This is one of the most bizarre but true statements you are likely to read all year. I had a good time getting my bilateral hip replacement, thanks to the top to bottom excellent and attentive care at the Hospital for Special Surgery. After so many years of dealing with crapification in pretty much every avenue of life, it was almost a shock to encounter an institution that functions at a consistent high level.
And I have to say it is depressing to compare my experience with that of my mother at St. Vincent’s in Birmingham, where an excellent ER is paired with a mediocre hospital. Nurses see my mother only once a shift. Her aide had to change her diapers. I’ve only gotten one call from the doctor as to what is up with her. The neurological eval and shoulder imaging preliminary to a cortisone shot have yet to happen. The nurse on duty lied about her occupational therapy session, which may reflect inaccurate reporting by the occupational therapist (the nurse said my mother had no shoulder pain when working with the OT; both the aide who was present and my mother said she complained).
For those of you who have not heard of it, New York City’s Hospital for Special Surgery performs only orthopedic procedures and defines its mission as treating musculoskeletal ailments. It has been rated #1 in the US for the past 11 years for orthopedics. It is also the only hospital in New York State to have received the Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times.1
The Hospital for Special Surgery performs more hip and knee replacements than any other US hospital. As a academic medical center, it has regularly developed improved techniques that have become industry norms. For instance, the Hospital for Special Surgery pioneered the use of epidurals (as opposed to general anesthesia) for hip replacements. It does not have an emergency room, but I was told it will from time to time receive patients from other hospitals who need advanced orthopedic interventions once they have been stabilized.
I had been putting off the procedure as long as possible, as in 3 1/2 years after a fall so hard that had I not been weight training for 30 years, I would have broken a bone or two. For the first nearly 3 years, I could still function adequately and was unduly optimistic that there might be a solution other than an operation. I was also resistant to surgery because I had developed a significant functional leg length difference (the damaged leg perversely was longer, to the degree that I had a significant limp). Hip replacements are normally very successful, but the number one reason for a redo in the first year is a leg leg difference. I wasn’t happy that the doctors I had seen were fixated on the lousy and worsening condition of my hip and weren’t interested in looking at what was creating the leg leg difference, which could not be just the busted hip (deteriorating hips if anything produce leg shortening, not apparent lengthening). If they weren’t willing to look at the whole picture, how could I have any confidence they’d get the leg length difference right?
I wound up at the Hospital for Special Surgery via Michael M. Thomas, who was a second generation Lehman partner at the time of his exodus in the early 1970s. Thomas has a resume that it would take most accomplished individuals several lifetimes to accumulate, such as having written nine novels. I first learned about Thomas through his acerbic and astute New York Observer column, Midas Watch. From the start of an archival piece:
One reason I love the Yale alumni magazine is that each new issue provides another compelling reason for any alumna or alumnus with a particle of common sense not to give a dime to Dear Old Eli.
I was chuffed in the early days of the site to learn Thomas was a reader and even more so when he invited me to lunch. We continued to lunch about once a year. Thomas is a great raconteur and knows where far too many elite bodies are buried.
Thomas referred me to Dr. Vijay Vad, who specializes in non and minimally invasive procedures and had helped Thomas a great deal many years ago when he’d had severe back pain that had stymied other specialists. Dr. Vad was willing to treat my hip and likely slowed its decay. But from our first session, he insisted I’d need a hip replacement in one to three years, which was not what I wanted to hear.
At the start of this year, Dr. Vad gave me two surgeon names, which I ignored. When I returned in March, Dr. Vad pressed me on the need to get my hip done in 2021. I sputtered that I had a leg length difference, no one seemed to be taking it seriously and I wasn’t about to get an operation unless I was confident the surgeon had sorted out how to address that.
Dr. Vad said, “You need to see the robot guys” and gave me two different names. Around this time, I had also gotten two referrals from IM Doc, one at UCSF, the other at Stanford. The idea of trekking around the West Coast, when every flight seemed to diminish my hip function, seemed daunting.
