On surviving yet again

Miscellaneous experiences and reflections

Three shoulder surgeries in 25 months. If you don’t think that sounds like fun, you really ought to try it sometime. This was my first joint replacement though, and recovery should be easier because less soft tissue was involved, and it’s soft tissue that takes forever to heal.

I remember getting a nerve block just before they rolled me into the O.R. at 7:30 Friday morning, but the O.R. anesthesiologist must have cold-cocked me the minute I arrived because I don’t remember anything after my gurney hit the swinging doors. I don’t even remember waking up in recovery or being rolled upstairs to my room.

Because I’ve lived on narcotics for so long, they no longer work well, so my first night in the hospital was hell. I had a PCA (Patient Controlled Anesthesia) pump that injected a xylocaine-like drug into my neck, but when the main block wore off in the middle of the night, the PCA didn’t touch my pain, so I was given intravenous morphine, Dilaudid, and oxycodone, all within ninety minutes and all without effect. Nurse Jen then called Mark (my surgeon) and he told her to double the Dilaudid, but even that didn’t help.

Jen then said “I don’t mind waking doctors up in the middle of the night, so if you think of something else that might help your pain, you tell me.” It soon hit me that I needed Neurontin along with the Dilaudid, so Nurse Jen woke Mark up a second time and got me a prescription for 900 mgs of Neurontin, and the two drugs together enabled me to sleep three hours for a two night total of seven hours. (Mark hates the drug, and he knows that I know this, so I laughed about him being awakened in the middle of the night to prescribe it.) As you might imagine, Saturday sucked, yet if I hadn’t suggested the Neurontin, no one else would have thought of it, and I wouldn’t have gotten any sleep.

Thirty-six hours after surgery, I could barely walk 200 feet, and I needed Peggy’s assistance to go that far. Twenty hours later, I came home and walked 2,000 feet all by myself. Today—three days post-op, I walked a mile.

I won’t take a medicine unless I know what it’s for, and this meant that I sometimes turned down medicines while I was in the hospital. If I asked a nurse what XXX was for, and she said, “I don’t know, but it’s on your schedule, so you need to take it,” I didn’t take it.

After I was put into a room, I was surrounded by seven machines of one kind or another, and I was hooked up to four of them around the clock. I literally couldn’t stand up to use my urinal without a lot of wires and tubes becoming entangled. Also, some of these machines had alarms that kept going off for no good reason. I finally insisted that the worst offender be disconnected, and after three hours of serious bitching on my part, it was.

My main physical therapist was an Aussie guy who didn't want to talk about anything but his diabetes and his desire to move back to Australia for the government run healthcare. I kept thinking: “I wish you were there now, dude; I wish you were there now.” If I had it to do over I would have asked for another therapist, but all it takes is a moment of weakness, and some selfish bastard will steamroll you every time. I’ll still complain about him, but doing so after the fact will be less satisfying.

I think that most nurses and doctors respect a patient more—and treat him better—when he’s not mindlessly compliant. As for the ones who are bothered by it, I assume they’re on a power trip, or else they’re so lazy that they resent being forced to actually think for a change.

I had my yearly physical just before my surgery, and, just for the hell of it, I called my internist “Doctor Kirk” (Kirk is his first name). I hadn’t called him by his title since I started going to him 21 years ago, and he looked flabbergasted. I interpret an insistence on being addressed by a title as indicative of a need to have people brown-nose you, so I guess it’s just as well that I’ll never meet the queen.

The anesthesiologist who performed my nerve block was so concerned because I’m “not narcotic naïve” (meaning that I take a lot of narcotics) that he came by twice on his days off to check on my pain level. I wanted to leap out of bed and kiss him. Doctors like that are to die for.

I’m pretty sure that a nurse stole some of my Dilaudid, but I believe you should be 99% sure before you formally complain about such a thing, and I was only at 98.5% (although I did mention my suspicions to her).

