Disorientation is a terrible feeling.  When you lose the ability to get your bearings, to keep things in perspective, the world becomes maddeningly, dizzyingly unnavigable.  Landmarks you have always used to get around transform into weird objects without meaning.  The torture of sleep deprivation is disorientation, you can’t figure out which way is up and all you want is sleep, but enemies are forcefully preventing it.  The stuff of nightmares, that.  It is often said, and I believe it:  the toughest person in the world will be broken by the torture of sleep deprivation in the end.

I had surgery to replace a worn out left knee joint three days ago.  Before the surgery I saw on my pre-surgical medical report that I was a high AWOL risk.  There was no explanation of what that meant, of course, or even a spelling out of the acronym AWOL.  The internet provided the usual one: Absent Without Official Leave.  In anesthesiologist parlance AWOL apparently means delirium after anesthesia.   As it turned out, they were right to assess me a high AWOL risk, apparently I was kicking with the leg they had just reconstructed as they wheeled me out of the operating room.  I have no memory of this because they injected me with something that caused complete amnesia during the surgery.  I recall being wheeled down a long, cold, metal corridor, I remember arriving in the operating room.  The next thing I remember is waking up hours later, saying hello to Sekhnet, then I was in my hospital room in a deep sleep for two hours or so.

Then, no more sleep for Bonzo.  The hospital, it turns out, is not a place for those who want to sleep.  Every time I chanced to fall asleep someone was calling my name, asking if it was OK to wake me up, inquiring about what I wanted for dinner and breakfast the next day, if I was comfortable, if they could take a little blood, if I needed anything (besides sleep).   My roommate, it turned out, was unable to fall asleep without the sounds of commercial radio.  He did not use headphones. I heard him explaining to someone at some point that he didn’t like them. 

When I woke up from a brief sleep at 4 a.m. Billy Joel was playing, followed by a louder commercial.  Apparently the station was playing a Billy Joel marathon, I heard several of his greatest hits, interspersed with enthusiastic exhortations from loud voiced shills.  Finally, when I realized where the music was coming from, I got a nurse to go over and shut the fucker’s phone off, fell into a deep sleep and fifteen minutes later was visited by another concerned hospital staff member with an urgent question. I never saw the surgeon.

The amount of pain I had after the operation came as something of a shock to me.  One medical site I later visited said the pain after surgery is no worse than the worst pre-surgical knee pain.  This statement is not true.  The pills they gave me to kill the pain, Rush Limbaugh’s favorite narcotic, did not really control the pain, though they combined quite efficiently with the anesthesia to kill the functioning of my usually clockwork bowels, as predicted  By the second night at home I’d be as disoriented and snarling as Medal of Freedom winner Limbaugh himself.  The reality that I was sent home with pain pills that did not control the pain was a bit disorienting, as was the lack of a heads up about severe pain and any clue about how to find comfort, and after a second consecutive terrible night’s sleep (my Fitbit rated it 43 sleep quality, extremely poor, a new record low) I greeted the physical therapist, a very pleasant man who promised me he’d begin torturing me as soon as the paperwork was done.  He was as good as his word.

He had me do three sets of 20 of a painful knee flexing exercise.  He told me to rest 30 seconds and do 20 more.  Then 30 seconds rest and twenty more.  “Do these three times a day,” he instructed.  He showed me two other exercises with the same instructions.  The sheet he gave me advised the patient to do sets of ten, two sets, and to repeat this twice a day.   I did the math as my new knee was throbbing angrily.  He’d had me do 60 reps times three, 180 daily.   The instructions he gave me called for 20 total reps, times two, 40 a day.   What is wrong with this picture?

He then had me lie on my back and created a support with three pillows, one expertly folded under my ankle.  The underside of my knee was not touching the pillows.  The position was to reduce the swelling and allow the fluids to return to the rest of my body, aided by gravity.  “You must sleep in this position,” he instructed me, warning me that trying to sleep on my side, as I always have, would result in the leg being bent in the fetal position, which was the worst possible way I could sleep after knee reconstruction surgery.   Then he said goodbye for the weekend, arranging to see me again on Monday.

After the second set of 60 reps of the first exercise he showed me (120 for the day), my new knee was inconsolable.   I was in so much pain that my final oxycodone/Tylenol cocktail of the day could only make a shallow dent, I tried to relax in the position he told me to sleep in.  It was uncomfortable to hold the position, let alone try to sleep in it. 

I became disoriented, found that although the hillbilly heroin was not effective against the pain, it was disorienting the hell out of me.  I felt myself turning into fucking Rush Limbaugh, I was close to raging.  How was it that nobody at the hospital had impressed on me that the crucial thing was to get a good night’s sleep, no matter how I had to sleep, and that it would do no damage to my recovery to sleep with legs slightly bent.  

I angrily pawed through the surgery recovery guide the hospital had provided, searching for even a word about the pain that ALL patients experience after the surgery and the difficulty sleeping that makes an internet search for “sleeping positions” autofill “after knee reconstruction surgery”.  Nobody can sleep without some good advice and some luck, and nobody can begin to recover without sleep.  The hospital’s  guide book went directly from successful surgery to rehab, with a short stop to note that necessary pain medication will provide a smooth transition back to total health, assuming one follows the directions of the rehab folks and does the work.

As I vented, Sekhnet, my devoted caretaker, became more and more upset.   She played me a guided relaxation track which I listened to without comment, somehow restraining myself for her sake, at least as long as the track lasted.

In the end I limped into the other room and spent a while on the internet trying to determine whether I could safely sleep without harming my recovery, something that after a decent night’s sleep seems quite obvious.  I felt much better after 7 and a half hours of sleep and I have no recollection of the positions I slept in to achieve that excellent result.  But sleep was exactly what I needed.  My attitude and pain level today were both much, much better.  I am trying to avoid the hillbilly heroin, having taken only one dose today.  Fucking Rush fucking Limbaugh and the fucking Sackler family of unaccountable criminal billionaire drug pushing shithogs.

And while I am cursing despicable forces at work let me not forget fucking rapacious capitalism, concerned only with profit for the wealthiest among us and not honesty, generosity, help, kindness or anything else that cannot be monetized and transferred to those most deserving of our citizens.

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