Connected to the Hip Bone
A aging boomer’s quest to repair the wear and tear
Ibegan running in the 1970s (“jogging,” we called it then), while touring the play Billy Bishop Goes to War, to counterbalance after-hours dissipation. I ran in London, Edinburgh, New York, Los Angeles, and Washington, DC. I ran in Denver, where there is hardly any oxygen. In Glasgow, I ran with increased speed past tenement yobs with razors in their boots. In Cologne, I ran for two hours, white with fatigue, searching for a street called Einbahnstrasse, which I later learned means “one-way street.” In Regina, I ran with a toque pulled down over my entire head, to avoid freezing my lungs.
And it did me good. I didn’t turn into a dirigible, despite the celebratory excess, and along the way I collected an album of mental snapshots, stamped on the brain with every step—the pounding rhythm of running as slide show.
Of course, as you get older you gain a more nuanced view of cause and effect: specifically, that it has little to do with the will. Yes, the things you always thought bad for you really were bad for you; but a lot of things you thought good for you were also bad for you. You fell prey to one of Donald Rumsfeld’s “unknown unknowns.”
In my case, the light dawned in the spring of 2002. Heading out on my usual five-mile run, I felt a pain in the rump I did not recognize, not muscular but down deep. Like an idiot, I tried to “run it out” and did more damage. I self-medicated with ibuprofen and nearly froze my hip solid with applications of ice, but only when I quit running and took up cycling and yoga did the pain gradually go away. Six months later, it was back—same pain, same place. I only managed to defeat the pain for a couple of months this time, and when it returned, like a dreaded relative, it stayed for good.
Chronic pain is a bore, in more ways than one. Like the social bore, it keeps showing up, poking a pressure point with a horny forefinger, or like the handshake buzzer out of a comic book, delivering unpredictable jolts of what my grandfather called a “lifter”—pain that nearly lifts you to the ceiling. Chronic pain is also boring in that it drills into you. You never get used to it. Rather, the more you get used to it, the less tolerable it becomes. It’s like Air Canada that way.
My forebears would have simply gritted their teeth and put up with it, but at what price? Was my nasty uncle really such a jerk, or was he in pain? And what about that eccentric aunt? Because pain makes you weird, too. After months of hobbling, I started referring to mine as Arthur. I would lurch about the house cursing Arthur aloud, like Jimmy Stewart in that movie about the invisible rabbit.
A grey-haired child of the ’60s, I tried to wax philosophical. For example, pain tells you that you’re alive and not dead. (Any war vet will tell you that the worst wounds are the ones you don’t feel.) And pain means there are blessed moments of relief, when you exclaim, What a lovely thing—I’m not in pain!
But these transcendental tricks were no match for Arthur. Friends told me I was starting to walk like an old man. I got snippy in return, but the fact is I moved less. Facing an errand, I counted the steps. Is it worth getting out of this chair to fetch the newspaper? Hours later, the newspaper would be by the door, and I would be sunk in my chair, still as a toad. When an old acquaintance informed me that in the year before his hip surgery his hair had turned white, I decided an X-ray might be in order.
My GP agreed, though she said it was probably soft tissue, and that a shot of something would do the trick. Within days, a discreet technician was arranging me this way and that on a long table before ducking into a booth to avoid the radiation.
“My goodness,” my GP exclaimed at the result, clinically amused. “You don’t seem to have much hip left.”
Enter Dr. Nelson Greidanus: an award-winning orthopaedic surgeon at Vancouver General Hospital; forty-something, with reddish hair, a stocky torso, and watchful eyes that remind me, in a good way, of Ricky Gervais; reported to go “out on a limb” for his patients.
So far, Greidanus didn’t know me, but I knew him. In fact, I’d accumulated a dossier on the man. The Internet abounds with intelligence, from official biographies with promotional glossies to patient reviews (i.e., ratemymd.ca, doctorscorecard.com)—rough instruments, sure, but they’re a way around the tyranny of professional associations dedicated to the illusion that talent doesn’t matter.
