My good neighbor from across the street was from West Virginia. He had a bit of a drawl, a country spun humor, and colloquial language: “Ain’t no bad ice cream.” “Now that I am older, my nose and my feet are mixed up; my nose runs and my feet smell.” He loved to tell jokes deprecative of West Virginians, and then watch your response with a slight wrinkling around the eyes, and hint of a smile. His mail box was always filled with requests for donations, because he gave freely, in small amounts, to any cause deemed by him to be worthy, as long as it was carried out by “Jews or Christians.” He put out corn and other feed for birds and deer, and then shot raccoons, possums and skunks that would appear, to also get a hand out. He said he did so because they were “varmints”, which should be eliminated, and did so even though he had houses on both sides of him and across the way, down the hill from him. Calling the Sheriff didn’t help. They said that, since we were in a Township, and not in the city, he could shoot his shotgun whenever he wanted, as long as it was into the ground and not into the air. We reluctantly put up with Earl’s shotgun happy habit for decades, until shortly before his transfer to the extended care facility. He was our good friend. He took care of my house for me and took care of my cats, whenever I was out of town.
It was winter of 2015/2016. I had just had my right hip replaced the prior week. Earl’s son, Roger, who frequently visited from Florida, was there for the weekend, and invited me to come over for salad and pizza that evening. We had a leisurely pleasant visit, during that stellar meal, but when trying to back away from the table, my chair stuck to the floor. I instinctively reached back with both feet and pushed, the net leverage effect of which is to put posterior pressure on the hips and move the chair back. That didn’t happen. Instead, my right hip popped out of socket, my right leg shortened, my right knee rode over my left knee, and my right hip hurt like sin. I had momentary thoughts of maneuvering my leg to put my hip back in position, but painfully reached the conclusion that was not a good idea.
“Would you call 911 for me?
“Why, what’s wrong?”
“My right hip has dislocated. I’ll have to go to the ER.”
“What? Can we do anything to help?”
“No, just call the squad. I’ll have to go in and have it reduced.”
Fortunately, it was early evening, and the orthopedic surgeon on call had finished his office hours. He came in, after x-rays had been obtained, and a few hours later, they put me out. I woke up with a straight leg brace on, and was told to wear it for 2 weeks.
The second dislocation did not go as well. I had been out for a walk that day, had fixed supper, watched the news, locked up the house, and had settled in for a nice reading session in the corner of the living room. I reached for a pen at the end of the coffee table, with my leg straight out in front of me, and my right hip popped out again. One again there was a protruding right hip, short leg, short right knee swayed over left leg, and inability to move without pain. I called the squad, and my great neighbor, Rhonda, came over to unlock the house and let them in. This time, the orthopedic surgeon was not available, and said to admit me, to do the reduction in the morning in in OR. That evening, my pressure went up because of the hip pain, my heart went into tachycardia, and I got chest pain, There was a mad scramble to start a nitroglycerine drip, get the hypertension, tachycardia and angina under control. That hip hurt all night, but there was finally relief after a trip to the OR the next morning. Once again, there was a straight leg splint for two weeks.
The third dislocation was a doozy. I was eating supper, and saw a food crumb on the floor beside me. I leaned over to pick it up and could feel the ball of my implanted hip tearing through the capsule of my hip joint, but could not shift my position back on the chair fast enough to stop it from completing that dislocation to the back, behind the socket. My cell phone was on the charger in the living room, and the kitchen phone was 10 feet away. Every scoot hurt really bad, until finally able to reach the phone and call the squad. In the ER, after a painful transfer to and from the X-ray table, the ER doc came in.
“You have two choices. I have put several of these back in place myself, and can do this reduction for you. If you want to wait for the orthopedic surgeon, I will call him.”
“I want you to do it. My last experience with ortho was not good.”
“Ok. Let me get things set up with respiratory therapy, and some extra holding help, and we will be back to take care of you.”
Once everyone was assembled, unbeknownst to me, he gave me 60 mg. of ketamine IV to knock me out prior to manipulating and reducing that hip. Ketamine is a drug which is now favored by ER docs, because it is safer. It does not cause respiratory depression as do other drugs used for sedation and anesthesia, such as pentothal, opiates and benzodiazepines. But it can have significant side effects. Sixty milligrams would be a correct dose for a healthy strapping adult male. For slender old me, it was an overdose.
There was a period of total blackness. Then, I found myself floating on a child size rubber raft, in a tunnel with grey stone walls, on a fluid stream of brilliant blue, yellow and red ribbons which were confluent but never mixed, while they undulated and bobbed up and down. The stream was flowing uphill, toward a bright white light at the end of the tunnel. There was no pain, just a floating sensation, but I was startled, and reached for the wall on one side to stop my progress, so I could figure out where I was, and what to do. The wall, however, melted away as I grasped it, and had no touch or substance. This is bizarre, I thought. Then it struck me. “Am I dying? Is this what it is like when you die? Is that why there is a light at the end of the tunnel? I reached the conclusion that either I was dying, or recovering after having a hip reduction, but could do nothing about it. I would have to ride it out, and accept recovery without hip pain, or death, whichever it was. Floating uphill was strange. Vivid bright fluid colors that wove together but did not mix were strange. Rock walls which had no substance were very strange. Total lack of control was strange. Moving toward a bright light at the end of a tunnel, which seemed to be receding rather than get closer, was strange. Everything was strange and scary. But I accepted my fate, and was willing to accept death, or life with a bum hip, whichever it was. I had no choice. It was out of my control.
After another period of blackness, I awoke to a clattering noise beside me, but could not move or see to determine what was causing it. Knowing that the computer was on my right side in that room, and that was where the clattering was coming from, I prayed that meant a nurse was making notes on the computer, that I was recovering from sedation, and had not died. Soon thereafter, vague grey lines and forms appeared in front of me, and a soft babble of voices in the distance, none of it forming discernible words. I next awakened to find the fuzzy form and voice of the ER doc beside me, and knew he was speaking to me, but was paralyzed, and could not respond to him or speak. All of a sudden, he stopped.
“Ahh. He’s still out of it. I’ll come back later.”
Gradually, over the next hour, fuzzy lines shifted into discernable windows and a door. Another nurse came in and made more clattering notes on the computer. The ER doc came back to give me home instructions. My neighbor was called to come pick me up, take me home.
The fourth dislocation was also a chair shifting event. This time, my ER doc was not a big strapping guy, but a young woman.
“I have done some of these reductions myself, and will take care of it here in the ER, if you want me to do it, although I may have to have some lifting help.”
“I want you to do it, but please, do not give me ketamine. I had a frightening ride with that drug last time.”
“But ketamine is the safest drug to use. I’m not comfortable using anything else.” Pause.
“What if we just give you 30 mg., or half the dose you had last time?”
Long pause.
“OK. I am afraid, but I will do it.”
So that’s what she did. There was, this time, no nightmare, no end of life experience. She said she struggled, and it took her 10 minutes of heaving, with help, to put my hip back in its socket. I have, since then, over the last year, done everything in my power to not make those maneuvers which result in hip dislocations. I do not want any more hip pain, immobilization, ketamine nightmares, end of life experiences, until the final one occurs. I do not want to stare at the bright eye of death straight ahead, while nothing makes sense, and I am totally out of control, until it is my necessary time.
Those vivid colors were beautiful, though.