Legs To Stand On: A Psychological Journey Continues
Part II: From Eight Weeks Out
Story tellers who draw their tales out ad nauseum, holding their listeners in a state of prolonged anticipation, have always annoyed me. So, for those of you who read my previous reflections and may be wondering how I've fared, I'll cut to the chase - or at least to the chase in process:
I am doing very well. I know it. And everybody says so.
I haven't used canes since the third week after surgery - and even then it was to alert bus drivers that they needed to lower the steps for me or for protection when walking in crowds,. When Naomi and I met for lunch last week I returned her "good luck" cane to her festooned with red ribbons. It was a celebration.
Now at eight weeks I can walk three miles, erectly, easily - without pain, without limping. I am sure I could do more if I tried. My surgeon doesn't want to see me until next year. He says the xrays are perfect, incisions healing nicely. He has released me from most of the claustrophobic "hip precautions". I can now go to work in earnest with my physical therapist. I can begin extension and flexion exercises. I can slowly resume a normal life.
I am reacting in two ways to being told that I don't have to see my surgeon for a year. On the one hand, I am elated: I must be very well indeed!
On the other, I now have no one to guide me. I'll have to become my own watch dog, keep myself from doing too much, from doing something dangerous that might damage or dislocate my new hips. This is not where I want to be right now. I'm on the other side. I want to gobble up life and, for a while, at least, I have to take dainty mouthfuls. More on this later
For the most part, as I said, I am not in pain. I haven't taken anything but Tylenol since several days after surgery. But sitting for too long hurts. A soreness where the external rotators were cut and reattached. And I still ache after climbing a lot of stairs. Every once in a while I am aware of my prostheses. If I take a step to the side I feel them moving over each other. This is not painful, just weird. I am told this will disappear as my muscles strengthen. Most of the rest of the time I forget that I am now a bionic woman.
I am certainly not depressed any more. I am still labile, though. I cry easily. (I also laugh easily.) I have to keep reminding myself that I've been through something major and that I need to treat myself gently.
I also find that my normal "healthy" energy level has not returned. I may have gone back to work too early, starting phone sessions on the 13th day after surgery and "live" sessions shortly thereafter. It may also be that my body is requiring a lot of energy to recuperate. I have energy for most of what I have to do. It's the extras I don't have energy for. And since I'm now of a mood to play hard, I feel frustrated. Time for a vacation!
I'm mostly aware of feeling grateful: grateful for the technology that made this surgery possible, grateful for my surgeon's skill, grateful for the care I got from a host of competent and tender professionals, grateful for all the love and support that's come my way from friends and family. I'm a lucky girl.
And now for the back story.
Three days before my surgery something curious happened: I stopped being so afraid. I realized I was no longer thinking about the surgery itself. I had done my homework diligently. I had been in "training" with my physical therapist for almost four months. I had kept my muscles strong. I had eaten well. I had tried (with moderate success) to resolve my ambivalence about the whole process. I had read the vitae of a number of surgeons and had interviewed three of them. If I hadn't chosen the best surgeon in the world, he was certainly among the very best. That was good enough for me. I had now done everything I could do. I was ready to let the surgeon do the rest.
Grisly fantasies of sawed-off bones, dislocated legs, cut tendons, drills, hammers, and bloody sponges suddenly gave way to images of easing myself out of bed using my hard won upper body strength. Then I was standing on my new hips. No pain! I saw myself taking my first hesitant steps, first with a walker, then with canes, finally, triumphantly, all by myself. Then I was striding briskly down the street or on the beach at Fire Island breathing deeply, arms swinging. I saw myself tangoing. Even heard the music...
These images would come to me at different times of the day, unexpected, but welcome visitors.
I was already in rehab.
And then it occurred to me that I was unconsciously doing with myself what I did so often with patients: I was using "visualization" techniques, techniques that my mother had introduced at the Gestalt Institute of Cleveland thirty years ago. I felt moved. She was still with me...
For those of you about to have surgery and unfamiliar with "visualization," Peggy Huddleston's tape "Prepare for surgery: heal faster" isn't bad. Personally, I dislike the heartbeat as background, but that's just my taste. Or, you could just make up your own healing meditation and images. If, like me, you want to participate constructively in your surgery, this is a good way to do it.
No matter how well prepared you think you are, life can throw you a curve ball. In retrospect, I handled most of the events around surgery very well. I had rehearsed them in my mind. I was ready. But there were a couple of things nobody warned me about.
