Bone on Bone
[ Issue 38 ]

Bone on Bone fascinates Emily Bronto

Permit Bikwil to acquaint you with the fascination of Bone on Bone

Bone on Bone

Tony Rogers here regales readers with far more than they wanted to know about his hip replacement surgery and its aftermath.
 

Having arrived, I promptly fainted. I came around with two or three people supporting my slumped form and someone else cooling my forehead with a wash-cloth. All my limbs were limp and woolly, so they had to get me back to bed using their famous Patient Hoist. After that, things could only improve. Well, almost all things.

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Bone on Bone — Tony Rogers

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“Well, judging by these X-rays, Mr Rogers, I’d say you were definitely a prime candidate for a hip replacement. There’s no cartilage to be seen at all.”

“Bone on bone, eh, Doctor?”

Before he could reply, his nurse asked, “Why is it that every joint replacement patient has to give the ‘bone on bone’ speech?”

She was right of course: I would soon hear that phrase myself many times, from other joint patients.

Now, providing an artificial hip joint is no minor job for an orthopaedic surgeon (it requires a lot of skill and can take up to four hours), yet tens of thousands of these operations a year are successfully performed in Australia. Even so, though I’d known men and women with osteoarthritis, I’d never ever met anyone who’d actually had a hip replacement.

Plenty of people who knew someone else who had, sure, but no one with any personal experience. Not that this stopped these second-hand experts giving advice: “You’ll never look back after you have the operation.”

Well, let me tell you right now: after you have a hip replacement it’s a while before you look in any direction — other than at your shuffling feet.

After putting it off for years, it was now time for me to commit to the operation. If things went well, the op would be followed by about a week in the acute-care hospital, then two weeks in a rehabilitation hospital. After that, the promise was that I would be free of arthritic pain in the hip, and perhaps, just perhaps, walk with less of a limp.

On admission day the nurse went through my forms (past operations, illnesses, current medication . . .). Suddenly she broke off and said, “Tooth abscess. I’m going to stop you right there. You can't have a hip replacement with such a recent infection in your body.”
Infections are a particular danger for people with artificial joints, and can prove disastrous if not checked early. For example, all my future visits to the dentist have to be preceded by antibiotic treatment.

I explained that my dentist had treated the abscess with medication, but prudently she went away and rang my orthopaedic surgeon, while Eleanor and I waited and wondered if the No Admittance sign was about to go up. Thankfully no; the surgeon accepted my explanation, and hips were once more on the agenda.

For the first day and a half after the op I was sufficiently zonked from the anaesthetic not to care much about much. The afternoon of the second day, however, I couldn’t fail to notice that they’d discovered that I was running a high temperature. An infection after all, but fortunately I responded to the drugs my surgeon ordered and lethargically moved on to the next little drama.

On day three I was unplugged from drip, transfusion (two bagfuls of homemade O Positive sopped up during the operation), catheter, wound drain and the epidural pain killer.

Patient Controlled Analgesia is a wonderful development. Instead of waiting six hours between pethidine injections, with the pain increasing minute by minute towards the unspeakable, today you can administer your own pain relief as soon as you feel it developing. And the remarkable thing is that in total you actually use less narcotic than you did in days of old, by controlling it yourself in tiny doses.

Soon I found myself sitting in a chair beside the bed, and then came the first time the nurses got me on to a commode chair en route to the toilet.

Having arrived, I promptly fainted.

I came around with two or three people supporting my slumped form and someone else cooling my forehead with a wash-cloth. All my limbs were limp and woolly, so they had to get me back to bed using their famous Patient Hoist.

After that, things could only improve. Well, almost all things.

Before I knew it they had me up and creeping about on a walking frame.

How times have changed.

Let me explain. I am in the unusual position of having a thirty-year history of lower limb operations, starting in 1973 when I broke both femurs in a car accident that involved a poignant and decisive debate with a telegraph pole.

In those days surgical practice was to put your legs in traction and “Wait Till the Bones Knit, Nellie”. Well, mine didn’t, so my man had to do a bone graft on each leg and then we all had to wait some more.

Wait some more! In all I was there on my back nearly nine months, and when at last they told me I could now learn to walk again, I was ramrod-rigid, with one leg shorter than the other. Ultimately these outcomes would lead to the osteoarthritis of the left hip.

