The Final Week

Making the Connections

Back on the bench again.  Monday/Tuesday December 12^th/13^th

I have a charming new room-mate, Leonardo. I can’t quite work out what he’s here for; I think it’s an intensive programme of physiotherapy to try and get some of his nerves and muscles reconnecting properly, so at least the poor chap has no harsh pain or post-operative wounds. He has brought a television, but unlike my previous room-mate, Leonardo is not over-addicted to glitzy game-shows and shopping channels, he does however like to keep it playing quietly in the background, well into the night but maybe he’ll switch off earlier tonight.

This final week is the build-up to being discharged as more-or-less independent. I asked the therapist whether I would be continuing with physio at my local hospital when I returned to Le Marche. But no, Friday will be the end of the enforced exercise and from next weekend onwards it will be up to me to get out and go walking. That’s quite a daunting prospect when you remember that I’ve only be allowed to walk unaccompanied for the past four days, and today was only the second time I’ve attempted a flight of stairs. But it is amazing just how fast the body learns. Suddenly the nerves appear to wake up as if to say Oh, that’s what you want me to do, is it? The best example is lying flat on my back and raising my left (operated) leg. Until yesterday afternoon that was impossible. The therapist would slip her hand under my heel and take the weight, but it didn’t matter how much effort I put into supporting my leg, it would fall back to the bench the moment she relaxed her hand. I have spent a lot of time lying on the bench, trying to raise that leg, but nothing that I twitched or tweaked had any effect. Then yesterday I managed to slow the rate at which the leg descended, and then – with a great deal of effort – managed to raise the leg again, all the way up to the 45 degree angle. This morning, it was all logged into the memory of my nervous system and I lay on the bench, happily raising and lowering either leg with impunity.

When I look back over the past three years since I first started limping, I feel a huge relief that is further reinforced by the experience of improved mobility each time I walk down the corridor. I can feel my balance improving every time. I have been so blessed by the way the operation and after-care have been handled.

Lambeth Palace

A surprise email.

I am eking out the last few hours of internet access as I have only a very small balance on the dongle in my netbook (laptop.) I logged on this morning to find an email from the Archbishop of Canterbury’s official residence, Lambeth Palace. I had received a formal acknowledgement to a letter I wrote 3 weeks ago, but never expected an individual reply from such a busy office. I had written to thank Rowan Williams and his colleagues for their positive support of the “Occupy” movement at St Paul’s Cathedral – a movement that has received terrible and inaccurate press coverage from most of the British media. I firmly believe that we are on the cusp of something that is every bit as revolutionary as everything that happened across the Arab world through the summer, and is perhaps as significant as the fall of the Berlin Wall. I have never been a Socialist because I always believed that Capitalism offered a more efficient system of social and commercial organisation, but we have now seen that when any political system – Left or Right –  becomes self-serving, it is the 99% of the population who suffer. I continue to follow developments keenly on the internet and hope that I can find some way to make a positive contribution as the changes progress. It’s all about communication – and that is my forte. If you want to get a glimpse of the scale of debate that is going on behind the scenes, you might well be surprised at the involvement of not only the protesters and the Church, but also Hector Sants, CEO of the Financial Services Authority and Ken Costa, former Vice-Chairman of UBS Investment Bank and Chairman of Lazard International. None of this appears to have been reported in the press but you can check it out at http://occupylsx.org/?p=2204

Back in the exercise room for my afternoon session and the girls crank it up again. No sooner was I revelling in the ability to raise my operated leg off the bench than the new exercise involves not merely raising the leg but then holding it at 45 degrees for a count of five and then lowering slowly and gently. I grunt and groan, but persevere. I can’t believe how tiring it is, nor how uncomfortable the hospital bed is, when I collapse on it, exhausted. I dream of sleeping horizontally across my double bed when I get back to Caldarola on Saturday.

Definitely lop-sided

Wednesday December 14^th

The doctor did his rounds of the exercise room this morning and decided that my legs are definitely different lengths, and after months/years of compensating for the limp caused by my worn-out hip, this is now creating something of a problem. They fiddled around with various cork insoles in my right shoe, and when I started walking I could feel quite a difference. In time, my body will adjust naturally, but while the hip is settling down, I’ll wear an insole in my right shoe to help me to rebalance.

I still can’t get used to how tiring all of this. One hour of physio and gentle walking and I am totally drained. I went out like a light this afternoon – and that’s not because of a heavy lunch! In fact the food has been pretty poor this week. I am leaving more and more on my plate because it’s just not worth eating something which is completely tasteless – carrot broth with mushy pasta, meatloaf with overcooked cauliflower, and yet another baked apple – I’ve been served an average of 8 or 9 plain baked apples each week. Of course, the upside is that all my shirts have expanded comfortably, but what a way to spend the traditionally lavish run-up to Christmas….!

Stairs again

Thursday December 15^th

Fabiola continues to show no mercy.

I try to kid myself that the exercises get easier. Maybe they do, but just as one routine becomes less painful, a new one is introduced that finds resistance somewhere else. After a particularly gruelling session we set off for the walk round the block, stopping at the top of a daunting flight of stairs. Ok, off you go, says Fabiola, and I search in vain for a handrail. There is none. I am at the top of a marble staircase with only my crutches. Fabiola encourages me to use whatever method I find most manageable. I put both crutches on the first step down and feel dangerously unstable. I try keeping my crutches on the top step and gingerly move one foot down a step. Nothing feels very safe, but after a step or two, and a dangerous wobble on the first landing, I start to get the hang of it.

