Two hospital attendants rolled me into a holding room at Brighton Nuffield Hospital, where an anesthetist gave me a spinal block and a sedative. Moments later, they wheeled me into an operating theater, flipped me onto my side – like Shamu awaiting treatment – and the anesthetist put me to sleep.
For the next hour or so, a towering, affable surgeon whose name – Mr. Sebastian Dawson-Bowling – is nearly as imposing as his 6’5″ frame, deftly parted the skin, muscles and ligaments on my left hip, exposed and removed my diseased joint, and inserted a replacement.
Two weeks later, I am walking with the aid of one crutch, pain-free and following an exercise regimen designed to restore my strength, flexibility and stamina.
Magically, and wonderfully, I am pain free.
Hip replacements are commonplace for people my age. More than 300,000 hips are replaced each year in the US; in the UK, more than 80,000. What’s noteworthy in my experience: four days after surgery, I was largely pain-free for the first time in nearly a year. The idea of walking a few hundred yards is no longer an unthinkable challenge.
Thirteen years ago, when I had my right hip replaced at Brigham and Women’s Hospital in Boston, it was weeks until I was able to do what I did this morning: walk for 20 minutes, pain-free, aided only by a pair of crutches that barely touched the ground as I strolled and breathed in the salty Eastbourne air on a sunny Sussex morning.
What a difference a decade has made, thanks to improved surgical techniques, decreased invasiveness and the disappearance of post-surgical ‘precautions’ that made it difficult to resume a normal life.
I chose Brighton Nuffield Hospital in southern England for two reasons: Mr. Dawson-Bowling and his professional countenance and direct, fact-based assessment; and cost. (Surgeons don’t go by ‘Dr.’ in the UK, but are referred to with the austere ‘Mr.’ in front of their names when they earn admission into the Royal College of Surgeons.)
Months ago, when I first met the surgeon, he took the time to show me my x-ray in detail and explain what was going on in layman’s terms. His outlook was direct, and honest, and he exuded confidence. He was personal, friendly, and asked me my story, and shared a bit of his. We got to know each other a bit, and laughed.
“I love to do hips. It’s the most satisfying work…nearly immediate positive response.” He recommended a shot of steroids to try to stave off surgery, which I accepted. When it failed, I booked myself in for surgery.
I also chose Brighton Nuffield for practical reasons: it was the least expensive option, yet offered a high quality medical facility with a reputation for personalized service.
I pointed out the relatively low cost to Mr. Dawson-Bowling.
“I don’t earn nearly what my counterparts do in the US,” he said with a half grin.
Normally, Gabi and I book flights to Bangkok for our medical needs. Our experiences at both Bumrungrad International and Samitivej Sukhumvit have yielded excellent care by western trained specialists at a fraction of the cost we’d face in the UK or US. This time, however, the quotes from the three hospitals came as a surprise: Brighton Nuffield was nearly $5k less than either of the other two.
What’s more, Brighton Nuffield responded to my questions urgently, personally, and over time constructed what turned out to be a personal relationship that dealt specifically with my needs and quirky lifestyle. The Bangkok hospitals generated stock cut-and-paste responses using commercial sales databases I used in business. Communicating with a hospital through a Salesforce.com interface loaded with ‘cut and paste’ answers was discomfiting. It was impersonal, structured, designed for mass marketing efforts. Not for me.
Money wound up talking, as usual, and loudly. Thirteen years ago, though I was covered by my company’s health insurance plan, I kept all the receipts from my four-day hospital stay and week in rehabilitation on Boston’s north shore. The total came to roughly $63,000, not including physical therapy follow-up. This time, a four-day stay including physio therapy was $13,800, which, lacking health insurance for anything other than accidental injury, I paid from savings.
Having lived outside the US for six years, I have been sheltered from the ridiculously high costs of a health care system that appears on life support. We buy accident insurance to cover us if we are bitten by an asp, come down with malaria, or are hit by a bus, but not for elective surgery like hip replacements.
