Big Tall Bob Used To Reek Geek

He's a giant of a man.  When I first met him, seven years ago, he reeked "geek." He's still shy, but now he's buff, tan, wears the coolest clothes, and his spirit seems to have grown into his height, and beyond it, hovering as icy blue aura, or just making the air shimmer..  He seems to move with grace, even in clunky exam rooms overcrowded with rolling stools and tables full of tape and bandages, and those cotton swabs that top only one end of long, thin wooden sticks.

He's never been paid for his part as "assistant surgeon" in any of the eleven or twelve operations in which he has helped.  The insurance companies write that my surgeries should not require extra assistance.  If I can, and that's a huge "if," I'm going to try and leave him some money in my will.  He would die of Extreme Blushing and Embarrassment were I to do it while alive -- and I love his anti-geekness too much to put him in danger of a return to stammering and crooked glasses.

That makes an elegant segue for my tale of yesterday's appointment with Bob, Brilliant ShoulderMan's Physician's Assistant.  Unfortunately, I need to take a break, grab some frozen strawberries, cover them with fake sugar, and splashes of milk.  This concoction has comforted me several times a day over the last few weeks.  I don't know why -- except that it does cool me down, and I'm starting today's fever.  So I'll be back.  It's also a chance to give Buddy -- who is looking after me this morning -- his favorite treat of bonito flakes, fresh from the one-pound package in the freezer.  (We got the "okay" from the vet to give him as much as he wants, and he wants, and wants, and wants...)

Bob listens to me, and hears me, too.  When I'm stupid, he ignores the babbling.  When I'm glossing over something difficult, he gets very still, a hard thing for a big man to pull off.  He has crystal aquamarine eyes.

We talk cats sometimes.

There have been late-afternoon appointments, over the years, where he and Brilliant ShoulderMan's nurse would both sort of collapse onto chairs or rolling stools, even putting their heads down on the exam table.  I was like a fixture, I guess, and attuned to their fatigue.  These are some hard-working people. Once, I think we all three dozed off.  I remember the nurse shaking herself awake, handing me some pre-op paperwork to sign.  She started to go over each document, then said, "Oh, you know the drill..."  Informed consent at its best!

In the hospital, it is Bob who rounds more than anyone else, so he was the one who got to witness most of my CRPS misery.  He'd drop by between 5 and 6 AM, and I'd be doing well.  Between operations, say around 11 AM, he'd pop in to find me writhing, jerking, cussing.  He heard it all, he heard me say I was giving up, he heard me full of bravado, he saw me when I could not even speak.

When they take me into the surgery suites, I'm always lost.  I cannot see, so I tend not to speak to anyone, whereas they all feel like we're old friends, and come up and crack jokes, say sweet things, explain what is going on.  ShoulderMan and Bob usually aren't in there then, they come swooping in as I am put to sleep, I guess.  But this last time, in June (has it been that long?), there was this unmistakably tall figure moving about the surgical suite, emitting a reverberating voice.

Moving from the pre-op gurney to the operating table is always difficult.  Normally, the surgical staff would help, and the patient would be grateful.  Me?  They knew me so well that should some Newbie reach for a leg to help guide me onto the table, a whole chorus of "Don't Touch Her Legs, Let Her Do It!" rang out.  (Why the nurses up on the floor couldn't grasp the concept, I dunno!)

But this time, my legs were seizing and out of my control, mostly. My left shoulder was shot, hurt horribly with any movement (we shall not intimate that the regional block FAILED miserably!), and that left my right arm as the only available appendage to see to this transfer from gurney to operating table.  Had there been a trapeze, I might have been able to just drag myself over with that one arm, but you can imagine how incredibly crowded it already was in that area... machine after machine, lights, tables full of instruments, and people, lots of people.

I had already led some of the nurses in a sing-a-long during the trip there, and even as we all pondered how this transfer was gonna take place, we were still humming.

Finally Bob's masked face came down to about an inch from my nose.  "Hi Bob," I called out.  I think he laughed.

"We're going to pick you up and move you, and we're going to be quick and gentle."  Before I could bitch and hem and haw, it was done, but not without Bob's face coming back into the one-inch-from-my-nose range.  "Are you alright?"

It would have been one of the easiest entrances into surgery for me ever had not the anesthesiologist screwed up.  I always ask that they please give me good warning before putting me to sleep, as I like to say "thank you" to everyone in the room first.  (Tevye: "Tradition!")  I asked the guy, he said "okie-dokie."

I am difficult to intubate, so much so that they have had to break my teeth in desperation.  I guess that is what he was thinking about.  Anyway, the bleepety-bleep-bleep gave me the paralytic and then couldn't get the tube in, and I was wide awake, unable to suck air for myself, having thanked no one, and was about to come off the table in panic.

Move along, prof, move along.  I am avoiding getting to yesterday.

