Diary of a knee replacement: 16 April to end May 2013

Note:  This is a purely personal record of a by no means unique experience, intended for family and friends.  It is of little or no interest to anyone else.  Comments appended at the end of the post will be read and appreciated but I shall not respond to them for the time being, anyway.  I shall add to this post from time to time to bring the diary up to date.

Tuesday 16 April 2013:  Operation day.  Waltz athletically into the hospital, wondering what has prompted me to volunteer to have a replacement of a knee that’s functioning pretty well, most of the time, anyway.  But the consultant orthopaedic surgeon, Mr F, insists that if I leave them, both knees will become unbearably painful, and that if I defer replacements much longer I’ll be too old to survive what is a very major operation.  (I’m 80 next year.)  Convinced, I ask Mr F about the possibility of having both knees replaced at the same time, to get it over — I recently met a middle-aged lady who had had both knees replaced only a few months earlier and who seemed to be in very good nick.  Mr F laughs lightly:  “At your age?  Out of the question.  You wouldn’t survive a double knee replacement.”  Rather thought-provoking.

Later same day:  I have chosen an injection in the spine rather than a traditional general anaesthetic so when I come to in the recovery room surrounded by sinister gowned figures I feel none of the discomforts (sore throat especially) usually associated with regaining consciousness after an operation.  But I’m still completely paralysed from the waist down.  Very odd feeling.

No pain so far.  But someone told me solemnly that a knee replacement is the most painful of all such ops, appreciably worse than a hip replacement as the hip has almost no moving parts to stretch and contract the surrounding mutilated muscles and tissue.  Pity I can’t stay half-paralysed until the tissue has healed and the pain worn off.

Wednesday 17 April:  Well, it certainly hurts now.  An array of painkillers of varying efficacy is provided.    Most have the  disagreeable side-effect of severe constipation.  At this stage am quite content to be constipated  as the relatively pain-free alternative to either the dreaded bed-pan or being forced to get out of bed and stumble to the loo on the faintly comical Zimmer frame.  Fortunately am still catheterised so liquid waste pours uncontrolled into capacious bag on the floor.

Thursday 18 April:  Catheter removed, quite a nasty sensation.  Find I have no bladder control, resulting in unseemly rush to get at bottle under the bed before it’s too late (it usually is).  Nurses promise that control will return.  Hope they’re right.

Am got out of bed to hobble about briefly on Zimmer frame.  Left (damaged) leg very painful in vertical position even when not weight-bearing.  Taken in wheel-chair to first of many sessions in the hydrotherapy pool.  White hospital stockings peeled off both legs for first time which is a relief. Struck by extraoridnary beauty of young hydro nurses:  hard to believe they are all sadists until they get their slender but strong hands on you.  Warm water in the hydro pool is pleasantly soothing but the exercises, mostly involving forcing left leg to bend at the knee further than it can go, are excruciating.  Sweating profusely from pain into the warm water.  Have a token shower, supported by Zimmer as usual.  Back to the ward where white pressure stockings are put on again by patient nurse who understandably can’t get stocking onto the left leg without forcing it to bend well beyond point of tolerance.  Indicate the effect of this by screaming.  This earns contemptuous look from nurse.

19 April:  Beginning to settle into routine of moderately effective painkillers for two days, constipation, manage without painkillers for next two days, start of end of constipation, resume painkillers.  Annoyingly, virtually impossible to read, despite early morning delivery of the Guardian, whole stack of books beckoning on Kindle, and inviting pile of old unread copies of the London Review of Books.  Pain is the biggest obstacle to reading, followed by constant interruptions for measuring blood pressure and blood sugar, delivery of quite nice looking meals for which I have no appetite and generally can’t force down (last meal arrives at 5:30pm!), and the ceremony of the presentation of the relevant pills from the locked safe on the wall, each humble pill checked and double-checked before being handed over to me to swallow it.  Pill deliveries have been divided up into an elaborate timetable under which certain pills are delivered at set times that bear no relation to reality or convenience.  The only real pleasure of these days is the morning mobile call to J,. and her two or three daily visits.

22 April:  New knee perceptibly more swollen (and painful) than three days ago.  Mr F, the consultant, on his morning visit, examines it and pronounces everything normal.  The swelling will come and go for the first week or two.  Nothing to worry about!  Admittedly before the operation the leg suffered from pronounced lymphoedema (swelling due to damage to lymphatic drainage system caused by a bike accident seven years ago) and a badly twisted calf muscle from tripping in early March in Charleston, SC, so there may never be the complete recovery to be expected of a previously healthy leg.  (Suppose I should have thought of that before choosing to have the left knee done first, or at all.)

