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.)

How I Got Here

I'm 68, and spent my first 37 years in Mississippi, most of them in the vicinity of Brookhaven, a town of 11,000. By 1983, I was so fed-up with the heat, poverty, ignorance, provincialism, and my own sense of alienation, that I started looking for a new home. Because my biggest problem was loneliness, I spent most of the next two years visiting communes. Tension at home became high because of my almost constant traveling and my near constant womanizing, and Peggy also objected to my use of marijuana (for which people went to prison back then) and the occasional hallucinogenic.

I wanted her to accompany me on my repeated eight week forays that took me as far as New Hampshire to the north, Colorado to the west, and numerous places in-between, but she was unwilling to give up her job. She did fly to a few communes that I liked. One was in Richmond and another in Denver, but my favorite was a 35 person commune in New York City. It was called The Foundation for Feedback Learning, and the people there embraced me as I had never been embraced.

Although I visited a number of rural communes--including the 1,400 person The Farm in Summertown, Tennessee--I wanted to live in a city, and what better city than New York City? I was to New York City in general, and to the Staten Island commune in particular, like a duck to water. Because my accent immediately advertised where I was from, I had expected New Yorkers to hate me just as I knew that Mississippians would have hated them. I was instead treated like a lost rube who needed protection, not just by the people in the commune, but by the people I stayed with in Greenwich Village (lower Manhattan) through a travel organization called Servas.* The first person I met when I got off the train in New York was a black taxi driver from Alabama, and even he treated me, a white Southerner, like home-folks.

Unfortunately, Peggy felt unsafe in the grungy city, and she had no interest in the hours and hours a day that the people at the commune spent bearing their souls around a huge table and giving one another what could be uncomfortable "feedback." While we decided what to do next, Peggy joined the Traveling Nurse Corps and was offered a three-month stint in a cardiac telemetry unit at St. Agnes Hospital in Fresno, California. We loaded our Ford Tempo and moved into an apartment provided by St. Agnes in April, 1986. We loved Fresno until the 115-degree summer heat arrived. Being skilled in various building trades, I had planned to work as a house painter, but I hurt my knee so badly while playing sand volleyball with the Fresno Sierra Club that I spent all of our time there recuperating. It is that knee that I'm finally going to have replaced in August.

We had previously visited the town of Eugene, Oregon, and would have moved there had there been a job opening for Peggy. The attraction of Eugene was its cool summers, its liberalism, and its reputation as a paradise for people who were looking for alternative lifestyles, i.e. communes, open marriages, and group marriages. I concluded that a group marriage would be even better than a commune because everyone would be more intimate. I had been lonely all my life, and I thought that if I could be close to enough people, I would never be lonely again. 

About the time that Peggy's job ended in Fresno, a permanent opening came up in the intensive care unit at Sacred Heart Hospital in Eugene. She got the job, so we left the Tempo in an acquaintance's driveway in Eugene and flew back to Mississippi to gather our belongings. We made the move in a U-Haul truck, and enjoyed ourselves thoroughly except for the evening that we crested a hill south of Amarillo and slammed into a load of brush that must have fallen off a pick-up. Right away, we smelled anti-freeze, and Peggy started to pull over. I told her to keep driving until the motor started to overheat, and we were able to reach a truck stop.

I had more friends in Eugene in a month than I had in Mississippi after decades. It was still a hippie town back then, and a person could literally make friends walking down the street. Moving to Eugene seemed downright exotic for a country boy from the Deep South. One of my first realizations was that everyone I knew had moved here from another state. When I told one of my new friends (a newcomer from the Bay Area) that Eugene was the first town I had lived in that had a good library, he thought I was joking, his basis for comparison being San Francisco. 

There was so much to love about Eugene that everyday was a wonderful new adventure. In Mississippi, if I wanted whole grain bread, I had to bake it, and the only flour I could find was wheat, while Eugene had several whole grain bakeries and numerous alternative grocery stores that carried grains like spelt and teff that I had never heard of. And instead of summer days being humid and 95 F (35 C), they were more often 75 F (24 C), and if I was out early or late, I needed a jacket. Everywhere I looked, I saw beards, tie-dye, long hair on both sexes, and Birkenstocks. Rather than supporting the war in Vietnam, demonstrators in Eugene had occupied university buildings and burned the draft board. Instead of the only radio stations being commercialized Top 40; Eugene had five commercial-free stations that played everything from talk, to rock, to reggae, to Big Band, to Baroque, and so on. Indeed the inspiration for this post came from listening to a program of classic rock while I did yard work on Saturday (Nazareth's version of "Love Hurts" put me in instant tears, and I hadn't heard "Pictures of Lily in decades).

