My dad is getting a new left knee. “The old one is shot,” he insists, and it’s true. He’s been hobbling for months.
I went with Dad to his orthopedic appointment. His doctor showed Dad the X-ray of his knees – the normal right one, next to the gnarly, arthritic one. We could both see that there wasn’t any cartilage left – just bone grinding on bone every time he bends his leg.
His orthopedist brought out a sample new knee. The metallic bone replacement gleamed like a shiny new socket wrench. As we watched the model flex, the metal slid seamlessly over the molded plastic cartilage. Ever the engineer, my dad looked impressed.
Dad’s doctor talked us through knee replacement. He described the operation. He reviewed the expected hospital stay and the typical time in rehab. Then he listed the risks and benefits with some percentages attached to the risks. Infection. Bleeding. Blood clots in the legs and lungs. There are risks from anesthesia too: heart attack, stroke, death. The numbers were minuscule, but the words were scary.
A little way into the risks, I stopped really listening. I sat quietly, awash in memories of the joint replacements I’d seen when I was a general surgery resident 20 years ago. There were power saws involved, which was how the bad bone was removed. And there were hammers and cement to fix the new knees in place. I remembered the buzzing of the saw and the clanging hammer. The OR had been as noisy as a garage. Now, decades later, the words “power saw” and “Dad’s knee” were being used in the same sentence. Dad was eager to proceed, but I was freaked out.
“Any questions?” Dad’s doctor asked kindly.
I shook my head no. I just wanted to get out of there.
At home when my husband asked about the appointment, all my fear came flooding out. I imagined Dad with an infected knee, Dad with blood clots, Dad after a heart attack or a stroke or some other catastrophe. Everything I envisioned ended the same way. Dad would be unable to do the thing that matters to him the most, which is to stand up and walk and take care of my mom, who has emphysema.
“Wow.” My husband shook his head at my outpouring.
Then he gently pointed out that I often work in intensive care, and that the patients who end up there are often patients with complications. “But how often are you seeing knee replacements gone sour?” he asked.
I had to admit that I couldn’t remember even one. It wasn’t comforting though. It’s hard to reassure someone like me, an anxious doctor-daughter who’s seen a lot of the sadder side of medicine.
Over a couple of weeks though I calmed down. Rationality prevailed. As I de-escalated my anxiety, I started thinking a lot about risk – how doctors talk about it and what patients and families hear when we do. I began observing my own patients as they absorbed the word “complication.”
Research indicates that many patients simply ignore risk. When asked, they don’t remember hearing about the complications when they discussed surgery.
That’s not true for everyone though. Some people simply accept the small but measurable risk, taking comfort in the tiny numbers as they review their disability coverage. Others are more fearful.
Many locate friends and acquaintances whose surgery went well. Over time, their fears dissipate as they discover one person after another whose outcome has been good. Another group reassures themselves by going online and researching qualifications.
They’re the ones who come to the office already knowing where I went to medical school. The Internet-savvy visit YouTube and watch videos of their operation. They ask questions about technique, demystifying what once was scary. My friend, who just had bunion surgery, reassured herself with research – she’s read more about bunions than any non-bunion surgeon on the planet.
Dad’s surgery has made me realize that I’m not reassured by research. I haven’t read one word about the ins and outs of knee surgery. Instead, I’m someone who’s reassured by reassuring people. The calm, matter-of-fact professionalism of my dad’s doctor has soothed me, as have his orthopedic colleagues, who heap praise on “his” knees.
My dad – a retired Navy pilot – deals with risk by preparing for it. So he approaches his surgery as he would a deployment. He’s making me review his finances. He’s bought a ton of bird feed so Mom can feed her birds.
In a couple of weeks, he’ll have his surgery, and after all of our thought and preparation, I’ll do the only thing left to do. I’ll sit in the waiting room with other families, all of whom have made their peace with risk, and I’ll wait quietly and hopefully for Dad’s surgery to be done.