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my caregiver daughter and photographer

Every year on the anniversary of my husband’s death, I have dedicated a blog post to that event. Marv passed away four years ago on July 25, and I’ve not had a minute to mindfully think about the impact of his loss in my life.

On July 25, Monday, I focused my attention on my hip surgery scheduled for the next day. First thing, I double checked that my blood work and chest x-ray results had made it to my patient chart and were within normal limits. Then I had a luscious massage with a favorite therapist. She’s recently launched her own business and has a whispery quiet room in a new office building five minutes from my home. She has decorated her room in soft grays and has a delicious warming blanket on her table. We talked about my surgery and the need to keep all my muscles warmed up and flexible.

I shopped for a few groceries so that my son from the West Coast who was flying in to stay with me would be able to craft some lunches and dinners for us. I threw in four heavily iced cinnamon rolls his dad used to like and lemonade that I knew for sure he would like.

In the afternoon, I had what I called the mandatory pre-op pedicure (at another place five minutes from home). Knowing I would not be driving for a month or more and not being able to paint my own toenails, it was a priority for me to have presentable nails during this sandal weather. Indeed, even one of my post-op physical therapists asked me if I’d gotten the pedicure for the surgical occasion.

That evening, I packed my bag. My own medications that the directions told me to do (and then they said at the hospital they weren’t allowed to use), a few cosmetics, and my new robe purchased on-line, and an almost matching nightgown, purchased at Kohl’s, applying my $5 coupon from an Amazon return. I did not want to look like an 80-year-old in the standard blue patterned cotton gown, with snaps in all the wrong places, that would fall off my neck and look like a cleaning cloth gone awry. And I’d not had a matching anything in the bedroom since a soft batiste matching peignoir set was given to me by Marv’s cousin on the birth of our son fifty-five years ago. I figured I was worth it. And, if not me, just my hip in question was worth the attention.

Promptly at ten the next morning, my son drove me to the hospital another five minutes from my house—this city is remarkably convenient for a former Chicago Loop resident. Shortly after we left home, my newly engaged cleaning lady arrived to scour my house for my return. Again, even if I’m not worth the expense of a cleaning lady, my new hip should be able to come home to clean surroundings. There’s always a justification there if you just allow yourself to find it.

The new hospital was beautiful—a wall of waterfalls in the stadium-sized foyer, valet service, an escort to your room, the private room large enough to hold three beds–with floor to ceiling windows, and the staff exceptionally competent and attentive. Every person who entered the room knocked first, introduced themselves, and asked “Is there anything I can do for you before I leave?” Honestly, for this older retired nursing professor, who at one time taught communication, this hospitalization looked like it would be a dream. Even the dietary department, called “room service,” asked me if I was sure I’d made all the choices I wanted. I had to tell one of them that my Weight Watchers leader would be appalled to know that I’d ordered a pancake, Raisin Bran, and yogurt all for the same meal. Even my brain had a hard time keeping up with the calories and points.

Surgery later Tuesday afternoon went without a hitch. The surgeon and his PA showed up ahead of time, and the main message I heard was that I should be careful not to fall in my postoperative life. The same message I’d heard in 2006 when I had fallen and fractured this same hip. At that time, they’d put in three screws to screw my femur (thigh bone) back together. Now, with the onset of osteoarthritis, those screws had to be removed to make way for the new hip prosthesis. So, technically, I would be having two surgeries: removal of the previous hardware and insertion of the new hip. Two separate incisions.

two incisions

Ok, then. Don’t fall. That had been my mantra since 2006.

After being wheeled into the operating room, which, incidentally, had quadrupled in size since I “scrubbed in” as a nursing student in 1961, a crowd of staff persons circled my gurney. I asked if it were possible to keep my screws, once they were removed, of course. I’m not sure if my request was common or not because there seemed to be a short silence, so I piped up to explain that those screws had kept me upright for the past 16 years, and I was grateful for their service. Furthermore, I may have an identity crisis if that part of me was so abruptly removed.

the beginnings of my necklace

When I woke up after surgery, those three screws, looking shiny and never used, lay in a denture cup with my belongings. I’m thinking of making them into a dangling necklace.

My son and daughter told me how much they appreciated the link on their phones that kept them apprised of my progression through surgery, recovery, and back to my room. They could sit at a Culvers across the street and get caught up with their lives and not worry that they’d miss a message or the doctor afterwards.

