Careway
Well folks, have I got a story to tell, and perhaps this will give you some insight as to why I haven’t written much as of late…
In July of 2023 we took our annual ski trip to Cardrona during the kids’ winter holiday. Everyone was looking forward to skiing, seeing some friends, eating, and generally having a fun trip. Unfortunately, that’s not the winter vacation I got. On Monday on my fourth run of the trip, I was leisurely skiing down White Star with a friend having a bit of an Elsa moment as the snow swirled around me when I hit a particularly icy patch and a bump and took a tumble. I felt my knee pop and knew it was bad. Really bad. My friend came up to check on me, and I told her that I was pretty sure my knee just blew and that was the end of skiing for me. In my stubbornness to never ask for help, I managed to get to the bottom of the run (despite my knee popping in and out of socket) where our husbands were waiting for us. I asked Jon to take me to the medical office on the mountain.
The staff quickly called the physio off the mountain to come take a look at my knee. After a quick exam, he went back to a supply closet and came back with a giant brace and crutches. It was obvious that I was done skiing and in need of some serious - though not urgent - medical attention.
He adjusted the brace and crutches and made a quick phone call. Afterwards, he told me that I had an appointment at the Wanaka Physio’s office the next afternoon and I should swing by the radiology place to get an x-ray prior to my appointment. I spent the next couple of hours in the lounge, enjoying my consolation prize: a bottle of champagne and some visits with friends as word spread that I had an accident and got hurt on the slopes.
The next afternoon the same friends who we were skiing with when all of this happened took our kids back to their place so Jon could attend the appointment with me. Wanaka is tiny so there is only one real medical facility with lots of different providers’ offices in the same building. At the radiologists there were several ski-related injuries waiting for their turns, but the queue moved quickly and I got my images done within about twenty minutes of arrival. Then I moved to Wanaka Physiotherapy where I met with Ginny. She did a more thorough exam and looked at the x-rays. Because my knee was quite swollen, she hooked me up to an ice machine while we talked through what was going to happen next.
She was certain I had an MCL injury, but the big question was what, if any, damage I did my ACL. I needed an MRI to get a better idea of what the extent of my injuries were. Since I lived in Auckland, she would refer me to a surgeon there who would order an MRI when I got back in town. In the meantime, I would come to her a couple of times to start the physiotherapy rehab necessary to get my knee working again. Sounded straightforward enough.
The next few days I spent at our AirBnb while Jon and the kids went up the mountain to ski. I discovered that Wanaka doesn’t have an Uber presence, but the people at Yello were absolutely lovely and helpful - even when I left my phone in their van. I was able to get to the Wanaka Medical Center very easily for my physio appointments and then spent the rest of the day on the couch. On Thursday, Ginny mentioned I would get a call from Mark Clatworthy’s office in Auckland as she had just talked to him about my knee. They decided I was a good candidate for Careway, a program I had never heard of before but is specifically for people with shoulder, knee, ankle and spine injuries, especially the type that require a lot of rehab and multiple service providers.
At this point in the story, I should digress and talk a little bit about the costs for the medical care I had received so far. Since this was clearly an accident, the physio on the mountain immediately set me up with an ACC claim. This decreased the amount of money I was paying, but didn’t eliminate it entirely. To be honest, I’m really confused on how ACC works in Wanaka. In the past when I’ve gotten scans for ACC injuries, they’ve been 100% covered, but for some reason the x-rays in Wanaka were NZ$60. And while it isn’t unheard of to have a small charge for an adult urgent care visit, We paid NZ$385 for the visit, brace, and crutches. My Wanaka Physiotherapy visits were NZ$59 - the ACC out-of-pocket cost. So even though this was an ACC covered injury, I was still paying a not insignificant sum for the medical care I was receiving. Given that I was looking at months of physiotherapy irregardless of whether or not I needed surgery, I was starting to wonder exactly how much my little fall was going to cost.
That’s where Careway comes in. It’s an ACC funded program to cover the costs for certain types of care completely. Careway was one of five escalated care pathways started in 2019 to provide a good, timely wrap around of care for people like me with injuries that needed several different types of providers. The is a list of providers who are a part of Careway, and as long as I chose providers on the list, I could take advantage of this program. (If I chose not to go with Careway providers, I would get the usual ACC discounts and be able to use my Southern Cross health insurance to cover any remaining costs.)
To be upfront, I didn’t really understand what was going on and decided that until I saw red flags, I would continue down this path of medical decisions being made for me. It all seemed too easy. So when Mark Clatworthy’s office called me on Thursday afternoon, we set up an initial appointment and I was told to expect a call from MSK Radiology to schedule my MRI and to pick out a physio near me to start with upon my return to Auckland. It seemed easy enough, so I sat back and enjoyed the rest of my vacation binging Grey’s Anatomy episodes until we returned to Auckland that weekend.
On Monday the kids were back at school, so I sat down to go through the list of physiotherapists. It was extensive, but I had a friend who had nothing but positive things to say at her experience at Peak Pilates and decided to start there. One phone call later, I had an appointment for that afternoon to get started. I also received a call from the radiologists and scheduled my MRI for Thursday. Everything was falling into place and I was past the initial shock of the injury.
