June 18, 2009

Heavy metal surgery in the developing world

GrayMeniscus.jpg The uniform was green and white plastic chiffon. They put me in a shirt, little booties and a skull cap. A cap? I'm bald! I found the whole outfit quite unbecoming and a tad chilly for this time of year! I was allowed to keep on my undies, which was a relief; the woman before me had had her surgery delayed until a maintenance man could come up in overalls and cut her ring off with a pliers.

María Julia had commented on the portly maintenance man in overalls "an example of the adaptability of human services in Latin America", and I suppose she is right. A patient in the US might be quite likely to sue her own public hospital for the jewelry and associated trauma —once post-op procedures were complete. In the US there is some justice in suing a hospital at least that way one might gauge back some cash from the insurance industry but in Argentina it would be considered bad ju-ju and wouldn´t fly anyway. My total cost of operation: two pints of blood donated by friends.

Horizontal on a slab I was hooked-up (rather roughly by a large nurse who kept missing veins). I have thick blood and fine fine veins :) On the other end of the tube was a drip which slowly emptied a clear liquid into into my right arm. I asked the large nurse who had butchered the inside of my elbow: "was it just saline?". "No", she replied, it also contained a drug (a calmante) and an antibiotic. I was a little annoyed about the antibiotic as I knew my homeopath would crucify me but that was the last of my problems! It is not like I had much of a say in the matter. The calmante was, however, all right by me. Roll on dreamland, drugs for the torture session. "So I shall sleep through the operation?" I asked. Again the answer was in the negative.

Next?

I looked around me. There were variously drugged women also lying in metal rolling beds. I recognized a face from the waiting area outside; the sporty-girl had been wheeled out. She popped her head up every now and again to look around too. I asked her if it hurt. "Not yet anyway!" and went on to complain to the large nurse about her boyfriend for being too tight to rent crutches from the hospital shop because they were asking nine dollars a week. "How am I supposed to get out of here?" she yelled toward the changing room as the poor dear brought in her street clothes. Turns out it can be hard to borrow a wheelchair in the Third World, presumably due to robbery risks. This is Buenos Aires, they steal the strangest of things: Apartment building elevators for example.

I gave the doctor my charts and scans but asked me anyway: "Which leg?" This was slightly unnerving. Even in my calmante state I remembered reading "left leg" on the MRI charts (and in Spanish too). Surely, of all people, the man wielding the knife should at least read my charts? I wasn't in any state to complain so I just pointed to the left knee with my unconnected arm. Off to the operating room.

There were various doctors, mostly students I learned later, many of whom had heard of the Irishman. I was celebrity meat! I recognized Dr. Kehoe from a pre-op check. The men made the usual silly comments about rugby, one of the few passions shared between Buenos Aires and Dublin. Out of my drug haze I asked her; "You're Kehoe right?". The nod assured me of great service and many brownie points for recognizing her with the face-mask on, and, more importantly, remembered her name! For me this was not difficult; it isn't too often that you meet a doctor in Buenos Aires with an Irish surname.

It was off one rolling bed onto another, whisked through the corridor and into the operating room. A huge bank of lights in the shape of a sunflower head would have beaming down on me from above, if they had been working, a splash of blood on the stem. To me, the apparatus looked like it had been borrowed from a Jules Verne submarine, in fact the whole room had a coherent 1950's look. A small army of people busied themselves fitted me to the operating slab with stirrups. I felt like I was about to give birth. They separated my legs to enable the knee torture to come, clamping my right so I couldn´t kick the doctor in the head.

A blue cloth was stretched from poles by my side to obscure my view of the action. On one of these was hung two inverted plastic bottles, not unlike those for my drip but MUCH bigger, which I later found, were connected via tubes to my knee to "dilate" it. By ´dilate´, our polite medical friends refer to a process of bloating the knee and the lower calf of the leg to the size of a twenty pound turkey. Having discovered this later I was glad that my view was blocked for I would surely have vomited.

A kind doctor came by and informed me that I was due for a wash, some needles, then ACTION! Heavy metal music was playing from a small ghetto blaster on a table to my left. I noticed one doctor ask me something. "I can't hear what you said for the music" I replied. They had politely asked me if I wanted a change of music, "something more tranquil?" I answered in the negative but they changed it anyway.

I'm squeamish about needles and injections into the knee are rather painful. When the boss encouraged doctor Dr. Kehoe to give me the last injection straight into the front of the knee, I realised she was in training. That was one of the more painful moments, I clenched my teeth and tried not to scream like a girl. The rest of the show took longer than expected. Because, I later discovered, both of my meniscii needed repair! Bits had been floating around loose in there for months now.

For those of you who are doctors please skip ahead, for those of you, who like me, prefer to know less about your innards than appears in Gray's Anatomy —or that horribly fascinating show "Bodies" which I had the misfortune to visit in Abasto last year— read on.

Both knees have two little half-moon shaped disks which are part of our suspension system —the lateral meniscus and the medial meniscus. They help our knees move and athletes often tear them. Yes, sounds painful doesn't it! A misstep usually leads to "turning" the knee. Ouch! Oops! Most of the reading I had found were articles about american football players which I am certainly not! I had my own theory that it happened when I tripped over a misplaced metal rod at the base of a door, falling drunk into the sidewalk out of the bar where they were showing the Obama election in Palermo last year.

Both of my meniscii were shredded and needed pairing back and the floaters removed. In all I survived about an hour of alternating twisting and grinding my integrity intact. The twisting was advanced manhandling. I have very muscular legs an inheritance from my father a sprinter on the national team. If the doctor really had played rugby then this part must have felt like he was working the ruck. I felt the trimming too, the drill made a rumbling noise like the hundred-year-old elevator motor next door. Yes the one I think might bring down the roof if they don't fix it soon. All in all grinding within the knee is not really as bad as having a tooth filed down.

It was over! After an hour that sorely challenged my ability to yelp politely without biting my tongue, I got a comforting pat on the head from Dr. Keogh. My legs, what was left of them, were released from the torture devices. I was wheeled out on another stretcher. Bandaged up, it was back to the changing room for weeks of rehabilitation. I took a taxi home where I still hop around on rented crutches.

Joy is me!

Posted by Tony Phillips at June 18, 2009 05:51 PM