In Surgery - Part 1: Going the Distance

Brian, the anaesthetist, is looking at my chart and calling me orthopaedically challenged. We both chuckle a little. I'm laughing mainly because I'm a little bit stoned and freaked out lying there in the operating room while everyone goes through their paces - crossing off their checklists and arranging equipment.

I like Brian - he has a sense of humour and a bit of devil-may-care about him. I've met a couple of anaesthetists in my time and they're all a bit quirky, in a good way, I think. And hope. The better part of their days involve whacking people out -that takes a certain character. I'll be awake for this procedure, so Brian must strike that delicate balance of pain relief, distraction, and alertness. Perhaps his little joke is a test to see how well his cocktail is working.

I have a nerve block for my arm and something for my head to relax me a little. I feel fine. Dr.G is all business but takes the time to make sure I can see the scalpel action on the tv screen above me and says he'll keep me posted throughout. I'm having a *minor* surgery, an arthroscopy, just to check the state of my lunate and sort anything that might need sorting. It's the first step towards real treatment for my Kienbock's and I am relieved.

The OR crew are relaxed and seem to know each other well. They share some jabs and jokes. I can see my opened wrist on the screen above but there's nothing too impressive there, certainly not the blood and guts-fest I had anticipated. Just the whitest bones you can imagine. The only significant thing I remember is Dr. G saying your lunate is in great shape. Why, thank you, I think to myself.

The entire event lasts no more than a hour and while I'm waiting in recovery, I watch Dr.G visit all his post-ops. I see more evidence of him being a good doctor, of him being a good man. Dr.G spends many minutes with an older man who is not sure what he needs to do next and many more minutes with an older woman who just wants to talk. When he gets to me, he is happy that there is no visible sign of damage to my lunate and hopes that this KD will stay in its infancy. He did clean up some fragments while he was in there. Fragments of what I will always wonder. It occurs to me that I may never have known I had KD in my right hand had I not lost the use of my left.

This is all good news. After a month or so, after my right hand heals and regains some strength, I'll be ready for the surgery I really need. I am thrilled. The nurse finally gives my husband and me the thumbs up for discharge, a prescription for painkillers, and 2 Tylenol 3's . The nerve block will wear off in about 12 hours she says, get ahead of the pain. I have no idea what she means. Yet.

My husband races with me to the ferry and we arrive just in time to see the Spirit of British Columbia pull from the dock. I'm groggy and tired and not too bothered by the 2-hour wait ahead of us. Hoping to catch the ferry, we decided to fill my prescription once we are home. The nurse said we had 12 hours, I remind Eric.

Within an hour, I am kneeling on the floor below the front passenger seat, breathing deeply and moaning a little, as if in labour, propping my bandaged arm on the seat. Nerve blocks don't wear off, they switch off. On. Off. I never get my 12 hours.

This is my recovery learning curve and there is no going back. My surgeon, my family, and I are
Going the Distance:

	Cake - Going the Distance .mp3
	Found at bee mp3 search engine

In Progress - Part 1: There's No Other Way

The rain is bucketing down, sheets of it, constant and punishing. How will we find the hospital if I can't even see the road?

Elvira is sitting beside me, white-knuckled, possibly praying. She is a good friend. I am thinking how ironic it would be if we are in a car crash and rushed into St. Paul's emerg by ambulance. Would I hop off my stretcher, broken leg askew, or worse, and say right then, must pop up to see Dr.G about this pesky wrist thing. Morbid thoughts? Maybe. Oddly, I am buoyed by them - it puts my condition in perspective. Now if we can just get there.

This first visit will be one of many and the route my mind and car are mapping through these unfamiliar and busy Vancouver streets will become as etched and automatic as the drive from my home to the grocery store. The parkade, the street, the fastest hospital elevator, and the waiting room protocol become small lessons I will quickly memorize and master.

We are both in dainty summer dresses and sandals, no jackets or umbrellas, completely unprepared for a rainy day downtown. I don't know what we were thinking. We weren't thinking we'd be spending the whole day in the city. My appointment is for 9:30 a.m. It is now 9:45. The ferry was late and the roads were brutal. We bolt from the covered parkade for the side door of St. Paul's. It is, by chance, the exact door through which we should be entering. Not knowing this, we follow the blue and yellow lines around St. Paul's until we eventually ask at an information desk. We are guided back to the door we initially came in. We're off to a good start.

I am worried that Dr.G won't see me now - I am worried I have insulted him by my lateness. I don't know it yet but he is going to raise the bar on waiting room wait times. Whatever the national average is, multiply that by 5.

What is both wonderful and terrible about St. Paul's is that it is a teaching hospital. What is both wonderful and terrible about Dr. G is that he is an excellent, well-respected surgeon. The wonderful and terrible thing about my new surgeon working out of St. Paul's is that it will be almost 3 hours before my name is called and I am ushered into an examination room. Late shmate.

The past 5 months have been hard and I've hardened myself as well - buttressing my body and fortifying my expectations. My cynical self is completely unprepared and undone by what happens next: it is Christmas again.

I am greeted with smiles, two interns, and two surgeons, one of whom I assume is Dr.G. I'm hoping he's the cute one on my right. Elvira is led out to the hall while four heads lean in and four sets of hands try to get their hands on my hands. The questions come; the range of motion and strength tests come; much nodding and writing and whispering takes place. Bilateral Kienbock's. My tiny examination room is literally abuzz. I feel special. I feel like I am finally going to get the treatment I need.

