I've been up for two-and-a-half hours. Hard to sleep, not because of pain, but idleness, a week now of sitting and reclining. At night I strap on my cpap mask breathe in and out of the flexible tubing with the constant stream of air pushes through my nose and down my throat, opening up the lazy _______. It's not uncomfortable and even soothing, the muted sounds of my breathing and the machine's shore-like hollow response. It's all gentle, almost soothing, despite the tubing and the head straps and the two plastic "pillows" in my nostrils.
But it's not sleep inducing. It's just an adaptive apparatus, like my sling. So for a week I recline in the sofa, pull the blanket over my legs, prop up my left elbow with two real pillows, close my eyes, and wait to fall asleep while breathing rhythmically into a small nasal mask...
Monday, March 2, 2015
Thursday, February 26, 2015
Wednesday, February 18, 2015
Reading the Results
It's not easy to see an orthopedic surgeon.
You make a call and in 3-4 weeks you can get in for an initial visit, xrays and a series of twists and pushes and pulls with your arm and shoulder to convince the physician's assistant that your arm is weak. This is the first mention of the multisyllabics: supraspiniti, infraspinitis, ________ There's a map of muscles and tendons and bones in your shoulder, a geography, a topography that makes a car's transmission seem simple. There's a mysterious architecture here displayed in the light and shadows of the xray. Displayed on the light box, nothing seems particularly complex or broken or out of place. The PA and later the orthopedist points a pencil as a white abstract shadowy area. THat looks like a tear. That coud be a tear. See this bridge of darkness here? That shouldn;t be there. Thata a birth defect. Bones didn't close. Nothiong to do about that now.
This is not an interview or an exchange. It's a monologue, complete with the darting pencil, the general circular motions near some light or shadow. See?
We're meant to follow the anatomy and the didactic pointing above the xray, as if writing on it, marking it, would somehow mar the sacred surface. The result is obfuscation. general motions that replace what could be pinpoint accuracy. Which is not how we read a map, especially whern we're trying to locate where we are. We trace our finger across the surface of roads and arteries and junctions. The sliding of the finger and halting on sites verifies our location. We trust maps better than we trust verbal directions at a gas station: go down south about a mile or two, take your second right after the bridge, past the dirt road, then turn left onto the old highway.
You are assigned 6 weeks of physical therapy, and then a follow-up with the orthopedist, and then, based on your status, you'll get more therapy, or a shot of cortisone, or arthroscopic surgery.
The follow-up lead to theneed for an MRI to confirm what was know during the first visit. Insurance compies requir this protocol, so you schedule an MRI and then another follow-up with the surgeon and by this time you're three months out from your first visit.
Once the MRI results are loaded on the screen the PA examines them, explains what they might mean, and then the surgeon comes in and dials into the results with alarming speed. You have two complete tears, here and here. You have a sliver of arthristis here. We can scrape that out. You have a tear in your biceps tendon here, we'll just cut that and let the musle slip down a bit, and you still have a tenderness in your elbow, we'll give you a shot. It's like the ditrections a baseball manager gives to pitcher when visiting the mound. We'll pitch to the lefty, nothing hittable, but challenge him high. If we walk hom then the bases are loaded and we have a double play set up everywhere.
You make a call and in 3-4 weeks you can get in for an initial visit, xrays and a series of twists and pushes and pulls with your arm and shoulder to convince the physician's assistant that your arm is weak. This is the first mention of the multisyllabics: supraspiniti, infraspinitis, ________ There's a map of muscles and tendons and bones in your shoulder, a geography, a topography that makes a car's transmission seem simple. There's a mysterious architecture here displayed in the light and shadows of the xray. Displayed on the light box, nothing seems particularly complex or broken or out of place. The PA and later the orthopedist points a pencil as a white abstract shadowy area. THat looks like a tear. That coud be a tear. See this bridge of darkness here? That shouldn;t be there. Thata a birth defect. Bones didn't close. Nothiong to do about that now.
This is not an interview or an exchange. It's a monologue, complete with the darting pencil, the general circular motions near some light or shadow. See?
