A Real Hip Story

Published 2 Dec 2016

                                                           Centre Hospitalier, Saint Junien

Well, I bore the disorder for as long as I could, but in the end the torment forced me to get it done. Or rather get both of them done. My hips, I mean. For I had reached the time of life when hips can become as much a problem as an asset.

So I decided to go in for 'hip replacements'.

Since the left one was the worst of the two, I had it dealt with first in the Centre Hospitalier of Saint Junien. The operation was conducted conventionally with the aide of a general anaesthetic and when I'd recovered from it's affect I felt like I'd been blessed with a new leg.

Two years later I resolved to have the right one done. Now, medical practice in France, where I live now, is a bit different from English practice. One of the differences is that prior to surgery the patient has to see the attending anaesthetist. When I did so, he asked me an unexpected question. Did I wish to have a general anaesthetic or a local one?

I was speechless. I never dreamed that an operation aimed at chopping off a chunk of leg could be tackled while the patient was awake!   However, when the advantages of local anaesthetic were explained to me,  such as pain relief for a longer period of time after the operation, reduced blood loss and faster return to normal eating and walking, I began to be convinced, especially since I recalled  suffering headaches and nausea for two weeks after that last medical episode.

But when the time came I began to regret that decision, for I found myself being restrained in a sitting position on the operating table while the anaesthetist inserted a needle into my spine. The pain of it was excruciating, and my back instinctively recoiled from the stab. I was asked to keep still while another puncture was ventured. A second serge of pain provoked  a second recoil. The anaesthetist (a charming man really) now told me firmly that I must keep still. I felt ashamed then for having appeared so feeble and vowed to myself that I would keep still this time no matter what the pain.

By a stoic effort I succeeded in keeping still this time for the injection and the burning sensation that followed it.

Next I was given a second painless injection in the arm to induce 'drowsiness'.  This I took to mean that I would be somewhat aware of what was going on, but only in a vague, dream-like sort of way.

The reality was quite different. In the event, I felt no more drowsy than if I’d drunk a glass of wine. In fact I was fully conscious throughout the entire operation, and aware of the smallest details of the undertaking, although I was spared any sight of it by a makeshift screen that had been erected between my head, lying sideways on the pillow, and my torpid trunk, which, though completely unfeeling now, I could still sense in a peculiar sort of way. Experimenting a little, I willed a leg muscle to contract, but nothing happened. On the other hand, I could sense the preparations being made to prepare the leg for the work. It was being elevated by some means or other (a jack?) and when the elevation ceased, I thought I knew quite accurately the angle of elevation.

Although I felt not a throb of pain during the entire operation, which lasted more than two hours, I could more or less tell, by means of vague sensations and/or very clear sounds, just about where we were up to in the proceedings. Thus, when the jacking and cramping had been finished I felt I knew the exact moment when the scalpel was inserted into the thigh and a slit made. Later, when I heard the sound of a small saw spring into life, I knew that the femur was being cut.

As he worked, my doctor sustained a ceaseless chatter with the anaesthetist and the nurses while now and then calling for a tool. It was shortly after he called for a hammer that I heard a series of taps, which I construed as preparatory work - possibly hollowing-out work - on the pelvis for the reception of the ‘cup’. At this point I felt like some statue taking shape – though not of David, regrettably ;-) – under the hammer and chisel of a sculptor.

Next a stage of heavy work began. Doubtless a heavier hammer was in use – to fix the ‘cup’ in place, in my estimation of things. At each blow, or thud, as I may say, my head slid slightly back on the pillow and then slid ahead again. This work went on for some considerable time, and as it required no particular close attention, as I supposed, my doctor took to singing while he worked, as though, instead of conducting a highly-skilled operation, he were merely beating a panel in an auto body shop.

A period of quieter, more delicate, work ensued, I thought, probably involving the fitting together of component parts, and then a series of extremely fine sensations conveyed the idea that my doctor was plying his needle and thread.

The aftermath of the affair showed the wisdom of my choice. I suffered no headaches or nausea.

It's interesting to note that the hip replacement operation was pioneered by John (later Sir John) Charnley at Wrightington Hospital in Lancashire, just three miles from where I lived in England.

