Hips

September 2000: first hip replaced in Edinburgh, Scotland.
July 2001: second hip replaced in Ganges, France.

These two letters were written a month after the second hip replacement

14 August 2001, in hospital

If this round robin letter sounds a little feverish, it is because I am! But I thought I would recount the events of the last two months, omitting the more gory details, in one fell swoop, as I am getting bored with boring people with what has been happening. Also, I felt I should record my experience for myself, before it becomes a blurred memory. So, apologies for the blow by blow account and skip the whole lot if this is not your thing. After this, hopefully I can start writing about what a wonderful time we are having in our rashly taken early retirement in France.

Many of you know I had one hip replaced in Edinburgh in September 2000. The day before the operation, the surgeon said, of course I needed both done urgently, so which one did I want him to do the next day ….

One week in hospital, minimal physiotherapy, a particularly miserable cold wet Edinburgh winter and several months later, I was still limping away with sticks. The hospital confirmed that the second hip needed doing urgently but no beds available until the following winter…..

To the rescue: the French health system.
Again, most of you know that our timetable this year was
March: sold our Edinburgh house;
April: bought a house in Brighton;
May: I established residency qualifications in France;
June: Chris took early retirement and I spent the month getting the Brighton house sorted out (including rebuilding the attic joists to take Chris’s book overflow…;
July: we finally both made it to France.

When I saw our lovely French GP in May, his reaction to my x-rays had been “Oh la la, la la, la la”, much sympathy over the pain I must have had, insistence that I get the operation as soon as possible, and a 50-minute consultation ending with making an appointment with the surgeon in a fortnight. WHAT a contrast to the miserable old bags in my local health centre in Edinburgh.

Similar expressions of sympathy from the surgeon were followed by a long discourse on the different systems used by British and most continental surgeons (I already knew from dire warnings from sceptical staff in the Edinburgh hospital and extensive literature on the Internet that French surgeons favoured the cementless hip) and then an invitation to name the date I wanted the operation!

So there I was on 17 July, at la Clinique at Ganges, some ten miles from our own little town, le Vigan, It is perhaps unfair to make comparisons between a run-down city orthopaedic hospital scheduled for closure and a little country hospital (rather like the Borders hospital, serving a vast rural hinterland), with wards built only 12 years ago. But some differences are probably true throughout the two countries.

In Edinburgh I was in a long ward with beds on either side, about 15 other women (many a couple of decades older than me!), two loos of dubious cleanliness, given my octogerian neighbours with zimmers, and some distance along a corridor. I did at least enjoy the splendid row of trees outside and the glimpse in the distance of the Pentland Hills (one of the reasons the land was scheduled for sale as a prime building site …)

In Ganges I was on my own, in a two-bed room with an en suite bathroom and a view across the Gendarmerie to the dry limestone hills which I knew divided me from one of our favourite wine areas, Pic St Loup. At the end of the corridor outside, was a lovely view of a picturesque old stone bridge over the River Herault and the other side the decaying but still splendid buildings of the silk factories, once the source of Ganges’ prosperity, against a backcloth of lovely green Cevenol hills.

Another big contrast of course was the weather. My week in Edinburgh coincided with one of the wettest periods in the autumn and Chris used to arrive soaked to the skin. In France it was the time of la canicule (scorching heat – the dog days) and a true test to Chris’s endurance on his scooter. My air-conditioned room was a welcome oasis for him.

I was immediately struck by the totally different relationship between staff and patients. In Edinburgh everybody, whether 19 or 90, was addressed by their first name (which can upset older women in particular) or with Scottish endearments such as ‘hen’, which I have always found comforting rather than offensive. In France I have always been Madame, or Madame Allen (emphasis on the second syllable). Similarly I address all doctors, nurses or whatever as Monsieur or Madame. I find that the frequent use of Monsieur et Madame, and many wishes of Bon Appetit, Bonne Soirée, or the local ‘Eh beh’ encourage a standard of civility in human exchange.

