Hip-pocrates And Me

tagWhen 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!

bedEverything 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.

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13 Responses to Hip-pocrates And Me

  1. Liz Patrick says:

    Glad you’re coming along okay. Wanna have them do my knees?? Hang in there (figuratively).

  2. Josh says:

    Yeah yeah, fine. But what about the really IMPORTANT stuff? What did you think of “Cloud Atlas?”

    • Tom Dupree says:

      I had already read the novel, which is organized as if digging into a set of Russian nesting dolls and then putting them back again. The filmmakers chose to intercut the six separate stories AND re-cast the principal actors over and over again. It was an amazing accomplishment, one of my favorite films of the year — I’ve already seen it twice. One of the best exemplars of “a book is a book, and a film is a film.” I’m sure David Mitchell is thrilled with the movie. I suspect, though, that some intricacies in the story are harder to follow by those who haven’t read the book, particularly Tom Hanks’s far-future pidgin patois, which is crystal-clear in the novel.

      “Really IMPORTANT stuff?” I thought you might be inquiring about the drugs!

  3. Beth says:

    OK – nitty-gritty … I am MORE THAN THRILLED you’re okay and witty as ever. Now, as a devotee to the UK NHS – what did all this cost? Ballpark …

    • Tom Dupree says:

      Insurance company’s listed value of the procedure without ancillary stuff: US$ mid-five figures. It varies depending on the part of the country, even the individual hospital. I can understand a certain amount of give — I’d imagine Ranawat earns more than Dr. Kildare, not to mention his higher cost of living in NYC — but shouldn’t the technological expenses be the same anywhere?

      Actual out-of-pocket cost to me? I won’t know until all the bills trickle in. I have a good health insurance plan that will cover most of them, but I’m sure there will be co-pays on testing, medication, etc. The one figure which shocked me was that I could have opted for a private room for…$900+ a night! A typical plan would subtract the semi-private charge — I took the default — and bill me for the balance. So, impossible to know just yet.

      Short version: absent health insurance, I would have seriously considered doing without.

  4. Sean McGrath says:

    I was also thinking ‘cost’ while reading this (knowing that you’re in the Land Of The Pay For It Yourself). I’m 46 and my left hip isn’t great, (it’s fine most of the time, but after a day of gut-busting exercise, e.g, running up a mountain and back down) then it lets me know that all is not well.

    There’s also a tradition on my mother’s side to need THRs (my mother is the lucky one in her family, her’s are fine). Hence I fully expect at least one THR in my lifetime. The good news… I live in one of those innumerable Western countries (pretty much all Western Countries other than the US) that has a “don’t worry, we’ll pay for your medical stuff from taxes” policy, so a THR won’t cost me a cent.

    Hope your rehabilitation goes well, if you’re a typical patient you’ll be wondering why you didn’t get it done years ago. 🙂

    • Tom Dupree says:

      Actually, the bothersome thing to me is unnecessary charges. I bought a walker which I outgrew in two weeks, plus some cushions and other stuff. I asked, why can’t I just rent these things, and the response from more than one person was, “Don’t worry, your insurance will pay for it.” Just as I asked my endocrinologist why he tested me in his office when I’d done the identical test on identical equipment three hours prior: “Forget it: the insurance pays.” I don’t want my insurance to pay for something it could avoid…that just means higher rates for everybody.

      • Sean McGrath says:

        Another advantage of nationalised healthcare. When the government is paying then waste is not tolerated (for long). E.g., a news item of the “Look where our taxes are being wasted” kind will require the minister in charge to do something about it if he wants to be re-elected.

        • Tom Dupree says:

          On 11/25/13, I donated the walker to my building; it folds up and stores easily. Everybody agreed it would be a shame to throw it away: you never know when somebody’s gonna be laid up for a short time. Now my neighbors won’t have to pay for a temporary walker! (Unless they’re all in the same accident…)

  5. Glenn Parris says:

    Sorry, I don’t participate in blogs often so forgive any breach in protocol. Sorry to hear about your hip. Must be scary. I’m sure you’ll do fine. Orthopods are good at Knee replacements but they are GREAT at hips! On another subject, I don’t know if knew him or not, but Dr. Michael Palmer, the novelist passed away this weekend. He had about 30 novels to his credit and I’m sure he had hundreds of writer-mentees. I’ll remember him as a kind and encouraging man who reached out to encourage me to continue writing when I almost gave up. His voice will be missed.

  6. debooker says:

    Aren’t you fortunate. When i woke up from my knee surgery, I thought hell was screaming at me. Not immediately. I was too groggy for that. But not too long after. And it has been screaming at one level or another ever since. But I’ll make it through.One way or another.

    Good luck with your recovery.

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