Chapter 24 – What To Expect During Your Hip Replacement Surgery Operation (A Play By Play Of My Operation)

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What To Expect During Your Hip Replacement Surgery Operation

The Other Side Of The Scalpel – This chapter chronicles what I experienced the day of my surgery. Your experience may be similar. Typically surgery takes, at very best, at least an hour and then you will be in the recovery room for one to two hours more.

Is It The End Of The World? There had been many potential Armageddon days I had lived through: Haley’s Comet, the Nostradamus King of Terror date, the Year 2000, Heaven’s Gate, the Mayan Calendar Apocalypse, the Keeping Up With the Kardashians TV show, and even my mother-in-law moving in. I had survived all, so I hoped for the same outcome with my surgery.

Bad Trip For The Bionic Man – My hip replacement surgery was surreal, sort of like that space between a head concussion and a bad LSD trip. (Of course, I have had neither.) The information below reflects my state of mind from the time I arrived for my surgery until the time I was bionically reassembled. Warning: I was a bit ‘spacey.’

Farmers Are Also Nice To Their Crops Just Before Harvesting – I go to the pre-operating holding area and all the nurses and doctors are very nice to me. They are comforting, caring, maybe a bit too nice. Hopefully, one of the staff didn’t have a family member who needed a kidney or heart that I was a perfect match for.

I removed my pair of shorts, a t-shirt, and flip flops (yes, that is the same outfit I will use for rehab) for the surgery and placed the clothing into what looked like a CSI specimen collection bag (makes it easy for the coroner, I guess).

“If it requires a uniform, it’s a worthless endeavor.”
George Carlin

Baby’s Got Back – I donned the official patient uniform of an open-backed gown. It was probably a size eight and I was at least a 2XL. Regardless, I proudly flaunted my backside to anyone who might be watching. Nobody was. Thankfully, my wife was spared any further embarrassment when she was politely escorted out of the holding area and back to the waiting room.

(Stunt double)

Who’s Trouble? Imagine hearing Ray LaMontagne’s song Trouble, playing in the background. It starts off with the word “trouble” sang six straight times. I was being a bit of a smart ass to the perky brunette operating room nurse and since she talked to me, it was obvious she hadn’t witnessed the back of my gown opening. I reminded her I was having the ‘Angelina Jolie lip enhancement’ procedure. She rolled her eyes and said, “I can see you are trouble.” To which I responded, “If I am trouble, you are Troublette.”

“No, No. Not Like That! Like This.” I then had to have an IV inserted into the back of my hands. I vaguely heard part of a conversation from one IV technician say to what must have been a new technician, “Next time you insert the IV, you should…” They soon were too far away to hear so I fortunately missed the tutorial, and, more importantly, if the new guy passed it. It was like a TV series that ends on a cliffhanger and promises a new season next year, only to find out the series gets canceled. (Remember, new residency programs typically start in July and my surgery was July 12th.)

Right Place? I was asked basic questions such as if I was allergic to latex or penicillin. I also confirmed my name, age, date of birth, and why I was there. I replied, “Isn’t this the non-invasive surgery option?” (Where was my surrogate wife when I needed her?)

Crossing The Rubicon – It was as if I came out of a heavy storm and had briefly entered the eye of the hurricane. For a brief period everything looked, and was calm. Then, I saw the dark, floor to beyond the sky; it was the eyewall cloud. It looked impenetrable, yet the orderly unlocked the wheels of my stretcher and with expressionless efficiency wheeled me towards the black vortex of a Category Five hurricane.

Up until now, I thought I could always go back and do the surgery later, but not now. I had crossed the Rubicon River. Now I could hear music, without words. It went like this:

“Duuun dun (pause) duuun dun (pause) duuun dun dun dun dun dun dun dun dun dun (louder) dun dun dun dun dun dun dun dun dunnnn (chomp).”
Jaws Theme Song

Cue The Theme From Jaws – There is one movie theme song that I don’t like. Having surfed for years, that music is from Jaws. I was finally wheeled down the hall, towards the operating room, and I had now that same feeling as when you are swimming in the ocean and look down and see a large, dark object moving underneath you: duuun dun… duuun dun.

Let The Party Begin – Upon arriving in the operating room, those same people, plus more, descend upon you, much like a neighborhood poker party around a small table.

“I’ll Have A Cocktail. Can I Get A Discount?” A cocktail of pain meds and other medical marvels were now added to my IV. I was too nervous to ask what was included and if I qualified for a senior discount since it was before 4 p.m. They rolled me on my good side with my bad hip now exposed to the world. I guess they were ready to play using me as their chips.

You’ve Got Some Nerve – Hmm, I always thought Spinal Tap was just a movie. Apparently there are two common ways to receive anesthesia for surgery: general, where they put a mask on you and run a tube down your throat, and the second method is a spinal. I asked the orthopedic physician’s assistant which method most people opt for and he said, “Ninety percent do a spinal nerve block.” I then asked which method he would select for himself and he confirmed the spinal tap.