In contrast there is an initial lack of warmth or personal interaction in a French hospital that the sheer overcrowding in Britain encourages. I sat in my little room the day before the operation, alone, somewhat scared, listening to the sounds of nurses bustling down the corridor outside. In Edinburgh someone would have come up and asked “What are you in for, dear, hip or knee?” and there would have been the to and fro-ing of tea trolleys, zimmers and bedpans.

After a painful trip to x-ray, lightened by being transported by a devastatingly good looking young porter, came the time for pre-op preparation. I will gloss over this, suffice to say it involved one of the French preoccupations which has long been abandoned in British hospitals. However, it is worth noting that whereas the British specialise in dressing you in peculiar and inadequate all revealing paper panties and top, in France I was dressed in a smart little cotton number which was actually big enough!

Then after one of those silly injections which is supposed to make you start floating away, down the corridor (sadly not the same porter) to the anaesthetics room. For some reason this was the temperature of a morgue and the equivalent of a giant hair dryer was shoved under my blanket to stop my teeth chattering. There was an interminable delay as one nurse after another failed to insert a needle into my disappearing veins (just as well I am not a drug addict), until I was referred to the chief anaesthetist. He must have succeeded, as the next thing I knew was being wheeled back to my room.

Let’s pass over the next two days, although to be honest the pain was not as bad as the first time. Even so, I managed to press the self-administered morphine button too often and was told that the computer would not let me have any more for quarter of an hour. My assurance complementaire (explaining the French health system is another loooong story) had allowed me to ask for a room on my own, plus free accommodation for Chris. I asked for him to stay the night after the op in case my French deserted me, so he endured an uncomfy night on a camp bed beside me.

Actually it was during the rest of the first week that my French had to undergo a rapid expansion, particularly of anatomical vocabularly, as I developed pains and sores in all sorts of unexpected places. Luckily, the Cévenols are pretty direct people and bedpan language, for example, consisted of them asking me whether I wanted to faire pepe or kaka. It was only later in Montpellier that I acquired the more genteel equivalents of the British hospital lavatorial language.

The first week was pretty awful, as one might expect, not helped by my developing an allergy to plaster which meant that my right leg blistered everywhere, had to be constantly and painfully dressed and hurt to lie on. I seem to have a ‘peau fragile’, but nursing staff in both Ganges and Montpellier were meticulous about rubbing cream all over me in the battle to prevent bedsores.

The second week started to improve, although I don’t remember feeling as poorly by the afternoon the first time round, and I have had constant sleepless nights. Because one stays for two not one week in France, there is a slower pace of getting you mobile. I’m not sure I entirely support this, given the skin problems I had lying in bed, but I was very relieved the day after the op when my kine (physio) said they did not believe in le système brutale: let the body recover from the trauma of the op before trying to mobilise it.

So it was only on the third day that I finally stood up and sat in a chair – only to have to be hastily returned to bed as I was about to faint. Then the next day, the first leaden steps with two sticks (here they use ‘cannes anglaises’ – sticks with arm supports, rather than the cruder walking sticks I had in Edinburgh). I was hampered at first by frequently feeling faint (more of that later), but determinedly increased my distance so that by the end of my second week I was walking several times a day up and down the corridor. In Edinburgh I had been wheeled miles down a corridor to a large gym where a manic Swede bullied and cajoled a group of us to walk, and perform various exercises. In Ganges my elderly, courteous kine, M Vait, visited me daily in my room and exhorted me with many exclamations of “Bravo, ma cherie”.

I was not well enough to shower, but had the luxury of my own bathroom, with two aide-soignantes (auxiliaries) to help me wash and dress. I even had my hair washed and a foot bath, performed by an enthusiastic young trainee performing one of her assignments.

My main criticism of Ganges (and indeed subsequently Montpellier) was the total absence of any furniture for taller patients. I know Mediterranean people are shorter, but …. Particularly serious was the complete absence of what I would have described as a standard disabled toilet, They were all too low for me and a wallbar on one side only is seriously dangerous when trying to lower oneself and not dislocate a hip. I simply cannot understand why they cannot instal the relatively cheap arms that come down on hinges which you find universally in public places in Britain. In both Ganges and Montpellier I had to make a fuss before being provided with a réhausseur to raise the level of the seat. I have also had to insist on having chairs with arms in bedroom, bathroom and dining room, with cushions added. It does make one feel a freak, but every list provided insists “Do not sit on chairs which are too low”!