I called the first of Dr. Vad’s names. The conversation with the assistant, this on a day when I was aware of being uncharacteristically measured, got bizarrely confrontational when she refused to believe my insurance worked the way it did . She then made up some nonsensical reasons for not wanting to accept payment at the time of service before falling back on “The doctor doesn’t want to do it that way.” That might even have been true, so why not start with that?
Since there are politer ways to say no, even an arbitrary-seeming no, I decided I didn’t want to see a surgeon who thought it was OK to deal with patients the way she had.
I then called the office of Dr. Seth Jerabek. His assistant also went a bit on tilt over my insurance but got over that quickly enough.
When I saw Dr. Jerabek in April, I started out by saying “I assume you have some sort of speech you give.”
He said, “Not really. I’m one of the guys here who does difficult cases.”
I wondered if that included difficult personalities.
I explained what I understood about my situation (he’d already gotten an MRI and a fresh X-ray) and had him look at my walk. At that point the other hip was getting noisy and unhappy too, so I suggested doing Bad Hip 1 first, seeing how my gait changed, and then making any leg length adjustment on Bad Hip 2.
He said, “That’s what I would have recommended.”
I gave him a list of questions that he answered.
He then showed me a full body X-ray, front and profile, of a man whose hip he had done recently. He said he measured everything before deciding what exactly to do.
I walked out having decided the surgeons on the West Coast might be different but were not likely to be all in better and I really was not keen about running all over the US. So I booked the procedure and went to New York for the pre-op. That was the weakest point of the experience with the Hospital for Special Surgery; I ran into some bureaucratic issues. But the doctors and techs were good. The internist I saw, Dr. Hollomon, who later visited me most days in the hospital after the surgery, gave me a partial waiver from the usual “No dietary supplements for two weeks before the surgery” and let me continue with ones that didn’t affect clotting. 2
As Bad Hip 2 deteriorated rapidly, I became more and more worried about how I could rehab without a “good” leg. I sent detailed e-mails. Dr. Jerabek called me several times to discuss further, which was surprising in a good way (as a friend said, “A doctor who talks to patients?”).
We traded calls the week after Labor Day and connected that Thursday after work NYC time. We made a battlefield decision to do a bilateral hip replacement. Mind you, the procedure was scheduled for the following Tuesday!
I was set to see him the day before the surgery (this was not typical; I had initially booked the time to discuss how to rehab with a not very functional “good” leg). Dr. Jerabek put up an X-ray of my hips. He explained that they normally use cementless replacements on patients under 50, cemented for patients over 70, and for patients in between, “It depends”. He said he’d tried modeling 100 cementless replacements for me and none of them fit. I gathered it wasn’t the ball and socket part so much as the top of the femur. He said he could modify a cemented one. It would be different than what I had but he thought it wouldn’t be hard for me to adapt. He suggested that that that abnormality might have played a role in my hip deterioration.
The hospital offered to call someone to let them know when I got out of surgery. This was more information than my mother needed, so I had them call a local friend who planned to and did help me a great deal while I was recovering. She was stunned that Dr. Jerabek spent ten minutes on the phone. She’d researched hip replacement (as in the devices) and they had a deep and meaningful conversation.
After the surgery I got a similar very high level of attention. I splurged for a private room which was mainly glass on two sides with views of the East River. Even though I was at the end of a corridor, away from the nurses’ station, the floors aren’t that large. The nurses normally came in less than 2 minutes of being called; the very worst was closer to ten minutes at shift change time. They were very good natured even about stupid things like having dropped my cell phone on the floor or getting me hot packs often during the night (my back was pretty bound up the first few nights). I was a bit of a dope and didn’t realize until part way through my stay that the Hospital for Special Surgery had been turned into a Covid hospital like all the others. When the nurses had a bit more time with me, like minding me when I walked up and down the corridor, I asked them about it. They lost one staffer and one patient. It was still a bit traumatizing for some of them to talk about it. I wish I could remember all their names to thank them personally.
