72 Years Old
A while back, I was sitting in a hot tub at the place I work out with three other guys. I took account absently as I sat in the bubbles of their stories. One shorter guy was at the beach, saw his grandchild fall face down in the surf, rushed over, stepped on a slippery rock, fell and broke his back. He is getting better. He has a year he says till retirement. Another medium size guy had just sold his business and retired. His loves to play tennis but his knees ache, and playing golf hurts his back. The third, real tall guy, retired a few years, complains about his hip. He had a hip replacement surgery 12 years ago, and the damn thing hurts every morning when he gets up. And, oh, he wages an ongoing battle with cramps. So, there we were three dudes, near, at or over 70, with almost no hair on our collective heads, sagging skin, and flaccid bellies. And these are our “sunset years.”
Once in my callow youth–this must have been the late seventies–I heard a group of old people talking. All they could seem to talk about was the last great meal they had eaten and their surgeries. In graphic detail. And this was back before arthroscopic when people had their chests cracked open for any sort of heart surgery. And little snot that I was, I disdainful. Is this all these people have to talk about? Their last great meal and their latest surgery? I mean what about world affairs, starvation, and air pollution? Now I know better. At my age, at 72, I fully acknowledge there is noting more important to talk about than your last great meal and your most recent surgery.
I managed to get to 72 without ever having broken a bone or spending a night in a hospital. Up till 2012 I had avoided surgery except for the removal of squamous cell on my upper lip. But, if HNBBB is accurate, I had begun to experience some pain in my shoulder clear back in 2008. Acknowledging that something was wrong, I took steps. I stopped swimming. Also my wife reminds me that I iced my neck almost nightly for five years. That helped. I had an x-ray that didn’t show much of anything. So I gutted it out till 2010 or 11 or so.
By that time, though, shoulder pain had begun to affect my sleep. I would wake with the right shoulder throbbing. Also I noticed I had a hard time lifting heavy things into the microwave set up over our stove. So I called the clinic, made an appointment with my primary care person, and she got me an appointment with an orthopedic surgeon. He turned out to be a short, energetic guy somewhere in his 50’s. I figured he worked out, played tennis, and was probably a cheerleader in high school. He had the bounce for it and was full of pep. He was into fixing things and making them better. I distrusted him immediately.
But he asked me to put my arm straight down by my side. He put his hand lightly on the back of my wrist and asked me to push against it as hard as I could. I tried and could hardly budge his hand. He had me. I could tell something was wrong. “You should take care of this now,” he said, “because in ten years you will be back and want me to replace your whole shoulder.” He spoke authoritatively. I decided to trust him and scheduled an appointment for an MRI.
I had never had one of those before and didn’t look forward to it. I understood they stuck you in a dark tube and the whole process was very noisy. I was worried that, stuck there in the dark, I might have an anxiety attack. But I went,anyway, took some deep meditation breaths, decided that none if really mattered anyway, and got through the ordeal. Back in his office, the doctor held up the picture from the MRI and pointed. “See that white there,” he said. “Yes,” I said. “That’s bone and I shouldn’t be seeing it.”
I was a candidate for rotator cuff surgery. The tendon had come off the bone; the tear was clean. I was young enough that there was a good chance I would be around a while to benefit from the procedure. So I was “cost efficient.” I waited for a pause his I-will-fix-it pitter-patter and asked, “Will I die?” He didn’t take me seriously; he just shrugged and said he had done a thousand procedures like the one he would do on me. That wasn’t really an answer as far as I was concerned. I didn’t pursue it though because I don’t know why I asked. I guess I was afraid. Because really there never was any doubt in my mind that I would do it. The shoulder hurt too much and I was retired. What else did I have to do?
Rotator Cuff Surgery: Right Shoulder
The prep for the surgery was more complicated than anticipated. I had to go to my primary care person twice before the surgery to make sure that I was fit for surgery. I had blood drawn. And I had to have a chat on the phone with the anesthesiologist for the surgery. He asked me questions about drugs. Seemed to me like a lot of prep for a surgery that didn’t kill people. But I knew that anytime you go “under the knife” something bad could happen. So I suppose overall I was happy they took these precautions and more reassured than not by them.
