Homeward Bound

We flew out of Bangalore on British Air at 7:30 am Nov. 4. Suhas picked us up promptly at 4am and accompanied us along with the driver who whisked us off to the airport. It’s the best time of the day to travel in this crowded Indian city so as not have to deal with the snarling excessive traffic. I was more than a little apprehensive about just how taxing this journey home would be. My knee was still not comfortable in the seated position for any length of time. We had a 10 hour flight between Bangalore and London. We’d get a room overnight near the airport and resume our journey the next day with an 8 hour flight into Denver. Once in Denver, Steve would be there to take us home in the Tiger where Ruth and I could both stretch out on the last leg of our 12,000 mile world journey, for the 4 hour drive home.

When I made our reservations I was clear in explaining the necessity of receiving bulkhead seating. There’s probably a good foot of extra leg room in the first row of seats behind each of the walled partitions. I was assured when I made the reservations that under my circumstances our needs would be cared for. I still don’t understand BA policy in reserving these seats. But they weren’t available for us when we checked in. However the flight was fairly empty so were each seated in our own row. It’s a long flight but it was extremely painless with this bounty of leg and elbow room. It also made getting up and moving through the cabin area easier with so few people to share the aisles with. We checked the bulk of our luggage through all the way to Denver. We each had a light carry on bag and the laptop. We arrived in London midday and it was Ruth’s initial plan to go out one more time on the streets of London. I thought that I would just hole up our room and get some writing done. But in retrospect it would have been immensely easier to have included the computer into my large checked suitcase. It would have fit and been protected by its case and my clothing. The extra 12 pounds was a lot to have to carry through those two intense days of travel.

Once we landed in Heathrow we had to disembark the plane by descending a long steep flight of metal stairs down onto the runway. From there we were shuttled by bus to terminal 5. This airport is bigger then many cities. Once there we had to walk a long way to go through customs and immigration. My knee was throbbing but I had no choice but to take it step by step. I could have ordered a wheel chair but I felt I needed the exercise and I had no clue just how far I would end up walking. With no baggage to claim we finally made our way to the transport area and waited for the “hoppa.” This is a local bus that takes passengers from the airport to the hotels in the airport vicinity. It was extremely helpful that we had spent two days in this wonderful city the beginning of our trip. We now knew the ropes well enough to hop on the right bus to get to our prized hotel room.

It was with tremendous relief that we checked in to the Holiday Inn by 3 o’clock in the afternoon. The room was costing us over $200 that night but as tired as we were we weren’t grumbling too loud about the cost. BA is gracious in their feeding schedule and we had two meals on the flight before we landed. We each took showers and snuggled into the twin beds. In truth they weren’t near as comfortable as the great beds we had in India, both in the hospital and the Woodrose. Those beds were excellent. These were kinda lumpy and soft, but again just being somewhere warm where we could put our feet up and snuggle in was Nirvana.

London time is 6 hours earlier than the east coast. We turned on the TV hoping to get some early election results. We saw the Clintons as they arrived to vote. Both Ruth and I were Hilary supporters. She and Bill both spoke briefly about their support for Obama and the Democratic Party.

It was too early with the time difference to get any significant information concerning the election. So we turned off the TV and drifted off to sleep. Ruth didn’t wake up for eight hours. I slept for a while, read for a while, and then tuned into the BBC for America’s election results. As the hours ticked by the preliminary results started coming in. The coverage was extremely informative. The station offered full non stop coverage with no commercials. The whole world is interested in American politics and there was an obvious sense of anticipation and relief that a new leader was about to be elected. Barrack Hussein Obama is extremely popular in both England and India. It was a thrilling moment in history to witness this powerfully positive changing of the guard. It was 5 AM England time when we rejoiced with the world in hearing Obama’s acceptance speech.

We slept for a few early morning hours and woke up starved. The hotel offered a breakfast buffet so we hobbled down to the restaurant. It was ridiculously expensive, 28 pounds which comes to $48. The food was wonderful though; especially since we hadn’t eaten in 20 hours.

We hopped on the “Hoppa” and headed to terminal 5 for the last flight of our journey. This plane was mostly full and we were once again not seated in the bulkhead. This segment of the journey proved to be the hardest for me. Again I’m not certain what British Airlines criteria are for reserving bulkhead seats. They say they can’t book them ahead of time but are reserved on the day of travel for travelers with young children and people with special needs. But they weren’t available for us, even with my medical issues. And it was really dismaying when we boarded the plane and saw that these seats were taken by able bodied passengers who had the luxury of stretching out their healthy legs while my newly sawed on leg was crammed into a regular seat. I asked the flight attendant for some water to take some pain medication early in the flight and she hastily told me I’d have to wait for the cart, which finally came a good 45 minutes later. Fortunately Ruth took matters into hand and went to the station to fetch me some desperately needed pill popping liquid. The flight seemed eternal. But all things do eventually end, landing in DIA was a monumental relief. This time I had a wheel chair waiting for me as I left the plane. We got through immigration, baggage claim and customs. I called Steve who was hanging near passenger pick-up in the Tiger, and then there he was. It was a glorious reunion. My but it felt good to be close to him again.