You also get to pick your food. I had opted for gluten free as the closest approximation to no starches. My first morning, after having gotten into my room at 1 AM by virtue of being released from the recovery room way ahead of the normal schedule, I did get a lot of stuff (including their very good coffee) but not anything I wanted (cereals, gah, sweetened yogurt, gah) except a little fresh fruit. I grumbled to the nurse. She ran down the food cart and got me a couple of hard boiled eggs, which made me happy.
Later that morning, a live human being came in with a lunch and dinner menu. 15 entrees. 3 appetizers. 6 vegetables. 3 desserts. Some bread type options. Even though the food was closer to institutional that gourmet, getting to pick what you want makes a big difference. She also took my breakfast order. And a live human came every day to take the food choices.
Rather than seeing the stereotypical cavalcade of anonymous doctors, I’d have a doctor check on me 2 or 3 times a day, one a member of Dr. Jerabek’s team, usually very early, later Dr. Jerabek, and in the first couple of days, Dr. Hollomon.
Remarkably, the anesthesiologist also came by to explain what had happened. I had wanted not to be put into twilight sleep until I had decided I’d had enough (either unpleasantness or boredom). I woke up in the recovery room complaining about having been put under. I was told then “You tried helping Dr. Jerabek. He didn’t need help.”
The full explanation from the anesthesiologist was that I’d had trouble with the position they put you in (Dr. Jerabek had warned me that might bug me) and they’d had to use the twilight sleep a few times at certain junctures. When I came back to each time, I beefed. Mind you, I have no memory of this. It was Dr. Jerabek who said I finally started hyperventilating so they had to knock me out. But the anesthesiologist stopped by, as if to apologize, when I’d been the bad actor!
The social worker was tearing her hair over arranging for physical therapy for me in Alabama and at the rehab hotel until she understood that my oddball insurance made it easier. Luckily I got through to a fellow Yankee at one of the home health care agencies here and she got it sorted.
The physical therapists were also very skilled. I would see them twice a day, usually led by Hi-Chan. I was discharged to a rehab hotel owned by the Hospital for Special Surgery (Dr. Jerabek’s surgical assistant Denise leaned on the staff to wheel me across the bridge connecting the two buildings) and the handoff to my friends went like clockwork. There, Marc Friedman would see me for an hour a day and put me through my paces and then sent a list of exercises for me to do on my own. He also gave me the name of an excellent and inexpensive omakase restaurant at about a 4 minute unimpaired person walking distance, and gave me permission to go there with an escort. I went with my friend NT and we had a great time.
Finally, even the housekeeper was with the program. I got a much nicer room than I needed because it was the last one left, but the bathroom wasn’t set up for handicapped people. The housekeeper came in, saw me standing in a walker, and said “Hip replacement?” When I said yes, she came back with a heavy chair with a high and well padded seat, and then fetched a ton of ice bags and warned me about the treacherous shower, to not use it or be super careful.
Finally, reader jr, formerly of the West Village, now of Williamsburg, came by for lunch and then the next day graciously supervised my packing and helped get me into a car.
I am sure I missed some people and I hope you aren’t offended. Everyone at the Hospital for Special Surgery did a great job with my surgery and I am very grateful.
Dr. Jerabek’s short video also cites the excellence of the Hospital for Special Services. I didn’t believe it when I first saw it. Now I do.
_____
1 The award is valid for four years, so the Hospital for Special Surgery has held this recognition since 2002.
2 I had walked into that session prepared, including the half lives of all the stuff I took. But I didn’t have to negotiate. Dr. Hollomon was sensible.
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This is wonderful, Yves. Thank you for sharing these details. Did you say in another post that they don’t accept Medicare? That would be their one draw-back.
Actually that was intel from a friend which appears to be inaccurate. The hospital site says they do:
https://www.hss.edu/radiology-imaging-accepted-insurance.asp
Some doctors at HSS like Dr. Vad do not. A lot of what Dr. Vad does is seen as experimental so my insurance paid for the office visit part but not the treatment part.
