Tuesday, November 4, 2008

November 4

Goodness! I don’t write to you for a while and look what happens. So much is going on this week, I don’t know where to begin. But while you and Daddy sit in the living room waiting to see who will be our next president, I will catch you up a bit.

For the last few weeks I have been looking forward to your ptosis surgery which was scheduled for this Thursday. And in those weeks we have been fighting with insurance that refuses to pay for it. They don’t doubt the medical necessity of the procedure, but they tell us it isn’t included in our benefits plan. Since so often it is used for cosmetic reasons, they just don’t cover this surgery. Period. Necessary or not. For now insurance is a dead end.

So today I received a call from the surgery scheduler (whose name is also Audrey!) telling me they were going to cancel your Thursday operating room time. I asked her if I could just pay for the surgery out of pocket, and Audrey said she would advise against it since this condition isn’t detrimental to your health. I explained to her why I thought it was…at almost 5 months old you aren’t smiling, holding your head up, or rolling. All of this can be at least partially, if not completely, attributed to your lack of vision and I am not willing to put the surgery off any longer. She made some phone calls and asked me to meet with a TCH financial counselor after your dermatology appointment this morning.

So we met and while she finds it hard to believe insurance can justify not paying for the surgery, she had me fill out an application to have it done pro bono. I left her office with the peace of knowing that the surgery was still on for Thursday with or without insurance. That alone was a big answer to prayer—Daddy and I don’t care about the price tag on this surgery. We only care about the timing of it. But insurance hasn’t been our only obstacle this week…

Monday I started trying to decide the best way for you to get an IV for the surgery. The anesthesiologist was unable to get one in your tiny little veins last surgery so he recommended you come in the evening before to get a PIC line this time. This isn’t ideal for you because PIC lines have to stay a minimum of ten days, and it just seems silly to do that for an hour long surgery. The alternative is to go in Thursday morning and…well, I forget what this one is called…but basically they do an ultrasound to find the right vein to stick. This requires extra OR time which you don’t have (I have found it is all about OR scheduling). So while the doctors were going back and forth about what would be best, I asked the nurse if it would be safe to reverse the colostomy within the ten days following the ptosis surgery. I know for sure you will need a PIC line for that one since you will be on TPN for a few days and you blow IV’s so quickly. We could make the PIC do double duty. The ophthalmology nurse didn’t see why not since the areas to be worked on are on opposite ends and the ptosis doesn’t require a major cut. I called pedi-surg to see if the reversal could be worked into Dr. Kim’s schedule, but was told I wouldn’t get an answer until Wednesday morning. When I updated the other surgery scheduler Renee, suggested we do both surgeries at the same time. When I told her it was Dr. Paysse, the ptosis surgeon, who didn’t want to combine, Renee seemed surprised. So we left with plans for me to talk to Dr. Kim, Renee to talk to Dr. Paysse, and tomorrow decide if the two procedures should be done together or not.

I am all for combining the surgeries for a number of reasons. The anesthesia always worries me and the less you go under the better. Insurance would pay for the anesthesia, OR, hospital stay--all of the operation except for the ptosis portion. If separate you would be on stronger pain meds for the colostomy reversal than for the ptosis surgery, so combined your recovery would be less painful for the ptosis. The only drawback is that the chance of combining both surgeries for Thursday is next to none. That means the ptosis would be postponed until surgeons and OR could be coordinated. I want what is safest for you whether that means to do the surgeries separate to lessen the chance of infection, or do them together to lessen the risk of anesthesia. I pray that God will give us the wisdom to make the right decision.

Well, Daddy just came out to the office to tell me the race for presidency has been decided and Barack Obama won. History has been made, fireworks are going off in the neighborhood, and you are crying. Tonight I take comfort in knowing that in matters of both our country and our family, God is in control.

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