Have you seen Blackbeard's gold hidden in this here cave?

If your idea of a good time is dropping a roll of toilet paper down the john and repeatedly trying to flush it, then you should just love narcotics because that’s what they do to the human excretory system. How can a person even want to get high on something that makes him constipated? It just ain’t dignified. Besides, pills are for sick people.

I thought I had stopped them yesterday (two days after surgery), but pain woke me up in the wee hours this morning, so I took first one Percocet and, when that didn’t work, another. I called the physician’s assistant today, and, to my great surprise, she said that most people take narcotics day and night for several weeks after shoulder surgery. She also said that patients tend to migrate from their beds to their recliners.

I was in such pain last fall that the only relief I could find was in a recliner that Peggy bought with her inheritance from her grandmother (and even then I could only stay halfway comfortable for a few minutes at a time). Now that I’m having to sleep with my lower arm sticking straight up into the air, maybe I will have to move back to Granny's recliner.

Peggy took a week off to stay with me, and I don’t know what I will do when she goes back to work—or when she leaves on her two trips in April. It’s not just the practical help; it’s having someone to keep me company now that there isn’t much I can do with myself. I can’t lift anything; I can’t take my arm out of my sling; I can’t even turn my palm up. If I break any of these rules, I risk pulling the stitches out, and that would leave me worse off than I was before the surgery. This is a state of affairs that will have to last for at least 42 days. The worst part is knowing that, no matter how careful I am, the stitches might come out anyway.

I’m enclosing some pictures of myself in my get-up. The black thing is my sling, and it comes with a thick pad that holds it several inches away from my body. The blue thing is a bladder that I have to fill with ice water several times a day. I wear the sling and the bladder all the time. The cooler is what the ice water stays in. I don’t always carry it in my hand as if I’m so stoned on narcotics that I think I’m in a cave holding a lantern.

You will note that I look like an axe murderer who is trying to pass himself off as a friendly sort of regular guy. That is because Peggy made me smile. If Peggy didn't make me smile, I would look quite handsome, but Peggy hates me and wants me to look ridiculous, so every time she takes my picture, she insists that I smile. I always say that I don’t want to smile, but she makes funny faces and silly noises until I do, and it is then that she takes my picture. People with cameras have been doing this shit to me for sixty years, and I hope they all fall down the shaft of the mine that I’m exploring with my lantern.

The hand-carved bowl on the wall was my Granny’s dough bowl that she received as a wedding gift on Sand Mountain in Alabama in 1896. It's made of the wood of the Tulip Tree. At a little under 200 feet, the Tulip Tree is the largest tree in the eastern U.S. and is the state tree of Indiana, Kentucky, and Tennessee. It also grows where planted here in the Willamette Valley. I’ll enclose a photo of its leaves and flowers.

Title to come later

I took two Demerol tablets and went to church today, my arm in its sling and the sling under Walt’s extra large pile jacket. My midriff insisted upon exposing itself from time to time, but I could neither get my arm through a shirt nor keep my sweatpants high enough to stay covered. Fortunately—for me anyway—I am not a modest person.

We discussed prayer. “If God is all powerful, all knowing, and perfect in every virtue, is it conceivable that he would cure someone of cancer or bring an end to a war because he was prayed to, but would not do so otherwise?” I asked. Most seemed to think so, but either they didn’t understand the dilemma I posed, or they had no answer for it. In any event, it was not addressed. A few expressed faith in prayer as a means of healing, but I reflected (to myself) that, despite the prayers of millions, many a pope has died well ahead of those who lacked such an advantage.

I told the class that I think of prayer as an opening of my heart as well as a meditation upon, and a dedication to, my highest values, but it was a definition that appeared to fall short in the eyes of many if not all, and I despaired of offering anything more to the discussion. Sometimes, I go to church and contribute greatly; other times, many people—including myself—seem to think I would have done better had I stayed home.

The question of teaching children about prayer was also touched upon. For the first time in decades, I remembered being too young to take communion at church, so I would pray and serve myself Welch’s Grape Juice and Premium Saltines at home. When I was ten, my family moved into town, and I built a wooden altar under a wisteria arbor. I set our big old family Bible upon my altar, preached to the neighborhood kids, and served them communion. My mother fretted over what God would think, but a preacher told her that God wouldn't object. It was about this time that a Negro deacon who worked with my father said that the Lord had his hand upon me, and that I would become “a great man of God” someday. His name was Truly Westbrook, and I felt sorry for him because he had to put up with endless profanity from my father.