I don’t recall signing a Medicare waiver for Dr. Jerabek.
!! That’s great news, Thanks for the update. Since Hip Replacements are so necessary in the 65+ patients, not being able to use Medicare would be a challenge.
I had a similar experience with Medicare when I got Cataract surgery. I got lenses that they didn’t think were necessary so I had to pay the difference myself.
What they don’t accept (at least as of 2019) is Medicare Advantage. I had to switch from Medicare Advantage to regular Medicaid Supplemental insurance in order to see the surgeon who did a knee replacement there several years ago.
Most Medicare Advantage plans are HMOs…..so this is not a surprise.
Glad and grateful all went so well, and that you’re continuing to do well. Keeping your mother in my thoughts.
You were lucky to find the right doctor. It makes all the difference. What physical restrictions, if any, do you have going forward? What does it feel like physically to have the two new hips? Will they last a lifetime?
That’s a great result that with a winning combination. A great hospital, excellent doctors & nurses and a bunch of good friends willing to go the extra mile. When you compare that with the experiences of so many people here that found themselves caught up in a medical sh*tstorm, you kinda breath a sigh of relief. Give a few weeks more and our Yves will probably give us a report how she is taking up tap-dancing. And I am sure that that hospital is chuffed to see themselves get a good write up to for their good work.
Not clear on the cause of the leg lengthening of Leg 2- indirect result, somehow, of the femur malformation
(my word)?
No, it was an asymptomatic lower back injury that I incurred at the same time I fell and messed up my hip. Not serious but enough for me to exaggerate a compensation pattern I already had.
I had a functional leg length difference for a while. It wasn’t because the bones were different lengths, but because the hip joint socket was lower on one side than the other (i.e., my pelvis was misaligned). The consequence was that I would stand with most of my weight on one leg, and the other one slightly bent at the knee, without realizing it.
You can’t make bones longer or shorter with exercise (I think) but you can realign your pelvis to move your hip joints up or down relative to each other, which is functionally very similar.
Yves, I had much the same experience with a Kidney Transplant at UPenn’s Transplant Institute. Yes, the first few days were excruciating. It is a big incision. But that was made up for by the Doctors (Amazing) and Nursing Staff (just as amazing). I got there by a recommendation of a local Long Island Nephrologist. It is a gift to experience what medical care should be.
Congratulations on your successful and good experience with your surgery. Here’s hoping your rehab is just as pleasant.
I second the congratulations!
I have too little experience with hospitals from either end, so I just wish that everyone who needs it gets as high quality care as yours seem to be.
Hope that your rehabilitation goes even better, Yves!
I had a heart attack. cardiac cath, ultrasound, MRI, EKG, 3 stents, and god knows what else a couple of months ago, and also have nothing but good to say about my experience. The heart attack was diagnosed early (by me, when I felt unusual pains) and after only 4 days in the hospital I was released with no permanent damage as far as anyone knows.
As I’ve said before, my mothers 3 hip replacements (one didn’t take) worked wonderfully and gave her 15 year more of active life,
The relevance of all this is that I used to be someone who sneered at high tech medicine , and I just can’t do that any more.
I should add that my father knew my mother would outlive him and spent the last 5 or 10 years of his life making sure my mom had great insurance. She also lived in Minnesota, where public health has not been starved and where she got very helpful home visits both after her surgeries and during her last year when she received excellent palliative care.
To ramble on, I think that there’s an enormous amount of great medicine on this country, but it’s very unevenly distributed, to put it mildly, and. a big chunk of the population sees almost none of it.
@ John Emerson,10:22 am.
Illustrating “a big chunk of the population sees almost none of it”: According to Pollin et al. of the University of Massachusetts 8.8% of the US population has no insurance coverage at all and 26% has inadequate coverage meaning they can’t actually access the care they are supposedly covered for due to prohibitively high cost. So in total 34.8% of U-ians have no access to health care.
