Tuesday, 8 July 2008

"House bound" reflections approaching the 2nd stage

In 48 hours time, all being well, I will be wheeled into the operating theatre after having an epidural inserted and some muscle relaxant and sleep inducing substance squirted through a cannula in my arm. I will have been asked to count down from 10 and probably have reached 6 before being unable to continue.

The next thing I should be aware of is waking up - probably in the recovery room or the new Post Operative Surgical Unit (POSU) I described in an earlier posting - after the surgery.

In between I would have been given regular whiffs of general anaesthetic to stop me from being aware of the process of:
  • "unzipping" the scar from previous operations,
  • "knocking out" (probably literally) the cement and metal rod that have been the nearest I could get to having a functioning right hip for the last few months before
  • replacing it with a shiny new prosthesis that will be fixed and aligned to ensure somewhere near an optimum functioning of the knee , associate tendons and muscles that have been strained in recent months, before
  • "zipping me up again by closing the incision needed to gain access to most of my right thigh.
Anyway I hope the operation does not hold too many surprises for the surgeons and that the anaesthetist remembers to keep checking on my level of consciousness, as well as all the other things (s)he has to attend to, as I would not want to have any awareness of the hammering that will be taking place. I was aware a couple of times during the first stage operation of metallic echoing hammering sounds while sensing that I was moving up the table. Apparently I began "flailing about" so I think I managed to find a way of communicating my slightly aroused level of awareness to all around me!

So with that approaching it is perhaps not surprising that I have been reflecting on recent experiences of being a one hip wonder and a housebound husband.

I recall, from a visit to the Viking Museum in Largs, that the derivation of the term husband was from the term "house bound". It seems the shortage of coastal farming land in Norway in particular caused the Vikings there to need to accumulate wealth by sea faring and pillaging. While the eldest sons would inherit the limited farm land the younger ones had to accumulate wealth in this way to have the dowry to get married. Once married they neither had the need or inclination to travel away from the family home so were described as being "house bound" and therefore no longer available for selection for the next away leg in the European competition they then seemed to compete in most successfully. A similar fate seems to await recently married (30+ year old) men these days. They too are no longer being available for selection - for the pub soccer team team instead of the cross channel rowing running and wrestling that seems to have been required of the Viking precursors of today's "iron man" competitors.

Unsurprisingly I have both positive and negative thoughts approaching the next stage.

As political commentators know negatives always tend to outweigh the positives - so I shall start with the 5 things I will be most glad to see the back of (assuming all turns out as expected):

"In no particular order":

  1. The absence of spontaneity: Every movement, particularly if it involves carrying anything from one place to another, has to be planned in stages like a carefully managed project. In fact to follow the analogy further a successful outcome even requires mid stage reviews as well as a careful scoping of what is and is not possible.

    For example to wash in the morning means:
    (1) manoeuvre power chair through bathroom door ( preferably opened first!)
    (1a) Optional enabling measure - if bathroom mat is on floor carefully reach forward without tipping out of chair and place over side of bath to avoid snagging up in the rear wheels of chair
    (2) Continue straight ahead toward WC far enough to reach behind to close bathroom door behind the chair - twisting sufficiently to avoid dislocating right shoulder.
    (3) Carefully reverse into the space alongside sink - making sure sink is on the left side to avoid stretching across temporarily misaligned right leg.
    (4) Reach right to remove flannel and bath towel from heated towel rail.
    (5) Place towel folded in half across knees with open end facing away thus allowing it to be unrolled upwards to dry upper body when washed.
    (6) Half fill sink with hot water and begin washing with soapy flannel rinsing when necessary.
    (7) Use wet flannel to damp hair and then reach into cupboard above sink for brush to arrange remaining hair in an acceptable manner - i.e. away from balding front of head in a sweeping back fashion thus accentuating the few remaining dark streaks among the mostly white and few grey strands.
    (8) Replace brush and reach into cupboard for electric shaver (ignoring safety razor lather and brush that used to be the preferred method of shaving somehow inextricably associated with standing up!)
    (9) Apply pre electric shaving cream from supply at back of razor head, plunge razor into sink (its a wet electric shaver after all so why not?) and shave. On completion open razor head and clean in used water then place in razor stand in cupboard and close door.
    (10) Watch with some satisfaction as the mornings stubble arranges itself like magnetised iron filings in a pleasing pattern as the water drains away while the stubble remains on the inside of the sink.
    (11) Rinse sink with cold water , rinse out flannel and return along with bath towel to heated towel rail.
    (12) Manoeuvre chair forward sufficiently to be able to reach behind to open bathroom door.
    (13) Open bathroom door fully so as to be able to reverse out of bathroom safely.
    (14) Reverse out of bathroom taking care not to scratch door or door post on way out particularly if tempted to turn chair around while reversing - always a risky thing to do and a little like a F1 car attempting to overtake at a chicane ( I say only a little because of the relative speeds involved - OK its nothing like a F1 car overtaking but there is still the problem of losing control and driving through the obstacles instead of around them!)
    (15) Start planning the "getting dressed" project!