By the end of my fortnight, I was beginning to feel quite at home in Ganges. Apart from a couple of rather gormless night staff who seemed unable to cope with my insomnia (in Edinburgh I would have at least been offered a cup of tea), the staff were kind, friendly and chatty. When I finally left, several willingly posed for photos and there were several bises on the cheeks. Then I was taken by ambulance the thirty miles to Montpellier for the second stage of my recovery, at a maison de rééducation.

This is where the French system really scores. After leaving hospital there are three sorts of ‘maison’: une maison de retraite (a retirement or nursing home), une maison de repos (a convalescent home but with no treatment) and une maison de rééducation (a convalescent home with active therapy to get you fit again). It seems taken for granted that after orthopaedic surgery you go to a maison de rééducation, the cost of treatment being met by your social security and the cost of ‘logement’ – your room and food etc by your assurance complémentaire.

My first day at la Clinique Fontfroide, reputed to be one of the best in Montpellier (again, I was able to choose which one to go to) left me feeling very low and depressed. Montpellier is probably the centre of medicine and associated research in France and over the past ten years an absolutely ghastly plethora of modern concrete buildings has sprung up in the Parc Euromédicine and my clinique is probably typical of these. I was wheeled into a cool, marble floored, ultra modern and characterless reception hall and met by an unsmiling and presumably bored receptionist who fired questions at me in a broad Montpellier accent with no concession being made for my being foreign. I was then whisked up to my room, very similar to the one in Ganges, but with even more electric buttons to control bed height and angle and to open and close the shutters. Very reminiscent of that Jacques Tati film about his brother’s house. I was told I should wait in my room till I was visited by the chief doctor, chief kine, my personal kine and the nurse. So I sat and waited and waited. Obviously I had hit a bad time of day – lunch-time. But I felt very alone as well as weak after my journey and wished I was back in Ganges. The only auxiliary I saw spoke the fastest Montpellier French I had heard with ill-fitting false teeth and I failed to get her to understand my urgent need for a réhausseur for the lavatory. I felt better after meeting the various doctors and kines (and after a brighter auxiliary supplied me with the necessary loo seat!).

My first big event was dinner. All except the very incapacitated eat in a large dining hall. I was assigned to a table of four. My companions were an octogenerian – on the ball but I can only take in half of her comments, particularly when she eats with her mouth full. Next to her is a dapper, chirpy 77-year-old whom I have gradually warmed to despite her being a devout Catholic and pied noir from Tunisia! The Church is very much at the centre of her life, with many visits to Messes and a desire to lead a life ‘pieuse’. She had been pregnant 11 times and had had eight children, the first six in Tunisia under apparently very primitive conditions. So for her, Church and family is everything. Some of our conversations have been hilarious. She expressed disapproval of a copy of ‘Elle’ she had been given because of all the nudity in it and said that in her 60 years of married life her husband had never seen her nude. Then the next evening the fourth woman said they had switched to two single beds next to each other to give themselves more room, and our Catholic friend said yes, they had thought of this, but she would like to be so far apart that she was not touched (funnier in French). The fourth woman had the clearest French, perhaps because she comes from Normandy originally. She is a nice, quiet woman of my age, who is worrying like mad about what happens when she leaves here. She worked as housekeeper and childminder for a wealthy Montpellier couple and in exchange she and her husband had a flat there. Four days after she broke her shoulder, the couple sacked her – she has no rights as they were employed without papers. So they have nowhere to live and cannot find a cheap enough flat to rent.

The octogenerian seems to have been moved and has been replaced by a newcomer, a lively energetic 76 year old who talks more than I do! She is batty but entertaining and is apparently driving a lot of people mad already, including her longsuffering roommate. The Catholic has also left and is replaced by a woman who had two spinal vertebrae operated on and in the course of this the surgeon accidentally cut the spinal cord, so she is paralysed in her legs.