Source: Pollin, et al., ”Economic Analysis of Medicare for All”, November 30, 2018. Political Economy Research Institute. University of Massachusetts, Amherst.
I had a great time Yves, thanks again for lunch. I’m glad to hear your recovery continues apace!
And why does this sound characteristic?
I was told then “You tried helping Dr. Jerabek. He didn’t need help.”
But what I recalled was one of the dinners at D4 in Chicago when you ordered a dessert and passed it around during a meetup as we were all discussing economic and social affairs. In short: Generosity and insight. (Dr. Jerabek may not see it quite that way, but he’ll come around.)
Your description of your treatment reminds me of some blog posts and articles about how Americans experience medical care in France. All of us can have this level of service all the time–but we have to get the skimmers and nonmedical types out of the system. Let nurses run the hospitals. Let’s stop pretending that this level of care for all is unattainable.
You are being polite, as was the staff. I think the “helping” was intruding.
Dr. Jerabek had agreed to my staying awake provided I didn’t speak to him: “I need to concentrate. You can talk to the anesthesiologist.” He did consent to narrating the surgery. So it looks like a broke the deal and was distracting Dr. Jerabek.
> All of us can have this level of service all the time
Hospitals should be the medical equivalent of the Moscow subway system: Palaces for the people.
We’re a long way from that.
Yves, great post! Glad you had a positive experience. (Hospitals do have competent and caring staff–if the CEO will advance care first and compensation second.
From the narrative it is clear you’re a novelist at heart. Exploring characters (including self) is the challenge of the novel. Love the tenacity and the demand for excellence in yourself and others. Happy to have you back!
It is good to hear that your situation was handled well and that you are now in recovery.
The problems with geriatric care that have plagued your mother are a sorry indication of the many problems affecting the overall medical situation in the US. I wish that the euphemism “healthcare” would be replaced with the more correct term “medical care.” Health care is up to me, medical care is what is done to me to keep me alive and kicking.
My right hip replacement was a piece of cake. I had pre-operative physical therapy (water walking for 2 months), an epidural, (I actually wanted to be awake as I was for my cataract surgery enjoying chatting with the ophthalmologist, but they wouldn’t let me), and anterior entry. They sawed of my femur, pounded in the rod that had the ball into the marrow of my leg (at a perfect length), and polished and glued in the new cup.
I was out of bed and walking on the following morning, using a walker on the second morning and returned home on the third. No pain meds after waking up, and happy now 8 years later. I’m 83 and a great patient, happy with all the various medical interventions in my life: mumps followed by meningitis followed by acute appendicis at age 20 while in my junior year, ruptured disc repair, cataract surgery, and a variety of teeth issues resulting in posts and removal (using a jackhammer) of my wisdom teeth.
I love local anesthestics.
What a wonderful story! Thanks for sharing it with us.
Yves, I’m so glad this went so well. It seemed like you were really needing to catch a break recently(as in having something go well). I was laughing out loud about you trying to help the doctor. That was brilliant. Sending good thoughts for the rest of your recovery, and for your Mom. All the best.
Yves!! So happy you have your hips successfully treated and it was such a positive experience (I declare from an area of California that has some of the worst medical care in the country…)! I’ve no doubt you will make a full recovery!
I have a significant other with a complex totally cracked up shoulder that has a previously completely fractured humerus to boot. (Dominant arm, of course.) Has been told there’s zero chance of anything. No shoulder replacement, zip. I’m wondering if Dr Jerebek would see him?
That said, thank you for your informative reporting sharing your experience. I sincerely wish you and your mom nothing but smooth sailing from here out. Hip hip hooray! (Pun intended…)
Ex-employee here.
Now you understand you were at the Billionaire’s hospital right. The David Koch entrance, etc. It has been billionaire supported since the beginning, a lot of Rockefeller, Vanderbilt and other NYC blue blood monies in there. Actually the hospital has quite a history. Started with Dr. Knight circa 1862 picking up disabled homeless kids and taking care of them. The logo in the lab coat patches says – The New York Society for the Care of the Ruptures and Crippled Maintaing the Hospital for Special Surgery “. The word medical resident comes from there, as Dr. Knight required staff physicians to live in. They do a lot difficult little people, pediatric, and adult scoliosis and complex orthopedic situation.