Jump ahead. Around seven that evening, I sent my son, and my daughter and her husband who live locally, home. I was fine. I had a TV with a zillion channels, and a book if none of them sufficed. Staff came in and asked if I was ready to walk. Sure. Adorned with a gait belt, I easily walked the hallways with them. Upon return, one asked if I’d like to try a trip to the bathroom (I’m sure you all know that this is very important after having spinal anesthesia). Sure, again. After making sure I felt fine, no dizziness, no lightheadness, they left me perched on the throne, call bell in place. “Pull that cord when you need us.”

Da da da, da de dum. There I sat feeling fine, until I didn’t. A very vague feeling of lightheadedness passed into my awareness. I pulled the cord for the call bell. The staff came immediately. I recall standing, using my walker to brace me, one staff person in front of me stabilizing my walker, another securely holding my gait belt in the back. I remember saying something about starting to feel lightheaded. The next sentence I remember saying was, “Please lift my feet up.” I’d opened my eyes to find myself spread out comfortably on the floor, many faces above me peering around my circumference. I guess as a nurse, I knew I needed blood to my head, thus the request for them to raise my feet. (I later learned they’d already raised my feet!)

My next recollection were the doctor’s words about the importance of not falling. I was absolutely sick to my stomach. Had I wrecked the surgery? Had I messed up the delicate, intricate, complicated work of the surgeon’s hands?

I remembered a time when I was a young head nurse at Blodgett Memorial Hospital in Grand Rapids, Michigan. A Dr. D performed an intricate, delicate, complicated surgery called a gastrojejunostomy that required a sensitive suture line. A drainage tube from the surgical area had to be very, very gently irrigated every two hours to keep it patent (open). Dr. D wrote orders that only Mrs. Roelofs (me) was allowed to irrigate that tube. He explained to me that, other than the interns, I was the only one he trusted not to “wreck” his surgery. Too much pressure on that irrigating syringe could pop that suture line open. I was honored, big time, that he trusted me, a young nurse about 22 years old.

But now, as a hip patient being carefully and slowly moved from the bathroom floor and lifted into my bed, I simply wanted to weep and say I’m sorry. I did not want to be part of wrecking any well-intentioned surgeon’s meticulous work. Of course, my fainting was no one’s fault—no one had acted negligently. And all I wanted to do was to assure them that I knew they had promptly and competently handled the emergency I had caused.

But I had to ask, too, out of an old-time memory from my nursing practice days, if they’d had to notify the doctor and fill out a report. The nurse told me yes. I remembered having to do that myself and not being overjoyed about the extra time it took.

I also knew about “good patient syndrome.” A syndrome where the patient tries to please the staff or her doctor and wants to be viewed as a patient who doesn’t cause problems. Was that part of what I was feeling?

I quickly disabused myself of that thought. If anything, working in healthcare for forty years, I’d always been hypercritical of any encounter with health care personnel that didn’t meet my standards. I’d be more likely to call them out. Or at least broadcast their shortcomings to my students or friends.

The simple fact was that I had fainted. I had not fallen. The staff had ahold of me the whole time and carefully lowered me down to the floor. As one of the staff told me later, “We are trained to do that.” In other words, no big deal. I’d even helped patients, and once a student, glide to the floor myself.

After a two-night stay trying to manage the postoperative pain and getting the approval of physical therapy and occupational therapy, I was discharged. One of my in-home physical therapists summed up those early days perfectly: “The first two weeks suck.”

being discharged with my son

Meanwhile I was adjusting at home with the help of my kids and grandkids. It was such a pleasure to have both my West Coast son and local daughter in the living room with me while they went through memorabilia from their dad that I had just finished compiling during my bankers’ boxes cleansing. It was so fun to witness them giggling at memories of their dad.

loved seeing my kids going through their father’s things

I was coping okay and having lots of laughs with my kids and grandkids over my clumsiness using my walker attached to my hands, my infamous and essential raised toilet seat, my added fancy side rail for my bed, and pulling on (and taking off) my tourniquet-like tight TED hose. I also was developing a new appreciation for all folks needing to live with these adaptive devices.