Of Course You Could Stay Awake During Your Operation – What doctor doesn’t love hearing the Jimi Hendrix version of the Star-Spangled Banner?

Easy Decision – Based on these early poll results, I opted for the spinal method. Since I was already on my side, the staff member touched one of my vertebrae and, like a bony abacus, he counted down until he reached the correct place. The resident anesthesiologist asked for a needle, was handed one, and just before insertion he asks for the next larger size. He then inserts the jumbo needle into my back, performing a spinal tap to block pain. Fortunately, I had reviewed the a la carte menu and had ordered the optional feature where they not only do the spinal tap, they also knock you out (definitely select this option).

Advantage Of A Nerve Block – A nerve block decreases the amount of narcotic pain medication required. In this way, you can be more alert with lower chances of nausea and constipation. Not that you will be standing right away, but you must have hospital staff next to you when you attempt to stand due to the strength of the medication.

“Hmm… So That’s A Catheter?” Just before I ‘went under’ I saw the OR nurse holding a very long, skinny plastic tube. Since I had been repositioned to my back, I only saw the nurse out of the corner of my eye. He was holding tubing outstretched from one arm to the other arm and back it again. The last time I had seen someone with outstretched arms this way was 40 years ago when my grandmother was at a fabric store measuring out a couple of yards of material to make herself something. Even though I was without my glasses, I thought, “Hmm, that is awfully long. That’s not a catheter, is it? I just knew I should have had a Brazilian before surgery.”

Read more about my revenge of the catheter: “Before the catheter, I could cut down an entire swath of bamboo trees with my urination stream. Children would flee… Women would gasp… Men would cheer!”

Counting Backwards From 100 – I was expecting to have to count back from 100 to prove that I was under the control of anesthesia. I was going to be a smart ass and count forward by prime numbers. However, they never asked me. Instead, I sort of heard a whirling sound, like the fan/helicopter sounds from the opening scene of Apocalypse Now:

Next, I was fast forwarded in the movie to the scene where the Doors sing The End. It was a very strange blackness.

Still Counting Backwards From 100 – I had one more ready-to-pass-out gaze from the operating table and everyone suddenly looked like the kid from Deliverance. And with that thought, I was gone, totally blacked out and unaware of anything from that point forward. It was probably a good thing. Unlike when you walk into a lightless room and you sense the absence of light, when you start to ‘go under,’ the blackness not only comes to you, it permeates your very being.

I Put A Spell On You – While I was totally under the influence of the IV cocktail, I later learned of the details involving my surgery. The operation begins as an incision is cut from the top of my femur bone up towards my right buttock. My hip surgery class assured me that no muscle would be cut. Depending upon your orthopedic physician, and how artistic they are as well as their technique for doing the initial skin cut, you get somewhere between a long, straight incision resembling Frankenstein’s stitches to a more graceful, Nike-esque swoosh cutting of your skin. I guess I opted for the permanent, upside down, smiley face scar. It’s cute in a way, but I assume that design is already trademarked.

I’m Your Joystick – Because many orthopods like to leverage their expertise and time, you may find that the physician’s assistant gets to do a lot of the effort and positioning to dislocate your hip. The assistant held my leg like a jumbo joystick and lifts, pulls, pushes, slides, and glides my hip into the optimal gaming position so the physician can gently slice the labrum. The labrum is like that little piece of plastic that keeps a roll-on deodorant ball from falling out.

Snap, Crackle, POP – My physician assistant did so, then dislocated my hip. Later, he told me it was one of the loudest pops they had ever heard. Apparently, everyone around my surgical poker table either nodded, went “ahhh” or said, “Sounds good.” I guess those comments confirmed that the game was on and everyone was all-in on my hip.

What My Wife Would Have Said – Of course, if I had been awake for the dislocation pop sound, I would have said, as in the same vein as when my wife has an intended quiet release of flatulence that turns into a room-filing audible rumble, “Holy crap – did that come from me?”

Ring Tone – I saw my orthopod six weeks later (he was on vacation for the three-week check up) and, even though all that time had passed, he also commented on how loud the dislocation sound had been. I suggested he should have recorded the sound with his smart phone and turned my popping into a unique ring tone. He probably could have made millions in sales, or at least made a car payment. No news on whether there were any additional sounds that could lead to more ring tones for this part of the operation.

Ever Wonder Why An Orthopedic Surgeon’s Hands Are So Strong? Back to my total hip replacement operation… You frequently see operating rooms on TV where the surgeons are playing classical music as they cut into their patient. I can only wonder what song they might select for my operation.

Don’t Bogart That Femur Head – Imagine George Thorogood’s Bad To The Bone playing in the background.

The orthopod’s strong hands next cut off the head to my femur. I can only assume, based on interest I created with my dislocation sound, that my femur head was passed around like a joint at a college dorm room so everyone can have a look and comment as well. My orthopod then drilled a hole down the middle of my thigh bone and finally, like the Golden Spike of the first transcontinental railroad, he hammered the balled, metal-stemmed prosthesis inside my bone.

