Total Hip Disaster

I am once again waiting, but this time I know approximately when the surgery will be done and tentatively what will be done. My surgeon is hoping to only remove the stem of the prosthesis. It should come out quite easily since it did not properly bond with the bone in the first place. Hopefully, the cup will not have to be replaced. I asked about the chances of another fracture: he believes they are low because he will go in through a very long incision--the classic technique.

So what now? Clearly, I feel much better knowing that something can and will be done. However, my job (should I choose to accept it) is to come to terms with my psychological state, to whit, my feeling that disaster is once again in the cards. Actually, I'm not sure that I feel the overwhelming sense of dread I felt the first time around.

But now that I am in a relatively calm state, it is time to peek once again under the bed where the monsters lurk in order to hopefully smoke them out.

Why the title, "Judge, Defendant and Prosecutor"? It comes from a discussion I had with my therapist today. I think it is extremely relevant. I am the defendant, envelopped in fear. The prosecutor is the past, replete with damning evidence that seems to point inexorably toward disaster in the future. The judge is the rational, adult me who has to weigh the arguments.

I just realized, there is one person missing from this equation. Where is defense counsel? Who is defending me? Perhaps I must find a fourth person.

On June 16 I went back to see my surgeon after six weeks off physiotherapy. I was prepared with a list of questions and comments on my non-recovery. I was also ready to figuratively bash in the head of the student who would interview me before the doctor came in.

Nothing went as I had expected.

When I arrived at the hospital, I immediately starting trembling. Waiting for my husband outside the door to the Orthopedic Surgery Department, I couldn't read or relax. Even seeing the words "orthopedic surgery" brought tears of fear to my eyes. When my husband arrived, we went into the OS waiting room. The man who took my hospital card looked at my name and then said that someone had just been talking about me. He went into the back and came out to say that they were wondering when I would arrive. I burst into tears. A few minutes later, I was ushered into the examining room and the "fellow" (junior surgeon) du jour, a young Australian, came in to ask me the usual "student" questions. I was ready to give him a piece of my mind before he even said a word. He started by asking how I was feeling and whether there had been any improvement over the past six weeks. I was shocked, but pleasantly so. He had actually looked at my file before coming in! What a change!

My surgeon came in shortly thereafter. I started crying as soon as I began to talk about my situation. We talked briefly and he asked me how I was doing. As soon as he heard my comments, he said that he would operate again to fix the problem. This time, he said that he took entire responsibility for what had happened to me. Many of those to whom I have told this story, have pooh-poohed his apologies. I, on the other hand, feel incredibly gratified to have heard him say that. He came down off his pedestal to meet me in my space. He treated me humanely and with concern. Yes, I'm sure he's thinking about his reputation and the possibility of a lawsuit, but both my husband and I felt that his words contained true, human concern for someone who is suffering and a genuine desire to make things better.

When he said more surgery, I again began to cry--not out of fear (which is there, nevertheless) but rather because I was afraid I would have to wait until the winter. His response was immediate: surgery will take place in August.

"People mean well and do not see how distancing insistent cheeriness is,how it denies another's reality, denies a sick person the space or right to be sick and in pain."

Marilyn French

I ran across this quote in our local newspaper and found it so insightful and, dare I say, refreshing, that I copied it out and taped it to the wall in my office.

There is nothing that puts me in a worse mood than being told to stick a goofy grin on my face, buck up and THINK POSITIVE. I've come to the conclusion that being a Gemini means there are two warring people within me: one is the New Ager who believes in the strong link between mind and body, pain and emotions, etc. and the other one who is a cynic to the core and considers all this positive thinking to be merely a way for those who fear suffering to politely distance themselves from the sufferer. I know. I did it myself with my mother.

My mother's suffering went beyond her extremely debilitating arthritis. She also had a condition called tinnitis--a ringing in the ear. It would drive her mad. Her face would crumple into a mass of suffering. It was the tinnitus, much more than the arthritis, that truly crushed her spirit. What could I do? I remember thinking she needed to read books of jokes and see funny movies to take her mind off the physical suffering she endured. That was the only solution I could see. Needless to say, it didn't work.

Then there's another spin on positivity: "il faut prendre son mal en patience", you must bear your suffering with patience (read: graciously). Be a real woman and suffer in silence. Men make a fuss when they suffer and they get a response. Women suffer quietly, smile, do the laundry, tend to the kids and try to downplay what's going on 'til they finally can't get out of bed anymore--and even then.

