There’s a way, but is there a will?
By Tom Wade
As I was wheeled into the operating room, I heard Lionel Richie's inimitable voice, loud and clear. Across the room from me, I saw four or five people dressed in scrubs waving their hands over their heads, swaying to the beat. I wasn't hallucinating. These performers were nurses and physician assistants (the doctors weren't there yet). Their antics, or perhaps ritual, culminated the preparation phase for a procedure that I hoped would end the constant, though fluctuating, pain.
I had arrived at the hospital surgery centre at 5.30am that morning. From entering the front door to anaesthesia, I was directed or escorted each step of the way, starting with a greeting from a calm, sympathetic person. Soon thereafter, I was in a bed and changed into a nightgown; then came a series of encounters with nurses and other staff confirming my identity (multiple times), informing me about what will be happening now and later, taking vital signs, and loading me up with drugs for pain, nausea, muscle tightness, and the other effects of having the top of my femur replaced with a titanium ball fitted into a ceramic socket in my pelvis.
I rested in the bed for about 20 minutes before being wheeled into the operating room at 7.35am. As I rode a gurney, for what seemed like 40 yards or more, down a well-lit hallway, I was entertained by the back and forth bantering of the attendants guiding my rolling cot. They said something about a Lionel Richie theme – comments I presently came to understand. The couple of hours following the music and dance interlude were a blank, and the rest of the day after that a blur.
Osteoarthritis can be the product of bad genetic luck or physical wear and tear, with the odds of either cause at 50 percent. In my case, which is the norm, it came on gradually. Most of those afflicted with arthritis are over 45, and a third of the people over 65 are symptomatic. The cartilage allowing my hip to smoothly rotate had become pitted and frayed inducing stiffness and aches. But treatment, ranging from lifestyle improvements to several surgery alternatives, is available to sufferers. The option for the most serious cases is getting a new hip. While estimates of longevity for the artificial joint are currently 25 to 30 years, it can't sustain the same impact a healthy hip can absorb. But the pain ceases and the recipient can lead an active life, just no marathons or aggressive basketball games.
For the past six or seven years, the morning's first 10 minutes were, for me, the worst part of the day. The hurting was so intense I could barely drag my left foot as I shuffled over 15 feet of hardwood floor to the bathroom. Although the aching subsided after moving around and working out, it didn't cease. Besides sleeping, sitting was the main source of my suffering. Being in motion brought relief, though too much activity such as brisk walking or cutting the grass revived the soreness, which was sometimes acute. I realised I no longer had the agility of youth, and seeing myself in store window reflections as an old man with a shambling gait chipped away at my self-esteem. Despite the distress, compared to before its onset, arthritis had only a minimal effect on my outlook: There was a slight uptick in gloomy spells and a small decrease in pleasant periods. Up until a few months prior to surgery, I had the impression my disease wasn't serious enough to get a new hip, and so I accepted (not without complaint) the discomfort, believing it couldn't be alleviated until my condition worsened.
Because the irritation plagued me daily and was at times severe, I was open to any alternative that might ameliorate it. By happenstance I heard about hip resurfacing. It's a less severe procedure in which the femur is capped and placed in a cup inserted in the pelvis, creating a rebuilt socket. Presuming I wasn't a candidate for a new hip, I decided to check out this new approach. I made an appointment with an orthopaedist versed in both hip replacement and resurfacing.
Sitting in the large waiting room before my first appointment, I felt out of place among all the people using canes, walkers and wheelchairs. With only a slight limp, I began fretting I was wasting my time and money. Thus I was taken aback when the doctor told me x-rays showed both hips are in "bad shape". They were too far gone and, though he didn't say it, I was too old for resurfacing. If I wanted the surgery, I had to select the side I deemed in worse shape. I did, feeling a burden had dissipated. My joints were far more worn and damaged than I had thought, revealing the extent to which I had ignored the distress in my body.
After the operation, I was faced with hip precautions – not bending more than 90 degrees, not allowing the left knee to intersect an imaginary line dividing my body, not crossing my legs – which for three months interfered with the routine of getting dressed and made it impossible for me to retrieve an item dropped on the ground. Initially I didn't sleep well. My unstable walking, exacerbated by drowsiness, called for using urinal bottles to avoid getting out of bed three or four times a night. Though they increased my safety and comfort, my handling of the bottles wasn't always steady, causing a couple of spills that lowered my already low spirits.
For the first week, my ankles, calves, knees and thighs were bloated, adding 10 or 11 pounds to my weight. After a month, my sleeping improved (and I began walking to the bathroom) but I still had bouts of restlessness several times every night. Further, my appetite was dulled to the point I had to force myself to eat my regular breakfast of cereal and toast, as well as peanut butter sandwich lunches. For over two months, I had unrelenting indigestion and, to ease or mask the effects of my recovery, I took handfuls of pills that, though tasteless, left a bad taste in my mouth. While vexing, these difficulties were expected; what was not expected was nerve damage resulting in drop foot.
