Family Consultation

Christmas in North Andover provided an opportunity to discuss a scheduled knee replacement with the people I consider family.

Joe, a pediatrician with a teaching gig at Harvard Medical School, is married to Magda, my goddaughter.  They have three children so we don't usually get a lot of adult time during my visits to their home in South Boston.  But we were tasked to pick up a couple of pies at Whole Foods while Magda drove the D-Kids to Tom's and Audrey's for Christmas in North Andover.

Joe's Graduation from Columbia Medical School

"I'm not an orthopedist but you've got to keep in mind that surgery is their bread and butter," he explained.  "The hospital probably lost money on your consultation.  Of course he's going to want to do the surgery there."

"Yeah, I get that.  But do you think I'm crazy to consider having the operation in New York mostly because I trust this guy after he replaced my hip?  His refusal to replace my knee eight years ago convinced me he's motivated less by money than by doing what's best for the patient."

"No, trusting your physician is only natural," Joe replied.

I also confessed that I had been feeling less knee pain since scheduling the surgery.  "Isn't that crazy?  Nothing has changed."

Joe smiled.  "Medicine still doesn't entirely understand the impact our minds have on our bodies.  You probably reduced a lot of stress just by making a plan to move forward."

He was right, of course.  Instead of imagining the worst case scenario--having to leave New York City--on a daily basis, I started to think more positively about the future.

Tom, Joe's father-in-law, and I go all the way back to Columbia.  We also share another, more relevant bond:  the same orthopedic surgeon at the Hospital for Special Surgery. Dr. Ranawat replaced both of Tom's hips; prior to the surgeries, he barely could walk. But both Tom and Audrey thought I was nuts to have my knee replaced in New York when I could just as easily do it in Florida through the same hospital.

"Does he know that you have to climb two flights of stairs?  That you grocery shop 20 blocks away from where you live?  That you ride your bike to do your laundry?  That you live with two other people in Florida who can help you recover?"

They wore me down.  I agreed to explore other options upon arrival at the Folly. 

Grin and Bear It

It's amazing what you can get used to.  I lived with occasional knee pain (~ level 5 on a scale of 10), mostly going up and down the stairs of my rent-stabilized apartment in Manhattan, for eight years.  Relocation to a ground-floor unit or a building with an elevator was never an option because a significant increase in rent would have had a negative impact on my already modest lifestyle.

But I'd also followed my orthopedist's advice, up to a point.  Not long after he suggested I move instead of replacing my knee in 2016, I bought a house in Florida with two friends. And he was absolutely right:  not much knee pain at all during my three snowbird months every year although the pandemic proved that if I resided at the Folly any longer than that I would go crazy.  Sunshine, ocean swims and flat surfaces do not feed the heart and mind, although the social benefits (and frustrations) of house-sharing cannot be denied.

Still, time catches up.  After returning to 47 Pianos last spring, the knee pain became more constant and debilitating enough to change my routine: instead of carrying my bike and up and down the stairs nearly every day, I left it locked downstairs, outdoors.  And once my knees occasionally started to buckle, I began to fear a fall bad enough that would leave me no choice but to give up the space where I had lived since 1978.

I scheduled another appointment with Dr. Ranawat at the Hospital for Special Surgery whose office seemed somewhat diminished, if not his brusque intensity.  He ordered X-rays for both knees and hips.  My hip had been replaced at the relatively youthful age of 57, at which time he told me that the ceramic prosthesis he had implanted generally lasted 10-15 years.  I was at the outer limit but he said everything looked OK, and I realized the estimated lifespan probably had more to do with the mortality of elderly patients than the durability of the hardware.

But the X-rays also indicated that the arthritis in both my knees had worsened.  Given my reluctance to move, he recommended a knee replacement.  "Some people with arthritis like yours that affects mostly the knee cap area opt for a partial knee replacement, but they're not always satisfied with the outcome," he said.  Without thinking too much about it, I shook my head no and insisted I would want a complete replacement and began peppering him with questions.

Question:  Will I be able to get up and down the stairs after surgery?

Answer:  Yes, we don't release you until you can walk up stairs.

Q:  How long will it take to recover?  Staying physically fit by swimming, biking and walking definitely contributes to my mental health. 

A:  Around three months before you'll be able to resume your regular activities.

Q:  Can I get both knees done at the same time?

A:  No, I don't recommend that.  Your recovery will be more difficult and a blood transfusion may be required.

Q:  How soon can I get the other knee done?

A:  Three months later.

Q:  Would it be better to do have the surgery in Florida where I don't have any stairs and there are people around who can help me?

A:  Not necessarily.  But if you want to go to Florida after the surgery, you can fly in three weeks.

Q:  I'm a single man without family who doesn't plan on being around much longer than five more years. Living in New York means almost everything to me. Will successful knee replacement surgery reduce the pain enough to avoid moving to Florida full-time?  

A:  It should.

Q.  Will my knees get worse without surgery?

A.  Probably.

Embarrassingly, tears welled up in my eyes during the final part of this exchange. Whether or not Dr. Ranawat and his fellow realized it, they were witnessing a depressed man making a very emotional, life-altering decision.  To their credit, neither reacted with discomfort although I easily could imagine a de-brief where each expressed his desire to get out of that consulting room before the unstable patient broke down completely.

I scheduled an appointment for April 30, two weeks after my planned return from Florida.

Here's the peculiar thing:  my knees didn't bother me at all while walking the two miles back home.  Just making the decision, I felt better than I had in weeks.