So... yesterday.  I had an appointment with Bob, one of the interminable "follow-ups." He asked, first thing, how it had gone with World Famous Hip Guy, who was supposed to have done an ultrasound and/or fluoroscope-guided aspiration of my hips, tracking down that wily Propionibacterium acnes.  The journey that led to me losing a shoulder was to begin with my hips.

I picked a spot on the wall behind Bob's right ear.  I told him that World Famous Hip Guy refused to operate on "someone like me" and wasn't eager, therefore, to do the diagnostics.  I told him we were kind of like oil and water.

Then I told him that I was giving up, and relayed the info from the biofilms expert, paraphrasing his "first there is a wound, then they lose a toe, a foot, a leg, and then they die." He did some fast blinking, as did I, and I risked looking at him.  He made it easy:

"So we're going to concentrate on pain control, then?"  blinkblinkblink

"Yeah, I think that is what makes the most sense..."

I was proud of Bob and proud of myself, in that I did not do that awful thing of asking:  "What do you think I should do?"

Somehow, we started cracking bad jokes, the best kind.  And we talked about the carbon footprint of sending a power wheelchair I am trying like hell to donate to someone in Haiti -- where my orthopedic team does mission work twice a year.  There is a local agency that could use it but they won't get their act together and come pick it up and we cannot deliver it for lack of a stabilizing bar for the lift.  BlahBlahBlah.

Suddenly, Bob blew it.  "You're a very special person."  Aw, damn. I, who know me, cannot let that stand, it feels like acid poured on my soul.

I made a rote denial and then managed a "Thank you, Bob, and thank you for everything you have done for me."

More blinking, and that was it.  He made some recommendations for drugs that won't make my stomach bleed, made me promise to come back in 3 months, and blinkblink, I woke the sleeping Fred in the waiting room, where people seemed to be guarding his snoring frame from disturbances.

"Awww." murmured the people, the Greek Chorus, as Fred struggled back to consciousness, cute as the dickens.

We did not speak of the appointment during the long ride home, and I was able to pretend to be bothered by the sun in my eyes.

in lieu of originality....

in lieu of a post dedicated to marlinspike hall and manor fans alone, please allow me to copy the high wit and zaniness that i sent out to my friends and family list last night and this morning.

i must highlight a scientific discovery, however:  dark chocolate seems to be the cure for most illness.  dark, dark chocolate -- low sugar.  sensuous.  you heard it here first.

okay, here are my cut and paste offerings:

#1.  To MDVIP  Go-To-Guy and his hopping nurse, Jalapeño:



HI -- 


I just called yesterday to say that I was going home from X Hospital.  Dr. D felt good about the surgery, did not see obvious infection, removed the spacer, etc. so I am shoulderless on the left.   Dr.B did not feel so optimistic -- seems more worried about the situation in the bone and less about the joint space, and ordered another bleeping PICC line and a month to 6 weeks of intravenous antibiotics.-- daptomycin.


He said I need either vancomycin or daptomycin -- vanco messes up my ears, and I get high liver enzymes on daptomycin, but those are my only choices [?].


I am exhausted and depressed and hurt.... BUT if we had not been able to stop the CRPS spasms beforehand?  This would have been a disaster -- so I THANK YOU FROM THE BOTTOM OF MY HEART for helping to get those stopped.


We have to make numerous trips back and forth to Dr. B's office and Fred is unhappy.  Five minutes before we left the Manor Monday to check in for surgery, he told me he was not going to stay with me after surgery, and "so what should I do with your stuff?" [like a *wheelchair*]  I made him leave once he dropped me off, because all I was getting was more ADHD/PTSD stuff and I couldn't take it anymore.  So I went into surgery sobbing like a nincompoop and he didn't show up until 4 on Tuesday, just in time to leave the hospital... I don't believe he remembers doing or saying any of that stuff on Monday.  It's amazing, infuriating, depressing, scary, and it makes me very lonely sometimes.  But love is miraculous, and on the way home he stopped of his own accord to get me some chocolate.  Sometimes buying your partner chocolate is the biggest "I love you" you are gonna get.


This time, though, even if he has to lose it for a little while, I am okay, I am not febrile and falling down!  It's time to take care of Fred for a bit.  And ManorFest is now just weeks away.  We are thinking of submitting the film of this surgery to the Sundance Festival Competition, Cannes, and have a preliminary showing here, shown on the outside wall of the Labyrinth -- which is now big enough to serve as an IMAX screen.


Okay, well, let me get busy trying to see what life without a shoulder is like!  So far, I haven't even had the guts to look at the wound but Dr. D seemed very pleased.


You all are wonderful.  There is no need for home nursing or any of that -- Fred, Bianca, or I (probably me) will do the PICC infusions -- they are just once a day.  If I can get the long extensions put on the PICC do-dads, then I can use my left hand for flushing the lines.  Fun, fun, fun!


