The Day and the Hour Rapidly Approach

Men Sleeping in the Rain, Green Park, London, 1902

"It was a welter of rags and filth, of all manner of loathsome skin diseases, open sores, bruises, grossness, indecency, leering monstrosities, and bestial faces. A chill raw wind was blowing, and these creatures huddled there in their rags, sleeping for the most part, or trying to sleep....It was this sleeping that puzzled me. Why were nine out of ten of them trying to sleep? But it was not till afterward that I learned. It is a law of the powers that be that the homeless shall not sleep by night." (Jack London, from The People of the Abyss)
I've had one other joint replacement--my left shoulder--and am astounded by how different the required preparation has become. I got ready for that 2011 operation by going to a surgeon who looked at my x-rays and gave me a date for the procedure. A week prior to that date, I underwent blood tests, a brief visit with an anesthesiologist, and maybe an EKG. Here's what I have to do this time around:

In June, I had my first visit with a surgeon who looked at my x-rays and proposed a total knee replacement. A few weeks later, I spent an hour with my assigned "care coordinator." Ten days after that, Peggy and I attended a required two-hour joint replacement class. This Monday, I spent a combined ninety minutes with a medical assistant, a phlebotomist, an EKG technician, and an anesthesiologist. Today, I have a preparatory visit with the surgeon. So there you have it--many things to do, many people to see, many assigned exercises that I'm in too much pain to do, and a large binder of reading materials. I feel more unnerved than informed by all of this because it makes the surgery seem like a big deal, which it is, of course, but I could do with a few less reminders.

Before I had my first shoulder surgery, I made the mistake of watching the procedure on the Internet, and what I learned was that I have NO desire to ever again watch a surgery for which imagination alone will suffice. You might wonder why I am SO scared, and I've asked myself that same question. Aside from the risk of stroke, infection, weeks of pain and disability, and the failure of the new joint to bring relief, the thing that bothers me most is that I feel like a genetic weakling because so many parts of my body hurt so much, and because only one of the bone-related surgeries I've had (carpel tunnel) brought me significant relief. After this knee replacement, I'll be having elbow surgery, and then there's the likelihood of more shoulder surgeries. Even if I am so fortunate that these things help, I'll still live with significant back pain, and I'll still live in fear that my narcotics will be taken away. Ergo, I have no hope that I will ever be without pain and disability, and the fact that I'm about to do something that, for a couple of months, will add to that pain, makes me tremble.

On the bright side, I recognize that there is cause for hope based upon the skill of my surgeon and the advanced state of knee replacements. I tell myself that this surgery is just one more thing of many things that I have endured, or will endure, and that my life is a bowl of cherries compared to the lives of millions of creatures.

I'm a lover of Jack London, who made a career of writing about--and photographing--human misery, and who himself endured great pain toward the end of his forty-year life. I read him now partly because I need perspective, and I get it from reminding myself of the many millions of people who were--and are--far worse off than I due to the fact that they had no money, no safety, no shelter, no healthcare, little food, no loved ones, and no cause for hope. Compared to the misery of the humans and other creatures with whom London came in contact during his travels around the world, my problems are minor:

"From the slimy, spittle-drenched sidewalk, they were picking up bits of orange peel, apple skins, and grape stems, and they were eating them... They picked up stray crumbs of bread the size of peas, apple cores so black and dirty one would not take them to be apple cores, and these things the two men took into their mouths and chewed them, and this between six and seven o'clock in the evening of August 20, the year of our Lord 1902, in the heart of the greatest, wealthiest, and most powerful empire of the world." (op. cit.)


angela said...

Good luck on your pending operation
My friend has just had her second knee replacement in the last few months
And the rigmarole before hand was astonishing
She even had to bathe in special stuff to kill all the germs, good and bad, that live on our skin!
But if it helps with infection I guess it's worth it

Elephant's Child said...

You read Jack London and I continue my voluntary work. Both serve as reminders that we are better off than many. Despite that reminder neither take away our own pain(s). In fact, in difficult times that reminder makes me feel like a chronic whinger and inadequate...
Good luck with the surgery. I hope it goes smoothly and your recovery is swift and complete.

kylie said...

Great and powerful empires seem to be very bad at looking after their least fortunate.

I don't think you should be seeing yourself as a genetic weakling but as a man who has worked physically hard and is suffering the consequences of that.

You have my best wishes for a complication free surgery and great recovery.


joared said...

