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DEaVF1 Essay 6 Tuesday, April 20, 1982 10/23 (43%) candidate joints hospital surgical replacement
– Dreams, "Evolution", and Value Fulfillment: Volume One
– © 2012 Laurel Davies-Butts
– Introductory Essays by Robert F. Butts
– Essay 6 Tuesday, April 20, 1982

(8:47 A.M. Our original idea was to insert the session Jane gave this morning in one of the earlier essays. This would have been a very mechanical approach. More, it would have involved altering dates, and changing or eliminating some of the copy to make the rest of it fit—all things I dislike doing. After Jane came through with her dictation I told myself I’d know what to do with it, and awoke the next morning with the clear understanding that her session should be presented just as is, and when we received it. Jane said okay. The subjects discussed are deeply charged for us, and the physical and psychological aspects of some of them could be devastating if we allowed them to be. Presenting the session in a more isolated manner here, then, may give the reader a clearer idea of how we felt during Jane’s early days in the hospital [and later too, for that matter]. This course also lets the session serve as an automatic bridge to some of the material in the earlier essays.

[... 3 paragraphs ...]

Several of the brightest young rheumatologists and orthopedic surgeons had my future all mapped out for me, or so it appeared, as they discussed my case. When they spoke to Rob and me I tried to listen, but my hearing was still so poor that it was nearly impossible to make out one full sentence at a time. All the doctors seemed to agree that I had a kind of burned-out case of rheumatoid arthritis, with little active inflammation. But one doctor soberly told me that I’d never walk again, or even put my weight upon my feet again, unless I underwent a series of joint-replacement operations—if, he cautioned, I proved to be a “proper candidate.”

[... 1 paragraph ...]

My condition had certain drawbacks, however: The two sides of my body were uneven, so I could end up with four bright new metal and plastic joints and still not be able to walk properly. I might need a cane, or a walker. Medical science would be willing to try, however. Out of the goodness of its heart, all of its scientific procedures would be put at my disposal. True, the amount of money required for such surgical possibilities was staggering, but insurance of one kind or another could be found to carry the cost. (We didn’t have nearly enough money, but could qualify for adequate insurance by fulfilling the terms of an 11-month waiting period.) But regardless of cost, one orthopedist saw me staying right in the hospital—now that I was there—until the entire procedure was finished. Particularly if, again, I proved to be a proper candidate.

(Long pause at 9:02.) Being a proper candidate meant getting rid of those bedsores, for one thing, as well as taking extensive physical therapy. As I listened to the doctor talk, poor hearing or no, I could almost feel medical science starting up all of its gears, ready to go to work on my behalf—and I wasn’t ready to make any such decision right then. I wanted to see how my body would react to the synthetic thyroid hormone and to therapy first. I wished to hell I could (underlined) run, I thought, for boy, I’d have run right out of there, fast!

[... 8 paragraphs ...]

(9:25 A.M. “That’s all of the stuff on the Introduction, then….” And now Jane dictated the equivalent of three typewritten pages of “other hospital material” that she knew she’d eventually want to use somewhere.)

Actually, I came to realize, Jane was so terrified by the thought of those operations that mentally she shunted aside all such prospects. Only when she was home did she begin to fathom the possible depths of the physical reality she’d created for herself, with my help. To coin a phrase, she was “truly, deeply shocked.” The doctors wanted to literally cut the major joints out of her body! To replace them with metal and plastic joints inserted into the bone ends and cemented in place. Jane cried. Her voice shook. “But in spite of everything, over all those years I never felt sick until I went into the hospital,” she wailed. The glowing reports we heard and read about successful joint-replacement operations meant little to her. “Sure, for one joint, or two, maybe,” I said, then shut up, not wanting to add my own fears to her fears. But four of those operations? And why stop there? If they fixed her knees and hips, what about her shoulders? She couldn’t raise her arms level with them. “Oh, they’d operate on the shoulders, too,” a doctor told me in front of Jane, without inflection, as though we were discussing an inanimate mechanism that needed rebuilding. Six operations, then. But what about my wife’s elbows, and her fingers? Somebody at the hospital —I forget who—told us that joint replacements for the fingers and/or knuckles usually weren’t all that successful: The bones in the hands were pretty small and delicate. But it could well be argued that Jane needed to be able to write with a pen or pencil, to express her basic creativity in that particular elementary fashion, even more than she needed to walk. (It would be great if she could at least use a typewriter!) So there could be eight operations, or ten, or …?

What might happen to the body, I wondered, even if its psychic tenant were willing to endure any or all of those “surgical procedures”? I answered my own question by remembering accounts I had on file, explaining how people of various ages had withstood numerous, incredible operations, sometimes over a period of years. But I was horrified to think that my dear wife might become involved in a similar reality, with or without my unwitting compliance. I knew that she was far from making any decisions about surgery, but I recoiled from pushing any such suggestions upon her, no matter how fine it would be to see her on her feet. Joint-replacement operations were irreversible procedures, and I also had on file material about how they sometimes failed.

Short of outright failure, however, some of the articles I’ve collected contain the information that a conventional artificial joint replacement—for a knee, say—usually lasts only from four to seven years before loosening. A most discouraging prospect! What does one do when the insert begins to wobble? None of the doctors we’d talked to had mentioned such a possibility. (One can always claim that being able to walk for even four years is a lot better than not walking at all!) Jane and I also read that through experiments with animals medical designers are working to perfect an artificial knee joint with porous surfaces, to promote better bonding of bone to metal; it could last 15 years or more. Someday, I told Jane, and regardless of whether or not we ever choose to take advantage of any of them, we’ll be questioning orthopedic surgeons very closely about what “surgical procedures” are available.

As I wrote in the first essay, “the trouble with having something diagnosed as rheumatoid arthritis is that not only do you have it when you go into the hospital, but when you leave it.” Even if Jane had all of those operations—even if she ended up able to walk after a fashion—she’d still have arthritis. She was suffused with it. Our beliefs said so. So did her body, as everyone could see. “Your joints are destroyed,” Dr. Mandali told Jane, after getting the opinion of the young out-of-town rheumatologist she’d asked to examine my wife. “Do you want to spend the rest of your life inside, in a wheelchair? That’s a pretty limited existence you’re talking about there….” And Jane, trying to protect herself from the negative suggestions that had been administered to her like psychic hammerblows, ever since she’d entered the hospital, could only weakly demur on the subject of operations.

Let me quickly add that all of the doctors who examined her advanced their suggestions while trying to be helpful, and in the name of “truth” as they saw it—with individual variations, of course. To us, however, in all but one case their general unconscious biases were negative. The exception was the youngish doctor Jane had referred to at the very end of her last session. As it happened, he was the one who’d had her admitted to the hospital to begin with. He’d offered Jane encouragement as she is, and she had felt an immediate psychic rapport with him. But he was a neurologist, and we saw less and less of him as it was determined that his special skills wouldn’t be of continuing help in Jane’s situation. In the overwhelming medical view, then, as Jane said, the operations were the only way for her to go….

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