Oh yes, and then there's the "I'm suffering much more than you and I'M POSITIVE, I thank the Lord every day for the blue skies and the pretty flowers." Well, I'm glad that's the way you feel. I ask the Lord every day, "Why me? What great sin did I commit to deserve this crap?

Last night I had trouble getting to sleep. As I am wont to do, I started obsessing over my dreadful situation, constructing conversations in my head with the surgeon, revisiting all the "what ifs", feeling anger, sadness and frustration welling up in me. When I finally fell asleep, this is what I dreamt:

It was before my operation and I was with my surgeon. I was crying and begging him not to do the operation because I knew what awaited me. He didn't listen. It was as if I were a ghost that he couldn't see. I still feel the depth of my anguish as I cried and begged.

This morning, not surprisingly, the feeling remains. I have just come out of a crying/wailing session. The straw that broke the camel's back this morning was going up the stairs to the second floor, carrying a bottle of water and my cane. With my cane in the crook of my arm, I went up a step at a time, putting the bottle of water one or two steps higher. Just as I reached the top, my cane went tumbling down and I had to go all the way back down to recover it. Of course, I couldn't do any of this if I didn't have one railing on either side of the stairs. I had the second railing put in after my surgery. Otherwise I would have been unable to tackle the stairs on one foot with crutches.

All this leads me to the subject of this post: power. Like it or not, most patients who go through a medical crisis or serious illness do not have the specialized knowledge to make a truly informed decision when choosing a medical practitioner to (hopefully) bring them back to health. We trust in our instincts and in the recommendations of others. Then we relinquish our power. When we put ourselves literally in the hands of a surgeon, we have no more power. He (or less frequently, she) takes over the course one's life. The anesthetist puts us into a sort of coma and the surgeon proceeds to place us in a life-threatening though controlled situation in order to restore us to wellness. When the surgeon's efforts fail for whatever reason, the patient's feeling of powerlessness, which was originally associated with trust, now comes to the surface and bonds with anger, hate, fear and depression.

Powerlessness--perceived and real--is one of the greatest enemies I face now. As my body continues to fall apart due to the surgery (now the elbow of my cane arm is hurting, since it has to take so much pressure), my sense of power and control are sorely tested. I have been robbed and violated.

In the course of cleaning out my e-mail box, I came across a message from a close friend who now lives in Florida. Her husband, a professor of sociology, had been the subject of an article dealing with his work on trauma. I re-read the article and a light went on in my head. Then, this morning, my therapist brought up the same subject. The light shone even brighter. Here is the gist of it:

When we think of trauma, it is usually in relation to those who have experienced the traumatic event directly (i.e. being abused as a child, being raped, etc.). But now, researchers and front-line professionals like social workers are beginning to focus in on the trauma resulting from having witnessed someone else going through a traumatic event.

I now realize that growing up as an only child with a severely handicapped mother has impressed upon me a vision of my own life that, at least for the time being, is impossible to shake off. Her physical trials imprinted themselves on me much more deeply than I could have ever imagined.

As I have said before, the emotional and professional aspects of my life have in many ways been a radical departure from my mother's experience: Whereas my mother was criticized and soon abandoned by a cold, distant man who married her essentially because he wanted a maid (he was a Holocaust survivor and in poor health), I have found a wonderful man who has made it abundantly clear to me that he loves me as I am and will stay by side no matter what the future brings. Whereas my mother, though intelligent and thoughtful, never got a university education and worked as a secretary until her health forced her to go on welfare, I have been able to further my education and now work in a challenging, high-pressure profession which I find in turns frightening and exhilarating and which provides me with quite a decent income. Furthermore, despite my increased handicap, I can still carry out my work quite effectively.

But on a physical level, heredity has shown itself to be a colossal steamroller that seems to leave no room for personal choice. When I was growing up, I saw arthritis and how it had ravaged my mother's life as her problem. It had nothing to do with me. Mom used to say that her arthritis (and her sister's) came from the fact that when they were growing up in Russia in the early twentieth century, they had been poor and thus deprived of proper food (especially calcium). This had led to osteoarthritis in later years. Now I know that her theory was untrue. I am sure that if she had been able to explore her family tree, she would have probably found a number of women whose lives had followed the same path.