The weather in Colorado had been about perfect while we were gone. Clear blue skies, crisp mountain air that warms as the sun rises higher in the sky. But we arrived the same time as the first winter storm. We were barely in the foot hills when the flurries began. As the sky darkened with the setting sun the visibility for driving became a real issue with the falling snow. Fortunately Steve is a wonderful driver. He’s lived in the mountains of Colorado for over 30 years and he knows how to get around. Slow and steady is the rule through a storm. The GT Tiger is a small camper on a Chevy Astro chassis. It’s an all wheel drive van with plenty of tread on the tires so we were in good shape, especially with Steve at the helm. There’s plenty of room for stretching out, so we indulged in the leg room and just got comfortable leavingthe driving and stress to Steve. We pulled into our sweet little mountain home and spa before 11pm. A great rush of gratitude and relief was felt at being safely home.

Week Two, Convalescing at Woodrose

Moving to the Woodrose Club was such a welcoming next chapter in my healing process. Ruth and I were shown into a small yet comfortable room. The twin beds were extraordinarily comfortable, plus we had a balcony that over looked the well cared for grounds. Two Indian men were mowing the grass with an eletric mower. One mowing, the other disignated "keeper of the cord." Behind them a beautifully attired Indian woman squatted behind them sweeping up the clippings with a branch. She was so effective with this method. Can you imagine squatting for hours, actually moving with her feet on the ground, sweeping at the same time? It hurt my knees looking at her and yet her dexterity was remarkable.

This place is a Mecca for the well to do able bodied. It sports a gorgeous swimming pool, tennis, badminton, ping pong, and racket ball courts, with full weight room and aerobic exercise equipment. It’s a beautifully laid out complex, with long walkways of black granite tile, gardens, stairways, and something we were really looking forward to after a week of hospital food, an excellent restaurant.

My appetite had returned. That first breakfast of fresh squeezed grape juice, omelet, toast and jam was gobbled down with gusto. I’ve been an avid coffee drinker for decades but somehow in India, I’d lost my taste for it and shifted to a bonafide tea drinker.

My only responsibity here was to heal. I returned to the hospital daily for PT. I was transported via taxi. It was less than two miles, but what a daily ride this was for me. The traffic in Bangalore is atrocious. The streets are clogged with cars, trucks, busses, rickshaw taxis, scooters, bicycles, cows, and ox drawn carts. It is pure madness. Pedestrians have no right of way. And as Ruth discovered, Bangalore has the worst side walks in India. The only way a pedestrian can cross a street is to find others and as a team, wind your way through the maize of traffic. Individually you’d be road kill but with three or four joined together you have a slightly better chance of reaching the other side in tact. This was not my fate to experience anything so daring. But just riding in a taxi through the throngs was a full day’s entertainment.

The PT at Wockhardt was challenging and just the spurt of energy I needed to recoup some of my waning strength. The ladies who guided me through the daily grind were young, fun loving and serious about the importance of establishing a good routine of strength and flexibility exercises. Everyday they pushed me a little harder. I seemed to be omproving most days, though still painful, but a few days were still excruciating; the pain in my knee was raw and unbearable. On those days they worked me a little easier. This would be a good model for the long haul of future rehab and healing.

Back at Woodrose, the dining was the highlight of the day. Great soups, salads, and spicy Indian cuisine were there for our dining pleasure three meals a day. Almost immediately we both started having “watery motion.” At first it was quite welcome to clear out the pipes from the week of hospital sluggishness. But after a few days of mild to moderate diarrhea we started rethinking our food choices. We eliminated all the fresh produce from our meals. This made no difference. I even backed away from the restaurant and bought cereal and yogurt from the commissary, but this also had little effect on my body’s purging. A week of this is going to be plenty.

The festival of Devali, the goddess of light happens in India the last part of October. This is the biggest celebration of the year and it goes on for four days. One of the recent trends in the celebration is the lighting of “fancy crackers.” It used to be sparklers and colorful fountains but in recent years the entire city goes crazy with loud booming explosive fire crackers. The blasting goes on for hours. The working class of India, whose average salary is about $150 a month, spends millions on these banal explosives. It really sounded like a war being waged from our hotel room. Fortunately Ruth never travels without ear plugs, so we witnessed this famous Indian celebration hunkered down in our room, attempting to muffle the deafening sound.