Having cast Greidanus as my man, I set about networking with the enthusiasm of an Avon lady. In Canada, where the degrees of separation are closer to two than six, access to the best health care isn’t so much a function of money but rather who you know, and who they know. So I tapped every medical professional who might have a lead, every school chum and golf partner, my son’s friend’s father, someone in my wife’s running group; I was a proboscis, snouting for influence. And it worked. Soon I found someone who knew the specialist who routinely refers to Greidanus. But even so, the egalitarian aspect of the Canadian system held, for I would have to wait my turn.
It was three miserable months before I sat in the sunny atrium outside Greidanus’s office, and several hours more before I was called in. When he finally whisked into the room, he glanced at my X-ray, let out a kind of snort, and ordered me to walk up and down the hall. I was prepped to tell him my story, but he didn’t care; it didn’t matter now. “You need a new hip,” he announced, then opened a drawer and brought out my options: three metal doorknobs of various sizes, plus one metal mushroom.
In the case of a total hip replacement, he intended to saw off my femur at the head and replace it with a doorknob that would fit into a socket implanted in my pelvis. For hip resurfacing, he would shave the head (“like a sno-cone”) and cap it with a metal mushroom fitted to the socket. In both cases, bone would grow into the implants, making them, effectively, me.
The differences between replacement and resurfacing have to do with range of motion. For most patients, Greidanus explained, the standard, golf ball–sized doorknob would be perfectly adequate. I told him I do yoga, and demonstrated the lotus position; he admitted that with a “total” there would be no more of that. But it was up to me, he emphasized, which I took to mean that the situation called for yet another Internet search.
Hip replacements, it turns out, have been around since the nineteenth century, involving such materials as ivory, glass, plastic, ceramic, steel, chromium, Teflon, titanium, and mysterious alloys meant for outer space. The challenge has always been minimizing friction. In the procedure Greidanus was recommending, a polyethylene socket liner guards against bits of metal grinding their way into my bloodstream. However, in order to fit into the hip the ball itself has to be quite small. And plastic, too, can wear out, necessitating a second operation sometimes called “changing a tire.” Space-age alloys, which up until very recently were assumed to make it safe to dispense with the liner, allow for a bigger doorknob and greater range of motion.
Hip resurfacing, which has been around for about eighteen years, involves less bone and blood loss and offers complete range of motion, amounting to a “superior quality of life,” according to a report co-authored by Greidanus himself. Plus, if the thing failed later on I could still go for a total. If I had a total and it wore out, I’d have less to work with the second time around.
At a cost of around $14,000 for a total and more for resurfacing, there were some 30,000 hip replacements in Canada in 2007; and the market is growing, thanks to the generational bubble that claimed the word “hippie.” (In roughly the same amount of time that has passed since the first hip was resurfaced, roughly one in three Canadians will be over fifty-five.) Medicare has taken the accountant’s way out of this predicament, so with few exceptions only the total involving the small doorknob is fully covered, starting at age fifty-five, and whether the patient is a morbidly obese diabetic or a fifty-six-year-old Ironman doesn’t seem to come into it. At sixty-two, a hip resurfacing would set me back $3,780, of which Greidanus probably wouldn’t get a cent for the additional skills involved.
The way I see it, even if the cost of repairing all these degenerating hips were to increase with better prostheses, given that a coronary bypass can set the taxpayer back $23,000 it seems a good investment to keep the codgers up and running as long as possible. And if such reckoning is beyond policy-makers, they might consider the following: a friend of mine, sixty-three years old, had his hip resurfaced at the Asian Regional Center for Hip Resurfacing in Chennai, on the Bay of Bengal, for $8,000, including rehab, and it went well. In other words, medicare would save far more money by chartering planes and flying the boomers to India.
Iarrived in Admitting at 6:30 on the morning of my hip resurfacing, feeling fragile. In the first fifteen minutes, my driver’s licence was checked twice, once at the front desk, and again by a nurse who would not have looked out of place at a United Church square dance. After leading me to a cubicle, she gave me a bag for my clothes, told me to change into hospital gear, and left.