We're meant to follow the anatomy and the didactic pointing above the xray, as if writing on it, marking it, would somehow mar the sacred surface. The result is obfuscation. general motions that replace what could be pinpoint accuracy. Which is not how we read a map, especially whern we're trying to locate where we are. We trace our finger across the surface of roads and arteries and junctions. The sliding of the finger and halting on sites verifies our location. We trust maps better than we trust verbal directions at a gas station: go down south about a mile or two, take your second right after the bridge, past the dirt road, then turn left onto the old highway.
You are assigned 6 weeks of physical therapy, and then a follow-up with the orthopedist, and then, based on your status, you'll get more therapy, or a shot of cortisone, or arthroscopic surgery.
The follow-up lead to theneed for an MRI to confirm what was know during the first visit. Insurance compies requir this protocol, so you schedule an MRI and then another follow-up with the surgeon and by this time you're three months out from your first visit.
Once the MRI results are loaded on the screen the PA examines them, explains what they might mean, and then the surgeon comes in and dials into the results with alarming speed. You have two complete tears, here and here. You have a sliver of arthristis here. We can scrape that out. You have a tear in your biceps tendon here, we'll just cut that and let the musle slip down a bit, and you still have a tenderness in your elbow, we'll give you a shot. It's like the ditrections a baseball manager gives to pitcher when visiting the mound. We'll pitch to the lefty, nothing hittable, but challenge him high. If we walk hom then the bases are loaded and we have a double play set up everywhere.
Saturday, February 14, 2015
Here is what I know. In a week I will enter the hospital with the full use of both arms and both legs, and later that day, when I leave, I will not be able to move my arm for the next six weeks. I will not be able to tie my shoes, buckle my belt, put on my sox, or sleep on my back.
I will be the man in those one-armed man stories that float through our culture.
The man who escaped from prison and comes across a couple necking out in the moonlit summer's night. The girl has been growing anxious ever since she heard the new flash on the radio. The boy assured her it was OK and insisted that they keep kissing. The girl finally convinces the boy to take her home and, upon opening the door, screams bloody murder. There, hanging from the car door, is the steel claw arm of the one-armed prisoner!
Or The Fugitive. That television series from the '60's where a doctor is accused of murdering his wife is forced to live a life on the run, seeking the true killer. One man is haubnted by the authories and the FBI, the other is a one-armed bandit being chased to justice by our fugitive hero. It's a shadow story, both men on the run. One man the shadow side or doppleganger of the other. For years we only see glimpses of the one-armnsed killer eluding our hero. Each episode dedicated to a new predicament that the fugitive finds himself, each predicament an opportunity for him to improve the lives of others around him. Both men trapped in a television series chasing each other, chasing the truth.
I will be the one-armed man in a sling haunting the shadow of my own life. .
I will be the man in those one-armed man stories that float through our culture.
The man who escaped from prison and comes across a couple necking out in the moonlit summer's night. The girl has been growing anxious ever since she heard the new flash on the radio. The boy assured her it was OK and insisted that they keep kissing. The girl finally convinces the boy to take her home and, upon opening the door, screams bloody murder. There, hanging from the car door, is the steel claw arm of the one-armed prisoner!
Or The Fugitive. That television series from the '60's where a doctor is accused of murdering his wife is forced to live a life on the run, seeking the true killer. One man is haubnted by the authories and the FBI, the other is a one-armed bandit being chased to justice by our fugitive hero. It's a shadow story, both men on the run. One man the shadow side or doppleganger of the other. For years we only see glimpses of the one-armnsed killer eluding our hero. Each episode dedicated to a new predicament that the fugitive finds himself, each predicament an opportunity for him to improve the lives of others around him. Both men trapped in a television series chasing each other, chasing the truth.
I will be the one-armed man in a sling haunting the shadow of my own life. .
At least you have a story.
This, from Dr. Wreck, caught me off guard.
The tonality was off. Suggesting that I was lying. Like getting caught in a lie in the principal's office. Guilt by association.
Or, if not guilty, that I felt needed to fabricate a story tty that she's not interested in. Everyone who enters her domain has a story. The patients' stories are immaterial. What's important is the procedure.
