Middle-class in the age of COVID19

There has been a lot of talk lately about White privilege and its blinders, but I’d like to talk about Middle class privilege. In mid-March, the CEO of my employer sent home all employees not already working remotely. At the time, I found the move ridiculous and a little paranoid. I was barely following the COVID19 news. I barely follow the news. The news gives me anxiety at worst and bores me at best. And most of the time, I can do that without consequence—ignore it.

After we all got set up at home—we did that smoothly and efficiently, we’re a software company—I started paying attention to the news and got on board with social distancing, washing hands, wearing masks, limiting my time in public places. It was little skin off my nose to do these things; my livelihood put me behind a laptop in my guest bedroom/home office. And I’m a loner introvert at heart. I’m not squirming over an impacted social life. I joked a lot about the virus changing very little in my life except an annoying daily commute.

That worked just fine for a couple months. I worried about states lifting quarantine and the possibility that the CEO might invite us all back to the office, which I thought was unsafe. Turns out he was more interested in saving money on office leasing and expenses and decided that we should all be working from home from now on. My company was going 100% virtual. Because we could. He would also be giving us a small stipend to update our home office equipment. I could have skated through the COVID19 crisis with little more than a vitamin D deficiency.

Then something happened. Shortly after the decision to become 100% virtual, I tripped on a dumbbell in my bedroom (yeah, yeah, who’s the dumbbell?) and broke my wrist on the dominant hand. I did not like the idea of going to an emergency room during this virus crisis, but I went, and I ended up getting surgery on that wrist (a titanium plate) and having to spend the night at the hospital. That was where I had my first COVID19 test. I was released to go home with a doctor’s order for physical therapy which after one session at the clinic, I was able to do by Telehealth.

It wasn’t easy returning to a job that requires typing after that, but I managed with the help of voice transcription software. I would probably not be able to put together my new stand-up desk and articulating keyboard, but I could pay to get that done by somebody else. On Father’s Day, I went for a walk in the early afternoon down to the corner store. For someone who is now so careful about COVID-19 safety, I am dismayed to say I left home without a mask. Didn’t matter though; I never made it to the store. As I was exiting my neighborhood and stepping onto a slight rise in the grass, my right foot came down into a hole. The rest of me continued forward under the force of momentum and gravity. I toppled over. My left foot tried to catch my fall and was sprained. My right knee, which had a nine-month-old total knee replacement, was wrenched, and the femur fractured. I didn’t know this at the time and tried to stand up so I could hobble home. I fell over again.

So, I made my second call of 2020 to 911. This time, I asked to be taken to a different hospital than the first time because my personal physician had freaked out over my choice of hospitals when my wrist was broken. The emergency tech gave me a paper surgical mask to wear. The ER staff attempted to splint both my left ankle and my right knee in the emergency room. The left ankle was no problem; but my right leg was in such excruciating pain and undergoing muscle spasms, I screamed every time it was touched or a muscle flexed, as muscles are apt to do whenever you tense up or move. Somehow, the staff was able to give me an x-ray so an initial diagnosis could be made.

I was in the emergency room for several hours with no pain meds and only half the stabilization treatment I required. A friend was able to bring me my reading glasses and my phone charger so I could complete the insurance paperwork, but naturally, she was not allowed to come in and keep me company.

Finally, the staff moved me where they were taking all “stable” emergency room adults—to a wing of the children’s ward—not my final destination, just the emergency room overflow. There, I had to wait for hours to receive pain medication and a CAT scan. I remember my knee seizing up and twitching repeatedly, and every time it happened the pain was intolerable, and I would scream down the hall. Not just scream. Curse the nurses, who sounded to my ears as if they were having a coffee klatch. At one point, one of them was impelled to my room. By then, I was texting my personal physician demanding she help me find an alternative treatment location at 11 PM at night. I cannot begin to tell you how much this is not the kind of person I am. It was “the pain talking.” Pain, and an expectation about how emergency room treatment should proceed.

I paused in my texting and told the nurse in my best Karen voice that I was, “texting my doctor to get me out of here.” Then I asked him, “What kind of hospital is this?” He gritted his teeth with tested patience and answered, “a busy one.” Honestly, I had absolutely no idea that I had put myself in an emergency room when Arizona was spiking in its record-breaking second wave of COVID19 infections. Why should I know that? I don’t have to stay informed of, nor did I want to stay informed of, the news.

And just so you know, it’s not that the nurses didn’t want to help me; their hands were tied until a doctor signed off on anything: morphine, an immobilization splint, a CAT scan, a Tylenol. I texted my brother, grousing that I imagined the doctors somewhere playing poker until they deigned to write a prescription or put together a treatment plan. My brother, more informed than me, commented that the doctors probably had their hands full with COVID19 cases.

The first attempt to give me a CT scan—without which I could not get a treatment plan—was a disaster. There was no way I could lie flat or even be moved off my bed without screeching. I went to the hospital between 2:30 p.m. and 3 pm and finally got my CT scan at 1 am after the nurses got me a shot of dilaudid. I got a final hospital room assignment at about 3 am.

I am a chronic insomniac, and with the pain, I went 42 hours without sleep. And pretty much food. And water. Not due to neglect in the case of food and water; it was an open question whether I would need surgery. That’s the treatment plan I was waiting on. That decision came around 7 am Monday morning. No surgery. My left ankle was to be booted and… “Oh hey, this patient is supposed to have an immobilizing splint on her right leg.” “Yeah, we know. It’s lying over there.” By then, I was ready to bite the bullet and get that thing put on. To the man’s credit, he and the nurse got the splint on me with minimum pain. Him and the nurse and birthing labor breath techniques.

