My Knee: Reflections on Medical Care in Our Time

Everything was going so well. I had gotten all my approvals for surgery. I had settled on the doctor who offered the earliest date—April 12. He told me, as he has on each of my previous two joint replacements (left and right hip) that there was no guarantee that I would be accepted into rehab. If I wasn’t, there was the option of going home with a big machine to bend my leg, pain killers, and the guarantee of Medicare-provided PT, visiting nurse, and home health aide, 6 days a week for about three weeks. But since I had been accepted the previous two times at the in-house rehab center, Rusk of the superlative reputation, and since knee replacement rehab is more painful and difficult than hip replacement rehab, I wasn’t worried.

My internist sent me for an echo cardiogram and a stress test, which I passed with flying colors—on the treadmill! no namby-pamby injections for  me. The eye doctor who’s been treating my blocked vein with an incredibly expensive medication also greenlighted me. I felt secure enough to cancel the tentative evaluation and later surgery date  with another surgeon at another hospital. He had in fact been my first choice, but he was out of town longer than the other guy, who had a cancellation that I decided to take, because it got the whole thing over with earlier, and I really didn’t want to think about it too much.

The next day (yesterday )I went to the hospital for all the pre-admission testing and instructions. That, too, went very well, though there was a curious tendency on the part of the admissions clerk and the nurse practitioner to make really silly jokes about anesthesia consisting of a block of wood and a bottle of vodka. I wondered if there had been a memo about lighthearted charm.

But three nurses double-checked my age because I didn’t look it, my blood pressure was back in 120/80 territory, I was charming, everyone was charming, and  the nurse practitioner whom I asked about the effects of the surgery assured me that I could get “110%” mobility back, provided I did all the exercises in the one to two weeks of rehab I might be approved for. I waxed semi-poetic about the quality of rehab at Rusk/HJD, and said it was a major reason for my choice of the hospital for going-on-3 surgeries. We beamed at each other.

Thenl I got home and got a call from another nurse at the hospital to discuss my “discharge plan.” That was when I found out that Rusk of the superlative reputation would not be available to me, a mere orthopedic-surgery patient, because Big Rusk on 34th St. had been seriously damaged by Sandy and now Rusk at the Hospital for Joint Diseases was fully occupied by stroke/brain damage patients transferred from Big Rusk. I went mildly postal (I did not have a gun). Why hadn’t my doctor or my doctor’s office or the hospital told me this in the past three weeks in any of our discussions of rehab??? My choices would now be a fairly small number of “acute” inpatient facilities, only two of which were in Manhattan, or some “subacute” facilities. I hung up.

Knee replacement, for those who don’t know, boils down to basically having your leg severed at the knee, except for theligaments and muscles, depending on the skill of the surgeon. It is not small time.

That night I framed a reasonable e-mail to my surgeon’s office, explaining the reasons why I felt I should be admmitted to inpatient rehab in an actual hospital. I mentioned the vision problems which had caused a lot of falls which had necessitated most of the joint replacements. I said I live alone and have an unfortunate tendency to fall. I said I might have to cancel the surgery.

I got a call back from the Scandinavian office manager—let us call her Brunhilde—whom I usually picture wearing a leather garter belt and wielding a whip. She said, in brief, that it was all Medicare’s fault, they’d changed the rules, and really I had to talk to them, and no, she had no idea what sort of language the “new rules”might be couched in, but if I wanted to cancel I should try to do so today, since there were others who would like the slot–which I knew wasn’t true, because I’d been told the doctor had only three surgeries scheduled that day, instead of the ten he does when business is good.

So I chortled inwardly and called Medicare, where a very helpful young woman in Virginia (whose grandmother had had a hip replacement recently) told me that the rules hadn’t changed, that Medicare covered inpatient rehab if the surgeon recommended it, and perhaps the problem was with the rehab facilities themselves. She had never heard of “subacute” rehab.

Back to Brunhilde, who said “that’s what Medicare says, but that’s not what happens.” Then on to the nurse from the day before. We both apologized to each other, she for being the bearer of bad news, I for losing my temper, and we began reviewing the options again. Guess what they call “subacute” rehab facilities??? Nursing homes with orthopedic rehab.I know about those. My mother was in one for four years during which I visited her 3 weekends out of 4. “Rehab” and “PT” mainly consisted of building up strength among the demented so they could get their spoons of gruel to their trembling lips, and working their legs enough so they could get to the toilet before they soiled their pajamas. You wouldn’t get me in one as a patient unless I were paralyzed and couldn’t run away.