The anesthetic. Rendering me unconscious. Or unfeeling. Speechless. A human form, just like any other human form, a mass of flesh. A human being without a story. Reduced to numbers, readings, outcomes.
The surgeon performs the work. But the anesthesiologist is the one that makes surgery possible. Dr. Wreck is the one who will transform me from a sentient being to a fully prepped and unconscious state, something that can be cut and sawn and scraped and stitched. I will be a homeless, nameless lump of flesh. A body without a story. The only story that counts is what unites us in the cold operating theater: rotator cuff tear. A procedure, not a story, will take place. And then she will return me to consciousness. I will return to the wonders of thought and speech and story.
How did it go?, they will ask
Fine, I will say, not really knowing. I will be the evidence that an event took place, but without a witness or a sense of awareness, it will only be an event. A process. A medical procedure.
Do I want Dr. Wreck to know my story?
Yes. But only because she asked. I want her to know that it's my story, it's why I'm here, drama. It has energy. It has a beginning, a sense of place, specific images and details. It has an ironic point of view. I want to enchant my listener with, give them a sense of delight.
It's my story.
This, from Dr. Wreck, caught me off guard.
The tonality was off. Suggesting that I was lying. Like getting caught in a lie in the principal's office. Guilt by association.
Or, if not guilty, that I felt needed to fabricate a story tty that she's not interested in. Everyone who enters her domain has a story. The patients' stories are immaterial. What's important is the procedure.
The anesthetic. Rendering me unconscious. Or unfeeling. Speechless. A human form, just like any other human form, a mass of flesh. A human being without a story. Reduced to numbers, readings, outcomes.
The surgeon performs the work. But the anesthesiologist is the one that makes surgery possible. Dr. Wreck is the one who will transform me from a sentient being to a fully prepped and unconscious state, something that can be cut and sawn and scraped and stitched. I will be a homeless, nameless lump of flesh. A body without a story. The only story that counts is what unites us in the cold operating theater: rotator cuff tear. A procedure, not a story, will take place. And then she will return me to consciousness. I will return to the wonders of thought and speech and story.
How did it go?, they will ask
Fine, I will say, not really knowing. I will be the evidence that an event took place, but without a witness or a sense of awareness, it will only be an event. A process. A medical procedure.
Do I want Dr. Wreck to know my story?
Yes. But only because she asked. I want her to know that it's my story, it's why I'm here, drama. It has energy. It has a beginning, a sense of place, specific images and details. It has an ironic point of view. I want to enchant my listener with, give them a sense of delight.
It's my story.
Sunday, February 8, 2015
There is a narrative structure to a Pre-Op, and then the surgery. Plot, theme, conflict, setting and character. All unfolding neatly in familiar pattern.
You're scheduled for an appointment to meet first with your Pre-op nurse, then your EKG technician, then your Pharmacist's aide, then your Pharmacist, then your Anesthesiologist's assistant, and then your anesthesiologist. Each of them verifies your date of birth, reviews your record, makes suggestions about your prognosis, the surgeon's expertise, notes how he's quirky.
Your blood pressure is up. They all say that.
You're heavy, obese, large, fit, depending on the interviewer.
You have diabetes. You have sleep apnea. That means you're a category. In this case, that category is high risk. That means everyone triple checks your chart. They comment on your blood pressure.
You tell them each that your blood pressure has never been this high. You're anxious. They each say you need to go your doctor and get your meds increased. Then they check your history and repeat the test. Turns out you're anxious.
But you're still a category. Being high risk means you will be in the hospital longer.
You see them all, one by one, a series of events in a tiny room equipped with a small bed, two chairs, a computer and desk, and a monstrously large and fire engine red hazardous materials disposal unit mounted on the wall that looks incredibly complicated.
