Monday, June 13, 2022

 Monday, June 13, 2022

 

   Today was Dorothy's 77th birthday. She had the pleasure of spending it holding her second grandson Eli born on May 22. She was in Seattle helping Karin with childcare. Besides the baby, there was three-year-old Sam. So far, both were good kids, reasonably easy to deal with.

   Last night, I woke up in the wee hours of the morning and couldn't go back to sleep. I had been sleeping much; needing less wasn't a surprise. However, I also suffered sciatic pain. I ran out of hydrocodone pills on Saturday night. It finally dawned on me I could take a Tylenol. I did. It helped. I am slow to consider taking pain medication. I fell back to sleep and put in another several hours.

   I had my follow-up appointment with Dr. Salassa, my surgeon, this morning. It was scheduled for 10:30. When it dawned on me that this would conflict with my Reading and Writing office hours for Step Up Tutoring, I contacted the doctor's nurse to change the appointment. She told me to come in early. Yvette drove me. She came up at 7 am to check on me when she heard from Scott that I wasn't up yet. 

   Before I left, I created a sign for the office hours participants if I didn't make it back in time, saying, "Sorry. I got held up at a doctor's appointment. Try again in half an hour." I joined the Zoom meeting controlled by Step Up. At 11 am, I would be allowed in. I placed the sign participating tutors would see. 

   Yvette and I left around twenty to eight. As we turned onto Kaiminani St., my cell beeped. When I saw it was from Scott, I told Yvette to pull over. I knew one of us had forgotten something. Oh, yes. Yvette got her purse, etc. We turned around and headed back.  

   Yvette dropped me off at the entrance to the Kaiser clinic. She had a bag into which we packed my water bottle, my bag of whole-grain taco chips, a tangerine, a book, and a small blanket. You wonder why I would want a blanket.

   Kaiser clinic is kept at meat locker temperatures. I asked why they kept it so cold at my last medical appointment. The doctor answered, "To torture us." The true answer was that they have trouble regulating the temperature with the radical temperature changes in Hawaii. The evenings are almost always cool. However, if the sun is full out, it can be intense. The building isn't well insulated. I warned Yvette last night to dress appropriately. Employees regularly wear hoodies and winter jackets. It is freezing cold. I had a hoody on with shorts. I took a blanket in anticipation of having to sit there till 10:30 for my actual appointment. 

    I had to check in at reception first. I needed to get on the line instead of using the kiosk because I needed an X-ray first. Two people were being served, and four were ahead of me, waiting in line. I noticed everyone was wearing a mask. I hadn't donned a mask for eleven days. Masks? What are those? I asked a passing nurse if she knew where I could get one. She was in a hurry on another chore but told me to ask reception. The woman behind me volunteered to ask. I texted Yvette to tell her she would need one. After dropping me off, she went to Starbucks for a coffee.

  After checking in, I headed to the bathroom. It was the first time I had used the automatic door opener. Wrestling with that heavy door with a walker would have been a challenge. The locking system was new. It was digital. I had to press a button. When it turned green, the door was locked. When I was done, I tried to press the button again to open the door. That didn't work. I tried cranking the handle. That didn't work. I pressed the automatic opener again and exited. There was someone else in line. I told him what I had discovered about opening the lock. Someone might spend more time than I did in distressing confusion, wondering how to get out of the bathroom.

    I made it down to X-ray. My wait wasn't long. The X-ray technician and I are bosom buddies by now; I've been there so many times. I asked her the one question I hadn't so far. What was her name? June. Was she born in June? No, April. When I had my last hip X-ray, I said I hoped not to see her again except at Safeway. When I greeted her this morning, I said, "You knew I would be back." She nodded. This post-surgical X-ray is standard.

   June is one of those lucky humans who loves the work she does. She planned to be a lawyer but discovered she couldn't stand the people in the profession. A family friend directed her to radiology, and she was happy as a lark. I asked her if she knew the history of X-ray machines. The one she used was a far cry from what I remember in the 40s or 50s. I don't know when I got my first X-ray. She said she made a point of forgetting that information the moment she passed the test on the subject. When she saw that Dr. Salassa was my surgeon, she took a picture of my lower abdomen because she knew the doctor preferred that shot. 

