Arthroscopy 5 - It's All Online

I lie in the spare room at my sister's home, resting. Sleep eludes me due to leg pain, so I decide to distract myself. I log onto Youtube and watch some videos of arthroscopic surgery. Yuck. I feel the pain shoot through me as the online surgeon shaves down someone's medial meniscus and snips and sutures a tear, all on film. That's enough for me, good night.

Next day it seems prudent to get a second opinion on my prognosis for recovery. A quick google search of "recovery after arthroscopy" leads me to a wealth of information about recovery times, suggestions and personal experiences. Being at my sister's home, I don’t have the opportunity to arrange to see a physiotherapist as recommended by the hospital. No problem! Suggested post surgical exercises with diagrams and explanations appear in abundance. I set myself an exercise regime accordingly, pleased to have saved the time and effort of going out to find a physiotherapist.

I must admit that I am quite proud of myself. With laptop in hand, I have my whole office with me. Voicemail to my home phone is forwarded to my email, online VOIP software serves as my telephone. My apartment, it seems, will not be missed.

But then things get out of hand. Well wishing friends begin calling by the dozen. I am bombarded with wishes for a speedy recovery from friends via cellphone, sms, email, Skype, google-talk and more. Oh, yeh, and they manage to get hold of my sister's home phone number too. Don't get me wrong: I appreciate the messages and feel lucky to have such wonderful and supportive friends. Friends call to offer to bring cooked food, to do my shopping, to drive me places, to water my plants, collect my mail, to run errands of all sorts…I almost feel guilty denying them the opportunity by being not being at home. 

I ponder the technological revolution and decide to make a little experiment. Signing into Facebook, a program I hold in some disdain for its ability to stop people talking to each other due to their efforts to connect, I do something I almost never do: I post a status update.

Alan Meerkin has been released from hospital and is recovering after having been assaulted. The procedure was successful. He is with family and being well looked after. Friends are welcome to email, but please, no more sms's.

The response is astounding. Numerous people respond with fear that I have been attacked by thugs. But things get out of hand when my sister in law, who is not aware of my surgery, calls from the Himalayas to find out what was going on. I allay her fears, but on ending the call the phone rings again. Friends from Australia have all been on alert since my message, not sure whether to call me or my mother for fear of the worst. The experiment has run its course. I again sign into Facebook and post a response:

Thanks for all your wishes - I am fine. I just had long awaited knee surgery. When I said I was assaulted I meant by the surgeons. Any pain I am suffering is my own doing - having consented to the procedure.

Arthroscopy 4 - Reality Bites - 1st Day Post Op

The night I return from the hospital, pins and needles shoot though my leg, parts of which are also numb. It’s scary. By early next morning however, the feeling in my leg has returned. 

That first night I dream that all my friends from Jerusalem have dropped by sister's home to pay a visit, but that some bastard has hidden my crutches. I wake up, take some pain killers and then soon drop back to sleep.

My first day post-op is spent in bed with my hot laptop resting on disabled knees. Later on I try to stand up. Despite only having a small gauze over the surgical wound, I feel like my leg is in a plaster cast. The entire leg has swelled up and I take the opportunity to inspect it closer. My knee, of course, is in incredible pain. But then I notice the bruising along the underside of the knee and along my calf. In fact, the bruising comes high up my thigh. Spots of dry blood and needle puncture marks dot various points of my leg. I can remember someone inserting an IV in my arm, and I look for the spot. The entire area shows a dark bruise. I then recall that after surgery an IV needle was removed from the surface of my hand, and I look there. A large bruise paints my hand. In fact, a number of needle points show themselves on the top of my hand. Wow, those doctors really had a good go at me. I feel as though I have been assaulted.

In truth I have, in fact, been assaulted, although it was not illegal. Prior to surgery I was required to sign a consent form. But it makes you wonder; on what basis should I trust these guys? I had actually agreed, in writing, to submit my person and my body to their good will. They could have done anything to me in there. What am I, an idiot? 