By the time she returned, I had transformed into Mr. Patient, one smock tied in back and another in front, to protect my bare bum. She clicked a plastic bracelet around my wrist and stuck an IV needle into my arm, connecting it to a plastic bag dangling from a chrome pole with splayed toes that reminded me of a stork.
Dressed in green scrubs, Greidanus burst into the room with the focused intensity of a star hockey forward. His first item of business was to make sure I’d paid my extra fees. “A couple of guys stiffed us,” he explained. “The bureaucrats tried to murder me.” Before leaving, seconds later, he took out a marker and actually scrawled his autograph on my right hip. “Just so we get the right one,” he said with a wink.
My nurse, who had transformed into my mother, helped me to my feet, and together we wheeled my stork down the hall to the OR, a brightly lit room twice the size of a country kitchen, with a padded table in the centre and wall-to-wall stainless countertops arrayed with what looked to be a set of tools from Lee Valley.
Mats, my anaesthetist, introduced himself with Nordic good humour and injected something into my IV that made me anybody’s baby. Then he stuck a needle into my spine (which hurt, but I didn’t care), and erected a cloth screen so I couldn’t see what was going on below my chest. Beyond the partition, I didn’t exist.
At a midpoint between waking and dreaming, I listened to the muttered comments, the clink of instruments, the moist swish of God-knows-what, and I nearly wept with gratitude. All these skilled people paying attention to me, with no objective but to make me better! Whatever management has done to the art of medicine, if you do not experience regard for the human race when you’re on the table, you never will.
The metallic clank of hammer on chisel, the kind of hard whack you’d administer to crack a block of ice, shattered my euphoria. Thanks to Mats’s nuanced ministrations, I could check out at will:
I arrive at the room where souls wait while their bodies are having operations. I pass the triple bypasses and various ectomies, waiting to find out what’s left. I pass the innocents: disaster victims, genetic malfunctions, babies with holes in their hearts. Finally, I join the majority: liposuction thighs, cigarette lungs, whisky livers, joint transplants—the wear-and-tear crowd, the guys and gals who did it to ourselves…
I opened my eyes to behold Mats’s avuncular smile.
“That’s it? ”
“That’s it,” he said.
“How long did it take? ”
“An hour and ten minutes.”
He added that it went smoothly, no loss of blood. While I found it difficult to envisage having one’s right buttock sliced open without blood loss, I was in no position to question good news.
I waved to Greidanus as they wheeled me away, and he waved back, somewhat absently. He had another seven joints to go.
“Thank you, everyone!” I called out.
“You’re welcome!” replied a few voices, in semi-unison.
When next I opened my eyes, I was parked in a stall with walls of green cloth, and two young women were tickling my feet. It’s been said there are certain Middle Eastern sects whose adherents believe that Heaven contains seventy-two virgins at a man’s service, and suddenly I saw the catch. When you enter this celestial harem, your body no longer exists. As with the Christian version, with its harps and wings, this heaven might just as well be hell.
“Can you feel this? ” asked one radiant young woman, having tickled her way up my left calf.
“Or this? ” added the other, infuriatingly pretty, working on my other leg.
“No on both counts,” I replied. “You might as well tickle the wall.”
Two athletic young men then wheeled me to into an empty double room, where a nurse handed me a small device with a button she told me to push when I needed more morphine. “Fine for now, thanks,” I replied groggily, and lapsed into a black hole.
Hours or minutes later, I awoke with my finger already pressing the button, my leg swollen and throbbing as if it had been pounded with a meat tenderizer. A nurse built like a Russian tennis player came to pour cold water into my parched mouth and, Houdini-like, replace my sweat-soaked smock. Fully awake now, I surveyed the room in horror: industrial furniture, fluorescent lighting, and directly opposite, a message board on which some visitor had scribbled, “No Whining!” beside a doodle of a girl in a bikini and, below that, “We Love You, Grandpa!” It was like an episode of The Prisoner; someone had set out to dislodge my reality base.