It was early and dark when my wife and I drove downtown to the out-patient surgical center (as they called it) close by the main hospital. It was housed in a former apartment building; we parked where the former tenants had parked, and entered through the former kitchen. That’s where we parked and entered through the former kitchen. It was clean and well lilt. I put on the non-slip surgery socks they had given me. Somebody stuck a needle in my arm, and as I passed out I noticed that one of the attendants had a big tattoo of a knife on the inside of his fore-arm. After that everything went black, and by mid afternoon I was back home in my own bed.
I had been cut open, my shoulder bone had been tenderized, so that the tendon might more readily re-attach itself. I could tell I was in great pain, but I didn’t feel it because they had given me Percocet. This is a mixture of Tylenol and Oxycontin. It proved very effective. I was in a fog for a number of days, during which time my wife would wake me occasionally and feed me soda crackers. Because of this practice, I grew very fond of soda crackers, and for a number of years ate two–no more or less–soda crackers before brushing my teeth and going to bed.
After a week or so of being on this drug, my wife told me she feared for my life. I didn’t know what she was talking about. But it seems I had started to snore in a most alarming way. I of course was not awake to hear this but was alarmed to hear she had heard it. I had suffered sleep apnea a number of years before, and she seemed to indicate that it had returned with a vengeance. She was alarmed by the snoring since she said it seemed as if I stopped breathing completely and then snorted my breathing back into motion. We stopped the Percocet quickly, then and there, because previous experience seemed to indicate that drugs of that kind, along with my preternaturally long uvula, inclined me towards sleep apnea.
But while I did stop the drug, the awful snoring persisted. Again, I had not heard the snoring myself, but my wife’s account suggested that I might pass away at any moment while I slept. So I contacted my primary care person and through her made an appointment with a sleep center. I had been to one of those places before and it had been a horrible experience. You try to go to sleep in a sort of motel room–a room in any case, not your own, on a bed not your own–while hooked up to numerous electrodes all over the upper body and head. They are all knotted together at one point in a sort of bundle, so that you might get out of the bed more easily should you need to go to the bathroom. You go to the bathroom hoping you do not urinate on your wires.
So there I lay, flat on my back, with my arm in a sling, trying to get to sleep. I tried and tried. I took drugs. Nothing worked. To make matters worse, this was the day of the Boston Bombing. Thoughts of that, images from the TV, kept intruding and made sleep impossible. Sadly, if you are unable to sleep, the young man sitting in the room adjacent to yours, watching multiple re-outs from the various electrodes is unable to determine if you have sleep apnea. So I had to reschedule.
On the second run, it was determined that, yes, indeed, I had sleep apnea. So once again I went through all the rigmarole of getting a new CPAP machine–these are not cheap–and looking at all the sleep apnea masks they have out there. None of them fit properly, and all of them seemed to leave red welts on my sensitive skin. But I did it, and hooked myself up. My wife, in any case, was able to breathe easier. Unfortunately I couldn’t sleep.
I was no longer, at that point, on any pain meds. My shoulder would start hurting an hour or so after I dozed off. I don’t understand the mechanics of it, but apparently when one goes to sleeps one’s body relaxes. And the muscles, active and tense during the day, that hold the shoulder in place in the joint also relax. The arm then begins to hang in the joint and with the force of gravity to pull it down….producing pain in the connection between shoulder and joint. The cure, I was told, for this was to not sleep flat on your back.
But I couldn’t sleep on my right side because that was the side of the surgery and lying on it hurt. And I couldn’t sleep on my left side because my right shoulder would relax and start to hang across my body. That would hurt also. So all other avenues eliminated I was told I had to sleep–if I could mange it–sitting up. Suddenly, I was in the market for a recliner. I had never had one of those, but was not particularly surprised to learn that they are expensive. We decided to go to one of those rent to own stores. There we rented a big, ugly, red recliner that we figured, wrongly, to return in six months, once my shoulder was healed.