What soon becomes clear is that there are so many things that the body has to learn and re-learn, and that I simply must not put everything at risk by trying to learn new tricks too quickly. I am, after all, an old dog, and you know what they say about old dogs and new tricks.

That colour doesn’t suit you…

My room-mate’s wife

I hope she doesn’t turn up tonight, because I have such a problem keeping a straight face. I am still trying to understand Italian marital relationships after the dining room episodes of cutting up food and spoon-feeding. Last night Leonardo’s wife arrived with three carrier bags of new clothes. She decided that he had to have the appropriate clothes to wear in the exercise room, and whereas most people have track-suit bottoms and some sort of tee-shirt, my room-mate was to be kitted out with what the Americans call leisure suits. Furthermore she decided his pyjamas needed replacing and he needed a casual jacket.

By the time she had opened the bags and boxes and spread her purchases on the bed, I could see that he would have been well-equipped for a 3-week Saga cruise. Then the humiliation started in earnest as he was forced to try on the various outfits and stand there, deeply embarrassed while I tried to keep a straight face and avoid catching the eye of his adult son who was also trying to avoid revealing his amusement. My favourite was the purple and pink plush outfit – but my mirth was swiftly overwhelmed by my grief for my room-mate, unable to argue with his wife’s effervescent enthusiasm.

Then she marched him off to the bathroom to give him a shower. Yes, shower him! He has some restricted movement – which is why he’s here for treatment at the clinic – but nothing very much and is perfectly capable of caring for himself. I wept silently as I heard him complaining at the shampoo and shower gel that were lavished all over him. 24 hours later, the bathroom still has a lingering scent of body-wash, overlaid with the Gucci cologne she bought for him.

I thought I had seen it all: pampered husbands being spoon-fed at dinner, washed, dried and preened, then finally dressed up like favourite dolls in awful, garish outfits, but it was the breakfast routine that really got me. The hospital orderlies come round with the choice of hot drinks and packets of biscuits or rusks with jam. Leonardo always chooses rusks and sits expectantly while the girls spread a paper napkin, unwrap the packets of rusks and take the lids off the portions of jam.

One last session

Friday December 16^th

At 5.30 this morning the vampires stuck a needle in my arm and took their samples; at 6.00 they pushed a pill in my mouth and at 7.00 I decided I wanted to get wet and get clean. Showering is still a bit of a performance – there’s a hand-shower in the corner of the bathroom, and a stool,  but no curtains so no matter how careful one is, the water sprays pretty much everywhere. But it’s hot, and wet, and feels wonderful – even if the bathroom does end up flooded. [The cleaners took care of that before anyone slipped and had an accident.]

Nothing was going to stop the therapists upping the pressure for the final sessions. Fabiola tried new ways to bend back my left leg, and found new positions for me to lie before ordering me to move my disobedient limb. Lying on my stomach, straining to get it to rise, until she gently encouraged it and, amazingly, the nerves reconnected and started a twitch that became a nudge and the foot lifted just a fraction. A couple of attempts more, and my leg started to obey, but I felt the sweat breaking out on my forehead as I struggled to comply.

They have given me a list of exercises to work on in the coming weeks, and told me to make my follow-up appointment with Dr Passotti, the surgeon, as soon as I can – bearing in mind the Christmas breaks. The clinic doctor tried to persuade me to stay on for a further week, just to strengthen the hip and buttock muscles a bit more, but I fought my corner because I just cannot face another lone weekend here at the clinic. I have a suspicion that as the patient numbers decline for Christmas, his true motive is to ensure he has enough work to keep the therapists busy. Either way, it’s all agreed now, and I will be discharged sometime after 10 tomorrow morning.

…and in conclusion.

I have been very lucky. I have had intensive physiotherapy for more than three weeks and I could quite easily stride out from here with no more support than a normal walking stick. But if I did that, I think the nurses would kidnap me and lock me back behind the raised sides of my hospital bed, as they did on the day I arrived. They have a very strict routine, but all the evidence is that it works very effectively. I’ve kept in touch with my sister in Birmingham and exchanged notes on the speed of my recovery (she had her hip done in February.) Based on what she tells me of her expereicne, I am confident that this wonderfully extravagant process of intensive therapy is extremely beneficial.

I’ll miss the staff; the little nurse who christened me Santa Claus, the nurses who keep trying out a few words of English, the strange mix of other men and their dominant, fussy wives, and Lisa – the ex ballet-dancer turned journalist, fighting back from the brink of death after her car crash this summer to get back to presenting news stories on Italian television’s Channel 7.

Lots of stories, lots of experiences… and for me – it’s probably the start of a completely new lease of life.

Thanks to all of you who’ve expressed your pleasure in reading this blog; it’s kept me sane, amused and entertained. Since I now have the url www.bob-harvey.blogspot.com this site will live on with other stories of my continuing adventures. Just click “follow” to be updated automatically.