The festival of Devali is also celebrated by lighting oil candles. The restaurant was beautiful as these whispers of light lined the window cells and perimeter of the gracious room. Ruth and I were the only ones in the restaurant this particular night. We were seated right by the window looking out on the courtyard that was also lit up with colorful lights. The place was really slow during the holidays. I was not feeling well and ordered only a seven-up for my dinner. This was Ruth’s birthday and she was feeling a little let down partly because I was so self focused on my painful condition and there was no sense of celebration honoring her day. Our conversation was strained so with a feeling of heaviness I got up to return to our room. My long hair brushed into the lit candles and unbeknownst to me, provided additional fire works. Ruth fortunately noticed that my hair was on fire and immediately smothered the flames with her shawl. It was quite comical, but I found no humor in the event. My nerves were shot from the trauma of surgery, and painful recovery, and I went into shock realizing just how close I came to utter disaster. When I got to our room, I covered my singed, stinky hair with a bandana, took a valium sleeping aid and curling up in the fetal position, rocked my miserable self to sleep.

The next morning, after a very good night’s sleep, we were able to talk about how each of us was feeling. At this point I could laugh at the previous night’s debacle, and thanking her from the bottom of my heart for her quick saving action, we both felt relieved and back on our sisterly track.

Most of this week at Woodrose was spent resting on the comfortable bed, writing and reading e-mails, reading this great book, Shantaram, about an escaped convict who flees to India. He falls in love with Bombay and relays one extraordinary tale after another. It's written by Gregory David Roberts, and is a book I highly recommend. Not being able to seek out adventures myself, ( are you kidding, I couldn't even stray far from a toilet!) I found great delight in reading about another's love affair with India.

The Salon at Woodrose proved to be excellent in the treatments offered. I went in for a pedicure. It was such a healing experience. The ladies working there were from a northern state in India, they were Oriental looking and just exquisitely beautiful. They were completely present in the treatments offered, and so attentive to my well being and comfort. I availed myself to their healing hands receiving facial, scalp massage, and manicure each on a different day.

One of my main concerns during this week was how I was going to handle the return passage to home. I still could not bend my knee comfortably. Mostly I needed to keep my leg up on the bed or chair as the pain became really intense when I sat for any length of time. Our trip home would take place starting on Tuesday Nov. 4, Election Day. This was exactly two weeks after my surgery. Ruth wisely counseled me to not dwell on this future event but just take each day as it comes, and work at increasing my range of motion. The day before we were to fly home I had the staples removed from my incision. There it was, this Frankenstein scar, six inches in length, tight and sore. I was instructed to keep the wound unbandaged and allow the fresh air to aid in healing. My last day of PT they had me lay on my stomach, which felt really weird and uncomfortable, and had me bend my knee back beyond 90 degrees. The young therapist who I’d worked with some, assisted this stretch really cranking on it, a bit too aggressively I felt, but got it to bend further. I was told to add this stretch to the repertoire of exercises they had established for me. Of course my knee responded to this extreme bending by swelling up good and stiff, with the pain increasing. Just what I needed before I traveling. This was the last of my guided time. From this point on I was on my own to heal and continue my strengthening and rehabilitation. But first I had to undergo the long journey back home.

A Week of Care at Wockhardt Hospital

It felt good to be back in my own room. Ruth was certainly glad to have me close by where she could keep an eye on me. Dr. Sanjay Pai burst into the room with his entourage of junior surgeons and charismatic presence. “Your knee was the worst thing I’d ever seen for a woman your age. The repaired ACL was crumpled and torn, it was a mess. This is why the surgery took longer than I assumed. And as for your R knee, don’t waste your hard earned money on anything other than a full replacement when the time comes to do it. The x-ray shows that everything went extremely well. Now it’s up to you. I will send in the physical therapists and you can begin your rehab. In the United States you would be preparing to go home by tomorrow, here we look after you for at least a week.” Then he was gone.

I was bed bound with a catheter, my knee somewhat numbed by the epidural line with pain medication administered through a connected canister. I was also receiving oral pain meds, along with anti nausea, and anti vomiting meds every few hours. Sam & Sally the PT’s walked in and introduced themselves. I was instructed to roll a towel and place it under my knee, then tighten my quads and push down with the back of my knee into the towel. This movement elicited a soaring pain, really rough and raw. Then with my leg flat on the bed I was instructed to focus on my heel and move it smoothly up to form a painful bend then down again, back and forth. Then lastly they taught me to roll over on my right side with a pillow between my legs for support and sleep and rest in this position to give my back side a much needed break as I’d been lying in this position for 24 hours or more. They were both extremely professional and unhurried. The Doctor’s rushed in and out but the PT’s were there to spend time, explain the healing process, field my questions, and establish from the get go a strong physical therapy program.

As the hours ticked on I was feeling queasy and weak, with sleep my only relief. Food was brought to the room but I had no appetite for anything other than water and the apple juice the hospital provided.

