Three days after we got back from Barbados I drove Rosamond down to Lennox Hill Hospital early in the morning. Soon she was being prepped, and an anesthetic dripped into her arm. When she was unconscious, Ken, her surgeon (and as it happened the best friend of her son, David, since high school) used his scalpel to make a five inch incision deep into the upper part of her left thigh. He then went in and sawed off the top of her femur. You may have heard that doctors take an oath to do no harm. Like many other things, this simple principle obviously needs to be qualified.
Rosamond herself has often pointed out that we let doctors do things we wouldn’t let others do, like cut into us with knives and give us poisons and ask about our bowel habits and sex lives, all this presumably for our own (eventual) good. So, since doctors have these special privileges (and special knowledge and skills), they should have special duties and obligations. Foremost among these is to seek trust and deserve it. This may seem a universal principle, but the trick is in the deserving. Melville’s confidence man, the sellers of mortgage backed securities, Bernie Madolf, and the prototypical used car salesman are all experts in fostering trust but can hardly be said to deserve it. Physicians, though, cannot successfully ply their trade without trust, cannot act for our good, so any breach of trust jeopardizes the enterprise as a whole. Or so Rosamond quite successfully, I think, argues.
Pursuing this line of thought a little more, there are alternatives to trust as a mediator among people. Absolute authority comes to mind–Ahab and Queeg and other captains of ships and states. The ragtag crew of the Pequod didn’t trust Ahab to bring them safely home with a hold full of whale oil. They could only hope, a not very efficacious strategy as it turned out. And authority of the absolute variety (and even not so absolute) risks events like teenage rebellion and Arab springs and, returning to Melville, Bartelby.
So there she is, dead to the world, but having previously given consent to this violation of her bodily integrity, while Ken inserts an artificial hip ball and socket. The need for the surgery was the deterioration, caused by arthritis, of the cartilage between the ball and socket. Bone rubbing on bone equals pain. This operation only goes back fifty or sixty years. Before 1960, say, you just had to live with the pain, probably had to use a cane just to get to the bathroom, probably didn’t go out much. And, as with Rosamond, if one hip went the other probably would, too (she had her right hip replaced a year and a half ago). Now, there are over 285,000 of these operations performed a year. That’s a lot of pain being alleviated (and a lot of revenue for surgeons and hospitals).Some patients have problems with the replacement devices as we have been reading about in the press, and some versions of the surgery require a longer and more restricted recovery time than the approach Ken used (anterior).
Since this is not a life-threatening condition, those without means or insurance have to suffer the pain and the disability. How this will factor into the economics of universal health care remains to be seen, but the experience of people with this condition in other countries should be illuminating.
With that many operations being performed, Rosamond’s was not a special case. But it was special to her and to me. It was her pain, her leg that was being invaded, her now almost sprightly gait. Soon, as the weather warms up we can go for long walks in the neighborhood, out on the coast, through the woods in Van Cortlant Park without distraction, as if we were perennially young.
After the surgery, which took about an hour, and after the anesthetic wore off, Rosamond seemed chipper enough all things considered, but she had a bad night–a moaning roommate, noise in the hall–so she was determined to go home the next day. She had to show she could walk and also go up and down stairs. She did, and home we went. Our house has stairs and no bathroom on the ground floor. One step at a time, good leg up first going up, bad leg first going down. Rosamond has a strong independent streak and wouldn’t let me do all the things I wanted to do to help, but I got to help her put on socks, kneeling at her feet, a position I have metaphorically assumed for years.
It has been six weeks now since the operation, and things are going swimmingly. She uses the cane only for long walks and probably for not much longer. For several weeks she has been going into work from time to time and has done a lot of work at home. I liked having her around even if she was glued to the computer, but soon we will be back to normal, normal being full hip function, no pain, and working like crazy.