Nathalie at G's switched me to 25 fentanyl patches.  Do you think she will believe me that we went through 3 of them in 3 days?  One fell off in the shower on Sunday, they pulled the next one off in pre-op, put a new one on that Hank pulled off, thinking it was tape,  We are a lot like the Marx Brothers.


Much love and appreciation for your prayers and good thoughts.  If I spike a temp or feel really rotten, I will call: you, D, B -- in that order!


Profderien, Gimp par excellence


PS My new least favorite experience?  Being given the paralytic medicine in the operating room before having access to any breathing tube... can you say "panic"?






#2 To Friends and Family, with a few foes thrown in for good measure:



howdy, group --


i am home, but now you can only cry on one shoulder.  you can only put your head on one shoulder... i can't think of any decent shoulder jokes!


there was a divergence of opinion -- the surgeon felt there was no "significant infection," and the infectious disease doctor was more concerned with the state of the bone, not the joint space.  in battles between infectious disease bigwigs and shoulder surgeon bigwigs, it's the "ID" guy who wins.


so they inserted another bleepety-bleep PICC line yesterday and started 6 weeks of daptomycin.  never mind that it gives me liver toxicity, ID Man says "we'll keep an eye on it and if it gets too bad, we'll switch to vancomycin."  vancomycin makes me have auditory hallucinations, and ringing in the ears which can be permanent.


if i did not like and trust ID Man so much, i'd have taken off at high speed in my trusty chair, clearing the way with a cane wielded with fierce precision.


okay, so it hurts like the dickens, i have not had the guts to look at the wound, and we have to be at ID Man's office in just a bit.  so this well-written, well-thought out missive must end.  don't cry...


fred is fine.  i about killed him, but he's fine.  i don't think he has any memory of the crap he pulled prior to surgery, which is just as well....


i love all of y'all, and have appreciated your support over the ten surgeries these past three years!


if you are not an obama supporter, and i suppose that is in the realm of possibility, please still give thanks to the man for giving me the opportunity to buy insurance when all the private companies refused to cover me any longer.  it is still a bankrupting situation, but i am covered and treated well.  i grieve for those who are not.  i am pretty sure that romney would not recognize me as either a corporation or a "person." 


love ya,
profderien, the one-shouldered gimplet

sunday night check-in

i apologize for not "checking in" before now -- and hope to post something worth a read tomorrow or tuesday.  my legs are giving me fits, and the pain/fevers/chills from the infected shoulder make me a very uninteresting person, indeed.

saw the surgeon thursday, and remembered why he and his staff will always be heros to me.  what they are attempting to do for me is technically and medically difficult, something my go-to-guy doctor and i both tend to forget.  so it mattered to take a few minutes thursday to recognize that fact.

the down side of such emoting was the ensuing hug fest -- which rapidly degenerated into friendly shoulder pats that nearly made me scream.

there was one little bit of unexpected news.

dr. shoulderman was trying to walk me through the process and i was only half-listening, as this is not exactly new territory.  he'd gone over the ins-and-outs of the first surgery, talked about the need for a new infectious disease specialist, the PICC line, and 6 weeks or so or intravenous antibiotics.  (he briefly cradled his head in what might have been exasperation at the news that i was still taking oral doxicycline when surgery was 10 days away.  so shoot me... no one told me to stop and it just did not occur to me that it would screw up the culture sampling.  i stopped taking it thursday and pray that was soon enough for it to exit my tissues.)

he paused, and i entertained notions of actually going home and curling up under a few inches of soft flannel, as i just could not get warm.  i have even resorted to covering my feet, something that causes severe burning pain, as even my feet feel cold these days -- and this, after a decade of sleeping with them uncovered.  i also thought about trying to line up the roto-rooter treatment for my port, which, at the moment, will allow stuff to be administered but will not, in turn, surrender any blood for testing.  and, to be honest, there were some thoughts of stopping somewhere for lunch.  i was thinking taco bell when dr. shoulderman's voice took on a new tone...

"after 3-6 months, if all goes well, we will want to go in and remove the spacer, of course.  if it appears successful and we find no obvious evidence of infection, there are then two choices."

i think i probably smiled.  i didn't know i had choices!  this was great news!  i thought there was just the one option, the option we had bandied about for over a year -- the old reverse total shoulder replacement.  a woman with choice, a woman with options, now that's a happening woman.  i put taco bell and roto-rooting plans away, and tried to pay attention.

"we can put in a new prosthesis..." he said this in the most desultory way, as if it were something too awful to contemplate.  odd, i thought, since that is, of course, the best outcome -- a clean shoulder, a new bit of bionic wonder.

"i thought of you last week as we finished surgery on a gentleman in much the same situation. i put in a new prosthesis, the frozen sections looked good, it seems like he had beat the infection.  then eight days later, i get a call saying that something has grown in his cultures -- p. acnes.(this is the major suspect in my case, as well) -- and now he is back on the merry-go-round."

why, dr. shoulderman, that sounds suspiciously like a cautionary tale!

more sober talking, more somber scenarios in which it looks like i have beat the pathogens all to pieces when, behold!  the suckers were just lurking in the hope of reasserting themselves on some new implant.  there were dire descriptions of the state of my bones (no news there), and at the opportune moment, shoulderman shifted gears...

