I Have Been Away

After months of careful planning, on September 27 I signed my consents for a right total knee replacement surgery. As I signed, I was already familiar with the potential complications, including the well-documented, persistent risk that 2% of post-op knee patients develop a joint infection. I had been careful in my prep; I had done the right things. Like most people, I read 2% to mean “somebody other than me.”

I did very well post-op and had just returned to work at the beginning of November, when a sudden increase in pain around my knee told me something was not right. I had a fever by the time I went to the ED, and, in retrospect, emerging septic shock when I went back into surgery that evening to “scrub out” the joint.

The plan after that was to go home with supplies to give myself six weeks of continuous antibiotics and see how things went. They didn’t go well. I was persistently nauseated until we finally changed to an different antibiotic. By then, the original antibiotic (aided, no doubt, by that bit of septic shock) had led to acute kidney injury. Back into the hospital for several miserable days of waiting, followed by a third surgery on November 28. All of the original knee hardware was removed and replaced by a temporary set of “spacers” embedded in antibiotic cement. A supposed two-hour surgery lasted four hours, then back to another hospital room until I could demonstrate the ability to hobble far enough to get into my house again. Yet another surgery awaits in a few weeks, to essentially start over with new hardware.

And that’s where I’m at. Pain improved, nausea mostly improved, appetite still poor, mobility very limited. It feels like my right leg is attached to my thigh with a 79 cent brass hinge from Ace hardware. Again, very little pain, but freakishly weird.

What I really want to talk about, though, is how unprepared I was for the emotional experience. My confidence has been replaced with anxiety. Nights are particularly tough, trying to sleep in unfamiliar positions while dealing with things attached to my body. I have had a couple of near panic episodes. The hours drag by. Whatever I do, I cannot drop it from my mind. My day is regimented by tasks that used to be thoughtless, but now require careful planning. And every 8 hours, I must attend to the 20 minute ritual of giving myself another dose of antibiotic. Without a doubt, my topsies have been turvied.

This is an observation, though, not a complaint. I have had an overwhelming abundance of support. Brenda has hardly left my side during the entire time, only taking time to try and keep up with a house and dogs. Her work has been incredibly supportive, as has mine, both with time off and with gestures of support. My family, all of whom live far away, are just a moment away by text. I could not have it better.

If I have a message, other than just an update, it is that over the years I’ve failed to understand the degree to which serious medical complications affect the emotional status of patients. Oh sure, a psych consult is available if someone is in severe distress, but otherwise the medical machine churns on, pleasant, efficient, and mostly uninterested in “how are you feeling?” at any given moment. Not “what is your pain from one to ten?” (and do I have some things to say about that someday), not collecting lab and vitals data, but just sitting down to ask “how are you handling this? I can’t promise a solution to anything, but I thought you might just want to talk.”

During the middle of my third hospitalization, when I was at my lowest, a hospitalist, an internist I have known since we were both on residency night call together, came into my room. I have kept in distant contact with this individual throughout my career, but I wouldn’t characterize us as much more than acquaintances. Still, he sat and talked for much of an hour, not just about diagnoses and prognoses, but about how it must feel, and marveled at how people manage to deal with it. It was a tremendously moving experience, and I will forever be grateful for that 45 minutes of human interest and commiseration. That was the healing touch I needed that late evening.

I haven’t been to the Farmhouse since the surgery. It’s good to remind myself that it’s still up there, waiting for me to heal (and occasionally visited by Aaron and Devan to make sure things are well). I’m sure I’ll be back before the ice shanties have to be removed, while there is still time to savor the stillness.