My left knee
Words: Fay Weldon. Photographs: Mike Owen
I have a new knee, eight weeks old as I write. I love it as I would a new baby.
I admire the neat, flexible, new, lightweight nylon, sheer painlessness of it. I even alarm others by asking, ‘Would you like to see my scar?’ so proud am I of the way it has healed. Half of those asked show polite interest; the other half shudder and refuse, expecting some hideous gaping wound, when actually all there is to see is a fine, neat line embroidered with a kind of pink and white crosshatching. The district nurse really admires it:
‘We can always tell Mr Cox’s scars – such neat stitching.’
I marvel at the capacity of my knee to zip itself up so quickly. It reminds me of a film rewinding: start with the wound, rewind to smooth flesh. I conclude I must be in good basic health, and feel I am going to live for ever, though I can see this is highly unlikely.
In other words, I had a good experience. Others tell me that they suffered a great deal more, and I don’t doubt it. Things can go wrong, infection can set in, bones fail to knit and so on. But with quite a few I suspect the problem is as much emotional as physical. A familiar part of the body has gone missing, the self has changed.
I have a friend who fainted away when she had her ears pierced, and that was the loss of a mere pin-hole’s worth of flesh – but to lose a whole knee? Have it chucked in the bin? And then to make matters worse, it’s the addition – a large modern alien object has taken up residence in one’s body, albeit by invitation. It can’t be just ignored. Some even complain of disturbing clicks and rattles emanating in the night from the nylon invader – though mine, I must say, has stayed resolutely silent.
I spent years on the waiting list – mostly my own fault; I underplayed my symptoms and postponed once. The build-up to the operation – they prefer you call it a ‘procedure’, presumably as it sounds less drastic – was far worse than the deed itself. I had to try not to dwell too much on the actual process of replacement. If I did, the operating table of my conjecture began to resemble a carpentry bench, complete with saws, hammers, vices and clamps, and the theatre a charnel house. I did my best to keep the concept verbal rather than visual, to regard the process as something neat, hygienic, bowdlerised, sanitised, and above all silent – no sound of sawing bone – like a childbirth, starting at the first gentle pain, then cutting to mother sitting up in bed, scented and fresh, the newborn smiling in her arms.
Did this moral cowardice help? I think so. At least when I came to the end of the three-to-four-day conveyor belt that is modern orthopaedic surgery, I stepped off it trauma-free. I left reality at the hospital entrance; only came back into it with the first step outside. Much like what happens when you enter an airport; you become a consenting cipher. Join the queue, dump the bags, get through security, ignore the turbulence, eat the food, and there you are safely in Arrivals. In hospital it’s take the pills, drink the water, don’t argue, do the exercises and consent to being you again with your first breath of unconditioned air.
The norm now is the good knee op (80,000 of us a year), not the bad, and those many still putting off the day, limping around because of the pain in the knee, the thigh, yet refusing to call the clinic, are blinding themselves to what medical progress has to offer. Sure an operation is a major life event, but so is moving house. You dread it, think it will be terrible, but what you find when it’s over are new friends, new ideas and a new lease of life.
Contrary to expectation, the shock of change isn’t weakening, it’s reviving. I worried, as we older people tend to, in case my brain ‘went’. But here I am, still meeting deadlines. I resigned myself to being out of action for at least six weeks, but no. I am a churchgoer; I missed just one Sunday service, stood up to receive Communion the next, and at the one after that knelt at the rail before I realised what I was doing. I had worried about pain. I needn’t have. In the hierarchy of pain, as I’ve experienced it over the eight decades of my life – compared with childbirth, gallstone, frozen shoulder or jawbone ulcer – knee replacement is, I promise you, a breeze. There are pills for everything. Today’s painkillers are efficient.
Fear is not so easily treated. It can go underground. Mine did. Only in retrospect do I realise I went to the ‘procedure’ in the expectation of meeting my maker. I practised insouciance, assured everyone I was not worried, was too busy to worry, while finding myself sorting out drawers and papers and getting rid of things I wouldn’t want those who come after me to have to deal with. I checked my will.
An occupational therapist came to check my home was up to scratch, that my furniture measured up (seats for the knee-op survivor need to be at least 16 inches from the ground) and offered me a perching chair so I could clean my vegetables at the kitchen sink in comfort. I was touched at so much solicitation, though it seemed oddly morbid.
