Monday, 21 September 2015

Washout and Girdlestone
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Back in ARI, the surgeon considered the rat that was trying to escape from my scar. “We’ll open it up and wash it out,” he said. Um, did that mean the flowery gown and the balance along the prune spectrum, all over again? Of course it did. But it would be a very minor thing this time, no learning to walk again, no rehab, home as soon as the stitches were out.
And so it proved. Whew! So that was fixed, then?
Well, not entirely, because it wouldn’t quite close up again, and stuff kept oozing out of it. Community nurses came two or three times a week to change the dressing. Every month I went back to the clinic, where the surgeon took a look: it’s just laudable pus, he said; oh, so that’s all right then, and we discussed cars (his a Porsche (envy), mine a mere Alfa Romeo) and his deerhound; he showed me its picture on his iphone, a splendid beast; of course I knew that cats (especially mine) were superior to dogs, but felt that truth was best left unsaid.
I wondered what was so laudable about pus, but the surgeon inspired confidence and the community nurses were a fine bunch – I looked forward to their visits, and I was at home, and able to walk not too badly, improving steadily. Surely this little thing would clear itself up?
Going shopping was a bit iffy, because quite often the pus would unpredictably burst forth from its dressing and start to leak through my trousers, and the passers-by would be embarrassed, not realising that it was just pus, and laudable.
Sometimes they tried a new type of dressing, but still the leak continued. “It’s bound to get better eventually,” I said to the most experienced nurse; she looked away and changed the subject, and I realised I was wrong. But so what? It was a nuisance, but that’s all, basically I was fine.
But there came a day when the surgeon said “I think we should do a revision”, and went on to explain what he had in mind: open up the leg and take out the existing prosthesis. But how will I get about without a bone? Well, we then fill up the space with cement full of powerful antibiotic, and that’ll zap the remaining infection. You’ll keep the cement leg for 10 weeks, and you’ll be able to get about on it. And then we’ll open it up and remove the cement and give you a new prosthesis, and you’ll be fine.
I felt a powerful resistance to this notion: two more lots of prune etc. Why not just carry on? The pus was a nuisance but I was doing okay, it was liveable.
He told me about long-term consequences of not dealing with the infection, and made an appointment for me to see the head of Infection Control, so that I could get another opinion.

Meantime I did some googling; it seemed that the unzapped MRSA bug could result in “pneumonia or inflammation of the heart, organ disruption and even death”. Mm.
On Girdlestone I found the description of how to do it (aarrggh) and this advice to the surgeon: “This is a difficult procedure and is for more experienced surgeons only ... If you are inexperienced: (1) The joint cavity may become infected and seal off. (2) You can injure his sciatic nerve. (3) You may have to abandon the procedure uncompleted, in which case you will feel ashamed, and he will be made worse.” Double aarrggh.
I went to hear Infection Control’s message. He considered all the technical details of the infection and state of leg, and inspected my hands, especially the nails, with care. He told me what would likely happen if the bug didn’t get zapped, and it was just as Google had said. His strong recommendation was to have the revision.
Back at the clinic, the surgeon said “My predecessor wouldn’t do this; he’d do the Girdlestone bit, but not a new prosthesis. He used to do Shetland. If you go up there you’ll see folk walking like this,“ and he did a realistic imitation of a chap limping along bent over, with one leg shorter than the other. Yes I’d seen folk walking like that, though I hadn’t known what was wrong. “It’s a difficult procedure; and you’ll need a longer prosthesis, specially ordered, expensive. But I’m willing to offer it. It’s your choice, no-one’s forcing you. If we’re going to do it, the sooner the better.” And we reverted to discussing Porsches and deerhounds, to give me time to think.
I tossed a mental penny, yes or no, and shut the frontal lobes down and consulted the lizard …
“Yes,” I said, “go ahead.”
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(How amusing will a cement leg turn out to be? Will a new, longer prosthesis be fun? or not? the next (and possibly last) instalment will reveal all)

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