What is often most dramatic to the body can be of less interest to medical professionals, particularly on a post-surgical ward. They know to expect edema, mild fever, anemia, precipitous drops in blood pressure, nausea, howling pain. All these are considered treatable but not significant—which is to say that they are normal, will go away, and are not usually indicative of anything dangerous or extraordinary.
I needed four transfusions in the first twenty-four hours after surgery, probably a result of my being small-framed and thus with less blood to lose and replace safely. My oxygen levels were too low; my blood pressure was 80 over 40, and I swooned every time I got up. My hematocrit, which measures the amount of red blood cells in the blood, was about half what it should have been. The concept of food was exquisite, the reality unbearable. A plate of meat loaf, once summoned, had all the appeal of stewed tire.
These details were alarming only to me, and then not very, because for a couple of days I was in a Disney world of peace and love, also known as a central line of morphine. I have a vague memory of walking the first night, and hollering from another stratosphere as I did. My leg was the size of a rugby player’s. To get in and out of bed I had to use my strong leg as a forklift for the right one. People—friends and nurses and physical therapists—came and went in the most routine fashion, but to me each event seemed monumental, a choreography of intrigue and hope. I told my physical therapists how much I loved them. I repeatedly plugged my cell-phone charger into the wall reserved for the cardio monitors; amazingly, no nurse tried to smother me with a pillow.
Even in the aftershock of surgery, I knew somewhere that all this acute melodrama was just that—the heightening of the banal that is the essence of the post-op experience. What stood out, though, in those first few days of illusory urgency, was the sound of Dr. Mattingly’s voice, coming to me across a great sea as he stood at my bed at 6 A.M. the day after surgery.
“Things went very well,” he said. And then: “We were able to lengthen the leg by about one and a half to two centimeters, or five-eighths of an inch.”
Long after that brief conversation in the dark, I still feel the relief and awe that his words evoked. “We were able to lengthen the leg …”—like saying, We were able to walk on water, or, We were able to lift the moon. I knew exactly, even in a morphine cloud, how vast and how little five-eighths of an inch was: It was going to be my golden mean.
Dr. Mattingly left that morning to make his rounds, and his surgical physician’s assistant stayed to give me the full report. They had found “a real mess” inside, she told me; it was much worse than the pre-op screens had suggested. “You had to do this,” she said. I let go of her hand and entered the land of post-op bliss. I had had to do this, and now it was done.
I have notes and exercise sheets and post-op instructions from those first few weeks, all meticulously organized by Jean and Nancy, and I can look at them now and remember the intensity that every detail held. To the patient, it feels as though some grand odyssey is unfolding, with a cast of one. It is the body, perfect machine, showing off its stuff. If everything is working right, it reacts to the major assault of surgery by becoming Luke Skywalker: Fluid rushes in and cells regenerate and muscles and nerves regrow. I was stunned by this drama, and humbled, and in the early days at home I learned that my will had little agency in the way the story unfolded.
Anatomical functions I had taken for granted revealed themselves with bells and whistles. When I stood I could feel the blood whooshing through my body as my blood pressure changed; when I walked a few steps, my heart raced and I was short of breath. I had no appetite but began to crave protein, like a great bear gathering resources. I’d hardly eaten during my days in the hospital, and had gained thirteen pounds of water weight, all of it from my waist to my toe.
More radical was the leg itself—the way it felt, the way it worked, the way my brain accepted so much new information. I remember thrusting my foot up and outward the first morning I was home, trying to accommodate the feeling of this longer, floppy limb, and I had the image of a foal standing for the first time, its long legs goofy and in the way until they got their bearings. I couldn’t limp the old way even if I’d wanted to; there was too much leg there now.