                  John Charnley

The Man in the Striped Pyjamas

Published 25 Sep 2016

One day in the autumn of 2001 I found myself in a bed of my local hospital in Lancashire suffering from pain in the region of my heart and left arm. When medical checks had been made I was told that I had suffered a heart attack.

On recovery from the shock of swallowing that bitter pill, I took on the task of adapting my habits to hospital practices, such as the changing of the bed sheets. On the morning of my second day of treatment I was asked to slip down to the floor, still attached to my wires and drip tube  and wait while two nursing assistants swapped the used sheets for clean ones.  

When this chore had been completed, a nurse, Angela by name, appeared with a basin full of water and placed it on my bedside table. Then she isolated my bed from the rest of the ward by dragging the bedside curtain across the space in front. Well, you can guess what was coming next. The woman, blonde of hair, clear of complexion and a little on the plump side, busied herself with preparations. Then – would you believe it? – she asked: "Are you still at (---)?" And here she named a school where I had taught some 12 years before.

What? I was to be bed-bathed by a former pupil of mine? How embarrassing!

"You didn’t actually teach me, I don’t think," she answered in response to my question, "but you were there when I was."

Well, that was a relief. But still...!

"I’ll do your back now," she said professionally, and while I was stripping off my pyjama top she wetted my facecloth and squeezed a blob of shower gel onto it. When she’d scrubbed my back and my arms as well she said she’d leave me to do my front and ‘lower down’ - unless I needed any help.

"No, no, that’s all right," I hastened to say. When she’d slipped through the curtain I eased my pyjama bottoms down and then ineptly spread a towel under my bottom before proceeding with the awkward job of washing ‘lower down’.

A couple of days later when I was detached from my array of medical instruments and freed from my bed to wander the ward, I was able to engage fellow patients in conversation. One, tenanting the bed on my left, was older than me. A pair of spectacles glimmered over his nose and a perpetual grin ornamented his lips. His name was William.

"Is this your first attack?" I asked him one day when he stopped on his walk by my bed.

“No, second!” he replied, almost with a touch of pride. I suppose he saw himself as a bit of a veteran here, while the rest of us were mere novices.

“I know what it was,” he said with his eternal grin, “doin’ too much in t’garden.”

He seemed to be enjoying his time here. One lunchtime when a nursing assistant was serving soup from a monumental metal cabinet she asked if I’d like it in a cup or a bowl. A voice from behind my left curtain grunted, “Ged a booget, Golin. It’s good!” in between spoonfuls of soup it sounded like.

On his first stroll out of the ward he returned with a gleeful grin and said simply, “A’ve sin t’leaves on t’trees. Ahm ‘appy.”

That spoke volumes to me.

Another patient, Mark, aged fifty-three, told me he’d been something of a runner in his time, racking up some ten miles a day. He’d undergone surgery for some complaint several weeks before arriving here, he told me, and on October 7^th – the fatal day for me too – he was engaged in doing exercises when he suffered what later proved to be a massive heart attack. His doctor told him that it had been caused by a blood clot from his operation that had moved up to the heart.

One wonders about that ten miles a day. What was he trying to prove? One wonders too why he was doing exercises following surgery. He was an inveterate talker and it was hard to insert a word into his continuous chatter. A certain reluctance to listen to reason was shown in his categorical statement that after a heart attack one could build up the heart to its former strength by exercise, and persisted in this opinion against my claim that a damaged heart could never be as strong as an undamaged one. 

But he clung to his view until compelled to desist when I said my claim came from the cardiac rehabilitation nurse. As I listened to him I felt that this would probably not be his last experience of a heart attack. He was a living example – only just! – that people are the architects of their own destiny. But he was a friendly sort and proffered his hand on parting, saying he’d see me at the rehabilitation sessions in a few weeks’ time.

It turned out that I never saw him again because my rehabilitation was delayed for three months when the administration of an electrocardiogram revealed that I was harbouring a little blood clot of my own, requiring treatment by regular doses of warfarin.

