Friday, October 12, 2018

Good Luck with That David

Before this last elective surgery I was working on a blog about Dylan, with a little Hemingway mixed in.  As the date for my trip to the hospital neared the list of things to get done before I couldn’t walk loomed large, and I didn’t finish it.  A random FB post had thrown me into a binge of old Dylan music, some of it on vinyl, and I became immersed in lyrics.  Before I knew it I was under the knife. 
The word elective surgery is fairly new, developed I’m sure during my lifetime.  The idea is this- “it's  not necessary to keep you alive, but if you want it done, someone will do it.  Whether they pay for it is another matter.”  

Really?  I can see the farmers I used to work scratching their heads at this idea.  Just for a little while mind you, before rejecting it completely.  The best way to avoid painful medical treatment, their steadfast goal, was to stay away from doctors first, and then hospitals at any cost.  And speaking of cost, those guys didn’t buy health insurance till the government handed it to them in the form of Medicare in the mid 60's.

Dentistry, and I mean the entire field, was seen as  elective for my Dad.  He grudgingly let  Mom take us to the dentist as kids, and even get dentures herself, but he elected to forgo dentists entirely.  He lost his teeth gradually.  Most of them blackened and sort of evaporated, the process hidden from us, until he got down to the molars.  Those he had to work fairly hard at.
I didn’t see my Dad him with pliers or vice grips in his mouth, but I wouldn’t be surprised if he secretly used them to persuade the exit of those big teeth from his gums.  I have a couple of his molars, yellow with long white roots.  He saved them in his desk drawer with the paper clips.  You tell me why.

If you wonder why you rarely see chopped sirloin on restaurant menus anymore, it’s because guys like my Dad are largely a thing of the past.  We’re now a country of straight white teeth, except of course for the poor, whom we don’t seem to care about.  Modern dentistry, along with fluoridation, has made those Americans who can afford it a country of proficient chewers. 

I made hay with a number of farmers who had complicated leather and steel trusses designed to hold in hernias.  There we were, trapped in  hay mows on long summer afternoons, hoisting 75 pound bales of hay, and sweating our asses off.  It was hard work, but I was a kid and had no intention of continuing to work that way once I graduated high school.  The men I worked with, both tenant farmers and land owners, had worked that hard their entire lives.  They worked on, burdened by the pain and trouble of hernias among other ailments, without complaining. 
“You can usually push them back in,” our neighbor once told me, after showing me what his truss did, custom made to press on the hernia and do basically the same thing.  “If you can’t get it back up in there you have to worry.  You gotta watch out they don’t get strangulated.  But if you don’t panic it usually takes care of itself.”

Those men were known not to panic.
None of the farmers with hernias elected to get them fixed that I knew of.  Not when you could manage it and avoid the doctor. 

We now consider health a worthy investment.  An improvement I’d say.  Our collective goal is taking care of our bodies so as to manage these much longer lives we’re living.  And with attitudes changing we now find ourselves with a menu of procedures to choose from.
For the purely cosmetic procedures, satisfying vanity more than improved function, you’re on your own dime.  But if you want to say, continue to use your shoulder as you are accustomed, or walk without pain, both Medicare and private insurance are more than willing to accommodate you.  Meet some low threshold criteria and the door is open for a raft of expensive procedures funded routinely every day.  I think the medical folks, and their partners in the drug industry, want the work.  And at the rates paid in the US for those procedures who wouldn’t?

Don’t get me wrong, I think this is a good thing.  I’m benefitting.  My Mom needed artificial knees in the worst way.  Had she been able to get them, she could have avoided years of pain, and enjoyed increased activity, maybe even living longer than she managed, alone there in our farm house, making it from the recliner, to the kitchen, out once a day to get the newspaper at the end of the walk, talking incessantly on the land line. 
Trouble was no one she knew had gone through that new idea of knee surgery.  No one at church, no women at the beauty parlor.  They took the best anti inflammatory pills and pain relievers the hometown family doctor could find and put up with it, so Mom did too.

I’m not willing to do that.  I want to walk down streets in towns I’ve not yet found.  I want to hike over the next hill.  I’m on this two year program to improve my mobility.  Last year I had my long messed up left ankle straightened and repaired, and this year it’s the knee on the right, maybe damaged by accommodating the weird gait of its partner all those years.  In any case, I’m joining the ranks of those with both bone reshaped, reconfigured, and repositioned to its original purpose and bionic joints, titanium replacing bone, plastic filling in for cartilage.
My legs served me well, and I used them hard.  I hitchhiked with a back pack for years in the 70’s, on four continents.  The longer I traveled the less I carried on my back, but all the same it was a load.  When vehicles stopped past me on the road I made a habit of running to them.  I thought it was bad form for a guy wanting a free ride to walk.  My backpack would bounce as I ran.  I could feel it in my knees but never thought a thing of it.

I wasn’t what you would call cautious about life then, and certainly not about my health.  That left ankle was never the same after a bad ski accident.  It was my second time on skis.  I thought I was ready for the big hill.
While elective surgery is now available, there’s still a calculation.  I’ve decided there really is no gain without pain, hard work in therapy, and recovery time.  When my friends related their new knee experiences, they encouraged me. 