For one, I had terrible edema. By the second day after surgery, both of my thighs were swollen to twice their normal size. The effect of trauma. So swollen, in fact, that when they removed the urinary catheter on day three, I couldn't get my legs apart enough to sit on the orthopedic toilet seat! When on day four, I entered rehab; my weight had gone from 135lbs before surgery to 153 lbs. Eighteen pounds of water! My skin was so stretched that I was in considerable pain - to say nothing of the painful prospect of spending the rest of my life pumped up like Woody Allen in "Sleeper"! It took almost two weeks for my legs to return to their normal size. And still today, eight weeks after surgery, my ankles and knees swell up if I sit for too long. Three to six months, my surgeon told me at the six week check up, before all will return to normal.
Another possibility I should have been alerted to was what happened to my vision: As soon as I was with it enough to notice, I realized that my left eye was not focusing properly. I was immediately convinced that something had happened during surgery. Perhaps a clot in the part of my brain that mediates vision. Things could deteriorate further. I could go blind....
It took Barbara, a lovely nurse from the Visiting Nurse Association, to assure me, three weeks later, that she had seen the same symptom in women who delivered their babies by epidural anesthesia - the anesthesia used in my surgery It would go away, Give it time.
She was right.
For my personality, a list of possible but unlikely side effects of surgery would have been helpful. Like the warning labels on drugs. Perhaps for others it would only be anxiety producing.
For me it's not true that "what you don't know won't hurt you"!
Letting Go and Letting In
When you've just had surgery, are terrified to move at all -and you're hooked up to IVs, pain and urinary catheters, it's difficult to be in charge.
You can fight it, or you can drift into a state of drowsy regression and let people take care of you.
In the recovery room, where I spent the first night, I got lots of attention. Every patient there was "critical" so there was constant monitoring of vital signs and verbal inquiries about how I was feeling. Uncharacteristically, I let myself go with it. When Allan came to see me, a couple of hours after I came down, I remember looking up at him from my gurney. He was examining the xrays of my new hips which were hanging on the gurney. He was telling me how beautiful they were. I felt luxuriously small and safe, removed from the world of grown-ups and their concerns. The grown-ups would worry about things and they would take care of me. That was a feeling I hadn't had for a very long time.
I had the same reaction to being bathed, powered, and fed through a straw. I didn't have exact memories of my mother caring for me in this way. But my body remembered. It was lovely.
As a surgical patient at HSS you don't get much time to enjoy being small and passive, however. Within an hour of my being installed in my room the next morning, I received a visit from the physical therapist. He was adorable: thirty-fivish, long dark hair in a pony tail, big blue eyes. The baby in me grew up fast. I was suddenly aware of the edema, of looking terrible, of needing a shower, and of having all sorts of tubes hanging from me. He didn't seem to notice. He took all my accoutrements and hung them on the walker he had brought along. We were going to take a walk!.
I was horrified when I saw him attach my urine bag to the front of the walker for all to see. "I apologize," I stammered, "This is the first time I've gone for a walk with an attractive man - preceded by my urine!"
Life's little indignities.
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In every major life experience there seem to be marking moments, moments that stay clear and present in memory when all the rest fades.
Sometimes you know it even at the time. You say to yourself, "I'm going to remember this. I'm going to remember how I feel right now. I'll see these surroundings, the expression on the faces of the people around me. I'll remember the sounds of these voices. I'll remember smells and textures." And you do.
Rehab was such a moment in my recuperation.
My surgeon had recommended New York Presbyterian's new rehab center. It had the convenience of being right next to the Hospital for Special Surgery and the advantage of being new. All the equipment is new, the corridors are long expanses of polished wood that invite you out to the middle like a newly surfaced ice skating rink. Of course, there are hand railings for when you're just starting out or feeling unadventurous.
Patient rooms and nurses' station are on the 17th floor, as are a beautiful family atrium, where there are lectures and concerts, and another family space with kitchen, TV and tables where family members can come have a meal with patients. The rehab equipment is on the 16th floor.
All windows afford breathtaking views of the East River and major bridges.
Here's the really good part: the staff is young, energetic, unflinchingly optimistic and encouraging.
I came to rehab in the fourth day after my surgery. I was still very swollen, cranky, afraid to move much on my own - even though I had accomplished multiple turns around the nurses' station on my walker while still at HSS. Then I looked around me.
There were people much worse off than I was. Two of the men had been operated on for brain tumors. Another was there for the third time: he had cancer. One of the women had had abdominal surgery. It was endless.