So that’s wehre I am. Do I cancel the surgery next Friday until I can be assured of a real rehab facility? Or do I go through with it, hoping I will get sent to a hospital for rehab, but knowing my choices might be EITHER home alone with a machine and painkillers and various “helpers,” at least some of whom will know enough English to call 911 if I fall down (unlike the home health aide for my recently deceased neighbor, who had the misfortune to fall on her language-challenged watch), OR a stint in a nursing home where doctors drop in once or twice a week to okay the drugs that make the patients quiescent. Stay tuned. I haven’t decided.

By the way, as near as I can tell, between White Plalins and mmidtown Manhattan there are roughly 300 beds for acute inpatient rehab, most of which are dedicated to brain injuries and stroke .It’s so great to live in the greatest city in the best country in the world….

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and besides

Now isn’t that the way it is? Commit to write and the brain freezes.

Ah. Writing about what matters. Came across that twice this week. In the editor’s (wonderful) commentary between pieces in The Next American Essay, he remarks that the best essays are those in which he senses the author is writing about something that matters to him or her. And lin another piece in Writers Ask, a writer says that the kinds of things he really likes to read are the ones that give him a sense that the author has wrestled with the issues in them, that they matter. 

So being a writer by habit if not by publication, I immediately asked myself, Am I writing about what matters to me? Then: What matters to me?

Which brings me to the difficult place, where the answers to those questions are No and I don’t know. Anymore.

And besides . . .  when I become passionate about things, it reads as strident and overdone. It does not rally the troops, it repels them

So I seem to have abandoned passion. Except when I have drunk or smoked or remembered too much and then I rage and sometimes weep

And besides . . .  there are so many things to be done. Dishes. Laundry. Filing. Taxes. Medical appointments to be made and kept.

acupuncture  chiropractic  physical therapy  dentist  occasional surgeon  primary  serious eye doctor

and there are exercises, practices

tuning forks   reiki   leg lifts   crunches   ankle alphabets   bicep curls       

and the job search   do they like me   will he hire me again    does that one make more per hour than I do and if so why   I am good at this and it’s not terribly important so why won’t they just say well done here’s money 

And besides . . .  I don’t care passionately anymore

though I do get angry at

politicians   church men   corporate ceos   women who best me   men who don’t acknowledge me   bosses who regard me less worthily than I regard myself   my legs for failing me   my choices that took me in the wrong direction   myself myself MYSELF for not seeing   not acting   not daring   not completing   

what matters . . .  

What matters? ? ?    

And besides . . . we grow old and die anyway

I think sometimes that everything is filler, except for certain moments when we have to choose, and those matter,  but not the rest, which is most of it 

 

 

Old Soldiers

A doctor’s waiting room. Manhattan. I’m here to get a shot in my funky knee. The chairs are arranged in a U. An Asian man comes in, with a thin, silver-colored cane and wearing  a cap with “Vietnam Veteran” spelled out in gold braid. He sits opposite me, closes his eyes. A few minutes later a young girl in her late teens, early 20s, comes in, apologizing for being late. She exchanges a few words with Max, the office manager, then sits in the chair beside the Asian man. She’s wearing thick winter tights, work boots, a short rough jacket and a white knit hat atop the long dark hair that frames her pleasantly pretty face.  Except for the hair, she doesn’t look particularly Asian, but she’s clearly a relative, probably his granddaughter. They like each other. That’s clear from the was he looks at her indulgently, half smiling, the way she speaks to him directlly, eye to eye, without condescension.

“Is this all you’re wearing?” She fingers the sleeve of his jacket. “It’s freezing out….” She asks him questions from the forms.  His answers don’t satisfy her. “You have to try….you can’t just give up….13...it’s 13. Last year was 2012, this year is 2013….” Her voice doesn’t plead or get angry, but it has an edge, a goad, a demand that he not be unreasonable. She is sure that he can fight this … this … thing that’s robbing him of his independence and her of her grandfather, if only he will. He smiles at her. She is the loveliest thing in his world. And then he looks away. She urges him toward a magazine with a cover story about Heroes. He declines it, dozes, She retreats into her cell phone.

Max comes back. He knows this family. His sister’s children were friends of the girl, and he evokes memories of Sundays in the Bronx when the two families had barbecues. “Remember…? Remember…?” The girl is protective, almost kneeling on the cushion of her chair behind her grandfather, both of them in profile, turned toward Max. “You remember….Max is auntie Jean’s brother and their two sons are Rob and Jerry….”  The man doesn’t say much, but he seems to, because she plays her role so well.

