Dr. Bose has warned me to stop taking aspirin or pain-killers a month before surgery. I try homeopathic remedies, but nothing works.
My cough grows worse, compounding the discomfort of 22 hours flying 8,380 miles as I stifle coughs and worry about infecting other passengers.
Will an American germ scuttle all our plans?
Fits of coughing disrupt our first night in a Chennai hotel, finally giving way to deep sleep interrupted early on January 17th by a phone call. The hospital wants us in today for surgery tomorrow. Dr. Bose has been asked to lecture in Mumbai tomorrow evening.
It’s just as well. Let the experts decide what to do about my throat.
Later I am relieved to learn the throat will not interfere with surgery. Treatment is a strong gargle and steam inhalation therapy. No antibiotics means no superbugs, remember?
In addition to Dr. Bose, our first contacts at the hospital are the international coordinator Ms. Shoba Bhasker (left) who made all advance hotel and resort reservations for us by email long in advance of our arrival, and the program administrator Mr. Mohan Kumar (right) who coordinated our journey once in India.
Mohan sends their driver to bring us from the hotel, greets us at the entrance to the hospital and takes us to the 4th floor.
Indians often identify their family name first--which some people call their "God-name." Receptionist Ms. Hamom Maria shows us our accommodations in the recently opened “Platinum Ward," where eight rooms and highly attentive staff cater to us spoiled international patients:
She teaches me to operate the new electric bed that earlier patients only dreamed of. Phil will enjoy the comfortable day-couch that serves as companion-bed. In contrast to us international patients, nearly half of Apollo's hip resurfacing patients will use stationery wooden beds.
The toilet is English-style, with a riser attached for hip-resurfacing patients.
The room is equipped with a refrigerator and restocked with water that is bottled and sealed--a particular concern for international patients who have not built up immunity to local microorganisms.
We never use the microwave, since meals here are frequent and generous.
Nor do we use the plasma TV, which offers programs in Tamil and the BBC in English. Indian newspapers provide fascinating news stories and editorials in English.
(By the way, most Indian women never go sleeveless. Although no one makes me feel inappropriate, I learn to cover up.) As we unpack and get settled, a steady stream of staff introduce themselves. We will see them again throughout our stay.
Dietician Ms. Manju P. George comes to check on my preferences. The hospital offers Continental European or Indian cuisine. (I soon develop a preference for lightly spiced Indian dishes. It is easy to understand why children raised on these spices soon find other food bland.)
Mr. Reegan Prabhu and others from Food Service deliver meals on a British schedule, beginning about 6:30 a.m. with coffee, tea or milk served in bed, followed by breakfast about 8:30, a mid-morning fruit shake about 10:30, a generous lunch about 12:30, tea about 4:30 p.m., and dinner about 7:30. Every dish and glass is tightly covered with plastic wrap that displays beautiful presentation while protecting against germs.
Housekeeping staff appear at least twice a day to sweep the room, remove trash, clean the bathroom, empty my urine bag in the days following surgery, and push my wheelchair when that is needed. This particular gentleman, Mr. Sabari Raman B., had already worked his usual six nine-hour days, when he came in an even longer seventh day to fill in for an absent employee.
Now he wisks me off in a wheelchair while still in my street clothes, down a busy elevator, to other floors, where patients wait in rows of chairs. Staff in modest rooms administer my electro- cardiogram, echo tests and x-rays using well-worn equipment.
Eventually I change into a hospital johnny, and deliver a urine sample. A nurse draws blood and starts inserting the needles and tubes that will make injections effortless. I am here to stay through six days that proceed like clockwork.
The anaesthetist, Dr. Bapuji, comes to examine me in preparation for tomorrow's surgery.
That evening Dr. Bose explains what he will do the next morning.
He shows us a cobalt-chromium prosthesis like the one that will be inserted in my femur. (I'm holding it upside-down. The post at top will extend down into my femur, which is the strongest bone in the body; The cap at bottom will be cemented up into my hip--the "resurfacing"--and the thinnest film of water will form between them, permanently lubricating the already smooth action and eliminating the locked and painful joint I now have.)
At left is the prosthesis for a total hip replacement, commonly used in the U.S. This device requires extensive cutting of the femur and too often gets dislodged from its plastic casing in the hip, so that it may require repeated operations. Once the femur has been cut, it is impossible to revert to hip resurfacing.
After midnight I can have no more food or water. By 10:30 a.m. Thursday, January 18th, I am wheeled down in the elevator to the operating room where Dr. Bapuji appears reassuringly at my side and skillfully dispatches me.
Later Dr. Bose gives us a DVD showing a similar hip resurfacing he performed. It helps us understand how, within one hour, he slices, spreads the flesh and muscle, dislodges the femur, saws, drills, hammers, glues, and sews to install the implants--none of which I recall from his surgery on me.
Along with the barcodes of these implants, he provides notes to document the entire procedure, how he determined exactly the right size implants for me.