A third patient, Ron, was only fifty-one. He’d had his attack on holiday in Whitby. Like me he hadn’t recognised the pain as that of a heart attack, but whatever it was, he said, he did not want to be confined in a hospital at Whitby, so he drove 120 miles home before being brought into hospital. To make matters worse his back troubled him though twice operated on in the past, and he was due for a third operation when the attack happened. That had left both arms feeling like dead weights, he said, so he’d pushed his driver’s seat forward in the car and had sat with the steering wheel gripped between his hands and his arms wedged between his knees all the way home. They just don’t make ‘em like that any more!

Life in the ward came to be pervaded by a grey uniformity. Nothing varied the endless succession of breakfast time, tablet time, lunch time, siesta time, dinner time, visiting time, tablet time again and lights out time – nothing, that is, till one night after lights out when I lay awake and watchful - since my bed curtains were just drawn out at the sides. A young man in a white coat and spectacles, new to our ward, came in and began a muffled conversation with Angela in the pale light of the nurse’s partition. Their words were out of hearing but the man’s manner was plainly insistent. Angela looked anxious. Something was afoot. The dialogue went on for about fifteen minutes, ending with a reluctant nod from the nurse. I think I heard her visitor say, "Thanks," before leaving.

Somewhat later the forward end of the curtain to my left rippled a little and then swung  rightward to obscure my view beyond the foot of my bed. Its back-lit folds then presented, like an old-time lantern show, the silhouette of a man towing the end of a bed. The movement of the curtain could have been accidental, but I had the impression it was deliberate. However that may be, the curtain's end came to a standstill some three feet short of meeting the end of the curtain on my right, and the man clutching the bed's end materialized in the three-foot gap. 

He looked in on my wide-eyed survey of this late-night dumb-show and made as it to say, "Hello," but then compressed his lips. Now a pair of pale feet came out from behind the curtain, followed by a pair of legs in striped pyjamas. Then a horizontal torso in a striped pyjama top sailed past, followed by a waxen face and head, straggled with silver strands, propped against a pillow, its chin slumped upon its chest.  A second man then tramped past, arms extended and hands grasping the head of the bed. When he was gone the curtain swung still and all was motionless once more.

The experience left me perplexed. Had the fellow in that bed been alive? But the show was not yet over. A little later a bed containing an aged lady tucked in it rambled past in the opposite direction, managed by the same two attendants. Later still, another ancient lady stretched in a bed taxied past in the same way. Naturally I was curious about all this traffic in the ward at that late hour when, generally, the work of hospitals has come to a close, but early in the morning my curiosity was seized again when two figures appeared on my curtain-screen with a shadow of a bed in the space between them. But in place of anything in the shape of a patient stretched upon it, it carried a rectangular thing almost the length of the bed.

As it ran past my curtain-cleft I saw that it was made of canvass and was maroon in colour. It was about eighteen inches high, and its sides were slightly slanted. Now, not only my curiosity was stirred, but my suspicion too, a suspicion that positively flamed when that strange shape came back again, travelling in the opposite direction, to flitter through my curtain-cleft and then go rippling away to the left, in company with its couple of ushers.

At breakfast time when Angela brought my tablets, I asked: “What was all the excitement about in the ward last night?”

“Oh, just a couple of ladies being brought in,” she said casually.

It had seemed to me that they were being taken out, and, significantly, she never mentioned any man in striped pyjamas.

  

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Later considerations

After lengthy  reflection on the topic I have come to the conclusion that my man in the striped pyjamas had in fact been dead. Several details of the affair favour that interpretation. First, the lateness of the hour. You would not expect to witness so much movement in a hospital after lights out.

Second, the urgent manner of the young man in the white coat and spectacles as he made what was clearly an  appeal to Angela, and the obvious resistance in the manner of her response, not to mention the reluctance of her bearing when she finally gave consent.

Third, the vale of secrecy flung over the whole affair, in particular the pathetic attempt to obscure my view of these events by means of a clumsy thrusting forward of my bed curtain, and most tellingly, the complete absence of the man in the striped pyjamas from the account Angela gave of the episode when questioned about it.

Last, and most important support for the claim that I had seen a dead man wheeled past my bed was the appearance in the morning of that rectangular canvas thing, maroon in colour, that passed by my bed from the left, and then several moments later passed it again from the right. A little research I conducted in preparation for the writing of this post revealed that the object I had seen looked much like the one shown in the photo below.

It is a box used in hospitals to move corpses around.