23 April:  Discharged and allowed home on probation!  No improvement so far in swelling and pain despite agonising hours of exercises in water and out of it.  Beginning of a serious ordeal for J, barely two months younger than me, for whom putting on the infernal stockings without reducing me to a howling infant is an almost insurmountable challenge.  Various bits of invalid equipment now litter the house — a raised toilet seat with handrail, an invaluable 4-foot grabber operated by a trigger, the essential white plastic bottle ingeniously shaped to accommodate the male anatomy, non-slip bathmat….

26 April: Unaccountably feeling much better.  After visit to hydro at the hospital (involving painful contortions getting into and out of the car, J standing appalled and unable to help), feel up to a visit to the Ms, our near neighbours, about 200 metres from the house.  Limp across on crutches over tricky cobbles, flagging towards the end.  Revive after refereshing Lapsang Souchong and manage to limp back to the house.  Navigate the stairs to the bedroom and fall on the bed, exhausted.

27 April:  Swelling and pain worse than ever.  Badly constipated.  Worst day yet.  No sign of any improvement except in ability to raise left foot from the floor by about two inches if absolutely essential.

28 April: Feeling very poorly. Back-ache from trying to sit up in bed without proper support from pillows.  Hollow laughter on reading several kind messages hoping that the “improvement will continue”.  What improvement?  Nature makes it impossible for people to conceive that anyone won’t have started to get better two weeks after a major operation.  Of course there are indeed improvements in a couple of marginal areas but the main problem of swelling, pain and restricted leg movement is no better and often worse.

Series of domestic disasters designed to aggravate the already barely tolerable heavy load on J.  The new washing machine delivered and installed by John Lewis, highly reputable UK store, bucks and bounds around the kitchen when it reaches the Spin mode, severely bruising J’s hands and arms as she struggles to subdue it.  The installers forgot to remove some retaining bolts used for transporting the machine.  John Lewis promise a replacement, apologetically.  Some painting and decorating due to be done during my absence in hospital has to be postponed pending delivery of new washing machine.  The shower in the spare bathroom that I was going to use (because it’s easier to struggle into and out of the bath there) turns out to be broken and seized up.  The cold tap in the downstairs loo suddenly gushes water, unstoppably, of course on a Sunday evening.  Call out plumbers from Yellow Pages and pay Sunday evening rates (our spelendid plumber neighbour is away).

Monday 29 April:  An hour of exceptionally expert physiotherapy at Inspire Atlanta, followed by 45 minutes of extraordinarily effective massage by a trained lymphoedema massage nurse (an attractive Portuguese-Angolan).  Could almost feel the hard lumps of grossly swollen tissue being gently softened and partly dispersed.  Now permitted two 10-minute crutches-assisted walks in the garden daily, and to sit at the dining-table or the computer  with wounded leg pointing south — both banned until now.  But still no reduction in the swelling or, therefore, the constant distracting pain.  Bending the leg at the knee still very limited and sometimes agonising.

One of the worst things about the experience, apart from the obvious ones, is that one’s forced into solipsism. All days and all conversations are focused exclusively on the condition of The Leg and the rest of the ancient carcase to which it’s attached.  Not only does one become solipsistic:  one’s infantilised, by total dependence, difficulty in performing simple actions, fighting to head off mounting obsession with excretory functions, constant moral pressure to try harder with the horrible painful exercises, with the threat, sometimes explicit, that if you don’t “try harder”, you’ll never get better.  The language used by most of the medics is that of the nursery.  “Try and slide your heel back a little further for me!”  “How are we feeling this morning?”  (We?)

The physios keep reminding me that it’s less than two weeks since the operation and that I mustn’t expect miracles.  The swelling will begin to go down, the pain will begin to recede, but it will all take time.  Meanwhile I feel distinctly weak and poorly most of the time, have to force myself to eat, dread the interminable reaches of every night. Still, must think positive:  J gallantly went out specially this evening to buy me a bed-rest contraption, to enable me to sit more or less upright in bed, built roughly on the principles of a deck-chair.  This will make a big difference and spare me much back pain.  My crutchmanship has earned me qualified praise.  I haven’t so far been plagued by my usual intermittent but severe tinnitus.  I think my mouth ulcers may be retreating, slowly.  The sun’s been shining and I have a lovely view from our bedroom window.  I am surely losing some weight and I’m not even tempted by wine, whisky or any other such tipple.  Today I managed to drag on a pair of shorts completely unaided   Out there in the real world thousands are being reduced to penury by a vicious ideology-driven government and I don’t even have to wrestle with my conscience over whether to go on protest marches, deliver Labour Party leaflets or attend dismal ward meetings.  J contnues to cope cheerfully and contrives somehow to conceal her utter exhaustion.  On Sky Arts 2 (television) overweight Austrians are performing the most hilariously overblown pretentious version of The Messiah I’ve ever seen or heard, and laughter is therapeutic.  I’m forced to concede that things could be worse.  But not much.