Apart from this surgical disaster, today she was recounting a side of the French medical system which is not so good. If you are in a state hospital, the fees for all operations are standard. If you are in a private hospital, the surgeon may charge a supplement. The private clinic where I had my operation operates as a non-profit making charity and states expressly that no surgeons charge anything more than the state fee. This woman was asked for an additional amount – I think about 300 quid – on the grounds that her operation was going to take 12 hours rather than the normal four. Some assurances complementaires pay up this additional sum, or part of it, but not all., It seems to me there is a danger of France slipping into a two-level health system by stealth if they are not careful. There is another row going on because doctors of different types receive dramatically different payments. One of the days when I was not quite on the ball I saw a table and reckoned that they all received quite a lot, but that anaesthetists, for example, earned far more than gynaecologists.

One of the humbling things about being here is to see so many people far worse off than I am. There are quite a few amputees, several of them young. One is a charming young Moroccan woman who was born with virtually no legs. And you see quite old women gamely setting off between two bars with their temporary new legs. I’m also sorry for the people with serious leg breaks: the recovery programme seems to take several months. They start by hobbling painfully on crutches, putting no weight on their leg and having rigorous exercises to strengthen muscles and gradually increase the weight put on the damaged leg. Then there are a huge number of young people who appear to have sporting injuries, mainly knee injuries. They include a devastatingly handsome and fit looking young black man. I havent found out what his sport is, but he runs effortlessly on the running machine for half an hour. (I have now progressed to use the same machine – set to 1.5 kilometres per hour!)

As you will have gathered, the other way we meet people is during the day’s ‘Programme de Soins’. My day starts at 9 with a session of ‘le mécano’. I lie on a table in a wire cage, attached to a series of pullies and weights. I then have to move my leg repetitively in a particular direction, against the weights, to strengthen the muscles in the hip. My kine, Natalie, has discovered that muscles round last year’s hip are seriously substandard, given the lack of any British physio program, so all strengthening exercises are being done to both hips. I then go and collapse on my bed for half an hour before going down to the gym for the far more strenuous exercises. I started with a programme of 20 times lifting up the knee, then swinging the leg forwards, then swinging the leg backwards, then standing on one leg and counting up to 20 and then standing on the other. Sounds easy if you have not just had all the muscles in your thigh cut through! I have another nasty exercise which consists of putting my right hand on the bar, sticking my right leg straight back, bending my left leg forwards (knees always pointing out to avoid dislocation) and stretching my left hand towards the ground to simulate picking something up. So far I can reach to within a foot of the ground.

Natalie soon moved me from two sticks to one and discovered that my new hip is a couple of centimetres longer than before, so I am going to have to have insoles built for all shoes. In the meantime she adds bits of foam to my baskets (tennis shoes) to assess just how much I need. And now I have just progressed to no sticks. I lurch along like an unsteady robot, but it is lovely not having to carry books between my teeth. Two days ago I had my first go on a walking machine, which is a bit like walking backwards on one of those moving paths at the airport.. Even at 1.5 km an hour this can be scary at first initially and I hung onto the bar in front of me. I’m getting the hang of it now, but still don’t dare walk without hanging on. My next big challenge is to get up high steps, in preparation for the steps to our house in the Cevennes. I can already walk up and down normal stairs, holding onto a rail. Tomorrow I am to try taking two steps at a time…

The speed with which I am regaining mobility compared with last time is remarkable, although it is not a truly fair comparison as the pain in my unoperated hip seriously impeded progress last time. Quick recovery is very important as the biggest danger for hip replacements is dislocation (and going back to square one), as the hip has absolutely no muscle to hold it in place. Hence the awkward way one has to lie, sit and move. One of the most dangerous manoeuvres, particularly for me as I have such long legs, is getting in and out of cars. I am dreading it and wish that I knew a few more people with luxury Range Rovers rather than battered Renault 4s!

