I have dealt with unstable knees since childhood. In December 2019, I noticed knee swelling, which would improve with rest. This flare-up was not unusual, except that the swelling and pain gradually became a routine fixture in my life. This was still pre-COVID, but winter is busy in the ICU, so I ignored my own health. We went on a trip to the beach in February, and I came back with a limp, and inability to navigate stairs and frequent knee instability.

I made an appointment with a local orthopedic surgeon and got an MRI in early March; this revealed a chronically subluxated patella, a large loose foreign body, and arthritis. Unfortunately, even I understood this meant surgery.

The shut down occurred in March, and I was unable to reach the surgeon (elective surgeries were canceled, and hence surgeons’ offices were closed; no response after multiple phone calls). I limped my way through 3 months in the COVID unit and finally got in to see a university-based surgeon, in June. He recommended MPFL ligament reconstruction. I would need six weeks to leave from work to recoup, and another six months of PT.

We saw a decline in COVID numbers. I talked to my boss, and we decided mid-July would work best for scheduling extended time off.

Thus, I started the FMLA process.

My boss directed me to contact the employee resource. I spoke to a representative and was directed to an external entity that administered FMLA for my organization. The most informative part of the process was my 20-minute contact with a representative, who detailed the 3-part process:

1. Approval of FMLA leave from the external FMLA entity. This would entail paperwork from my orthopod, detailing my procedure and leave. Once approved, it would confirm leave with my employer.

2. Contact the short-term disability insurance company. I was provided the customer service number, claim, and group number. I made sure to notate all instructions carefully.

3. Contact WA paid leave, which would supplement my short-term disability income. I was given the website and instructions to fill out the application online.

A few weeks later, I received forms for my doctor to fill out—repetitive, mind-numbing forms with redundant information and detail requirements. I contacted my doctor’s surgical coordinator. The orthopedic surgeon had a staff to fill out these forms: great use of overhead.

I perused the WA paid leave website and was utterly confused about why I needed to apply for this benefit when I had short term disability. I contacted the FMLA entity again, and they confirmed this benefit amount would be deducted from my short-term disability payment, whether I chose to apply or not. What a scam!

Was FMLA really this complicated? Did I really need to jump through all these hoops to justify the care of a serious health condition?

On further inquiry, employee resource informed me that they would direct someone with know-how to contact me via an online portal. A few days later, I received a cryptic response: “Your case has been closed with the following resolution,” and that I was to apply for WA paid leave. I was beyond annoyed. More time spent trying to reopen the case, and this time, I asked for a person to contact me directly. An employee resource representative called me a few days later and answered all my questions in a 10-minute call. I wish this had occurred weeks ago.

I created an account for WA state paid leave on the official website. There were the same medical forms that my doctor would need to fill. I contacted my doctor’s office, and they were super nice about this—round 2 of disability paperwork.

I received a letter from the short-term disability company, requiring more medical forms for my doctor to complete. Round 3 of disability paperwork! There were six pages for me to provide personal information like my SSN, bank account number, routing number, and legal mumbo jumbo disclaimers which required my acknowledgment with claim number/group number/name /signature/date repeated on each page since this information on one page would not suffice!

I then got a letter from the said company a week prior to surgery, stating my claim was not approved. I called them immediately. I was informed, that claims are not even examined till after confirmation of completion of the surgery, and to call back after surgery.

Surgery was 2 hours long, complicated by peri-operative hypotension, bradycardia, need for atropine and pressors. I managed to be discharged home that day.

I called the short term disability company the very next day. The representative asked me the same questions detailed in multiple forms that had been submitted a month prior, and that a claims adjuster would call me in 24 hours. I received that call 48 hours later. The claims adjuster left a long voicemail detailing that I would need to provide a voided check with my home address on it (I don’t print my address on checks), that proof of my income would need to be obtained from my employer, and I would need to apply for WA paid leave. Here I was three days post-op still not sure if I would have an income during FMLA.

On returning the call, another representative informed me that I needed a signed letter from the bank confirming my address. They would not accept any other proof of address. I sent an email via a secure bank messaging center requesting such a letter. The bank declined; they could not email said letter. I would need to mail or fax a signed letter of request. OK, sure! Letter written and faxed! Post-op day 4.

I checked WA paid leave website daily. My case is still pending. I have no idea when it will be approved.

It is now post-op day 7. I am feeling better. I am still on crutches and dependent on others for basic self-care. I still do not have confirmation of income.

Rizwana Khan is a pulmonary and critical care physician and can be reached at DrKhanMDOnCall.

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