Surgery

Let's talk about surgery. Despite being an effective tool for obtaining a higher quality of life, we are taught to fear, avoid, and even consider it a failure if we undergo surgery. This has always perplexed me, especially since I'm about to explore the possibility of having my 12th surgery. Why do we do this? Yes, there is risk, which we are also taught to fear, but that's another post. For example, after my right knee was scoped, I woke up hyper farsighted. Despite this unexpected side effect, my quality of life significantly improved because I had that surgery, so I consider it a success. Too often in healthcare, we want to judge success based on quantifiable measurements like waking up hyper farsighted, fear, and risk, but not reward or other positives that contribute to a higher quality of life. Maybe if we switched to metrics like reward, new life chapters, or even the coolness of one's scar, we would see higher quality of life scores. Here is my surgical story, which is being written after a 6-mile hike yesterday. Life isn't that bad despite the chronic, relentless pain and working towards my 12th surgery.

My Surgical Story

For this post, and to make life easier for you, the reader, I'm going to classify my surgeries as emergency and nonemergency. In my case, I'm defining emergency surgery as needed because a bone is pointing in the wrong direction or my heart is beating irregularly, putting my entire health—and in theory, my life—at risk. A nonemergency surgery would be pain-based. The pain is affecting my quality of life negatively, but if I must limp through life for a few more weeks until the surgery, it won't directly affect my overall health.

If you have followed my patient advocacy for a while, you know part of my claim to fame comes from falling off a cliff while rock climbing in June 2003. In addition to the six staples I needed in my head, I required ten screws and a plate in my left wrist to put it back together. My surgeon told me that my left arm was sticking up some 3.5 inches. In other words, my bone was pointing in the wrong direction. There was no question—emergency surgery was required to put Big Al back together again.

The initial plan of attack was for the emergency room to stabilize me enough so I could go home that night until my 4 p.m. surgery the following day. A main reason they wanted to send me home was because I did not have any health insurance at that time, and a hospital bed isn't cheap. Despite filling me up with a large amount of morphine, they could not get my pain under control, so around 1 a.m., they admitted me. As funny as this might sound, there was one advantage to not being able to control my pain. Due to the severity of my injury combined with the uncontrolled pain, I was able to get into surgery around 1 p.m. instead of having to wait until 4. Three hours might not sound like a long time to you, but for me, it felt more like saving three months.

Despite the pain and destruction my fall caused and continues to cause, you would be surprised how little I've regretted climbing that night. The fall, which maybe took a second or two at most, has ended up being one of the greatest learning opportunities of my life. One of the biggest lessons has been that when it comes to surgery, yesterday means almost nothing. Surgeons, family members, loved ones, and friends often look at surgery as a method to go back in time to a point where, in my case, my arm still worked like yours. Although that is a quantifiable goal, it is unrealistic simply because that is time travel, for one. It is also unrealistic because it does not respect the trauma which caused the need for my emergency surgery. Surgery can and will help us rebuild joints, reevaluate our quality-of-life definition, and significantly reduce pain. It can't help us process the trauma of falling off a cliff, the destructive power of rheumatoid arthritis, or the chronic pain of hip dysplasia, just to name a few examples. Those require constant vigilance, whereas surgery recovery is a moment in time healing process, even if it takes a year to complete.

Speaking of hip dysplasia, let's discuss my right hip replacement surgery, which was a result of that condition. That's a solid transition; I don't care what an English professor might say.

Largely due to my age, combined with the seriousness of a total joint replacement surgery, my surgeon wanted me to explore other options for pain control before proceeding. Although small, if something went wrong during surgery, I could potentially lose my entire leg. He wanted to make sure I was certain I wanted my hip replaced at a relatively young age, even though he understood I was a strong advocate for myself and others in similar situations. Since I had respect and admiration for him, which came from previous experience working with him on other issues, I set up appointments with my pain management clinic, rheumatology doctor, other patients, and a different surgeon who specializes in sports medicine to discuss other options.

After conferring with all of them, I was more certain than ever that having my hip replaced was the right decision. For me, the decision was easy. I wanted the opportunity to live my life at a high level now versus having to take it easy until I was 70 or 80, which is more common for replacement surgery. If I lost my leg to a mistake, error, or random rare side (like waking up hyper farsighted) effect during surgery, so be it. At least I was trying my best for a higher quality of life. Also, just because I would be down a leg that did not mean I couldn't have a high quality of life. All it meant was I would have to redefine my story; my climbing accident had already taught me how to do that, so I was confident that I could accomplish another story change.