The length Dr. Mattingly had gained in rebuilding my hip only hinted at my uprightness in the world, an ease and agency I glimpsed but couldn’t believe. For years my body had leaned toward its weakest point. Now it was as though someone had put a shim under a bureau, so that the entire structure was stable. I didn’t know yet that all the rest of my leg would have to play a long and painful catch-up—that nerves and muscles and tendons and ligaments would have to stretch, tear, readjust. For now I had only the sweet realization that I had been catapulted upward in the world. I was Alice eating the mushroom in Wonderland, and I felt powerful as well as tall: an instant dose of happy, to go up against the challenges of the next year.
It was nice to have these stoned epiphanies to appreciate, given the state I was in. Despite the transfusions, I was so weak I grew faint with almost no warning, and my newly arranged femur and leg had finally woken up to post-op pain. As my physical therapist warned me that first morning home, I had a few weeks of horrible ahead of me. But I also had Nancy, who came in and out continually, bearing the unflappable strength and good cheer of a doctor on M*A*S*H. She was tireless, she was hilarious, and somehow she had volunteered for this particular combat zone. And I had Peter running point with the canine unit—special ops in every way.
Standard protocol for a hospital release after hip surgery includes being able to climb six stair steps on crutches, and get yourself onto and up from a bed. This is pretty basic stuff. It does not include feeding yourself, answering a phone, picking up a newspaper, locking a door, pouring water in a dog’s dish, or making a cup of coffee. These, I learned in my first days home, are high-functioning talents, and anyone who pulls them off without occasional whimpering deserves a good-conduct medal, or at least a merit badge.
Any change that matters, or takes, begins as immeasurably small. Then it accumulates, moss on stone, and after a few thousand years of not interfering, you have a glen, or a waterfall, or a field of hope where sorrow used to be. You have a second chance, or an unexpected kindness, or a voice singing somewhere that floods you with light. You have a leg that works a little better than you ever believed possible.
But there’s always that moment, only a blink from the sacred to the mundane, when you think, Oh, Christ, I have wasted it all. I remember sitting on my couch in the dark one night when Caroline was dying, when I knew the gig was up, and thinking, I want to change my life, and of course we all think that, and then we don’t. It’s like trying to turn an ocean liner around and using a fork for a fulcrum. We just plug along and try not to mess up too badly.
Real change, though, is forgiving enough to take a little failure, strong enough to take despair in small doses. The ocean liner turns two degrees: different destination. You just don’t drink for one day. Don’t take the bait, load the gun, say the stupid thing. Do make the phone call, throw away the shoes that hurt. Just rest a little and then move another few inches down the path. When I was getting stronger I told a friend I felt like I was painting the kitchen floor with a watercolor brush: The point was never to look up.
David, Tink’s husband, had had a hip replacement a year ahead of me. Wise and kind David, who called regularly throughout my post-op ennui to cheer me on. “There will come a time when you’ll miss the old leg,” he told me one winter night, a piece of counsel that rang true for months afterward. He knew, I think, that we attach ourselves to our familiar miseries, an easier act sometimes than striking out for the territory. This is a sad truth, though not insurmountable: Despair and fear do not disappear overnight when the conditions that wrought them have changed.
But here’s something else I learned from all the work and frustration of that first year: Strength is how you keep yourself from falling. With two good legs, when
you start to fall, you can catch yourself.
I am standing in my living room in Cambridge, Massachusetts, and talking to my friend Stan, a former thoracic surgeon whose Alabama accent makes everything sound better. My visual perspective is so much higher than the last time I saw him that I laughingly pretend I’m as tall as he—about six feet—when I hug him hello.
As we talk, I try to get my hands around what I’ve been through. The past few weeks have been filled with distress and pain and occasional triumphs of possibility, and because I am so early in recovery from major surgery, I don’t know yet what it means. “I don’t know if what’s happened to me is a big deal or a little deal,” I tell Stan. “But whatever it is, I don’t want to miss it—I don’t want to turn away from this gift.”
Stan comes over and puts his hands on my shoulders. “Are you kidding?” he says. “It’s huge. It affects the entire notion of self.”
18.