Wed. 1 May:  At last some glimmerings of progress, no doubt to celebrate MayDay, the socialists’ festival.  In the past 48 hours the swelling around the knee (and down the calf) has definitely begun to subside, although almost imperceptibly.  The physios swear that the maximum extent to which I can bend the leg at the knee has increased from 55 to just over 80 degrees (don’t ask me to explain) in the past week.  I can raise my left foot about an inch off the floor, which is an inch more than a week ago.  But each of these dazzling achievements comes at an atrocious price in toil, tears and sweat, if not so far in blood.  I live on a diet of paracetamol and Tramadol, the latter offset by prunes and laxative in a delicate balance.  Apart from the prunes, virtually all food is nauseating to me, a totally unfamiliar experience.  I force down what I can, and J labours mightily to titillate the worn-out appetite, but inevitably I get steadily weaker.  Now that I’m allowed to have a few minutes’ walk each day in the open air, perhaps some vestiges of appetite will creep back.  But it’s not easy to fit in a mini-walk into the iron schedule:  ice leg;  do painful exercises; eat; go to the hospital for more hydro, dry-land physio, or Manual Lymphatic Drainage (or MLD) massage, the latter looking faintly suspect from its, or rather her, website, but certainly seeming to produce benefits.  Anyway, even if it’s bogus, it’s soothing and restful.  (Another session is due tomorrow.)

None of these activities looks particularly time-consuming, but if you could see me putting on shoes or manoeuvring myself into or out of the car, even with anxious assistance from J,  you’d begin to understand that everything takes around seven or eight times as long as it did in those dear long-ago careless days Before the Op.

Feelings of tightness, short of pain, around the chest (left-hand side only) are beginning to disturb me a little.  I think it’s muscular, associated with back-ache caused by too long leaning back on the iron mini-deck-chair on the bed, but I’m instructed to mention it to the GP when I see her on Friday, although what she can do about it is hard to imagine.

Exhaustion continues, of course — a given by now.  Still, I mustn’t lose sight of those glimmers of progress.  “Every day, in every way, I’m getting better, and better…”    Apparently it worked for M. Coué.

Last night I slept through without once having to get up because of pain or the more usual compulsions.  Well, I was awake every now and then, but went back to sleep.  Wonder if I can pull that one off again!

Good night.

Friday 3 May:  Feeling poorly again. Luckily have appaointment with GP to review progress (progress?) 10 days after the operation.  After half an hour’s wait in the GPs’ waiting-room in considerable discomfort, the young Muslim woman next in line for the GP tells J that her husband (me) looks so ill that she’s willing to swop places and let us go in first.  As I hobble in to the GP’s surgery on my crutches, sweating and struggling for breath, the GP looks horrified.

“I’ve never seen you so pale and grey before.  Are you having chest pains?”

“Yes,  among several other things.”

She helps me onto a treatment couch in the next-door treatment room, fastens an oxygen mask over my face and sends for an ambulance.  Less than an hour later I’m being examined by a young and beautiful doctor in Accident & Emergency at St George’s Hospital Tooting, our big NHS teaching hospital, after a battery of tests and more oxygen in the ambulance.  I’m moved along to the assessment ward.  More tests of every kind imaginable.  Finally, at around 10pm, I’m allowed to go home.  None of the tests suggests that I have had or am about to have a heart attack.   Another equally beautiful young doctor stresses that if my chest pains recur at any time, I’m to call an ambulance and come straight back to St George’s.

