Saturday, August 14, 2010

Pregnant Robot

My knees didn’t go bad all at once; it was a slow decline over a period of about five years. During that time, I slowly developed numerous coping mechanisms to avoid the pain that occurred when the bones in my knees ground together. This resulted in a stiff-legged hobble, and a tendency to lift my hip to step up over a curb, rather than bend my knee. Now, I’m struggling to ditch those bad habits.

My wife says that with my new knee joints, I walk “like a robot.” This is from a fear of becoming off-balance, and having to make a sudden, possibly painful, corrective move. My physical therapist tells me that I walk “like a pregnant woman,” because I still want to use the stiff-legged hobbling walk, and I tend to splay my legs to maintain balance.

So I use this “pregnant robot” criticism as a motivational tool to try and correct my gait. My physical therapist goads me into walking around the house “like a man,” lengthening my stride, lifting my feet as though stepping over a box of Kleenex, swinging my arms, and swiveling my head from side to side to force me to make balance corrections. It feels unnatural after so many years of cautious pain-avoidance. I feel like a comedian doing an exaggerated manly walk.

Despite my challenge to walk normally, my physical therapist has dubbed me “the poster child for bilateral knee replacement.” One reason she feels this way is that I’ve recovered a great deal of strength, and I’ve developed excellent knee flexion. Normal people can flex their knees to around 160 degrees. The anticipated maximum for knee replacement patients is around 130 degrees (due to limitations in the artificial joint). Currently, I can flex 134 degrees. I’m going to try and achieve even more flexion, because there are so many things I need to do around the house that involve squatting or kneeling back on my heels (kneeling is currently not a pleasant experience).

Unfortunately, I’m falling short of the goal for knee extension. Almost everyone can extend their legs to zero degrees (legs straight). Normal people actually exceed zero degrees when standing, “locking” their knees by bending the leg backward a few degrees. My physical therapist tells me that recovering this ability after knee replacement surgery is crucial, to avoid the possibility of the knees buckling. She also tells me that it’s the hardest goal to achieve, and I believe her. She has me sit on a chair, legs extended, my heels resting on another chair. Then she holds a measuring device up to my leg and presses down hard on the knee. Yeah, it hurts.

I’ve been going a little stir-crazy at home. My wife strictly forbade me to drive a car until my physical therapist said it was OK (my surgeon said it was OK weeks ago). Eventually, the two of them agreed that I was capable of driving, so I gratefully ran errands rather than sit home and watch TV. My boss told me that I’m not allowed to go into the office while on Short Term Disability, because of the insurance liability. So I got my doctor’s office to sign a “Return to Work” certificate, which means that on Monday, I’m officially off Short Term Disability and back to work. I wonder if my company’s insurance covers pregnant robots.

Wednesday, August 4, 2010


Once safely at home, I made it my business to move around on the walker as much as possible. Sitting on the edge of the bed, all I had to do was grit my teeth and make the transition from sitting to standing, the hardest and most painful part. After I’m vertical, there’s not much pain and I can shuffle around the house pretty much at will.

I was visited by the highly competent Home Health Care nurse, who inspected my incisions, took my vitals, and arranged for my doctor to issue prescriptions for the meds I’d need during my recovery. This included a bag of syringes preloaded with an expensive medication intended to prevent blood clots. She demonstrated the injection, and on her next visit, taught me to give it to myself, into a pinched roll of belly fat (which I have in abundance).

It’s surprisingly easy, although lots of my friends go white-faced at the mere idea of injecting themselves. The hardest thing is avoiding “reflex bounce.” This is where you jab in the needle, but before you can inject the medicine, you reflexively yank it out, and then have to jab yourself again.

The Home Health Care nurse came by daily for about 4 days, then every other day for a little while, and then stopped coming altogether, due to my dramatic improvements.

The Home Health Care physical therapist came by daily as well, giving me instructions on using the walker, and supervising a series of exercises to develop flexibility and strength. She’s a slim Filipina woman, gentle and encouraging, but she makes me work like a rented mule.

A friend of ours from Boston came down to visit for a week, providing much-needed distractions from the tedium of daytime TV. She and my wife shared the duty of ensuring that I did my exercises as required.

I made rapid progress. By the end of the first week home, I could get out of a chair easily, walk short distances without the walker, and leave the house occasionally. Today, nearing the end of three weeks since the surgery, I no longer require the walker (or a cane) for anything. I’ve been encouraged to use the stationary bicycle (with zero resistance) and swim in the pool for exercise.

Strangely, although I’ve always been a strong swimmer, I seem to have lost my flutter kick. I had an anxious moment in the deep end of the pool, where I was holding on to a float and tried to swim to the side, but just hovered there in the middle, not moving, wondering if I should call out for help. Eventually, was able to thrash my way to the stairs.

I can simulate a normal walking gait, though at this point it’s a bit less painful to walk with a pronounced limp.