   As I walked to the elevator to go upstairs for my appointment with the surgeon, Yvette arrived. She took the stairs; I grabbed the elevator. We hunkered down for the wait. A nurse stuck her head out several times, "Pamela?" No, Pamela. Yvette and I were the only ones there. I asked Yvette to grab her the next time she stuck her head out to ask if I could get in early to see Dr. Salassa. The nurse returned a few minutes after Yvette spoke to her and said I would be seen in a few minutes. There was no one else there. I suspect Dr. Salassa had just arrived. 

      Yvette and I went in together. I had been complaining about the aftercare information I had received. I was damned pissed about how poor it was, but I didn't want to be brutal on Dr. Salassa. I knew whatever the problems were, they were systemic not only at Kaiser but throughout the whole surgical profession. Being forthcoming about the impact of surgery is not the norm. My hanai sister, Jean, was not told to be flat on her back in a skilled nursing facility after she was discharged from the hospital. And then she wasn't told it would be at least two weeks before she could go home. It's outrageous. Surgery is the last holdout for informed consent. People say, "If surgeons told people what was involved in recovery, no one would have surgery."  

    The other excuse surgeons use for not being forthcoming is, "Everyone is different." True. But the good doctor had no trouble telling me, "If you live fifteen more years, your femoral head will collapse." Was it fifteen years from that moment? Could she guarantee me that I only had fifteen years? Doesn't the everyone's-different argument apply here? If not, why not? The other statistic the doctor gave me was, "The implant will last 15 years." That wasn't great news. When I looked it up, I found that the implant was almost guaranteed to last 15 years. Many lasted 25. The not-everyone's-the-same argument applies here too. If they used it to convince me to have surgery, why couldn't they use statical information to tell me what to expect after surgery. For example, how long would the impact of the spinal block last? How would I feel when it wore off? When should I anticipate needing the narcotics to help me get by? I didn't expect precise answers specifically designed for me, but a range would have been nice. I was left in the dark.

    I had a lovely visit with Dr. Salassa. She is a gorgeous young woman with a great reputation as a surgeon with a good 'bedside' manner. She looked at my X-rays and told me my implant was perfectly placed, exactly as she had intended. My incision was healing nicely. She asked me if I was a swimmer. No, I assured her. "I'm known as Princess Never Get Wet." I was not planning any immediate ocean swims.  

  I also brought up some of my dissatisfaction with the aftercare service. While I was told to brush my teeth at least twice daily before surgery, no one introduced the subject while I was on the hospital floor. I was bedridden until I left. I wasn't allowed to get out of bed. The nurse never said, "Let's brush your teeth." I had brought one with me.

  Also, no one checked my blood pressure. During the first PT visit, I was so dizzy she didn't dare have me walk. No one checked my blood pressure even after that. Dr. Salassa said I had a cuff on at all times. No, I didn't. I told her I checked my blood pressure when I got home and discovered it was below 100 over 60. Had I taken my blood pressure medication, I could have been so light-headed I would have fallen. That would not have been good.  

   I also had no instructions from the doctor on taking the hydrocodone and Tylenol prescribed. The prescription said one or two tablets every six hours. In the general instruction, it said as needed. I thought the doctor's prescription trumped boilerplate instructions. I still didn't take it as prescribed. After each pill, I added a half hour to the lag time when I discovered I wasn't in pain. I was up to 11 hours between pills rather than six when the visiting PT told me not to do that. I was to keep ahead of the pain. If the pain surged, I could wind up in the ER. Well, that scared me. I went back to taking the medication regularly. 

  The doctor said if she had her way, everyone would go home the day of the surgery and not stay overnight in the hospital. They do that with folks living on Oahu, but that doesn't work for us outer island folks who must fly home. The doctor told me Kaiser no longer had an orthopedic wing. When it did, three or four orthopedic nurses on staff knew what they were doing. The general practitioners weren't as specifically skilled. The doctor said she was particularly concerned about older people taking the pain medication. It was precisely because of my experience. The medication lowered blood pressure. The elderly were at risk of falling; I was at risk of falling. 