But my point here is that today the accepted wisdom is to screw/bolt/pin/plate/glue straight away and get you up on your feet as soon as possible. This has the added advantage of minimising the danger of blood clots, something they additionally combat by (a) having you glamorously attired in surgical stockings for several weeks, and (b) giving you a daily injection of blood thinners.

As predicted, my total stay in hospital this time was barely three weeks, as opposed to 36 weeks in 1973-4.

Anyway, there I was on day four, cock of the walk on my shuffle-frame — an unsteady fowl, mind you, and half anticipating another fainting spell.

One of the things they forewarn you about hip replacements is that in the early months there’s a risk of dislocating the new joint. In the first place, this means that bending at the waist to an angle more acute than ninety degrees is taboo, so as well as prohibiting reaching much below the knees, this precludes drawing the knees into the stomach.

Hence, to put on and take off pants you have to use what’s known as a “dressing stick”. To pick up things from the floor (light things only) you need a “reaching and grasping aid”. And your lovely white stockings have to be managed by a nurse or spouse. Later, you can put on your socks yourself if you buy a “sock aid”.

As well as that, you’re required to sit in higher chairs than normal — no sinking into soft armchairs. You have to procure a raised toilet seat, too. Right angles rule for hip replacements.

Secondly, you have to sleep on your back for nine weeks, with absolutely no leg crossing. After that period, if you’re lucky you may be allowed to sleep on your side, provided you keep a pillow between your legs.

As I mentioned in passing earlier, this sleeping on the back was not a new burden for me, just an unwelcome Remembrance of Things Past, for with it came the old menace — pressure points, known in Oldspeak as bed sores.

If there’s one thing that hospital economies in Australia have achieved it’s reduced time for nurses to attend to patients at risk for bed sores. To be sure, getting us ambulatory as soon as possible helps a lot, but there are still patients confined to bed on their backs (if only at night) who may need attention. I am such a patient — ever fated to be a martyr to bedridden posterior skin soreness.

I can clearly remember when in 1973 a nurse came in and asked, “Would you like your back rubbed?” When I said “O.K.”, I discovered that “back” was a euphemism for “buttocks and tailbone”. And so for my 36 weeks I received this soothing preventative every four hours or so.

No such care seems on offer these days. You have to complain (if you dare), and it wasn’t long after my hip job before I felt the burning urge to do so. I also enquired about the availability of a sheepskin to lie on. No luck there: too much “risk of cross-infection”.
Eleanor went out and bought one, but it was almost too late. When I arrived at the rehab hospital with a very inflamed left buttock, they were so dumbfounded that they discreetly enquired to know “which acute-care hospital” I’d come from.

It was day seven when I was transferred to the rehab hospital. There I resided and toiled another two weeks.

Toiled is right. “You haven’t come to rest, remember; you’ve come here to work.”

There are essentially two areas they help you with in a rehab establishment. They are “personal care activities” and “musculo skeletal rehabilitation”. During my stay a large proportion of the guest workers were orthopaedic patients like myself — men and women with joint replacements (“Are you a Hip or a Knee?”) or people recovering from broken limbs. We all had a similar regimen.

Before I get to the therapy work, let me enthral you with a bit about those personal care activities they train you in.

Getting used to dressing and undressing with little or no bending has its moments (“Knees down, Mother Brown”), but without doubt the gleaming pinnacle of accomplishment in a patient’s battle for independence has got to be learning how to take a shower.

First you have to find an available nurse to take off your stockings and then carry your day clothes while you crutch your rickety way to the bathroom. He or she next has to hang up or stack those clothes as far away from the shower itself, because there’s no shower hob (too difficult to get over) or curtain, so in the hands of an amateur water can blithely splash about everywhere.

Once you’re undressed and have gingerly installed yourself in the shower chair, depending on your recovery progress you may need assistance with showering itself. If not, the nurse departs to seek patients new. Then, when you’ve achieved what you can unaided, and haven’t dropped the soap, you buzz for the nurse again. Eventually he or she returns to wipe your feet and pass you your clothes and dressing stick, your underpants and trousers being laid on a soggy towel on the floor.

