interpreter to a deaf patient who needed one.
Here's another example: Imagine if you had low vision and someone
handed you written post-op instructions. Depending on your prefer-
ence, you might need those in braille, in a large print format or on
audiotape.
Q
Do surgical facilities need to improve the medical care they give
disabled patients?
A
Some certainly do. For example, some facilities do not have lifts
for heavy patients and some do not have scales that can accom-
modate patients who use wheelchairs and cannot stand on a standard
scale. If you're calculating anesthesia dosage, you need to know the
patient's actual weight. A guess is not good enough.
There are other anesthesia considerations as well. Some people
with high-level spinal cord injury can have reduced lung function.
Consultation with a pulmonologist might be indicated.
Positioning can be very important. Patients with neurological condi-
tions like stroke, spinal cord injury or multiple sclerosis can have spas-
ticity or contractures. For example, if your arms are contracted rigidly
across your chest, it might be difficult to place you prone on an OR
table. It's critical to think ahead, and consult specialists when needed.
Assumptions about medical conditions can also be very harmful or
even fatal. My best friend Michael, an extremely bright English physi-
cist, has primary progressive multiple sclerosis (PPMS). He is quadri-
plegic. He has a wheelchair with a miniature, chin-operated joystick,
which also controls his tablet computer. In 2014, he started develop-
ing bullae on his arms and legs. A dermatologist diagnosed bullous
pemphigoid, prescribed steroids and did not investigate further. Over
the succeeding months, Michael's skin worsened, and he developed
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