That may all be true but I asked to look at the fanciest private room (one was empty on my floor). By all accounts from friends who know other hospitals, it was vastly less plush that the big ticket private rooms at Columbia Presbyterian (and don’t get started on hospitals that already cater to the well off, like Cedars Sinai). And I don’t see how a rich patient could have gotten any better care than I did.
there seems to be local providers that actually help patients.
then there are others (we moved to Tucson this year back in May, up until today, we have been trying to get appointments with an electrophysiologist, but we first asked for that several weeks ago, didnt have luck till today..but it isnt till the end of August). but watch out for the billing department at the hospitals (short story i had a very minor procedure back in March ….and my wife asked 4-6 times how much our part would be. they told here every time it was $1800.66, but we got an EOB with about $5200 more . my wife was talking to the billing department, when she mentioned surprise billing, which seems to have sent the billing department back to the drawing board). on that EOB we were extremely surprised by the total cost, it was over $70,000. was estimated to be about $18,000 or so.
oh and we had no choice on where the procedure, it had to be at the hospital
needless to say this is a bad situation
course it is from a known bad actor in the hospital industry
Welcome to “health care” in Tucson. I keep myself healthy just so I can avoid it.
Happy to hear everything went so well for you Yves. All the best for your continuing recovery. And all the best for your mother.
Yves, so glad to understand the trajectory to your successful recovery but a continued dismay for your mother.
In the late eighties into the mid nineties I helped my mother care for my father. In the late seventies he had learned that his increased distress was due to MS. In early 1988 he had a stroke and that was the proverbial straw. That was when I joined in earnest for his home care. My mom was petite and would have done herself in with attempting to care for him. I was a relatively large and strong woman (not that large actually, I’m a size 10), but his height actually, and weight, though in his diminished state. My mom and I managed for seven years with the addition of aids when I worked as a musician. I had to literally pick him up a number of times. In the end, I had torn something in my hip (it reoccured for years). By this time my mom was worn out and in a wheelchair herself. My sister from CA visited (an actual nurse). We took him to the ER where the sores I had been tending to were understood to be late stage decubitus ulcers. These had been pointed to but ignored by his previous doctor. My dad shuttled between the hospitals and two medicare facilities for the four months until his last six weeks at home, then to be in hospice. I had some help from aids, but none would come in the middle of the night when I needed to turn him every two hours.. Essentially I played a round the clock nurse. Until he passed, in his own bed at home. After that I cared for my mom for another seven years, though she was a piece of cake compared to my dad. She was easy. She couldn’t drive. I shopped, I made our food. I did the chores, well sort of. I took her regularly to her doctors. I had aides when it seemed essential. The last three days she went down quickly. In the last moments I picked her up (never minding my hip), put her in my car and drove the five miles to the ER at forty mph over the speed limit. It was too late. I am confident to this day that an ambulance would not have arrived at our front door before I arrived at the ER.
Pip-Pip!
I am more of a lurker since economics/capitalism is not my expertise, ( I find your site, the articles and discussions so enlightening) however I am glad to learn your hip replacement went well and wish for your speedy recovery. Also good to know how highly you regard the Hospital For Special Surgery for my future reference as I have reached 76 and still reaching.
Hi Yves, long ago I worked briefly at the NYU Hospital for Joint Diseases (now the NYU Langone Orthopedic Hospital), which I guess is a competitor of the HSS. Do you have any idea of well rated it is today? Did you consider it? Just curious.
No, I was referral driven and didn’t have any referrals to surgeons there.
My last surgery at HSS was in the late 1980s. What is it like now? So very helpful to read about your experience there, especially since I recently met with your surgeon to discuss my need for a hip replacement. Thank you for your post and best wishes as you continue your rehabilitation.