As the numbers predicted, my hip replacement surgery was a success. Thanks to my experience and the skill of my doctor, one of the physical therapists at the hospital actually "told on me" because she thought I was pushing it too hard during my recovery. I wasn't pushing it too hard; I just wasn't listening or caring what she said because it was a one-size, no-flexibility approach for 70- or 80-year-old patients, not designed for someone with my abilities.

Here is both a humble brag and what happens when you trust your abilities and prepare for surgery along with having a skillful surgeon. I went skiing in the middle of December despite my hip replacement surgery being towards the end of that October. This is not typical, and I don't recommend it for most. One of the main reasons I went skiing is because I had been a ski instructor for many years and was skiing with my buddy Justin, who was both a better skier and instructor than me. Even if I was physically or mentally unable to ski that night, I was with someone who had the ability and confidence to help me get to the bottom safely despite only being a few weeks out from major surgery. I should also point out that I'm more comfortable and capable on my skis than I am in 99% of social situations that life offers.

What do I mean by "trust your abilities"? About 4 to 6 weeks before my replacement surgery, I started practicing walking correctly every day. With a bum hip, or any joint for that matter, we both consciously and subconsciously learn how to cope through the pain so we can continue to live. This manifests as limps, patients using strength instead of correct posture, or, in my case, walking on the middle part of my right foot instead of utilizing a heel-to-toe motion, which is the correct method of walking for our bodies. Basically, if my walk felt "normal," I would stop, readjust, and concentrate on the weird feeling of heel-to-toe. That weird feeling was the right way, which was easier to accomplish once I had a healthy hip again.

In addition to learning to walk again before I went under the knife, I spent a considerable amount of time concentrating on my cardio fitness. Due to the pain I was experiencing at that time, I was only able to ride about 20 miles without severe pain (at one time I was regularly going on 30 to 40 mile rides) or my right hip locking up to the point I would have to call for a rescue. So, with that in mind, I did a 15-mile ride the day before surgery. It wasn't like it mattered if I hurt my hip even more at that point, so why not go for a ride? Recovering from surgery is a marathon, not a sprint, which is why I was focused on my cardio. There will be bad days, weeks, and potentially even months after surgery. Bad weeks or months are not a bad thing; they just mean the trauma or seriousness of the condition that caused the surgery was worse than you had thought. What matters in recovery is one's ability to try again with the new sunrise. Yesterday is over and does not matter anymore; only today does. Are you sensing a theme here?

Yes, sometimes the experience sucks!

Before I start being accused of preaching toxic positivity, let's look at my first cardio ablation surgery. I ended up having two cardio ablations and two cardioversion procedures in a span of about 90 days, all of which were considered an emergency because my atrial fibrillation (afib) continued to get worse. If you are not familiar, a Cardioversion is a medical procedure that uses quick, low-energy shocks to restore a regular heart rhythm. On T.V., this is when they take the panels, yell “clear”, and then zap the patient. A cardio ablation is a procedure where the doctor guides a tube into your heart to destroy small areas of tissue that may be causing your abnormal heartbeat.

My afib was first discovered by my rheumatologist during a routine appointment in late July. He recommended I see my primary doctor as soon as possible. I was able to see Dr. Weinrobe something like 48 hours later, who confirmed I was in afib and needed to see a cardiologist as soon as possible. About 10 days later, I was meeting my new cardiologist, who told me my current condition required a cardioversion as soon as possible with the hope of slowing down my afib enough to increase the chances of only needing one cardio ablation surgery.

The cardiologist had a unique name, which I only mention because I was scheduled for both the cardioversion and ablation surgery before I knew how to spell it. This new condition was happening fast, which in the world of healthcare only happens when time is more important than the mountains of paperwork everything requires. Time also meant that in this case, I would have to rely heavily on my surgical experience versus taking time to learn and study the condition. In my case, comfort and confidence would have to come from my previous surgical experience and not knowledge, as I've used in the past. Success would depend on my ability to trust the system and its people since time was so important.