Saturday 5 May:  After a good night’s sleep, I get up and almost immediately feel the familiar chest pains again.  (Actually more tightnesws and pressure than pains.)  Suppress awareness of this in hope that I’m imagining it.  Eat some breakfast and sit to send a couple of long overdue emails when the awareness of the chest ‘pains’ forces me to admit to them to J.  She calls an ambulance.  The big yellow van fills the road outside our house in the Mews.  25 minutes of ECGs, blood tests, blood pressure tests, more oxygen, etc., in the ambulance before the young woman member of the crew drives off with us ensures that everyone in the Mews is aware of our mini-drama.  Back to A&E in St George’s.  Much longer waits this time before anyone examines me.  Again moved to the assessment ward.  More tests.  Decision to keep me in overnight – to my releif, because much as I hate night-time in a hospital ward at the mercy of idle and tyrannical night shift nurses, surrounded by genuinely sick fellow-patients wailing, groaning and shouting fruitlressly for “NURSE!!!”, I don’t feel well enough to go home and know it would be unfair to J if I did.  In fact, the nurses on the night shift on this occasion are pure Florence Nightingale, the few other patients are either to sensible or too unwell to make a sound all night, and having gratefully taken a powerful sleeping pill along with all my otherr pills, I fall almost instantly into a deep and dreamless sleep.

Sunday, 5 May:  2:10am:  awakened by one of the Florence Nightingales hauling my arm from under the sheet to wind a blood pressure sleeve round it and take my blood pressure.  After this I fail completely to go back to sleep and lie there in the semi-darkness wishing my wounded leg didn’t hurt so much.

4:30am:  more tests.  Find some paracetamol and take a couple of them.  They don’t seem to have any effect on my leg pain.

6:00am:  More tests.  A peculiarly horrible breakfast arrives;  eat a bit of it.  More nurses appear.  A phlebotamist comes to take a few more tubes of blood out of my arm, apparently on the orders of the cardiologists, a mile or two of corridor away.  Am told that the cardiologists will decide by remote control whether to take me over for stress echocardiogram tests and if necessary an angiogram, or whether to say that in the absence of evidence from 10,000 tests of anything amiss with my heart, arteries, etc., they will advise my discharge (again).  Am told to expect that The Team will arrive at any time to deliver their verdict.  Sure enough, The Team arrives, led by a kindly and authoritative lady Professor  and comprising four or five young women doctors all in visible awe of the Professor and scribbling down in their notebooks everything the Professor says.  The kindly and sympathetic Professor asks me to describe exactly what has happened, which I do for the 35th time.  She listens intently, then examines my chest and belly minutely.  Her murmured commentary is faithfully recorded by her retiunue.  Finally she tells me that there is no evidence of heart-related problems:  that her conclusion is that the chest pains are muscular, probably related to the stresses of using the crutches, aggravated by borderline anaemia following the operation; that they will supply me with batteries of pain-reliever pills; and that once again I may go home.  I have been added to the waiting-list for a stress Echo test which I will probably be invited back to undergo in four or five weeks’ time.  With a gentle, humane squeeze of my hand, the charismatic Professor is gone, her retinue streaming behind her.  A few hours later, loaded with innumerable boxes of pills and other medicaments, J and I are home, happy and utterly exhausted.

I had mentioned to the Professor the paradox (and my disappointment) that  despite having been admitted twice to St George’s Hospital on suspicion of a recent or impending heart attack, and having spent many hours in the hospital’s excellent care, I had never one seen a cardiologist.  The Professor agreed that this was disappointing and paradoxical.  But apparently so many patients are admitted with chest pains that the cardios can cope only with those whose test results include specific symptoms suggesting a heart problem.  None of mine did.  Fair enough, I suppose.

Despite all these excursions and diversions, I’ve missed only one session of physiotherapy because of the chest pains scare:  just as well, since the key to eventual recovery is evidently the intensive physiotherapy and hydrotherapy that prevent the damaged muscle and tissue surrounding the new artificial knee from hardening and forming scar tissue that would permanently prevent mobility of the joint and require a return to the operating theatre — back to square 1.  An intolerable prospect!  But the constant lengthy sessions of physiotherapy, the long arduous exercises performed on the bed, the floor or chair, the constant 30-minute sessions icing of the knee to reduce swelling, and the interminable time it takes to climb up or down stairs or pull on a pair of shorts or do anything else that normally takes seconds, add up toa surprisingly demanding routine.

Wednesday 8 May:  Still feeling distinctly below par.  Latest theory seems to be dehydration.  I think I’m subconsciously afraid to drink much liquid because I know the more I drink after about 4pm, the more frequently I’ll be going to the loo during the night, each such expedition currently requiring a giant effort because of the knee, crutches, problem getting the wounded leg off the bed and onto the floor and later vice versa, plus other apparently trivial practical problems which loom large at 2:10am, 3:40am, 4:45am, etc. etc.  Also drinking much of anything liquid makes me feel nauseous.  Fortunately or otherwise I have absolutely no desire for alcohol in any form.  (Nor for food, less fortunately.)