There is, of course, a dog story in all this—adjacent dramas in Tula’s world and mine. I will try here to be a reliable narrator, given that I am interpreting for us both.
Tula had been staying next door with Nancy and her family for the time I was in the hospital. The plan was that Nancy would bring Tula over to see me the first evening, then home for good the next day. So once I was set up in the downstairs guest room, in they came.
Tula heard my voice from the back door—“There’s my girl!” I cried—and she ran into the bedroom, ears back and eyes happy. She licked my face—excitedly at first. Then she got a whiff of what I’d been through, and she panicked. She looked away, her tail went down, and she got behind Nancy. When I spoke to her or called her name, her ears flattened but she averted her eyes, as though I were a predator, or a wounded human who smelled of blood and trauma. Then she started pulling toward the back door.
Now this seems straightforward and not all that mysterious. I knew of similar incidents, where friends had returned from a hospital visit to a dog who avoided them for days. And I knew from simple observation that Tula was terrified.
Dogs lead with their noses; they can smell another dog’s fear, illness, or aggression from half a block away. Their discernment and powers of smell are several orders of magnitude greater than ours, which is why we use them as seizure dogs, bomb-sniffing dogs, search-and-rescue dogs. Recent studies suggest their ability to detect cancer in humans before it shows up on medical tests. They know so much with their sense of smell that we don’t even know yet what they know.
I had a six-inch incision on my upper hip. When Tula ran up to me, she was banking on all the other sensate givens: her home, her human, my voice and affect. Then she smelled my wounded leg, probably my fear, plus a hundred hospital odors I can only guess at. Maybe she thought she was next. Months later, I would see her behave exactly the same way when Shiloh came back from a minor surgery.
Whatever part of me understood Tula’s response, I couldn’t absorb it with any equanimity. When I think back on all the misery of that first week home, this incident—a beloved dog turning away in fear—was the worst of it. I told Nancy to take Tula back to her house, and after they left, I broke down. Standing in the kitchen on crutches, I cried in Jean’s arms like I hadn’t cried through any of the past year. I wailed. I had let strangers carve me up like a grapefruit, and now Tula, frightened witness to this travesty, wanted none of it. For all the friends and flowers and casseroles waiting for me when I got home, I felt like an abandoned waif.
Tula reappeared the next afternoon, after a long walk with Peter and Shiloh. I was in a chair in the living room, and she ran up to me, slightly frantic in her shows of affection. Then she curled up across the room with me in her sight line, and slept as though in a coma.
It took a while for her to come around—to believe that I was still here, hadn’t been replaced by some alien creature with metal wings. The crutches were less unsettling to her than my inertia and weakness, and my having upended the spatial truths about our lives. The second night I was home, Donna slept over, and Tula went upstairs to my bedroom with her—a gesture I took as a herding instinct to keep an eye on the whole house. But even after I felt able to stay alone, she kept up her quiet, vigilant routine. At the end of each night, when I was in bed in the downstairs guest room and Nancy had made a final walk-through, Tula circled the first floor as though doing a dorm check, stopping at my doorway and looking at me. Then she slowly climbed the stairs. I could hear her walking overhead to my room, hear her pausing, probably near the bed, then curling up in her usual spot. She slept there alone each night for that first week, as though she were waiting, uncertain but loyal, for the real me to come back home.
Then something happened that changed my need-ridden, human interpretation of my dog’s behavior. I started sleeping upstairs again after a week. The first night, just after I had turned out the lights, Tula ran from the bedroom to the front windows and started barking—a ferocious, guard-dog bark I had heard only a few times, and always at perceived predators in the woods. This was a bark she had used once on a giant Newfoundland when she was young, and the bark she’d summoned at a faraway coyote. She ran from window to window, ignoring my calls to stop, and the barking was so intense and unrelenting I was certain she had seen a coyote or wild turkey on the lawn—rare but not implausible. Finally she went downstairs and made a last round of barking through the front and side of the house, then came back up and lay down beside me.