Going Alone at Last

Equilibrio

Back to work – Friday December 9th

My wheelchair turns left. All the time and, unnervingly, when it approaches the landing where a steep flight of stairs leads down on the left….it veers to the left, as if possessed by some demonic power. A wheelchair is surprisingly hard work, though rather less so since I got them to pump up the tyres. The slightest slope is quite a struggle and I am sure I have built up some upper-body strength when I’ve struggled to drive the wheelchair up the gentle incline in the corridor without veering left into the wall (or down the stairs!) The other big factor is the condition of the ground surface. It’s one thing to be spinning along on the vinyl flooring of the clinic’s corridors and quite different to be negotiating across the rough tarmac of the car park downstairs if I go down in search of a coffee from the vending machine in the entrance hall. It’s another opportunity to appreciate the plight of tens of thousands of wheelchair users around the globe, and to realise just how they struggle to fit into a world that is designed around able-bodied people.

The doctor has finally given his approval for me to move around the clinic independently, with my crutches. They have decided I have done enough exercise work to re-establish a working relationship in the muscles of my lower body, and I no longer need to be confined to the wheelchair. This evening, for the first time, I shall walk down the corridor to the dining room with a large cushion slung around my neck on a cord. Well, – when you’re on crutches, you can’t carry anything; and even in a wheelchair you need some sort of tray or attachment if you want to be sure you won’t drop your phone or whatever. Everyone needs a big cushion to raise the height of the chairs because the hip angle sitting on a low chair is dangerously acute.  Similarly, if you drop something, it’s no good thinking about bobbing down to pick it up; you mustn’t put strain on that prosthetic joint or you run the risk that it might just pop out of the socket…. And that doesn’t bear thinking about. Maggy has sent me a “litter-picker” for picking things up: the sort of novel gift that is normally found only in one of those booklets inserted into the colour supplements that accompany the Sunday papers.

The experience of doing circuits on crutches around the corridors is strange and unsettling. If I think back to the days after the operation, when I struggled from my bed in Foligno hospital to get to the loo, the pain in the hip and thigh was excruciating. Such activity would have the staff here up in arms, and it  is unforgivable that they fail totally to coordinate the post-operative process and treatment between the orthopaedic department at Foligno and the rehabilitation clinic here. There should have been rigid instructions about not moving from my bed without assistance. As it was I was lurching between beds and hanging on to the door-frame of the en-suite, just to take some of the weight off my joints. I think the sheer size of the prosthetic they inserted meant the incision had to be long and deep. I believe now that they should have kept a closer eye on me and given me more guidance about what I could and couldn’t do. On the contrary, what actually happened is that I remember the physio nurses and my surgeon applauding my attempts at walking in Foligno…Here they would have locked me in my bed and read the riot act – which is what they did as soon as I arrived here and started unpacking my suitcase.

But now, four weeks on from the operation, there is no pain in the joint. There’s some painful bruising around my backside and lower back, and some muscular ache from the exercises, but no hurtful pain where it’s all been healing. What is unsettling and somewhat disconcerting is the reduction in coordination and balance – equilibrio – is the new word in my Italian vocabulary. I feel a bit dizzy and light-headed and there’s the marionette sensation I described in an earlier post, that some ­of the strings connecting some of the brain’s commands to the limbs just aren’t getting through. We were doing an exercise this afternoon, lying on the stomach on the work-bench with the legs bending at the knee and kicking up and down like a child learning to swim. I realised that my legs were going all over the place to left and right and I had to concentrate hard to make them stay on a straight axis and not flop around.

The result of all of this is that walking with crutches is hard work, not so much because of any aches or pains in the joints but because I have to focus on staying steady, keeping the feet pointing straight forwards, not wobbling and maintaining a steady pace. When I get it right it is hugely gratifying but when I falter, or sway, I feel incredibly stupid and incompetent. It is all a fascinating process.

Another milestone today was a flight of stairs. I learned to my amusement that the mnemonic my sister Maggy had learnt at her Birmingham hospital is the same in the Italian health service:- Up to heaven, down to hell. What this means is that when you climb up the stairs, you lead with your good (heavenly) leg, and when you descend the stairs you lead with your bad (hellish) leg. It was much easier than I thought it would be, proving once again – I think – that the emphasis here on intensive bench exercises prior to walking practice all pays off. I have been very lucky; but Lord knows I could murder a good meal and a large Scotch.

A visitor from Rome

Saturday December 10^th

My elder sister’s son, Aldo is visiting me from Rome today. In the past few years, his family has turned out to be very musical – I think as much to their own surprise as to the surprise of everyone else. Aldo and both of the children sing in choirs that travel all over giving performances and participating in events. Tonight the children are singing in an opera at Spoleto, an Umbrian hill-town not far from here and tomorrow Aldo’s choir is singing somewhere else in the region. He has planned his trip so that he will be here at lunchtime today before he goes on to meet up with the children and be in the audience to support them tonight.