Max goes away and the man dozes again. The hems of his black jenas are frayed. His socks have wide red and gray stripes. He exercises his fingers, stretching them one by one, like a piano player. In another room,Max is talking about him on the phone. “…he’s cognitive … better off in a VA hospital….” Ah. So this is a kindly evaluation, among friends. And he and the girl are co-conspirators.

I wonder about him. When was he in Vietnam? Tet offensive?  What branch of service? Was he a draftee grunt plunked down in the middle of an established unit where nobody wanted to be around a greenie because he was more likely to get killed? A West Point 2nd looie looking for a bump in his pay grade for active duty?  Did he smoke pot in the jungle with the black-clad enemy, as young as he was? Did he see or do things so terrible that he’d rather foget everything,, slowly, than remember them? When he came back, did anybody notice?

My appointment is over, and I make a point of coming out into the waiting room to put on my coat. “Sir.” He opens his eyes, which are not empty, and looks at me “Thank you for your service.” “What service is that?” he asks mildly. I point to his hat. “You were in Vietnam.” The girl, who has become alert as soon as I spoke,  laughs.  “Oh, you forgot you were wearing your hat.” He smiles and for a minute I think I’m mistaken, he’s just an old man wearing a hat he likes. But then he gives me a jaunty salute, and I wonder if he was a flyboy.  He salutes and smiles a second time as I leave.

On the street, I feel tears rise and a lump in my throat. I’m not sure exactly why.

Technology Upgrade: Lurching forward. Part 1

There ought to be a photo here, but I haven’t gotten that far yet, so you have to imagine it: a work surface full of devices—one laptop, 1 laser printer, 1 ink-jet color printer; a sleek external hard drive and a CD/DVD reader and writer;  an MP-3 player; a modem; an iPhone; a mike stand holding a very cool-looking black-and-silver recording device ( Zoom HN4); the THAT-2 box for recording  phone interviews; an amplifier; a land line; a scanner, two 35-mm cameras and a Canon digital manual/point & shoot; two hand-held cassette recorders and one professional quality Marantz;  a collection of mics ranging from some vintage analogs that briefly made me a legend at the 58th St. Apple Store to a digital Blue Icicle that I purchased there; a boom box, a reel-to-reel tape deck, and a genuine 3-speed record player ca. 1972.

This have been the tools of my various trades and, taken together, are a record of  my entire technological history, if you don’t count the things I’ve thrown out, forgotten or lost, the supplies and manuals for all of the above, and the two defunct Macs in a storage facility in Ewing, New Jersey.

The iPhone is the newest thing,  I didn’t really lust after it. But after years with a truly primitive pay-as-you-go phone whose screen is only slightly larger than a postage stamp, I decided it was time I am 32 days up the learning curve. And I feel the Earth. Move. Under my feet. I  know I’ve stepped onto a path that perhaps can be slowed, but never reversed. Next will come the new computer, because the laptop is too old to be upgradable to an OS that can synch with the iPhone in the iCloud. Then there will be the tablet, probably two, because free-market capitalism dictates competition between the iPad and the Kindle Paperwhite (which I do lust after, sort of), and Apple and Amazon sell different books. Don’t lecture me about the romance of turning printed pages; I get it. But I have run out of shelf space and I can’t afford a bigger apartment. My eventual iPad will also replace my whining laptop as a traveling work station. And eventually I will stop being pissed off that the iPad does exactly the things that the iPhone does except make phone calls, and why the hell did I have to buy two separate devices?????

But hey, already I can make and answer calls on my iPhone, text, keep my calendar updated, write myself notes & reminders, take photos, and use Siri, the built-in automated assistant. iThe first time I pressed her button (ooohhhh), I asked “Are  you there, Siri?” and she answered, “I am everywhere, Kathleen.” I got chills.

Brave new digital world, here I come. Ain’t no flies on me. Byte me! [To be continued…]

On my knees. Again.

I was taking off my boots at the end of my birthday last week when something went very wrong with my left knee. Something very painful. Something that catapulted me out of a hard-won, barely established writing rhythm into  oh-my-god-I’m-heading-for-surgery-again, which means a preliminary one to three months of being barely able to walk, followed by  six months of semi-drugged recovery, then the attempt to figure out where the writing was when last we put it down. I know this because I’ve done it twice in the past three years.

Before this happened, I was on a writing roll. I was mining my journals,  making lists of story ideas, filing and sorting the scraps of paper accumulated over years of work on a long-term project. Essays, podcasts, blog posts, stories, novels were jockeying for position, competing for my attention, ready to emerge. I was considering writers’ conferences and classes. I was building a schedule around work I really wanted to do. I was getting ready to pitch.

