Surgery today — with anesthesia!
Two hundred years ago thing were really different — surgery was a thing of nightmares. Today it’s a walk in the park.
I write these introductory lines lying in a park clinic, in a wonderfully functional adjustable bed, my mini-notebook on a dinner tray just above my stomach, with fast WiFi service. I’m attached to a number of monitors — blood pressure, ECG, a drip into the back of my hand, and a few other things. I sip the rest of my breakfast coffee, while periodically a nurse or doctor will turn up to see if I am okay.
I am here for partial knee replacement surgery. Some years ago I had a garden accident (I have two or three much more interesting versions, but today we will stick to the truth): I was pulling out a shrub, which would not give, and then suddenly did. That sent me flying through the garden with a hideously injuring my knee. Orthopedic examination revealed that I had torn my right meniscus, the cartilage in the knee that cushions and stabilizes the joint, protecting the bones from wear and tear. All it takes is a good twist to tear the meniscus. Unfortunately this is one of the few tissues in the body that does not repair itself. It simply got progressively worse.
So I ended up with no cartilage between the femur and tibia on the inside of my right knee. After a few years of constant pain I decided to take the advice of my orthopaedic surgeon and go in for partial knee replacement — but not before I had checked with a top orthopaedist during a holiday in California, one who knew I would not be getting anything done in his clinic. He confirmed: I should get a medi Oxford Knee, exactly the kind my surgeon in Hamburg was suggesting. Important: always get a second opinion from a doctor who does not expect to do the expensive procedure himself.
Anyway I checked into a beautiful park clinic earlier this year, but was sent home after the first blood test: you have an infection, we can’t operate until that is gone. What I learned in the months that followed is that they are quite paranoid about getting everything right — making absolutely sure you do not die while undergoing non-essential surgery in their clinic. That is terrible for their reputation. It’s generally a good thing too.
Let us take a look back at what humanity had to endure for thousands of years — until the introduction of ether as an anaesthetic sedative in the 1840s.
Surgery without anaesthesia was unimaginably brutal and only performed in extreme circumstances. Patients were not told it was going to take place, until the last moment, in order to limit their anxiety. They had to be restrained by many helpers, and the surgeon who was quickest at conducting procedures was the one most sought after. I leave you to google for more on the subject if you are so inclined — here’s an impressive description.
I come to the part I want to narrate in this article: surgery under the use of modern anaesthetics. I checked into the clinic on Tuesday, and after a hearty lunch in their restaurant I was taken to the anaesthetist who spent half an hour quizzing me on my medical history. Then I was shown to my room. I shared it with an Argentinian born German aircraft engineer who turns out to be a thoroughly pleasant companion — affable and humorous. He has read my stories on Finding a Plane and the preposterously large A380, an aircraft on which he has worked. Alfredo was also there for knee replacement.
The afternoon and evening were spent checking me out, from head to foot. They took blood samples, checked my BP, heart, lungs, everything. They frowned at an ingrown toenail but decided that it did not jeopardize my chances of survival. I spent the night attached to different monitors, and they even tried an oxygen supply on me, to see if I could handle that well.
The next morning I was woken at 6 a.m. and prepped for the operation at eight. A needle was inserted in a vein on the back of my hand (“you’re going to feel a small prick”) and I was covered with green sterile sheets. After that the following conversation occurred:
Attending nurse: “I will now give you a mild sedative which will make you feel warm and calm…”
Me: Yes, it’s very nice… By the way, how long will the operation take?
Attending nurse: “It took just over an hour, and went very smoothly.”
That, I swear, is exactly how I experienced it: no time lapse between “It’s nice” and “How long will it take.” In spite of the fact that it had actually taken over an hour and had involved cutting, sawing, chiselling, filing, screwing and stapling (no explosives involved, I believe). They did not film anything — I wanted them to — but if you have strong nerves you can watch the procedure being performed on somebody else in this video.
Anyway, I was awake and cheerful immediately after the operation, and was taken back to my room. When the doctor asked if I was in any pain I said absolutely none. In fact for the first time in years I did not have the general ache in my right knee that was often there, even in repose.
I spent a quiet night with light beverages, completely at ease. The only thing that I found disquieting was the lump of meat and bone attached to my right side: I could feel nothing in my leg, couldn’t move a muscle.
The next day the pain came, slowly but growing. They asked me to calibrate on a scale from one to ten. When it reached four (genuine discomfort) they injected an anaesthetic substance into a very thin cannula leading into my leg, to the femoral nerve. And fifteen minutes later all traces of pain had disappeared. Once again the leg was numb, but absolutely no pain or discomfort.
That was Thursday, the day after the operation. They slowly weaned me off the direct femoral anaesthetization and replaced that with oral medication — with the net result that I have felt no pain since the intervention. My friend Alfredo in the bed next to me did not do quite so well and had to keep his femoral cannula in, to get follow-up doses when the pain was too much. They were emphatic: don’t bear it, just call us. There is no advantage to remain in pain.
One further important development: as a prophylaxis against deep vein thrombosis I am being given a daily injection of Fragmin, and I must continue administering it to myself for a couple of weeks. I tried it today, with the small one-way syringe (picture above) I will be getting box full of. You pinch the skin of your stomach and, acting against all instincts, plunge the needle in, right to the hilt. And you don’t feel a thing. I mean it’s not a tiny, bearable prick — it is actually nothing. I must remember to search for my screw gauge at home and measure the thickness of this needle. It must be close to zero.
Friday the physiotherapist came and allowed me to take first steps using a rollator (a walking frame). I spent half a day on that, and was allowed to traverse the length of the corridor. Saturday I was given forearm crutches and walked a few hundred yards — before discovering that I could do it perfectly without the crutches. Remember, this is the third day after surgery. Quite incredible. And still no pain — none at all. So I am cautiously optimistic…
Tuesday: this morning they removed the bandage — essentially simply a transparent film you see in the left image. When they took it off I could see how they “stitch” wounds these days: they use metal staples (right picture), for which they probably have a staple gun, like the one I used to attach foil to my roof. The staples are due to be removed in a week from now.
Wednesday: here are the x-ray images of my bionic knee, taken this morning. The surgeon said I was mistaken to think that now I would be able to kill people with a single kick. But I was assured that I would soon be able to walk and run like I hadn’t been able to do for a couple of years.