Within months, Peggy and I moved from a tiny apartment, to a duplex, to owning a house, but within two years of coming here, we "married" a woman named Vicki (our wedding included a ceremony, a cake, and a reception). I had met Vicki during my first summer in Eugene when we both worked at the University of Oregon, but she had since moved to Minnesota to pursue a doctorate in sociology. Meanwhile, Peggy was in pain from moving all of those unconscious patients around in the intensive care unit, and requested a transfer to labor and delivery. When Sacred Heart refused, she started looking at other employment options. I didn't want to move to Minneapolis, but with Vicki there and Peggy able to get an immediate job in an antepartum unit at Abbott Northwestern, I felt that I had no choice. We put our Oregon house on the market, bought another house in the Minneapolis suburb of Richfield, and loaded our belongings into a 24-foot Ryder truck behind which we towed our car.

We arrived in Minnesota in late October, and the first snow fell within the week. I remember driving on a freeway in Minneapolis while imagining that no one really lived in such a shitty climate, but that the whole existence of the city was a joke on me. I don't mean to say that I believed this, but it does illustrate my astonishment that anyone would choose to live in a place that got so cold that a daytime high of zero (-18 C) came to seem downright balmy if the day was windless and sunny. Really cold was -20 to -30 F (-29 to -34 C), which was so cold that I would put on a coat to take the trash out although the garbage can was ten feet from the door.

Vicki and I soon began fighting constantly, so two years after leaving Eugene, Peggy announced that she was going back to Oregon, and I could come if I pleased. The decision was a no-brainer. Peggy flew back first and moved in with two friends, and I flew out a little later to house shop. After finding a place, I returned to Minneapolis and continued to live a hellacious existence with Vicki until the Minnesota house was sold. I then rented another Ryder truck, which I loaded and drove alone.

If I had it all to do over, I would most certainly leave Mississippi again, but I probably wouldn't move 2,500 miles to Oregon, because that much distance makes it impossible to remain close to friends and family, watch nieces and nephews grow-up, and so forth. I miss the South, and while I wouldn't want to live there, I would like to visit. Living in Oregon means being in one corner of the country, and far from the rest. It's not so remote as Alaska or Hawaii, but it's in that direction. Finally, the Eugene metro area has more than doubled in size; gangs have moved in; and although pot is now legal, meth, crack and heroin have displaced acid. Whole Foods and Costco have overwhelmed the little alternative stores; and instead of the lead story on the local news being a house fire, it's more often a murder. 

On the bright side, there has been a peace demonstration in Eugene every single week since the U.S. invaded Iraq in 2003, and even though I haven't attended a protest in years (I used to go weekly), I take inspiration from the fact that Eugene has thirteen peace groups, forty-four environmental groups (including chapters and agencies), several atheist groups, and thirteen LGBT groups as well groups that support the rights of nonhumans.** Such things are like the 40-million year old mountains that surround Eugene (Eugene Skinner, the town's founder, compared the town's site to a bird's nest) in that they make Eugene the special place that it is. Last week, the area held its annual Country Fair (envision full-tilt freakishness)***, and the month-long Bach festival started in June. As with Eugene's opera, ballet, and symphony, these are things that I value though I never go. 

A new poster a year

When I moved here, I found people who believed that there was something unalterably radiant about Eugene in particular, but to a lesser extent, the whole of Oregon. One of my new friends said that if I hadn't already felt the magic in the air, I soon would. Everyone who came here wanted to shut the gate behind them for fear that Oregon would become like the places they had fled. It was an era of billboards and bumper stickers like the one at the top of this post, and an organization called the John G. Baine Society that did its utmost to keep new people out--as did Oregon's "environmental governor," Tom Mccall. Eugene tried to limit industry and outlaw big box stores. The town was no less naive than I. 

