My Uncle Stan

I just finished writing a blow by blow description of my Uncle Stan, age 94, falling in his apartment and breaking his left hip.  I hate what I wrote.  I don’t have the writing ability to keep your attention while describing all the running around I was doing accompanied by intense wildly vacillating emotions.  Some writers can grab you and put you in their shoes so that you feel the sadness, the anger, the helplessness of being the caretaker of someone who has been vital and in charge his entire life.  I had hoped the writing would push me to sort through a lot of my questions of American versus French medical systems as I’m at the age where I’m asking myself “Where do I want to grow old?”

I’m writing all this from my little desk in Paris.  I returned here over the weekend feeling no small amount of guilt for leaving Stan in the hands of Skilled Nursing. These are the things that have stuck to me and won’t let go.                                                                                                                                       Stan was so miserable, so uncomfortable, so humiliated by his powerlessness that he sank into depression and confessed that he wanted to die.  I couldn’t find any fault with that thinking.  The surgeons couldn’t do a hip surgery on him, he was too old.  They opted for two one-inch incisions at his left hip and placing small rods in to hold the hip together.  Then it was up to him to do Physical Therapy to strengthen himself enough to be able to walk again.  What I saw in front of me was an old man who was so thin, so small that he looked like a little boy lost in his twin size bed.  A man whose lack of any fat on him caused him to slip far down in his wheel chair until he became so unbearably uncomfortable that I’d go looking for aides to help pull him up again.  His hearing is so bad that even with his hearing aids, we had to almost yell to explain to him what was happening.  Due to another syndrome, his hands and feet got little circulation and he was cold most of the time.  I would wrap his Princeton stadium blanket around him as if he was a baby in a casket.  It wasn’t difficult at all to step into his slippers and think “I don’t want to live like this.”  He was completely helpless, dependent on me and the nursing staff.  He stopped eating.  He said he had no appetite, that this was the first symptom that Enid had (his wife who died six years ago) when she was sick with pancreatic cancer.  He convinced one of the nurses to include a blood test for pancreatic cancer in his lab work. I knew that he was saying “I just want to die.”

The Skilled Nursing unit of Stan’s Continuing Care Retirement Community was understaffed and underpaid.  I know they were working hard.  But they couldn’t be everywhere at once.  Sometimes when Stan pushed his call button, it would take 15 to 20 minutes before someone came in.  Stan has a primary doctor in Princeton but none of the staff could take orders from her.  They could consult with her.  After the first day back at Skilled Nursing, I didn’t hear about any consulting.  It seemed the right hand didn’t know what the left hand was doing.  When I mentioned this to any friends, they would nod knowingly as if this was an accepted fact of the American system.  Without an advocate, a person could easily be forgotten.  Especially someone like Stan who doesn’t like to make waves because he’s embarrassed to be seen as he is.  He made it clear he didn’t want any visitors.  We had to cook up a plan to encourage his friends to visit as if they were just passing by but not stay too long as it tired him too much.  No way were we going to leave Stan along with his depression.

By the time I left late Friday, the staff was going to put him on an IV to feed him.  My cousin, Joan, was there expertly taking over the reins to insure that Stan didn’t get lost in the system.  She wrote to say that the visits were cheering him up a bit.  Though it was only mentioned a couple of times to me, I couldn’t help but think that so much of this mess is due to our lousy Insurance system.  It was strongly hinted that he left the hospital too soon because insurance/medicare would pay another night.  When he wanted the extra lab work, a nurse took me aside and said that insurance may not pay for it.  The underpaid overworked staff remain so in order to line the pockets of those at the top of the Insurance Food chain.  I’ve had the experience of having to pay more for a medicine with my Co-Pay than the entire cost is here in Paris.  This is, of course, just my opinion but as I watched the week with Stan unfold, it struck me that this is one of the ways the Insurance men and laws deal with our elders–hide them and maybe they’ll go faster.  I don’t feel polite about my dealings with the health care system last week.  I made myself unlikeable to all the staff, sometimes even to me.  But what would have happened to Stan if I hadn’t been there?  It was Thanksgiving week and people were on vacation.

More on this later.

A bientôt,

Sara

 

 

 

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Hip Replacement Surgery–Part 2

I can be honest now, now that it’s all over.  I was terrified.  When I first heard I might need hip replacement surgery, I was a bit cavalier.  Ho hum.  Then I was given a reprieve.  My doctor thought that because my pain wasn’t constant that the problem might not be bone on bone but due to inflammation.  That reprieve lasted until December 18, when the Kaiser surgeon called me and said that the arthritis was bad, advanced and that taking cortisone shots would be a very short lived band-aid.  The surgery was back on.  Only this time, I wasn’t at all cavalier.  I was really scared.

