostly good experiences with this clinic but I may have to find another one if she continues in this direction, as this really doesn’t sit well with me. Her only suggestion was to “just breathe through it.” You can’t breathe through that level of pain. My first thought is maybe she could apply at GITMO. I’m sure those people would talk after that, LOL.

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