You do not move. The morning slides by with a series of polite knocks on the door, brief interviews, shaking hands, massaging hands with antibacterial soap, repeated questions, and then an suggestion of who will arrive next. A series of events with nondescript characters, self-effaced characters in a variety of medical wardrobes, no one, suspiciously, sporting the stand-by white jacket and stethoscope. Each wearing a Photo ID clipped to their chest, but you can't read the print. All of this is a mechanical process that leads, in the abstract future, to some planned event, the result of which will, in a sense, complete your story. The procedure went well. They found more damage. They had to cut you open. Things got complicated. They found something they didn't expect. This is the climax.
Then the denouement. You wake up and blubber through your pain meds and anesthetic. You get post-op instructions and they send you home with a home care sheet of instructions that's been photocopied far too many times.
Then the epiphany. You're in excruciating pain. This is all private, and then you realize the brutality of what's just taken place. Someone, some team of experts, executed their process. They tore holes in your body and probed your tissues with miniature steel tools and a live-feed video camera. They cut your tendons, trimmed and burred the floating flagellates of torn tissue, they drilled screws in your bone, they pumped a cortisone ooze into you. They stapled you shut and outfitted you in a special sling and then sent you home.
You are a strange commodity -- you go to a factory, they perform a procedure, and then you leave. Value-added. New and improved! Good to go. Your shelf life extended.
And then, the falling action, or "wrap -up": physical therapy.
All of this is a repeatable structure, a sequences of processes and protocols designed to separate you from the thing it is that's bothering you, as well as yourself from the process and the procedure, and to then, by the execution of expertise, return you to yourself wholly, perhaps, intact -- now you're fixed, resolved, or complete.
You're scheduled for an appointment to meet first with your Pre-op nurse, then your EKG technician, then your Pharmacist's aide, then your Pharmacist, then your Anesthesiologist's assistant, and then your anesthesiologist. Each of them verifies your date of birth, reviews your record, makes suggestions about your prognosis, the surgeon's expertise, notes how he's quirky.
Your blood pressure is up. They all say that.
You're heavy, obese, large, fit, depending on the interviewer.
You have diabetes. You have sleep apnea. That means you're a category. In this case, that category is high risk. That means everyone triple checks your chart. They comment on your blood pressure.
You tell them each that your blood pressure has never been this high. You're anxious. They each say you need to go your doctor and get your meds increased. Then they check your history and repeat the test. Turns out you're anxious.
But you're still a category. Being high risk means you will be in the hospital longer.
You see them all, one by one, a series of events in a tiny room equipped with a small bed, two chairs, a computer and desk, and a monstrously large and fire engine red hazardous materials disposal unit mounted on the wall that looks incredibly complicated.
You do not move. The morning slides by with a series of polite knocks on the door, brief interviews, shaking hands, massaging hands with antibacterial soap, repeated questions, and then an suggestion of who will arrive next. A series of events with nondescript characters, self-effaced characters in a variety of medical wardrobes, no one, suspiciously, sporting the stand-by white jacket and stethoscope. Each wearing a Photo ID clipped to their chest, but you can't read the print. All of this is a mechanical process that leads, in the abstract future, to some planned event, the result of which will, in a sense, complete your story. The procedure went well. They found more damage. They had to cut you open. Things got complicated. They found something they didn't expect. This is the climax.
Then the denouement. You wake up and blubber through your pain meds and anesthetic. You get post-op instructions and they send you home with a home care sheet of instructions that's been photocopied far too many times.
Then the epiphany. You're in excruciating pain. This is all private, and then you realize the brutality of what's just taken place. Someone, some team of experts, executed their process. They tore holes in your body and probed your tissues with miniature steel tools and a live-feed video camera. They cut your tendons, trimmed and burred the floating flagellates of torn tissue, they drilled screws in your bone, they pumped a cortisone ooze into you. They stapled you shut and outfitted you in a special sling and then sent you home.
You are a strange commodity -- you go to a factory, they perform a procedure, and then you leave. Value-added. New and improved! Good to go. Your shelf life extended.
And then, the falling action, or "wrap -up": physical therapy.
All of this is a repeatable structure, a sequences of processes and protocols designed to separate you from the thing it is that's bothering you, as well as yourself from the process and the procedure, and to then, by the execution of expertise, return you to yourself wholly, perhaps, intact -- now you're fixed, resolved, or complete.
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