"and so it may very well be that at the time of the second surgery, i will have to assess the situation and consider leaving you with a flail shoulder."

the smile stayed on my face because i had not the least notion of what a flail shoulder was.  i knew the term flail chest from some EMT courses way back when -- and knew it to be a horrible trauma that basically unhinged the rib cage in folks who slam into the steering wheel in a car wreck.  inane smile still plastered on my face, i interrupted to make my inquiry into our brave new lexicon.

turns out that flail shoulder is the polite surgical term for no-freaking-shoulder-at-all.


in truth, this result had been mentioned before, but only in passing, and only, i thought, as a conversational oddity, a bit of ripley's believe it or not.  i remember, most specifically, my go-to-guy doctor whispering, several years back, "this is not going to end well."

dr. shoulderman, kind and handsome, talked on.  some people were able to train themselves to use scar tissue as a kind of new muscle, thereby allowing for some arm movement. i was particularly thrilled to hear that "some people can learn to bring their hand to the mouth."

unfortunately, even the most scintillating of conversations have to end (this one, as that one!).  but i've carried on the talk inside my head, a few minutes at a time, more if the fever spikes a good bit and my frustrations pop out.  i keep imagining what ifs that don't help one bit but are nonetheless all too probable.  how will i do x now, how will i do y?

within two days, fred was already able to think productive, forward-inclining thoughts.  yesterday, he even inquired about the possibility of an external bit of hardware with which i might regain control of my left arm, once it's been rendered flail.  i was dismissive, as it seems like dr. shoulderman would have brought that up right away in his extemporaneous powerpoint presentation.  fred, as usual, is a great point man, and a quick googling of "flail arm" turns up many examples of braces, hooks, and goth-inspired hardware that can be strapped on, and, if nothing else, used to make me look fierce, tough, and borderline biker.

Stanmore orthosis with hook:
Add a clutch and silvertone choker studded with Swarovski crystals for an easy day-to-evening look.

i don't know whether it is the stress of it all, suddenly, or what, but my left leg is now the fugly spitting image of the right one, and both are spasming to the beat of a whacked-out drummer.  i refuse to repeat the die hard description that one crps-er after another has ripped off and reiterated: "imagine being doused in gasoline, lit on fire, and then kept that way 24 hours a day, 7 days a week, and knowing it was never going to be put out..." it's... depressing.

dr. shoulderman is wonderfully cognizant of my crps, and though we rarely discuss it, he is well-informed, as every orthopedic surgeon should be.  he has been distressed by the obvious crps spread, and the condition of my arms, as surgery anywhere is never wise with crps on board, and repeated surgeries in an area of lots of rsd activity is what polite society calls a "no-no."  so he decided to order repeat regional blocks in an effort to prevent further spread.  it was comforting, reassuring -- he cited a recent study, and did so in depth, an impressive feat for a man whose brain must be chock full o'important stuff.

tomorrow will be a long and uncomfortable day.  it's off to the hospital we go, for testing, testing, testing, and -- i predict -- some arguing with the billing office.  they say i owe over $3000 from a few years back -- they didn't file with my insurance company until 18 months passed from the date-of-service, and by then, i had switched to a new insurance, and -- of course -- the former company refused to pay.  if they make this admission contingent on paying that bill?  i will be in a tough spot.

ah, and tomorrow they'll culture skin and nares for mrsa... i have cultured positive several times before, therefore spending my time in isolation, with a very frustrated fred having to wear those awful yellow paper gowns, and be gloved up.

maybe i can have them give me the roto-rooter port clean-up tomorrow.  if we have to spend the day, may as well check off as many chores as possible.

so that's what has me away from the blog... although my heart is always at the manor, safe in marlinspike hall.

It's gonna be a Rockin' Birthday Eve

After a response time delay that successfully separated my stomach lining from its mother-organ, the assistant to Dr. ShoulderMan called last Tuesday evening with a date for surgery.  It's gonna be a Rockin' Birthday Eve Event on 23 January.

I was able to refrain from asking her to specify the year.

I was, as they say, fit to be tied from the rush to wait.  [I pity the fool who tries to get me into that straitjacket.]

My snark is misdirected, also irrelevant.  Turns out ShoulderMan's assistant, a nurse who is In Charge Of Everything in that particular workshop, had been out of the office the preceding five days.  It was my MDVIP Dr. Go-To-Guy's right hand woman who set me up with expectations... 

I'll let it go, this nonsense, let it float up to heaven tied to the end of a wildlife-smothering mylar balloon with bird-garroting ribbons streaming down, landfill fodder.

