Knee Replacement 4: Qualifying to be Cut

You don’t just stroll in off the street and have joint replacement surgery. You’ve got to prove that you can pay and are healthy enough not to die on the table. This means a checkup and sign-off from your primary care physician, a blood draw, nasal swab, piss test, and the sets of labs associated with these procedures. You’ll also need to visit your dentist to determine that you don’t have an infection in your mouth, and to the best of the dentist’s knowledge, you won’t need major dental surgery within the next year. Apparently, dental procedures run a high risk of spreading infection in your body. These tests and visits need to happen within a month of your surgery; don’t procrastinate. I did and it cost me.

As the big day drew near, I made an appointment to see my primary care doctor.

With the right amount of espresso, I can convince myself that I’m the master of my universe—will live forever, slay all foes—as long as I’m safely revolving in my own little orbit. But trapped in the bowels of Memorial Clinic, I can be felled by the slightest head shake, the tiniest frown from the guy in the white coat. Insecurity redlining—is this the time they find the thing—I hold my breath while he listens to my heart.

Breathe, he says. That’s better.

Pulling the tubes out of his ears, he steps around in front of me.

You’re so stinking healthy, he says.

He literally pats me on the back as I leave. Rocking out the sliding glass doors, I’m ready for anything.

Except for the call that comes a week later, just twenty-four hours before surgery.

Caller ID reads The Orthopedic Specialty Hospital. I tap the call to life.

Hello, this is The Orthopedic Specialty Hospital calling on a recorded line for William.

This is William.

Hello William, how are you today?

I consider telling her that I’m so stinking healthy, but I default to, I’m well. You?

I’m fine, thank you for asking. Can you confirm your full name and date of birth?

What? You called me.

We just need it for security purposes. Before we divulge any information.

I consider pointing out the absurdity of the request, but at the moment I’m more curious about the imminent divulging of information than bothered by procedural bullshit. After I recite my full name and date of birth digits, she says, We got your CBC results back, and I’m afraid we’re going to have to postpone your surgery.

I will later learn that CBC stands for Complete Blood Count, but given the other newsflash in her statement, I’m not concerned to decode the acronym.

What? Why?

The labs show that your platelet count is too low to admit you for an elective surgery.

Um, what’s a platelet?

As it turns out, platelets, also called thrombocytes, are tiny cell fragments in your bloodstream with one job: to stop bleeding. When a blood vessel is ruptured, platelets mob the site to form a temporary plug. They are the Marines of blood cells, and apparently, I don’t have enough to make a mob. A quaint little thrombocyte tea party wasn’t going to cut it for the bone-sawing brigade.

For the next thirteen months, I endured a crash course on Immune Thrombocytopenic Purpura (ITP), a condition where the immune system mistakenly attacks and destroys its own platelets, leading to a low platelet count (thrombocytopenia). Through humbling weekly visits to Utah Cancer Specialists—if a primary care physician could wobble me with a frown, you can imagine what occupying an infusion chair between chemo patients did to destroy confidence in my own health. Master of my universe no more, I couldn’t stop asking, What the hell happened to You’re so stinking healthy?

Could we just rewind the tape?

There was no rewinding. Only a steady march through bone marrow biopsies, steroids, intravenous injections of other people’s platelets, and eventually a splenectomy. Nothing worked to keep my platelet count high enough to allow the TOSH surgeons to operate, and after six months, they just stopped rescheduling me. The message was clear: You’re a difficult patient, and with months-long waiting lines, we don’t need difficult.

So much for seeing the Dallas Cowboys boots in the OR. Maybe I’d just have to accept that I would not ski, skate, pedal, or hike up mountains anymore. But what about simply climbing up the stairs to my house? When that becomes too difficult, what then? Only exist in flat places? No, I’m going to get new knees. Somehow. I’ve just got to find the right surgeon.