What I Did On My Summer Vacation
What I mostly did, at least during August, was get my right hip replaced. The old model had been stiff, painful, and a damn nuisance, for somewhere between five and eight years. Eventually, it forced me to the routine use of a cane, which (impelled by vanity) I put off for as long as I could. I bought one that was cheap but reasonably good-looking, but when it started looking beat up, I was faced with the choice between buying a really nice but rather expensive one that would serve as a fashion statement rather than a mere mobility aid, and getting the underlying problem fixed. All my friends who had had replacements told me the latter was absolutely the way to go. Well, so far, I think they were right, and I should have had it done at least five years back.
It was more complicated for me than it would have been for most of my friends, because Mr. Wired is, as I think I have mentioned, disabled and bed-bound. For more background on this issue, google “family caregivers”, which will send you to, among other places, the National Family Caregiver Alliance. They do good advocacy and education, and will tell you lots of what you will almost certainly need to know at some point in your life, unless you are an unmarried orphan only child in superb health, who has a written guarantee from Destiny of dropping dead at the age of 90 from One-Hoss Shay Syndrome.
When the operation was over, I spent two or three days in the hospital before being sent on to rehab. The situation was complicated by the fact that my surgeon, whom I regularly met with in downtown Chicago, actually had his main office, and did all of his surgery, out in the far suburbs, in what columnist Bob Greene used to call the Land Beyond O’Hare. So when the hospital people brought me a list of rehab facilities, all of them were also in the far boonies. I picked the one my surgeon seemed to prefer, which turned out to be a good choice. And then I signed myself into it for rehab, and Mr. Wired for respite care.
What is respite care? you may ask. The earliest reference I can find in a cursory search dates to 1979. I shudder to think of how people managed before then. When a disabled person is cared for by a family member, the family member sometimes has to spend time doing other things. Like earning a living, or getting health care herself. So somebody else may have to fill in for the family member, temporarily. These days, that somebody else is often provided by the community or by various charitable agencies. That’s respite care. Sorry about the 6th-grade locutions here, but many politicians and other eminent thinkers have trouble grasping this concept, probably because they really don’t understand that family care and housework are real work, which takes time and energy and thereby makes that time and energy unavailable for other things. For the family to accept respite care from the community or various charitable institutions does not constitute free-loading or “dependency.” On the contrary, it is the only alternative to total dependency (or, of course, death.). But I digress.
My rehab is covered by Medicare, which has managed to figure out that there is no point in getting a hip replaced if one must then immediately go back to mopping floors or running marathons until it breaks again. But Mr. Wired’s respite care isn’t. At least, not so far as I have been able to figure out. Some of it, I covered out of the family budget, thereby postponing payment of other necessary expenses. Some of it was covered by the two congregations I belong to, bless them. Some of it was written off by the rehab people, bless them.
Anyway, the two of us booked into a very decent mid-level facility (name available on request), in a shared room, where the staff viewed us as “cute” and “adorable” because we have been married for 46 years and still want to room together. The staff did everything for Mr. Wired that I had previously done, and provided me with intensive physical and occupational therapy. It was kind of like a cross between Club Med and West Point. It even felt kind of like a second honeymoon. Three therapy sessions a day, for three-plus weeks, until I was able to get around on my own on a walker or cane, and go home for more therapy at home and outpatient.
The rehab facility, which is also a nursing home and does a bunch of other stuff for somewhat different populations, is fascinatingly stratified. At the top are the administrators. Then come the doctors, the physician’s assistants, the advanced practice nurses, the RNs, and the therapists, in roughly that order. After them are the CNAs (who used to be LPNs, orderlies, and nursing assistants, I think—correct me if I’m wrong, docs), and then the housekeeping people. One learns very quickly never to ask any of these people to do something normally done on a lower level, except in emergencies and with profound apologies. They are, however, surprisingly nice about doing lower-level duties in a pinch if the patient behaves well. (I have heard that this is not necessarily true in other facilities.) At the top of this great chain of being is the facility dog, Gus, who is beloved by all and accountable to none.