    Its even more complicated if attempting to travel somewhere as this involves transfers from chair, use of crutches, perhaps use of previously fetched mobility scooter, transfer into car and relying on someone else (usually long suffering wife) to fetch and carry bags etc or dismantle mobility scooter to fit into car boot.

  2. Being a burden to others: I know this is unavoidable but that knowledge does not make it any the less difficult to bear.

  3. Bio mechanical pains around the knee : The temporary realignment of my right leg means that I am unable to straighten it. From the hip the best I seem to be able to manage is about 20 degrees from straight. This means that my knee tends to be rotated to allow my lower leg to bend in toward whenever my right foot rests near to the left foot. I think this causes a different load to pass through the knee cap and tendons around the knee to what nature intended.

  4. Static discharge: The rubber tyres of the power chair can generate static electricity - especially across the floor of the kitchen and utility room if I travel at any speed. I am usually unaware of this until I touch something metallic or get near to an earthed electricity switch. Then I am reminded with the shock of the discharge. What I have been surprised by is the ability to use this method to detect moisture levels in everyday things. For example the used tea bags in contact with the edge of the stainless steel sink can cause a nasty shock if I have been whizzing around making tea with trips to the fridge, kettle, sink, cupboards etc. The one consolation is that when I forget about the static build up and touch or sometime kiss my wife I can honestly say that even after nearly 35 years of marriage sparks still fly between us!

  5. Limited Horizons :I have previously referred to the "expanding archipelago" of my existence but even after being able to get out and about when someone else drives my horizons have remained limited.

    We stretched them last week however when I attended a research panel meeting at the Royal College of Surgeons (in my capacity as 1 of 3 lay members) and stayed overnight around London first in a Travelodge and then in my son and wife's flat. This was followed by a few days in a holiday cottage in Norfolk. Although I was able to join in with these events I was well outside the comfort zone that I had established at home. These were days almost totally reliant on the use of crutches and therefore a lot of my time spent staying in chairs (as distinct from "staining chairs" - which my wife once accurately reported over the phone to my daughter, that I was managing to accomplish, to which she replied "but he's always staying in chairs"! )
... And now the 6 things I am most looking forward to:

  1. Walking with or without the aid of a stick: My realistic goal by the end of the year is to be able to walk short distances with or without using a walking stick. I have not used muscles in my right leg for over a year and have had some of the muscle removed because of the infection. I do not expect to be running marathons but would like slowly to progress to using the static bicycle and multigym in the converted garage that also houses a half size slate snooker table that I would like to get back to using.

    In addition I want to be able to climb the stairs leading up to the converted loft space where the ceiling mounted projector allows me to watch sport projected onto a blank end wall of the house. The same equipment doubles up for using the nintendo wii for golf and other sport simulations which I have been unable to take advantage of for a year now, along with the wii platform bought a few months back to entertain visitors who might want to simulate skiing downhill. I can't wait to use the wii platform for fitness and Yoga exercises - my son coined the phrase "wiihab" for this, which I think we should probably patent along with a series of programs that exploit the platform's use for gentle rehabilitation. ( note to self: have a word with the community physiotherapist to see if she can advise!)

  2. Getting the vote again! By this I mean by virtue of being able to do things I will no longer be totally dependent on others and will therefore be able to exercise the right to "vote with my feet" and do my own thing if I wanted.