Until I had this operation, I’d never been in a hospital.  I haven’t even had my tonsils out.  When I closed my eyes and tried to visualize what might happen, all I could see was a big knife going into my back side deep.  That’s as far as I could get.  I’d shiver and try to distract myself.

I talked to a lot of people.  99% of my friends raved about total hip replacement surgery telling me that they were walking, dancing, doing yoga so much better than before and had no sign of anything irregular in their hip.  I heard them but I think the information didn’t lodge anywhere important or as one of my parents used to tell me “it went in one ear and out the other”.

Hip replacement surgery has come a long way since doctors first starting researching and experimenting with the possibilities in 1962.  I have titanium in my hip.  Initially it was stainless steel.  The ball part of the titanium is stuck into the hip socket tightly and only loosens up as the bone accepts the implant.  In the past, the replacement could come loose after only 10-12 years and cause more pain.  I’m under the impression this replacement could last the rest of my life.

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An X-ray showing a right hip (left of image) has been replaced, with the ball of this ball-and-socket joint replaced by a metal head that is set in the femur and the socket replaced by a white plastic cup (clear in this X-ray). from wikipedia

I had this surgery February 23rd.  I was released to my friends’ home February 24th.  I couldn’t go to my home because of so many steps.  On March 5th, I left my friends’ house and came to my own home.  I thought the 45 stairs going up to my front door would take me 30 minutes to climb.  It took me 5 minutes.  It was easy.  I followed instructions and used a crutch.  California stairs, as opposed to New York stairs, are not high and much longer.  That’s my observation anyway.  I didn’t have to lift either leg very high.  I was so excited.

The next day, a Physical Therapist came to my home and told me I should start using a cane.  He said I was walking well.  I was given exercises to do three times a day.  Today, I can walk around my house without even using the cane.  I go slow and step carefully.  I have to go up and down 10 stairs to go to the bathroom.  Easy peasy!

Today I have two big problems:  The first is trying to respond to all the people who have cared enough to write me an e-mail and ask after my recovery.  I tire easily and it’s hard to keep up with the correspondence.  This is what a friend of mine would call a luxury problem.

The second challenge is balancing out activity-meaning my leg and foot are towards the ground: I’m walking or sitting at the computer, making a meal with rest–meaning my leg is elevated and above my heart.  Each day I feel different but I have learned to follow directions and I err on the side of caution.

I’ve seen three different PTs and each one says that this operation is one of the best inventions of the 20th century.  I now agree.  Two months ago, I was checking on my will and my living will.  I was scared and non-believing of all these other folk who related tremendous success.  And here I am today, feeling in great spirits, pleased as punch with my progress and looking forward to my return to Paris!

I also have a lot of gratitude to the friends who have brought me over prepared food so I wouldn’t have to stand too long to make meals. To those who have driven me to stores or gone to the Library for me.  Especially to my friend Susan who flew out here from Arizona to help me transition from chez Koch to chez Sara.  She was a hard task master but I listened.  I hope I don’t have to have another surgery to remember how precious all these friendships are.  You know who you are.

A bientôt,

Sara

Hip Replacement Surgery–Part 1

Today I have a new hip, a round, probably cream colored ball, that replaces the round top of my femur, which is attached to a stem that fits into my thigh bone and has been placed in the empty socket where my old arthritic hip used to be.  Got that? I am nine days post-surgery and, for the second time in two days, feel a burst of morning energy.  I’ve made a few lists of things I can actually do and started checking them off.  I’ve begun the process of straightening and sorting all my belongings that made it over to chez Koch, my home away from home.

Chez Koch is where two remarkable and generous friends have let me stay for the first ten nights of my recovery.  It is a ranch style house, the only steps being the two very small ones that allowed me in the front door.  Between lots of naps, I’ve slowly been learning how to walk again with the aid of a walker.  My Physical Therapist at the hospital said “you have wonderful posture.  Were you a dancer?”  Meaning that if I stand erect and walk, the surgical leg moves directly behind me slightly stretching the thigh skin, exactly as it is supposed to do.  Then he said “You walk like Frankenstein”  In my cautiousness, I was forgetting to bend my knee of the surgical leg.  This produced a few chuckles from the watching staff.  Dancer and Frankenstein describing me within two minutes of each other! Well, as they say “only in San Francisco”.  It turns out there is a Ballet showing in the City at the moment called “Frankenstein”.

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Kaiser San Leandro Medical Center

For the record, I didn’t like being in the hospital.  It was my first time and, hopefully, my last.  It wasn’t the constant poking and prodding that I’d been warned about, it was the double speak.  I had the orthopedist who performed the surgery.  I had a Joint Care Coordinator, a physical therapist, an occupational therapist, a day time RN and a night time RN and both of them had trainees.  I had a substitute doctor as my surgeon was unavailable when I awoke Friday morning.  Each of these people knocked carefully on the door of my single room at Kaiser San Leandro Hospital.  Each entered with an opinion or feedback.  Almost all the opinions and feedback contradicted each other.  For me, already scared by someone having taken a scalpel to my backside, opening up a fairly large portion of said backside to go in and out of the hip area, not to mention drugged silly with anesthesia so as not feel the above mentioned activity, I just wanted one person to be decisive and tell me exactly what to do.