I was 15 when Aldo was born, and what seemed like a huge age difference at the time has – of course – diminished to the colleague category in recent years. I am finding something of a similar realignment as my children grow up; My eldest – Samantha in Hong Kong – faces the big Four-Oh shortly after Christmas while at the other end of the spectrum Digby, having recently become a father himself, moves into the final decade of his 20’s tomorrow. I hope that I can emulate my father by stretching the active years ahead. When we had the restaurant in Lincoln, Dad, well into his 70s, would be up and down ladders at this time of year, checking and changing the fairy-lights on the Christmas trees and giant star that decorated the fascias of the building. He once said that he rather fancied the idea of falling off the precarious ladder that was leaning on the Steep Hill side of the property. What better way to go, he said, than making Christmas brighter. The bottom of that 3-stage extending ladder was chocked up with some odd bits of wood and there was never anybody working with him and holding the ladder. My heart flutters when I think about it, even now. This was, of course, before Health & Safety legislation started to bite, and I imagine that today I would be locked up for dangerous working practices, whether or not there was an accident. He was constantly tearing a fingernail or cracking the dry skin of his thumbs when he worked in the bitter East wind that chills the side of Lincoln Cathedral after blowing across Holland and the Lincolnshire Wolds, direct from the Russian Urals. But Dad was careful, or maybe just plain lucky; he never injured himself with anything an Elastoplast couldn’t patch up. He would climb down at midday, hang up his colourfully patched jacket, smarten up his pullover and smooth back his hair with the palms of his hands, then perch on a stool in the bar with a glass or two of whatever red wine was open.

I’ve had 2 years of limping, and it has often made me think back to the time (at my age, more or less) when Dad was on the waiting-list for his hip operation. I used to get very angry with the Health Service when I saw his lack of mobility – the way he scrambled up the stairs on all-fours in his terraced house in Lincoln, and the way he winced as he limped along with a walking-stick. I’m not sure that I was ever as handicapped as he was at that time and I am incredibly fortunate to be able to take advantage of the huge advances in prosthetic surgery in the past 30 years. Even after just 4 weeks I can see that I have more flexibility of movement than Dad ever had after his operation. I remember Dad having to put elastic laces in his shoes because tying them himself was out of the question. I have to take it gently but I can already put on socks and tie my laces. I walked around the block this morning and the sensation remains the same; I have no pain, but I need to concentrate on my balance and stability. A few more weeks and…who knows?

Another day of rest

Sunday December 11^th

I lose track of the days. I forget it’s Sunday till I realise the corridor is unusually quiet and breakfast (well, a hot drink and dry biscuits!) has not yet arrived. The room is stuffy, and when I open the window to let in some fresh air in, it is unseasonably warm, blowing up from the south, from across the Sahara, the wind they call Sirocco. As it’s Sunday there will be no sessions in the exercise room, just a constant flow of visitors wandering slowly along the corridor, peering into the rooms looking for lost relatives and reinforcing the sensation that I am in a zoo, on the wrong side of the bars. Today I shall walk the corridors like these inquisitive visitors, testing myself to be a little more stable than yesterday, trying to be less hesitant when I turn the corner, building a steady rhythm and reducing with every step the amount of weight I bear down on the crutches. I take an unsupported step across my room to reach my hairbrush, but the room sways and my hip wobbles and I quickly reach for something to hold on to. The rate of progress is deceptive; one moment everything is solid and secure, then one slight falter and panic sweeps in and I am back to square one, rebuilding confidence like a house of cards that has collapsed at one glancing touch. I forget that it’s a slow process, but then I look at myself in the mirror and see this long, straight scar perfectly healed and I remind myself that it’s all going to plan, it won’t be rushed, I need that elusive quality… patience.

Counting my blessings

Lisa put her head round the door and gestured the universal sign language for coffee. I followed her to the lift and went down to the ground floor where we sat by the entrance area enjoying the mild late-autumn weather. I cannot imagine facing the sort of prospect that lies ahead for her, of knowing that the next 12 months will be spent in hospital with no certainty of just what kind of life lies beyond. At times like this one really does count blessings, and she was talking about the gift she enjoys of having suffered no kind of brain injury. Car crashes, as we know from family experience, can lead to extended periods of recuperation over months and years before the brain is fully recovered. Lisa, however, is very positive and appears to have lost none of her journalistic acumen and clear thinking. When I look at my own progress, especially in the past week, I find myself wondering what I have done to deserve such rapid development when others simply have no idea of their own prognosis.

I remember being in the private hospital a few years back, with all that incongruous ambiance of a ‘BUPA Hotel.’ It was a totally sanitised environment in a way that this clinic never is. We patients in Trevi are a mix of people adjusting to new knee joints or prosthetic hips on the one hand and people undergoing long-term treatment for serious disabilities on the other. While the ‘BUPA Hotel’ feels almost totally removed from healthcare and borders on cosmetic treatments, this clinic works across a wide range of abilities and disabilities. It’s an environment that constantly reminds me to count my blessings. 

Isolation

The impossibility of not thinking

The last week…or not….starting December 4th

When I run a workshop on communication, I have to get people to understand that they are in a constant state of communication. You may or may not be talking, but you speak volumes, even in your silence. My current state amounts to solitary confinement – being the sole occupant of my room and only able to have limited exchanges with people who have no practical knowledge of my language. While I have a working knowledge of Italian, the local Umbrian accent is about as impenetrable as the Glaswegian dialect would be to a Milanese sophisticate. What I have come to realise is that I cannot escape the tyranny of thought; I can’t switch off, stop thinking or drift away, and while part of this stems from boredom and lethargy, part is also medical, or rather it is a chemical response to the use of morphine in post-operative care.

My sister Maggy had warned me that if they gave me morphine after my operation, I should be prepared for some challenging after-effects. This was confirmed in a radio programme I was listening to through my computer last week, when David Aaronovich – a highly respected journalist and author – described his experiences in hospital after being sedated with morphine after an operation. He was convinced that the nurses were conspiring to kill and eat him. Aaronovich is not the sort of person to spin sensational fantasies, and he gave me a context for the terrifying nightmares and haunting internal debates that I have been experiencing in the past three weeks, keeping me awake at night and genuinely frightening me with the lucidity of the arguments that the dreams presented.