Hope all goes well for you with your surgery -- that you do ultimately have some pain relief. Genetics is only part of the picture for how our bodies age, often with some factors beyond our control despite the care we may or may not give them.

Emma Springfield said...

Try not to feel too bad about needing these surgeries. We are living longer than people used to live. Apparently our bodies have not adjusted to the new time span yet. Good luck.

Charles Gramlich said...

I hope everything goes smoothly. I'm a fan of Jack London myself, though I've not read this.

All Consuming said...

"On the bright side, I recognize that there is cause for hope based upon the skill of my surgeon and the advanced state of knee replacements." - Keep holding to that thought, and also seeing yourself being able to move more freely than you have for years with less pain. People heal better when they try to think positively because it means their bodies physically experience less stress, and stress is no friend to healing at all. Hugs and love to you dear. Xxx

Snowbrush said...

My visit with the surgeon went well. He and my previous joint surgeon (who moved to Denver) both looked like jocks (heavily muscled with close-cropped hair), and I went through school hating jocks. However, these two guys have taught me that being a jock doesn’t necessarily equate with being an arrogant moron. The first time I met this doctor (Brian is his name), he said he would prefer to do the surgery on an outpatient basis but that Medicare requires at least a one night in the hospital. Yesterday, to my horror, he predicted two to three nights in the hospital. I didn’t ask him about the discrepancy because I never want to make a doctor think I doubt his judgment unless it’s a matter of importance. I feel this way partly because I want to get along with people, but also because it doesn’t matter whether a person is a surgeon or a carpenter, he (or she) does better work for people who believe in him and don’t question him too closely about things that aren’t very important. How long I’ll be there depends a good bit on how hard I kick about getting out. My guess is that his desire to keep me there comes from getting my pain under control due to the fact that I already take narcotics. One downside of longterm narcotic use is that they make a person more susceptible to pain, and because I’m also in pain from other sources, I told him yesterday—prior to his two to three day pronouncement— that I worry about being in unmanageable pain.

“She even had to bathe in special stuff to kill all the germs, good and bad, that live on our skin!”

I’m supposed to bathe my whole body in liquid antibacterial soap everyday for a week, in Betadine every night for three nights, and, just before surgery, they’ll swab the inside of my nose with yet another germ killer (these measures would be even greater if I had ever had MRSA). If you get an infection in an artificial joint, odds are that the joint will have to be replaced, and germs gravitate to those area in which flesh and implant come together. There is also a concern about all the new antibiotic resistant germs. It’s a credit to our medical system that any of us emerge from the hospital alive.

Snowbrush said...

“In fact, in difficult times that reminder makes me feel like a chronic whinger and inadequate…”

Well, damn it to hell, Sue! For years now, I’ve completely hinged my own courage and resolve to your good example, and only now do you confess that you’re a coward and a whiner! Seriously, I would have you remember that some of those things that come easy to healthy people come hard to you, yet you have made my life—and the lives of many others—better. How have you made my life better? By caring for me, by being loyal to me, and by validating my feelings. I’ve heard you say that you are often judgmental and harsh, and while I don’t know to what extent this is true in your face-to-face life, I’m very aware you’re more than that.

Peggy is away this week, and I’m glad for it because the pain, the fear, and the sleeplessness that accompany the pain and the fear are making me so wretched that I’m glad she can be spared my company, and that she can do it while rooming with a friend as the two of them pursue an interest that they both love (she’s at the clothing button collectors’ national convention in Wisconsin). I want to be a strong and worthy husband to her, but sometimes my life is such a burden to myself that I don’t feel that I have much to give, yet your physical problems are surely many times worse than my own, but this doesn’t prevent you from giving good things of yourself. Hence, you do serve as a worthy example for me, and I very much celebrate your existence.

“I don't think you should be seeing yourself as a genetic weakling but as a man who has worked physically hard and is suffering the consequences of that.”

Well, my father worked a whole lot harder and held up a whole lot better without eating right and without ever wearing dust masks, goggles, hearing protection, or handling toxic materials in a safe manner. Even so, I agree that the term genetic weakling lacks objective merit. It’s simply expression of unhappiness and frustration that largely comes from invalid comparisons. So much of whom we are when we are born and what we become as we go through life is but a matter of luck. An unforeseen occurrence can leave any of us dead or infirm in the space of a heartbeat, and am convinced that in the final analysis, all that really matters is virtue because without virtue a person can have health, strength, and every other advantage, yet leave the world a worse place than he found it. I would offer Donald Trump as a example of someone who could have done so much good, yet he has used his many advantages in such a way that it would be have better had he not be born.

