Tuesday, June 27, 2006

The Second Opinion

When I first started writing this blog, I would write it after I got home from being with Robb in the hospital. I would be exhausted, and generally would have only the vaguest idea of what I was going to say. I would purge the experiences of the day, and then go to bed.

Then later, I had more time to reflect on what I was going to say. Some entries were the product of a lot of reflection. Some were more off the cuff.

Today, I'm at a bit of a loss for what to write.

It turns out that Highland Hospital, where Robb spent the first week, and where he visits his neurosurgeon, has not sent any of the records of Robb's follow-up care to the insurance company. Nothing from a doctor's visit, none of the xrays. (They have, however, continued to send bills to my HMO, and I get no fewer than three letters about that every week.)

So, because the insurance company is missing documentation of this aspect of Robb progress, they sent us to another physician for a second opinion. In this case, Robb was seen by a orthopedic surgeon in San Francisco. The insurance company needs some information from a doctor, regarding where Robb is in his recovery, and what an expected outcome might be.

We had a fairly long interview with the physician's assistant, and then the doctor met with us. Unlike most of the medical professionals we've met with so far, this doctor gave a pretty dire prognosis. He told Robb that, given the severity of his injury, Robb had better figure out what he was going to do with the rest of his life, because it was likely that he would be permanently disabled. He told Robb that he would have to "get over" his fatigue, and find the energy to create a new life. He also said that Robb would be under the care of a urologist for the rest of his life.

When he left the room, I looked at Robb and Linda our nurse case manager and said, "Well! That was blunt and harsh."

Robb and I both agree that we will accept whatever we end up with, but we both steadfastly believe that there can be a good outcome to all of this.

We have to believe that things will turn out well, and keep working toward that goal.


Anonymous said...

I think it's time for a third opintion.

Anonymous said...

Remember that an opinion is just that....an opinion. As I follow your blog, it sounds to me as though Robb is making remarkable progress. Keep your positive attitude and continue to push Robb to do all he can to and to regain his independence.

The flag bearer in all of this is Patrician Neal who had a massive stroke. The family was told she would never we able to walk, talk, or do anything "normal". She did all of that and returned to stage and film!!!!! A big streak of stubbornness can be a wonderful thing.

Gothknits said...

I'm astonished! Some doctors don't have any faith in the human spirit. What you both have accomplished since the beginning is evidence of what can happen. Don't let him get you down and have faith in each other if nothing else.
you know just because you can pass medical school doesn't mean you are a good doctor. Sheesh someone needed a class or two in bedside manner.

Gramatrick said...

I strongly believe that there can be a better outcome--after all, look how much incredible progress Robb has made! This doctor is lacking the original records, so he cannot see how much improvement Robb has already accomplished. He also doesn't know Robb and his will and strength, plus the amazing support team he has. I feel that he will continue to make great strides.

However, it's okay to to consider part of what the doctor said, while continuing to strive towards independence. The accident may be an opportunity for Robb to explore possible new paths, including a career change. I, for one, think he should enroll in the superhero training academy immediately. He already has part of the gear, and someone can knit him up a cape in no time. Now, what should be his alter-ego's catchy name?

--Laura (Dewberry)

MoonBunny said...

Wow, nothing like a dose of "worst case scenario" to liven things up.

I don't doubt that you both are aware of and have discussed the more dire possibilities. But to be prepared for the worst - and to expect the worse - are two different things.

You have a group of medical professionals you have worked with for over six months, watching your progress and helping your recovery along. And then you have one doctor whose office spent maybe a couple of hours with you, with incomplete records. I don't need to tell you whose opinion has more weight.

Anonymous said...

Well, Lisa and Robb-

It's not like the guy told you anything you didn't already sort of fear in the dark parts of your mind in the middle of the night. Now that "this part of the event" is spoken out loud, you can move past it.

Look at it this way- Robb didn't break his neck, he's not stuck in a bed for the rest of his life, and he's not a vegetable. Apparently he's also learned how to cook. Not Bad!

Things look up when ever even small advances are made. You have a choice- you can look at what he was like at the time of the accident, and see how far he's come- and continue to hope for the best. You MUST NOT loose hope. Robb was probably one of 40 patients the burned out Doc saw that day. That doc has got to learn more about balancing reality with possibility. My old Johns Hopkins Med student housemates used to tell me that as well. Reality in Robb's case shows him slowly advancing, right? He can feel his feet now, right?

