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 “Well,
judging by these X-rays, Mr Rogers, I’d say you were definitely a prime
candidate for a hip replacement. There’s no cartilage to be seen at
all.”
“Bone on bone, eh, Doctor?”
Before he could reply, his nurse asked, “Why is it that every joint
replacement patient has to give the ‘bone on bone’ speech?”
She was right of course: I would soon hear that phrase myself many
times, from other joint patients.
Now, providing an artificial hip joint is no minor job for an
orthopaedic surgeon (it requires a lot of skill and can take up to four
hours), yet tens of thousands of these operations a year are
successfully performed in Australia. Even so, though I’d known men and
women with osteoarthritis, I’d never ever met anyone who’d actually had
a hip replacement.
 Plenty of people who knew someone else who had, sure, but no one with
any personal experience. Not that this stopped these second-hand experts
giving advice: “You’ll never look back after you have the operation.”
Well, let me tell you right now: after you have a hip replacement it’s a
while before you look in any direction — other than at your shuffling
feet.
After putting it off for years, it was now time for me to commit to the
operation. If things went well, the op would be followed by about a week
in the acute-care hospital, then two weeks in a rehabilitation hospital.
After that, the promise was that I would be free of arthritic pain in
the hip, and perhaps, just perhaps, walk with less of a limp.
On admission day the nurse went through my forms (past operations,
illnesses, current medication . . .). Suddenly she broke off and said,
“Tooth abscess. I’m going to stop you right there. You can't have a hip
replacement with such a recent infection in your body.”
Infections are a particular danger for people with artificial joints,
and can prove disastrous if not checked early. For example, all my
future visits to the dentist have to be preceded by antibiotic
treatment.
I explained that my dentist had treated the abscess with medication, but
prudently she went away and rang my orthopaedic surgeon, while Eleanor
and I waited and wondered if the No Admittance sign was about to go up.
Thankfully no; the surgeon accepted my explanation, and hips were once
more on the agenda.
For the first day and a half after the op I was sufficiently zonked from
the anaesthetic not to care much about much. The afternoon of the second
day, however, I couldn’t fail to notice that they’d discovered that I
was running a high temperature. An infection after all, but fortunately
I responded to the drugs my surgeon ordered and lethargically moved on
to the next little drama.
On day three I was unplugged from drip, transfusion (two bagfuls of
homemade O Positive sopped up during the operation), catheter, wound
drain and the epidural pain killer.
Patient Controlled Analgesia is a wonderful development. Instead of
waiting six hours between pethidine injections, with the pain increasing
minute by minute towards the unspeakable, today you can administer your
own pain relief as soon as you feel it developing. And the remarkable
thing is that in total you actually use less narcotic than you did in
days of old, by controlling it yourself in tiny doses.
Soon I found myself sitting in a chair beside the bed, and then came the
first time the nurses got me on to a commode chair en route to the
toilet.
Having arrived, I promptly fainted.
I came around with two or three people supporting my slumped form and
someone else cooling my forehead with a wash-cloth. All my limbs were
limp and woolly, so they had to get me back to bed using their famous
Patient Hoist.
After that, things could only improve. Well, almost all things.
Before I knew it they had me up and creeping about on a walking frame.
How times have changed.
Let me explain. I am in the unusual position of having a thirty-year
history of lower limb operations, starting in 1973 when I broke both
femurs in a car accident that involved a poignant and decisive debate
with a telegraph pole.
In those days surgical practice was to put your legs in traction and
“Wait Till the Bones Knit, Nellie”. Well, mine didn’t, so my man had to
do a bone graft on each leg and then we all had to wait some more.
Wait some more! In all I was there on my back nearly nine months, and
when at last they told me I could now learn to walk again, I was
ramrod-rigid, with one leg shorter than the other. Ultimately these
outcomes would lead to the osteoarthritis of the left hip.
But my point here is that today the accepted wisdom is to
screw/bolt/pin/plate/glue straight away and get you up on your feet as
soon as possible. This has the added advantage of minimising the danger
of blood clots, something they additionally combat by (a) having you
glamorously attired in surgical stockings for several weeks, and (b)
giving you a daily injection of blood thinners.
As predicted, my total stay in hospital this time was barely three
weeks, as opposed to 36 weeks in 1973-4.