There was something of science-fiction scenario in waking up after my operation to find a piece of laboratory apparatus taped to my arm and linked to a feed into my vein. There was a glass tube containing a small sausage-shaped balloon – presumably the reservoir of morphine – which gradually deflated over the next couple of days. From what I could understand from the labelling it was a controlled-release 48-hour dosage. I certainly had very little pain, despite the scale of the operation, but I was uncomfortable at the idea of chemicals being drip-fed into my system constantly for the next 48 hours.

Since then, I have found myself lying awake, challenging every aspect of my existence and every facet of my lifestyle. While I have not had fears that the nurses were cannibals, I have been convincingly persuaded that my children and all those near and dear to me were simply putting on a pretence in their relationship with me. What was worse was that the arguments that developed in my brain were totally logical and perfectly reasoned and I could find no way to refute them when I awoke – if I ever did manage to get any sleep in the first place.

To confuse things further, a month away in the solitude of a hospital does focus the mind and does create the opportunity for serious re-evaluation of one’s life, lifestyle and purpose, in the way that a walk in the woods or a stroll along the beach simply does not allow. I have found myself confronting some pretty serious issues and I struggle to reach any conclusion as yet. But I refuse to go down that depressing road at this time; I think I would rather highlight some of the more amusing aspects of life in the Rehabilitation clinic.

Friends and Family

Moral support from back home

The most noticeable difference compared to British hospitals is the attitude to visitors. The whole Italian concept of family means that both at Foligno and here at Trevi, it’s not unusual for a close relative to simply move in and sleep in an arm-chair or sun-lounger next to the loved one. The nursing staff don’t seem to object because in such cases the patient often needs above-average care and the permanent presence of a family member makes life easier for them. A strange community evolves, with patients and their families mingling, comparing notes and gossiping. I'm surprised there aren't Primus stoves cooking up Nonna's favourite recipes.

Then there are the duty visits. The daughter of an elderly parent or relative arrives for the evening meal and keeps the patient company. There is no conversation, just a ritual vigil which ends with clearing the table and washing-up the cutlery (we all bring our own in Italy,) then a mumbled farewell till the next day. A variation on this is the fussing wife who tucks the napkin into her husband’s shirt collar, cuts up his meat, sprinkles the salt, chops up the salad and dresses it with oil. In extreme cases she will even spoon-feed him if he throws a tantrum. At least this provides some light relief on the male table, which is generally dominated by dour silence punctuated with the occasional grumbling remark about the quality of the fare, and the generous sharing of the newly harvested olive oil that each has brought from his own garden and which are individually compared and contrasted with epicurean analysis.

Even in hospital, appearances are all-important in Italy. The ambulance men delivered a new patient yesterday, wheeling her along the corridor strapped lying down on a trolley. Her hair was perfectly in place and she was wearing full make-up, lipstick, mascara, eye-liner, the works. She clearly wanted to be prepared for whomsoever she might meet along the way. Either that or she didn't trust the undertaker to do a good job if anything went wrong with her treatment.

There is no restriction on the use of mobile phones, and if there were then I imagine such a regulation would be ignored. The early evening is a cacophony of ringtones as most calls are missed or ignored.  Some of the older patients have been presented with a basic Nokia mobile especially for their stay in hospital, with the inevitable result that the phones are on factory settings. Consequently that infuriating Nokia signature tune will blast out at full volume while the aged relative first tries to locate the phone and then to work out how to answer it. Having missed the call there is then a slow punching in of a family phone number digit-by-digit since such niceties as “phone memory” and “call-back missed call,” were not explained by the kind-thinking offspring when they donated the device. Actually the operation probably was explained in great, complex detail - and rapidly forgotten. When the calls are made on these new-fangled mobiles the vocal communication is carried out fortissimo in the certain belief that the only way to be sure of getting a message through on such a tiny piece of technology is to be on the safe side, and shout.

The Integration of Shrek

Size matters

Of course, the biggest joke at the clinic is yours truly. I don’t think the locals have ever seen a full-size human male before, and I must have been asked my height at least a dozen times. There are some huge mirrors in the exercise room, and when I catch a glimpse of myself with one of the therapists, I crack up. It’s Shrek! – No question about it! I loom over everyone. I dwarf the therapist working with me and my feet hang off the end of the massage tables. My wheelchair has been taken apart and reassembled with extra bits to add width, depth and height and, of course, the jokes are endless. I think they assume that because they now have Shrek in their midst, they should be entertained by an oversized buffoon. I try to melt into the background, but – as Shrek himself would tell you – that’s easier said than done.

You’ll be pleased to know that I am making a major effort to integrate, but the men don’t speak to each other or even to themselves apart from the occasional grunt, and the women just gossip about whatever was on television last night – Italian X-factor or some complicated game show involving huge sums of money that are painfully won and then cruelly lost. If only I spoke better Italian we might perhaps discuss the Milan opera, the education system or the plight of the Euro. But somehow… I don’t think so.

