By JAN HOFFMAN
March 25, 2017
What if the surgeon started slicing into my knee before it was completely numb?
That was my biggest fear, while weighing whether to remain alert and watch the operation on the cartilage in my right knee, or to be put to sleep, preserving my peaceful ignorance.
Rational or otherwise, my reasons for staying awake — an option increasingly taken by patients, the subject of the accompanying article — prevailed.
1) I don’t like general anesthesia’s side effects.
2) For a long year, my knee pain had resisted straightforward diagnosis and treatment. I wanted an ah-ha! glimpse of the problem.
3) Ever since I was a child, I have watched when the doctor gives me an injection. Not because I am brave, masochistic or even curious. On the contrary. Looking away, I imagine something far scarier. So watching a medical procedure has always been a form of self-soothing.
(Related: As more patients stay awake for surgery, doctors have to watch what they say.)
There I lay on the operating room table at Hospital for Special Surgery in New York, jabbering nervously to the anesthesiologist, waiting for the spinal block, an injection that was supposed to render the lower part of my body numb, to kick in.
I didn’t know the etiquette.
Was I permitted to talk? Or would that distract everyone? How would they know when the block was working? Was I already talking too much? Was that beleaguered exasperation in the anesthesiologist’s eyes? I thought they had given me a sedative. Is this me on sedatives?
A blue surgical cloth had been draped over my hips. A nurse hoisted a bare limb and began washing it with sterilizer. How odd, I thought: Why have they brought a mannequin leg into the O.R.? Maybe a Halloween joke? I peered closely and recognized the chipped summer toenail polish.
Wait. That leg belonged to me.
The regional block was working.
My surgeon, Dr. Robert G. Marx, strode in, greeting everyone, just another day at the office. We were ready to begin. He called for music.
It so happens that about seven lifetimes ago, I was a disc jockey. The experience left me a little judgmental, perhaps, about others’ musical tastes.
What would I put on the playlist “Music for Watching One’s Own Surgery”? (Rod Stewart, “The First Cut Is the Deepest”; Louis Armstrong, “Mack the Knife”?)
It would certainly not include Dr. Marx’s go-to choice: Rush, the Canadian hard-rock band. But Dr. Marx was raised in Canada. (So many other maple-leaf musicians to choose from: Neil Young! Oscar Peterson! Drake! No, not Justin Bieber. Please.) Now he was bopping around, looking pumped. And there was my favorite right knee, naked, powerless in his hands. So I said nothing.
To a civilian like me, arthroscopic surgery is astonishing. Although I couldn’t see what Dr. Marx was doing, he narrated as he made two incisions: one for a tiny camera, the other for a tiny instrument.
Then, on an overhead monitor, video appeared. Now we could all have a good look around my knee innards.
Cartilage is relatively bloodless, shiny and white.
“There’s your honker!” Dr. Marx explained, using his highfalutin medical term for the floating fragment of my medial meniscus. Whenever I attacked stairs, that piece tugged on the highly sensitive knee capsule, dense with nerves.
I felt relief and affirmation. This pain had not been in my head. The fragments looked like rubbery slivers of squid sashimi, fluttering in dark video tunnels. Dr. Marx quietly pointed out that because I’d had this surgery once before (under general anesthesia), after today I would not have much medial meniscus remaining.
Anxiously hanging on his every word, I did not find the news reassuring. The wistful, shimmering mirage of my 5K morning runs dimmed. But I felt better prepared for whatever the surgical outcome might be. For I could see exactly what he was talking about.
Then he went after the honker and its progeny, elegantly chewing them up with an arthroscopic biter and smoothing down the edges with a shaver so that the remnants resembled a normal meniscus.
Afterward, as I waited for the regional block to wear off, I was alert, with none of the chills or grogginess that bedeviled me with general anesthesia.
I left the hospital a better-informed patient, with new respect for the operating room staff members. And a speech to deliver to Dr. Marx about his musical taste.