Anyway, there I was on day four, cock of the walk on my shuffle-frame —
an unsteady fowl, mind you, and half anticipating another fainting
spell.
One of the things they forewarn you about hip replacements is that in
the early months there’s a risk of dislocating the new joint. In the
first place, this means that bending at the waist to an angle more acute
than ninety degrees is taboo, so as well as prohibiting reaching much
below the knees, this precludes drawing the knees into the stomach.
Hence, to put on and take off pants you have to use what’s known as a
“dressing stick”. To pick up things from the floor (light things only)
you need a “reaching and grasping aid”. And your lovely white stockings
have to be managed by a nurse or spouse. Later, you can put on your
socks yourself if you buy a “sock aid”.
As well as that, you’re required to sit in higher chairs than normal —
no sinking into soft armchairs. You have to procure a raised toilet
seat, too. Right angles rule for hip replacements.
Secondly, you have to sleep on your back for nine weeks, with absolutely
no leg crossing. After that period, if you’re lucky you may be allowed
to sleep on your side, provided you keep a pillow between your legs.
As I mentioned in passing earlier, this sleeping on the back was not a
new burden for me, just an unwelcome Remembrance of Things Past, for
with it came the old menace — pressure points, known in Oldspeak as bed
sores.
If there’s one thing that hospital economies in Australia have achieved
it’s reduced time for nurses to attend to patients at risk for bed
sores. To be sure, getting us ambulatory as soon as possible helps a
lot, but there are still patients confined to bed on their backs (if
only at night) who may need attention. I am such a patient — ever fated
to be a martyr to bedridden posterior skin soreness.
I can clearly remember when in 1973 a nurse came in and asked, “Would
you like your back rubbed?” When I said “O.K.”, I discovered that “back”
was a euphemism for “buttocks and tailbone”. And so for my 36 weeks I
received this soothing preventative every four hours or so.
No such care seems on offer these days. You have to complain (if you
dare), and it wasn’t long after my hip job before I felt the burning
urge to do so. I also enquired about the availability of a sheepskin to
lie on. No luck there: too much “risk of cross-infection”.
Eleanor went out and bought one, but it was almost too late. When I
arrived at the rehab hospital with a very inflamed left buttock, they
were so dumbfounded that they discreetly enquired to know “which
acute-care hospital” I’d come from.
It was day seven when I was transferred to the rehab hospital. There I
resided and toiled another two weeks.
Toiled is right. “You haven’t come to rest, remember; you’ve come here
to work.”
There are essentially two areas they help you with in a rehab
establishment. They are “personal care activities” and “musculo skeletal
rehabilitation”. During my stay a large proportion of the guest workers
were orthopaedic patients like myself — men and women with joint
replacements (“Are you a Hip or a Knee?”) or people recovering from
broken limbs. We all had a similar regimen.
Before I get to the therapy work, let me enthral you with a bit about
those personal care activities they train you in.
Getting used to dressing and undressing with little or no bending has
its moments (“Knees down, Mother Brown”), but without doubt the gleaming
pinnacle of accomplishment in a patient’s battle for independence has
got to be learning how to take a shower.
First you have to find an available nurse to take off your stockings and
then carry your day clothes while you crutch your rickety way to the
bathroom. He or she next has to hang up or stack those clothes as far
away from the shower itself, because there’s no shower hob (too
difficult to get over) or curtain, so in the hands of an amateur water
can blithely splash about everywhere.
Once you’re undressed and have gingerly installed yourself in the shower
chair, depending on your recovery progress you may need assistance with
showering itself. If not, the nurse departs to seek patients new. Then,
when you’ve achieved what you can unaided, and haven’t dropped the soap,
you buzz for the nurse again. Eventually he or she returns to wipe your
feet and pass you your clothes and dressing stick, your underpants and
trousers being laid on a soggy towel on the floor.
Speaking of dropped soap, I dare say you’ve heard of the cure for that —
Soap-on-a-Rope. Having had past trouble in hospital with slippery soap,
before my ‘ip op I sent out search parties to get some Soap-on-a-Rope.
It used to be all the rage once, but these days it’s very hard to come
by. Just in case none was forthcoming from shops, I also investigated
mail-order possibilities via the Internet, but what was on offer seemed
confined to dubious shapes modelled on parts of the body. Ultimately a
friend tracked down a couple of inoffensive examples, and I was home and
hosed, as it were.