The next day the nurses bathed me. Being helpless and bathed by an empathetic care giver gives one the feeling that there is infinite kindness in the world. Sam came in and showed me how to use the walker which in turn allowed the catheter to be removed and I was now free to roam about my room. As the day progressed, so did my nausea. It was very miserable. I realized that I was experiencing the effects of all the strong pain medication I had been pumped with. This condition of extreme nausea is no doubt what the hospitals protocol tried to prevent, by not administering the copious amounts of drugs I needed that first night in ICU. Ruth got on line and researched my symptoms, and it was suggested to get off the drugs before a chronic condition of nausea sets in. So I told the nurses that I wanted to lay off the drugs for a while. They obliged and said to ring the bell if I needed anything. The pain was still tolerable because of the epidural medication that kept my right leg numb.

The epidural was removed 72 hours after insertion to prevent infection. As the sensation returned to my leg, the deep soaring pain became extremely acute. An internist came in and recommended returning to oral pain meds and shots through my IV port, upon request. So I was going back and forth between lots of pain meds, then none, kind of a yoyo game, but I think the 20 hour reprieve helped to get my system cleaned out enough to mitigate the upset condition I’d been enveloped in.

But pain is the name of this game. I thought about what it would be like to have had both knees replaced and I absolutely shuddered to contemplate twice the pain and the compounded condition of having two fiery hot legs to rehab and get around on. There’s absolutely no way I could have handled anymore than what this one knee was inflicting.

By day five the nausea was abating and I felt the first desire for food since surgery. The meals would come up from the kitchen regularly. Deepa is the kitchen manager of the hospital. She would make her daily rounds checking in and taking requests from her kitchen. Mostly the food went back hardly touched. It felt cruel to be wasting this food knowing that just outside this building were thousands of people not to mention feral dogs who would so appreciate this sustenance. So Ruth took it upon herself to bag up the uneaten scraps and would make her daily rounds outside to feed the hungriest dogs she could find.

Describing human functions on a personal basis is much easier through a key board. I've been unable to "pass motion” since the traumatic experience of surgery. Everyday the sweet nurses have asked and as the days have ticked on to number five I've had to admit that my bottom is locked up tighter than Fort Browning. I haven't had much of an appetite so the problem hadn't dominated my efforts. But yesterday I knew it was time to move this mountain. In the morning I requested a suppository. An hour later with not so much as the sound of gas to prove efficacy, I asked for an enema. At home I love enemas. I went for6 months and gave myself coffee enemies most mornings. It gets the days going off with a literal blast. The enema that was brought here however was this small tube of clear jelly that the nurse implanted in two seconds. Still nothing.......So now the Doctor's are taking an interest and asking me every time they make their rounds. Have you had motion yet? One of the nicest Doc's suggested MOM's remedy, Milk of Magnesia. I've also had problems with indigestion and heart burn so this sounded like a welcoming approach. I drank a good jigger of it, slammed down a quart of water, and still.......nothing. This was getting serious. Chemicals and drugs have had full reign of my innards for almost a week now, I'm feeling toxic and bordering on desperate to eliminate. So last night I asked the nurse if the hospital contained somewhere in its hidden places an enema bag that I could use on my own for the evening. "Ohhh" she said, shaking her head, "that's the old fashioned way. I haven't seen one of those in years." Well please inquire if there is one still hanging around please. This is what I need to solve my dilemma. She retuned an hour later, beaming. She had a stainless steel canister with tubing attached at the bottom and yes an insertion point. She wanted to help me but I begged her to just let me be. We have a small coffee maker in our room so Ruth got some hot water going with our filtered water. I won't go into all the details. But trying to have an enema with only one functioning leg and a small bathroom with no room to stretch out and let the water flow presented it's share of challenges. No one would ever confuse us with McGuiver but Ruth was totally devoted to this project and I can say that this morning I’ll have a positive response to this question of motion.

After enema magic, my energy picked up. Releasing all the toxicity of surgical trauma and drugs brought renewed vigor to my aching body. I really started looking forward to being released from the hospital and checking in to the Wood rose Club. Tonight was Pizza night at the hospital. Gosh but the thought of Dominoes Pizza and a coke got the juices flowing.

As the week in Wockhardt was coming to a close, I felt so fortunate to have had such good care from so many skilled and compassionate care givers. Early in the week Sam, my PT came in with the x-rays of my knee before and after surgery. It was such a remarkable picture. My knee which was crippled with arthritis and painful bone on bone was replaced with this rock solid bionic joint. Again I feel just so lucky that this procedure was available to me.

Suhas came in the last day to take us to Woodrose. I asked him if there were any other charges from the hospital that had accrued throughout the week. He assured me that the $7,000 I paid covered everything. It is remarkable and in sharp contrast to the medical costs we pay in the States. For $7,000 the hospital provided transportation to and from the airport, all of my pre testing including x-rays and MRI’s for both knees, my surgery and night in ICU, a week of care in a very gracious hospital suite with meals for both Ruth and myself, all of the medication including enough for the week at Woodrose, Physical Therapy everyday and a Walker and Cane.