Therapy is provided by two kinds of people: physical therapists and occupational therapists. Physical therapists are almost all female, young, and very good-looking. I don’t know if there is some appearance requirement for the training or it just works out that way, and haven’t had time to ask anybody yet. They are very strict about making sure the patient does all the work required but doesn’t transgress any of the Sacred Precautions. (For hip replacement, the Precautions are: no bending at the waist/hip tighter than 90 degrees, no crossing the legs, and no turning the toes inward. I assume there are other precautions for other kinds of problems.) My friends who have undergone intensive p.t. characterize the therapists as Florence Nightingale meets Drill Sergeant.
Occupational therapists are a broader mix of age, gender, and appearance. They need to know what the patient’s Outside World is like, so as to devise solutions to real-world problems. Florence Nightingale meets McGyver. (A friend of mine who was an o.t. some years ago had to perform her miracles for, I kid you not, a paraplegic pimp. She could not bring herself to explain the details.) I love Occupational Therapists. They are tremendously ingenious. They have figured out how I can do most of what I had been doing for Mr. Wired, and for the Wired Cat, without transgressing any of the Precautions.
Of course, real life is different from fantasy, dreams, hallucinations, and planning, because it can surprise you. There are always things the patient turns out to need to do that never occurred to her or even to Florence N. McGyver during therapy. For me, most of those things are on the floor, or in large bags. Dirt, trash, and laundry. Fortunately, for those things, the city’s Department of Aging provides us with a homemaker for at least the next four weeks. She, and the visiting nurse, both turned up last Friday to get organized. Which was kind of breathtaking for me, but I think will work out okay.
Life is also complicated by the fact that the Wired car isn’t working. Its exhaust system barely avoided dropping onto the pavement the last day I drove it before going to surgery. I figured that having it off the road for a month would give our mechanic time to get it taken care of. For some reason, it hasn’t. My surgeon says I’m okay to drive now, except when under the influence of painkillers, but it doesn’t matter, because the car isn’t. Maybe it’ll be done this coming week? Who knows?
But meanwhile, back at rehab—on my last day, we had to work out getting the two of us home. For me, it would have been no big deal. Mr.Wired, who can’t stand or sit for long, has to travel by ambulance. Medicare doesn’t cover this except for emergency or medical appointments. They paid part of the cost of getting him to the facility, but the necessity of eventually getting him back seems to have slipped their collective mind. Our first thought was to dose him up with painkillers so he could travel in a wheelchair by Medi-Car with me. But that plan broke down on the issue of getting him back into our apartment, which is on the first (European-style, thirteen steps up) floor, with no elevator. Medi-Car drivers (citing, of course, liability issues) don’t carry people upstairs. Only ambulance drivers do that. And the ambulance, from the boonies back into Chicago, would cost $500 per person, plus $5 per mile. Our next thought was getting the Medi-Car to take us to a site in Chicago, such as the local hospital where we get most of our care, and then get picked up there by an ambulance. The hospital (citing, guess what?, liability issues) vetoed that. Finally the social service people at the rehab place talked the ambulance into taking us all the way home for a mere $500 flat fee. (It’s amazing how reasonable that can be made to sound, compared to the original $1300. This is worthy of a separate post on how “reasonable” and “outrageous” get defined. I’ll write it someday if nobody else gets around to it by then.)
Ultimately, we not only got home in reasonably good shape, but the next day, I got to court for a final hearing on a federal case that has gone on for eleven years. In ensuing posts, I intend to cover communications technology in rehab—use of the iPhone, satellite TV, and some of the books our friends brought us to while away the time. Anyway, it’s good to be home and to have a keyboard. And thanks to Our Leader for not expecting me to do full-length posts on iPhone with my thumbs.
Also, since this is the beginning of the Jewish month of Elul, in which we tie up our moral loose ends before the New Year and the Day of Atonement, I ask forgiveness of all of you guys for anything I may have done to offend y’all, and I forgive any of you who may have offended me. Peace and light.