by Robert A. Duke

1. Learn the name or brand of the device to be implanted so you can search for its success rate and its recall history. I discovered devices similar to my fusion spacers were available from Taiwan packed in bulk for mere pennies per piece.

2. Get the all of costs of the device or implant. Titanium plates and screws, and a squirt of collagen to assist with fusion shouldn’t be expensive, but how much is labor (surgeon), parts (device) and facilities (hospital)? Costs should be itemized.

3. Surgery is a team effort, so from the first appointment to discharge ask for everyone’s name along the way. Someone is bound to ask, “Who said that?” and later you might wish to talk to a team member whose name you’ve forgotten.

4. Find out whether you can get your medications from a retail pharmacy instead of the hospital. The $5 Tylenol tablet hasn’t completely disappeared from hospital administered medication yet.

5. However, in recovery accept any medications you are offered when offered. It can take a half-hour to get that Tylenol tablet on demand (when it may be worth the $5). Worry about cost when you feel better.

6. If you are an oversized person, ask to have your bed modified. I’m 6’4,” and it takes building maintenance staff to lengthen my hospital bed. Nurses don’t have the tools.

7. Determine whether your hospital status is inpatient or outpatient. Just because you are in the hospital doesn’t mean you are an “inpatient.” Sometimes it’s trickier than in or out. Medicare said of my procedure, “Patient must spend two midnights in the hospital in order to have his surgery covered.” My surgeon swore he had an exemption, and I gambled that he did.

8. Find out the business relationship of your surgeon to the hospital. Some times it’s complicated with two or three sets of bills, but to you it was all one procedure. Also, your surgeon may have a business relationship with the device manufacturer that’s required to be disclosed to patients. It may be innocent, or maybe he’s getting a kickback on each device that’s implanted.

9. I got a referral to my orthopedic surgeon from an ER doctor, but the surgeon’s practice manager wanted me to switch surgeons, and I wouldn’t agree. Statistically, half of all doctors are below average, but they are all qualified, yet some are better than others. A doctor-to-doctor referral is too valuable to give up.

10. My cervical spine surgery was performed anteriorly, from the front, by moving my esophagus out of the way. My surgeon ordered a low residue diet as a precaution against swallowing difficulties, but the dietician sent me crispy bacon for breakfast. I choked when I couldn’t swallow it, because I had no problem swallowing water after surgery. So make sure you know all of your post surgical restrictions.
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Robert A. Duke is author of “Waking Up Dying: Caregiving When There Is No Tomorrow,” he lives in Bellingham. His email: boshduke@gmail.com