My Hip Replacement

Yeah, that is my hip…

“Let’s Just Screw That Cup In Here.” My hip is reamed out and shaped for the receiving cup (acetabulum). That cup is then secured by a surgical screw driven into my hip. The prosthetic femur head is then inserted into the cup socket. The ligament capsule is reattached over it and thus begins the long process of putting Humpty-Dumpty back together again. A plastic drainage tube was left in near my hip so gallons of post-surgical fluids could more easily, and graphically, drain.

Nobody Said It Would Be Quick – Due to the size of my bones and muscular structure, the operation that normally takes 60 to 90 minutes was approaching 2 hours and 15 minutes and, since all the chips I brought to the table were taken, the players were eager to take their winnings and go home. (“Hey!” I wanted to shout, “Who took all my chips?”)

More Anesthesia (Part Two) – Anesthesia is never nice and easy. Initially, my surgery was going quite well. I had been given the standard amount of anesthesia for a normal operation. But since my operation was running long and at about the two hour mark, I must have been about a quart low as my anesthesia was wearing off and I was about to get rough. The physician’s assistant said there was a scramble to get me back under before I started rolling, rolling, rolling on a stretcher, hitting people, like a crazed Ike Turner.

Silence Of The Mimes – Finally, a lot of stitches later, I must have been wheeled out of the OR and into the recovery room. I had a mild out of body experience as I was coming to consciousness. I could see myself from about six feet away and a nurse was leaning over me. I can remember vaguely seeing the OR nurse moving and waving her hands while looking at me, but I couldn’t hear anything. I briefly wondered if my worst fear had come true: I woke up to a world full of nurse mimes.

Wake Up And Get Out Of My Recovery Room – Imagine David Bowie’s Space Oddity playing in the background:

At first, there’s nothing I can do. I then started to hear the nurse mime transform into ground control and saying, “Can you hear me, (Major Tom)? Wake up, wake up. Can you hear me? Wake up!” It was being barked out by a woman with all the charm of a Catholic school nun who relied frequently, without impunity, on the teaching power of hard wood ruler.

I may have been spaced out, but her inflection and the monotone delivery of her voice had all the warmth and compassion of a 25 year veteran DMV receptionist and would make the synthesized voice of Stephen Hawking sound like Sinatra. Her lack of tonal sincerity indicated there had been hundreds and hundreds and hundreds of others should had welcomed back into the waking world.

I think I liked the mime world better.

“Bueller? Bueller?” It started with the theme song from Jaws, then a sequence from Ferris Bueller’s Day Off (“Bueller? Bueller?”):

For a few seconds, I could see myself lying on the stretcher with this Nurse Ratched clone methodically tapping my arm, sounding like Ben Stein, as she called my name over and over, waiting for a response that wasn’t to come.

Next was the opening scene from Apocalypse Now (all the way through the part where the Doors, ominously sing The End), then my mind flashed to the scene where the kid from Deliverance:

He’s playing a banjo, then back to George Thorogood’s Bad To The Bone playing in the background, then went to Ike and Tina Turner’s Proud Mary:

(rolling, rolling, rolling on a stretcher)

Then a Nurse Ratched impersonator sequence, and if that all isn’t enough, it is all summed up like an alien abduction. That is how my surgery went.

The Eagle Has Landed – It was as if the needle had dropped on an old 45, and I could hear that first crackle as I suddenly re-entered my body, still very groggy.

The next thing I knew, I was awake and trying to assess if I had gone from the B side to side A. The internal music was getting clearer and I now was realizing my operation was over. The one (semi-clear) thought I remember was, “Gosh, that didn’t hurt… I don’t think.”

“We Control The Horizontal, We Control The Vertical.” As a surreal bonus, I had an Outer Limits surprise when I woke up and saw what appeared to be a urine bag — quite full I might add. I soon determined the bag was somehow attached, as an alien appendage, extruding from my urethra, spiraling downward, allowing gravity to work its magic. I still was not sure how, and when, it got inserted, but it definitely was there. I was too weak (afraid?) to look under the sheets to see how it really attached.

Gray Matter Doesn’t Matter – Nurse Ratched abruptly left and I was soon being back in the care of Troublette. She proficiently wheeled me to another holding area, apparently to get me ready for transit to my hospital recovery room. I looked up at Troublette, wanting to spout out a stream of wisecracks, but my mind was whacked and all my thoughts somehow ricocheted from gray matter to ‘doesn’t matter.’

Felt Like My Fourth Alien Abduction – Sadly, all I could say was, “I haven’t felt like this since my fourth alien abduction. But I think you forgot to do the anal probe.” After that spacey comment, I was too far gone to make any more comments. Troublette knew I was starting to go back to deep sleep and with her gray skin, enlarged head, black penetrating eyes, and four-fingered hands moving slowly, she simply nodded without blinking, then smiled.

And with that, I was asleep again.

Alrighty… that concludes Chapter 24.