May 19, 2019
Dr. Firestone replaced both my knees 15 months ago, and last week, I completed a three-day hike to the bottom of the Grand Canyon (and back up again)! I had exactly zero pain for the entire hike.
Before I met Dr. Firestone, two other orthopedic surgeons had told me that I needed to live in a house on one level (because I wouldn’t ever be able to go up and down stairs regularly) and that knee surgery would probably reduce the extreme pain I had, but would not restore functionality.
They told me that I would never hike again, and that I should delay having surgery until I had accepted this fact. They also said things like, “No one ever died of knee pain,” and “This is purely elective surgery.”
After Dr. Firestone operated, he noted that if I had not had the surgery when I did, I would probably have ended up permanently consigned to a wheelchair within two years, due to the deteriorated state of my knees.
Two days after I got out of the canyon, I hiked to… the top of Granite Mountain in Prescott, AZ, another 6 hours of hiking for me, round trip.
Even before Dr. Firestone operated, I was more impressed with him, his focus, and the protocols and arrangements he had put in place than I have been with any other doctor who has ever treated me.
Some of the reasons are:
1. He was the first doctor whose opening remarks to me were about the pain he realized I must be experiencing. He turned from the computer screen to meet my eyes and said, “You must be in so much pain!” (Other doctors typically focus on the technical issues – joint space narrowing, lack of cartilage – but not the impact of those issues on me and my life.)
2. He consistently looked at me when he was talking to me, rather than being focused solely on the computer screen. I felt that he actually saw me, not simply the case.
3. He quoted infection and readmission statistics to me, which no other doctor has ever done, and he contrasted national results to his (better) results, which was not only reassuring on the face of it, but indicated that he pays attention to the results that patients get – not just on what happens during surgery.
4. He had experience with patients with a comorbidity I have, and he described clearly why he expected me to get good results despite it. He was the first doctor to tell me why the comorbidity would not be an issue, instead of simply saying, “Don’t worry about it.”
5. He wanted to send me directly home instead of to rehab, for two reasons: infection rates in institutions can be troublesome, and people do better convalescing in their own homes. In my experience, doctors typically default to sending patients to rehab for a few weeks, and his approach and his reasons for it make more sense to me.
6. He also asked me, though, whether going home would be workable for me, instead of assuming either that it would or wouldn’t be.
7. In the initial consultation, as we talked about the challenges of having surgery on both knees at the same time, he remarked, “You’re tough. You can do this.” That was an unusual thing to say, and I was both amused and impressed that he was able to draw that conclusion so quickly. I am tough, and I did do this. But I’m still not sure how he knew that!
8. He has a spectacular nurse practitioner, part of whose job it is to answer questions for patients who are about to have surgery, a very practical arrangement, and the incumbent, Jeanette Jumawan, was very patient, generous of her time, knowledgeable, clear, thorough, and reassuring in answering my questions.
9. Jeanette’s answers were factual and informative. When I asked if I would be able to walk 150 feet when I first got home, she replied, “Our patients walk 300 feet before discharge. That is the distance from the patient’s room, around the nursing station, and back to the patient’s room.” Many practitioners would have answered by saying, “Oh, you should be able to walk a good distance.”
10. When I asked about the environment in the operating room – was there typically a lot of conversation? Or was music typically playing? Or was it quiet? – Jeanette seemed genuinely appalled at the idea that it could be anything but very quiet, with a complete focus on the job at hand. I was very happy to hear that the focus is on the patient, not on banter, music, etc.
11. When I asked about a protocol to reduce the odds of delirium, Jeanette answered the question and then commented, “You know, it has been a very long time since we had a patient develop delirium.” This was startling and welcome news. The national statistics on delirium in the hospital are very high, even outside the ICU – depending on the study, perhaps 20%-70% of patients develop delirium, and the long-term consequences can be horrific. The idea that this is an exceedingly rare experience among his patients was spectacular news.
12. Jeanette finished every conversation by saying, “If you have any more questions, call me,” rather than implying that she was too busy to take additional calls.
13. Jeanette was also very welcoming and inclusive when I arranged extra support for myself, such as a care manager and a massage therapist. This attitude can be rare, and I appreciate it.
14. Dr. Firestone sent out surveys to track before-and-after pain and functionality, which implies an interest in knowing if the intervention has improved the patient’s quality of life. In my experience, this focus is unusual. It is also highly significant to me.
15. The antiemetic he typically uses is listed as a good alternative to more common ones for people with one of the comorbidities I have. I was grateful to hear that.
16. He uses aspirin rather than other standard but more dangerous blood thinners, and I was very happy to hear this.
17. He talks to patients before they are put under. I have had experiences in th
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