The recliner downstairs, with me hooked up to the CPAP machine, helped the sleep situation. And I did, of course, what my doctor told me to do. Exercises, daily, lying on my back to strengthen the arm. And I went to PT twice a week at first and then once. This went on for some months. I kept the arm in a sling, as ordered, for all that time as well. I would go to the place where I exercise and sit on a stationary bike and pedal away for an hour with my arm in the sling. I would shave with my arm in a sling, and drive with my arm in a sling. You cannot fully understand how much you use your right arm–if you are right handed–until you cannot use it.
The Left Shoulder Surgery and Percocet
So instead, to get around in a daily way, I used my left arm. I used it to drive, and to hold up my right arm while I inserted the car key in the key hole, and I used it to shave, and to brush my teeth. It was left arm this and left arm that. And after a couple of months of using my left arm, it became clear, as an MRI relieved, I had a significant tear in my left rortator cuff. Indeed, while I cannot fully grasp the technical terms used to describe it, the condition of my left arm, before surgery, may well have been worse than the condition of my right.
Consequently, I scheduled another surgery about six months after the previous one and went through all the attendant rigmarole once again with precautionary doctor visits and calls from an anesthesiologist. And I drove once again to the out patient surgical center in the wee hours of the morning. And once again I was home in bed by early afternoon. This time though I did not snore, as I had before, because I had the CPAP machine to correct the apnea issue. And possibly for that reason or possibly because my discomfort was greater, having now two suspect limbs with attendant pain, I took the Percocet quite a bit longer than I had the first time around.
I took it a number of weeks in fact, going on a month, as I recollect. I started cutting back almost immediately but I stretched it out because the situation seemed to warrant it and because I liked how the drug made me feel. In fact, as I reduced the dose, I found myself looking forward to my daily late afternoon cut of the drug as affording me an escape from the rigors of the day–whatever those had been. I just felt, on the drug, lighter. What worries I might have about getting old or having both arms all screwed up or the sagging skin on my arms or the fact that my eyes were getting worse, all that seemed distant, almost faintly amusing. I could take a deep breath, shrug it off, and just float in the moment.
I could even “function” on the drug. I could drive. I could watch TV. I could read. And I could see why someone who had fallen into despair or into pain could get hooked on that stuff. You could still get by. No one had to know. The only problem was that to keep getting that high, you had to keep taking the drug and more of it too as time went by. And I could easily see how there might come a day when one would decide just to stay home, shrug off work, and go to sleep. Forever. I could see it as I said, but I was not in the least temped. Over time, I kept pinching away at the drug, and one day I was off it.
For a while I suffered surgeon envy. Walking around with that sling, people would naturally say, “What’s that?” or “What’s wrong with your arm?” And I would tell them I had rotator cuff surgery, and in the process of these conversations, I began to get some idea of the rather large number of persons all around me who had had some nasty version or other of orthopedic surgery on shoulders, like mine, on knees (quite, quite painful), and most seriously on hips. And, quite naturally, in the course of this conversation the person would ask, “Who was your surgeon?” I would say and over time I grew alarmed that nobody seemed to have heard of my surgeon.
I suppose I shouldn’t have been. All one had to do was to go out to the parking lot. It was full of giant SUV’s, Lexus es, Mercedes, Jeeps, BMW’s, and the occasionally Tesla. And then there was my 2000 Toyota, that I had inherited from my wife’s mother. The folks at the club where I worked out and where people asked me what was wrong with my shoulder were a rung or two or three above me on the social, economic ladder. They all had the sort of medical plans, the more expensive ones, that allowed them to go to the surgeon of their choice. So naturally, with this buying power, they shopped, and asked around, trying to get the best surgeon possible. I didn’t. I took the one that the clinic gave me. I could have gotten a second opinion of course. But, as I said, the guy seemed OK to me.
Looking back now from 2018, I don’t regret the decision to get surgery. I do wish I had been better prepared for the recovery. It was far more arduous than I had expected, although I don’t know honestly what I had expected. It probably wouldn’t have done me any good to have the doctor tell me, “Well, the surgery is good and generally effective, but the recovery–what to say–is a real agonozing son of a bitch.” I certainly hadn’t anticipated that it would take so long, or that I would sleep in a recliner for a year and a half, or lose a whole year of my life in a narcotized haze.
But, hey, what’s new?