People in the hospital, the nursing home and Home Health Care have been very impressed with my progress, which everyone attributes to my age. One large Jamaican nurse, watching me struggle to my feet on the walker, said “Dot’s yoof working for you, mon.”

My physical therapist comes by every other day now, and has transitioned me to rubber-band exercises. These are wide bands about three feet long, color-coded yellow, red, green and blue. The colors represent the thickness of the rubber (yellow is the thinnest). She’ll make a loop of one, wrap it around my ankles, and have me fight the resistance of the rubber to spread my legs. Or she’ll loop it around a chair leg and an ankle and have me straighten my leg from the knee. We’ve been moving through the color spectrum for the past week, and we’re on green, which is really hard. “Next time blue,” she threatened me today. Thank God I have my yoof.

Tuesday, August 3, 2010

Rehab, Part 4: The Metaphor

To my wife’s great credit, she took my demands seriously. Her eyes opened to the incompetence, the deficiencies, the indifference. We rang the Call button at one point and waited 20 minutes without a visit from an attendant. My wife stormed off to the desk and found one of the attendants there, who had set down a clipboard in such a way as to cover the Call light panel.

Before long, we had the administrator in my room, apologizing. I demanded to know what plan, if any, existed for my physical therapy. I had been there for 16 hours and nobody had thought to discuss it with me. Her response was, “The physical therapist comes in at 3. You can talk to him then.”

“Four more hours?” I sputtered. “I have to spend almost a full day here before someone is available to discuss my treatment program? Once again I have to ask if anyone in this place knew I was coming.”

The administrator again began a series of useless apologies, and suggested that we might be more satisfied with Home Health Care. I suspect that she would be thrilled to see us leave, since all I had done since my arrival was point out the gaping holes in her carefully-wrought treatment facility.

At that very moment, I became aware of a change in my body – a movement, a gurgle, a pressure – and realized that my long-awaited bowel movement was about to arrive. For six days, this reluctant slug of feces had resisted daily doses of stool softener and laxatives, hindered by anesthesia and pain medication. And now, during the discussions of my release from the nursing home hellhole, it had broken free of its bonds and was cruising towards freedom, a metaphor in transit.

I had to interrupt the discussion and request privacy. The curtain was drawn around my bed, and I painfully slid myself over and onto the commode – a maneuver I had not yet tried. Once enthroned, I had to conduct my business while listening to the discussions continuing on the other side of the curtain.

Within minutes, a great wave of relief washed over me, and I was able to return to the itchy, uncomfortable nursing home bed with a sense of accomplishment. The discussions between my wife and the administrator had resulted in an agreement, and the paperwork for my release was being prepared. The bowel movement was merely the icing on the cake (sorry, that was irresistible).

During the wait for the paperwork, the physical therapist arrived. He was a nice guy, intelligent, committed and probably good at his work. Had our paths crossed the previous day, it might have changed the outcome of this story.

Almost exactly 24 hours after I had been admitted to the nursing home, I was released. A male attendant helped me into a wheelchair, and I literally burned rubber on that thing heading for the exit.

I cannot adequately describe the feeling of returning home. I was able to use the walker to get from the car to our bed, and I lay there in ecstatic gratitude. I told my wife that if the day ever came where she had to decide whether or not to put me in a nursing home, she should just give me list of things to pick up at Costco, and then cut the brake lines on the car.

Monday, August 2, 2010

Rehab, Part 3: Economics

I had a fitful, sleepless night with little relief from my pain medication. Earlier, I mentioned the two unused desks in the room, each of which had an equally-unused trash can in the kneehole. I had asked an attendant to move one of the trash cans near my bed, so that I could discard the tissue I used whenever I employed the urinal.

Early in the morning, a woman came in to replace the plastic liners in the trash cans. This was a fruitless task, because there was normally nothing in either can. She looked slowly around the room for the missing trash can, eventually finding it next to my bed. She replaced the liner, and then, as she had done hundreds of times before, put the trash can under the desk across the room, where it was useless to me.

“Miss?” I called to her, “Will you put the trash can next to my bed where you found it so that I can use it to dispose of these tissues?”

She nodded, picked up the trash can and then, perhaps from force of habit, slid it underneath the bedside commode, where I couldn’t reach it. I had slumped back onto the bed, and didn’t notice until she had gone. I spent the morning tossing used tissues onto the floor in frustrated attempts to make a Larry Bird hook shot.

I use this example to illustrate a sad reality I had begun to observe about the nursing home: After my stay in the hospital, everything seemed substandard, cut back to the thinnest veneer of quality. Nursing homes take the Social Security check of each resident to pay for their care. It's not much, probably less than $30 a day. To make a profit, they have to reduce costs.

The bed was narrow and uncomfortable, the sheets were rough – seemingly a blend of burlap and asbestos. Believe me, you notice such things when you’re bedridden.

There was a pervasive odor – a mixture of urine and cleaning products – that I’ve decided to call “pissinfectant.” The food was all canned glop poured over pasta.