Doctor’s verdict

Wednesday December 7^th

It was time for my dressing to be changed when the doctor did his round this morning. Everything is healing up perfectly and the layers of gauze and tape have now been replaced with one modest Elastoplast covering the final inch or so of the wound. He set my discharge date for Saturday December 17^th which will make my total stay just over 5 weeks in the two establishments, divided between the orthopaedics department of Foligno hospital and the rehabilitation clinic here in Trevi. Meanwhile, I am still strictly confined to my wheelchair except for short, escorted excursions with crutches, up and down the corridor as part of my therapy sessions. It is starting to make me a little nervous because I’d like to feel more competently independent, but all I can do is put my complete faith in the specialists and see how it all pans out. I secretly hope they are going to banish me from my wheelchair at the end of the week so that I have a full week of relative independence, managing with my crutches, before I go home.

The limited internet access is annoying. I have a dongle that plugs into the USB port on the laptop, but the signal is weak and intermittent. By using a remote LAN that fools the BBC into thinking that I am in Maidenhead I can access BBC and BBC i-player, but it is rare that there is sufficient broadband capacity for a reliable connection. Last night I was watching Young Apprentice, and it got to the when Lord Sugar was about to fire one of the contestants when the screen froze and the “insufficient bandwidth” message appeared. There is however plenty of capacity for downloading radio 4 and I have a library of Midweek, In Our Time, Saturday Live and Thinking Allowed that keep me entertained.

But who did Sugar choose? – the nice guy or the feisty girl?

Gynaecological Miscalculation

Thursday December 8^th

I slept slightly better and was up and ready in plenty of time for the first session in the Exercise Room, - so early in fact that the doors were still closed when I wheeled down the corridor. It was suspiciously quiet so, wondering whether my watch had stopped I headed backed towards my room only to be met by the breakfast nurse gesticulating and laughing. ‘No, Santa Claus!’ (She has dubbed me Santa Claus as being more appropriate and slightly less offensive than Shrek.) ‘Oggi e festa, no palestra oggi.’ Today is a festival, no exercise room today.

And then I remembered something Fi had said when she’d driven the 200 mile round trip to bring me clean underwear yesterday. December 7^th is the Feast of the Immaculate Conception, and it’s an Italian public holiday. Now, I know I’m only a bloke and not fully conversant with all aspects of childbirth but after fathering a substantial Harvey clan I do know that December 7^th – December 25^th is not a realistic full-term human pregnancy. I’m not sure that it’s even full-term for a mouse or hamster, come to think of it. Of course, it is J.C. we’re talking about here and so maybe we are not looking at a normal human confinement, though I have always had the impression that Mary was pregnant in a visibly human way and the mystery was how she got herself into that condition, not whether or not it was otherwise conventional.  Perhaps this 18-day pregnancy is all part of the miraculous, immaculate bit, but frankly, I don’t think that washes and I’ve seen nothing about it in the Gospels nor ever heard about it in Church. If my dongle were more efficient I would hit Google and probably come up with some really interesting research about the Council of Constantinople or a Papal Edict of 1124 A.D. but I can’t get that worked up about it. I’d rather sit down with some village priest and make my point that it’s all very silly and just an excuse for getting the congregation in practice for Christmas. It’s a bit like Harrods opening Santa’s Grotto in August when they can catch the long-haul tourist market. It’s faintly embarrassing and decidedly inappropriate.

Locked out of the Exercise Room

An excuse for a coffee break

So there it is. Another day with no physiotherapy: no leg-stretching, back-bending or toe-curling. Instead there is a constant flow of nurses and fellow-inmates putting their heads around the door and asking me why I am working, as if the only possible reason for writing were something to do with work…. And then a pleasant surprise when a different head looked in at the door.

One of the less elderly inmates is Lisa,– I imagine in her 30s – who, like most of the residents is wheelchair-bound and who wears a frightening piece of moulded plastic body armour that holds her upper body rigid. She appeared at my doorway while I was writing and asked if I fancied a coffee as she was heading off for one and wasn’t allowed to go alone. I had no idea that coffee was available anywhere, nor that we were allowed to leave the 2^nd floor, but apparently we are allowed access to the ground floor as long as the nursing staff know what we are doing and we do not go alone. Imagine my feelings after 28 days of incarceration! Five minutes later I was over the moon, sitting in my wheelchair in the courtyard in the bright winter sunshine, enjoying my first cup of coffee since dinner at the hotel in Foligno four weeks ago.

Lisa is in much tougher plight than I. She was in a serious car accident in the summer and has been in the clinic since mid-September. In January she will have further surgery but there is no clear prognosis as to how things will turn out and she is likely to be back in the clinic for much of next year. She told me how she had trained as a ballet dancer and then built up a successful career as a television journalist… now she just has to live from one day to the next.

We were talking about the tough regime at Trevi, and also about the fact that they do not rush to get patients on their feet and mobile. The whole emphasis is on getting the muscles and the nerves working properly before putting them into practice with standing and walking. We were both describing the awful sensation of impotence when you try to move a limb and the body offers no response. I will lie on my back in a physio session and the therapist will tell me to raise my left leg – the one that was operated on. Try as I might, I can manage no more than a mild twitch, and even when the therapist takes some of the weight the exercise feels nigh on impossible. I can best describe the sensation by comparing it to a marionette with one or two strings no longer connected to the puppeteer. It is not so much painful as just blank. Nothing happens, there is no sensation, just a total disconnect between the brain’s demands and the limb’s response. It is this that I most want to overcome, because it engenders a quite terrifying sense of impotence and incapacity.

