The technical terms that were used were “comminuted sub-trochanteric femur fracture,” meaning that the thigh bone had shattered into a bunch of different pieces just below the ball joint of the hip. It wasn’t your average geriatric fracture, where the ball of the femur snaps off from osteoporosis. This was the thickest part of the femur, crushed into several disorganized pieces. I had really fallen hard.
There seemed to be no question that I would need surgery. They were planning on installing a plate with screws under the skin, and I had to trust them. I was also suffering greatly from the Thompson splint they put on my leg: it was a big iron ring around my incredibly swollen thigh, digging into my groin, connected down my leg with bandages to a one-kilogram weight hanging off the edge of the bed. The purpose is to keep the leg stretched, so the muscles won’t pull the fracture against itself, and to make an understatement, it was extremely uncomfortable. Munshi kept saying, “Look at it this way: if this were a hundred years ago, you would have to wear that for months, until the bone healed. You’re lucky!” Needless to say, I was thankful that modern orthopedic surgery now has alternatives!
But there were several major hiccups before they would perform the surgery.
Firstly, they wanted money up front. They had maxed out my emergency credit card already, within an hour of my admission to the hospital. The next day, a finely dressed young professional came to my room to deal with the full payment. I suppose they didn’t expect to have any problems with an Amerikani, but when she said, very plainly, that they require ten thousand pounds before the surgery could begin, I had to disappoint her. I simply didn’t have that much money, and I was exceedingly disgusted with the system. Truly, sick and injured people, people in desperate, emergency situations, should not have to worry about ultimatums like that. Anywhere. I felt like they were trying to take advantage of me, using my situation as leverage to suck me dry. But I suppose they were just trying to cover their costs. I was honest and told her, and the administrator that arrived later, that I did have some money, but it wasn’t anywhere near that much, and if I gave them that, then I would have nothing when I left the hospital. No, it was going to have to be up to the insurance company.
Thank the Universe I had invested in six months of traveler’s insurance! It wasn’t easy, especially with the room phone on the fritz, but I convinced the hospital’s people to contact the insurance company’s people and figure that shit out. The insurance company sent a representative, and the U.S. Embassy actually sent someone to smooth things over, and after a few days the payment issue was resolved.
In the meantime, we were also dealing with a different problem: blood shortage. The doctors explained that being so soon after Ramadan, the blood banks were tapped out; no one donates blood during the Holy Month of fasting. My semi-rare blood type was not available, apparently, and they were not willing to do the surgery without at least one unit on hand, in case the bleeding was severe. They were looking into having some transferred in(“Do you require Christian blood?”) but they never seemed very confident that would happen. In the end, incredibly, it wasn’t the hospital that supplied the blood. It was Munshi. Or rather, people he, and my other good friend Mostafa, knew. I’m not sure exactly how it happened, all I know is that someone arrived with a small travel cooler, like the type you would bring to the beach, except instead of beer there was a bag of blood inside. I paid for it in cash, right from my hospital bed. The lab screened it, and my surgery was scheduled the next day.
I’m really not sure which was the greater hold-up, the shortage of payment or the shortage of blood. But after four miserable days in that bed, far from home and family, I was one embittered patient. I was drowning in a mire of my own making, unable to see outside my own pain. I didn’t have the energy to be gracefully patient, or compassionate about differences in culture. I was just pissed off.
But on the morning of the surgery, I vowed things would be different. I wouldn’t bring my negativity to the operating table; I firmly believe that attitude is a big factor in medicine, and I didn’t want to affect the attitude of the surgeons that would hold my future in their hands.
I woke up that morning, groggy, in a haze of pain, as usual. I grimaced and started to complain… then realized I had a different plan. When the nurse answered my call, I sat up against the pain, and smiled hugely, producing a pleasant “Good morning!” She looked at me like I was from outer space. Where was the bitter American that was here last night?
I was the same all morning; happy and enthusiastic through sheer force of will. And the results were instantly apparent; everyone I interacted with seemed positive and good-humored. I would be fine.
They wheeled me down to the operating room and lifted me through a roll-down window. There were already several docs there, scrubbed and masked and ready to go. I greeted them all boisterously, “Hey everybody! How are we doing today? Everyone in a good mood? Alright! Let’s do this!”
Speaking with the anesthesiologist was a real test of my resolve. They explained succinctly, something about my recovery, surgery, benefits, yadda yadda yadda, and said they were going to give me a “spinal.”
“You mean, um, you’re going to stick a huge needle into my spine? Um, okay, but… are you sure that’s necessary?” I felt my mask of pleasantness cracking, but I continued. “Alright, go ahead then. I TRUST YOU.”
He prepared the weapon, which I refused to look at, and told me to sit up straight.
“Don’t move at all, okay?” he instructed me. I could barely keep myself upright, and was swaying badly.
“Okay, but, um, I think I need someone to help me. Can I hold on to someone while you do this?” Another doc came over and lent me his arm. I steadied myself, arching my back as straight as possible, tense with fear and anticipation. I could imagine the anesthesiologist behind me, watching the liquid squirt out the tip of his gigantic spike-needle. I wondered if he had slept well the night before. Was he fighting with his wife? How likely was it that he might slip, or poke too far, or….
“Okay, we will do general anesthesia instead. It’s okay, you can lie down.”
“What? No needle? You’re not going to do the spinal?” WHEW!
Soon they had the standard breathing-mask apparatus set up, and I was counting backwards from ten.
My big bushy beard was interfering with the mask, though; I wasn’t passing out. My eyes darted around frantically, trying to determine if they realized. I didn’t want to be awake for my surgery! A blue latex hand pressed down on the mask with real force, as if he were trying to suffocate me… and he was. I passed out.
I awoke in the recovery room to the sight of bright red blood, hanging in a bag above me and steadily filtering down a narrow tube into the IV on my hand. After I shook off the post-anesthesia confusion, they told me that I had, indeed, lost a lot of blood, much of it internal from the original injury, and more from the 15” incision cutting through all the layers of my biggest muscle: the biker’s thigh. The installation of the plate and screws had gone without complications, but I had still come out of surgery in critical condition, dare I say even… near death. Thank the Universe they had insisted on having blood on hand!
But there were only two units, and my blood numbers were drastically low even after those transfusions. Munshi walked into my room after the surgery, looked at my chart, and immediately went out to demand, “Why isn’t this man in the ICU?!” Apparently, they didn’t consider that necessary, because my vital signs were still okay – heart rate and blood pressure still acceptable, due to the fluids they were pumping into me for lack of actual blood to pressurize my system – and because I “still had a sense of humor.” So I was stable, for now. But we needed more blood, and desperately; Muslim blood, Christian, Jewish – whatever, as long as it’s my type!
I felt… down. I had no energy, I saw no way up. I thought after the surgery things would start looking better, but it seemed the crisis hadn’t yet run its course. I was more than a little frustrated that there wasn’t blood available for transfusion. My mother recommended I do some “visioning,” to try to encourage my body’s cells to produce what I needed. Late one night, she guided me in a relaxation meditation over the phone, and as soon as we hung up, I attempted my own inner journey. I would try to contact my bone marrow cells.