The cute surgeon leaves. He is not Dr.G. The three remaining men huddle around a large screen showing my MRI. I have no idea what they see. Dr.G is like an excited kid - he wants to show and explain everything to his interns, to me. He is constantly in motion. The interns move aside so I can see the image. I suspect Dr.G is a great teacher. He is patient and thorough. It is like there aren't 40 more people in the waiting room.

During my examination, we discussed all possible procedures, even MCD. Dr. G seems willing to try it or at least consider it. All treatment options are open.

I hear Dr. G say do you see this? but I'm not really following. I've been lulled and comforted by these knowledgeable men-of-action. I know what they are discussing is important, urgent, but to me it is a melodic background. I'm jarred to attention by Dr.G. Look right here. The lunate has collapsed oddly. On the left. Can you see?

I guess I can see it; I don't know. So what. You just told me you can do anything. I'm thinking these thoughts and I'm feeling strange again because one of the interns is now looking at me closely.

What he means is there is nothing we can do. A salvage surgery is your only option now. The intern says this softly and kindly and I am deeply grateful for him at this moment. Dr.G, too, is gentle, suggests I go have lunch before I come back to get my right arm casted and book the surgery for my left.

I've read about salvage procedures; they sound as horrible and permanent as the word itself. I am devastated. Screw lunch. Elvira and I run, hands like useless umbrellas over our heads, jaywalking across Burrard and down Georgia until we find a bar. We slip, dripping, into a booth. Two martinis please. Cold. Dry. Martinis. It's 1:25 in the afternoon.

There's No Other Way:

	Blur - There's No Other Way .mp3
	Found at bee mp3 search engine

In Limbo - Part 4: The Last Day of Our Acquaintance

I am 50/50 when I pick up the phone.

50% wanting to get some answers out of the man. 50% freaking out because my right wrist is now hurting quite a bit and, it seems, losing some range of motion. Sigh. All 100% of me needs to meet with my surgeon asap.

I live on beautiful Vancouver Island, off the coast of British Columbia, Canada. Victoria is the provincial capital and a haven for young families and retirees alike. We are blessed with a medical system that is accessible to everyone, although it can creak along at a dinosaur pace at times. In Victoria, all hand and wrist surgery is performed by plastic surgeons. We have 4 plastic surgeons. Number of plastic surgeons in Victoria who will treat Kienbock's: 1

The answers I seek are elusive. I know this. In addition to all I have read and researched, I joined an online support group and though Kienbock's Disease is classified as "rare", the numbers in the group belie such designation. All the information I have and all the stories I am now intimate with make it crystal-clear that each case it very different and each corresponding treatment debatable. There are some constants, though, and it's these that give me the confidence to approach my surgeon again.

For those with Kienbock's, or KD as I have come to know it, the abbreviations and terms I use next will be familiar; for those unencumbered, the abbr. will be more than adequate. Suffice to say, the lunate bone is "dying" because it is no longer receiving blood and there are a number of stages and corresponding treatments and surgical procedures that attempt to either trigger or redirect that blood flow again, "revascularize", or essentially act as pain management, known as "salvage procedures". Skip ahead even. Trust me.

I am diagnosed Stage 1, possibly Stage 2 (although I'll later doubt this original diagnosis - this is what I have for the moment) and my surgeon wants to perform a radial shortening with a VBG. I am negligibly ulnar negative, -1mm. Therefore, while I don't take any major issue with the VBG, I feel pretty strongly that I am NOT a candidate for radial shortening, particularly having read so many of the complications and "non-success" stories arising from that procedure. I'm also keen to discuss MCD, a relatively new procedure that is less invasive and has reported good outcomes.

I've got my print-outs ready again. I'll stick to my guns this time. My husband is with me this third visit - he knows I might crack and we talk strategy. Stay focused, he reminds me.

It all goes wrong almost immediately. My surgeon walks in the room, barely glances at either of us, and says: So, what is it?

I decide to go with the warm up, a plea to that side of him that is supposed to help me. Help me. I tell him that my right hand is giving me trouble and I am worried. He nods, completes an x-ray requisition and hands it to me. He doesn't examine my wrist. He doesn't touch me or even look at me.

I ask him when I can get my cast off. He says in 10 more weeks. I ask then what? He says that depends.

I am starting to panic, feel a bit crazy. He's treating me like I am crazy. I don't understand. I do realize though that this is probably my last chance. I ask him if he has ever heard of MCD. I feel the air leave the room. I can see that he is deciding whether to be civil with me or not. He decides yes - for the moment.

He tells me that he has read something about it but doesn't know anyone who has performed it. I seize the moment. I show him the copies of articles on MCD that I have brought. I mutter something about good outcomes. My eyes and my body language practically beg him to look down at the papers or even take them. I feel like a Jehovah's Witness on a Catholic's doorstep.

He stops being civil. He suggests that I am wasting his time. I crack. I am not going to cry in front of this man. I say I have to go and rush out the door. While I am running down the stairs, he is telling my husband that he cannot treat me anymore.

I am crying, again, in the undergound parkade. I am clutching the x-ray requisition, the eventual test and results of which one week from now will suggest I also have Kienbock's in my right wrist. My surgeon never passes on those results. My surgeon never refers me to another doctor. I will see this man again one day, in a horrible moment neither of us can predict, but for now:

My left arm is in a cast. I have bilateral Kienbock's. I have no surgeon.


The Last Day of Our Acquaintance:

	Sinéad O'Connor - The Last Day Of Our Acquaintance .mp3
	Found at bee mp3 search engine