Take the pee bottle, an opaque purple, ergonomically—meaning counterintuitively—shaped contraption designed by Henry Moore. Being of Presbyterian descent, there was no way in the universe I was about to take instruction on its use from one of the nurses. So whenever I peed it was constant anguish, not knowing exactly where the pee was going, or when the bottle was about to overflow.
And while I’d never harboured illusions about the quality of hospital cuisine, still it came as a shock to see just how bad it can get (again, a bit like Air Canada). Dinner reminded me of winter in Nova Scotia circa 1952, when the meat was grey-brown and the vegetables grey-green, and constipation was not a complaint but a lifestyle. The next morning, a gentle South Asian nurse asked me if I wanted to move my bowels. “Hardly,” I replied. “The Globe and Mail would have provided more fibre.”
Meanwhile, my blood pudding leg had begun to throb just above the knee, nowhere near the site of Greidanus’s handiwork. Nobody seemed to have an explanation, except to note that they had seen worse. So I pushed the morphine button again—a winner for pain, but at the price of macabre dream creatures I could have done without, like the child committing hara-kiri with a saw.
Somewhere around the thirty-hour mark, I awoke to a chipper Englishwoman ordering me to get up. With surrealistic efficiency, she levered me onto my feet, pushed a walker before me, and instructed me to make it to the door. Like an obedient zombie, I lurched the ten paces there and back, heaven knows how, while a plummy voice in my ear whispered that I was doing “fine, just fine!” Perhaps, but I later surfaced from the abyss with pain that redefined the pain scale. More morphine. More Poe dreams involving bones and teeth.
Jim, my new roommate, arrived fresh off a knee replacement (even more in demand than hips, I understand) the next afternoon. The privacy curtain was immediately drawn, and anyway neither of us was up for a chat. Even so, I’m sorry I didn’t warn him about the portable urinal. Some sort of explosion took place behind the privacy curtain that required four orderlies to clean up.
In due course, Jim and I tacitly designed a conversation we would repeat until one of us was gone:
“How’s it going? ”
“Not too bad. How’s it with you? ”
“Oh, pretty fair.”
The bonds of shared experience don’t apply in hospital. Patients learn things about each other that, lacking a previous intimacy, are best forgotten. Soon we would leave this place, and that knowledge would, by mutual agreement, cease to exist.
Still, it happened much sooner than expected. Just three days after a skilled young man cut through inches of fat and muscle and reconfigured one of the largest joints in my body, one last young woman was instructing me on various at-home precautions (no leg crossing, no leg bending beyond ninety degrees) and demonstrating sock reachers and the proper way to sit on the toilet, all in a tone reminiscent of Writers and Company host Eleanor Wachtel—a quality the poet Milton Acorn once described as “vicious sincerity.”
Dressed in street clothes, a pamphlet of rehab exercises in my pocket, I was then wheeled down the hall into an elevator, down another hall, and out a set of whooshing double doors. I have been through car washes that felt less rushed.
Back home it was, as expected, a rough week. My leg throbbed damnably without the hospital’s potent painkillers. Lifting the limb was out of the question, unless it was to perform the compulsory exercises—most unpleasant. I slept, if that’s the word, in the guest room on the main floor; as with any guest, other floors were effectively out of bounds. My loyal mate emptied my pee bottle (a wine carafe works perfectly well) and changed my sweat-soaked sheets, and I found out what it’s like to be at the helpless end of old age.
In a remarkably short time, however, I graduated from walker to crutches to cane, and though it hurt like hell it didn’t hurt in the same way. The part of my brain that had dealt with chronic pain was free for other tasks, and as this became more apparent I experienced a strange, childlike euphoria, like taking off a pair of too-tight skates or getting out of jail (I have done both).
Two months later, I could walk for an hour without pain or cane. My long-term task—according to my physiotherapist, a Hemingwayesque personality who has had metal hips for decades—is to awaken perfectly good muscles, atrophied from years of neglect, old habits, and abuse. A metaphor for medicare, perhaps.
People tell me I look younger. I tend to agree.