The next hurdle was the physical therapist’s evaluation to determine if I could go home. I got the home health option talked up to me, and it’s what I wanted—to be back in cozy, safe sheltering-in-place. The thought of a rehab place freaked me out: nursing homes, assisted living facilities, inpatient care in general—are under siege by COVID19. Rehab seemed a dicey proposition. Short version: my evaluation Tuesday night (yes, two days after admission) did not go well. I was told I could put 100% of my weight on my booted left foot, but with only one arm strong enough to handle transfer maneuvers, the typical low force “pirouette” on the weaker leg was a non-starter. I did some sort of one-legged shuffle while babbling in a panicked voice about how I didn’t know what to do (they’d instructed me; it just seemed none of their instructions applied). The physical therapist and nurse helped me transfer from the bed to a chair and from the chair to another chair. But from the therapist’s frown, I knew I wasn’t going home. She left me stranded in the chair with instructions to order and eat dinner (it takes the kitchen an hour to deliver any meal; this long sit, though, was going to be good practice for my next bed transfer, which involved nightmare constipation management).

With the therapist’s evaluation made, I simply had to await room at a rehabilitation facility. That would end up taking four additional days. So, a week of lying around doing little but healing and managing pain (and constipation from pain meds, ahem). The hospital did not give me any actual physical therapy until the day I was transferred, nearly a week after my second fall. I did wrist PT exercises, and a few of my knee PT exercises, but little else. Truthfully, my situation could have been a lot worse. I have insurance. I have sick leave. I could have been sent home with no treatment plan and no mobility and no housemates. Getting pissy because I was stuck in the hospital unable to work or recover optimally for five days while being waited on by gracious nurses is beyond entitled.

I stayed safe in the general hospital. I got my second COVID19 test of the year as a prerequisite for transfer to the rehabilitation hospital and it was negative. The hospitalist recommended intensive rehabilitation; soon after, a facility with top-notch care started wooing me. Two things were required to get transferred there: (1) pass a second COVID19 test, which I had, and (2) get insurance authorization. The day after my COVID19 test, the TopNotch Facility called to tell me my insurance had denied intensive rehabilitation. It was recommended that I try to get the hospitalist to do a peer-to-peer call to my insurance company’s doctors, but late on a Friday afternoon, that wasn’t going to happen.

Case management came in to see me on Saturday along with the hospitalist. We discussed my options at that time and what my insurance HAD authorized was a skilled nursing facility. I was moved to such a facility Saturday evening. My whole idea of rehabilitation hospitals is based on my elderly mother’s stays: private rooms, 4-star hotel clean corridors, meal menus. So, arriving at an hour after I’d usually be asleep, I had a meltdown when I discovered (a) I had to share a room with another patient, (b) the hallway smelled like kitty litter, (c) I was an average of twenty years younger than the other patients (the facility doctor even commented that I was “too young to be here” during our initial consultation), (d) they gave me tap water to drink (I actually made a face the first time I tasted it) and (e) institutional take-it-or-leave-it meals to eat, and (f) while being wheeled out for my weigh in, I saw an entire ward blocked off by a plastic barrier (I suppose it could be under construction?).

This reaction did not get me off on “the right foot” with the night-shift nurse’s aide. That first night, I had another insomniac all-nighter on a mattress that was hard as a rock and stabbed my call button over and over to get adjusted in the bed, to get pain meds, to use a bed pan. I was a high-maintenance whiner who had learned over the year to be the squeaky wheel that got the grease. This doesn’t go over well with overworked drudge gophers.

Over time, I have found ways to adjust to all the things I find initially hard to tolerate. Noise-cancelling headphones and ear plugs, an over-abundance of pillows to cradle my arthritic back and neck and healing bones, left over anti-bacterial spray from the first hospital aimed at my silverware, extra hard work on PT so I could transition from a bed pan to a porta-potty, my computer so I can do my day job or write.

But I have never won back the respect of that nurse’s aide. All of them seem to take an hour to respond to any call light (including Oh, hey! I’ve been sitting on this frigging bed pan since six pm!!), and no doubt it’s because they are overworked. I get it. I just got used to being spoiled in the observation ward of the hospital. As a result, now I work hard to thank each of the aides and nurses profusely for thankless tasks like emptying out my potty tank or bringing me coffee (which takes a special request). The other day, that first night nurse’s aide commented that she “was surprised I had not requested a private room.” My reaction was, “That’s a thing? I got the impression that wasn’t a thing here.” There was some passive-aggressiveness in her comment. She sees me now through the lens of that Obnoxious Karen in 35A. I don’t think I can change that perception, ever, because I’m still relatively helpless and depend on these aides to do trivial tasks for me. Please shut my door. Where are my meds. Refill my water bottle. Can you get my roommate to turn off Fox News and go to bed now?

And oh, by the way, I asked the billing department staff person about the private rooms since it had been mentioned to me. Turns out, they do have them here at this facility, and they are mostly using them to temporarily quarantine patients who transfer in without a verified negative COVID19 test. Jesus.

I am working hard in PT and OT so I can get out of here, but it is an eye-opener to see how I navigate my world from a point of privilege that has never been utterly invisible to me, but that I took for granted more often than I expressed gratitude for it.

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