A couple of days later, Emily, Nancy and Jim’s fourteen-year-old daughter, came over to see me. We were pals, which is to say that she would tell me the following story without editing.
“Did you hear a bunch of noise in your driveway late the other night?” she asked. My driveway abutted theirs; whatever one of us heard, both of us heard. “Two boys I know were trying to come to my window,” Emily said. “They said they came down the driveway and tried to get me to wake up, but that there was this ferocious dog in the upstairs windows who was going crazy.”
So those were the predators Tula was after: two harmless teenage boys, looking for the girl next door. For any Samoyed to look ferocious is an act of extreme camouflage. I live in a walkers’ neighborhood, where people come and go on my street at all hours. As far as I knew, my dog had never barked at a human passerby in her life. But with me flat on my back, Tula stepped up and became the mother bear of us all.
We got better on parallel paths. She walked next to me in the house, an undulating wave of white, while I made my way from room to room on crutches. A physical therapist came three mornings a week, and Tula lay in the foyer like a slab of marble while we walked outside. On stairs she stood next to me on the landing, serene and implacable, until I found the energy to go ahead. When I took a shower, she either curled up on the bathroom floor or poked her head inside the shower curtain, and tried to lick my wounded leg.
People moved through my house and state of mind, a parade of comfort. They dropped off lasagna, soups, chicken, homemade smoothies. Even from my state of bearable misery, I knew my life resembled a sitcom, with food arriving at the front door and sometimes going out the back, to replenish Nancy’s family. There were dogs underfoot and Nancy toodling “Hellooooo!” as she let herself in, and Jean rearranging the mail and refrigerator as though these were tasks of pleasure. We had hung a sign on the front door reading PLEASE DO NOT RING BELL—IT WILL SET OFF THE DOGS, assuming that would send the right message to burglars as well as friends. Only Peter systematically ignored this instruction, even though he had helped write it; he figured that now when the bell rang, I would know who was about to charge inside. My old friend Pete came over and raised the bed in the guest room with a carpenter’s act of levitation, and Donna elevated the sofa cushions in the living room, making the couch into a wacky-looking daybed-throne. I lay among the happy chaos, a stoned queen with her reach-stick scepter, wondering how I got so lucky.
It astounds me to consider the care I had. I can be temperamentally dark; gratitude samplers do not hang in my kitchen.
But friendship—not a cynical or skeptical bone in my body. Maybe this absolute embrace comes from my having had and lost Caroline; I know now that our friendship was something precious and unfounded, a grace note with my name on it, and so her death has become a part of me and my ongoing narrative and touched everything else I love: as though she knew no one could replace her, so she sent me a whole truckload of friends to help me through.
Some of my luck was geographical. I live in a neighborhood that resembles a village—parks and ponds and rivers within a half-mile radius, groceries and shops a few blocks away. The crooked sidewalks are as well traveled as the streets they border. Everyone walks, especially dog people, on their way to the reservoir or the river. After a decade of living here, I was on a first-name basis with half the people on our long city block.
I also know that my living alone had a huge impact on the help I got, and not simply because people think, “Oh, she’s solo; she needs a hand.” It’s because solitude itself makes you stretch your heart—the usual buffers of spouse and children are missing, so you reach toward the next circle of intimacy. I’ve appreciated this distinction for years: Single people form different depths and kinds of attachments with their principals, partly because of the time and space being vacated where a partner might have stood. If my little milieu included a dog and a spouse, none of my experience—Jean fielding calls and Tink marching down the street in her apron, looking like Mrs. Dalloway, and me lounging about with my crutches and complaints—would be even close to the same. Instead there might be a heroic husband taking care of everything, or an ambivalent spouse dealing with her own caretaker issues, or a teenage son stealing my painkillers or deciding to go to medical school. Romantic partners and offspring always get first shot at being the main characters, and inevitably they change the plot around. Happens every time.
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