One therapy which I am sadly having to skip is a daily session in the heated pool, with more supervised leg exercises. This is because I suffered a rather dramatic (and painful) allergy to the plasters over my hip scars, resulting in blistering down my right thigh and after two weeks these still show no signs of growing new skin.

The other more serious setback I had is finally being resolved. In the first two weeks I had no appetite, but was not surprised, as this happened last time and was followed by a period of prolonged greed. This time, when I moved to Fontfroide, I still had to force myself to eat, finding the only thing I could really taste was the wine (served will all meals of course!). I was also completely exhausted and felt I was seeing the world through a cloud. Then I started to develop a temperature every afternoon, at which point the medical system stepped in with impressive rapidity and I was given a series of blood tests, told I was anaemic and instantly given large doses of iron. At yesterday’s weekly review the doctor explained that I had had a severe reaction to the operation and I think she said (my knowledge of blood is nil) that the level of all cells and platelets had been severely upset almost to the point when they would have had to take more drastic action (presumably a blood transfusion). Luckily since yesterday I have been feeling much better (hence this long scrawl) and happily, or rather unhappily, my appetite has returned and I now appreciate why the food at Fontfroide is so popular. Lunch today was melon followed by cote d’agneau and pommes dauphinois, Camembert cheese, and a flan with icecream covered in pistachio nuts. The diet starts tomorrow.

When I think how at this stage last year I sat at home alone with my aches and pains and sores, worrying poor Chris and with no help or advice at hand, I am doubly impressed by the rigorous care taken. I have already had an x-ray to check the new hip is exactly in place, I’ve been on some sort of computer to check there is no phlebitis in the leg, I am visited weekly by the chief doctor and physio, and am having daily visits by another doctor to discuss what to do about my insomnia. Since the operation I have been unable to sleep for longer than two hours at a stretch and I am now on my sixth cocktail of drugs. The doctor says that she has one or two other things she wants to try. If these fail, Montpellier has a sleep specialist!

Because of my blood problems and the extra work needed on the left hip, the doctor says I should stay an additional two weeks longer than the original fortnight we had anticipated. So I think I will be stuck here until the end of August. A strange way to spend our first summer as French residents! Poor Chris has an odd life, grabbing lifts to Montpellier whenever these are offered, and otherwise finding it difficult to make the transition from being on holiday to being a permanent resident, ie getting down to the various bits of fixing and building needed. One task he has had to take on is walking the dogs. We were worried about how they would take to the climate and change of life, but they are shedding their eleven years with a joie de vivre as they chase butterflies, eat grass, try to escape through Chris’s new dog gate, boldly tell passers by to get off their road or just bask in the sun. (Why do dogs not get sunstroke?)

Time for my afternoon stroll in the garden (no gym today as it is one of France’s Saints days). I am trying to build up the distance I can walk so that perhaps by the end of September, I will be able to reach our local village, Serres.

You will be relieved to see that I have run out of steam and all that is left to say is many thanks indeed to those who have rung or written to ask how I have been progressing. I much appreciate this and do not want our emigration or current immobility to mean we lose contact.

à bientot

Frances

26 August, two days after leaving hospital

I think because I tend to smile at everyone and talk too much, I ended up knowing an awful lot of the patients and hearing some of their very sad stories.

In the room next to me were two Moroccan woman. The older one told me that she had been knocked over by a motorist who was rushing back to the supermarket to get the fish he had promised his neighbour. She had been in hospital for months with multiple injuries to face and both arms. One arm and hand were still not usable. The case had apparently gone to court with nobody taking evidence from her! I urged her to get her family to get a lawyer. I talked to her about the difference between Algerians and Moroccans. They don’t like each other, she said: the Algerians tend to be too excitable while the Moroccans are calmer.

The other woman was the one born with no legs – just two stumps, and for some reason now at the age of 37 was being given artifical legs. She was a beautiful but sad woman who told me that her one dream in life was to have a little boy. She seemed to attach more importance to this than the challenge of walking – though this she did with great determination each day and lots of exercises to strengthen the legs stumps. She was married, but her husband in Morocco had not phoned her once during her stay in hospital and she was obviously resigned to living alone in France when she left hospital..