I really feel like an old man at last – not too surprisingly, considering that that’s what I am.  It’s just that the operation has made me around ten years older. Anyway, all the medics promise that it will eventually become less swollen and less painful and that moving will become easier.  Of course it’s possible that they are all lying…

Friday 10 May:  Back to my GP to report on my hospital stays and review progress, if any.  She is much relieved to see me looking reasonably well, in contrast to the old grey breathless figure whom she had despatched by ambulance to hospital the previous week.  We agree that the absence of evidence of any cardiac event (so far) is welcome.  The GP is sceptical about the need for some of the drugs prescribed and provided by the hospital when I was discharged.  I share her scepticism and agree to stash them away unused, unless the situation changes.  GP prescribes an alternative painkiller and a fresh supply of the most effective, somewhat addictive, sleeping pills.

Afternoon:  another taxing session in the hydrotherapy pool at the (original) hospital.  Standing on one leg, waist-deep in warm water, when the one leg is “the operated leg” (not supposed to be called “my bad leg”), proves unexpectedly painful and difficult.  Showering and changing in the tiny dressing-room afterwards with another elderly gent who has had a hip replacement (kid’s play compared with a knee replacement, of course) we agree that it’s one of the great failings of medical science to be unable to offer an effective pain-killer that doesn’t also cause vile constipation.  We also agree that it’s only when constipated that one remembers how ill and nauseous that condition makes one feel.

Get home exhausted but manage to write a few overdue emails before collapsing into bed.  I take one of the GP’s sleeping pills and two of her new painkillers in the hope of calming down my aching leg — the operated one, which I insist is also the ‘bad’ one.

Saturday 11 May:  Wake up at about 6:30 to the dizzy realisation that for the first time since my operation I have had a whole night’s uninterrupted sleep and that on waking up I detect no significant pain from the ‘bad’ leg.  Joy!  Six cheers for my GP!  It’s probably a one-off success but it proves that it can be done.

Sunday 12 May:  Paying a heavy price for the good night’s sleep of Friday night, produced by painkillers from the GP that contain codeine.  Feeling ill and depressed all day.  Forced to resort to laxatives again.  Perhaps it’s better to put up with the pain and throw away the codeine — and the laxatives.  But that’s not how I feel when the pain in the knee and thigh wake me up at 1:25am, 2:45am, 3:20am and so on until the radio comes on at 7:15am.

Monday 13 May:  The mysterious chest pains continue but they seem to have become less frequent and less severe since I started using only one crutch, under the right arm, while indoors.  This may suggest that the pains in the left-hand side of my chest have been either caused or aggravated by over-dependence on the crutch under my left arm, over-compensating for the weakness of the left knee and leg.

I have good days (and nights) and rather more bad ones;  it’s too early to read any significance into either.  I’m told not to expect any appreciable relief from the swelling and pain until eight to twelve weeks after the operation, and so far it’s only four weeks since I had it.  They say that I should notice a further improvement six months after the op (which takes me to mid-October), and that after one year I should be virtually back to normal (April 2014).  I suppose at that point I shall have to decide whether to have the other knee done as well, which will put paid to 2014-15 if I do.  The other knee is apparently even more badly worn than the one that’s just been carved out.  It will be an appalling decision.  I prefer not to think about it.

Whether it’s a good day (or night) or a bad one seems to be at the whim of the gods, but also partly dependent on the state of the perpetual duel between the pain-killers and the laxatives, another impossible choice.  Yesterday was grim; today has been a lot better.  Tomorrow will probably be bad again.  No long-term trend can be extrapolated from these random changes for the better or the worse.  The medics all insist that the thing is taking its normal course and that it will all get gradually better over the next six to eleven months.  Well, they would, wouldn’t they?

Thursday 16 May:  After another bad and mainly sleepless night of pain and discomfort, a rather good day in which my mobility does seem to have improved and an ingenious cocktail of painkillers has largely silenced the swollen knee’s protests.  Am now allowed to limp round the house without crutches (except of course when tottering up and down the stairs) and to go out of doors for walks with only one crutch instead of two.  The swelling is obstinately resistant to vigorous physio massaging from calf up to groin, but I have to remind the physios that the leg was swollen (souvenir of a bad bike accident seven or eight years ago) even before the knee replacement operation just four weeks ago.  It may be too much to hope that physiotherapy for the knee op now will restore the leg to anything resembling its condition eight years ago.