“Genetics is only part of the picture for how our bodies age, often with some factors beyond our control despite the care we may or may not give them.”

This knee has bothered me since 1986 when I injured it, so I know what you mean.

Elephant's Child said...

Thank you. I think this is the first time I have been held up as a good example. More seriously I will try and remember your kind words next time I am having an attack of the inadequacies and/or beating myself up because 'normal' people manage what I can't.

Sue in Italia/In the Land Of Cancer said...

I wish you well during this surgery and hope your recovery is speedy and uncomplicated. I am sure Peggy didn't marry you for your joints. You have plenty to offer her: Compassion, affection and intellect come to mind.

Strayer said...

Sometimes less information is easier. Really, all those appointments and meet ups prior to surgery? That's never happened to me. My back surgery in 2005, I will ill prepared at home after and was released without a plan, wheeled out with no clue what awaited. I got stuck on my toilet, couldn't get up. Couldn't take a shower, or bend over and pick anything up. Being alone, the learning curve on how to survive post back surgery was severe. I got along. Cut the bottom from a lawn chair to put over the toilet, so I had arms for leverage so I could get up. Another lawn chair went in the shower....etc. I hope the prelude to this surgery you are having doesn't mean it has high failure rates? I think I would worry more about infection than other things.

Snowbrush said...

In listing preparatory precautions before surgery, I forgot to mention that I’m supposed to change my bedcovers on each of the last two nights that I’m home

“We are living longer than people used to live. Apparently our bodies have not adjusted to the new time span yet.”

Dying young can spare a person a lot of misery, and extending the quantity of life is of questionable merit if it doesn’t also extend the quality. I often think of how much people use to suffer, not just before joint replacements but even before the ability to the properly set broken bones. I talked to a woman in the doctor’s waiting room who said she was born with her hips dislocated. Those who are born today with her condition can be diagnosed early and spared surgery (by wearing supports for many months, the purpose of which is to force the baby’s hips into their sockets). Unfortunately for her, she wasn’t diagnosed early, and the modern treatment didn’t exist, so she has had several surgeries, and has come out of them with one leg two inches shorter than the other.

“I'm a fan of Jack London myself, though I've not read this.”

I would have bet money that you like London. “People of the Abyss” is a straightforward account that surely created a sensation in England. I have a friend who lives in Manchester, and has sent me two books about 19th and early 20the century poverty in that city. I should think that the lives of many people in England back then were in some ways harder than were the lives of slaves in this country because slaves at least represented an investment, and hence there was a financial reason to provide them with life’s basic necessities, whereas few people in England were invested in whether that nation’s poor lived or died, and as today, they were blamed for their poverty. I think that if the Republicans had their way, most if not all social programs would be eliminated, and we would be back to those days. London made the claim that it was a criminal offense (morally) for the destitute of England to even have children, and it would certainly seem so to be. He wrote of one woman who killed her three small children and then herself because she could neither feed them nor put a roof over their heads.

Snowbrush said...

“People heal better when they try to think positively because it means their bodies physically experience less stress…”

I believe that this is true, but I also think that it’s important to not take it so far that the sufferer ends up being blamed for his or her suffering. After having abdominal pains for years, Peggy had a hysterectomy, and while she was still recovering, some idiot told her that she (the idiot) would never need a hysterectomy because she would never get into the negative mindset that—in her imagination—causes disease, but that even if she did, she would be able to turn the problem around without medical intervention. I would guess that you too have gotten comments from people who thought that your problems are somehow caused by negativity, yet you’re one of the more positive people I know, especially given how much you suffer. Anyway, I agree that a positive attitude does indeed promote healing, but I don’t know how to bring it about. Staying busy helps, and one of the fears I have regarding this surgery is that I won’t be able to stay physically busy for at least six weeks.

Just last week, I had the doc increase my dose of Remeron (it’s specifically for “major depressive disorder”) from 30 mgs to 45, which is the maximum. Peggy is not just supportive of me treating my depression, she’s insistent upon it because she says I’m over-the-top hard to get along with when I’m depressed. Specifically, in regard to how I relate to her, I take things too personally. In how I relate to other people, taking things personally isn’t so great a problem because I’m not as invested in their approval of me. What is a problem with other people is that, as you’ve pointed out, I can be tactless. I will sometimes say something, and can tell by the look on the listener’s face that I might have worded it better. The thing is, I don’t know to what extent depression is behind this.