Although apprehensive about the unresponsive extremity, my anxiety was mitigated by knowing that most people recover from injuries such as this; so I awaited a forthcoming neurological exam with a mixture of hope and apprehension. I knew a positive prognosis would still mean a long period of recovery, but normalcy would follow. A negative or indeterminate prognosis, on the other hand, would be disheartening, compounded by being aware of the aberrancy of hip surgery-induced drop foot. The nerve damage remained a persistent worry. The numb and lifeless foot was a reminder of how we don't always win, even when the odds are with us.
Daily for two months, I wanted to do a couple of hours of work, but I couldn't concentrate; I wanted to relax by reading a book, but I couldn't get comfortable; I wanted to exercise vigorously, but I couldn't command traumatised muscles; I wanted to get around without assistance, but I couldn't overcome my weakness. It was a fortnight before I had a dream I could remember, an ephemeral scene in a dim, grey setting. The post-surgical experience was not what I thought it would be: Anticipating a surge of big pain, I instead encountered a stream of little pains.
While abiding the soreness and stiffness of the new joint along with the drop foot, I endured the aches inflicted by arthritis in the other hip. I'd dealt with arthritic throes, at times excruciating, in my left hip for seven or eight years, and it became apparent I would be dealing with them on my right side, which was worsening, for the near future. Can such anguish yield a positive gain?
These days it's common to hear about being on a "journey", as in illness takes us on a course from infirmity to tangibly enhanced lives. But Ian Kidd in an Aeon essay, 'Being Ill, Living Well', notes the journey metaphor is contentious, with antagonists saying it doesn't apply to "those who don't witness much personal growth, or those who don't recover." Some argue poor health, particularly long-term disease such as cancer, doesn't build character; rather it robs its victims emotionally and physically. To claim otherwise reveals dreamy ignorance.
These assertions notwithstanding, Kidd sees opportunity for virtue in our corporal misfortunes. The body, he observes, is regarded in different ways. There is the "biological body" that medical practitioners treat and there is the body we experience, the "lived body" that is "the locus of our agency, activity and concerns." Sickness is felt most forcefully in our lived bodies when activities become circumscribed, resulting in loss of control and unsettling worries. When in good health we feel secure, but when unwell we feel exposed and burdened from dealing with the consequences of our debilitation.
Illness is an intermediary for examining ourselves and our place in the world. Examination can lead to the adoption of certain emotions and behaviour. While some are negative such as despair, anger and fear, some are positive or "edifying" such as adaptability, patience and tenacity. How we respond to illness has to do with who we are, the disease itself and the "practical and social support available." Pertaining to the last, Kidd reprises the view our character is formed through interactions with those around us. We are dependent on friends and relatives to assist us in learning from adversity. Nevertheless, even with encouragement, some will find illness a problem to bear, a state without redeeming qualities. But others will be edified, their outlook and values changed. The way in which we react to affliction – our own and that of people close to us – both affects and reflects our moral makeup.
My medical problems had reached a low point when I received a call from one of my aunts, a call that left me embarrassed, to no small degree, by my bitching. She often had a gloomy tone in her voice, evincing the maladies typical for an 89-year-old woman who had lived a hard life, but this time the sole impetus for her cheerless words was her son. He is my age, mid-60s, residing in a nursing home after suffering a stroke a year and a half ago. Paralysed on his left side, he's in bed much of the time and in a wheelchair the remaining hours. His surroundings – the patients and setting – are constant reminders of disease, disability and death. To add to his distress, he's been on a feeding tube since a bout of pneumonia waylaid him six months earlier. His mother, my aunt, telephoned to let me know he was still on the feeding tube and he wasn't getting better. Her dismal update brought home the realisation that though my life is frustrating, his is futile. He would be overjoyed if tomorrow he woke up with only numbness and partial loss of motion in his left calf and foot, and an incessant aching in his right hip – the ailments at the centre of my difficulties and the source of my misery.
I saw a neurologist about the nerve damage and was pleased to hear there's no reason I won't recover, though it could take a year or longer. I was given this news six weeks after the surgery. During that time the uncertainty about what lay in store increased my anxiety. It was a period from which I gained a displeasing perspective of myself. From these physical impairments, I came to understand I'm unable to face even minor limits for the rest of my days, without self-pity.
I'm fortunate my immediate family is patient and encouraging, and with their support I have, in accordance with Kidd, the assistance needed to enhance my character. But edification will require more than social support. If I am to become a better person, I will have to strive to adapt to my infirmities in a constructive manner that contributes to my ethical development. The question is: Do I have the willpower to use this condition to promote personal virtue, or when faced with the unyielding pain and discomfort, will I give up?QLRS Vol. 17 No. 1 Jan 2018