A wee little surgery

I’ve seen so many orthopedists over the years that I’ve lost count. Yesterday, I went to a new one for my left knee which has bothered me since 1986, after a game of beach volleyball. I came away from that game with a Baker Cyst (a fluid-filled sac on the back of my knee) and was in so much pain that I could only walk slowly and with a limp for weeks. The limp went away, but the Baker Cyst often swelled to the point that it was visible. By 2006, my knee hurt so much that I had a surgical meniscus debridement, which didn’t help and during which (I was awake) the surgeon broke my heart by suggesting that I give up hiking. I’ve since been on various NSAIDS, had innumerable steroid injections, two series of orthovisc injections, and a RFA (radiofrequency ablation). I’m now to the point that I don't even take short walks, and even with that, I'm limping by evening each day.

Those of you who recall my three shoulders surgeries, might suspect that I’m a fan of surgery, and indeed I used to be. “Have a problem—cut it out and get on with your life,” I thought. And indeed, that philosophy worked for the first ten or so surgeries that included the removal of anal polyps, oral cysts,  tonsils, and a whopping neuroma on right thigh. Carpel tunnel repair was a breeze, the first surgery on my nasal septum didn't cramp my style, but that changed when it had to be redone at the Oregon Health Science University in Portland as a part of a massive surgery on my sinuses, turbinates, and septum. I had insisted on remaining awake for every surgery but the tonsillectomy. Then the day came when a surgeon took a biopsy of an osteonecrotic cervical vertebra by putting a scope through my throat, and she said there was no way she would do it with me awake. My combination hernia repair and lymph node biopsy was no fun either, and when the doctor refused to give me adequate narcotics, I went down to his office without an appointment and sat there until he did.

Then came those three shoulder surgeries that included such strange sounding elements as subacromial decompression, supraspinatus repair, biceps tenodesis, humeral head resurfacing, and a partial joint replacement. I was in such pain prior to these surgeries that I had to sleep sitting up with ice packs draped over my shoulders, and I was in such pain after them that I had to sleep sitting up with ice packs draped over my shoulders. I wasn’t even allowed to lift a toothbrush for the first six weeks after these surgeries, and nothing over five pounds for the next six weeks.
The recovery time was between six months and a year, yet my shoulders still hurt so much that I worry that I might have to return to sleeping in a chair. 

So, I’ve lost my faith in surgery as a quick fix. In fact, I'll never again go into surgery with overwhelming confidence that I’ll emerge alive. After all, the odds of dying from a clot, a nosocomial infection, a pierced organ (a risk during shoulder surgery), a medication error, or the incompetence of any one of the scores of people who have the opportunity to kill me are significant.(https://www.usnews.com/news/articles/2016-05-03/medical-errors-are-third-leading-cause-of-death-in-the-us).

The new doc is tall, muscular, and dripping with testosterone. In Peggy’s words, “He’s full of himself.” Indeed, he needed a mop to clean up his arrogance. He walked briskly into the examining room, took my hand, and stood staring into my eyes as if sizing me up, but sizing me up as what—a man? A patient? I was already upset over a fight with Peggy about a missed highway exit, and feeling like a weakling because I’ve needed so many surgeries. This meant that I was hardly in the mood to deal with a doctor who seemed to regard himself as my overall superior about a problem that I’ve had since he was a lad, but since I had waited for months to get in to see him, I had to do my best. It helped that there were things about him  I liked. For instance, he introduced himself by his first name (Brian); apologized for being late; agreed to my requests (more about them later); is highly rated on the doctor-rating sites; and did his fellowship in adult joint reconstruction at the Anderson Orthopedic Research Institute. I considered his profanity unprofessional, but it certainly went with his macho shtick.

After a brief exam, Brian proposed a full knee replacement. I was agreeably surprised because, since I was a new patient, I had expected the same-old-same-old: a steroid shot, a prescription for an anti-inflammatory, a referral to physical therapy, and the words, “We’ll talk again in a couple of months.” 

I made four requests of Brian: that I could remain awake during surgery; that he would give me a steroid shot to help tide me over until August when I’m ready to have the surgery done (which is the earliest he can do it anyway); that he give me whole lot more post-surgical narcotics than I’m already taking (he said he would double the amount for the first six weeks); and that he give me a prescription for a brace. He agreed to these requests, but I didn’t get the brace because the one they had wasn’t as good as the two that I already own (I’m an hardcore hoarder of medical devices).

Brian is my second orthopedist this year. The first was Alex, and Alex advised against surgery because, as he put it, “Your arthritis just isn’t that bad.” Since this contradicted what every other doctor had said (ten years ago, one had even told me that my knee was in such bad shape that it might collapse out from under me), I asked Brian what he saw in Alex’s X-rays that might justify Alex’s opinion. “Nothing,” he said. “Then why would Alex say it?” “Because he’s unwilling to take on difficult cases.” “Me difficult—but why?” Because you’ve been in knee pain for a long time, because you’re in pain from other sources, and because you suffer from depression.” Such factors could put me among the 5% of knee replacement patients who surgery doesn’t help. 