Not to be.  I had immediate problems.  I couldn’t stand up long enough to get anywhere to take a pee.  My blood pressure would drop to the floor, giving my stomach a good shuffle on the way down so I thought I might vomit.  I’d break out in sweats while shivering.  This all turns out to be normal if one has low blood pressure to begin with and then adds anesthesia to the mix which drops blood pressure even more.  I suppose it’s nice to have that information but what I felt was weak, vulnerable, lonely and wanting someone strong to tell me what to do.

By Friday afternoon, I had a mini-meltdown, no one would agree what should happen to me.  I thought I was in a crazy house and wanted out.  I called my friend Jane and she came and got me.  Kaiser I’m sure was happy to see me go.  I’d like to think I’d been mirroring back their very bad communication efforts and they wanted me GONE but I think that would be a bit arrogant.  I’m sure I was just a difficult patient.

From Friday evening, February 24 thru Saturday, March 4, my world became my bedroom, my slow trips from bedroom to bathroom and then slow trips from bedroom to kitchen.  The most difficult thing physically that I had to accomplish was hauling my surgical leg up onto the bed when getting ready for a rest.  I had to use a bungee cord that I would hook around the insole of my foot and gently pull the leg up, followed by the good leg, until both legs were safely propped on a pillow.

It’s been a kind of nether world.  Not much exists outside of these walls. Friends have been bringing me meals and doing shopping for me, often staying for a bite and a visit.  Everyone wants to know about me so I have perfected the story.  I see the paper each morning and that the same man is still President but it feels so far away as not to really touch me.  I’ve read four mysteries. It’s not a vacation from life, it’s more like a detour.  I’m off the track I know.  I don’t know this one very well so I’ve slowed down to a crawl and trying to pay attention.  The problems of my normal track aren’t the problems of my today.  Today, it’s how to balance out activity and rest so as not to push myself too far.  Today, it’s the fine line between pain meds and laxatives so that a secondary pain doesn’t take over all my attention from my healing hip.  These are huge problems to me.

Part 2 soon….

A bientôt,

Sara

Network, the movie

Until Saturday evening, I had never seen the movie “Network” that won four Oscars in 1976.  Turner Classic Movies is probably my favorite TV channel in the US and, as usual, leading up to Oscar Sunday, TCM is showing 31 Days of Oscar…..in alphabetical order!

I don’t know how I missed this movie.  I was recently out of Graduate School, wanted to stay in the Bay Area where jobs were scarce and was probably working around the clock to make ends meet.  I remember the iconic line “I’m mad as hell and I’m not going to take this anymore”.  I also remember that Peter Finch, who starred in the movie and won the Oscar for Best Actor, died before he could pick up his Oscar.  The belief is that his heart was already weak and some of the long impassioned speeches compromised his heart even more and he died of a heart attack months after the release of the movie.

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What was stunning to me as I watched Saturday evening, was how prescient the movie was.  Although supposed to be a “outrageous satire”(Leonard Maltin) , it predicted the news as entertainment and the hero worship of men who express their anger on TV and therefore relate and identify with the supposed mass majority of the American public. The movie opened forty-one years ago and predicted the rise of Donald Trump: a figure that TV made.

In a review that the great Roger Ebert wrote in 1976, he said “we may doubt that a Howard Beale could get on the air, but we have no doubt the idea would be discussed as the movie suggests. And then Chayefsky and the director, Sidney Lumet, edge the backstage network material over into satire, too–but subtly, so that in the final late-night meeting where the executives decide what to do about Howard Beale, we have entered the madhouse without noticing.”

Ladies and Gentlemen, welcome to the madhouse.

This is indeed a great movie.  I encourage you to read the Ebert review then think about the rise of Donald Trump.

http://www.rogerebert.com/reviews/great-movie-network-1976

Don’t forget to watch the Oscars this coming Sunday 4pm PST and 7pm EST.  There’s always something memorable even if you have to slog through a lot of commercials and boring speeches to get there.

This will be my last post for awhile.  On Thursday morning, I will be having total hip replacement surgery on my right hip.  I’m told that the process has advanced so much that  I could go home the same day.  I asked to spend one night in the hospital.  I have to learn Physical Therapy and be disciplined about doing it three times a day.  My goal and reward is, if everything goes well as is predicted, I have a return flight to Paris on May 2nd.  I miss Paris terribly.  It is something I will hold in front of me as the undisciplined part of me tries to talk me out of doing PT.

A bientôt,

Sara