I recalled when I signed the consent form for my appendectomy. Unlike this knee surgery, on that occasion I didn't really have a choice; failure to sign would almost certainly have meant that I would die (now there's a sobering thought). I considered the possibilities of living with recurring knee pain for the rest of my life. What did cave men do when they suffered meniscal tears and arthroscopic surgery was not an option? I pictured myself as a Neanderthal, hunting in the fields, limping towards my pray. Would the other tribe members share food with me? Or would I spend my time gathering fruit with the tribe's women folk? Come to think of it, that's pretty much what I spend my time doing these days.

I thank my lucky stars that I came away from this latest medical experience with only a few bruises.

Arthroscopy 3 - Nursey Nursey or Listen to my Heart

I open my eyes. Not sure where I am. My friend, operated on before me and recovered from his catatonic state, is next to me. 

"Hey good to see you" I think I said. A pretty nurse is hovering around me. A machine is beeping above my head. Every few minutes it sounds an alarm. The nurse rushes over and presses a button. The alarm stops. 

"Are you married?" I think I hear someone ask me. 

"No" I answer. 

"That pretty nurse is single" comes the response. My friend is wheeled out of the room. My mind drifts elsewhere. I look around me in a daze. 

"You're in the recovery room," says the nurse, "how do you feel?". I say something, but I can't remember what. My mobile phone rings. Instinctively I answer, assuming it to be my sister. It’s a client. 

"Where are you? We sent you some translation work. It's urgent!" Despite my situation, my commitment to service shines through. 

"I'm in the hospital recovery room. I've just had surgery. I'll have the work done for you tomorrow", I croak. Then I ring off, just before dozing off.

"Beep, Beep". The monitor above my head keeps sounding an alarm, rousing my brain. The pretty nurse runs towards me. Am I still dreaming? 

"Your heart rate is slow, I am keeping you here a little longer" she says. My eyes follow her around the room. 

"Have you ever had a patient who has not asked you out?" I ask. Her constantly stern look cracks into a little smile. 

"It has happened, on occasion" she responds. With my heart rate going awry I suddenly understand the wartime ditty that my father taught my siblings and me as little children, from his army days. "Nursey, come over here and hold my hand, 
I feel awful shy
Nursey when I look at you,
my heart goes boo boo boo,
Nursey Nursey I'm getting' worsey, what ya gonna do?"

The anaesthetist comes by and her opinion of my affairs of the heart is sought by the nurse. 

"Who cares if he has a slow heart-rate. He's clearly a sportsman, that's normal". I giggle in my half-sleep. 

"Look at me - I am a skinny runt. Do I look like a sportsman to you?"

My clothes are brought to me and I make a valiant effort to put on my pants, despite not being able to manoeuvre my leg.

A surgeon – not mine – approaches and tells me what happened during the surgery. I am pleased to receive the report, although I would also be happy if he would just help me get my pants on. However I am disappointed that my surgeon was a virtual ghost throughout this entire process. In fact, for all I know, he may not have even been present during the operation. (I later discover that of the 3 surgeons recorded as present throughout the procedure, his name was not among them).

As my consciousness returns I am helped over to an armchair. I have been the last patient for the day and the medical staff wants to close up shop. My throat is parched and I am given a glass of water. 

My sister and brother in law arrive to the delight of both me and the head nurse who is happy to give me my walking papers. She removes an IV needle from the top of my hand (how did that get there? I wonder). 

"Here are your documents. Keep your leg-bandage dry. You don't need crutches – you can walk to the car from here. Start physiotherapy as soon as possible. Take painkillers as necessary. You have a follow up appointment in 10 days." I try to take in her instructions, but her words all seem to float past my still-drugged up brain. The state of my mind must be obvious. 

"Look, it’s all written on this paper that I am sticking in your bag. Any last questions?" asks the nurse. I looked up at her lovingly. 