Feel entitled to celebrate improvement in mobility — I can actually bend the operated leg at a sharper angle than just a week ago, and can cautiously put some weight on it with only occasional buckling — although it’s far too soon to interpret it as the start of a process of release from pain, forecast for around a month from now at the earliest.  Unfortunately when I received my initial visit from The Good Fairy almost 79 years ago, she forgot to deliver a ration of stoical patience among the package of virtues being distributed.

Friday 17 May:  A stunningly good night, thanks to a single Zopiclone which had roughly the effect of being hit on the back of the head by a baseball bat.  Unfortunately Zopi is somewhat addictive, although at my age….   Only begin to regain consciousness at around 10am.  No doubt the leg was hurting like hell all night but I was blissfully unaware of it.  Zopi 1, knee 0.

Extract from today’s report by J to friends:

Brian’s leg continues to be as painful as he had been warned it would be but his mobility is getting better and the leg is making good progress.  He is still pretty knocked out by the experience.  It’s no wonder that Mr F [knee surgeon] warned him a couple of years ago that if he left it too long to have the replacements he wouldn’t survive the operations.  It’s obviously a very major shock to an ageing body.  He has good days when he eats with some relish and looks more like his old self but,  just now, after a session of hydrotherapy, he is absolutely down again.  It’s going to be a long haul.  But the New Yorkers [NYC-based daughter and two granddaughters of university age] are arriving on 3 June and we have various events planned during their stay involving the whole family so that should kill or cure.

Wednesday 22 May:  Two sessions at the hospital this afternoon, half an hour with my usual physiotherapist and an hour with the lymphatic drainage massage expert.  By the end of these my leg feels as if it’s been put through a wringer.  But between them these two energetic pummellers have added six or seven points to the angle at which I can bend my leg so I suppose it’s worth it.  Until now, it’s been one of my better days, having had a restful night despite an almost total lack of sleep.  Spent much of the night composing limericks about knee surgery.  At around 4am this morning several of these seemed so outstandingly brilliant that I was considering sending them to my knee surgeon in the morning.  But in the cold light of day (about 6am) I had to acknowledge that they are utterly inane.

Thursday 23 May:  1:20am.  Whether or not because of the hard pummelling of the leg yesterday, it’s painful enough tonight to make sleep seem a hopeless ambition and even a moderately comfortable position in bed unattainable.  I get up very quietly (although it takes very little to wake J up, unfortunately), limp about from room to room to stop the leg seizing up, and take another (different) pain-killer and a couple of the pills that have been prescribed for my occasional bouts of really intolerable tinnitus but which also tend to send me to sleep.  Decide I might as well bring the Knee Diary up to date while I wait for these latest chemicals to start working on my system.  Actually I wonder whether the cumulative effect of all the chemicals that I now imbibe in one form or another every 24 hours might be to affect my consciousness in some way.  I certainly experience a curious sense of unreality as (with J’s help at almost every turn) I stagger through each day’s almost indistinguishable routines, crutch-assisted descents and ascents of our rather steep narrow stairs, crutchless limping around the bedroom and the kitchen, forcing down small quantities of carefully chosen food that just six weeks ago I would have wolfed down with unseemly greed, icing the leg, doing my exercises, into the car to go to the hospital for more physio, back to the bedroom to ice the leg and do the exercises again.  And always the pills.  And the horrible scratchy white hospital stockings, from toe to groin, to guard against deep vein thrombosis — with luck I’ll be allowed to discard them when I see the consultant surgeon again next week.  And always the pills, and the pain that the pills sometimes dull and sometimes don’t.  Often it’s the knee itself that seems to hurt, as if the hunk of steel and plastic that has replaced the old worn-out joint has the capacity to produce pain.  Perhaps a pain chip is embedded in it to mimic real knee pain.

1:45am:  No sign of pain reduction or sleepiness so far.  Reflect on progress.  I get irritated by continuing flow of kind messages welcoming recent signs of progress in recovery when in fact I often feel just about as unwell most days as I did two, three, even four weeks ago.  But I have to admit to myself that the knee and the leg in which it has been skilfully inserted have made perceptible progress over the five weeks since the operation, in mobility, bendability, capacity for weight-bearing (with occasional bucklings), and beginnings of reduction of swelling, although in that department there still seems a hell of a long way still to go, especially as the leg was already quite badly swollen (from a bike accident seven years ago) even before the knee replacement,  and it’s probably too much to hope that any amount of pummelling by the physios, and of painful exercises on the bed or on the floor, will make much impression on that old injury and its consequent swelling.   The most I suppose I can reasonably hope for is to get the swelling down to what it was before the operation five weeks ago.