I C U in pain

As the epidural started wearing off, I was moved into ICU. The only instructions I was given was to keep pumping my ankle back and forth pushing the back of my knee down and to keep this up continually while I was awake. I was also on oxygen and told to keep the mask on for the rest of the night. Ruth followed along but was stopped at the door and told that she couldn’t come in until they had me settled. Settled meant that I was wheeled in to my curtained space and left alone. The pain was really starting to come on. I kept asking for help, someone would walk over and explain that I was receiving pain medication through the epidural, just on a more moderate basis than what is used during surgery. I felt a huge pounding in my knee that was growing in intensity. Finally a doctor came over and started listening to my chest with his stethoscope. His English was impossible to understand and was asking me if I had an “arrhythmia?” What did you say? No No, asthma, he said. Do you have asthma? Does it sound like it? I asked. Oh no, he said, this is just a routine question. Stop asking me these ridiculous questions and help me get this pain under control. I was writhing by this time. He saunters away. Finally Ruth shows up and I tell her that my pain is more than I can endure but no one is helping me. She goes in search of help and comes back with this very kind looking male nurse. He gives me a shot through the IV and said that within 20 minutes this should help. Then he hooks me up to a device that administers pain med intravenously on a regular basis. I tried to calm myself down, but still the pain was relentless. I was told to be patient and by the morning I would feel much better. I didn’t believe this, how could one night make a difference in the pain, and in the meantime I was at my limit of endurance. Nothing they gave me was helping. The nurse came in with another shot and finally there was relief. I could feel the calming effect of the narcotic as it washed over me and dulled the mind screwing pain that had me up against the wall. The ICU staff encouraged Ruth to go but she refused. She perched on a chair and stayed at my side. She brought me some ear plugs to soften the sounds of the monitors continuous beeping as well as the sounds of others painful moaning. I was able to drift off in relative peace by now, my body loaded with very strong drugs. She was finally convinced to go and get some sleep, and I slept, much needed rest as the arduous task of healing was at hand.

I awoke early just as Ruth walked in. She found a way to sneak into the ICU ward, sleuth that she is. I was feeling so much better. The intense pain from the night before had abated, and having had a few hours of sleep I felt that I had survived the worst of the ordeal. I was offered juice or breakfast, but all I wanted was a few sips of water. A sweet nurse came in and said she would sponge bathe me. So Ruth left and I submitted to her skilled hands. I lay there while she scrubbed and rinsed my body. I had a catheter and she cleaned this area with betodine. Then she combed my hair and allowed me to brush my teeth. I felt half way human. The hours ticked by. A few Doctor’s were making their rounds and I was told to keep pumping my ankle, this I did faithfully, like a prayer wheel turning and turning so my ankle was pumping back and forth over and over.

Around noon I was told that I was going back to my own hospital room. I was unplugged from all the beeping gadgets. The pain med pump was staying with me along with an oxygen tank. I was wheeled out on my bed, but first I was brought to x-ray. I wasn’t looking forward to having to move out of bed for the x-rays but fortunately they were able to take the necessary pictures without having to get off my bed.

When we got to my room , they wheeled out my former bed and I could stay all tucked in and cozy in the same bed used in ICU. From this point on, for the next 7 days, the hospital and staff did everything possible to aid and care for me in a very kind and professional manner during this first week of recovery.

Surgery India Style

I was awakened on the day of surgery by a sharp pang in my neck. It was a searing pain that kept my neck in spasm throughout the day. There was a bit of unease settling in because of this really. What an auspicious way to start this already dreadful day. The surgery was scheduled to start at 1 pm. But the gurney didn’t arrive until close to 3. Ruth and I spent those pre surgery potentially fretful hours watching the Simpson’s, seeking comic relief. She also rubbed my neck through out the day, helping the pain a great deal.

I really didn’t feel too nervous. I had implicit trust in my surgeon Dr. Sanjay Pai. I made this decision months ago, and now it was time to surrender. I gave Ruth the thumbs up as I was wheeled down to the “theatre”, as the OR is referred to at Wockhardt.

I’ve practiced mindful breathing for many years. At a time like this, it is invaluable. I use my breathe to breathe in God’s love, and then I breathe out God’s love, sharing it with the world. I breathe in God’s healing power, and I breathe out God’s healing power, and so on. So I was fairly calm and positive as I was wheeled through the corridors and down the elevator.

