When you have hip trouble due to the normal arthritis of advancing years (as opposed to a collision or other violent trauma), no doctor is going to tell you, “My advice is to have a Total Hip Replacement.” They won’t let you defer the decision to somebody else, not even an authority figure wearing a lab coat. What you get instead is, “When your hip adversely affects your quality of life, that’s when you should consider a THR.”
I’ve suffered from intense discomfort – it didn’t actually rise to pain unless I stepped on a cobblestone wrong with my right leg – since spending a month in Phoenix with my father-in-law after his wife passed away four years ago. Each day I squeezed into and out of her little car for two short trips. By the time I got back home, my right hip had started aching – and it never really stopped.
After I postponed a trip to the chiropractor for about a year (hey: I’m a guy), x-rays revealed that both my hips were arthritic, and, in fact, the left one was technically even worse. But because I hadn’t been using it to corkscrew into a car seat, I never felt any discomfort on the left side, and I still don’t. What, doc, I need a new hip? “When your hip adversely affects your quality of life…”
My malady was intermittent. Some days going up a flight of stairs was agony. (Anybody who’s ever ridden New York express-line subways will immediately apprehend my problem.) Some days I’d limp noticeably, other times I looked just fine. My quality of life sure as hell deteriorated, but it was gradual, like that frog in the slowly heating pan. I could still walk a long way, but not as fast as everybody else. I couldn’t sprint or stop on a dime; no more tennis. I had to use a “recumbent” bike at the gym to keep the load off my hip. I haven’t attempted a golf swing since this thing really got serious, but just the thought of it brings on some imaginary owies. I can’t take a stress test on a treadmill because I can’t walk fast enough to rev my ticker. (The solution is a “nuclear” IV that races your heart while you’re just lying there, which is far creepier than being winded fair and square.)
Finally I gathered up the courage to ask my friend Josh Chasin, who’d just had a successful THR, for the name of his surgeon. I checked with my own M.D., Jeff Buckner, and a few other health care people I knew, and all thumbs were raised. Not only was Dr. Amar Ranawat one of the leading sawbones around (his pop and brother are also in the family business), but the Hospital for Special Surgery was about the top place in the country to host the procedure. So I found myself in his office with a few staff on September 9, after undergoing a battery of preliminary x-rays and tests. I kept waiting for somebody to say you can’t do it because of your blahblahosis, but everybody kept staring at me. Dr. Ranawat said, “You might think you just wasted four years suffering. You didn’t. That’s what gave you the guts to come in today. But first, you had to decide that you’d finally had enough.” He sent me to his scheduler, who would not let me leave the office until we set a date. I’ve heard this is SOP for crybabies like me. I bluffed: “I have to check with my wife.” She called: “What’s her number? Let’s do it right now.” When I walked out (without checking), I was on the docket for Tuesday, October 15.
Thus began a full month of utter scared-shitlessness.
First, I’m squeamish to a significant but not quite neurotic degree. I have never, ever, ever wanted to be a doctor: can’t take the ick. Several physicians are among the finest people I’ve ever known: caustic, playful, tolerant, skeptical – you guys (and gals) take that vital profession and enjoy; enjoy. But now we’re talking about cutting on me? This would be my very first time under the knife: I’ve never so much as broken a bone. It would be lots easier if, oh, I’d smashed my hip in Woodstock riding bitch behind Bob Dylan; then it wouldn’t be up to me. But no, I’m bringing this on myself, by choice. As they say, there’s no such thing as “minor surgery” when it’s on you. I guess it requires a smidge of fortitude, but bravery? That’s the infantryman in Walter Reed who charged into a free-fire zone because the sarge ordered him to and is still fighting for his life nine months later. All I could summon up for “bravery” was to resist the operating-table urge to blubber like Daffy Duck. (“Is this it, Doc?…I think I see <kaff, kaff> that old wagon comin <kaff> round the bend…”)
As with all things, the anticipation is far worse than the actuality. Dread wins every time. Creators of horror stories and movies have been dining out on this phenomenon for years: the less you show, the more the audience will fill in for itself, and who knows what gruesome little beasties live inside those innocent psyches. Let them invent their own terrors. To you this was just some routine hip surgery; to me it was time for the Five Stages Of Grief, beginning with Denial: as long as it was still September, I had nuthin to worry about! Then Father Time dragged his raggedy ass into October, and a week out from renewed hipness I went over to HSS and spent most of the day there. I took a class on what to expect and how to rehab, got blood work and an EKG, and met Dr. Joseph Markenson, the on-site M.D. who would be looking out for me. When I left the Doc’s office, it had become real real. Three days later I had to take one last stress test, and when that failed to wave it away, there was nothing else between me and the slab.
You have to show up three hours before surgery, so you can (a) fill out a shitload of admission forms and (b) lie around in a hospital gown on a gurney, waiting for this or that person to deliver their own personal forms and ask you the same questions over and over. Even at the world’s greatest medical centers, the various departments don’t coordinate with each other, and there’s no Permanent Record like your grade-school teachers threatened you with (well, mine did). I presume the thinking is to get it right by redundancy and eliminate the possibility of a data-entry error that sticks around (though see Pastoral Care below). Before my orientation class, the teacher had asked me to list all the prescription drugs I was taking, the dosage, frequency, etc. I had brought the info as instructed and transferred it to a sheet of paper. She left and came back with 10 photocopies. “You’re going to need these. Make sure you take them everywhere.” It was the single best piece of advice I got. Sure enough, every sumbitch I saw, beginning with Dr. Markenson that day and ending with a gas-passer while I was lying on the gurney a week later, asked me for a list of my scrips. From my point of view, why not just enter them into The System? Accuracy through redundancy. (We’ll pass over the possibility that I myself might have made a data-entry error on that handwritten sheet so as not to frighten ourselves any further.)
