Knee Replacements
By Gene Aronowitz
“I can’t believe you’re not screaming,” he said, twisting my right leg and then my left with escalating compression.
” He looked up at me. “You might need to have your knees replaced sometime, but not right now.”
“Why not,” I replied.
“Because it doesn’t hurt enough.”
That makes no sense, I thought, looked at him, and said, “I don’t understand.”
“There are still some things we can try that are not so invasive and we should give them a chance to work.”
“But I don’t like the way I feel.”
“I know, but you can still get around without much difficulty. When you can’t, that’s the time for a major operation like this one, which, by the way, doesn’t always turn out perfectly.”
I shrugged my shoulders, then nodded, and closed my eyes as the orthopedist gave me the third in a series of steroid injections.
As I was leaving, he said “Keep on doing whatever you’re doing.”
What I was doing was consuming twelve different anti-inflammatory supplements every day. I was also keeping the pressure off of my knees and away from the muscles around my knees, skills I learned during my involvement with the Alexander Technique. For example, I would lift myself out of chairs by pushing up with my arms until almost erect and then pushing out to complete the process.
It was true that I was not in pain, but life was a continuous struggle, a seemingly endless series of skirmishes.
I was living in Brooklyn and working at an agency two subway rides away. Each workday, I walked a half block down a steep hill to the subway station and then two flights down to the platform. Walking down can often be more difficult than walking up. I always had to stand while waiting for trains to arrive and, once on the train, rarely got a seat. Having bad knees is a disability, but an invisible one, so I was never offered a seat. It was difficult to balance myself because of the sway of the trains speeding from station to station. En route, the trains would start and stop unexpectedly, lurching me forward and back. As passengers entered the train and jostled for position, bodily collisions were frequent, and elbows did their best to move me forcefully out of the way. When I reached Manhattan, I had to climb two flights of steps from the subway platform and then walk almost six blocks to where I worked. There, I had to climb an elongated stairway to get to my office on the second floor, a stairway I had to use several times a day to get to the bathroom or to our conference room or to get some lunch. At the end of the day, again at rush hour, the commute would repeat itself in reverse, down the steps, a ten-minute walk to the subway, two flights down to the platform, two trains to Brooklyn, two flights up to street level, and then the climb up a very steep hill to my house, which was three stories high plus a cellar. My home office was on the third floor
The area surrounding my knees was frequently throbbing but not painful enough to convince my orthopedist that I needed new knees. However, my lifestyle was distressing. I never exercised and felt flabby. Standing for extended lengths of time was fatiguing and sitting for extended lengths of time was stiffening so when I got up, I walked like the Frankenstein monster. I had begun climbing and descending all the steps like a toddler – one step at a time. I looked and felt like a very old man.I have to put an end to all this, I thought. I just don’t want to live like this anymore.
Changes were necessary. My job was OK but getting to it wasn’t, so I gave a month’s notice and left. I contacted a highly recommended surgeon at the Hospital for Special Surgery in New York City to discuss a knee replacement. Because of my age – 77 at the time – I couldn’t have both knees replaced simultaneously, so I agreed, reluctantly, to have them done sequentially, a process that would consume six months out of whatever time I had remaining. This operation for the replacement of my right knee was scheduled for August 25th, 2015
About a month before that date, X-rays were taken. As I looked at the radiograph, my legs were a pair of parentheses, only the bones displayed, without all the muscles, fat, and skin surrounding them.
On the day of the operation, my wife and I were escorted to the presurgical holding area, where I was provided a revealing hospital gown and where I met my surgeon for only the second time. He marked my right knee so there would be no chance of removing the left one. He told me I was in good hands, and I believed him.
I don’t remember the operation itself except for being wheeled in and looking up at the masked face of the anesthesiologist looking down. He told me to start counting and, as I counted, my mind briefly reviewed my health proxy and living will. Preparing these documents in a lawyer’s office was fairly perfunctory but wondering if the anesthesiologist’s eyes, mask, and voice would be my final memory was very scary.
After spending a little time in the recovery room, I was conveyed, as if a package, to an inpatient unit. I was immediately given a plastic object that resembled a snorkel, designed to rid my airway and lung passages of mucus. The task was to inhale through the mouthpiece in order to push a ball up the vertical tube to the top. I felt as if I was in competition with all the other patients. Perhaps, I thought, there’s a hospital record to be broken. I worked at it until I could propel the ball to the top effortlessly and demonstrated my prowess for every nurse that entered my room.
Soon, a physical therapist came by, got me out of bed, fitted a walker to my height, and got me going. By the next day, I was practicing step climbing. On the third day, I was discharged, first given a prescription for OxyContin, a strong pain-killing drug that contained an opioid. In retrospect, the hospital seemed pretty cavalier about my use of this drug. They told me to call them before I ran out and they would send me another prescription. That was four years before the opioid crisis hit the United States and, at the time, I did not recognize the dangers involved. I used the drug frequently whenever I anticipated pain and since I had two knee operations, my convalescence and consequent drug use extended over a period of six months. I’ve often thought that I could have had a serious drug addiction or, worse, be reduced to a dot on some epidemiologist’s overdose fatality graph like hundreds of thousands of others.
A few days after arriving home from the hospital, nurses and physical therapists started showing up and rehabilitation began in earnest. I walked as much as I could to Marine Corps drill instructor cadence calls, reminiscent of my time in the Marines. These recordings provided motivation to keep moving as well as a regular rhythm that discouraged sauntering.
When I was able to walk well enough, I was referred to an outpatient physical therapy center. I didn’t need a cane, but I carried one to help me get a seat on the bus. After one particularly painful session, I called a friend and said, “My therapist had me on my stomach with my knees bent and pushed my legs down toward my back. It hurt like hell and I couldn’t stop screaming.”
“Yeah, scream all you want but it’s good for you.”
“Doesn’t it ever stop hurting?”
“Not until you stop physical therapy. It’s like when I had my baby. It didn’t hurt so much in retrospect. You know what P.T. stands for?”
“No what?”
“Pain and torture. That’s what it stands for. Pain and torture. Get used to it.”
I laughed and, ultimately, came to understand how necessary it was. It did the job.
Throughout that period, I needed to ice my knee frequently and did so while lying on our sofa watching videos, particularly The West Wing. I had already seen all seven seasons (156 episodes) twice and, as I iced, I watched all seven seasons twice more.
Many people are afraid to have their knees replaced one at a time because they think the first will be so painful that they won’t want to do the second one. But I felt terrific and was anxious to get the left knee done as soon as possible. The second operation took place about three months after the first. That process mirrored the earlier operation but was easier because I knew the routine. When I had my physical, the hospital internist told me, with a smile on her face, that my BMI (Body Mass Index) was now normal, not because I had lost any weight, but because I was now taller, my right leg now straightened out. While icing my knees for the second time around, I watched all seven seasons of the West Wing twice more, bringing my total to six, or almost a thousand episodes. I love that show and continue to watch it.
The replacements were life-changers; I walk effortlessly and painlessly. I did not resume running; I think long-distance running is what caused me all that aggravation. They say that, on average, new knees should last ten to fifteen years. If I outlive mine, I won’t hesitate a minute before I arrange for new ones, pain or no pain.