I did not personally experience her incapacity as a child. I experienced it in embarassment and frustration, for instance when she called for a taxi just to take her up the street--taxi drivers hate short trips! Now I am in the same situation, though thankfully, I can drive. But I can no longer go to places where parking is an issue, since I doubt I could step up into a bus and I can no longer walk distances that I could walk fairly easily before my surgery.

The outcome of a trial is hopefully based on evidence, the profession a person chooses is often based on the "evidence" of their mom's or dad's profession, we choose to buy a mutual fund based on evidence of past performance. Well, I have seen the "evidence" and so far there is nothing that shows that I will ever get better. Reminding myself that surgical techniques have changed amazingly in the past thirty years or that I am simply not inhabiting my mother's body but in fact my own is cold comfort. The overwhelming proof points in one direction and one direction only.

Much as I hate to admit it, I was expecting a bad outcome from the surgery. The writing was on the wall. I feel that the physical hand that I was dealt mandates that I cannot depart from the script that heredity handed me at birth. If I have one issue to overcome, it is the feeling that all this has been pre-ordained.

I cannot say that I had never felt depressed before this disaster occurred. Yes, there were things in my life that really got me down--one of them being the move we made from a city I adored to a city that I am only starting to appreciate after almost four years living here. In fact, about ten months before my total hip disaster, I had begun to see a therapist to work through all the feelings that had come to the surface after our move. A few months before the surgery (I have trouble calling it that, butchery seems more apt) I had begun spacing out my visits to the therapist and was feeling more "aware" of my feelings and able to deal with them as an adult and not a hurt child.

But the black depression that has come over me due to my new, much more severe incapacity poses a psychological challenge that I would not wish on anyone.

I entered into this adventure with trepidation but also armed with dozens of success stories. The reality has often been too much for me to bear. Like a woman who miscarries and is constantly obliged to explain to those around her that no, she lost the baby, she is not a tired though happy new mom, I too find myself having to explain that I am one of the very few whose hip replacement has resulted in disaster.

Every day, I wake up with the physical reminder of how badly things have gone and the question mark of what my future holds. Luckily, I am able to work (I am self-employed) and the rigours of my job , which fortunately is done sitting down, keep me from obsessing non-stop over the damage done to me.

I began seeing my therapist again before I could even get out of the house but also before I had confirmation of how badly things had gone. He came to my house once and though I was happy to see him, I did not recommence regular sessions until I could once again drive to his office. Many's the time I have sat in his waiting room quietly crying.

I consider my therapist part of my "professional team" along with my GP. Of course my husband and children are integral to keeping me from totally going over the deep end. The three of them give me their total love and support and I am also lifted up by having to/wanting to love them back as much as I can. As I write this, I realize that I don't see my surgeon as being part of this team. No one is perfect and even the best of surgeons make mistakes but he made that mistake on me and it's hard to feel that I'm in good hands considering the enormity of the crime he and his henchmen committed on my body and my life. Strangely, though, I suspect he will be the one to correct the disaster if I have to go for further surgery. But as I say this, I also realize that I will probably go for a second opinion, or maybe even a third.

My arsenal also includes anti-depressants, something I had never used in my life before now. Initially, it was psychologically hard to accept that I would be better off taking them. And this feeling was infinitely compounded by the fact that I have been prescribed exactly the same anti-depressants as those my mother took. It seems to support my feeling of being cursed and that there is no way I will ever get better BECAUSE MY MOTHER NEVER GOT BETTER, ONLY WORSE, NO MATTER WHAT TREATMENT SHE RECEIVED.

Which leads me to the other part of this post: blaming the victim. I blame myself, first and foremost, for even hoping that the surgery would make me better. Given my mother's experience, in my deepest soul I do not believe that I can break free from the road that her life has traced for me. I know this sounds melodramatic but the fact remains that physically, my experience has never deviated from that of my mother's, right down to that one little hair on my chinny chin chin. My physical life has so far been a carbon copy of hers. Professionally and personally, I have been successful in leading my own life but physically I have suffered as much, if not more than she did at the same age. So far, I have no proof that anything will be different. I even blame myself for hoping that something good will happen--something different from my mother's slide into disability. Well, yes, it is different. She slid. I have been projected headlong and years earlier into significant disability.