But the worst example of nursing home economics was the staff. There was an administrator and a nurse on duty during the night. Everyone else appeared to be trained zombies.

They were undoubtedly minimum-wage jobs, which were boring, repetitive and demeaning. So the quality of people who take those jobs are the borderline retarded - those who take comfort in routine, unchallenged by novelty or crises. They plod numbly through their days, changing diapers and bed linens, moving patients to the dining room or the TV room, bathing the patients occasionally, and then returning them to their rooms for the night.

Earlier that night, before I tried to sleep, I asked an attendant to strap on my leg straighteners, which are reinforced wraps that are closed by Velcro straps. She held one up and turned it around and around, trying to figure out how to put it on.

“You lay it flat on the bed,” I instructed, “with the foam pad facing up. Narrow end by the ankle, wide end by the upper thigh. Then you lift my leg onto it and strap it closed.”

She continued to turn it around and around, her brain struggling with the complex geometry necessary to distinguish “wide” from “narrow.” Eventually, I had to pull myself up painfully and arrange it for her.

I had complained about the stifling heat in the room, so they sent a maintenance guy later that day. He looked at the air conditioner and declared that it was set to 60 degrees. “Yes, I can see that,” I said, patiently. “But it’s not 60 in here, is it?”

He and I stared at each other, a classic Mexican standoff. He eventually mumbled something and left, but it was a moot issue. I had made up my mind.

When my wife arrived around 10 a.m. to see how I was settling in, I pulled her close to me and said, “I want out of here right now. Right now. Sign any papers you have to sign, get me in a wheelchair and take me home. I’m not staying here another night.”

Sunday, August 1, 2010

Rehab, Part 2: The Call Button

The ambulance team wheeled me down a long corridor to an end room. There were two beds, one occupied by an elderly man with advanced Alzheimer’s Disease, unable to walk, talk, or feed himself. The team lifted me into the unoccupied bed, gathered their equipment and left.

I took a few minutes to assess my situation. My inflamed knees were screaming for pain meds, and my five-day constipation struggle had put me into a foul mood. The room felt absurdly hot, even though there was an air-conditioning unit next to my bed that was set to 60 degrees. There were no amenities near the bed – no tray table, no bedside commode, no urinal, no walker, no wheelchair.

Across the room were two desks, clearly unused by any resident since they were assembled 10 years ago. My roommate’s desk had a small TV, loudly blaring an episode of Little House on the Prairie. At every commercial break, an older man and woman dressed in conservative clothing thanked the viewers for watching the show, “depicting the early pioneer days of American history, based on the core biblical values of faith and family.” They would then ask for donations to enable them to continue such programming. That was it – no other advertising.

I decided to deal with the medication issue first, and reached for the Call button. There wasn’t one. Horrified, I started to call out: “HEY! ANYBODY THERE?” Down the hall I could hear other elderly residents in various stages of dementia take up the call, like so many magpies: “Heeeeyyyy! Hellooooo! HEY!” It occurred to me that the attendants had long ago learned to ignore them.

I yelled myself raw for about 10 minutes before somebody showed up. Red-faced, I demanded to know why there was no Call button. “Were you not expecting me today?” I sputtered. “What if I had a medical emergency?” The attendant listened to me, wide-eyed, and then said she would go get the nurse. The nurse waddled in, an older woman with the spreading thighs of a desk-bound bureaucrat.

“You don’t have a Call button? She asked. “I guess we should find one for you.”

Once the Call button was hooked up, the nurse turned to me and asked the stupidest question imaginable: “Is there anything else you need?”

“Well, we can start with the reason I wanted the Call button in the first place,” I snarled. “I need my pain medication.”

“It’s not here yet,” she said. “We had to order it.”

Once again, I was dumbfounded. “You’ve had all day to prepare for my arrival!” I was red-faced now, and shouting. “If you’re unable to provide the basic essentials for my care, I should never have been transferred here! Has anyone read my chart? I’m not ambulatory! I’ve been constipated for a week, and I could launch this torpedo at any time! How were you planning to handle my bathroom visits? Is someone going to bring a wheelchair and take me to the bathroom?”

“No,” she told me, “we can’t do that because you haven’t been trained how to transfer from a wheelchair to a toilet yet. Too dangerous.”

“OK!” I exclaimed. “Got it! Now what the hell is Plan B?”

“I suppose we could find you a bedside commode,” she suggested hesitantly.

“Excellent idea. Why don’t you do that, and while you’re at it, find out when exactly my meds will arrive.”

I lay there fuming, while the wide-eyed attendant watched me from across the room, fully expecting my head to explode. I get the impression that most residents don’t possess the capacity to complain, and this was a new phenomenon.

The nurse returned shortly with a commode, which they placed next to my bed, along with a tray table and a urinal. By then it was 9 p.m. The nurse told me my meds should arrive within an hour and a half, and then they got the hell out of there.

The meds showed up at 2:20 a.m., by which time I was sobbing from the pain and discomfort.