No wonder the whole experience is having this consciousness-altering effect when all I can write about at nearly 2 o’clock in the morning is the state of the damn knee and the difficulty of getting any sleep.  Those in pain tend to  (a) obsess about their own condition and (b)  bore the pants off everyone else on the subject.  I should be writing about the gruesome decapitation on a street in Woolwich yesterday afternoon of, probably, an off-duty [Muslim][1] British soldier returning to his barracks, and the way the prime minister has cut short his official visit to Paris to “rush back” to London to take control of the crisis, pausing only to utter a fatuous sub-Churchillian statement about how Britain will never ‘buckle under’ to terrorism and has always defeated the terrorist threat to our way of life by expressing the bulldog spirit, etc. etc. — as if squadrons of passenger planes hijacked by crazed Islamicists had spent all day flying into all our landmark public buildings. Whereas all that has happened so far is a single murder, admittedly of exceptionally obscene brutality, carried out by two men shouting gibberish about their determination to keep on fighting until we leave “their” countries alone.  Since both men seem to have spoken, or shouted, in broad south London accents, one wonders which “their countries” could be —  Afghanistan and Iraq, presumably, Libya possibly, although I doubt whether either of the ‘suspects’ has ever been anywhere near to any of these countries. Apparently they hung about at the scene of the killing for about 20 minutes, shouting and gesticulating about having carried out the will of Allah and being filmed doing so on the mobile telephones of passers-by, waving bloodstained hands and knives and a meat cleaver.  My guess is that they wanted to be killed (‘martyred’) by the police and security forces but they took so long to get there that this became a bit of an anticlimax and anyway when they did manage to get shot, they were only wounded:  when the police finally arrived, the bloodied ‘suspects’ tried to rush the police vehicle but a policewoman emerged from it and shot them both, not immediately fatally — both are in (separate) hospitals undergoing treatment for their gunshot injuries and under armed guard.  The home secretary immediately summoned an emergency meeting of COBRA (stands for Cabinet Office Briefing Room A) to discuss the emergency with various solemn functionaries, confirming that Cameron, cutting short his Paris trip, will be back in time to chair another COBRA meeting at the crack of dawn today, i.e. in a few hours’ time.  All a gross over-reaction to what is probably a single private act of jihadism with a single (Muslim) victim, hardly a threat to our whole way of life as represented by Cameron at his joint press conference with the unfortunate French President Hollande, who looked as if he was wondering what on earth Cameron was on about.

One sad by-product of this murder and the official over-reaction to it is that it has driven off the front pages and the lead stories in the TV news bulletins a much more sobering statement by the generally hyper-conservative IMF telling Osborne to inject some instant new infra-structure spending and tax reductions into our flagging economy to stimulate demand and spending even if it involves a short-term additional increase in government borrowing.  Osborne is wilfully misinterpreting this as praise for his existing austerity programme which as everyone on the left and the right can see is visibly failing and going nowhere.  There’s nothing like a gruesome murder of a single unfortunate individual on a London street to take UK minds off the spectacle of even the IMF counselling a change of direction in the obsessive pursuit of deficit reduction even it will mean additional government borrowing in the short term. But the government is having to borrow billions more than its own forecasts anyway to finance its own failure.  As Ed Balls has been predicting for three years now, austerity isn’t working but Osborne dare not deliberately change course and borrow even more in the short term to pump some demand back into the economy and start to restore domestic confidence, for fear of exposure as a failure and a fear that he’ll get sacked and relegated to the back benches as a failure.  Balls talks very appositely about the ‘automatic stabilisers’ but Osborne shows no sign of knowing what they might be.

2:30am: Well, that makes a change!  But the new painkiller seems to have become a pacifist, the leg is protesting at being marooned in front of the computer and sleep seems as far away as ever.  Debate whether to struggle down to the kitchen to make myself another mug of Ovaltine or perhaps a clear beef consommé to while away the time until it starts getting light.  Decide this would be defeatist and that the only thing to do is crawl back into bed, lie on my back with the leg stretched out and have another go at some limericks to pass the time until daybreak and the new day’s fresh assault with chemical weapons.

[1]  I thought I had heard the murdered British soldier described on television as a Muslim, but I now find that this was a mistake and there has been no such report.

2:43am:  At last!  My eyelids have started to droop.  Back to bed before I wake up again.

Tuesday 28 May:   Exactly six weeks since the knee replacement operation.  Had a good night (lightly chemically assisted) but feel weak and seedy all today.