Maybe I expressed myself badly today. I meant no disrespect, yet I must confess that I am often at a loss to understand people’s religious beliefs. They often appear, to me, to echo Tertullian’s statement about the Christian faith:

“…it is wholly credible, because it is unsound…
…it is certain, because it is impossible.”

In short: Credo quia absurdum—I believe because it is absurd.

Ataraxia, the only true happiness

He’s dead, he’s dead,
Hooray, hooray;
His surgeon killed him yesterday,
But his life insurance will quickly pay,
And with his doc I’ll gladly lay.

Oh, I think we’ll go to Borneo
Where there’s little risk of seeing snow,
And the brush it grows extremely low,
And wild, wild parties will we throw!

by the former Mrs. Snow

Actually, it was by the husband of the woman who got up every hour last night to ice his shoulder. Hopefully, you knew that. Such humor sets very poorly with people who don’t get it.

After reading what I wrote on Thursday, you might be challenged to believe that I went to bed feeling positive—almost cheerful—but I did. Your support was largely responsible, as was the support of local friends. I also sought the wisdom of Epictetus. The ancient Stoics, especially Marcus Aurelius (see photo), have often comforted me, and the worse off I am, the more effective is their counsel. As we turned out the light, I told Peggy that I had found my courage, as indeed I had. I even refused the “nerve pill” that I was offered at the hospital.

The surgery lasted two and a half hours, and Peggy was told that it went well. I awoke sometime later, eager to come home.

I worry that I am expressing myself poorly because of the drugs, and I am having a devil of a time typing in this sling, but I wanted to check-in, and I surely owed it to you to do so.

I send to you my deepest appreciation for your kindness, freshly showered by tears of gratitude.

It happens tomorrow

Mark (that would be my surgeon) takes his hardest cases first, and I’m first. I have to check-in at 6:00 a.m. He will remove a bursa, chisel down my acromium (a bone in the shoulder), sever and reattach at least one tendon, and possibly sever and reattach my biceps. He’ll try doing it all arthroscopically, but there is a possibility that he will have to cut me open.

If all goes well, I will be sent home tomorrow afternoon with my arm in a sling, and the sling fastened around my body. The sling comes with a thick pad that will hold my arm three inches away from my chest. I have to wear the sling day and night for six weeks. During the first two weeks, Peggy is supposed to use a weird looking apparatus to pump ice water around my shoulder once an hour for 25 minutes.

After the sling is removed, I will begin flexing exercises. After a month of those, I will (hopefully) be allowed to lift things that weigh a pound or two, and will begin strengthening exercises. After a year, I should have regained 90% of my strength and range of motion. Sometime during that year, I will start the process again on my left shoulder.

I’ve had twelve surgeries (or will have after tomorrow), eight of them since the year 2000, and three of them last year alone. I used to regard surgery as an adventure rather than something to fear. I’ll still grant that it’s an adventure all right, but if my fear were any stronger, I would have to be in constant screaming agony to let anyone near me with a scalpel. The reason for the change was that the more surgeries I had, the more I observed that things just never seemed to turn out the way they were supposed to. Based upon this, I’ve come to expect an unexpectedly bad outcome.

When I had my first fairly serious surgery in 2003, I got into an argument with the anesthesiologist about whether I needed something to calm my nerves pre-operatively. I said I didn’t because I wasn’t scared, and he said I did because anybody in my position would be scared. Now, I want all of everything as I lie there awaiting that gurney ride to the operating room.

Since learning what a drag chronic pain can be, I’ve gone out of my way to stash narcotics. I will actually endure considerable pain rather than take the drugs now at the risk of not having them at some future time when I might be truly desperate. I won’t do that this time because I expect the pain to be of such intensity that it might build to the point that the narcotics won’t be as effective. It’s like when you have a headache. If you treat it early on, you might be able to head it off (pardon the pun), whereas if you wait, you probably won't.

I wish I could think of something good to say, but the only thing that comes to mind is that it will be adventure. God knows; it will be that. And, hell, things might even turn out okay. A year from now, I might be feeling pretty good. Stranger things have happened…I guess. Well, maybe they haven’t. I wouldn’t want to run amuck with optimism here.