If Scientists can fix the back of a crappy lab rodent, they can certainly fix the back of someone who doesn't lick his own ass as part of a sanitary act. That's my opinion on it, and I'm not stupid.

Be glad your "Govern-ator" has the stones to continue stem-cell research as well. If you guys had to suffer an injury like this in your life, your in the right state for it.

Stick with your regular care givers if at all possible, and also investigate just "good thinking" people as well. The power of the mind is incredible. In many ways, now is the toughest time, needing to rest and repair. Patience is a virtue. Keep up with the outdoor walks- even nature destroyed by a violent act recovers in time, and we are all a part of nature. It's not like you guys are fat, overweight, cocaine swilling, cigarette smokers either.

Also, what if Robb doesnt heal 100 percent back to what he was before? It's not like he's completely "lost" and joined some weirdo cult, or something like that - you've still got him, and he's still got you, and that puts you guys way ahead of many, many other people in this world.

My thoughts are with you- Annalisa

Robb said...

Thank you all for your reassuring comments.

In truth, I was not so rattled by this office visit. As Laura pointed out, the opinion was rendered without reference to all the records. Also, I think this Dr. felt obliged to give a conservative estimation (for a variety of reasons).

On the other hand, he was the first health pro I've talked to to tell me what I've known all along, I need to plan for major career shift.

On the drive home, Lisa and I found ourselves in complete and comforting agreement about the prognosis:

We can accept my condition as it is today but fully expect that I will be as good as new.

Love and thanks to you all.

shiloh said...

There is always the possibility that the Doc was giving an opinion for the insurance co. so that they could say "Well since your not going to get any better we don't have to pay anymore." Get a thinrd opinion,hopefully with you current records. You should be able to get them yourself.

Anonymous said...

Well...Look at it optomistically... actually, there is some financial security here. The opinion is that you can qualify for disability...so the cash (as reduced as it is) keeps coming in. And... there is great potential for THEM to pay for your preparation for a new career.

So, take what you can get out of it. Then, in the end, when you have a new career... and you have been healing and improving all along... you can stride right back into the jerk's office and say...Here's my opinion!!!


Anonymous said...

as one who has toiled for more than 49 years in the legal market place, I have found that any MD who is has fallen into the disgraceful netherland of doing workups for insurance companies, is either close to complete burnout, on the verge of having his Md tag being pulled or has been digging too deep into his closet of drug goodies.

Derek said...
This comment has been removed by a blog administrator.
Derek said...

Well, I think the responses above me speak the speach that I have in mind, but I think you should give this web link a look (and a listen).


I am not sure if you ever listen to this show, but this past Sunday host Krista Tippett interviewed Cardiovascular surgeon Dr. Mehmet Oz. This is a man who made his mark in the realms of science and technology, but now endorses alternative forms of healing. I found his attitude refreshing and compelling.

Robb and Lisa, the doctor who spoke to you doesn't KNOW either of you. If he did, he'd have to reconsider his diagnosis. You're both too determined to be limited by Robb's injuries. Your spirits are remarkable. No third, fourth, or twentieth opinion could ever be valid if the doctor doesn't consider your determination and desire to get better.

As Willie Nelson once said, “My doctor tells me I should start slowing it down -- but there are more old drunks than there are old doctors so let's all have another round.”

Some doctors only speak the language of xrays and lab reports. That's not enough. They need to speak the language of spirit.

To see a world in a grain of sand,
And a heaven in a wild flower,
Hold infinity in the palm of your hand,
And eternity in an hour.

-William Blake

I am thinking of both of you.


Eclipse said...

I've been through some pretty major medical trauma in my life. I've seen a lot of doctors and had a lot of opinions. I was, not so long ago, at a point when I wasn't sure if I'd ever be able to walk unassisted again. Going through all of this, with doctors cold and warm, taught me one important thing: a doctor may be able to shed light on your situation and give you a professional opinion on your prognosis, but ultimately it's nothing more than that - an opinion. The human body is astounding it its ability to recover and adapt - and you have already overcome any limitations potentially put upon you by doubtful doctors or even yourselves. As in all other of life's endeavors, the bigger you dream, the more you will achieve. Your bravery and strength is nothing short of heroic, and you have come so far that I have no doubt that Robb's recovery will continue to amaze. You have nowhere to go but up!


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