I also blame myself for not searching harder for a surgeon (see my first posts) and not finding out more about MIS. I blame myself for putting my trust in a doctor. But then again, none of the people I truly trust in life could have performed a total hip replacement...

The expression "caveat emptor" comes to mind: buyer beware. But shopping for a hip replacement requires specialized knowledge that I, for one, don't have. I trusted professionals (my former surgeon, Dr. "Parent", the nurse in the operating theatre, the physiotherapists and all of their advice was WRONG.

Depression and blame are horrible feelings.

All told, I was hospitalized for slightly over four weeks after my surgery. I came home just before Christmas. Of course, I was still not allowed any weight-bearing so I hopped around on my crutches and for the most part stayed upstairs, either in my bedroom or my office. Thank goodness for the Internet.

I live in a city that can get quite cold and snowy in the winter. Up until I came home, we had had very little snow, but shortly after my return home, winter hit with a vengeance. Because I couldn't use my operated leg, I couldn't go outside except when a special transportation service came and picked me up to take me to physiotherapy. As the weeks went by and the snow and ice continued to pile up, I really thought I would go out of my mind. I exercised every day and when I was finally allowed to walk on my operated leg, I paced up and down my tiny upstairs hallway, doing five minutes, then ten, then twenty.

Sleeping was practically impossible. For the first 12 weeks, you have to be extremely careful or your new hip can dislocate. The only totally safe way to sleep was on my back, but grinding groin pain kept me from sleeping more than an hour at a time. Fortunately, my husband is a sound sleeper so the TV and I developed an intimate late-night relationship. At week 10, I couldn't take it anymore and called my surgeon to see if I could safely sleep on my unoperated side with a pillow between my legs to keep me safe. Permission was given and I immediately starting sleeping if not like a baby, then at least passably well.

As the weeks went by, I began to wonder about my recovery. I had been in such pitiful shape immediately after the operation that I couldn't even bend my knee 1 week post-op. Basic movement had come back but I felt that no significant improvement was taking place. My physio kept saying that things were going slowly because of the fracture, but with time I would get better. She went so far as to say that it could take up to 18 months! This was a horrible shock since in my conversations with "hippies" on the Internet, people were starting to get back to normal within about three months.

But I soldiered on, doing my exercises faithfully and crying in frustration every few days.

After about eight weeks seeing the outpatient physiotherapist at the convalescent hospital, I switched to a private clinic and a physio who had been highly recommended to me by a wonderful hippy friend I'd made through the Internet. After examining me, he too said all the problems were related to the fracture and that with time and exercise I would get better. He said my muscles were terribly weak and that was why I was unable to walk at all without a cane. After a few weeks, and seeing no appreciable improvement, I made an appointment with the doctor who ran the clinic. Again, the response was the same. Exercise, build your muscles and you'll be fine.

In February, the knee on my operated side began to hurt. My physio said not to worry, it would get better. In fact, it got worse and worse. At the same time, I became more and more depressed since I felt that now my knee was preventing me from recovering. At times, I even went back to crutches because the pain in my knee was so intense.

In April, I saw my GP who measured my legs and told me that the operated leg was 1 1/2 cm shorter. She suggested orthotics. Though expensive, I had them made and found that they helped with the pain in my knee. At this writing, although not perfect, my knee is much better.

When she examined me, my GP was struck by the extent to which my muscles were atrophied and immediately called my surgeon. The upshot was an appointment ASAP. As usual, I was first met by a fellow (student surgeon) who asked me a few basic questions. I have always found the students to be loathsome, unfeeling creatures. This one was no exception. He started by asking me when my surgery was scheduled for! Obviously, he had not read my file at all. Between gritted teeth, I told him that I had already had surgery. Though this exchange took place almost five weeks ago, it still festers in my mind. If, at my next appointment, I am asked the same stupid question I will send the student packing.

When the surgeon came in, he asked me to walk without my cane. I replied that I wasn't sure that I could. I did manage to take three halting steps and that was it. Immediately, he sent me for x-rays.

