Thursday, December 04, 2014

Vignettes From A Brief Foray Into Knee Surgery

The phone rang one evening and a pleasant voice was on the other end.  "Hi, my name is nurse So-and-so and I'm the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?" she asked.  "It's very helpful to go over things before and after  your surgery and to answer any questions you might have."

I thought about this.  The 11am session was right smack dab in the middle of my clinical day.  But I thought it best to attend and agreed.

It is not easy deciding to have an elective surgery, especially one that will sideline you from your vocation for an extended period.  Some said I waited too long.  Others said you should wait as long as possible.  For me: two good years of limping, looking at long halls that kept getting longer and seeing my formerly active social life dwindle spurred me to proceed.  It was time to surrender myself to The System.

Unfortunately, clinical demands caused me to arrive 20 minutes late to my pre-op orientation. I entered a room filled with people and their spouses, all arranged in a large semicircle facing a middle-aged nurse educator in the middle of the room.  Men and women of all ages - some younger, some older.  Some with partners, some without. Teams.  Total knee, partial knees, hips galore!

I had no idea. 

"Here's and information packet," she said as she handed me an envelope as I became one of the crowd.  "I'll review what your missed at the end of the session."  I took a seat as discretely as I could.

Surely if they can do this," I pondered, "I can do this."


"Take everything off, then wipe yourself down with one of these towelettes, then put this on," she said, handing me a neatly folded hospital gown.  "Follow the directions printed here on this diagram: there are eight of these towelettes, four in each package, use one towelette for both arms, one for your chest, one for your back, one for your abdomen, then one for each leg, one for your privates, one for your butt, your wife can help you with your back…"

Welcome to being a patient!

She left and I removed my clothes. Standing buck naked in a cubicle as I changed, quite a "patient-appreciation day."  It was clear this was carefully choreographed preparatory dance, held solo by a doctor who stood naked and a bit confused about the intricacies of sterile towelette application to various body parts, then wiping this part and that - especially since she forgot to tell me that the warmed towelettes cooled quickly and their evaporative loss helped redefine the term "shrinkage" as my chemical pre-operative shower concluded..  Then came the comical assembly of the hospital gown he'd seen his patients endure so many times before.  In a word: dashing!


"Hello, doctor."

I looked up to see an man somewhat older than me, who spoke with an accent - maybe he was from India? - I wasn't sure.

"I am here to shave your leg."

"She's all yours," I said.

And with that a pair of electric shears appeared and he went to work.  It was clear he enjoyed his work.  "Soon you will look like Miley Cyrus," he said softly, smiling quietly to himself .  Looking down at my leg a short while later, I saw a sheen on my legs that I had never seen before - damn thing looked as smooth as a baby's butt.  He proudly applied adhesive tape over the area to remove the excess hair.  He walked away briefly to throw the tape away and then returned.  He leaned over to my wife whispering loudly enough so I could hear: "I'm so sorry," he said shaling his head, "I made a mistake."

My wife, somewhat puzzled, looked briefly concerned.

He grinned: "He looks more like Madonna."


"Okay, I discussed the anesthesia plan with your doctor and he and I think the best option for you would be to have a spinal for this procedure, then we'll give you some propofol and you should do fine. First, I'm going to inject you leg above your knee to give you some ongoing pain relief after your surgery.  I'm going to use an ultrasound machine to infuse this area, okay?"

"Uh, sure.  Less pain, more gain for me!"

I watched as he localized the vascular bundle in my adductor canal using ultrasound, then injected local.  It stung just a tiny bit as he local was infused, but wasn't too severe. Piece of cake, I thought.

"Now, I'd like you to sit at the edge of the bed."

I sat dutifully at the edge of the bed, placing my head in this contraption that contained a headrest and was clearly designed for this moment - complete with foot rests and the places to place your hands.  As I leaned forward, I could feel him preparing the area on my lower back, draping it with a sterile drape, then feeling for the iliac crests bilaterally.  Once, then again.  Then…

"You might feel a little electric shock sensation down your leg - let me know…"

And almost instantly, I felt the slightest of electric shock sensations shoot down my left leg.  I brought this to his attention.  He did something to relieve the mild sensation.

"There, is that better?"

"Yes," I replied, comfortable as ever.

Moments later I could feel both my legs feel warm almost instantly.  They helped be lie back in bed.  Within seconds, the strangest sensation occurred: paralysis.  No matter how hard my brain asked my legs to move, they refused.  I felt just below my belly button.  Nothing to feel there, either!  Paralysis, particularly while you are conscious, is a bizarre sensation.  Try as you might you try to move your legs: nothing.  Like a Vulcan mind meld that goes bad you try to tell you legs to do anything and… nothing.  I was able to feel a tiny piece of my right 2nd toe for a bit - at least I thought I could, but nothing else.  I felt oddly peaceful despite it all - probably Versed, I thought.  