I try to counter my problems in how I treat people by performing little kindnesses. I don’t mean to say that I only do this as a self-centered way to counter my bluntness; I do it because I want to make other people feel happy and appreciated. I’m going to boast a bit so that I can communicate what I’m talking about. Last week, I found reason to praise three different people at there different businesses with their supervisors. On Friday, I was working out in the front yard when this fellow biked up to me and asked if I would pay him $10 to paint my house number on the curb. I consider house numbers on curbs a waste of paint, so I said no, and he got on his bike (he was pulling a trailer with his supplies) and left. I immediately reflected that here was a very poor man who was at least trying to something in a courteous and dignified way in order to keep food on the table for himself and his disabled wife, so I jumped in the car and went after him. I never do big things, never make grand gestures, but I can at least do small things that cost me nothing and can be completed within seconds or minutes. The older I get, the more important such things are to me, and the more I believe that they have the potential to matter greatly. Just having a stranger wave at me when, for example, I’m out in the yard can mean so much when I’m despondent. I fully believe that it would bring me dishonor if I didn’t repay such the kindnesses that people show me by passing them along to others. The more I have reflected upon the matter, the less I believe that small kindnesses only bring small results. In fact, I am confident that lives have been saved because it takes so little sometimes to encourage a person.

Snowbrush said...

“I think this is the first time I have been held up as a good example.”

As turns out, I got you mixed-up with someone else, so I guess you haven’t hit the first time yet, but keep trying. Actually, people like you make people like me feel like sissies. I’ve read at two accounts of people who killed themselves while still in their fifties because they could see a reduction in their physical and mental strength, and they knew that things would keep going downhill everyday that they lived. Yet here you are, not only the “victim” of the years (as we all are) but the victim of MS (just having MS means that your suicide rate is double the average). My hats off to you. I didn’t expect my own life to be this hard at age 68, but if I hadn’t fallen off that ladder and broke my back, things wouldn’t be so bad because the knee is remediable, and the shoulders are mostly endurable. Just that one careless moment, and I’ll be in pain as long as I live. Bummer. As to suicide, I’ve thought about it much, and while I’m nowhere near it, I can foresee doing it at some point. For example if I had Alzheimers; or if my pain were enormous and I could do nothing to relieve it; or if Peggy should die; I would be at risk. I’m fairly certainly that I wouldn’t choose to live if the first two things should happen, but I suppose it’s possible that I could survive her loss. After all, I have the cats to think of, and I also have my few friends. It’s discouraging to people when a friend kills himself.

“I am sure Peggy didn't marry you for your joints.”

Just as I didn't marry her for her soft brown eyes, or for her brown hair that reflects an auburn tint when the sun hits it, but I’m glad she has these things. It’s funny that some of what I love about Peggy’s appearance are things that she grew up regretting. For example, she hated her hair because she wanted it to be wavy. She also wanted her teeth to be straight. I grew up with wavy hair and despised it, partly because I couldn’t do anything with it, and partly because when you’re a boy, and woman after woman tells you that your hair should have been on a girl, you want to make like an ostrich and stick your head in the sand. I love Peggy’s straight hair, so imagine my horror when, many years ago, she got one of those tight perms. Thankfully, she didn’t like it either. As for her teeth, they’re not so crooked that anyone but she notices them, and, as to their appearance, I wouldn’t want them to be different. They make it a bit hard to do things like bite into an apple, and while I regret that, I wouldn’t prefer them just as they are.

More later…

Snowbrush said...

"I wouldn’t prefer them just as they are."

I meant to say that I wouldn't want to be different. Sometimes, editing for clarity causes what I write to come out muddled.

Elephant's Child said...

I do understand exactly why you retain suicide as an option. And hope that you can avoid it.

Winifred said...

I hope it all goes well Snow. I remember when my son was having open heart surgery and we had to put the antibacterial stuff in his bath on the night & morning before his operation. After the operation when he was recovering he asked me why there wasn't a toilet in the bathroom & I explained it was to reduce the risk of infection from the germs in a toilet. Well he said when I saw there wasn't a loo I just had wee in the bath!

Sad thing is that in London like all big cities now there are still people sleeping rough but not in Green Park, mainly doorways. I was shocked a couple of years ago in Boston when I saw blokes lying around on the Common. You sadly see it everywhere.

Best of luck with the op!

Snowbrush said...

“Really, all those appointments and meet ups prior to surgery?”

