Sorry for the break. The past two days have been busy, and (as I keep complaing) everything is so hard. Those of you who have had surgery know this, but this is my first real surgery since tonsils in Kindergarten (when they gave me a little tractor in the OR to get me to breathe gas, then after the operation ‘nobody could find it!)

Saturday we got up at 4:45 (as many of you do) to get to the airport on time for a wheelchair. I was pushed everywhere, which was nice… but it made me realize how helpless one is in these knew, auto-lock wheelchairs! Perry Mason would not have been able to wheel himself into court, and the image of being pushed? He wouldn’t have had a chance!!

The flight had one scary moment. Those cabins are slightly depressurized, I knew because reduces metal fatigue. I did NOT anticipate how much that could impact someone like me. I’ve now ‘run numbers’ and see the difference. Room air and air cabins consist of 21% oxygen. The rest is mostly nitrogen. On the ground, that is 21% of 760 mm HG, a unit of pressure– or about 160 mm HG (in medicine solids are usually measured in terms of weight, and gases in terms of pressure or partial pressure. We could get to actual number of molecules; older anesthesiologists used ‘Copper Kettles’ and my teachers made us go through the calculations from length of surgery, 2% ether, halothane or whatever, to number of molecules needed, molecular weight, and the volume of anesthetic needed to remove an appendix on a desert island having only the Copper Kettle machine. Just math once you know what the pathway is — like converting from number of boards to support a deck with so many people).

If you reduce cabin pressure 5%, the partial pressure of oxygen also falls. Even a 5% drop makes a big difference to someone.with marginal function, because adding hemoglobin adds a new dynamic. Hemoglobin stops absorbing oxygen very quickly as O2 falls below a pressure of about 150 mm HG. (hemoglobin developed that way so that it can dump oxygen in the body in the places where it is being used the most).

For me, the pressure of oxygen in a jet at 30,000 feet is where hemoglobin DUMPS oxygen. So when I walked to and from that ridiculously tiny lavatory, my ‘saturation’ —the percent of hemoglobin molecules saturated with oxygen — went to 73%. That means my muscles and brains must function with 25% less oxygen than normal. The pressure of oxygen imy My numbers are even worse because for whatever reason, my hemoglobin is ‘hanging on to’ less oxygen than the pulse-ox indicates.

I felt faint, cranked the oxygen, and it came up over 10 minutes. No biggie, but the numbers scared me. I’m realizing I didn’t explain the best way, but you get the point.

We couldn’t find the car charger for the oxygen generator and I was running out, so we stopped at an oasis over I 94 for an hour to recharge. Got into FDL in the early evening.

Yesterday I spent mostly sitting around. I have other ‘articles’ I’m writing for a range of reasons, mostly related to myself. It has been fun to think back and reconnect. My best friend in med school was BIll , now a radiologist in NY. He is a great guy who was subject to racism (he is Black) by the wealthy east-coast prep-school kids in my class. We never knew who, but people wrote things on his locker like ‘you smell! (he didn’t, and I’m not hard of smelling!), or ‘go back to Brooklyn!’ (which is now the hippest place on Earth and where my son lives). Oddly, we were both ‘under the knife’ almost to the day. We used to lift weights together (I hear you laughing) and he still works out. He tore his triceps tendon early this year, a very tough repair that requires months of immobilization…. then a L total hip replacement, and during my operation, a R total hip replacement. We haven’t talked for 4-5 yrs like many male ‘best friends’. But like my friend in FDL, he has been checking in on me every few days with encouragement and advice.

I fear you will all see difference in me. I certainly feel different, with a new appreciation for gazing out the window or talking with my kids. Going forward I plan some changes, in case something like this happens again… finally make the change to electronic prescribing for example. I also might free up Nancy a bit, as she is usually at least as busy as me, and that doesn’t feel fair to me. There are systems where people schedule themselves, if they put down a credit card for the cost of the appointment. Even besides that I have to say that I’m not poor, but I’m not wealthy either. Nancy and I make about what a couple of two teachers or two prison guards would make — and we don’t have the pension plan as they do.

What I am getting to is that we currently have lots of extra bills. And at the same time, my ability to see people takes a lot more out of me. So we would like to stop the business of extending credit for one or two months. We have always been ‘pay at the time of service’ and we are now asking people to actually do that — in ALL cases. I understand if people have to move on; I’m just not in the position I was in the past, and time out or the office — to rest or eventually play – has become more important.

This decison is probably a little easier after paying $800 to see my cardiologist and $800 for my new pulmonologist. Yes, they take my ‘HMO’ insurance — but I am left with $400 to pay on my own for each of them. My costs are not changing; just asking for it when we meet.

Thank you all so much for your support.

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