Despite its growing problems, Oregon is still a good place to live in a world that contains fewer and fewer good places. From my perspective, if an area doesn't have one fatal flaw, it's likely to have another. If it's not the heat, it's the cold; if it's not the standard of living, it's the boring topography; if it's not too few people, it's too many people. The worst thing I can say about my part of Oregon--the Willamette Valley--is that it has become too crowded, that its winters are long and drizzly, and that it doesn't have a long recorded history because it was only settled in mid-1800s. or evidence of past inhabitants. On the plus side, temperature extremes are rare in Eugene; Oregon was inhabited by humans as long ago as 15,000 years; and we lived but an hour's drive from places in which we might not see or hear another person for days. Although we're but a ten minute walk from the heart of downtown, we regularly see raccoons, nutria, and Great Blue Herons; our neighbor just put up a fence to keep deer out of her garden; mallards often land in our front yard; we've seen wild turkeys in our backyard; and, in some years, river otters inhabit the canal across the street.

Oregon has more square miles in public lands (both state and federal) than most states have square miles. I can reach a Pacific Ocean beach (every beach in Oregon is owned by the public) in an hour; be hiking in the Old Cascades in less than that; and the high desert that occupies two-thirds of Oregon is but two hours away. Oregon's climate ranges from mild to Arctic; its precipitation from desert to rainforest; its elevation from sea level to eleven thousand feet.

Epilogue (as the screen read when The Fugitive ended****)

Peggy and I still live in the house that we bought upon our return from Minneapolis in 1990, and we'll be celebrating our 46th anniversary in December. When I looked Vicki up a few years ago, she was Dr. ___ and living on the East Coast. As for the NYC commune, my web search showed that it still exists, although the name the commune goes by differs from its non-profit business name, which is what I knew it by. Some of the people whom I knew are still there: http://ganas.org/ .

Peggy used to keep an Ashleigh Brilliant card on the fridge. It read, "Believe it or not, my life is based upon a true story." Our lives are less exciting now; we have fewer adventures to look forward to; and less energy and optimism with which to live on what we and our friends used to call "the cutting edge of the psycho-social frontier." It's a time for reflection, gentleness, and living at the speed of our cats, because god knows we've been through enough craziness and drama. We both have some regrets, and I certainly made many mistakes along the way, but I couldn't see down a road that I hadn't yet taken. Wishful thinking combined with idealism will do that to a person.

* https://usservas.org/
** http://getinvolvedineugene.com/ 
*** https://www.oregoncountryfair.org/
**** http://www.imdb.com/title/tt0056757/?ref_=nv_sr_2

A wee little surgery

I’ve seen so many orthopedists over the years that I’ve lost count. Yesterday, I went to a new one for my left knee which has bothered me since 1986, after a game of beach volleyball. I came away from that game with a Baker Cyst (a fluid-filled sac on the back of my knee) and was in so much pain that I could only walk slowly and with a limp for weeks. The limp went away, but the Baker Cyst often swelled to the point that it was visible. By 2006, my knee hurt so much that I had a surgical meniscus debridement, which didn’t help and during which (I was awake) the surgeon broke my heart by suggesting that I give up hiking. I’ve since been on various NSAIDS, had innumerable steroid injections, two series of orthovisc injections, and a RFA (radiofrequency ablation). I’m now to the point that I don't even take short walks, and even with that, I'm limping by evening each day.

Those of you who recall my three shoulders surgeries, might suspect that I’m a fan of surgery, and indeed I used to be. “Have a problem—cut it out and get on with your life,” I thought. And indeed, that philosophy worked for the first ten or so surgeries that included the removal of anal polyps, oral cysts,  tonsils, and a whopping neuroma on right thigh. Carpel tunnel repair was a breeze, the first surgery on my nasal septum didn't cramp my style, but that changed when it had to be redone at the Oregon Health Science University in Portland as a part of a massive surgery on my sinuses, turbinates, and septum. I had insisted on remaining awake for every surgery but the tonsillectomy. Then the day came when a surgeon took a biopsy of an osteonecrotic cervical vertebra by putting a scope through my throat, and she said there was no way she would do it with me awake. My combination hernia repair and lymph node biopsy was no fun either, and when the doctor refused to give me adequate narcotics, I went down to his office without an appointment and sat there until he did.