I was changed into a sterile gown and wheeled into the theatre, where it was freezing cold. Here two anesthesiologists attempted to start an IV. They were examining my arm and the small veins I possess. It’s always been a challenge for medical personal to hook me up. The man who seemed to be a student attempted to stick me. It was botched. I thought “great, I’m being used as a practice dummy.” After much discussion he tried again and hit my vein. The next task was to start the epidural. They had me shift to the operating table. It was cold and hard. They had me sit up, opened my back side and sprayed this ice cold aerosol anti bacterial liquid. It was impossible not to shiver. But I was urgently and not too gently admonished to hold perfectly still. The same student attempted to put in my epidural. He found the spot and I felt a huge bolt of pain sore up my spine. I collapsed and was rolled onto my side again none too gently. Oxygen was administered and then another attempt was made to get it in place. This time they found the correct pathway down my spinal column and an immediate sense of numbing was felt running down my legs. I was rolled onto my back where my arms were brought out to each side, crucifixion style; An IV on my left, blood pressure and pulse gauges on my right and heart monitors on my chest. I was asked if I wanted to be sedated so that I’d sleep through the surgery. I assured them that yes indeed put me out for this, especially since as all of this was going on I heard the sound of the saws and drills being tested that were soon to be applied to my very own flesh. I drifted off to sleep

I awoke just as the surgery started. My Dr. Sanjay Pai had not made his presence known to me but I was pretty sure I heard his commanding voice, beyond the screen that was placed between me and the surgical team. In the periphery were the pain guys, who by this time were totally bored and the Dr. sitting closest to me was gently snoring. I heard cell phones ringing and being answered, “hello, yea I’m in surgery, call you later.” Click.

I lay awake during the entire procedure. The sounds of the machinery cutting through my bone tissue, the smell of my flesh and bone being rendered will never be forgotten. At one point I heard Dr. Pai’s voice say “no, that’s not right, we’ll have to do that again.” The surgery seemed to go on forever. My neck and arms were very achy and I attempted to move them around some, seeking a measure of relief. No one, not once, checked in on me or sought in any way to comfort me or administer more medicine so that I could sleep. The thought crossed my mind that these very interesting, brilliant Indian people simply do not possess qualities of empathy or compassion. It’s just not a part of their framework. This surgery was all about my knee being replaced. They were totally tuned into that. My comfort and mental well being were not a priority. And perhaps the fact that I’m a woman and the entire surgical team were men, made it even less a priority that any care be given to my physical and emotional needs.

Finally, I was told that the surgery was just about over and the wound would be stapled. I asked if everything went all right, and I was given a perfunctory affirmative, yes, everything is fine.

Dr. Pai did not address me at this point either. As the dismantling of all the equipment transpired and the various weights I was held down with were removed I became fraught with convulsive shivers. I was so cold. A hose blasting hot air was tucked under my sheet and I clung to this with all of my draining might.

I was wheeled into post op and left entirely alone until Ruth appeared. She had that wild look of fear, fatigue, and fight in her eyes and I knew then that this surgery was as hard on her as on me. By this time it was 6:30, three and a half hours since she had last seen me, and no one was telling her anything either.

She went looking for a Dr. who would impart some information. Finally the older anesthesiologist who had snored through my surgery came over and said that everything went fine.

Indian Exposure

We arrived in Bangalore India around 4 am India time on a 10 hour direct flight out of Heathrow. India is 12 1/2 hours a head of our time in Colorado. Immigration was a breeze but the baggage claim was excruciatingly slow. The three hundred plus weary travelers from our all night flight congregated around the baggage belt that sqealed like a pig and watched, like zombies, as one bag every minute or so presented itself on the belt. Finally our one checked bag appeared. We were waived through customs and proceeded through the gate in search of our driver that Moe promised would be waiting for us. No sooner did we exit the terminal when a young man asked if we were Susan and Ruth. Now that's service! His name is Suhas and is the guest relations officer at Wockhardt Hospital. He came to the airport with a driver at this early hour, 4am, to make certain we were cared for. When our plane arrived he called immigration and got a discription of our clothing. We were quicly in route. He was warm, friendly and graciously fielded our myriad of questions . The dawn was cracking as we made our way through the sprawling and immense city, affording us our first glimpse of India.

Bangalore is a burgeoning city of 12 million. Four years ago it held 8 million so the growth here is far too rapid for infrastructure to keep up with. Bangalore by India standards is a prosperous city, nevertheless many areas of the city are extremely poor. Tons of rubbish and rubble line the streets where many find their homes. We drove through an area with modern high rise office structures. This is the IT capital of India. Many of the jobs outsourced from the US are found here. An hours drive found us in the hospital district, where we drove up to the front doors of Wockhardt. We were escorted to the 7th of the hospitals 8 floors into a large rather inviting hospital room containing two beds, a small fridge, desk with computer, table, two chairs, and private bath. It smelled strongly of moth balls. Suhas gave us his cell number with strict assurance to call him with any questions or concerns. We showered then waited for the tests we had scheduled to transpire.