I’m sure that some of you wonder if I’m ever tempted to pray given that I’m in chronic pain and have had numerous surgeries. No, I’m not. When someone tells me that their oncologist had “given up” on their Aunt Matilda, but that god dropped by and healed her cancer, I think about how much more impressed I would be had god re-grown her missing leg, or eye—or even her missing toenail. Funny how religious people only pray for things that might happen anyway. Why is this, religious people? Why not ask god to raise the dead or at least re-grow teeth? I mean, jeez, how difficult could a bicuspid be?

Finally—and for the hundredth time—allow me to warn you against ever allowing yourself to be intimidated by a lot of diplomas and certificates, or by a bigger than life personality. I promise you, you will occasionally have an idea that is so brilliant yet so seemingly obvious that you will be appalled that the experts overlooked it. Yet, they did because even the most brilliant, caring, and educated people suffer from the all too human tendency of falling into a rut.

Surgery day

I told the nurse that the patient whose room she had sent me to wasn’t Peggy. She said that it was Peggy, but I still had to look at the old, pale, and puffy woman in the bed for awhile to be sure (I had told Peggy just before her surgery that she looked sexy in her purple hospital gown--which she did). My advice to you is this: if you’re supposed to be in a beauty contest one night, don’t have surgery earlier that day.

While I sat by Peggy’s bed, I pictured us when we were in our twenties, holding hands while we ran for joy across the prairie in Saskatchewan (I remember that day because we were nearly struck by lightning). Now, we hold hands while we hobble into doctors’ offices. Well, we don’t exactly hobble, but we’re getting there.

The universe never promised us an easy life.

The universe never promised us a happy life.

The universe never promised us a peaceful end to life.

The universe doesn’t even know that we exist.

We live for no purpose, and then we die, and the fearsomeness of this thought is why people believe in god.

I’m scheduled for my first of four joint replacements, which means that Peggy and I will be one-armed together. The surgeon and I all but argued—over Peggy’s bed, no less—about which hospital to use for my surgery. I said I wanted to go to Sacred Heart because I could have a private room at no extra charge, and he said he could use his influence to get me a private room at McKenzie Willamette at no extra charge (I have good reason for wanting a private room). “Besides,” he said, “I can give you far better care at McKenzie Willamette.” “Then it sounds like a no-brainer to me,” I said.

Peggy is resting now. I held her hair out of her face while she threw up. How many times have I done that over the last four decades? I’ll tell you. Many.

I just took two stiff drinks. I hurt so much that it’s hard to care anymore what I take or how much I take as long as it stops the pain. I’m not supposed to take narcotics until after my surgery because if I do, they won’t work when, presumably, I need them most. Well, hell, they don’t work that well now. Nothing works that well now, but if I pile pill atop pill and use ice, I can at least sleep a little bit before I have to get up and do it all again.

You don’t think I complain too much, or that I complain without a good reason, do you? Pain is such a private phenomenon that I often wonder where I am on the scale of having a justifiable response. This might surprise you, but I think I handle pain better than most people, but it’s hard to know for sure.

I read from Camus’ The Stranger while I sat by Peggy’s bedside (the morphine made her doze, so I had a little time on my hands).

“He was wearing a soft felt hat with a round crown and a wide brim, a suit with trousers that corkscrewed down around his ankles, and a black tie with a knot that was too small for the big white collar of his shirt. His lips were trembling below a nose dotted with blackheads. Strange, floppy, thick-rimmed ears stuck out through his fine white hair, and I was struck by their blood-red color against the pallor of his face.”

When I was young, such passages were about someone with whom I had nothing in common. Now, they’re about how I will be in fifteen years. Sometimes, I wonder if I will even live another fifteen years. Come to think of it, that’s about the length of a dog’s life—if the dog lives to be fairly old.