But my pain level stayed about the same even though I was on my second pain medication. The pain was mostly on the lateral side of my right leg where the screws had been removed. The major jumps in pain seemed to happen after my left leg, which was my “helper” leg, lost contact with my affected leg. The first time I was in bed, the second time on the couch, and I was trying to get from a lying to a sitting position. I cradled my left helper ankle under my right ankle and began slowly moving them to the side of the bed when, just that fast, my right ankle slid off the helper ankle. With no support, the affected leg had to jerk into action to prevent flailing about. My screams could have been heard miles away.

I recovered from this first incident with a flailing leg intact and a multitude of tears, while vowing to be more vigilant in the future. This was not a time for a high wire act.

However, the next day, the same thing happened while I was on the couch. In all the preoperative information that I’d been given, there had been no warning that your bladder acts when you think you are simply trying to get from a lying to a sitting position. So picture the following if your mind can take it:

 A signal arrives from your brain that you should consider going to the bathroom. Soon. You double check with your mind to see if it is a serious warning. You determine it is. You loop your helper ankle under the ankle of your affected leg, grab at the fleece blanket under you, make a fist of the blanket, pull that fisted blanket really hard as you raise your torso and swing your lower extremities toward the edge of couch.

Take a breath. Now you are almost at your goal of sliding those feet onto the floor by your walker. But this is when your affected leg breaks free from its helper ankle, the screams begin, and you realize you have lost control of that painful leg once again. It is not falling, at least, but flailing.

Concomitantly, not only do you lose control of that leg, but your bladder somehow decides to attend the “losing control” party.

Before you know it, you have helped yourself swim down to the floor ensconced in a river of fisted blanket.

You are now not going anywhere. You text your daughter. You know she’s coming sometime that day but are not sure when. You ask. She answers she and her husband are on their way. Perfect timing!

She enters your house, moseys down your hallway, hollers, “We’re here,” enters the living room, and stops short.  She glares at you. Finally, she says, “Are you on the floor for a reason?”

How does one explain sitting on the floor when the intent was to get to the bathroom? You can’t, so with good humor, you allow your daughter to assist you unceremoniously from the floor to one knee (of the good leg) and slide backwards onto a leather hassock, shimmy backwards onto the couch, and start over.

don’t ask! but there was No injury to the hip!

While you are gaily skipping with your walker to the bathroom, seemingly 5000 steps, your daughter has started a huge load of washing.

At my two-week postoperative appointment, I recounted incidents of when and where my pain had increased. They had taken their routine post op x-rays and noted a slight “shift” in some bone. The surgeon had told me all the possible risks of the surgery during my pre-op visit and again just before surgery when I signed the operative permit. A fracture was on that long list that could occur during surgery or afterwards with little to no provocation. He had explained that when the screws are removed, that leaves an open tunnel, that until bone grows back in, will leave a weak spot that will be susceptible to fracture.

You find out at this appointment, that for no immediately identifiable reason, you have sustained a fracture in the operative hip. You remember your surgeon’s words and also reading that a fracture can occur during surgery, of course, or simply by standing on the leg or twisting. No matter what caused it, now you are sent home with more orders for PT at home, continuous use of walker, a different–hopefully more effective–pain medication, weight-bearing on the affected leg only as tolerated, and check back in a month.

Now, at three weeks post op, the highlight of my day is making it to the bathroom on time. Little things, they say, mean a lot! But if that is not possible, my long-time nursing friend, Marianna, a retired nurse practitioner and home care nurse, has introduced me to pull-ups. And to hear my grandkids come in the house with their mother, laden with packages from Sam’s Club and shouting, “Grandma, we got you your diapers,” adds more humor to my day. (I hope they don’t still have Show and Tell at school.)

And that physical therapist who had warned me that the first two weeks suck, gave me another reason for joy. She complimented me on my ability to multitask. It seems not everyone can void and walk at the same time. I have that skill down perfectly.

And that cookie sheet in my bed? My affected leg had loved sailing back and forth on it during physical therapy. Marv might agree that at this four-year mark, that cookie sheet is just what I need. But, until my hip pain settles down, that exercise is on hiatus. Instead, I can continue the isometrics, and I plan to have the tightest muscles from ankles to waist of all of my octogenarian friends.

For the first time in my life, I should look great in a bikini! If I make it through this pain.

after two-week appointment, my daughter drove my car