But the spirit of the place was such that before long we all felt ourselves members of a unique little family: we were there to get better. We would help each other get better. We cheered each other on, We watched each other take first faltering steps, lift weights, empty dishwashers. We clapped and whistled and teased.
And we got better.
The therapists were our young parents. They demonstrated, cajoled, cautioned, pushed when necessary.
My therapist, Theodora, took my walker away on the second day and told me that if I wanted to get around I would have to switch to canes. She then presented me with two of them that had just been cut to my measurements. She showed me how to use them.
She pointed out something astounding: even though I now had two perfectly functioning hips, I was still limping badly, favoring my left side. Before surgery it had been the more severely damaged of the two. My brain had to learn that I no longer needed to make an adjustment for impairment.
What a wonderful metaphor for how we carry into adulthood behavior that may have served us long ago, but no longer does!
Eric stretched me to ninety degrees, normalizing the position that all hip patients fear. Monica. my "occupational therapist," demystified the process of putting on shoes and socks. It was she who took me out for my first walk on the city streets on day six.. One cane. I tried to insist I wasn't ready
I did that a lot.(And still do.) I would say "I can't possibly do that." Then I would do it..
"Feel the fear and do it anyway."
One of the memorable events of that week in rehab was the day that four or five of us were told that we were going to make taco soup. We were presented with a recipe and the ingredients. At that point I could stand but needed two canes to walk. I chopped vegetables. Sara was mostly confined to a wheelchair but could stand long enough to combine the ingredients and stir them on the stove. George was weak but not
so weak that he couldn't open cans And so on. We made the soup and then we
sat down at the family table to eat it.
Allan had just come to visit. We invited him to dinner.
So strong was our affinity during that week and so essential to our progress that on the day of my "six week check up" I went back to visit not only the nurses who had cared for me at HSS, but the doctors, nurses, attendants, and therapists at New York Hospital who had been so important to me. I showed off shamelessly: "Watch me walk now!
Better, huh?" It was a family reunion…
The patient population had changed in the five weeks I'd been gone. No one was left of the old gang. I found myself wishing that I had taken the phone numbers of George and Sara and some of the others so that I could find out how they were getting along. At least I had done so with my room mate, Lorraine.
As I look back on my rehab experience from this vantage point, a word comes to mind. It's not an overstatement.
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The proof is in the pudding. As they say.
I chose Dr. Paul Pellicci for a number of reasons. He had been highly recommended by a person whose opinion I respected. In addition, another of his patients attended my gym and seemed totally restored at one year.
More generally, he had a fine reputation. So did The Hospital for Special Surgery.
Most importantly, however, my experience of him was that he was a person who would listen to me and address my special concern, see me as an individual.. He looked at me when he spoke to me, answered my questions directly, if briefly. He had a sense of humor. These things matter to me. I'm prepared to believe that other surgeons I interviewed might have performed excellent surgeries. I needed more than my hips attended to...
An example. In preparation for my six-week check up I had drawn sixteen stick figures performing various exercises. I wanted to know which of them I was now free to do, which were still off limits. Not everyone would have taken the time, but Dr. Pellicci smiled, amused probably, by my zeal, and then examined each of the figures, making annotations about how the exercise in question should be done.
I had given Dr. Pellicci a copy of the first part of "Legs to Stand On". When I asked him just before surgery if he had read it, he admitted that he had not. "I haven't but I will."
I hope he reads this part, and I hope that one day he will write something for this important website. He has much to contribute.
When I reacted with dismay to his suggestion that I not see him again until the anniversary of my surgery, he reassured me: "I'm only a phone call away."
The way it feels right now, I will make that call in a couple of months and set up an appointment. Just to be reassured.
But maybe not.
Most of my questions have been expertly handled on the phone either by his nurse, Patricia, a softly competent young woman who confers with him and calls me back (She also visited me in the hospital.), or by his excellent, warm office managers, Diana and Millie.
A doctor's office staff can make a big difference. Human contact is everything.
Love and healing
It seems beyond argument that love and support positively affect the healing process. I got a lot of both.
Allan rarely left my side during the critical hospital and rehab period. Because classes were in session at the time of my surgery this often meant running to New Haven and coming back- in a single day. Above and beyond the call, I would say. And he has been unerringly sweet and loving.
During one particularly hectic period when he simply could not go back and forth my niece, Calen, came from Cleveland to stay with me. She was wonderful company and pampered me outrageously. I'll never forget the night she gave me a pedicure and foot massage!