Have you heard stories about mistaken operations on the wrong hip? At HSS, that’s impossible – at least, I can’t come up with a scenario in which it happens by accident. First, you get an ID band which goes on the opposite wrist from the operating area and never comes off till you’re back home. You have to state the name and birthdate on that band from memory before anybody will do anything for you. (That’s mine in the photo up top, instants after I grabbed a pair of scissors from my beloved desk drawer and liberated the frackin mammajamma from my wrist.) Second, the parade of people with clipboards each asks you exactly what you’re here for (after glomming hisser own personal copy of your page of scrips), along with an identical list of health history questions – the anesthesiologist needs his, the pharmacist needs his, the surgeon needs his, etc. Finally the great man comes in to wish you well, and signs the correct surgical location with a Sharpie. To foil this system, Al Qaeda would have to sneak in, cut the ID band and clip a phony copy onto the other wrist, stain off the Sharpie and replace it with a perfect forgery, re-prep the wrong side, and never be seen by the dietician who’s been standing there this whole time waiting to get another goddam health history and page of scrips. And all the terrorists would have for this prodigious effort is a USA patriot who limps on the left side.
Those pre-op hours were the most nerve-wracking of all. By now I just wanted to get it over with. I’d invented a Zen thought to help me through recovery: when I wake up after surgery, I’ve already started healing. Om, right? Fortunately I had my trusty Kindle and a really lightweight, easily interruptible book, the Johnny Carson revenge tell-all by his former lawyer Henry Bushkin. I finished it in-hospital and moved on to my first post-film reading of David Mitchell’s CLOUD ATLAS. Avid readers make their own sort of anesthetic; within moments we can render ourselves oblivious. A medicine for monotony.
Finally came high noon. Actually, about four o‘clock; I’d been on-site since high noon and on-slab (comfy, with my Kindle) since maybe two. No more clipboards, just a gang of big burly masked men who rolled me through the halls. This trip is almost a relief, but they know you’re still scared. I said, “Too late to back out now?” One puckish guy said, “You have about thirty seconds, but I wouldn’t make the surgeon mad right now.” The point-of-view seemed like Rock Hudson’s in SECONDS; that’s how shallow I am. (I wanted some fuzzy focus and goofy zooms, as if Al Qaeda had drugged me after sabotaging my surgery.) Now into the operating room itself, and enough lights to perform “Swanee.”
A veteran colonoscopy patient, I knew this would be my last memory of the actual procedure. As is my custom, I asked the anesthesiologist for “the full monty,” s’il vous plaît. He said, “think of a really nice place.” Annnd…cut.
# # # # #
Weirdest thing? When you wake up, it doesn’t hurt. Second weirdest thing? It doesn’t hurt because you’re doped out of your mind. Linda had planned to come visit me at about 8:30 (they call your loved one directly afterwards to tell them the surgery went fine), which would have been perfect, but a bureaucratic blood-test snafu held up the start time. So I was still in Oz when she got there. I remember waking up, lying on my non-operated side, looking at a chair, and mumbling to the docs. I must have fallen asleep again, because Linda appeared in the chair, POP!, like a Méliès effect. I spoke to the ghostly figure. I remember cogent sentences being formed in my mind, but even I couldn’t understand the gibberish coming out of my mouth. “I’ve already started healing” might turn into “I red sharty hee.” G’night, honey!
Everything up to now, everything that really counted, had been buttoned-down and by the book. Everybody had been superb. But now that we’d crossed a certain summit of physical danger and were headed downhill again, the place reverted, in some aspects, to the clutter and bustle of a normal hospital, complete with tardiness, dietetic errors and lots of mole-whacking by the overworked staff. I only found out upon leaving that the upcoming weekend would be one of HSS’s infrequent “Surgical Saturdays,” devised to let patients complete their work weeks. The in- and outflow at the dropoff point was amazing, like Grand Central. The orderly who helped me out said, “your bed was filled again in about thirty seconds.” The place was packed, and would remain so through the weekend. That explained a lot of confused service, and a constant shuffling of personnel: “my night nurse” might not still be mine by the end of her shift.
My teacher at the orientation said she’d been in this line of work for thirty years, and back then, THR patients stayed in the hospital for a whole month. I spent three nights there, and the third was my choice; I wanted just a little more physical therapy practice before I went home. As I was enjoying my final lunch, a nice woman from Pastoral Care came in and said she was sorry for the mistake because I had requested some spiritual care and they’d just gotten to it now. I said, (1) I didn’t request any spiritual care, and (2) anyhow, another nice lady with a clipboard bearing the same erroneous info had come to visit the previous day. Somebody must have made a data entry error, and two different departments got the same wild goose to chase. I’m going to call that progress.
I came home last Friday, almost a week ago, and began the process of rehab. And that is the point on the road to recovery where I’m sitting right now.