The paper work was refreshingly minimal. Basically they got my name, marital status, birth date and religion. Being disconnected from any religious organization I left this last question blank. Two different times individual nurses came back and asked me to please verfiy my religion. Not wanting to offend I begrudgingly agreed to state, "Christian." There was an obvious sign of relief emanating from their sweet faces. Dr Sanjay Pai, my venerable surgeon, walked into our room and gave me a quick preview. He stated quite emphatically that I was too young for knee reconstruction as prosthesis only last 10-15 years. I told him about my constant pain and instablility. I've traveled all this way and I want both knees examined with MRI. I was swiftly taken down to x-ray. At this point I was feeling a bit mifted and a little freaked and felt like fleeing the hospital using this time to travel through India and forget this whole medical tourism business. A short itme later I received two MRI's. Blood tests and urine samples were taken and at least three times this first day my blood pressure was measured. In the afternoon Dr. Sanjay Pai returned and stated that the results of the tests revealed both knees arthritic with the left in advanced stage of degeneration. We discussed various prosthesis and it was his opinion that my left knee is certainly bad enough to receive a TKR.

After he left Ruth and I discussed my condition and options. I firmly beleive that surgery is a last option. But my R knee, though not nearly as painful as my L is in pretty bad shape. It tweaks, burns, pops, and gives out on me. This is my opportunity to correct my disability. I've traveled across the globe at great expense, taking the necesary time off work for this trip as will as the lengthy rehabilitaion time. Who knows if and when I'll ever have this opportunity again.

Glimpse of London

We leave for India in the morning. We've been in London for parts of the past two days. It actually feels longer. The flight from Denver was long and we were extremely glad to have a few days off the plane before the next leg.

As the whole world and we now know, London is a most amazing city. Our hotel room is near Heathrow which is many miles from the downtown core. But public transportation is very efficient. The "tube" or subway gets you just about anywhere one wants to go in the city. It's user friendly and utilized by throngs of locals and tourists alike. Yesterday we took and unguided walking tour to Buckingham Palace, Westminster Abbey and Cathedral, St. James Parkway and along the Thames River. The architecture is beyond awe. We were in the presence of over a 1000 years of history. But it's the people watching that is the real kick. What a cosmopolitan arena. People from the entire globe gather to this epic city. And everyone it seemed was having the time of their lives. From the start we noticed just how good natured Londoners are. Before we would even ask for directions someone was offering advice. It didn't take long to find out though that everyone had a different idea of which direction or bus we should take.

People seem so much happier here and in better shape. Of the thousands we observed reveling through the city few were over weight. People were not necesarily super athletic, or pencil thin, but rather quite normal. Fashion rules and the varied attire and wild and chic hair cuts added much to our delight. When Europeans talk about holidays they are referring to the long vacation and travel time workers enjoy every year rather than the orgy of mandatory spending and eating we annually and frantically participate in. Pubs close down here at the reasonable hour of 11pm, not 2am. There are lots of restaurants, but way fewer fast food options. Lovers are everywhere and unabashed in diplaying affection. It seems to be a more casual relaxed way of being that our hurried lifestyle prevents. Faces are softer, quick to smile and engage in interaction. A casual observation reveals a refreshing lightness and a love of life look and feel from the managerie of people congregating in this grand city.

We knew before arriving that London is very expensive. But we didn't expect the hotel to charge extremely high prices for amenities we're not used to paying for, especially when we paid so dearly for our tiny room. Internet service, 10 pounds for a half hour, an extra tea bag? 3 pounds, airport/hotel shuttle which is a ten minute ride/4 pounds each. The exchange rate is the best it's been in years for the US dollar. But it's still $1.70 for each pound.

The news here as everywhere is the devastated world economy. One of the biggest stories is Obama's presidential campaign. The Brits and their papers love him. They predict and hope for a landslide victory and feel his ability to govern and lead will set the States and the interconnected world on a far better course.

Today we slept in until noon. Ahhhh, holidays! Ruth got her hair cut and I got a massage. This evening we saw the theatre production, "Stomp." Percussion created by janitorial tools; brooms, trash cans and lids, match boxes and plastic bags. It was so creative and loads of fun. Everyone left happy and revved. Afterward we found a pub and toasted our farewell to London and the start of our Indian adventure.

Preparations & Posterings

We leave for London and India in two days. We’re packing as light as possible . Our instructions were to bring cotton dresses to India and warmer clothing for our London tour. My lap top is key, a few books and DVD's, camera, chargers, cell phones and a small feather pillow. Comfortable sleep is a priority. Just a few "good luck" charms of polished rock and rose quartz crystal, along with Aura Soma Serapis Bey. We heal through our senses and this elixor bestows our sense of smell of earth's and angels gift to our inner passages.

As the economy in the US reveals the imaginary and decrepit value in which we have placed our trust , we experience moments of wary upon leaving our home soil. What if during our time away this “sucker” goes down. We could be stranded. Our assets could be frozen. Who knows what and on and on.

If things are about to get really rough here, I want two strong legs to walk on. This is one way to achieve that miracle. Ruth is smart, savvy and a true lover of adventure and travel. So we’re going, but of course. In every life there are times when one casts their fate to the winds, surely this is one for me.