After examining the x-rays, my surgeon announced the news. He suspected the stem of the prosthesis was loose--again due to the fracture. The recommended course of action was to cease all physiotherapy and wait and see if the bone would finally grow into the prosthesis. This in itself was devastating news, but it was compounded by the fact that neither the physiotherapists I had dealt with nor the doctor at the clinic had detected this problem. All the physiotherapy I had been doing was in fact making me much worse. How could they have not seen this? I suspect that it's because hip replacements are practically always successful. Only the trained eye of the surgeon is able to see when there is a problem. It's also because NO ONE LISTENS TO THE PATIENT. For months I had been saying that I wasn't improving. I felt as if I was healing into a crippled state--as if someone had slashed my face with a razor and then denied me plastic surgery. Yes, you heal, but without proper care your face will just be a mass of scars.


It's been five weeks since I stopped physiotherapy. I am less stiff in the morning, but the pain continues. My ability to walk unaided is no better than it was in February. In fact, I am walking much shorter distances now than I was before my knee began to hurt. It's not my knee that stops me now, but rather pain in the buttock, below the buttock, on the side and sometimes in the groin area.

I will be seeing my surgeon again in ten days, but he has already told my GP that he wants to wait six months before performing further surgery. That will put me back in the winter and a winter recovery is something I don't think I can handle a second time. Not being able to go out was soul-destroying and I think it also helped to mask my lack of progress. When you go out and put yourself to the test, you can really see what's happening. Also, walking on wooden floors is much easier than on concrete--again, the lack of progress is not so evident.

I realize that I've been avoiding actually talking about my operation. Well, I'm about to face the monster head on:

I had my surgery on November 18, 2003 in a large well-regarded hospital in a major North-American city. My surgeon is one of the top orthopedic surgeons in our area, if not in the country.

A few months before the surgery he asked me if I would be interested in minimally invasive surgery (MIS), a relatively new technique. I immediately got on the Internet to see what information was available. Well, to quote someone else who has recently suffered an MIS-related complication, pretty much everything you find on the Net regarding MIS touts it as the best thing since sliced bread: faster recovery, on your feet right away, smaller incision...I was thrilled to bits that my surgeon felt I could be a candidate for this wonderful surgery.

My surgery began around 12:30 p.m. It was supposed to last 3 hours. My husband was sent to wait in the special waiting room reserved for those waiting for a patient in surgery. When they closed the waiting room, I was still not back. They sent him to wait in my room.

The surgery took 5 hours. When I awoke in the operating theatre I remember seeing my surgeon and some other people standing over me. All I can recall is immediately hearing that my femur had been fractured during the operation. Of course, I was shocked, groggy and in pain. "I'm confused," said I. To which a nurse responded, "Do you know what day it is?" Well of course I did!! But a fracture? That wasn't something I'd had any inkling could happen. I was overwhelmed.

They took me back to my room and told me that I was not allowed to move for the next week. And here I was expecting to be in physiotherapy the next day. The first night I was awoken at regular intervals to check my vital signs. I didn't have to worry about urinating as they had inserted a catheter. I was allowed to "eat" ice-chips--the best ice chips I'd ever eaten in my life.

My surgeon visited twice, staying perhaps a total of five minutes. He was always surrounded by his accolytes--young surgeons in training who no doubt hung on every word he said. He did not seem particularly concerned with what had happened to me and in fact admonished me to keep my leg straight.

The day after surgery, I was taken for a CT scan. I thought it had to do with the fracture and nobody told me otherwise. I was in a lot of pain lying flat on the table and I was also terribly frightened of being moved and somehow disturbing my fractured leg. The day I left for the convalescent hospital I was again taken for another scan and this time I asked why. It had nothing to do with my leg. Apparently, they had detected an anomaly on my lung in an x-ray taken before the surgery and wanted to check it out further. Couldn't someone have said something, or was I too stupid to be given the information? The scans didn't seem to reveal anything worrisome but I will have to go back again for another scan next November. I worry a tiny bit, but mostly I feel furious about how I was treated.

During the eight days I spent in the hospital I felt very weak, but I had lots of visitors and felt that this was but a relatively minor setback in my march towards a new and better life.

On the eighth day post-op (hey, this is sounding biblical!), I was transfered to a convalescent hospital where I stayed for just over three weeks. It was a wonderful place where I went from being totally dependent on others for everything except feeding myself to being able to dress myself, take a shower, use crutches, etc. I began physiotherapy the day after my arrival and felt excited about finally getting on the road to recovery. I was still not allowed to put any weight on my operated leg and would remain three-legged (one leg, two crutches) until seven full weeks after my surgery.