Despite my extensive surgical past, the world of cardiology has a completely different vibe than the orthopedic and neurological world I was more familiar with. For example, schedules are not as tight as in the orthopedic world. Even though I had a check-in and start time for the ablation surgery, I had to wait almost two hours before it was my turn. When it was finally my turn, it felt like it was suddenly my fault that everything was behind schedule, which caused undue stress and made me angry. After all, I had spent the last couple of hours lying in their bed naked, twiddling my thumbs because there isn't a lot to do while naked in a cold, unfamiliar spot like a hospital.

To hurry the process along, they had multiple people start shaving my "god stick" area, as Jon Stewart calls it, along with my chest. By multiple people, I mean people who I had never met but were expected to trust and allow to get personal with me just because they had a hospital badge on. Others were starting to feed me pills, whom I had first met five minutes earlier. Instead of nice, calming, confidence-inspiring thoughts before a surgical procedure involving my heart, I was having thoughts about how in any other context, I would be allowed and legally justified to use violence to get away from these people. Not exactly the best state of mind to have before a procedure of any type.

The strangers had not finished shaving me before it was time to wheel me to the operating room. This meant a new group of strangers were rapidly trying to finish the job before the anesthesiologist put me under. Up until that point in my life, I had never experienced a panic or anxiety attack. I'm almost positive I was starting to experience one right as the anesthesiologist started the process of putting me to sleep. The last thing I remember was a wave of anger hitting me because I wanted everyone to quit touching and shaving me at that moment. I had had enough and needed to regain some semblance of control, but the drugs hit me before I could turn my frustration-based confusion into action, and I was out.

I woke up in recovery with a bad cough and was still in the same frustration-based confused state of mind. Some nurse kept yelling at me to stop coughing but did nothing to help stop it, which only made me angrier, which doesn't happen often. At one point, I remember making a fist because if she yelled at me again for something I wasn't doing on purpose, I had rationalized that I had the right to use violence to make it stop. Luckily, some other nurse realized what was going on and gave me something that made me go back to sleep for a while longer. When I woke a second time, I was in a much better state of mind and wasn't coughing. Funny, offering help for a medical issue seems to work better than just yelling at a patient to stop it. I'm not sure, but I think there might be a valuable lesson about care and validation in this story of mine.

Unfortunately, my cardioversion and ablation only bought about three days of stability. Not only did I slip back into afib, but I also got worse. At one point, my resting heart rate was something like 180 beats per minute, which is a marathon runner's heart rate. I was so bad that my doctor almost went straight to a pacemaker instead of trying another cardioversion and ablation. In the end, we decided on another round, which finally brought my heart back to normal. This time, there was no anger or panic attacks. I went through both procedures with a confidence that made recovery easier. Experience is a wonderful tool when dealing with surgery but doesn't get the respect or recognition it deserves.

As I start to process the possibility of a 12th surgery, it would be easy to say that the previous 11 must have been failures. It would be easy to blame it on greedy doctors, greedy pharmaceutical companies, or a profit-based healthcare system that does not want to see me "healed." I hate conspiracy theories, but I do think there is merit in the profit-based healthcare system reasoning! The truth is, the previous 11 surgeries gave me the opportunity to ski more, write this post, go hiking yesterday despite it being the hottest day of the year, look for a new career, hang out with friends like Justin, regularly go to the gym, and even be a patient advocate.

Reflection and Conclusion

Both as a culture and country, we have a bizarre fascination regarding the application of risk. For example, we don’t consider or even think about the risk of getting into a car wreck when going to dinner with friends simply because we are taught there is nothing more precious than spending time with them so that trumps everything else. However, we label skiing with friends as an extreme sport even though the numbers suggest you are statistically more likely to get into a car wreck on the way to the mountain than hurting yourself while skiing. Surgery is the same way. We will take pills and other chemicals without a second thought but start crying if a doctor even mentions surgery even though it has a better chance of improving one’s quality of life. Risk is a perception which is often based on the negative. Risk should be thought of as an opportunity, the dream of improvement.  

Surgery is not about fixing or curing; it's about opportunity. It’s about having the chance to try again, even though someone might not get this chance due to economic barriers. The question is not, what are the risks associated with a surgery? That is not where the risk lies. The question is, what are the risks of not having said surgery? If the answer is you can't ski anymore, write patient advocate blog posts, go hiking, go to the gym, go out with friends and family, or participate in a quality of life that you are happy with, then the answer is easy. What time do you want me at the hospital, doctor? Let's get to work.