   She showed me my before and after X-rays. The implant had a straight line from the femoral head into the leg. My old joint had a bend in it. My doctor friend, Melissa, told me it's an angled joint. The neck was actually bent. That was why my left leg was shorter than my right. No doctor had explained why they knew my hip was a problem except to say, "You have arthritis." Duh! I was over 60 years old; of course, I had arthritis. However, was that the cause of my pain, or was it a wrenched muscle from Mike nearly yanking my leg right out of its socket? I was offered no explanation other than, "I said so." Not even the good Dr. Salassa showed me this beforehand. I knew she wouldn't adjust the leg length to ensure they were even. That had been one of my fears. Whatever her limitations, she was the only doctor I trusted not to play God. 

   I told her the PT told me to take my pills as directed 'to stay ahead of the pain." The phrase wound up being an advertising ploy of pharma. They convinced doctors to keep giving their narcotics, arguing, "They're not in pain because the meds are working. Make sure they stay on it to prevent pain from coming back. Stay ahead of the pain." So much for that good advice.

  I asked the doctor how much the implant weighed. When I weighed myself Saturday the 4th, two days after the operation, the scale was three pounds higher than before. I checked how much it might weigh. I saw one at five pounds. Ah, that explained the weight gain. I asked the doctor how much my implant weighed—one pound. The rest was from additional fluid, probably my body working to clear out any junk from the surgical area.

  Yvette dropped me off at Home Depot while she went for gas at Costco. I need more batteries. My blood pressure monitor batteries were low after something like five days. Good thing I already ordered a new one. I opened it only to discover I had ordered the wrong brand. This is the second mistake I made because of the drugs. I ordered the Omron brand immediately. This is the only home blood pressure monitor brand reputed to give consistent readings. 

    I also picked up a backpack garden sprayer for the gardeners to use with the high-potency vinegar I bought. Yvette and Josh won't allow Round Up to be used. The alternative is high-potency vinegar. The gardeners would use it. This is a large property. It requires a lot of work. I could do more once my new hip was in working order.

   I made it home in plenty of time for my Reading & Writing Office hours. Only one of the participants had already met with her student. She was a fourth-grade girl who had trouble decoding multi-syllable words. The other two were there because the program required them to attend an office hour. I know many people don't fulfill any requirements. We are all volunteers. The program only has so much leverage. I addressed the problem of decoding multi-syllable words while advising them to watch my YouTube videos, The Phonics Discovery System Phase I and II. The tutor who had already worked with her student thanked me. "I've learned so much." It was gratifying to hear that.

   Jean Mabry called. She was busy but had no other complaints. She told me a fantastic story. Her daughter and grandchildren were sitting together in a bedroom when an oblong "orb" danced across the wall. There was no question in their minds. This was something spiritual. Her daughter believed it was her recently deceased grandmother. I had never heard of such a thing.

   I lay down to read on the sofa on the lanai. As usual, Elsa jumped up and settled on my chest as I was ready to get up. She stretched out and went limp, enjoying the rocking motion of my breath. I fell asleep and only woke up when the home care PT arrived. 

   Today was her second and final visit. I told her I was frightened post-operatively because two PTs and my acupuncturist told me I wouldn't do well with a hip replacement. Their comments did not induce a comfortable recovery. She was critical of their negativity. I didn't point out that she, too, had said something that set me off in a spiral of fear when she told me I should take my medication as prescribed to "stay ahead of the pain."

    When I spoke to the doctor, she said it would be okay to switch from the walker to a cane. I tried that, but it didn't feel right. I had to use my right leg to compensate for the weakness in the left hip when I walked. It's essential to avoid compensatory movement. I started using the walker again. That felt much better.

  I spent the evening listening to Evening Jazz and playing FreeCell. I stayed up till eleven because I'd slept too much during the day.