Nurses can tell that I adore Peggy, and that touches them. I asked one of Peggy’s nurses today if she will be my nurse when I have surgery, and she gave me her home phone number so I can be sure she’s working that day. She said that if she’s not working that day, she’ll refer me to someone who is. Now, I have my surgeon, my anesthesiologist, and one of my nurses all picked out. My advice to you is this: if someone is good at what they do, stick with that person, and let them know that you respect them. You get better service that way. As you know, I was kidding about the beauty contest, but I’m being serious now. While I’m giving you advice, I’ll also suggest that you praise good workers to their supervisors. One reason for this is that they’ll feel beholden to you, and the other is that you owe it to them.

Do ever feel when you’re writing that, after every paragraph, you could go in a dozen different directions. How do you choose? I choose really fast because otherwise I get too bogged down.

Those two drinks—taken on an empty stomach—were too much. I thought they might be, but I found it hard to care. Now that I feel as if I too could barf, I do care, but it’s too late. Most wisdom comes after the fact, but since the rules about a lot of things are forever changing, after-the-fact wisdom isn’t necessarily better than no wisdom at all.

Baxter's not the only one with problems

Peggy had an ovarian cancer scare last month after her yearly physical, but blood tests, two ultrasounds, and a visit to a surgical gynecologist made it seem unlikely. The only way to rule cancer out completely would be an ovariectomy, but her surgeon recommended against it. Peggy had initially said, “Get this thing out of me!” but she trusted her doctor enough to leave it in.

Yesterday, I went to my orthopedist, Mark (see photo), because my own pain has been through the roof lately. Of the many narcotics I’ve tried, I still have a good supply of Vicodin, Norco, Percocet, and Demerol, but none of them help much, and they sometimes make me very ill. I also have the sleeping pills Ambien, Lunesta, Restoril, and Dalmane, all of which work better than the narcotics.

When I go to a doctor, I usually give him a written overview of why I am there, and what I want done. Mark usually does everything I ask. Yesterday, he gave me a steroid shot in my left shoulder, a prescription for Tramadol (a painkiller), and a humongous prescription for the sleeping pill Dalmane (Dalmane is so good that I call it "The Great God Dalmane.") He also agreed to hyaluronate injections (a joint lubricant).

I love Mark. If there were only one thing that I could counsel you to do if you should need surgery, it would be to find a surgeon whom you trust technically and as a caring human being. I’ve had the uncaring kind twice, and I promise you, if you don’t like your surgeon before surgery (no matter how good everyone says he is), you will want to murder him after surgery when you are overwhelmed with pain and despair, and he doesn’t give a rip. I can’t overemphasize the importance of having a good rapport with your doctor. The following is what I wrote for Mark yesterday.

“Pain in my left shoulder still awakens me many times each night and requires ice. Pain in my right shoulder also continues to be a problem. At times, it bothers me almost as much as the left. Bilateral shoulder pain in combination with bilateral knee pain has made both hiking and handyman projects disagreeable if not impossible.

“I saw a pain specialist in April due to shoulder pain and to sunburn-like pain in both shins. My internist said I had Chronic Regional Pain Syndrome, but the pain specialist suspected syringomyelia, and prescribed Neurontin and Tofranil. They helped the shin pain but did nothing for the shoulder or knee pain.

“I am here to get your thoughts about the continued left shoulder pain in particular, and a recent and severe increase in pain in both knees and both shoulders.

“I would also like to discuss alternatives for pain relief. The narcotics I’ve tried don’t help much, and they make me itch too much to sleep. Sleeping pills continue to be my best option—especially Dalmane—but the pain still awakens me ten times or more times each night.

“I read that Tramadol is sometimes used for moderate to severe arthritic pain, and would like to try it. Ultrasound is another option, but I haven’t found anyone who uses it, and my PT said the home units are a waste of money. I would also like to talk about hyaluronate injections—read the enclosed info at your convenience.

“I’m wondering if steroid shots might also help, although I’ve had mixed results from them in the past. I’m especially concerned about any harm they might do to joints.

“I’m now more open to the possibility of partial shoulder replacements, although I had rather pursue any reasonable option before agreeing to a joint replacement.

“In the last nine days, I’ve intentionally lost four pounds to make things easier on my knees, and I’m experimenting with a gluten-free diet. Other ideas would be appreciated.”