Until Thursday. I went in for the MRI and it all went smoothly. I could feel such an improvement in my knee that I was certain they wouldn’t find anything majorly wrong with it and almost felt silly going in. My appointment was at 9:30 in the morning, andI was in and out without much trouble. I had my MRI report and the surgeon’s notes by 4:30 that afternoon. The prognosis wasn’t what I thought at all: ruptured ACL, grade II MCL sprain, and a smattering of other scary things like an “impaction fracture.” To say I was surprised that my little fall had caused so much damage was an understatement. The surgeon’s notes to the physio were to go ahead and start pre-hab in preparation for surgery.
I went into my initial appointment with Mark Clatworthy with three pieces of information about him. First, all he does is knees. Lots and lots of knees. So many knees that he teaches other people how to do knees. Secondly, one friend who had knee problems a year ago, didn’t want to go to him because she didn’t want someone who was going to recommend surgery if it wasn’t necessary and she thought he would. Finally, a random lady stopped me on the street to ask me about my knee one day, and when I told her I was going to see Mark Clatworthy, she couldn’t stop raving about how he was one of the best and she was upset she wasn’t able to get in to see him when she needed knee surgery. I figured I would see what he had to say, ask a lot of questions, and see how comfortable I felt with him after the initial consultation.
He checked all of my boxes. After an initial physical exam, we sat down and looked at the MRI and he walked me through why surgery was a good idea and what that would look like. In all, we spent about half an hour going through everything. As it was so straight forward, we looked at possible surgery dates, and I picked one at the beginning of September when I would’ve had enough time for adequate pre-hab and Jon would be in town. I was surprised to learn that it was important to strengthen my leg and lengthen my hamstring before surgery, but I was happy to have a little bit of time before needing to rush into anything.
The next few weeks I spent visiting my new physio. Some days she made me work really hard, other days I got pampered with massage, and sometimes she did dry needling when something was really tight. I could feel my leg getting stronger and soon I was able to ditch the crutches and hobble about without too much trouble. If it hadn’t been for the constant instability in my knee and the knowledge that with a quick movement it would easily slip out again, I would’ve reconsidered the operation. But before I knew it, it was the day before my scheduled surgery and I spent time on the phone with my anaesthesiologist before eating a giant dinner and going to bed.
The next morning we dropped the kids off at school and Jon and I headed over to Mercy Ascot hospital where the surgery center was located. I quickly checked in and was led to a private waiting area where we proceeded to wait. and wait. and wait. About two hours later people started coming in and out of my room to go through the pre-surgery procedures, and finally after about three hours, I walked myself into an intimidating operating room where I promptly got extremely nervous, started talking way too much, and was kindly knocked out by the anaesthesiologist before I could truly embarrass myself.
I woke up about an hour later in a recovery area with my knee on fire. The first thing I said was a very pathetic, “It HURTS!” and then they were nice enough to give me some good drugs that took the pain away. After a bit of drug-induced haziness, the nurse helped me get dressed and a physical therapist came over to give me some exercises and make sure I could handle myself on crutches. After walking to the other side of the recovery unit, I got to relax in a very comfortable recliner and was given the option of food and water. I had my phone and airpods with me and spent the next couple of hours zoning out to podcasts, and before long, Jon arrived back at the hospital to pick me up and take me home. He got some basic instructions and a few prescriptions to get filled at the pharmacy downstairs, and we were off.
You’ll notice that in no part of this day was there ever any request for payment or insurance or anything. Everything was covered under the Careway program and I didn’t have to worry about the administrative nightmare that I would’ve faced in an American hospital, like making sure the people involved in my case were considered in-network.
The next seven days I basically spent on the couch with my knee iced and raised. I dutifully did my exercises on the handy cheat sheet the physical therapist gave me after surgery. My knee was extremely sore for that first week, and I was grateful for the painkillers they prescribed, but after a week things started to feel a little bit better and I decided to stick with Panadol - the acetaminophen equivalent in New Zealand. I also knew it was time for me to get back on the physical therapy bandwagon and I returned for even more post-op care.
Since the surgery, I’ve had physical therapy twice a week. That’s over six months of frequent physio that has been free to me thanks to the Careway program. I’ve seen my physical therapist more than anyone else outside of immediate family. I can tell you all about her dog, her partner, her immigration journey (she’s from Malaysia), and her love of mixed martial arts. I’ve also had regular checkups with my surgeon, starting two weeks after surgery, then a month, and about every two to three months since. After every meeting, he coordinates with the physio to make any needed recommendations. She’s actually commented on how helpful it is to get his letters and how other surgeons don’t do that. The Careway system seems to be a well-oiled machine that has worked out well for me.
I’m not done with physio or in the clear yet. Mark Clatworthy was very upfront with the nine month recovery time for this kind of injury, but as of my last appointment, he thinks I’ll be good to go for yet another July ski trip with the kids this year. I just have to decide if I’m ready for another run down the mountain.