Eight days out

I struggle to make doctors see me as a person because my health is a very personal matter and because, if they see me as a person, they will do better work. For example, radiologists find more tumors after being shown pictures of the people whose x-rays they’re studying. My problem with getting doctors to see me as a person is that a lot of doctors, especially surgeons, are hell-bent on staying detached, clinical, sterile, emotionless. They regard a patient’s fear and suffering as an irrelevant and annoying nuisance rather than something requiring compassion. If possible, they would prefer that people just drop off whatever body parts are giving them trouble. I don’t play these games at all well, which is partly why Mark (I call doctors by their given names) is my fourth orthopedist in eleven months.

I gave him the following today. My surgery is next Friday. Mark said I’ll be first in line because he takes the more challenging cases first. I hope this means that he anticipates an easy day.


(Mark, Peggy and I went to the hospital yesterday for my pre-op, and I later wrote the following for my blog. Please don’t take it personally. It is not about you; it is about my fears.)

The clerk says that my surgery will cost $10,000, and that’s just for the O.R. and post-op care. The surgeon’s and the anesthesiologist’s bills will be separate.

The nurse says, “I see that you’re having rotator cuff debridement and tendon reattachment—that is SO PAINFUL. People who have had a lot of joint surgeries say it’s the WORST. We had to take my grandfather back to the hospital after his surgery because his pain got OUT OF CONTROL. Why do you think YOU have this problem?”

“It started in yoga, and was made worse by throwing tennis balls to my blue heeler.”

“Well, you’ll be throwing UNDERHANDED from now on, EVEN IF the surgery works.”

Nursey is TOTALLY UNHAPPY that Peggy is going on TWO TRIPS the month after my surgery. We try to explain that these are IMPORTANT trips that were planned LONG AGO, and that I FULLY support. Nursey frowns.

Nursey takes my blood pressure; it is WAY higher than it has ever been.

She takes me to the anesthesiologist’s “closet,” which really is smaller than your average walk-in closet. After a half hour’s wait during which we summon him twice, the anesthesiologist arrives. He looks BORED and SLEEPY, or maybe JUST BORED, or maybe JUST SLEEPY.

“May I have a nerve block instead of a general,” I ask hopefully. “I HATE being put to sleep.”

“No, but you can have both.”

“Both?”

“Yes, the block might not be enough without the general, but with the block, you can have a lighter general. Also, the block lasts half a day, so you will need fewer narcotics after you wake up.”

“Are there many risks with the block?”

“Just one big one really. It sometimes deadens the nerve that makes you BREATHE.”

“Uh, the nerve WILL WAKE UP again—right?”

“Well, they’re following patients now to see if any of them EVER recover.”

I wonder why “THEY” don't already know this. Nerve blocks aren’t NEW; are they? But I don't ask. I'm too busy developing FACIAL TICS and HYPERVENTILATING. I remember a documentary in which a woman was BEHEADED in a sports arena in Saudi Arabia, and I envy her because the physical part of her suffering was over FAST.

Peggy puts her hand on my arm. I assume she has a question. No, she's just trying to CALM me DOWN. Not that I'm EXCITED. I mean ALL I’m doing is turning my LIFE and my ability to BREATHE without a respirator over to a bunch of STRANGERS who I hope aren’t in the 50% of all doctors and nurses who are BELOW AVERAGE. If I’m REALLY lucky, none of my ABOVE AVERAGE doctors and nurses will be ALCOHOLICS, or have COLDS, or be in the middle of MESSY DIVORCES, or HATE MEN, or have stayed up all night PARTYING. MAYBE the MAJOR EARTHQUAKE that is FIFTY YEARS OVERDUE won’t hit, and MAYBE the anesthesiologist won’t SNEEZE while he’s injecting my NERVE BLOCK.

“Well, if a nerve block won’t do anything worse than destroy my ability to BREATHE, sure, LET ME HAVE IT. For dessert, I would like DILAUDID, FENTANYL, VICODIN, DEMEROL, and PERCOCET, all mixed together and smothered in a thick and creamy MORPHINE SAUCE. Oh, by the way, could your bring us some VALIUM STICKS?”

After finishing up at the hospital, we go to Fred Myers to buy EXTRA LARGE SHIRTS that will fit OVER my arm, and VELCRO SHOES because I won’t be able to wear a regular shirt or tie regular shoes, maybe for MONTHS.

I decide that I want a drink. Then I think that, no, I NEED a drink—a double. If liquor didn’t turn me into a bumbling, stumbling, dizzy, nauseated, cotton mouthed moron, I might come to like it. Even with these downsides, I like how I feel WITH IT better than how I felt WITHOUT IT.

“How about a nice movie to take your mind off things,” Peggy asked.

It might take a bit more than a movie, I think, but don't say anything.