“It will be nothing compared to your ankle I guarantee.”
My ankle, which was done early April of 2017, was long term.  I couldn’t bear weight on it for months.  When I did walking was tentative and gradual.  It took a long time to get to anything that resembled normal.  It’s still getting better now, 19 months later.  The surgeon told me I’d see improvement for up to two years.  I thought he was kidding me.  Funny, how we hear things but don’t believe them.  Some things seem incredible.

Knee replacement is totally different.  When you get out of the hospital there is a fully functioning knee in there.  My ankle procedure required bone to knit together.  My artificial knee was firmly attached to my bones.  Don’t ask me how.  I haven’t yet watched the video.  The physical therapist in the hospital got me up and walked me down the hall, mostly to show me it was possible I think.  Recovery in the case of my knee is getting the muscle, ligaments, and tissue around the knee back to normal after being so rudely pushed aside.
It’s major surgery.  Power tools are involved.  Protractors and stuff I’m sure.  I’ll find out later.  They’re surgeons, the orthopedic people that do this work, but just as heart surgeons take after plumbers, the orthopedic folks embody the hearts of carpenters. 

Let’s go back to my buddies with fresh new knees.  When I ask them how long it takes to fully recover from the surgery they say:
“Well, it keeps getting better for a year I’d say.  But it gets good pretty quickly.”

I’ll be a month past surgery next Friday.  I’m convinced that as humans we lack the ability to remember or appreciate physical pain.  Maybe it’s the opiates.  In any case because it’s my right knee I can’t drive.  Those pain pills became my friends.  I don’t regret doing it, but it hurts more than I anticipated.  Getting back to a decent range of motion takes work.  I think the physical therapists are actually the most important part of the deal.  I’m doing what they tell me.  I think and hope I‘ll have a good result.
Still in all, it’s a calculation.  You sacrifice freedom for increased mobility in the future.  You willingly walk into hospitals, surrender yourself to their system, allow someone you barely know to knock you out and work you over in almost sadistic ways, and then you thank them when it’s over.  It’s counter intuitive when you think about it.

Between loads the guys in the haymow, my neighbors, used to take breaks.  We’d climb down from the heat of the haymow, find some shade, a breeze if there was one, and have a blow till the next rack wagon arrived.   We had great conversation, five or ten minutes at a time.  I’ve imagined trying to explain what I’m doing with those old farmers.  It would probably go like this.
“So David, my wife found out from your Mom that you’re going to get a new knee somehow. Mechanical deal.  Is that so?”

Farm women talked constantly and the men kept their mouths shut.  But if the men listened to their wives they could find out everything there was to know about the people around them.  I mean everything.  It was amazing how little privacy there was.  You think social media is bad.  Consider the party lines given to us by the phone company that we shared with four or five other families..  
“Yeah, that’s right.”

“How’s that work?  I mean just what are they doing to you?”
“Well, they make a slice down your knee, pull away the muscle and stuff to expose the joint, and then saw the top of your knee away from your thigh bone, they do the same thing on the bottom, from your shin bone, and then they put an artificial knee in the center of those bones, line them up good, pound it in to the ends of the bones and glue it.  They got the right sized knee already, from an x ray and a CAT scan.”

I can imagine how wide their eyes would be.  Stubbly beards.  Blue chambray shirts sweated through.  They would all be over a hundred years old today.
“Who’s doing it?”

“Orthopedic surgeon out Bloomington.”
“Young guy?”

 Eyes would roll.

“How many times you figure he’s done this kind of thing?”
“Plenty I think.  It’s about all he does.”

“Who makes that knee they’re putting in you?”
I’m sure they would feel better if the manufacturer was Allis Chalmers, or John Deere.  Craftsman or Snap On would work too.  They would be thinking of the joint as something like the knuckles we used on the speed jacks and power take offs.  I still do sort of.

“I have no idea.”
“I’d find out if I were you.”

There’d be a pause.  Reacting to their suspicion I’d tell them more.
“As I get it with these tests they find out the exact angle of the bones, then a computer gives them real precise measurements, maybe even something of a jig, so they cut the bones exactly right to accept the knee.  Pretty high tech.”

Their eyes would grow wider.
“What kind of saw they use?”

“Probably something like a small hand held power Skilsaw.  I didn’t ask.”
“And when it's all over this artificial knee is going to work like your God given knee?”

That’s what they say.”
“Is that right.”

Those farmers used that particular line "is that right" not as a question. Their voice didn’t rise at the end of the sentence.  They didn’t expect an answer.  You didn’t know exactly what they meant.  That’s what they intended.  They rarely expressed disbelief, giving you the benefit of the doubt.  But they doubted a lot of things without showing it.  
We would hear a tractor down the lane.  When we looked, a rack wagon stacked with bales would be making its way toward the barn.  We would pull on those yellow cotton work gloves and head back towards the haymow.

“Yeah well good luck with that knee deal David.  Let us know how it turns out.”
They would no more have their knee sawed out of their leg and replaced with a mechanical one than they would go to New York City on vacation.  To them it would have sounded crazy, risky, and expensive.  They wouldn’t have asked how much it cost because where I lived it was impolite to talk about money.  But there is no way in hell those men I worked with fifty years ago would have turned their body over to some doctor for anything as drastic as that. 

Times change.  Today we have developed faith in both the skills of our medical folks and the technology they use.  We’ll take outrageous measures to extend the useful life of these bodies we have.  I hope I’m right on this one. I’ll let you know.