Surgical experience makes all the difference. My implants do not come from Birmingham, England, that gave this process its name, but from Leeds, where DuPuy manufactures a greater variety of sizes suitable to smaller bones. Before he ever made his incision, Dr. Bose had the full range of options lined up to make the best possible decisions.
Next thing I remember is trying to open leaden eyelids, and hearing enthusiastic voices exclaim: "Excellent!" "Perfect operation!"
This is a good sign, I decide, and go back to sleep.
POD 1 January 19th
On my first post-operative day, the nurses gently wake me for pills and a sponge bath, then put on the white elastic TEDS stockings I must wear to avoid clots forming. I am puffy and completely askew, but the staff (left to right: Receptionist Harmom, Nurses Rajeswari and Sasikala, who are called "Sister" in the British tradition) treat me like a star.
I hope they do not remember that I am supposed to stand up today. If Dr. Bose has gone to Mumbai (formerly Bombay), the others may forget.
I am wrong of course. Another member of the surgical team, Dr. Biswagit Dutta Barnah, arrives to check on me and remind me that everything is proceeding perfectly on schedule.
Then I meet yet another of Apollo's stars, senior physiotherapist Mr. S.K. Pandian. He is quiet, clear, respectful--the gentlest of teachers. He reassures me that moving will not do any damage to the implants in my hip. They are there to stay.
The only thing I may not do is cross my legs, and that is easy to avoid by keeping a pillow between them.
He teaches me exercises I must repeat several times a day: pointing and flexing my toes, turning my ankles, pressing my knees down into a pillow, tightening my buttocks, inhaling deeply and exhaling. Then he and Sister Jemy John help me stand.
With a walker I reach the chair.
They knew I could do it!
POD 2 January 20th
Day and night as I struggle to get comfortable, I repeat the exercises, knowing they will hasten the healing. I realize what a privilege it is to have this bed, and wish all hip patients could have one.
Discomfort? Yes. Pain? No. The pain is perfectly managed with a round pump at my left side the size of a small rubber ball that dispenses painkiller.
Always, there is more food than I can eat. We are spoiled.
On the second post-operative day, I navigate the hallway with the walker, helped by another physiotherapist.
POD 3 January 21st
On the third day, Dr. Biswajit removes the two drains and covers the wound with a waterproof bandage so I can shower.
Finally I learn to use elbow forearm crutches--a light, excellent design, made in India by Vissco.
POD 4 January 22nd
On the fourth day, I learn to climb stairs.
POD 5 January 23rd
On the fifth day, we are ready to leave. Dr. Bose presents me with my post-operative x-ray and a plastic file documenting all the medical reports and procedures they have performed.
The most amazing thing in the file is the itemized bill, accounting for every cent of my $7,000. The most expensive item is the implant, imported from England for $2,475.
Dr. Bose' fee comes to $1,028. Dr. Bapuji's is $182. The cardiologist's is $11. The entire bill for nursing is $100. An additional charge of $29 covers Phil's meals and laundry for the week.
The bill reminds us of the Canadian couple who arrived the day before we did.
They had called a surgeon in Seattle, who agreed to perform the same operation for $35,000 up front and non-refundable before the first consultation. When they asked about his experience with hip resurfacing, the doctor's answer seemed disturbingly vague. So they chose to come to India instead.
Remember Dr. Koen DeSmet's study of revisions that showed a direct correlation between surgical inexperience and lack of success? Perhaps surgeons seeking experience with hip resurfacing should pay their first hundred patients to practice the procedure on them.
(We are also astonished at the long hours staff work here in every department. I hear that three years working in an Indian hospital give staff the equivalent of six years elsewhere because of the sheer volume of patients they serve.)
Maud has been pressuring me to ask Dr. Bose a question:
"Are there any women surgeons doing this procedure?"
"No." As far as he knows, there are none in the world. But there should be, he says.
"Some people think it takes physical strength to do this kind of surgery. But that's not true," he insists. "It takes finesse and precision."
Maud beams at his answer. She laughs delightedly when he says that he comes from a family of doctors, including several women--his mother, auntie, wife, and sister.
My kind of doctor, she grins--brilliant and humble! He sees women as his equal!
Then he explains the regimen of pills I must take for the next thirty days. I realize the little plastic box with a tiny spoon that nurses have been using to dispense my pills is also a teaching device that will go home with me as a reminder to stay on schedule.
I will see him again in a week for a final checkup before we leave India.
Another patient will soon move into our room. I hobble around packing our bags and notice Maud standing at the window, watching the street below. She is weeping.
"What is it, Maud?" I ask. She shakes her head, unable to answer.
Later, she says. I'll tell you later.
The complexities of India are more than we can absorb.
So I am leaving the hospital with a shiny new hip joint.
I am learning the surface-hippy dance.
But we are being changed in other ways, too, by the people we meet here.
And we have so much more to learn.
