There had been no MRI, ever, and I told him so.
“OK, what about the X-ray?” Same answer. In the twenty or so years I had been experiencing difficulty—sprains and injuries and progressive weakness and discomfort—no one, in orthopedics or internal medicine or neurology or physical therapy, had ever ordered or even mentioned an X-ray. When I told him this, his wide, kind face furrowed, and he asked me to walk for him. Then he arranged me on the table to examine my leg. His first touch, on the outside of my upper leg, sent me through the ceiling. “You’re going to radiology when you leave here,” he said gently. “Then we’ll go from there.”
I was relieved and grateful to this man, who seemed genuinely caring about my condition, but I didn’t really expect much; I’d seen too many heads shake over the years about what couldn’t be done to treat polio or its enervating aftermath. The next evening, I was getting dressed for a friend’s book party when the phone rang. “I have your results,” Dr. Ranere said, by way of introduction. “I’m looking at the X-rays. No wonder you’re in so much pain. You have no hip left.”
I grabbed a pen and started taking notes, an old habit from my years as a journalist that kicks in whenever I get bad news. “No hip,” reads my scrawl on the back of an envelope. “Ball of hip is completely flattened. Bone on bone. Cysts, spurs, scarring. Severe degenerative arthritis. Total hip replacement.”
I don’t remember the rest of the conversation until its end, when Dr. Ranere asked if I had any questions. “Well, I have a lot of them,” I said. “But the main one is—how do you feel about all this?” I don’t know what made me ask this, though now it seems the best thing I could have asked him, and my candor may have taken him off-guard.
“To tell you the truth, I’m relieved,” he told me. “If we were dealing with the effects of polio, we couldn’t do anything about it. But we can fix this. The only thing that concerns me about a hip replacement for you is the rehab.”
I went to the book party that night and made an effort to be sociable, even though I could barely make it up the driveway. My mind was reeling. I knew that I had been given extraordinary news: This new diagnosis, as common as rain, changed the facts about the recent past and the possibilities for the future. I had been limping around for a decade while friends worried and doctors shrugged, and yet the polio had been such a basic starting point that no one could see beyond it.
The dictum in medical training, drilled into the minds of prospective doctors, is “When you hear hoofbeats, think horses, not zebras.” My medical history had presented the opposite problem. Polio, rare and specific, had been the zebra in range from the beginning, and that shadowy presence prevented anyone from thinking, Well, heck, maybe there’s a horse around here, too. Until now.
So began my one-woman research project. Over the next several weeks I read so much about hip-replacement surgery—the approaches, failure rates, rehabilitation programs, recovery, and outcomes—that the data began to blur and threatened to become meaningless. The procedure has improved dramatically in the past two decades, and the patients lining up for it have increased accordingly: some three hundred thousand hip replacements are done each year in the United States alone. Everyone, it seemed, knew someone who knew someone. There is danger in this glut of commonality. As with pregnancy or grieving or torn rotator cuffs, strangers on the street are happy to predict your outcome. You must endure the tall tales of the man who played tennis five minutes after surgery, the woman whose aunt never walked well again. Euphemisms and horror stories and happy endings abound. There are videos and stories on Web forums that range from the terrifying to the miraculous. Hungry and hostage, I devoured them all.
Dr. Ranere had referred me to the orthopedics department of a nearby teaching hospital, and when I made an appointment, I was asked to bring a digital copy of my X-rays. I picked up the disc the day it was ready and drove home so that I could see it for myself. I knew no more than the average layman about reading an X-ray, but when the images came on the screen I gasped. Here was my “good” hip, the left one, its femoral ball of pearly white contained in its socket, surrounded by a dark-gray space of cartilage, which cushions joints and allows bones to move without knocking into one another. And then here was my other hip. It was an explosion of white. The image looked like a drawing from an anatomy book on one side and an overexposed negative on the other. The top of the femoral ball was as flat as a kitchen table, and it was flush against the pelvic socket that held it in place. I felt like I was shaking hands with my own history. Oh, so there it is, I thought. There’s a picture of all that pain.
The intake questionnaire I was given in the waiting room had a special section, with seventeen descriptors for the type of pain the patient had experienced in the past six months: burning and piercing and shooting and constant and dull and throbbing. Being a word person, I appreciated these precise distinctions. I checked off eleven of the seventeen.
Dr. M. fit the standard surgical model: straightforward and laconic, gazing much more intently at my X-rays than at me. He called the damage “significant,” confirmed what Dr. Ranere had told me, and said he could get me in for surgery within a couple of months. I asked him if he could tell how long this had been going on, and he shrugged. “More than five years, more like ten.”
I asked him to quantify how bad my hip was. “You look at hundreds of X-rays a year,” I said. “At one end of the spectrum you have a guy who can wait two years for surgery, at the other, someone who should book an O.R. tomorrow. Where do I fall?”
He didn’t shrug this time. He said, “Most people with these X-rays would have gotten here a long time before now.”
A standard X-ray is one of the most common and efficient tests in medicine. I’d lost count of the medical professionals I had seen regarding my leg over the previous twenty years. I was given exercises, referrals to physical therapy, painkillers, brochures on cortisone shots, a suggestion from one professional to visit—her word—a cobbler. And yet no one, including me, had thought to suggest a test that takes ten minutes and generally costs a few hundred dollars.