But then I look at someone like Lisa. Clearly from her dance training she will have been in total control of her movement and coordination before the accident; she now has no idea what the future holds for her. How can I possibly complain about spending 4 weeks here when she faces the prospect of spending most of 2012 here with no certain future for her life stretched out ahead of her? Slipping out for a coffee this morning gave me far more than fresh air and a reviving brew, it put a lot of things into perspective.

The other thing we talked about – as people always do in a hospital environment – was food. For anyone who likes food, eating in hospital is a pretty awful experience. I try to remain positive, and at least with today being a nationally recognised Feast Day, there was some improvement. A little lasagne, followed by slices of roast turkey with a light gravy (we will gloss over the accompanying sprouts.) Then there was a custard-filled pastry, a piece of fruit and a banana yoghurt. Not great, but way better than the usual fare. Lisa is fortunate in having her support team of friends and relatives who supply her with packed lunches and suppers; I don’t think she could possibly survive months here on the regular offerings.

Stoicism is not normally perceived as an Italian characteristic. Lisa exemplifies a calm inner strength and her fortitude and attitude have left me humbled and in admiration.

 I must stop complaining; I am the lucky one who knows when I’ll be leaving and that I will be fully recovered in a relatively short period of time.

Writer in Residence

The Numbers Game

The Weekend - November 26^th- 27^th

In the UK there are approximately 1,000 hip replacement operations every week. My guess is that many Britons expect to have the operation sometime in their 60s or thereabouts, just as they expect to be wearing spectacles and having teeth crowned. I don’t get the impression that it’s like that in Italy.

The initial shock was the specialist at Trevi asking me why I had a hip replacement operation carried out at such a young age (67.) I was quite taken aback and tried to explain that the X-rays showed that I have virtually no cartilage remaining in my hip joint and was becoming increasingly less mobile, but I don’t think he fully understood. The reality is that when I am out and about locally in Italy, I see many more people walking with sticks – bent over and moving slowly, than I would have seen around the town in Tunbridge Wells. It seems almost to be an accepted condition that comes with age, like a State Pension.

Then I look at this amazing Centre and am blown away by the quality and intensity of the care. Last week there have been just 19 patients in the post-operational unit; there are a few more on the floor below, where they care for people with more complex conditions resulting from serious accidents. The 19 patients comprise 5 men, of whom I am most certainly the youngest, and 14 women. We are all here for 3 weeks of intensive physiotherapy, 2 hours every day, 5 days a week, with the morning sessions being 1:1 and the afternoon sessions being in groups of 3 – 5 patients. From the moment I arrived, the rules were set down: no movement without assistance, no getting out of bed to go to the bathroom, no dressing myself, no standing without shoes on my feet, no attempting to move around without my wheelchair. My crutches are kept in the exercise room and I will not be allowed to have them in my room until they are confident of my ability to handle myself safely. They keep on nagging me to the point that it becomes quite irritating. How did you get out of bed this morning? Who dressed you? You must stop leaning forward when you work on the computer. Don’t get out of bed without a pillow gripped between your knees….and so on.

By contrast the hospital back in Foligno imposed no restrictions whatsoever. Nobody objected if I staggered to the bathroom, clinging to furniture and door-frames; nobody offered to help me with my socks or slippers and my attempts at walking up and down the corridor were met with admiring remarks and encouragement.

In UK and the US the emphasis seems to be on rapid recovery. I have looked at several UK and US websites dealing with hip replacements and I am staggered to read things like:

“On days 1 or 2, most total hip replacement patients are given a walker to stabilize them. By the third day after the surgery, most patients can go home.”

Today is my 15^th day after the operation, and they are still rigid here about what I can and cannot do. On the other hand, I am virtually unaware of my wound/scar and have no pain at all when I stand to get in and out of the wheelchair.

Then there’s the matter of medication. The UK and US sites suggest that by day 5 the occasional paracetamol should be sufficient to control any discomfort. I am still having daily checks on blood-pressure, antibiotics twice daily and a nightly injection of an anti-coagulant into the stomach wall. Is this overdoing things, or does the UK NHS skimp and cut corners? I just don’t know.

In the exercise room, any walking with crutches is expected to be as upright, normal and steady as possible, and while it is tiring, it is virtually pain-free. I watch elderly women who have completed their stay striding out confidently, albeit with two crutches. So what’s the answer? My instinct says that this 3-week rehabilitation course is an extravagant luxury that I have been fortunate enough to be offered on the local health programme. We’ll see how I am in a couple of weeks’ time. The surgeon at Foligno predicted that I’d walk out of here without crutches…. Now that would be quite an achievement, and for all their cheek and nagging and bullying, I’ll be extremely grateful to the staff I leave behind.

Lop-sided

The Week,  November 28^th – December 2^nd

The intense medical attention continues: blood pressure, blood samples for analysis, body temperature,  pulse rate and, of course, as in hospitals everywhere, the close interrogation about bowel movements. When such constant, detailed attention is paid to my condition, you will understand that it was something of a shock when the doctor examining me one afternoon paused and asked, with a slightly quizzical expression, ‘Have you always had one leg shorter than the other?’ When you put this in the context of the fact that they’d sawed a chunk out of my thigh bone in order to fit the prosthetic hip joint, you can see that I wondered whether they’d misread their measurements. In fact, I remember that many years ago, my local chiropodist in Lincoln identified a slight difference in my leg length, and commented that very few people had legs exactly the same length. I decided against putting my Italian doctor’s mind at rest and replied ambiguously ‘Most people have some difference in their leg length.’ He raised his eyebrows and gave an Italian shrug.