[Yeah, that's right, I'm crazed by all the balloon releases that people announce -- as tributes to children dead from evil cancer, usually.  I guess the balloon signifies childhood and the act of watching attached wishes and sentiments rise to the assumptive vault of heaven is cathartic. My vote goes to... I dunno... quilt panels and living memorials of plants and trees.  I'll shut up now.]

I have been brought pretty low of late by things physical, something that is only truly possible by the acquiescence of the mind to things petty.  I've caved in, near implosion, from debilitating sweats, for example, that seem to be accompanied by vicious head and neck aches.  But mostly, it's been the Return of the Spasm that has had me wailing, alone, behind carefully closed doors.

Okay, that's a lie.  I have stopped closing the doors, mostly because every ear in Marlinspike Hall is now entirely immune to the impact of my screams, and never did much react to my cries, anyway, preferring that I announce myself with tasty offerings, via the dinner bell, or with folded clean clothes, after the alarming bark of the dryer timer.

It's not that Fred and La Bonne et Belle Bianca Castafiore don't care;  It's more that no one can sustain the level of pity that I require, especially over an extended period of time.

Thank God for blogging, eh?

Even the Feline Remnant has developed a disturbing catty commentary on my painful inertia.  Dobby has begun leaping onto my blimpy red oozing legs without the least bit of apology, no hint of embarrassment at my yelp of pain.  That glint in his eye had better be a trick of the light.

Personally, I think that with just a tad more dedication and practice, the Indentured Staff, Haddock Middle Management, and Comedic Cling-Ons, all, could whip up sufficient sympathetic fervor -- but that's just me, the hopeless optimist.

The spasms seem to only last about two hours -- that'd be for the one, at most, two, extended sessions of yowling jerkiness per day.  The rest of the time, it's a blitzkrieg sort of experience that clearly derives from techniques of guerrilla and modern urban warfare.  Rapid, apparently disorganized small strikes meant to demoralize as much as disable.  Enmity buried in the ordinary, wide-eyed innocence masking murderous intent.

What?  No, I do not think that the characterization of schtuff (above) is excessively self-important and self-pitying.  What's wrong with you?  Whose blog is it, anyway?

I thought we'd found the formula to defeat CRPS' spasticity, or, at least, the appropriate drug.  It's no surprise -- It's Baclofen.  Also good for hiccups and alcoholism, not necessarily in that order.

Unfortunately, Baclofen can leave me drooling, which begs the important question:  Is life more worth living as a Somnolent Slobberer than as a Total Jerk?  We are trying to ignore the clamor of outside voices, those ninnies who feel no shame in telling me what I ought to do ("Just distract yourself, don't over-medicate!"; "Eat a banana!").  There is always one Ninny who wants to blame a low potassium, who hasn't heard that cantaloupes, prunes, and papaya beat out the banana, or that tomato juice with a baked potato will fill the void, as well.  Be all that as it may, my potassium is fine.

Où est donc le fil de ma pensée? 


Anyway, the Baclofen stopped working, and I cut it back from 80 mg per day to 50-60 mg total, with the result that I no longer spew spittle about The Manor as I twist and twirl and scream.

How is the CRPS, overall?

The Edema Wars continue on, skirmish by skirmish, no real victor in evidence.  I had to spend three days straight in bed to bring down the puffy, liquid nature.of my legs and hands.  It's no longer an extraneous detail, this edema, for when it is uncontrolled, my legs are in the red zone, but with patches both very cold and very hot.  If diuretics, elevation, and rest work their magic and my fingers and ankles reappear?  Then the CRPS slips into deep purples, and every appendage is ice cold.

In terms of pain, CRPS rarely lets up.  The few moments when I am not in pain really are attributable to either unconsciousness or Blessed Distraction.  Unfortunately, pain and sleep are not friendly with one another, so I continue to sleep very little, with the result that pain seems worse, and life, hopeless.  It's wonderful, those occasions when I do get good rest, and simply amazing how much less pain I perceive.  (The lessons of Reality-as-Perception are popular review topics around here.)

Highest on the list of Blessed Distractions?  Books with pace.  The Republican presidential nominees (though we fear their entertainment factor may begin a steep decline as that peculiar segment of the electorate begins to weed, in earnest). Suppression of cat hair in my environment. Cooking and baking.  Crossword puzzles. Counseling the inpatient addicted carnies during their stay in Haddock Rehab (headquartered in the barn).  Short parkour and ballet vids on YouTube.  Bed-bopping and wheelchair-whirling to familiar golden oldies, archaeological rock.  Checking for updates to Pete's Pustulant Pimple over at PopThatZit.  Dobby the Runt, Marmy Fluffy Butt, and Buddy the Freakishly Large Kitten.   Fred.  La Bonne et Belle Bianca Castafiore.  The Crack Whore across the country lane (We sometimes sit and listen to her soliloquize in the middle of the night;  Lately, she has addressed one astonishing speech after another to her Ugg boots.).