I’ve always liked the joke about the loudmouth whose tombstone reads YEAH, BUT I WAS RIGHT. I have a tendency to be that person—so attached to my own convictions that I can miss the wider or more nuanced story. I’d spent a lifetime trying to overcome the consequences of polio, and in so doing I’d shaped the narrative in a way that didn’t leave much room for anything else. Dr. Ranere was the first medical professional I’d seen in years who was less interested in my assumptions than in his own observations.
Of all the things I’ve learned from the realizations of the past few years—the hallelujah moment when I got a new diagnosis—one of the most important had to do with my own humility. With the idea that I didn’t have to know the whole story, already iron-clad, didn’t have to be the smartest person in the room. That sometimes the smartest person in the room is the one who says, “I have no idea.”
An old friend used to say you could find out anything in the world with two phone calls: The first was to find out whom to call. I was lucky to live in one of the best medical communities in the world. My trip to Dr. M. had been an initial research foray, and I knew what was next.
More than a decade earlier, I had shared a two-family house with a young couple, a surgeon and an attorney, whose black Lab had grown up with Clementine; the three of us had been good friends and stayed in touch after we’d moved on. Now Marc was a highly regarded vascular surgeon at a top Boston teaching hospital. In the years we had shared a house (and dog care), I came to know him in particular and personal ways. He was as calm and considered as a redwood tree, and I trusted him utterly. I sent him a long email and hoped he would respond when he could; I already knew from talking to Jill, his wife, that he had to deal with hundreds of messages in a day.
Less than twenty-four hours later I had a reply. Marc had talked to colleagues and to people who worked in the O.R.; he had the name of the surgeon whom the surgeons went to
see when they needed joint replacement. Within minutes I called Dr. Mattingly’s office to make an appointment. His closest opening was four months away, in early July. From what I’d been told, that meant we would be scheduling surgery sometime in the fall.
I tend to research things small and large to the point of obsession, which is one reason my sister calls me a border collie. I had the opposite reaction after hearing from Marc. I felt free, as though I’d been given a pass on all that worrying and gone straight to the surgeon I needed. No second-guessing, no third and fourth opinions. Given that this was the man who would be taking a bone saw to my femur, it was a fairly critical decision. But from that day on I felt as though I’d been handed a map for the next part of my life. I didn’t have to watch the procedure on YouTube, go to medical school, talk to four thousand people about what I was about to go through. I just had to hold on to my fear and wait it out.
14.
I met my surgeon on a hot morning in July, days after returning from Taos. For the first time in my traveling life I’d requested a wheelchair to get me from one gate to another. This concession was hard fought: I was prideful, and ashamed of my pride, and the airlines’ staff did little to relieve my discomfort. At one gate I had to wait half an hour for a prescheduled wheelchair; at the next, the attendant wheeling me through the airport threw my carry-on suitcase on my lap and treated me like a piece of cargo. I was getting a twenty-minute glimpse at real disability, at the de-personalization and powerlessness that seems to go along with it, and any ambivalence I had about the impending surgery disappeared in a wave of gratitude. Unlike millions of people, I had a remedy available—an obvious fact that took a long time for me to comprehend, both leading up to the surgery and in the months following it. A compromised leg was my version of normal. To think that I could change that—that I might be one of those people thoughtlessly gliding from one place to another—was a conceptual challenge without a guidebook; it required a huge leap of the imagination.
A physician friend once pointed out that orthopedic surgeons tend to be hale and hearty because they need to be; theirs is the most physical of the surgical specialties. Dr. Mattingly was a friendly, handsome, take-charge man about my age who looked like the first-rate college football player he had been. He exuded confidence. He shook my hand warmly, turned to the X-rays waiting on the screen, and chuffed in response to what he saw. “Only one thing to do here!” he said. “You need a total hip replacement.”
Later, I would be hit by the classic amnesia of medical encounters; if not for my notepad, I would remember very little of what we said that day. Typically, I had come armed with a list of questions—when I could swim and walk the dog were my most urgent and least medical—but most of them paled before Mattingly’s authority. I knew enough about how surgeons think to realize he was telling me what mattered.
The next fifteen minutes were a blur of information: I would be on two crutches for six weeks, which he believed brought better long-term results. The prosthesis was uncemented, a better choice for more active patients. He would make a six-inch posterolateral incision on the side of my upper hip, then separate the strands of the gluteus medius to get to the femur. I would spend a day at New England Baptist Hospital doing pre-op, digital scans, and blood work, as well as donate my own blood weeks prior to the procedure. When I asked him if he had done the surgery on polio patients before, he answered yes, quietly, and I could tell from his answer he was being polite—it might have been like asking me if I was familiar with nouns and verbs.
It is testament to my naïveté, or denial, that I asked him the following question: “I have tendons and muscles that are tighter than those in a normal leg,” I told him. Would it be helpful for him to know where they were and what their limitations were, in terms of positioning me during surgery? Mattingly looked at me as though I’d just offered to hold the scalpel, and he smiled. “Well, you’re going to be asleep,” he said gently, and when I still didn’t get it, he added, “We can do anything we want.”