As useful as it is, however, such soap tends to be very soft, so it all
too soon detaches from its rope. We solved this problem when it occurred
by getting the poor man’s substitute — soap you keep in a stocking.
Eleanor bought me a cheap pair of pantyhose, cut it into two legs, and
behold, a double helping of Soap-in-a-Sock.
I warn you, though: all this use of stockings, surgical and soapy, may
well have left me with a stocking fetish. Time will tell.
You know, it isn’t only the patient who has a challenging time of it in
the shower. Let’s not forget the grim toll that bath-time takes on
nurses. For those driving to work for the a.m. shift the prospect of the
morning can only be one of “why in the name of Florence Nightingale am I
putting myself through this insanity?”
There were forty patients on my floor in varying stages of helplessness
and after breakfast we all had to be showered in turn in five bathrooms
— preferably by ten o’clock. Somehow it all got done, but a strong
rumour persists that, in a vain endeavour to bring order out of morning
chaos, certain residents were paid a fee to get forgotten.
Some of us postponed our showers anyway. We did this when we were
rostered for hydrotherapy late in the morning, or in the afternoon. I
took great pains to ascertain why on earth the physio and hydro
timetables changed from day to day, but my valiant efforts went
unrewarded, though I have my suspicions. More about this classic
timetable anon, but let’s stay with the nurses a little longer.
Waiting for your turn in the shower brought its own delights, like
demonstrations of express bed-making — a sight to behold, let me assure
you, but only if you don’t blink.
Once upon a time, nurses might have changed the sheets every day, but
21st century hospital cost-cutting measures have become all-inclusive,
so now, except for emergency situations, beds are fully remade only when
a patient is discharged. A quick fold here, a deft tuck there, and voilà,
a made bed.
Regarding beds . . .
Almost all of us were in shared accommodation at the rehab, in contrast
to the private rooms in the acute-care hospital. Unsurprisingly, this
meant that you were thrown together with strangers, like ’em or lump
’em. For my part, I grew to like ’em, though occasionally they caught me
off guard, as in the following exchange, initiated by the fellow in the
bed opposite.
“You woke me up last night.”
“Did I? Sorry.”
“You were talking in your sleep.”
“You shouldn’t listen.”
“But I wanted to find out what you were saying.”
Further to the subject of hospital cutbacks, by the way, one nurse
expressed a view that is no doubt shared by many of her co-workers.
Namely, that on those rare occasions when the neglected nursing
profession is granted a pay increase, privately run institutions somehow
find themselves immediately motivated to reduce each working shift by
one registered nurse, and substitute a nursing assistant. On top of
that, several times a week nurses and nursing assistants have to be
imported temporarily from an agency.
One morning our room was graced by, not one, but two temp bed makers,
both very young and one of them female. Obviously keen to impress her
with his sway over innocent patients, the young man took one look in my
direction and greeted me with, “Jeez, you’ve got a messy bed!”
I didn’t find this idea per se worth exploring, but believing that I’d
caught the spirit of the moment, quick as a flash I responded with, “If
you give me a second, I’ll think of something nice to say about you.”
I had misjudged them both, though. My reply went over like the
proverbial lead balloon. I resolved to keep irony for future reference.
Attempts at patient-staff banter had a tad more success with the older,
more experienced nurses. As you know, the question that every nurse’s
heart yearns to ask is this: “Have you opened your bowels today?” Having
weathered this question for a week , I decided that a mere “Yes” had
become an inadequate reply, so this particular day I ventured, in a loud
voice, “Yes, I Have Opened My Bowels Today.”
Apart from a few local chuckles from the nurse and my fellow inmates,
this was not the roaring triumph I’d hoped. It just wasn’t forceful
enough.
I heard what “forceful enough” and “roaring triumph” were a couple of
nights later — a performance in the same general domain of human
endeavour, too.
Up the corridor, about 8.30, came the call, in a rich and robust female
voice. Stentorian.
Perfectly measured in its round-toned articulation.
Utterly self-assured.
“May — I — Have — A — Bed — Pan — Now — Please — Nurse?”
This was succeeded by muffled hysterics from bedrooms everywhere.
[ This tale will be concluded in
the next issue. ]
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