The only one that was largely a waste of time was, oddly enough, the class. If it had been a small group that was focused on knee replacements only, it wouldn’t have been bad, but it contained 25 to 30 people who were having different replacements, and no one got to meet anyone.

“My back surgery in 2005, I will ill prepared at home after and was released without a plan, wheeled out with no clue what awaited.”

I can’t imagine what you must have gone through, or why it happened as it did. Might it have been that way because you were on Medicaid? When I saw the surgeon last week, his first question was, “Where are you going after the surgery?” by which he meant home or to a rehab facility. When I said home, he asked who would be staying with me. If I had said no one, I’m confident that he would have cancelled the operation, as I think he should. He then asked if I had arranged for physical therapy, and, fortunately, I could answer that question satisfactorily too. It’s common anymore that I can’t even have many outpatient procedures without someone being there to drive me home (orthovist shots for example), and I don’t mean a taxi. I saw a woman being turned away from a simple procedure because she had planned to drive herself home. No doubt, a part of this concern is the fear of lawsuits, but I would hope that it is also comes from a genuine interest in the welfare of the patient and, in the case of the patient driving, whomever the patient might run over. I’m actually pretty impressed with Slocum right now (I’m assuming you know of it). I had one surgery there years ago, and went to three of its doctors (and hate two of them), so I had low expectations this time around, but so far so good.

Snowbrush said...

“I do understand exactly why you retain suicide as an option.”

I would hate being a burden, and I would hate wasting Medicare money (Medicare is government health insurance for the elderly and disabled), as would happen in spades if I had Alzheimers. In the case of Peggy’s death, it makes sense to me that a young man would make every effort to rebuild his life (I know I would have), but the older I get, the more I realize that I wouldn’t have time to rebuild my life if she should die. In other words, I would grieve intensely everyday until I died. The fact is that we men need you women more than you need us, which is why we die like flies upon the death of our spouses. It’s a funny thing how we men imagine ourselves to be the strong sex when we are young, only to grow old and discover that the only we were ever stronger was in brute muscle strength, and what good is that except for things like moving furniture around? Peggy isn’t just my partner, she’s my purpose in life. I can’t even say that we get along especially well much of the time, but there still exists a very strong bond between us. I spent my first 22 years without her, and my next 46-years with her, so how could I possibly go on if I lost her? I would hope I would do my best, but I just don’t know… As for living in pain, I’ve experienced enough of pain to know that there’s pain that’s a distraction and then there’s pain that’s so consuming that it’s as if nothing exists in the entire universe but it and me. The former I can handle, but I can’t imagine anyone who wouldn’t kill themselves if they were experiencing the latter without hope of relief.

“Sad thing is that in London like all big cities now there are still people sleeping rough but not in Green Park, mainly doorways.”

It is my understanding from different sources that the poor of England back in Victorian times had it even worse than the poor in America (although my father, who was born in 1909, told me of growing up among people who didn’t always have food on the table). Now, it is probably the reverse, but even so, there is now some degree of help in both places for many people who would not have received help back then. When I consider the secularism of the UK, I wonder how much of it originated in the fact that the church there simply didn’t care about the lives of the impoverished. Now, it’s that way here. There is, of course, diversity in American Christianity, but even so, Trump’s primary support comes from those parts of America that most identify as Christian, and in which the citizenry tends to blame the problems of the poor on laziness (as did the Victorian church in England). I believe that the church here has made a grievous mistake in allying itself with conservative politics because to the extent that the latter fails, the former will follow. It is a great wonder to me how people can, on the one hand, claim to follow Jesus and then turn right around and vote for men like Trump, but they do it by the million, and I believe it shows their religion for the lie that it is. If there is anything that is a greater mystery to me than how people can believe in a benevolent deity in the first place, it’s how they can do it and then justify voting for a political party that only excels in being callous and mercenary.

All Consuming said...

"How long I’ll be there depends a good bit on how hard I kick about getting out." - He will also be taking into account how well you do recovering from the operation istelf and from the mega drugs taken, especially because you are older than, well than someone younger I shall say, hahahaha. But this is true, so don't be running out before you are well enough, I;ll play the spoons on the street corner and get Rosie to tap dance for some pennies to send for an extraday if needed. (I am exceptionally good at the spoons, but Rosie is a better dancer all the same).

You are kind, and trying to be kind is kindness itself, the awareness of it. My comments have posted here so I hope this one does too. You are a sweetheart Snow, love from across the water Xx