Speaking of dropped soap, I dare say you’ve heard of the cure for that — Soap-on-a-Rope. Having had past trouble in hospital with slippery soap, before my ‘ip op I sent out search parties to get some Soap-on-a-Rope. It used to be all the rage once, but these days it’s very hard to come by. Just in case none was forthcoming from shops, I also investigated mail-order possibilities via the Internet, but what was on offer seemed confined to dubious shapes modelled on parts of the body. Ultimately a friend tracked down a couple of inoffensive examples, and I was home and hosed, as it were.

As useful as it is, however, such soap tends to be very soft, so it all too soon detaches from its rope. We solved this problem when it occurred by getting the poor man’s substitute — soap you keep in a stocking. Eleanor bought me a cheap pair of pantyhose, cut it into two legs, and behold, a double helping of Soap-in-a-Sock.

I warn you, though: all this use of stockings, surgical and soapy, may well have left me with a stocking fetish. Time will tell.

You know, it isn’t only the patient who has a challenging time of it in the shower. Let’s not forget the grim toll that bath-time takes on nurses. For those driving to work for the a.m. shift the prospect of the morning can only be one of “why in the name of Florence Nightingale am I putting myself through this insanity?”

There were forty patients on my floor in varying stages of helplessness and after breakfast we all had to be showered in turn in five bathrooms — preferably by ten o’clock. Somehow it all got done, but a strong rumour persists that, in a vain endeavour to bring order out of morning chaos, certain residents were paid a fee to get forgotten.

Some of us postponed our showers anyway. We did this when we were rostered for hydrotherapy late in the morning, or in the afternoon. I took great pains to ascertain why on earth the physio and hydro timetables changed from day to day, but my valiant efforts went unrewarded, though I have my suspicions. More about this classic timetable anon, but let’s stay with the nurses a little longer.

Waiting for your turn in the shower brought its own delights, like demonstrations of express bed-making — a sight to behold, let me assure you, but only if you don’t blink.

Once upon a time, nurses might have changed the sheets every day, but 21st century hospital cost-cutting measures have become all-inclusive, so now, except for emergency situations, beds are fully remade only when a patient is discharged. A quick fold here, a deft tuck there, and voilà, a made bed.

Regarding beds . . .

Almost all of us were in shared accommodation at the rehab, in contrast to the private rooms in the acute-care hospital. Unsurprisingly, this meant that you were thrown together with strangers, like ’em or lump ’em. For my part, I grew to like ’em, though occasionally they caught me off guard, as in the following exchange, initiated by the fellow in the bed opposite.

“You woke me up last night.”

“Did I? Sorry.”

“You were talking in your sleep.”

“You shouldn’t listen.”

“But I wanted to find out what you were saying.”

Further to the subject of hospital cutbacks, by the way, one nurse expressed a view that is no doubt shared by many of her co-workers. Namely, that on those rare occasions when the neglected nursing profession is granted a pay increase, privately run institutions somehow find themselves immediately motivated to reduce each working shift by one registered nurse, and substitute a nursing assistant. On top of that, several times a week nurses and nursing assistants have to be imported temporarily from an agency.

One morning our room was graced by, not one, but two temp bed makers, both very young and one of them female. Obviously keen to impress her with his sway over innocent patients, the young man took one look in my direction and greeted me with, “Jeez, you’ve got a messy bed!”

I didn’t find this idea per se worth exploring, but believing that I’d caught the spirit of the moment, quick as a flash I responded with, “If you give me a second, I’ll think of something nice to say about you.”

I had misjudged them both, though. My reply went over like the proverbial lead balloon. I resolved to keep irony for future reference.

Attempts at patient-staff banter had a tad more success with the older, more experienced nurses. As you know, the question that every nurse’s heart yearns to ask is this: “Have you opened your bowels today?” Having weathered this question for a week , I decided that a mere “Yes” had become an inadequate reply, so this particular day I ventured, in a loud voice, “Yes, I Have Opened My Bowels Today.”

Apart from a few local chuckles from the nurse and my fellow inmates, this was not the roaring triumph I’d hoped. It just wasn’t forceful enough.

I heard what “forceful enough” and “roaring triumph” were a couple of nights later — a performance in the same general domain of human endeavour, too.

Up the corridor, about 8.30, came the call, in a rich and robust female voice. Stentorian.

Perfectly measured in its round-toned articulation. Utterly self-assured.

“May — I — Have — A — Bed — Pan — Now — Please — Nurse?”

This was succeeded by muffled hysterics from bedrooms everywhere.

[ This tale will be concluded in the next issue. ]

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