Then there was the woman in her sixties whose husband had committed suicide when she was 40, having spent several years in some form of institution before that. From that time on, her only son left home and made no contact with his mother. They must have seen a psychiatrist at some stage as he told the woman that she must comfort herself it was not her fault. Apparently her mother in law had also committed suicide and the woman reckoned that her son, afraid for his own sanity, blamed her for marrrying knowingly into a family of with this tendency. Last year she had cancer, and the son who is a high up lawyer in Strasbourg, would not come and visit her. This year she was operated on her back and the surgeon accidentally cut the nerve to one leg, so she is paralysed down one side. The son still does not visit. The woman lives alone in the centre of Montpellier, can no longer work, and seems to have only two friends in the world. Not much to live for. Needless to say she longs for me to visit once she leaves hospital.

Not all the patients had such sad cases: about half were young, extremely fit – apart from their injury, invariably got playing sport. Having a hosptial population where half are under the age of thirty definitely livens things up. These included the spectacularly beautiful black football player I have already nmentioned. Watching him on the running machine was a sheer (aesthetic of course) pleasure.

The physios and other staff did tend to spend a lot of time on their younger patients, with a lot of the sort of flirtatious exchange that I find somewhat annoying about the French. Natalie, my very good looking physio, was particularly guilty of this. It is as if being somewhat coquettish is second nature to young French women. However, I forgive her all as her treatment for me was absolutely first rate. She always noticed when I was getting tired when I was still ill and firmly stopped me, spotted which muscles were being particularly weak and ordering appropriate treatment, she massaged the wound, causing problems because of my allergy to plaster, with expert and gentle care, spotted the problem of one leg now being two centimetres longer than the other immediately and proceeded to reeducate me to walk in a less lurchy fashion, and generanerallychecked me every time she saw me walking badly in the corridors.

I think thanks to her I suddenly got much better at walking and my departure was brought forward a week.and on Friday 24th I was discharged. After saying goodbye to an awful lot of people, with exchange of addresses, was sped away from Montpellier and back into the lovely Cevennes in an ambulance car (all paid for of course by our ‘mutuelle’ insurance).

The homecoming was a strange one, though. I was somewhat overcome by the heat, having spent five weeks in largely air conditioned rooms. More sadly, Boucheka, our favourite dog, had been ill since the previous Saturday. For four years she has suffered from Addisons Disease (a failure of the adrenalin gland which mainly affects humans) but had been kept alive by a daily dose of a drug called Florinef. When we left Scotland, the vet gave us enough to keep us going for a month in France. While I was in hospital Chris discovered that the local vet had not heard of the disease and indeed that Florinef was not on the pharmacist’s list of permitted drugs.

Our Scottish vet hastily sent out another six months supply (illegally), but there were three days when we had to reduce her dose and supplement it with cortisone. Boucheka suffered an Addison crisis, though the Scottish vet was not sure that the temporary reduction of Florinef was necessarily the cause.

The French vet, who eagerly read all information from the Internet that we provided and sought through us advice from the Scottish vet, did what she could to get Boucheka to recover, but she did not eat for a a week and you could see her body systems gradually closing down. She was an unhappy little dog and so were we. Miserably yesterday, the day after my arrival home, we decided to take her to the vet who equally miserably, agreed to put her to sleep.

Today, Sunday, we are trying to put all these events behind us and start our living in France as we mean it to continue. That is, we spent two hours drinking aperitifs in the local village square with friends, came home skipped lunch and collapsed into a long siesta instead – only to be woken by a phone call from my Normandy friend from hospital, out for the weekend with her husband. So they then visited and another few hours passed by….

We have just had a pleasant long supper, eating local trout washed down by a delicious rosé and at 10 have finally come in, rather reluctantly, as the new moon and stars start to fill the sky. It is very hot at present and everybody is hoping the weather will last long enough for what promises to be an exceptional year for the Languedoc wine harvest . It is apparently going to be a bumper year for the onion crop in our valley too!

à bientot

Frances