There are 4 orchestra chairs haphazardly places around a music stand. They seem to be under the spotlight.

The Maestro

Cue the orchestra. The Maestro is ready to play once again. This time with special guest star COVID-19.

I do not know a thing about reading music. I took piano lessons for 3 years, and the best I can play is middle C on a Story & Clark piano. If you want a concerto in middle C and have a Story & Clark piano, I am your guy.

If you want someone to sub in and strike middle C at just the right moment and you have a Story & Clark piano, my services are available. I realize there is no need for my talent, but I am waiting in the wings just in case.

It is much like playing basketball for Indiana University (IU). I saved my college basketball eligibility for over 40 years just in case IU calls. If Coach Woodson is reading this and needs my number, it is on your answering machine 129 times. Give me a ring, and I will be there.

Getting clearance for surgery

Sorry, I got off track there for a second, now back to this orchestra piece that I am working on today. It is a surgery concerto. I will tell you about that in Act 2 of this concerto if we even get to Act 2.

Suffice it to say, I need surgery. That has unleashed a torrent of activity just to get approved.

Cardiologist

One might think that the rheumatologist plays the first chair in my run-up to surgery. Not so.

The first chair is always my cardiologist. I like her, and I have been her patient for over 20 years. She is thorough, challenging, persnickety, and a royal pain in the butt. That is what I like about her. It is also what I dislike about her. She can stop a freight train with one glance.

When I spoke to my surgeon about this upcoming procedure, he asked, "Who is your cardiologist?" When I told him, it looked like the blood rushed from his face.

I could have told him it might not be 2 weeks since I just had a big round of cardiac testing in June. But why spoil the fun of watching him sweat while thinking about what will happen when he sends the request for cardiac clearance and, instead of a yes or no, gets a 30-minute lecture on how he better treat me well because she will be checking up?

Cha-ching - add two weeks to the pre-surgery schedule.

Rheumatologist

Up next is rheumatology. Usually, rheumatology drives the schedule.

Usually, the rheumatologist notes that surgery should occur within 15 days of my next infusion but not after some magic date, lest I have issues with healing. Blah blah blah.

The rheumatologist adds that little bit of complication that is seldomly encountered elsewhere, so surgeons are always tripped up a bit.

With the rheumatologist clearance, I usually get a call from the office telling me that we will need to add 1 to 3 months to the schedule. The special blend of powerful biologic medications and the interminable infusion scheduling process can slow the march to surgery down to a crawl.

It can also speed things up. Like when the surgeon's office calls to tell me that the rheumatologist says, "If we do not want to wait 5 months, we must do this now." See you next Tuesday or even tomorrow.

Rheumatology adds a flare of uncertainty to my orchestra. In comparison, other parts of my usual orchestra operate in predictable patterns.

The rheumatologist is a mysterious wild card that no one wants. While one would think an infusion schedule would be straightforward, in truth, rheumatoid arthritis - with its potential for a flare and difficulty with the change of seasons - can make any planning schedule look like pie in the sky thinking. Or not.

Endocrinologist

In the third chair is diabetes. For this performance, we have a new endocrinologist to follow the case and give approval. I have only met her a couple of times, and she seems easygoing and relatable, but who knows for sure?

I could predict what my former endocrinologist would have done in a run-up to surgery. But he retired, and my new endocrinologist is still an unknown quantity to me. She might toss a grenade in the pre-planning to get agency, or she might check the box and go on.

I know she will not let me go 48 hours in the hospital with any insulin. How do I know this? Last year when I had surgery, she was filling in on rounds, and she stood at the floor desk informing them that a person with Type 1 diabetes does not go 48 hours without insulin.

It was that interaction that caused me to select her when I need to chose a new endocrinologist. I like witnessing drama, and I thought about what would happen if my cardiologist and endocrinologist disagreed.

Of course, the cardiologist would win the disagreement. But darn - it would be fun to watch something like that. Doc fight!!

Other doctors and specialists

In the fourth chair are the rest of my specialists. It is always fun to bet on which one might get their bell rung.

Who knows who else might step out and cause a clearance issue? Will it be gastrointestinal, neurology, or psychology? You never know, and it is what makes the run-up to surgery interesting.

Planning surgery during the pandemic

Oh, and yes - I almost forgot the special guest in this performance, COVID-19. Surgery is to be at least 6 weeks from now, but since no one knows if coronavirus will shut down elective surgeries (in my case, no one is giving me the chance to elect not to do it, but I can pick the time).

It is most unclear what will be occurring after 6 weeks. Frankly, it does not look particularly good at this point. The surgeon said I will have to be in the hospital for 2 nights. But if the hospital is closed to elective surgery or packed with COVID-19 cases, I will not be allowed to have the surgery.

Hurry up and wait

Not knowing if the surgery can happen or exactly when it will happen makes everyone nervous. It has been my experience that delay occurs when the players get nervous. Nothing like a special guest star such as COVID-19 to upset the system.

So, if I clear all these hurdles, we can assume nothing. Just because you are the Maestro, it does not mean the orchestra will play along.

What has been your experience when you have had surgery? Are you the Maestro of your orchestra, or does one of the other players take over?

Ahh, if only surgery were as straightforward as playing middle C on a Story & Clark piano.

By providing your email address, you are agreeing to our privacy policy. We never sell or share your email address.

More on this topic

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Join the conversation

or create an account to comment.