"Yes, just one. Do you think I need a haircut?" She flashes me a friendly but impatient smile. 

"Not at all. The curls are cute. Now get out of here".

My brother in law manages to get a wheelchair and I am rolled out of the building in style. You won’t bloody well catch me walking an hour after knee surgery!

Arthroscopy 2 - The Big Day

5.55 am. 
I stood on the street, cellphone in hand. "Hi, I want to confirm a cab to Assaf Harofe Hospital…". The cab turned up at 6am, the driver apologising for being late.

I got in.

"Going to hospital for surgery?" asked the driver. "What a coincidence, I am going to Kivrot Tzaddikim today, the graves of righteous rabbis. What is your Hebrew name, I will pray for you". 

How nice.

On hearing of my Australian background the driver insisted on sharing his dreams of big business and importing garden furniture from Australia, hoping to convince me to join him. But instead of convincing me he lost his way, and we took an unexpected detour. We only arrived at the hospital at 6.50, much later than I had hoped. Frustrated, I handed him some cash and bolted as he called after me to keep in contact.

Paper Chase

I found the hospital admissions desk. 

"ID card and payment approval from your Health Insurer" requested the attendant. I had been careful to make sure that all my papers were in order and with good reason. I have had much experience throughout my life with the notoriously bad handwriting of doctors. The procedure I was going in for was called a partial meniscectomy. It just seemed too easy for this word to be misread by the hospital admissions officer, who might refer me to a vasectomy. I wanted no mix-ups. The woman took my documents. 

"Sorry," she said, looking up at me, "these are the wrong papers".

Do you know that feeling of cold sweat that hits you in a moment of helplessness or awful realisation? I sure do.

"What do you mean?" I asked. Apparently my fears were not so much wrong as misplaced. I had been approved as an outpatient, not a surgery case. Still, this could be a disastrous development. "So what now?" I asked, bewildered. 

The first step, I was told, was to enquire with the operating theatre when my procedure was scheduled for and whether I had time to fix my paperwork. The theatre would not open for another 10 minutes. I had to wait, and that 10 minutes felt like an hour. 

"Come when you are ready, as soon as possible. You will be treated on arrival". The clock showed 7 am. I looked to the admissions’ attendant again, pleadingly.
"Now we wait for your Health Insurer to open at 8am. Just 1 hour away. (1 hour!) Relax, wander around". I thought about how glad I was that I had decided to spend a few hundred sheqels taking an intercity taxi to get to the hospital early (Not!)

Killing Time

What would I do during an hour of nervousness? I was fasting under doctor's orders, so passing the time over a coffee in the cafeteria was not an option. I sat at the entrance of the emergency ward, watching as people of all shapes and sizes, in various states of distress, came through the doors seeking help. A woman in tears of pain begged to see a dentist. A couple walked in with their 14 year old son who moaned hysterically, hit his mother, walked a few steps like a normal kid, then screamed and moaned again. The staff handled everyone with a calm efficiency. I rifled through my bag for the newspaper, when I hit upon an idea.

"Can I deposit valuables with you?" I asked at the emergency desk. I spent 15 minutes pulling out my valuables, repacking them and itemising them on a safe deposit slip. With that done, I looked at the clock. 7.55am "See you in 5 minutes" I said to the attendant before I went to sit down and count the minutes.

8am. I returned to the admissions desk. The attendants were already on the phone calling my insurer. After 7 minutes of recorded messages and being put on hold, the call got cut off. We tried again. This time the phone was handed to me. I got through to the switchboard, which put me through to the payment authorisation office, but no one answered. Eventually the switchboard operator came back on the line and told me to call back later. 

"No, please! I am here in hospital, the surgeon is waiting and you have given me the wrong document, I am fasting and have taken the week off work. I can’t wait or call back!" To her credit the switchboard operator was sympathetic and said she would call me back. 15 minutes later my cellphone rang. I would need to fax through some documents. Without putting too fine a point on it, things continued in this fashion as I sat patiently but nervously biting my fingernails – a habit that is normally foreign to me. Then, finally, approval for surgery was faxed through to the hospital. I looked up at the clock: 9.15am.