    On the recent weekend break I accompanied everyone else around parts of Norfolk but tended to stay in the front car seat - it was too much of a task to continually get out and about then transfer back in when only using crutches. The mobility scooter was packed but remained in the car back at the cottage and not in the car we shared to travel around. I now know what elderly relatives must feel like on similar outings. Don't get me wrong I am grateful for being included in the plans but felt I had no right to contribute to discussions about what to do next - after all I could not do much - hence I had no vote.

  3. Returning to Voluntary Work Although I continue to manage the Sheffield Talking News web site from home I have not been able to attend the regular readings and therefore stopped being involved as an occasional reader, recording technician and editor. I have also been unable to contribute to the planning of services for older people in Sheffield (POPPS) as an "expert elder" to which I was very much committed until a year ago.

    Although I did manage to undertake a thematic analysis for the local PCT of comments on their proposed strategy and continue to try to resurrect its Clinical Audit Patient Panel , I have not regretted being a little more distant from the frustrations of local NHS management. After all despite protestations to the contrary neither the Acute Foundation Trust (of which I was a Patient Governor) nor the PCT are truly ready to listen to and respond to local expressions of what is wanted - especially when it is at variance with national attempts to steer local decisions. ("What do you mean you don't really want choice and you just want easy access to someone providing continuity of care? You've got it wrong - choice is good for you! So we'll provide you with what you really want but don't know it yet - lots of different ways of getting semi qualified practitioners to practice on you and if you are lucky some might travel all the way from Eastern Europe for the privilege!")

    My continuing membership of a national panel that prioritises NHS funded pharmaceutical research is a different matter and was worth the effort of attending 2 meetings in the last 4 months. I think its because its members are sure enough of their own abilities that they do not feel threatened by the views of lay members and are therefore prepared to listen respond and on occasions even be swayed by them.

    So I will get back to attending the Citizenship & Involvement Group of the local Healthy Cities Partnership but probably avoid the newly established LINks body that replaces CHC and Patient Forums (until such time as the democratic deficit in local health management is addressed and corrected.)

  4. Helping around the house and garden I will have no excuse and a lot of catching up to do. My wife has had to do everything while I could only watch, sometimes advise and support and occasionally help (the mobility scooter doubling up as a garden truck to fetch and carry implements, plants and weeds to and fro).

    During the course of the last 18 months or so we did manage to redesign the layout of an area of garden and to install a slate water feature. This required trips to organise purchase and delivery but also needed some preparatory electrical work first. I knew what I wanted to do but could not do it. So I bought the parts and found a local electrician prepared to carry out what I wanted to do. Then we needed to wait for our gardeners to find both time and men to manhandle the slate obelisk into place - it took 6 men in the end. The whole process took a lot longer than otherwise needed and I did not get to see the pleasing effect until some time after it had been completed during a brief window of mobility following a change in antibiotics but before the first stage operation.

  5. Some overseas travel The seven years from the right hip being diagnosed as needing to be replaced to hopefully a successful replacement with no infection has been full of cancelled trips (to Iceland and the Arctic to see the annular Solar eclipse, to Sydney for an IT conference and visit with my son who was working there at the time, to Sienna to join some Australian friends on tour and to exchange cricket memorabilia following the successful Ashes test series the year before for example)

    We did manage some trips together to Germany to stay with friends and to Rhodes last year (although the infection was taking hold with a vengeance then but we did not know it) My wife managed some trips abroad to exciting places with my daughter but we feel we have not had as eventful a holiday together as we used to. We have had good times in Northumberland in recent years but always armed with a suit case full of dressings that needed to be changed daily to keep the infection under some sort of control.

    So with luck next year we might be able to enjoy a rail journey to Moscow via Warsaw and then a 10 day river cruise to St Petersburg before a flight back to London. I doubt I will be able to see much of the Hermitage ( but then again who does - its so huge apparently). Both the rail and boat trips will allow me to travel without having to be too energetic so if it comes off it will be a transitional type of holiday before we become a little more independent in future.

  6. Woodturning hopefully moving on from one legged bowls to some more adventurous turning. I might even take up DJ's suggestion of selling some from a web site.
All being well after the operation I shall return in an even more contemplative mood and will in time add some postscripts which should fill in the "back story" of the last 7 years. I will however aim for those postings to be briefer than this one has been.

In conclusion therefore .... fingers crossed, wish me luck and .... TTFN

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