There's a new category of CRPS misery -- skin.  Skin that rips and tears, bleeds and blisters, openly weeps and lightly leaks.  Skin that burns, skin that, once broken, refuses to heal.  I suppose my new friend, The Fistula, falls in this category.  The Fistula had stopped leaking and I was full of hope that it would go away, but then I mopped all 27 of The Manor's medieval and early renaissance kitchens last week... and wouldn't you know, the hole in my upper arm turned bright red and produced stringy yellow pus.  The idea that this thing has tunneled all the way from my shoulder prosthesis is so... gross.  *Bleck*!  *Ack*-*Ack*


My right leg is particularly prone to skin weirdness, as well as injury, upon which skin weirdness thrives.  Between cat talon punctures, dropped laptops, and doorway collisions, the leg is pocked with holes and eruptions, and regularly bathed in the terrible brine of lymphatic fluid.  It can be depressing.

Prior to my last visit with MDVIP Dr. Go-To-Guy, I decided to do some heavy maintenance of that leg, and took a brush to it, thinking that maybe the crud and crap could just be scrubbed away.  (Very sleepwalking Lady Macbeth.)  In the shower, perched on the plastic chair [that has a screw poking through its seat right into mine own seat, ouch!], I administered a brief flurry of boar bristles.  Never again.  I still burst into spontaneous fits of bleeding if I leave that leg haphazardly upright, or should I remove the Hello Kitty Band-Aids.  In addition to what can only be described as holes, new pores on steroids, there are shiny, raised, red whorls.

My hands primarily burn, though there are now stabbing pains on the outside of the palm and up the side of the pinky finger, with the foremost complaint-worthy problem being edema and slowness to react, clumsiness.  This puts a real crimp in my legendary culinary knife skills.

We've been keeping Ruby the Honda CRV defrosted, de-iced, juiced up, and just generally ready because the infection in my left shoulder is raging, and there have been a few afternoons when it seemed like I was becoming septic, or, at least, loopy.  I sometimes get hit with chills and sweats simultaneously, cannot get warm, and wrap myself up like a papoose destined for frozen tundra.

So that's the state of things.  My goal is simply to get to January 23 in as great a condition as possible, with a mind prepared for another long haul of seek-and-destroy.  ShoulderMan will team up with another local folk hero, Infectious Disease Dood, and together they'll organize the antibiotic or antifungal (ewww) attack during the post-op period with the spacer in place.  If they are successful, ShoulderMan will be able to regift me with a shoulder (most likely a "reverse" prosthesis) in about three to four months time.

I am so lucky to be in their good hands.

Now... to get there. and with sanity intact!

Passing the Duck Test

Late last week, I opened a blog post with those impossible to live down words:  "i'm sitting here weeping." 

Those words don't cause me shame, that's not the problem.  The lack of capitalization?  No, that could be readily fixed (I'm told).

Once again, it's the absence of heart, or as some WizKid might recast it all: my hopelessness.

Between you and me, I've been sitting around weeping a lot lately.  Of the twelve things most likely to be happening in our bedroom here in the Easternmost of the East Wings of Marlinspike Hall, me sitting whilst weeping is in the Top Four.

It's disgusting and not inspirational of anything except, perhaps, a triple-dose of nausea medication.

I saw my MDVIP Go-To-Guy on Monday, and left his office very confused, for he assured me that I made sense, thought logically, and was not being overly-demanding in my health care requests.

He intimated, even pretty much said, that my reactions, too, were not over-the-top, and that references to the Book of Job were correct within his understanding of the Biblical literary tradition.  Because I am not the type to interrupt my Physician while He is trying to speak, I thought -- demurely, quietly -- to myself, alone: "Doubtless the edition illustrated by William Blake!"

Lo, let that night be solitary, let no peaceful voice come therein (Job iii: 7).

Let the day perish wherein I was born (Job iii: 3)

So they sat down with him upon the ground seven days and seven nights, and none spake a word unto him: for they saw that his grief was very great (Job ii: 13).

In other words, he did the old "if it quacks like a duck" routine in reference to my suspicions that my left shoulder prosthesis remains, or is once again, infected.

He is a kind man, is my MDVIP Go-To-Guy, an excellent doctor, and I am glad we scrape the underpinnings of the more modern furniture, mostly reproductions, in The Manor's public vending areas and grateful that the miniature families on the domestic staff willingly sift the silty bottom of the moat for spare change.  We split the haul, fifty-fifty, because square is square.

You'd be amazed at the number of people who think that throwing things into the moat is an acceptable romantic substitution for tossing pennies into a well or euros in the Trevi fountain.  Of course, given that we sometimes attract a crowd heavily into the religious life, here more for our next door neighbors, The Cistercians, or equally heavy into heroin, hoping to score an inpatient bed at the posh Haddock Family Enterprises Addiction Center, headquartered in our barn -- we don't always come away rich in cast off coinage.