I could detail all the acts of love and friendship, the calls, flowers, gifts that I received from other family members, friends, colleagues, neighbors, fellow co-op Board members, patients, apartment staff. But the list would be over-long.
Suffice it to say that when people tell me my progress is amazing I tell them that I've had a lot of help.
In one of our pre-surgical appointments Dr, Pellicci had outlined his recovery strategy. "Now, you're going to be doing a lot of walking…”. On the day you come home from rehab I want you to walk half a mile. By the end of the first week I want you walking a mile a day, By the end of the second week, two miles a day, By the third week, three miles a day"
I alerted Allan and all my friends that I was going to need to walk a lot and that if they wanted to do something nice for me they should come walk with me. Everyone I asked was delighted. My medical prescription turned into an opportunity to spend time with people I cared about and whom I didn't see as much as I wanted to in my "normal" life
It was April. Trees were greening after the long winter. We walked in Riverside Park, watching the boats. Feeling the wind off the water. Or we walked in Central Park. Kids were playing, cyclists were out. And roller bladers. Life was returning…
Dr. Pellicci later told me that I had misunderstood him and doubled all the distances.
The mind-body problem: sense of self
In my earlier reflections I chronicled the progressive loss of identity I was experiencing as I became more and more debilitated.
Where am I now?
Coming up fast.
As I've said, I certainly walk better than before my surgery.. Walking, I'd say I'm my old self again. I can stride forcefully, swinging my arms; I can mince, I can sway my hips and wiggle my butt. This is important to feeling female. And I do.
I just bought a new skirt.
I can be erect and use my core to support me which was impossible when I was in so much pain. As long as I have the core of me, I am me.
I have returned to physical therapy. Michelle, whom I wrote about in Part I has left Westside Dance to work closer to her home upstate. But she has referred me to someone equally wonderful. Rocky, an ex-dancer and Pilates person, is beginning to do flexion, balance, and extension
work with me. She "gets" me after just a few sessions, thinks it's hilarious that the first thing I always say when she asks me to do something new is "I can't." Her big blue eyes twinkle and narrow.
Michelle had advised her to slow me down.
I'm back at the gym. I started the cross trainer and upper body workouts with weights at the end of the third week. Now, released from the "precautions," I'm starting some light weight work with my legs.
My muscle tone, I must say, is not what it was. Time to beef up.
I'm aware of feeling excited.. Every day's an adventure Every day I find I can do something I couldn't do the day before.. I'm re-creating myself, learning a lot. One day a couple of weeks ago I found that I could bend down and pick up my cat. Now, that's living!
I'm sure the day will come when the pace of my progress will slow and I will be more in touch with my limitations than with my miniature triumphs. For now I'm enjoying the challenge of working on things I can't do yet.
Perhaps because my current identity is not based on being a professional dancer or stage performer, I find that I can give myself some breaks. My turnout's not great.. I can't touch my nose to my knees. My releves stink. I haven't tried to tango because I'm still not allowed to do some of the movements the tango requires… But it's only eight weeks.
In important ways I have legs to stand on. I feel intact. Certainly. I'm less narcissistically wounded than before surgery… I don't feel diminished: I'm in creative mode. And the people I care about are responding to me as if I were the same old girl.
My practice is as busy as before. I may be a better therapist. I'm using my experience, finding so many parallels between my journey and those of my patients. Like my continuing to limp when I didn’t have to.
I've gone back to work on my new play.
I know that there are things I may never do again. I wonder about roller blading. I love roller blading. I feel expansive and free. The movement is
fine, I've been told. Just don't fall. Fracturing your femur or your pelvis could be bad... Unfortunately I'm a blader who falls.
If I decide to give it up, it will be with great regret…
At eight weeks I watch the dancers who work out at my gym stretching and moving in ways that used to be mine. It makes me sick to my stomach.
My hips would dislocate in a minute. Or so I fear.
I'd better get over this.
In my wallet is a card to use at security checkpoints. It states that the bearer has metal implants and may set off security devises. It also warns that the bearer has increased susceptibility to infection and must take antibiotics before unremarkable procedures like dental cleaning.
All that's a drag.
I am trying hard to not become an overly careful or fearful person. I think I can do that by staying in the moment and taking pleasure in the substantial functioning that has been returned to me.
But I wonder how I'll be on icy sidewalks.
Time will tell.
Lois Meredith, Ph.D.
30 May 2004
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Back to Part I: Moving Towards Surgery