A few observations about my interaction with the health care bureaucracy leading up to Tuesday morning’s surgery at a hospital in Manhattan.

First general thing I’ll say is that the pathway to access brilliant human skill, technology and infrastructure that produces what you hope is a good medical outcome is littered with all sorts of soul-sucking interference.

Nobody’s gonna grab your hand and pull you back in when one’s apparent course of action sputters or goes awry. The patient must have a firm, persistent hold on the reins of one’s own situation. Otherwise, you’ll get lost, cast aside by some combination of indifference, inefficiency or incompetence.

It’s kind of like if your flight is cancelled. Instead of waiting in that long line – or dialing the 1-800 number to get re-booked, it’s helpful if you can use your own understanding of how the system works to get back on track quickly. Get a seat somehow and get going.

I just turned 50 last month. The mind is sound but the body is entering a phase that requires some upkeep. I suffered a near-fatal on-the-job accident involving machinery at the age of 32. The ensuing 18 years have been pretty good physically considering how bad I was torn up.

This surgery on Tuesday (deemed successful by the doc) is the first repair job on the affected limb since the accident and hopefully the last.

What was shittiest about the long preparation for this procedure was when the outfit that fronts for the company issuing the final stamp of approval for the insurer stepped in and vetoed – or refused to approve a portion of the surgery. Without having ever met me – or talked to me – a medical doctor paid by a company that evaluates worker’s comp claims/cases filed paperwork with NY state deeming a portion of the proposed surgery as “not medically necessary.” The written summary backing the position contained inaccurate and misleading assertions about my condition and health. Other than this third-party doctor’s access to a portion of bare-bones medical notes associated with my case, his decision to block a possible element of what a world class surgeon proposed to do seemed motivated purely by a knee-jerk inclination to say no simply to say no. Let’s say “no” to save money on behalf of a corporation which hopes its worker’s comp insurance payouts come in under some number without regard for the well-being of the worker who was injured.

My surgeon’s office manager assured me the effort by the front outfit to dictate medical outcome from afar would not alter the doc’s game plan on the portion of the surgery being contested. But it still struck me as a wildly unfair and illogical development.

On the day of the surgery, a series of harried interactions with different professionals at the hospital produced more potential pitfalls that only the patient could prevent. First, there was a nurse who asserted that the records she was reviewing showed the original injury occurred as the result of “an automobile accident.”

“No,” I said. There was no automobile involved.

“OK,” she said. “Let me correct the record.”

Later, a young intern asked me to sign an authorization form describing the surgery in completely different terms as the ones submitted to me and the insurer by the primary surgeon. It also omitted the name of a second doc who the primary surgeon said would be required to be present given the expectation the procedure needed the skill sets of two distinctly different types of specialists. So, 120 seconds later, the intern presented a revised authorization form that matched almost verbatim what I had just told him from memory. It almost seems like I could have told him I expected to have surgery that would cover the big bald spot on the top of my head and he would have put it on the form.

It was such a blur of commotion on a hospital floor that somehow manages to work pretty seamlessly as an assembly line of surgery with same day discharges. Most of the people you encounter first ask you to confirm your identity. A dozen times you tell them who you are and when you were born just to avoid any possibility of getting mixed up with somebody else.

At one point, the same nurse who corrected the facts on the cause of the original injury lowered her voice and said: “This is something we ask everybody: Do you feel safe in your community? Do you feel safe in your home?” She wanted to know if anybody in my life – in my family – in my circle – was abusive to me. It was a standard vetting type question that I’d not heard in the hospital setting but I thought it was cool. A good idea. The hospital is meant to be a safe haven. Where better to discover people who might need some help other than for their condition at hand. The nurse concluded her line of questioning on this theme by asking if I was suicidal. God no, I said in a firm tone.

When they wheeled me into the operating room, I passed some fifty or sixty medical professionals of all types in the congested hallway and watched as they all prepared to start their day. It was like a TV show. Actually, it was better than a TV show in terms of the visual drama.

Once in O-R, the anesthesiologist went to work. He was a MD. He had a Russian accent and made a few funny comments before starting the flow of juice that put me under.

When I came to about 2.5 hours later, I was under the excellent care of a middle-aged Irish woman who like all the nurses I’ve ever come in contact with in my life – was sweet and cool.

The going home part was a little tricky but only from a logistical standpoint. The hospital doesn’t cut you loose unless you have someone to walk you out the door. I didn’t want my family to come all the way out here for something like this – and everybody else I know here is a working person. So, I enlisted the aid of NYU’s social work program and they set me up with a “medical escort.” For a flat fee, a gentle and kind older woman from Crown Heights walked out of the hospital with me. As a condition of the arrangement, she would see me to my apartment door. I hailed a yellow taxi outside the hospital and we rode together to Queens. We didn’t say much to each other until the tablet of Percocet I popped about a half hour before exiting the hospital started kicking in. “I’m feeling it,” I said.

“What does it feel like?” she said as we crossed the 59th Street Bridge.