Time for Bed

My big fear was that the surgeon would finish his other duties and quit the grounds without attending to me, leaving me to another doctor. I raced like a madman through the hospital grounds until I reached the operating theatre where I was buzzed in, huffing and puffing and tired from fasting. The calm, quiet, clean, air-conditioned atmosphere was wonderful. 

"Relax, take a breath. Here is your bed and some clothes to get into" said one of the nurses comfortingly. 

"Is my surgeon still here?" I asked with excitement. 

"Oh, don't worry, you are second in line for that surgeon. Anyway, he won't get here for a while…" Indeed, the surgeon didn't arrive until after 11am. Why in God's name was I told to be there by 7am?

So at 9.30 in the morning I put on pyjamas and  climbed into bed with the newspaper I had brought from home. A body lay still in the bed next to me. Suddenly a head poked out from the sheets. 

"Hello" he said. It was a bald headed fellow about my age whom I had seen at the outpatients clinic a week earlier. He was ahead of me in line for surgery. We chatted for a while about life, the universe and everything. A senior military officer, he was coming up for retirement next year. He was occupied with thoughts of what to do and had just finished studying for a law degree. I found it amusing – here was a guy my age about to retire, and I still had no clear idea what I wanted to be when I grow up.

We joked around, and the nurses found the two patients in the corner to be quite convivial. I was certainly impressed by his military pull. I told about my 2 years of knee pain and 8 months trying to arrange surgery. 

"I first felt pain 2 months ago" he said. "I had an MRI scan and the military specialist told me this surgeon was the best, and so I made an appointment." Wow – and it took me 2 months of screaming just to get the MRI done !

We watched and waited for our surgeon to arrive. Initially we were told he would come at 10am. By 10.30 the anaesthetist came over, and at 11am my friend was taken away. "Come back safely"I said as he floated away, accompanied by guards of green.

The head nurse came over to shave my leg. I told her a dirty joke about shaving that my grandfather had told me in Yiddish as a boy, and to my delight she spoke Yiddish fluently. Of course, this resulted in her telling me some jokes of her own. The friendly banter continued until my friend came floating out of the operating room, his eyes closed and his head flung to one side. It was like being in a science fiction movie, where we had been kidnapped by aliens who were conducting experiments on us. Or maybe like the final scene in "One Flew Over the Cuckoo's Nest", where the main protagonist is wheeled out of surgery, catatonic, presumably having undergone a lobotomy for misbehaviour.

They're Coming to Tale Me Away Ho Ho, Hee Hee, Haa Haa

Two nurses surrounded my bed. "It's time" they said, and I requested a quick reprieve to call my sister and update her. That done, I put the phone away and addressed my assailants. 

"Ok" I said with resignation, like a dead man walking. They wheeled me through some sliding doors to a sterile corridor. 

"Off the bed" they suddenly commanded and, wearing little disposal booties and a shower cap, I walked into a room full of instruments of torture and a table in the middle. I hopped on the table. Although I don't smoke, I felt like someone should have at least offered me a last cigarette. No-one was smiling, and I was annoyed at that. Lying on my back, I was required to extend my arms out as if being crucified. While I only heard Hebrew being spoken around me, everyone was speaking in a Russian accent. An IV needle was poked into my arm at the elbow and the pain was excruciating. The sour faced perpetrator ignored me when I protested. I will be asleep soon anyway I reasoned, and all pain will be gone. Another Russian fellow fussed around me. 

"What do you do for a living?: he asked, and I wondered if he was genuinely being pleasant or just trying to distract me. 

"I am a translator. What about you? What do you do for a living". I was hoping for a silly smile, some recognition of the stupidity of the question. The lack of any response told me the answer; there was no pleasantness in this room. A mask was put on my face. 