Moe, our honorable medical tourist guide, arranged for us to stay at a 5 star resort in Goa. It was horribly expensive, especially by India standards, $700 for four nights including all meals. The Rough guide to Southern India tells us that $10 a night will buy one a sufficient room near the beach. We also want to search out our own special places and meals. His featured resort would totally insulate us from any participation in real travel. So we’re on our own for finding accommodations. Our e-mails have turned up a response from a small inn near the beach, Heaven Goa. They have our reservation.

Becoming Medical Tourists

I tore the ACL in my left knee skiing 32 years ago. I lived with it for 24 years before my right knee crumbled underneath me, leaving me without a strong leg to stand on. I underwent bi lateral ACL reconstruction in 2000. I never healed from the surgery. I developed severe tendonitis from the patella graft that was taken to replace my torn ligaments and my knees have been mush ever since. After my divorce I was paying $550 a month for health insurance. Not only was this a tremendous drain on me financially but the process of filing a claim and getting the insurance to actually pay for medical care was excruciating. I made the decision to give it up. The whole system was actually making me sick. I had no money after paying the monthly premiums for wellness. I knew that once I gave it up I would never again be able to insure my knees. But I bluntly cut myself off from this broken system.

As the years ticked by my knees have continued to erode. I’m 54 now and I can no longer ski, hike, or play any of the outdoor games that entice us to stay active. I have talked with many others who like me have endured the loss of healthy joint tissue and function. Many have undergone the procedure of total knee replacement. Without fail everyone I’ve spoken with has felt that this was the best medical decision ever made. Knee and hip replacement is considered miracles of modern medicine. The success rate is in the high 90% category. But obviously because I don’t have health insurance this procedure is not available to me here.

In my internet surfing I discovered the world of “medical tourism.” I chanced upon an organization called Healthbase. They act as a liaison between patients and doctors from other countries. From the start I felt a sense of comfort and confidence working with Moe, the Healthbase representative in the US. He is from India and now lives in Boston. He became my source of information for doctors and procedures offered across the globe.

We discussed having surgery in Mexico, just across the border from San Diego, as well as in Thailand and India. Cost was definitely a factor in my decision, but of course more than that I wanted the best surgeon and technology available to me. The medical costs of TKR in Mexico / $13,000, Thailand / $9,000, and India /$7,000 per knee. This includes all medical costs including one week of care in the hospital. It does not include costs of travel. The average cost that I could ascertain for this procedure in the US was $38,000, with the average in-hospital stay of 48 hours.

Moe strongly recommended India as the best place for me. His Mother had undergone bilateral TKR there and was greatly improved with the results. Dr. Sanjai Pai who performed his Mother’s TKR was the world class surgeon available to me. His bio is most impressive having worked as an orthopedic surgeon for 20 plus years performing over 3000 joint replacement procedures. He’s also been a forerunner of minimally invasive joint replacements. With the use of a computer that allows pin point accuracy the incision is smaller with less muscle tissue traumatized. Recovery time as well as pain is reduced. All of this sounded convincing to me. My sister Ruth, in her caring and consistent way of supporting me, agreed to join me on this across the world venture into India and surgery.

She loves the adventure of travel. She’s always dreamed of traveling to India. This trip is hardly what she had in mind. But at our age we all have health issues. So being the practical person that she is, decided to use this opportunity to have a serious injury to her cervical spine examined, with the additional possibilities of Lasik surgery, dental work, and a complete physical. My surgery is pretty straight forward but hers is quite unique and specific, frought with alarming consequences. Moe sent us the name of the surgeon he would arrange to meet with Ruth, Dr. Rajakumar. He also has quite an impressive bio. He is renowned in India for his innovation, skill and interest in minimizing the trauma induced with surgery. We both feel confident and excited about what we are about to embark on. There is a sense of liberation and gratitude that there are other possibilities for our own health and welfare as we are so cut off from medical care in our own country.

Our flight is booked with British Airline. There is a direct flight between Denver and Heathrow London; and then a direct flight from London to Bangalore, India. To travel around the globe it just doesn’t get much easier than that. Since neither of us have ever been in London, we opted to spend two nights there for a whirl wind tour of this famous city. This will help to mitigate the extreme jet lag one would expect to encounter for such a lengthy flight. We’re also taking the first five days in India to experience the mystical sea coast of Goa and the palaces and city of Bangalore before mine and possibly Ruth’s daunting surgeries take place. Moe through Healthbase has arranged our entire itinerary. We have rooms at a hotel near Heathrow, a driver when we arrive in Bangalore from the airport to the hospital for the initial consultations, air travel to Goa, transportation to our arranged stay there, transportation back to the airport, with a driver there to take us back to the hospital. The hospitals in Bangalore have rooms large enough to bed the patient as well as a traveling companion. So if Ruth doesn’t become a patient she will stay in my room. They seem to be more than accommodating to those of us who arrive from other countries.