When you pay out of pocket, you think carefully about your choices.
But having a hip replaced is more than choosing a hospital, surgeon and location, or thinking about cost. As itinerant nomads with no home base, we had to find suitable accommodation near the hospital, emergency services just in case, pharmacies, food sources, and more. Finding a place to live for six weeks turned out to be nearly as important as selecting a hospital.
I’ve developed added empathy for the elderly or physically impaired over the past two weeks. The challenge of getting around the apartment is enough to tucker you out and leave you limping for the comfort of an armchair. Venturing out for a change of scenery and some exercise carries risks. Fear of unmanaged children backing into you in a crowded mall, or an overenthusiastic dog leaping up for a scratch behind the ears become sources of concern.
Then there are the simple acts of a normal life, suddenly complex and challenging.
Some of the things to think about:
Where to live? We needed one-floor, accessible living, and found it in an apartment on the English Channel in Eastbourne, 45 minutes from the hospital, but close to Gabi’s mum. It came with indoor parking and an elevator straight to our second-floor apartment. Two bedrooms came in handy so I could thrash about, sleepless, in my own bed while Gabi got a reprieve from care and feeding of a recovering invalid.
The countless details. Is there a comfortable place to sit? What about shower access? Is the toilet accessible? Are there stairs to climb (not impossible, but a challenge in the early going)? Our flat came with a fully reclining lounge chair, where I have spent every day and the majority of my nights and since coming home from hospital. The flat’s 2.5 bathrooms included a shower stall that was easy to enter and exit, and only seven steps to exit the front door for walks.
Proximity to services. We were lucky and found a place that offered a sea view and comfort. Our flat is close to supermarkets, takeout restaurants and entertainment options so Gabi can catch a show or a movie with her mom, coffee with friends, or something other than fetching glasses of water for me while I do my exercises and consume hours of daytime English game shows and D-grade movies.
Do the work. I am an dedicated to my exercise regimen, and have asked for and received supplemental exercises to help me gain strength, build stamina and to find a way to sleep. Having been an amateur athlete most of my life has served me well, as the “no pain, no gain” mantra comes into daily play as I retrain my muscles to carry my sorry butt forward.
Know when enough is enough. Overdoing it is a complete disaster, and will set you back days. You must pay attention to what your body says, and stop when it’s time. That means balancing the urge to take an extended walk against doing so much that it’s counterproductive.
Don’t be a hero. Upon discharge, the hospital gave me a prescription for Nafopram – a strong synthetic opioid that caused a violent and troubling nervous system reaction when I took it twice during my four day stay – so I gave it back. I’d rather rely on over the counter pain relief than deal with Nafopram’s effects. I take paracetamol and ibuprofen as needed when the pain starts to build while exercising. You get no medals for doing without, and easing the pain helps proceed with your exercises.
Be sure to have a support system. Thirteen years ago, I went into a rehab hospital for eight days, then home on my own to a two-story apartment and challenging days and nights navigating stairs, figuring ways to make and carry food, and recovering. Friends popped in and out, bringing food and important visits, but I was mostly on my own.
This time, I have the indefatigable Gabi on hand to cook, clean, listen to my frustrations, and massage my aching back and swollen feet. We considered a stint in a UK rehab facility, but we’re glad we decided to simply come home and get on with it. If you don’t have support, look to a rehab facility to help make the transition.
Our formula worked perfectly. My physiotherapist grinned earlier this week when I walked into my appointment with one crutch, did a new regimen of exercises flawlessly, and articulated my commitment to doing whatever necessary to recover and get on with my life.
And yesterday morning – two weeks to the day when Mr. Dawson-Bowling sliced me open – I walked from bed to bathroom, kitchen to living room, steaming hot of coffee in my hand and a silly grin on my face.
I am pain free for the first time in nearly a year.
I can walk, aided but otherwise unimpeded, for the first time in six months.
It’s February – new month in a new year.
And it gets even better from now on.