Then came those three shoulder surgeries that included such strange sounding elements as subacromial decompression, supraspinatus repair, biceps tenodesis, humeral head resurfacing, and a partial joint replacement. I was in such pain prior to these surgeries that I had to sleep sitting up with ice packs draped over my shoulders, and I was in such pain after them that I had to sleep sitting up with ice packs draped over my shoulders. I wasn’t even allowed to lift a toothbrush for the first six weeks after these surgeries, and nothing over five pounds for the next six weeks. The recovery time was between six months and a year, yet my shoulders still hurt so much that I worry that I might have to return to sleeping in a chair. 

So, I’ve lost my faith in surgery as a quick fix. In fact, I'll never again go into surgery with overwhelming confidence that I’ll emerge alive. After all, the odds of dying from a clot, a nosocomial infection, a pierced organ (a risk during shoulder surgery), a medication error, or the incompetence of any one of the scores of people who have the opportunity to kill me are significant.(https://www.usnews.com/news/articles/2016-05-03/medical-errors-are-third-leading-cause-of-death-in-the-us).

The new doc is tall, muscular, and dripping with testosterone. In Peggy’s words, “He’s full of himself.” Indeed, he needed a mop to clean up his arrogance. He walked briskly into the examining room, took my hand, and stood staring into my eyes as if sizing me up, but sizing me up as what—a man? A patient? I was already upset over a fight with Peggy about a missed highway exit, and feeling like a weakling because I’ve needed so many surgeries. This meant that I was hardly in the mood to deal with a doctor who seemed to regard himself as my overall superior about a problem that I’ve had since he was a lad, but since I had waited for months to get in to see him, I had to do my best. It helped that there were things about him  I liked. For instance, he introduced himself by his first name (Brian); apologized for being late; agreed to my requests (more about them later); is highly rated on the doctor-rating sites; and did his fellowship in adult joint reconstruction at the Anderson Orthopedic Research Institute. I considered his profanity unprofessional, but it certainly went with his macho shtick.

After a brief exam, Brian proposed a full knee replacement. I was agreeably surprised because, since I was a new patient, I had expected the same-old-same-old: a steroid shot, a prescription for an anti-inflammatory, a referral to physical therapy, and the words, “We’ll talk again in a couple of months.” 

I made four requests of Brian: that I could remain awake during surgery; that he would give me a steroid shot to help tide me over until August when I’m ready to have the surgery done (which is the earliest he can do it anyway); that he give me whole lot more post-surgical narcotics than I’m already taking (he said he would double the amount for the first six weeks); and that he give me a prescription for a brace. He agreed to these requests, but I didn’t get the brace because the one they had wasn’t as good as the two that I already own (I’m an hardcore hoarder of medical devices).

Brian is my second orthopedist this year. The first was Alex, and Alex advised against surgery because, as he put it, “Your arthritis just isn’t that bad.” Since this contradicted what every other doctor had said (ten years ago, one had even told me that my knee was in such bad shape that it might collapse out from under me), I asked Brian what he saw in Alex’s X-rays that might justify Alex’s opinion. “Nothing,” he said. “Then why would Alex say it?” “Because he’s unwilling to take on difficult cases.” “Me difficult—but why?” Because you’ve been in knee pain for a long time, because you’re in pain from other sources, and because you suffer from depression.” Such factors could put me among the 5% of knee replacement patients who surgery doesn’t help. 

I try to cheer myself by being grateful that I at least have access to surgery, there being millions of people and other animals who have no choice but to suffer until they die, and some of them will die sooner rather than later because their problem makes them unable to support themselves. Yet, I'm tormented by the knowledge that I'll be going  from being unable to do many of the things that I would like to do because I have a bad knee to being unable to do them because I have an artificial knee. That is why I've waited so long to have the replacement, that and the knowledge that in a mere ten or fifteen years, I would have to have the replacement replaced, and that there would be less hope that the revision would work as well. Brian did have good news on that score. He said that the two metal parts of the joint would last me a lifetime, and that the plastic part should last for many years after which it can be replaced in ten minutes. Maybe I did well to put the surgery off for all of these years, but I sure do dread it now. I suppose it makes sense that past surgeries would leave me less fearful of additional surgeries, but the truth is that they make me more fearful. I think of them as like playing Russian Roulette.