I didn't want to confuse you with haphazard detail, but most of those who drop by the Haddock homestead are also somehow related to the carnival, and are, in fact, often carnies.  Fred thinks its because we exude some sort of Rabelaisian exuberance, that we are, in short, relentlessly robust.  Fred obviously knows nothing of my time spent weeping and the suggestion that that might be one of the chief occupations of his boudoir would shame him.

Fred likes the more complicated explanations.  Me?  I'm all about Occam's Razor.  We attract addicted Catholic carnies because the Haddock Corporation opened a detox/rehab and decided to headquarter it in our barn, next to its tantalizing rope structures (connecting to the Manor proper via the Computer Turret), which fairly sings to those with gymnastic training, which is most everyone.  Oh, right, and we are smack dab next to Abbot Truffatore's Internet Office Supply Center, cleverly disguised as a rather ancient monastery.

Forgive the sarcasm, Abbot!

Anyway, I put every bit of money that we earn, find, and grow on trees into my MDVIP fund each year.  Even when I did not have the money for health insurance, at least, not at the rate charged by BCBS of Tête de Hergé, a cool $1513 per month -- Even then, I found the odd pile of silver so that I could continue under the care of an excellent physician who knew me well and was absolutely dedicated to keeping me out of the hospital and well, if the fates were so inclined.  Now that I have a PCIP health insurance policy, thanks to President Obama's Affordable Health Care Act For Expats Lost In The Heads Of Dead Belgians, I continue the tradition of remaining remarkably poor and still spending money I cannot spare on a boutique-type doctor.

Studies show that my method is both madness and cost-effective.  My MDVIP Go-To-Guy affords me the knowledge base and the organizational support I need as we go tripping and skipping around to the specialists, trying to keep the various disease conflagrations under control.

Like I said, he's a kind man, and an excellent doctor.  He answers his own phone, is forthright, and from what I hear around the custom coffee centre, plays passable tennis.  Add to that list of positives that his nurse has a superb head for politics and can always find a vein, and you've got overwhelming indicators for a fine medical practice of personalized primary care.

Monday afternoon, he was probably thinking, "Don't make any sudden moves... Smile a lot... Support her in her delusions..."

I felt about that crazy.  It's tiring, being led by the nose from one appointment or test to another, believing against the available evidence that you are following some master plan for a return to health, only to have that psychotic rug pulled out from under you.

It can lead to things like a bedroom dedicated to weeping and not wanton pleasure (or, if you cannot sleep, sex).

He carefully went over my lab work from the week before, and after pointing out the abnormal infection indicators, affirmed that I had, indeed, passed the Duck Test, and that he would call my orthopedic surgeon that very afternoon.

[The peculiar reason for which I was weeping in the boudoir last Thursday morning was an early morning call advising me that there was no need to keep my appointment with the surgeon that afternoon, as the (failed) aspiration of my shoulder had grown no pathogens in the lab.  "Great news," was the message.  "Great news, my chapped ass," was my ladylike response.]

Believe me, I know how strange it is to actually want surgery!  I feel downright odd fantasizing about ripping this bloody prosthesis from its slipping anchor, mwa ha ha!  If there were a home-based, non-surgical way to get rid of the infection, we'd have done it... three years ago.  If you are new to the Shoulder Saga, it is best summed up that way:  an infection of my bilateral shoulder prostheses that we are unable to eradicate or control, which is causing much pain and decline in quality of life.  Also, I am not serving anywhere near as many blistering aces as I oughta be.

The damned microbes refuse to show themselves when so invited by certified laboratory personnel.  They're exceedingly shy or something.

You may have noticed, as I sure had, that today was Wednesday.  There's been no crying or gnashing of teeth, but there has been a lot of pain and existing under cover of soft, worn quilts.  A quieter depression instead of a theatrical meltdown. Lots of pain and fever.  When I saw Go-To-Guy, I was at 100.5, and that's after I had taken a pound of Tylenol.  I have been hitting 101 most every afternoon, and feeling charming through chills and sweats, snarling with hypoglycemia, dry as a bone from dehydration, drifting off into polyuric dreams when the blood sugars climb too high from infection and steroids.

In all of those good times, I kept hearing him promise to speak with Surgeon ShoulderMan.  Bless the ShoulderMan's heart -- the infection persists in spite of his great skills.  He did my replacement on the right, then three years later, did a series of seven surgeries, yanking prostheses, putting in temporary spacers, regifting me with new prostheses, all the while managing my several sidetrips to Respirator Land.  It has been nothing short of a miracle, and my gratitude knows no bounds.  Unfortunately, neither does the infection in my left shoulder.

Monday afternoon, Tuesday, Wednesday.  Wednesday afternoon.

Yay!  MDVIP Go-To-Guy's nurse called this afternoon and I answered the telephone as if it were my greatest friend and not the object of my phobia.  She knew to cut to the chase, so she did: "Doc spoke with ShoulderMan.  His office will be calling you later today to set up surgery."

