Late in the summer, I can no longer stand the pain in my shoulder. I have a history of high tolerance for pain, but this pain tops the charts. I have put off a visit to the doctor; not wanting to curtail glorious weekends spent camping, hiking, swimming at the lake. I want to enjoy the few weeks of bright sunshine and warmth, savor the cloudless, snowless days. I want to honor promises I’ve made to loved ones. I want to delay bad news.
The doctor visit confirms my worst premonitions. I have three tears in my left rotator cuff. The shoulder will require a surgical repair that demands several months of recuperation. Even when I return to work, physical limits will apply. The MRI shows what the X-rays failed to, what the doctor attempts to explain. He goes on in that confident, knowledgeable voice common to surgeons, but I understand the picture better than I do his words.
I am a visual learner. I associate words with images, rather than finite definitions. The doctor recommends physical therapy for several weeks prior to the operation. I stare at the grainy, magnified black and white image of my shoulder, focus on the three cloudy white spots on the tendon. This area shows the location of the tears. In a sea of darkness, the whitecaps here warn of stormy weather, a battle with internal elements my inner rigging isn’t capable of riding out without assistance. The limited range of motion, the lack of strength I exhibit during his series of assessment tests have alerted the doctor to the possibility that healing will take at least twice as long without the prescribed regimen of exercises. He tells me I should have come to see him months ago.
Procrastination is not one of my usual faults, but I’ve had issues with the left side of my body ever since the awful car accident. This shoulder is only one of many residual physical reminders of that wreck. The operation for a detached retina in my left eye came on the heels of the automobile crash. The collision that damn near totaled my life—as well as my car—has come back to haunt me once again.
I don’t notice any injuries right after the accident. Adrenaline pumps though my veins, and I somehow drag myself from my car, stumble to the side of the road. The other driver slumps over the wheel. Other motorists stop; some stay until the highway patrol and ambulance show up. I have no memory of pain at all that night. As the wreckage is cleared, I’m too busy being thankful that no one else was in my car with me, that no other cars were involved. I’m grateful that my insurance will replace my car. And, I’m relieved that the other driver has minor injuries, even though he should have been driving sober.
The pain manifests the next morning. Doctors promise physical therapy will take care of the problem areas on the left side of my body. I learn later these high-impact injuries from automobile collisions cause a wide variety of problems not initially reported or discovered. Immediately after impact, the body is in a state of shock and the brain does not register the injuries.
I leave the doctor’s office angry to the point of tears. I sit behind the wheel of my new vehicle, cursing the irresponsible middle-aged man who chose to drive his Ford LTD while inebriated. I curse myself for not complaining more, louder, longer. For not speaking up sooner, for not taking better care of myself.
I arrive home and fill the bathtub with water as hot as I can stand it, pour in some Epsom salts. I play the Ella Fitzgerald CD and soak away some of the pain, some of the anger, some of the regret.
If I’m honest with myself, the accident is only one factor affecting the shoulder. My job—the work I do—has aggravated the problem. Lifting surgical trays demands physical stamina. The average surgical instrument tray weighs about twenty pounds. The facility I work at does numerous orthopedic operations. Ortho trays weigh between thirty and forty pounds. So, I pretty much do my weight training while I’m on the job. On any given day, I may load fifteen to twenty case carts with trays, tear down carts from cancelled operations, redistribute trays in an emergency scenario, run trays into surgery without a cart, and re-shelf sterilized trays. I don’t sit much. Mostly, I am in high gear from the time I arrive for my shift until I go home for the day. All these repetitive tasks exacerbate underlying physical trauma.
I have surgery scheduled for November, after two months of physical therapy to strengthen my weak muscles. I have four months of physical therapy after the surgery. I’ll lose some income during my months off, and have the added expense of a portion of the medical bills. The good news: the hospital holds my job, as promised.
I return to work, but the atmosphere has changed. My boss is checking off days on the calendar until she can retire with a full pension. She is moody, impatient, sarcastic. I don’t seem to move fast enough for her anymore. Neither do any of the other employees. She doesn’t want to hear about problems, doesn’t want to deal with Materials Management (the department we order all disposable products from). I inherit the responsibility for assuring we don’t run out of any supplies. My boss never mentions the added training she promised when she hired me. Now, I am doing the work of two people. Coworkers come to me with their concerns, instead of my boss. I’m exhausted when I get home at the end of each day.
The department I work in is located in the basement. Off and on, the ceiling leaks. The problem gets worse as the months wear on. One morning I walk into my section to find a two-man maintenance crew attending to a large water leak. They estimate the completion of the work within two days. I work around the draped off area.
Two weeks later, the cascading waterfall of plastic still hangs from the ceiling. When I grip the edge of my desk, the gritty dust that settles on a daily basis on every surface sticks to my fingers. I’m tired of cleaning it up, tired of asking about the repair schedule. I’m tired of feeling sick every day when I leave work. My coworkers complain, but none of them will approach our boss.
Two floors down, working in a basement with no windows, I begin to question my own sense of right and wrong. I’ve promised to adhere to the rules regarding the sterile processing of products and instruments. I’m committed to providing safe health care to all patients. But, I need this job.
Contamination of any kind is unacceptable in a sterile environment. The fiberglass dust is a health safety issue. It does not dissipate in air, does not dissolve in water. It causes skin and eye irritation, and breathing problems. Fiberglass insulation is treated with formaldehyde, and is a probable carcinogen. The ominous residue clings to every surface, and when I change out at the end of my shift, glittering fibrous pieces of deteriorating fiberglass drift through the air. I take my concerns to my boss. She is irritated, and tells me to clean up the mess, to do my job—if I expect to keep it.
Inside I fume. My boss’s attitude is one of willful negligence. People’s lives are in danger. I can’t keep quiet any longer. I need this job, but not badly enough to risk the lives of others. I don’t need this job badly enough to risk my own health, either.
I decide to plan a strategy. To cover my ass. I email a couple of administrators.
At the monthly meeting, I notice the Surgical Director and the Patient Safety Officer in one corner of the room. I wait until my boss asks if there are any questions or comments from the Central Services staff.
I speak up; pass around the information about fiberglass duct liner I gathered on my own time from the internet. Combined with dirt, dust and moisture, fiberglass provides the perfect medium for microbial growth: mold, fungus, Legionella bacteria.
The Surgical Director and the Patient Safety Officer tour the department with me. My boss tags along.
The next morning three maintenance men are finishing the work on the leaking pipe and the crumbling ceiling. I discover my boss has quietly resigned.