"We're ready to take him to the OR," they told her as the transporter and anesthesiologist assisted.  "Give him a kiss."

I remembered my wife's kiss, and later moving to the OR table, and from the corner of my eye a scrub nurse in an isolation suit that looked like an Ebola isolation outfit.  "Can we get him to sleep now?" I heard someone say. "Let me get his systolic above 75 first," another female voice said.  "Oh great," I remembered thinking, but somehow didn't care.  Clearly it was a team effort.  A guy was working on my foley, but I wasn't sure - couldn't feel a thing.  Somehow that part scared me the most and it was nothing. Then...

I woke bit later - minutes it seemed.  To the right of me was a lady - was it a nurse? - in a lit football helmet-like head gear.  What the …?   The drape over her face had been removed.  Others were similarly garbed: modified Ebola outfits.  Cool.  I want these in my OR, I thought.  Drugs are an amazing thing.

"We're going to move you off the table now, Wes."  And they lifted me over to a gurney.  I wheeled back to the holding area, feeling victorious.  The procedure I had wanted, but dreaded, was over.  Now the recovery.

"You can eat when you get upstairs."

I really wasn't that hungry.


"Welcome to your new room.  I think it's the biggest on the floor!" she exclaimed.  I'm here to give you your meds.  Can I have your name and date of birth?"

She clicked this and that, then gave be the pills in a small plastic cup - all kinds of them!

"The pain team has a specific regimen of medications they want you on," she explained.  Not wanting to rock the boat, especially when it came to pain, I complied.  If you need anything, let us know.  We'll keep the ICE machine full.  Let us know if you think you need more ice.  Here's you incentive spirometer - 3200 cc's every hour, okay?

It was a new room, equipped with all the amenities.  Classy, welcome, bigger than I needed, but I was sure it would impress the family.  I could hear the saline infusion cranking quietly in the background all night.  I remembered my days on the ortho ward as an intern and promised to myself: "I'll be damned if I get in-land salt water drowning! Watch the fluids."

A continuous parade of individuals from the hospital, the nurses, the technicians, PT, OT paraded through.  "We try to check on you once an hour," I heard them say.  I wondered when I'd get sleep.   A bit after midnight it finally happened, and with another Norco sleep came easily.


05:50AM: "Good morning, I'm hear to draw your blood."

Heck of a wake-up call.  She was young, skilled, soft-spoken.  She found my vein in an instant.  I learned she left home at every day at 5am, made her rounds drawing blood, then went to school.

She came early every morning, then went on her way.  It was easier once we knew each other and knew what to expect each day: a confident harpooning.


Being a patient is a good exercise for a doctor.  You an see what works, and what doesn't.  You can appreciate your vulnerability and the vulnerability of your patients.  I saw the coldness of the EMR and the distant computer stares as they never looked up, clicking: "Name and date of birth, please."  "Tell me your name and date of birth." The another time: "Name?" "Date of birth?"   

Like someone taking a mini-mental status exam on a robot.

But I also saw a team of people who were genuinely concerned with my well-being, many of whom were the people you never hear about: the orderlies, the cleaning personnel, the medical assistants, the pharmacists, and food service personnel.  Not to say that the nursing, physical therapy and physician staff weren't great (they were), but it was great to see so many people not just doing their jobs, but enjoying them too. 

Perhaps more than this, though, there was a humbling revelation: that like our patients, we are aging. The unlimited days of racing to a code or standing in the cath lab correcting an arrhythmia for hours at a time aren't unlimited after all. As a doctor, we've known this intellectually.  But as a patient, we see this and come to appreciate this reality first-hand.  And as a result, I suppose I've found a new appreciation: an appreciation for what we do and the the brevity of the time we have to do it as a doctor, the wonder of caring for patients, teaching students, and having family and loved ones that have shared this journey with us.  Perhaps most of all, becoming a patient gives us a new appreciation for the finite time we have doing what we love here on this earth.



Anonymous said...

I agree. Had some surgery myself last spring, and the transition from doctor to patient was enlightening. I think in some ways it has given me more compassion for the patients.

Anonymous said...

thanks for sharing your story. curious if you'd ever seen Berwick's piece "My Right Knee." Did you shop around since you waited as long as you could?

Rich Lang said...


Welcome to the other side of the drape! You perfectly captured the patient experience inside and outside the OR. I have watched other doctors become patients, and it is a great and enriching learning experience. Hope you are recovering well.

Rich Lang