It made no sense that I was tongue-tied, but I was, and still am.  Of course, it is now 8:30 pm and nary a soul from that office has phoned, but maybe they are flying around the world backward on a rainbow jet stream of surgical gel and are experiencing a different time zone.

Maybe Buddy the Freakishly Large Kitten chewed through the landline phone wires again... Hmm.  (Nope, they're okay!)

If the past holds true, scheduling an infected joint "clean out" can be a bear.  They want you to be their last case of the day, so that the surgical suite can be thoroughly disinfected before they operate on anyone else -- but these are kind people and they know that sitting in a waiting room for hours, waiting to be called for major surgery, is stressful, too.  Factor in that it is the holiday season ("We celebrate them all!") and that they have a few gazillion other patients clamoring for action, as well... and it may be Friday before they call with info.

[How's that for pretending to be cool, calm, and collected?]

But there you go, Dear Readers, we are off on another surgical tour of the gunk inside these necrotic bones.  There is, literally, no other option that makes any sense, and even though we've failed in subduing these tiny forces of unrepentant evil thus far, this time we are gonna prevail... or I will come out of the experiment sans shoulders.  At least I know what that is like, now, and am not afraid of living without that thing defined by the area between the arm and the neck.

It's not like my brain is involved, duh.

Thank you so much, MDVIP Go-To-Guy.

No more sitting weeping from frustration.  Maybe I'll give fearlessness a try and give hopelessness a rest.  It could happen.

And... we're off!

How is it that hearing exactly what I expected to hear from the surgeon could depress me?  What is the point of even having expectations if they don't shield you from the negative effects of your own neurotransmitters?  Hmm?                              

Also, in case anyone had any lingering doubts, yes, pain is, indeed, subjective.

I recall this scenario having unfolded every time I've received the "we need to operate" response from ShoulderMan, a scenario that is now over the half-dozen mark.  By the time we are back home at The Manor, my pain levels rise to an obscene point, approaching the landmark "ten."  It honestly seems to hurt worse just because my excellent surgeon has opined that yes, surgery does look necessary.  That's nuts, makes no sense, and yet, is true.

We are going to proceed with the usual futility first, though:  Yes, another aspiration of the shoulder under fluoroscopy!  The eighth one.  May it be productive, because the first seven were not... Then, in 2 weeks, I will go back to hear how nothing continues to grow in the lab, and to finalize the scheduling for surgery.

At least I have an excellent excuse for bailing on the Wheelchair Negotiations for today.  The man handling my case is an idiot.  No, really, he is.  He also lies with excessive ease.  I don't know whether we are going to take our relationship to the next level of actually acquiring the new lightweight and speedy transport.

But, as I am trying to convince myself -- let that go until tomorrow.  I am spoiling for a fight, for anything that might distract me from the prospect of major surgery during the holidays, PICC lines and vancomycin (can't use the bleepety-bleep-bleep port installed in my chest wall for the post-op antibiotics), surgical cement spacers, and the subsequent surgery or surgeries to try and put in another prosthetic shoulder.

It's a darned good thing that The Nutcracker is such a piece of crap, both as music and as ballet -- because I am going to miss seeing it performed again this year!

That was supposed to be funny.

Fred has that deer caught in the headlights stare going on. Bless his heart, bless his bones.

The only good thing thus far today?  My surgeon just got back from Haiti, where things are, of course, really bad -- though he said things were more settled than they were immediately following the major quake, at least.  They desperately need orthopedic supplies -- crutches, walkers, canes, splints, slings, etc. -- and we have at our disposal an entire closet dedicated to the storage of such supplies.  It feels good to be able to put the stuff to some use, or it will, once Fred, Bianca, Sven, and I go over each item and refurbish things as best we can.  So that is one good thing for the day...

I just feel like weeping:  Therefore, let's post some cat videos!  If sending my orthopedic closet collection to Haiti and uploading a bunch of cute cat action doesn't dry my tears, what will?

First, we have Buddy in a Box.  Unfortunately, most of the footage of Buddy in a Box consists of no sign of Buddy but minute after minute of a mysteriously wiggling box.  Since he is more interested in me, for some reason, than his Bodacious Box, you lucked out this time, Beloved Readers!

Isn't it amazing how HUGE he has gotten, this freakishly large kitten that turned out to be a Maine Coon? Fred and I peer helplessly at one another and cry, "Who knew?" several times each day.

Next we have the Old Married Couple Series.  These are three videos of Dobby and Buddy, who suddenly have decided to promulgate peace, love, and understanding instead of trying to wipe each other from the face of the planet.  Okay, so Buddy is something of a recidivist, as he goes for Dobby's throat in the second video -- but he gets over the impulse and is soon right back to being a perversely large kitten, and all cuddly again in the third take.

As usual, please ignore the audio.  Seriously, it's embarrassing.