Extract from reply to kind message from old friend:

I’m getting appreciably better at moving around and bending the damaged leg but still feel generally lousy three days out of four, with problems of pain and insomnia most nights.  I’m seeing the man with the scalpel tomorrow for a review of ‘progress’ and am devoutly hoping that he will permit me to discontinue the horrible scratchy hot white hospital stockings, toe to groin on both legs, which if so will mark a real improvement in my condition, trivial though it sounds.  But the official forecast – no significant improvement for 8 to 12 weeks after the op, then another at six months, complete recovery after about a year – seems likely to prove accurate, and the operation was only six weeks ago today.  (I’m only gradually coming to terms with the near-certainty that I’ll have to go through it all over again, probably next year, to replace the other knee, even more badly worn than the one just replaced.)  …   Thanks again for the expressions of sympathy.  I have probably been exaggerating current unpleasantnesses although it hasn’t felt like an exaggeration at the time of writing, and doesn’t now! 

Wednesday, 29 May, the final entry in this log:  Visited my consultant orthopaedic surgeon, Mr F, for a routine review of the knee just six weeks after the operation.  At last some rays of light and hope!  Mr F is obviously astonished to see me get up from my chair in the waiting-room without having to lever myself up by the hands and arms, and then walk at a reasonable pace in a straight line to his room, holding but not using my walking stick (no crutches).  Apparently all this is distinctly unusual at only six weeks.  Once up on his couch, bending and stretching the leg, with Mr F cautiously feeling, manipulating and pressing it, I’m even more gratified that he’s even more admiring of what seems to have been exceptional progress in the mobility of the knee joint and surrounding tissue, although it’s still badly swollen and intermittently painful.  Apparently many patients much younger than me make appreciably less progress in the first six weeks.  On this basis, Mr F predicts, I will make an excellent recovery — but it will take time.

All this is very good for morale, and unexpected.  But more boosts are to come.  Yes, I can dispense at once with the miserable white hospital anti-DVT scratchy stockings.  Yes, I can drive the car whenever I feel sufficiently confident (happily it’s an automatic so there’s nothing for the left leg to do).  Yes, I can have a bath instead of a shower, once I’m satisfied that I can climb out of it.  Yes, I can take my powerful sleeping pills every night for a few weeks, reducing the frequency gradually, without risk of addiction.  Best of all:  I probably won’t ever need to have the other knee replaced after all.  Once the new knee is fully operational, around a year after the operation, it will take most of the strain, relieving the other knee of a lot of the stress and thus reducing further wear and tear on it.  Discreetly checking my date of birth, Mr F reckons that with one good knee in place, the other will probably see me out — excellent news, if slightly double-edged….  So I probably shan’t have to go through all this again after all.

There won’t, I’m warned, be any dramatic reduction in pain levels, especially at night, for several more weeks.  I’m still only able to walk, or limp, for limited distances, and longer outings will not be possible for some time.  Painkillers will continue to fight their dismal war with laxatives for the foreseeable future.  No sudden recovery is to be expected.  Regular sessions of punitive physiotherapy continue for at least another six weeks.  I’ll continue to have good days and bad days, perhaps in slowly improving proportions. Things should start looking up about 6 months after the operation — next October.  But today’s review has cheered me up more than anything that’s happened since the scalpel sliced open my leg on 16 April, which feels like forty years ago.  Hurrah!

And on that somewhat belatedly cheerful note, I close this diary for ever.

__________________________________

Kind, solicitous and perceptive messages (and comments appended below) continue to arrive from good friends and much-loved relatives, many of whom have gone through much worse than anything I’m currently experiencing.  I love to receive and read them and re-read them.  Thank you profoundly for every one.  And thank you for not expecting answers to every one of them.

A final PS:  several kind friends have enquired about coming over to see us while I’m still recovering (i.e. for the next six to nine months).  For the next two months a lot of our time will be spent with our New Yorker family, daughter, granddaughters and sundry boy-friends and suchlike, all arriving at various times during the next week or so, popping over to the continent and returning, and going back to New York in relays.  Meanwhile for my part an amazing amount of time is committed to constantly icing the swollen knee and repeatedly performing the fiendish exercises to which I’ve been sentenced.  Ordinary everyday activities like getting dressed and having a shower take five times as long as they did before.  Of course fleeting visits for a 10-minute chat are nearly always welcome — but at pre-arranged times, please, in case I’m out having more physio or seeing the GP or something.  I’m sorry to say that more extended visits are going to have to wait for a few more weeks.  But do check the position (please by email) in two or three weeks’ time if you might be able to pop in for a chat.

Brian