I don’t know if they did correct the leg length difference in the course of surgery, because I feel unbalanced now, anyway. Balance is one thing that is drastically affected by this operation. Your body has to learn it all over again. I often feel quite dizzy as I stand up – though I prefer to think that this is the direct result of a severe drop in food intake combined with a total lack of alcohol. The nerves need to reconnect where the muscles have been damaged and it all takes time. We are not used to being patient and letting time move at its own pace; we expect quick-fix remedies, and the body doesn’t work like that when it comes to healing. I have spent a week trying to learn to slow down, rest, take naps and doze, but it doesn’t come naturally.

Physiotherapy is a mix of pain and pleasure. The morning session is one-on-one and most of the session involves deep massage around the wound area. I start stretched out on a work-bench the size and height of a dining-room table. The first sensation is one of discomfort, lying on a hard surface and feeling the muscles stretching out to the maximum. When the therapist starts I can hardly feel the fingers rubbing my muscles, and at other times I wince and squirm as she hits the spot. Then she starts to get my muscles working, getting me to press my legs downwards into the bench, or push my legs outwards. The challenges start when I have to move the leg that has been operated on. She tells me to raise it 45 degrees and it simply doesn’t move until she takes some of the weight in her hand. Then she gets me to draw circles in the air with my pointed toes and the leg simply doesn’t understand left, right, up or down.

All the exercises are designed to stimulate muscles that have been underutilised while I’ve been limping around back at home with a stick, or muscles that are adjusting to a new role now that the hip joint has been replaced. The exercises are never weight-bearing; - in fact the whole attitude to mobility is rigid. In UK they get you up and walking in a couple of days, but it’s now 3 weeks since my operation and here at the clinic in Trevi they still insist I move around in a wheelchair, and they keep my crutches in the Exercise Room for supervised walks.

After the best part of an hour on the bench, they bring me my crutches and allow me to walk, but this is not about my ability to move around, it’s about my ability to walk perfectly upright, steady, controlled, feet pointing perfectly forward, back straight and hips first – like a mannequin. That’s an awful lot to remember at the same time as thinking about balance and stability so it takes a few strides to get it all together. The therapists are true disciplinarians with demanding standards and run a constant commentary of criticism – head up – chest out – feet pointing forward – move both crutches together – take shorter steps – take bigger steps – shoulders back…..and so on, so that the 10 minute walk becomes quite exhausting.

We finish up back at the wheelchair and while the therapist whisks away my crutches I spin back to my room to rest and probably doze.

The afternoon session is in groups of 5 or 6 and involves exercises which the therapist supervises like a Sergeant-Major on the parade ground. We are scattered around the room, lying on individual workbenches, and follow a series of exercises that involve working both legs independently, and other exercises that develop lower back muscles. No nice gentle massage in this session, just work that brings tears to the eyes. After the best part of an hour, we again have walking practice with the crutches.

I think it gets easier, I think the walking becomes more sedate and better synchronised, and the greatest frustration is probably having to climb back into the wheelchair at the end of the session and spin off back to the room. Maybe I’ll be allowed to move around on crutches next week – I’ll just have to wait and see.

The Constant Chatter of Friends and Relations

The weekend – 3^rd- 4^th December

It’s Saturday and the clinic is deafening with the buzz of visitors up and down the corridor. Several of the patients came round this morning, wishing a cheery goodbye as they left at the completion of their stay, others have been whisked away back home for some proper food and a few home comforts and will return later. My taciturn room-mate, known only by his surname to one and all, was collected by his daughter after breakfast. I could never penetrate his thick Umbrian accent, but he had a ready smile and reminded me of Grancio, the contadino who share-cropped Dad’s vines and olives, with his wrinkled leathery complexion, slow, steady movements and fixed, friendly smile. He had brought a small television with him and this was permanently tuned to a constant output of game shows and news broadcasts, whether he was awake or asleep, or even in the room. Since went home the room has been blissfully quiet, though this does increase the sensation of solitary confinement.

The cleaners have now given the room a thorough going-over ready for the next resident. The cleaning both here and previously at Foligno is an eye-opener. It is literally on-going and meticulous. This afternoon they stripped the vacated bed of its mattress and started to deep-clean the bed frame and the mechanism that raises and lowers it. Finally, they reassembled everything and shrouded it in a clean sheet ready to be made up as and when a new occupant is expected. Everything in the room is cleaned on a daily basis, from skirting boards to door frames – and they do two cleans a day just in case they miss something.

This morning they changed the dressing on my wound but still won’t say when I’ll be discharged. They want the wound to be completely healed, so I’ll just have to wait and see how things develop day by day. I’ve spent the day catching up on Radio 4 – I hadn’t realised how much I had missed the intelligent banter and witty comedy – and I still have a couple of unread books in Fi’s Kindle. There’s no reason to be bored, though the routine inevitably becomes monotonous.

The one treat I can look forward to is that at weekends I will have a yoghurt as well as an apple for my dessert, and in this institutionalised existence it’s amazing how such tiny factors achieve great significance. I wonder if it will be banana flavour or strawberry flavour.