Then a week before I am due to go in, they call to say the operation will be delayed. There has been a spate of the old and the vulnerable suffering falls, snapping wrists and ankles like matchsticks: routine procedures must be postponed.
I have been reprieved. My reaction is delight. The death sentence has been lifted. Suddenly I have a future again. I make the most of the four weeks’ grace. I now do the exercises I have been told to do and haven’t, marvel at the speed with which muscles restore themselves after decades of neglect. I determine to finish the novel I am writing, but it doesn’t happen. The words come too slowly. Can it be that I normally write at speed in the expectation of imminent death? I hope not. At any rate I enjoy what I’m writing. I am in a wholly different mood now. I go off to hospital at 7am as if to battle.
Fourteen years ago, in May 1997, I had my right knee replaced. 2011 is to be the left knee. I am struck by how much things have changed. Then you came to hospital the night before for ‘observation’. Now it’s straight to Surgical Admissions and into the theatre within the half hour. Nil-by-mouth for 12 hours before the anaesthetic is now left up to the patient, not the nurses, to enforce.
Otherwise, now, as then, all decision-making is taken away. Clothes are put in one plastic bag, jewellery and valuables listed and put in another. Now, as then, it’s just between the naked patient and the NHS. But now the ride on the conveyor belt is, for the patient, smooth, fast and seamless, not cranky, slow and bumpy. The nurses are, with very few exceptions, thoughtful, attentive and kind. Then you lay in bed with a morphine drip for a couple of weeks before being thrown out. Now you are given pills and injections to keep you comfortable and eased out firmly and politely after only three or four days into a previously checked-out environment. The new left knee is a hi-tech lightweight, long-lasting model; the old right knee is titanium, heavy, failing and, what is more, now obsolete technology. If you need one of these old ones repaired, spare parts have to be found and fitted, as for some old jalopy.
In 1997 I was given a heavy, old-fashioned anaesthetic that knocked me out for four hours. Now I have an epidural (no feeling beneath the waist until tomorrow), backed up with a light anaesthetic and am out of the theatre within two hours. Epidural needles these days are more or less fail-safe. The anaesthetist looked like a schoolboy but his touch was reassuringly competent as he searched for the spot. A prick in the small of the back and then I am in the recovery room and a nurse is telling me who and where I am. No pain, just a neat, slim dressing down my knee. A sort of outboard motor is clipped to my bed and drives it to the ward, which is new, spacious and light, with a picture-window vista of green fields and the timeless spire of Salisbury cathedral.
Back then you had a blood transfusion: now you have a drip that contains your own blood, saved during the operation, filtered, and fed back to you, and with it your strength. This is the only time the extraordinarily major aspect of what has just happened rises to awe and alarm you. If they’d put the blood in an opaque bag and not a transparent one, you wouldn’t even realise you’d actually lost blood. Back then you had only to look at your swollen tree trunk of a leg to see what a battering it had received. Now there’s just this smooth, normal-looking leg with its neat crosshatching. It’s true that the tramadol (synthetic morphine) made me see the odd busy beetle, which the nurse assured me did not exist, on the bedstead. But in 1997 I was telling visitors that Mrs Thatcher had come to tea. The insects were small beer in comparison.
Back then you could claim age and infirmity and could beg to rest, and they allowed you to. Now the passage of years is seen as no excuse for idleness. It’s not that the old are persecuted for being old, just that they are not allowed to wallow in the state. Back then hospital food was horrible, strange grey stuff, one dish much like another. But now it is rather good. Pork crackling and apple sauce for supper on the third day was memorably delicious.
Perhaps I was just really hungry after all the exercise. Because what there is now in 2011, which wasn’t there in 1997, is exercise: physiotherapists – a team of bright-eyed, eager young persons, who bounce into the ward at nine every morning, and work on you until the heels that could not be raised are raised, the knees that would not bend, bend, and have you walking first in a Zimmer frame for one day, then on two crutches, and get you out of the building under your own steam in just four days.
I leave hospital, as after a conference, with a goody bag full, not of soaps and scents, but of pills, wound dressings and admonitory leaflets. I am weaker than I thought. I am exhausted. I need painkillers at night, if not the day, and still will for another week. I manage a shower. I get to the hairdresser. I get back to work. I am back to normal – almost – though I sleep a lot. And I have a brand new knee. Would you like to see my scar? No? Oh. Pity.
This article can be found in the October issue of Saga Magazine.
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