Day 8

I was about to flush this blog, thinking no one would find it when, alas, I discovered a comment from someone scheduled for a knee replacement. With confirmation that someone is actually out there, I guess I have reason to continue. (Of course, I would have real evidence whether I'm getting any hits if I could make Google Analytics work.)

Now, a week removed from surgery, I can say that each day is better than the next. The level of pain is slightly better. Flex and strength in the knee is slightly better. And I've also been sleeping slightly better. I am more than happy to accept incremental improvement at this point.

I've established a routine since returning home that has chiefly involved help from wife. Unfortunately, she'll be returning to work tomorrow and I'll be on my own for much of the day. It complicates things slightly, but I'm sure I'll manage. Life is not too complicated at the moment.

I'll take some time now to discuss a portion of my hospital experience, from surgery through post-op. When I have the energy to do so, I'll write about my time on the hospital ward. Knee replacement and the need to take a steady dose of pain relievers, in this case, high-powered Percocet, makes writing a chore. I'm hoping less pain and fewer drugs will make writing a bit easier in the near future.

And I think I've settled more-or-less on a format for this blog. I'll return as often as I can to detail various aspects of the surgery and recovery with an eye toward providing a level of detail that someone who is contemplating knee replacement might find useful.

Tuesday. Feb. 24, 2009

M.L. and I arrived at the hospital at 6 a.m. as scheduled and were directed to a waiting area outside the operating suite. Within a minute, myself and another man led inside to a changing area where we would strip, don hospital gowns and bag up our clothes and belongings. I asked the other fellow what kind of surgery he was having. He said he hoped to have a biopsy. After 10 years of battling bladder cancer, doctors had detected a mass on one of his kidneys. That reality made my knee replacement look like a minor procedure.

Once in my gown, I was directed to a hospital in an area where doctors, nurses and anethesiologists gathered around patients. The room had an air of quiet urgency. An older nurse stopped by first and asked a litany of questions. A different nurse managed to insert an IV port and draw blood despite shaky hands. (That one was a bit odd.)

An anethesiologist nurse then explained to me that I would be receiving an epidural, which would block all sensation from the waist down. The epidural would be given in concert with some kind of sedative that would make me unaware of the shenanigans occurring at the far end of the table. I half-joked with the nurse that I feared waking up to find the doctor cutting off my bones. She assured me that would not be a problem, that I'd be out for the chain saw portion of the program.

A surgical resident talked with me for a few seconds and placed his initials above my knee with a felt-tipped marker. That gave me confidence that they'd be operating on the correct leg, although the right will be a candidate for replacement some day as well. Just not yet.

Finally, they allowed my wife to come back and visit with me for a moment. I gave her my wedding band, she gave me a kiss and off I went into surgery.

I have but a vague recollection of the operating theater itself. The room seemed small and cramped, but for all I know now it was the size of Carnegie Hall. Someone immediately pushed the sedative (don't what kind) through my IV and I was off to Dreamland.

I was told that I would be in the operating room for about 45 minutes before the actually surgery would begin. It was during that time that they cleaned and shaved my knee and the surrounding area and inserted a Foley catheter, a device with a balloon on the end that is inserted through your penis into your bladder to redirect urine into a bag. I'm quite grateful for having missed that nasty piece of business.

Ironically, I did regain consciousness at one point during the surgery to the unmistake hum of a high-powered surgical saw. I couldn't feel a thing, but I certainly could hear it. My recall having had a brief conversation with someone standing at the head of the operating table and then quickly being pushed back to oblivion.

When I woke up next, I was being wheeled out of the operating room for a short trip to the post-op area. I was surprisingly clear-headed, able to converse without difficulty. It was far preferable to the emotional and physical discomfort that surrounds emerging from general anethesia. When I complained I was thirsty, the nurse fed me a few ice chips.

I felt no pain at that point. In fact, I felt nothing at all from the waist down. I tried desperately to wiggle the toes of my right foot as soon as I realized this but could not. I told myself to breathe, that it was no time to panic. I have a few phobias -- enclosed spaces and heights are the big ones -- but I guess we can throw paralysis into the mix. I was told that this condition would only last about another hour, yet remained anxious until I could finally command my right foot to move.

My left knee was bound by ace bandages that I'm sure at least doubled its normal circumference. As I recall, a blanket or something had been rolled up and place underneath the knee.

The Knee Replacement Guy, still in his scrubs, stopped by to tell me that everything had gone swimmingly. The resident had come by earlier. I asked him how badly damaged my knee had been. He said it was bad, but provided no details. (I had this weird fear that they would open my knee and discover that it was actually fine. I admit that was not a rational notion.) I later learned from yet another surgical resident that there was considerable bone damage and spurring caused by the loss of cartilage. (Spurs are areas where the bone develops growth where it comes in contact with other bones.)

I had to remain in the post-op area an extra 30 minutes, probably longer, to wait for a busy young anethesiologist. She finally arrived to insert a thin wire-like catheter near my groin that would pump extra pain medication into nerve bundles at the top of my knee. They said it wouldn't help with pain beneath my knee. Someone had already connected me to a pain control device -- a machine that allows a patient to push a button and direct a small quantity of dilaudid, a high-powered narcotic -- through an IV line once every six minutes.

"Don't be afraid to push the button," more than one person told me. I'd soon learn how much button pushing I would need.