"Breathe deeply" ordered the anaesthetist, "it's only oxygen". I still don't believe them, because that's the point when things always start to go fuzzy. And indeed, the room started swirling slightly. After a minute I spoke up, 

"Are you sure this is oxygen – whatever it is, nothing's happening". 

"Stop talking!" I heard someone squeal as two attendants lurched forward to slam the now slipping mask back onto my face.

If only these people would smile, I thought. How can I entrust them with my body? It didn't matter any more anyway, because that would be the last time I ever see them.

Arthroscopy 1- At Home In Hospital

Although I am a late starter, this year has been a real boon for me when it comes to surgery.

Not that my previous surgical experience – an appendectomy – was something I would like to repeat. But at least on that occasion it was kind of nice not having to deal with all the bureaucracy associated with medical treatment. After all, I only had 3 hours notice between being diagnosed with a funny tummy and going under the knife.

This time is different. I have had niggling knee pain over an extended period that has become progressively worse, and I know that surgery is inevitable. I won't go into the whole process, which has taken several months, but suffice it to say that after undergoing an MRI scan, examination by three different specialists and pulling some strings in the medical world, I have managed to arrange a date for knee surgery with my surgeon of choice.

Things to Prepare

A week before surgery I visited Kupat Holim – my health insurer – to undergo pre-surgical tests and to obtain their undertaking to pay for the procedure. Everything was apparently falling into place. As it happened, my surgeon did not operate in Jerusalem and so I made preparations to leave town for the duration. It was all strictly planned: When the big day arrived I would take the early morning bus from Jerusalem to the hospital, admit myself and then and go under the knife. After waking from the anaesthetic as an invalid, my sister and brother in law would take me to their home in the Shomron, an hour's trip north and lavish me with nursing care.

I deemed it prudent to stock my apartment in advance with food items so that I wouldn't go hungry after returning home from my sister's care, but still on crutches. So I nipped out to the supermarket the day before the procedure. While wandering the aisles, another shopper called her friend on the phone: "Hey, it's me! Yes, I just got back from a trip to China and had knee surgery too. I feel great!"

Now that's a coincidence, I thought, that’s my story too! I approached the woman and we swapped experiences about China. Then she told me of her arthroscopy. It has just been a week since her procedure. "Ah, child's play. I didn't need crutches at all - maybe a walking stick for a couple of days. Here, let me show you the incision". And with that she raised her leg so that everyone waiting in line at the supermarket cashier could see the stitches sticking out of her knee. "I am absolutely fine now," she exclaimed before wishing me well and limping away like a wounded deer.

Packing for Hospital

I returned home and packed a large bag with clothes, laptop and other valuables that I would need at my sister's place, where I would be going there straight after surgery. Hospitals, however, are notorious for their pickpockets and I was nervous that while under the influence of medically approved narcotics and being assaulted by trained professionals, my laptop might mysteriously find a new owner. These are usually opportunistic thieves, not the professional, premeditated variety. I placed everything inside 2 bags (one inside the other) and put a padlock on the outer bag. To top it off, I brought a bicycle cable to anchor the bag to my bed. That should do it.

Travel Arrangements

I was asked to be at the operating theatre by 7am. As it happens the hospital is a 1 hour bus ride from Jerusalem. No problem thought I, there must be a 5.30 am bus. I was horrified to find that the first bus of the day would get me to the hospital way after 7am. I spoke with someone at the hospital admissions desk who has made it clear that patients are not operated on a first come, first served basis, so coming late would not be critical. On the other hand, the particular surgeon I arranged - after jumping though several hoops - to do the procedure was doing me a favor, so I should try to be on time. A taxi would drive me right into the hospital grounds, saving me the need to drag my heavy bag from the bus stop and display its contents to a security guard at the hospital's pedestrian entrance.
I ordered a taxi to pick me up at 5.55am.

Wish me luck.