The birthday, too, had been great. It wasn’t a major birthday (divisible by five), but it was made special by an old friend who invited me for an exceptionally elegant lunch. More than a decade ago, we were passionately involved, this man and I. Now, after a long hiatus, we have successfully transitioned into being good friends with a history, an achievement worth celebrating in itself. Looking out over a wintry sculpture garden while a troop of gray-jerkin-clad waiters and captains and busboys brought courses, explalined the nuances of their composition, and inquired about our pleasure in each, I  felt marvelous. The day, the ambience, the relationship, the future—all had a very satisfyng patina of New York sophistication and creative possibility.

And then my knee “went out.”  I should have expected it, since my joints have a history of giving out when I’m feeling particularly good. To the credit of the cosmos, it happened this time at 12:13 a.m. on the day after my birthday, so strictly speaking, it didn’t ruin the day. But it has ruined every day since, flinging me out of urban sophistication into a wall of anger and self-pity. Since this is a writer’s blog, allow me a few moments of writer’s whine. I am pissed, have lost focus and momentum, feel incapable of thinking creatively.  If it wouldn’t make my knee worse, I would kick furniture. It feels like Groundhog’s Day, the movie: starting over, again and again and again. If I could kneel down, I would plead with the writing gods for rescue.

But the gods help those who help themselves, and the muses only assist writers who show up, so I know I’m on my own.  For the moment, I am urged on by a handout from a writing teacher with health issues of her own. It’s a piece of colored 8.5-by-11 paper with the words DO IT ANYWAY! in very large, bold  type. It’s taped to my kitchen cabinet, so that I see it every time I go into the kitchen and stand in front of the open refrigerator, which I do whenever I lose the thread of my writing—about three times and hour. The regular post is my current instrument of salvation, my way of doing it anyway. It may be boring as hell for the reader, which is why I’m not publicizing the blog yet. But it brings me to the blank page. Again and again and again.

 

Big Apple elegance

There’s a row of low buildings across from the Museum of Modern Art. They may be owned by the museum. I hope so, because that means they have a chance of lasting. They’re from the turn-of-the-20th-century New York Golden Age, I’d say, about 4 or 5 stories high, different-colored stone, packed tightly together between taller buildings on either side. One of the nicest things they do is leave a space for sky, for flags to wave, clouds to drift by.

They’re elegant, these buildings, and New York elegance is unique. It’s not just a product of old or new money, or old names, though Vanderbilts and Astors and Kennedys snd Gambinos are  all part of it. There’s something brash in it, even overdone, that speaks of and to aspiration, the possibility of getting from where you came from to where you want to go.

Once, on Lower Broadway, I saw a skinny black man in a shabby coat loudly shouting a mantra of his own invention as he strutted defiantly toward 23rd St,: “The Big Apple! The B-I-I-I-I-I-G Apple! Make you or break you! The BIG APPLE!”

When those buildings were built, they were a sign that someone had made it, had not been broken. At least not in any visible way.

Playing scales

The first time I came  into NYC on my own  it was snowing, and I was 14. I’m sure I was wearing fashionable boots and a smart, warm hat that made me look at least two years older than I was.  I’d spent the morning wandering the West Village. Walking down Grove St. toward Sheridan Square, I passed a little kid, no more than 4, stuffed like a sausage into a snowsuit and standing on the first step of a brownstone stoop. His palms and his gaze were turned upward. “Snow!” he said as I passed, as though he couldn’t hold in his delight, “Yes!” I said. “Isn’t it wonderful?” He shook his head yes, and we laughed, sharing our first New York City snowstorm. Now whenever I  pass those Grove St. brownstones, and whenever it snows, I remember that feeling.

The skyline, the big picture, of course, is iconic. Is it New York hubris to think that anywhere in the world, people recognize a photo of the New York skyline? Maybe. But each of us has an internal cityscape as well, a map of things that happened here, lovers we kissed or parted from there, a life-changing conversation  in a wood-paneled bar that used to be where that formica-and-plastic chain-restaurant, is now; the subway stairs we ran up to be on time for our first big-city job. We anchor events in our lives to physical landmarks, which in New York are buildings and the spaces between them and the way they fit together, clash, loom, invite, change, just like the identities we move through in our lives.

Oh god, this has no energy. Have I lost the words? I know I’ll edit this out eventually. I was told once by someone who knew it to be true that Pablo Casals played scales every morning. If Pablo Casals could do that, I can plod through this writing until it’s fun again, until the words flow better than they do today. Till then, I post. regularly … do, re, mi, fa, sol, la, si….