Only then did I begin to allow for the anatomical assault of this procedure, one of the most common surgeries in the world and also one of the most aggressive. The hip and socket are exposed and the hip joint is dislocated (think turkey drumstick). The femoral head and stem are removed with a surgical bone saw. The acetabulum, the cup that rests in the pelvic socket and allows the leg bone to rotate, is power-washed to get rid of osteophytes, bone fragments, and cysts. The alignment of the hip is measured and remeasured for range of motion and optimal placement; the prosthesis is selected and tested for precise positioning. The surgical team replaces the acetabular cup and liner and drills out the remaining femoral bone to make room for the prosthesis, which is then hammered into place with a rubber mallet.
I knew most of this before I met Mattingly, but my mind chose to arrange the facts in a capsule of innocence, as though cheerful doctors and nurses were going to rearrange me like Legos, then give me a lollipop and a morphine drip. This was a helpful state to abide in for a while, just as it would be crucial later on for me to leave it behind, to absorb exactly what was being done to me and to what effect. But that morning I was a willing recruit; I made the necessary transfer of power to Dr. Mattingly within moments of meeting him. How much of my pain did he think this would address? About 95 percent. What kind of rehab could I expect? Ordinary. (Only this answer would prove too optimistic.) And finally, incredible though it seemed, he told me he could lengthen my leg—and reduce at least by half the discrepancy I had had since polio. In other words, since I had taken my first step.
The digital bone scan he was ordering would give him exact measurements of the leg; the polio, he believed, had left my bones alone. “Your muscles are firing,” he said. “From the X-rays, the bones are unaffected. You’ve been through rehab; you’re motivated. I’m not worried about you. I’m worried about the guy who won’t get off the couch and still thinks this will change his life.”
My limp and my pain had been the two ways in which I’d been able to chart my decline, but probably more telling was the amount of muscular atrophy that had crept up on me in the past few years. Because my right leg was about 1.5 inches shorter than my left and the Achilles tendon was tight, my right foot couldn’t really touch the ground if I straightened my left leg. I walked on my right toes to compensate, and this correction had gone from slightly cumbersome to dramatic in the past ten years. I had a photo on my refrigerator that Caroline had taken in the late 1990s, when we were in the White Mountains. I am standing with one leg on a rock, looking strong and happy. The leg is flexed; the calf is defined. When I found the picture, some years after she died, I thought it was my strong left leg. Then I realized it was my right leg. I was in my mid-forties, and my leg used to be strong, and now I could barely flex that muscle, and it looked like a different leg.
I shook Dr. Mattingly’s hand, walked out to the front office, and scheduled surgery for the first date available, in November.
15.
I learned to row when I was forty-seven, the summer of 1998. An avid sculler for years, Caroline had convinced me to get in her racing shell one summer on a lake in New Hampshire, and the few strokes I managed sent my heart aloft. I came home and called Community Rowing, in Watertown, and signed up for beginning sculling classes. They were held on the serpentine Charles River, where novices had to share space with eight-person crews and zealous singles and the usual river population of kayaks and canoes. My class started out with eight people, but a week into it, the other woman my age dropped out. So now we were seven: two brawny men about my age, a pair of young women who had rowed crew together in college, a thirty-year-old yoga fanatic, a twenty-two-year-old former gymnast, and me.
I was the slowest and weakest rower in the boats. The coach, a good-humored man named John, paired me with Rachel, the gymnast; maybe he hoped her quads would make up for mine. We started off in huge wherries and graduated to tubby mid-size shells; we did sprints in pairs, rowing along beside each othe
r, learning starts and turns and how to get back in the boat after capsizing. I became the guinea pig for this remount when I rowed enthusiastically into hidden weeds one afternoon and catapulted into the Charles. Because I was a lifelong swimmer and had already flipped once in Caroline’s boat, this neither frightened nor deterred me. I had one trait that allowed me entrance into the rowing community: I was so stubborn they couldn’t get rid of me. Rachel was tireless and the two men were driven—one a surgeon, the other a securities lawyer—and still I tried, day after day, to race them as we advanced to slender racing shells.
One day I sagged over my oars at the end of a sprint, disheartened, because the lawyer had creamed me once again. Rachel was impatient with my delusions. “Gail,” she said, the writing on the wall, “he has a back the size of your sofa.” But I kept rowing, and rowing, and by the end of the summer I had deltoids I was proud of and I had bored Caroline on the phone each night with tales of my exploits. We rowed that year until late October, and John and I became fond of each other, though it was clear he didn’t think I was racing material. One evening we were walking up the dock to the boathouse. “You know, John,” I said, “there’s one difference between me and the rest of the class you haven’t noticed yet.”
“Really?” he said.
“Yeah,” I said, and grinned as I headed for my car. “Next summer, I’ll still be here.”
He laughed, and probably didn’t give me a second thought. But I remember that moment, because fourteen years later, I’m still on the river, good days and bad, and I’ve never seen any of the rest of them again.
New Life, No Instructions Page 7