I try to cheer myself by being grateful that I at least have access to surgery, there being millions of people and other animals who have no choice but to suffer until they die, and some of them will die sooner rather than later because their problem makes them unable to support themselves. Yet, I'm tormented by the knowledge that I'll be going  from being unable to do many of the things that I would like to do because I have a bad knee to being unable to do them because I have an artificial knee. That is why I've waited so long to have the replacement, that and the knowledge that in a mere ten or fifteen years, I would have to have the replacement replaced, and that there would be less hope that the revision would work as well. Brian did have good news on that score. He said that the two metal parts of the joint would last me a lifetime, and that the plastic part should last for many years after which it can be replaced in ten minutes. Maybe I did well to put the surgery off for all of these years, but I sure do dread it now. I suppose it makes sense that past surgeries would leave me less fearful of additional surgeries, but the truth is that they make me more fearful. I think of them as like playing Russian Roulette.

Death in Oregon, Asininity in Europe

Jeremy Joseph Christian
Three men had their throats slashed on a commuter train in Portland (100 miles up the road from where I live), last weekend while trying to diffuse a situation in which two teenage girls--one black, the other white and wearing a hijab--were being insulted by Jeremy Christian. Although the train was crowded, only these three spoke up, and two of them were killed.

I'm no fan of Ayn Rand, the atheist writer who has inspired right-wing religious Republicans, but I've read several of her books. One of the questions she raised was: why should a person die for a stranger? Yes, why? What is the rationale for depriving your loved ones of your existence by dying for someone about whose nature you are ignorant? Although we praise those who risk their lives, which of us would even give a kidney for a stranger?

One of the men who died had four children. Was it right for him to deprive his children of a father? Would it be right for me to deprive Peggy of a husband?

Fifty years ago, I saw a man beating another man with a pistol. When I yelled, "Stop!" he turned the pistol on me, and I ran. It's not a decision that I have regretted.

I would guess that, out of every hundred people who die for a stranger, nearly all are young men, suggesting that evolution has arranged things so that the impetus to jump into the fray falls upon those who are the best able to come out alive.
Ayn Rand 1905-1982

A major downside of dying for someone is that it eliminates every other good thing a person might have done in life. The people whom I most respect aren't the ones who die for something, but the ones who live for something. For instance there's my blog buddy (http://catwomanflix.blogspot.com/) who has devoted her life to rescuing cats. Instead of praising Jodi for her sacrifice in spending her time and money on cats, and her heroism in crawling under abandoned houses and setting live traps in bad neighborhoods, most people contemptuously call her "the cat lady." This points to another thing about heroes: to win human approbation, they must help humans. Another misgiving I have about those Portland heroes is that I respect few of the people I know enough to die for them, so I'm hardly keen on dying for a stranger....

Maybe I would die for a child--particularly a child I knew--because I don't have a lot of years left to live anyway (call my thoughts about this a matter of economy, if you will). I would imagine that most people feel "programmed" to protect children without regard to either person's gender. But where the protector is male it's "women and children first." When I reflect upon the behavior of the men on the Titanic, I'm struck by the thought that all of those men who, it would appear, deemed their lives as less valuable than women's nonetheless denied legal, social, and political equality to women....

1 of 1,000s of Jodi's rescues
I heard a black woman on the radio say that the men who died in Portland wouldn't be receiving much praise had they been black. If the children they died protecting had been white, I suppose this same woman would have said they wouldn't have died for black children...

The only difference--within myself--that I can image had the men been black would be that their deaths would have countered my image of black people as criminals based upon the fact that the only black people I see on the local news are athletes and criminals, and even then, the athletes are often on the news because they got in trouble with the law. Because of this image, it's easier for a black person to make a favorable impression on me because I so much want to think well of blacks that I cling to their every act of virtue.

Because I so hate Islam, Peggy asked if I would have been less likely to speak up because one of the girls was wearing a hijab. Although I deplore hijabs (which I see as a sure symbol of gender oppression), the fact that one of the girls was wearing one wasn't the issue. The issue was that they were children who were being abused by a depraved bully. Speculating about what I might have done is an irresistible impossibility because I cannot know. All I can know is that, while I don't want to die for nothing, it doesn't follow that I wouldn't die for anything.

Ever the asshole
In other news... I was so outraged by Donald Trump's boorish behavior in Europe (my opinion of Trump is such that I rather think he would have approved of the behavior of the Portland bully, although he would have been too self-serving to have killed anyone himself), that I wrote to a newspaper in Montenegro. At least I tried to write, first to one newspaper in Montenegro, and then to every newspaper in Montenegro, but not a single email got through. I offer this letter as example of the kind of thing that I often do, and that might even, over the long-term, have more impact than martyrdom. In any event, it makes me feel better to do this kind of thing than to not do it.

"I am a lifelong citizen of the United States, and I live in Eugene, Oregon. I am writing to ask your forgiveness for an incident in which the childish man who represents my nation to the world shoved aside the man who represents your nation to the world. Neither I nor most of the people of my nation voted for Donald Trump, yet his boorish behavior reflects negatively upon us.

"After witnessing the campaign which put Trump into office, combined with the months he has been in office, I have come to understand Donald Trump fairly well—it’s easy to see the bottom of a shallow puddle—but what I don’t understand is why Dusko Markovic didn’t object to Trump shoving him aside as if he were a dead limb on a unwanted shrub. As if that apparent acceptance of his relative unimportance were not bad enough, Markovic added, “It is natural that the president of the United States is in the front row.”

"Sad though it is for the people of my nation to be represented by a brainless narcissist like Donald Trump, is it not also sad for the people of your nation to be represented by a man who fails to speak up when the dignity of his nation has been offended?"