Where Did It All Go??

I lost a week somewhere. Well, not somewhere, actually – last week, specifically. I fell into the abyss of modern medicine, a place I unfortunately know too well. 

There are many wonderful modern medical techniques, but one of the best advances are the painkillers. Seems every time I have another operation they’ve come up with something to help you be more comfortable during recovery.

As an example of how far they’ve come, I always remember the days of my first knee operation in 1976. To combat some persistent post-op inflammation my doctor prescribed the powerful anti inflammatory, phenylbutazone, commonly called ‘bute.’ They don’t give that to humans anymore; it’s reserved for race horses. Horses! Of course, my body also knows all the latest common over-the-counter varieties and too many of the popular prescription big boys – tramadol, Oxycodone, OxyContin, and that great old standby, morphine. It’s interesting the drug cocktails seem to change slightly every time I go in for another surgery.

Then there are the super cool little catheter-delivered gems like ROPivacaine, that trip down your adductor nerve canal to deaden the femoral nerve next to the new pieces of exotic metals in your leg. Whoa – what?!

You see, while I was asleep and on my way to losing that week somewhere, they cut out my old knee and threw it away. Just like that. Big hole in my leg where useful stuff used to be. I have shiny alloys and snow white plastics now, all hammered, screwed, cut, trimmed and cemented in place. Very cool. High tech. I’m now an example of high tech. Six Million Dollar man shit. Yeah!

It’s amazing how many people have these, and I can tell you there’s really nothing quite like it. But, there’s also something not that great about it – the pain. It’s said total knee transplants are one of the most painful operations we endure. Why? Well, mostly it’s because they do an extraordinary amount of cutting and reshaping of bones, big bones. 

It turns out bones are very sensitive. So when you cut them they scream bloody murder. Do a bunch of cutting and you have a relentless, howling, barking, whining herd of hyena’s. No joke. It’s seriously painful.

Orthopedic docs are carpenters and they have all the special carpenter tools to prove it. Things like circle saws, sawzalls, electric drills and screwdrivers, chisels, hammers – all that fun stuff. They rebuild, reshape, remodel, reassemble. They don’t seem that far removed from a great engine mechanic or finish carpenter. Guys who know how to fix things and build stuff. Still, doesn’t sound all that reassuring, does it?

But, watch a few of these knee replacement procedures and you’ll see exactly what I’m talking about. The good ones don’t waste a single movement. They’re thorough, efficient and skilled. Amazing to watch. Just not so cool when you realize it’s your leg they’re chopping on.

So, why is all this such a lost week? Well, mainly because you don’t remember shit. They use some wicked good drugs that are spectacular at wiping out your memory. In recovery I can sit there and appear to be 100% awake and coherent and not remember a single thing, as if I were completely unconscious. Sleeping with eyes wide open. I can carry on a conversation with my doctors, answer questions, respond as if I know and comprehend everything they’re telling me – and an hour later have no inkling at all of the encounter.

The doctors have fun with that. My orthopedic doc bet my anesthesiologist a cup of coffee I would remember the conversation we had. The anesthesiologist said no way. My last knee replacement surgery I surprised him by actually remembering everything they told me, so my ortho was betting on the same thing this time. Haha – sorry, no way. I had no clue whatsoever. In fact, I spent the day wondering why he hadn’t come by to see me, because he always does. The next morning was the first time I remember seeing him again….

I like to call those 24 hours after surgery the honeymoon. A good doc will shoot you full of 24-hour painkillers at the start of your procedure. That, combined with a spinal block and that post-op femoral catheter pretty much knock out any pain – for the first day. You’ll come to and be feeling no pain. ‘What’s all the fuss about?’ you’ll probably think. This isn’t bad at all. Ah, don’t get too cocky my friend. There’s much more to come.

Once you get home and that stuff wears off, look out. Now the real world comes to visit. The saving grace is the catheter bathing your femoral nerve in a constant supply of that exotic ‘caine stuff. That little bag on your hip (reminds me of a colostomy bag, but oh so much better) is your lifeline to the saving grace of modern chemistry. It lulls you into thinking this won’t be THAT hard. But then, when it runs out on day four and you have to pull the catheter out of your thigh yourself, the hammer drops. You will undoubtedly begin calling a cocktail of Oxycodone, tramadol and Tylenol your close friend. Still, all it does is reduce things to a dull roar, just tolerable. Adding in ice and elevation will make things much better. And that’s the next two weeks of your drug-addled life. You’ll be happy to forget this ever happened, much of which you’ll never remember anyway. After all, you’re now officially a space captain.

Oh, but wait – there’s more. Pain and Torture, commonly known as physical therapy, or PT, follows. You know, the guy who gets paid quite well to make you cry in pain. Multiple times a week for months. As a bonus he gives you other special painful things to do at home. Really a special time. You’ll always remember him, just not in a good way. 

I’ve done this major knee surgery thing six times now, the last three being knee replacements. Can’t wait to see my Physical Therapist again. He’s always so friendly, smiling while he forces my leg to bend in ways it doesn’t want to consider. It brings tears to my eyes just thinking about it. No, I mean real tears.

So, two days ago was the beginning of my latest lost week. I thought I’d write it down before I forgot. Probly won’t even remember I wrote this. If I do, I’ll let you know how it worked out in about 9 months.