Things to Consider As You Read

Richards - 1

The following are excerpts from an interview between Dr. Loreen Herwaldt and a writer named Teresa Richards. Richards discusses the time leading up to and the experience of having both hips replaced in her late forties and early fifties.

Things to consider as you read:

• Think about the questions that Herwaldt asks. Which ones might work best for the types of interviews that you’ll be doing? Which ones might not work as well? Why?
• Which moments in this interview were most striking or memorable to you? Why?
• What seems to be the general upshot of much of what Richards tells Herwaldt? Which specific moments in the interview get that point across best?

Herwaldt:You mentioned going to a chiropractor and taking a lot of supplements and vitamins. Did you ever go to other alternative or complimentary medical providers?

Richards:I made phone calls. I was looking into the possibility of acupuncture but I couldn’t find someone in Iowa City. Who else did I call? I don’t think I ever saw them though.

Herwaldt:Okay. Was that because you were not getting what you wanted out of traditional Western medicine?

Richards:Well, I wanted something that was going to get that cartilage back and right after I had the second one done I saw about glucosamine and I remember bring this up to Dr. Clark and he just dismissed that right away. He said “that wouldn’t have done anything for you.”

Herwaldt:Maybe in your 30’s.

Richards:That was his implication. That I was too far gone for that. But, I will never know.

Herwaldt:Did that prompt you to sort of plummet in terms of your mood at that point.

Richards:Yes it did, a lot. I felt like I already had these bones sawed off and they were gone and there might have been hope for getting them back.

Herwaldt:You mention a couple of times in the essay like this image of your hips being incinerated and turned to ash. Were you really thinking about, I mean, were those kind of images coming to you while you were in this recovery period?

Richards:I don’t know when that came to me. When I was in the hospital I didn’t think about any of that stuff. I only thought about getting out of there. But, I think after I got home I started thinking about that these bones… I mean that they actually saw these bones off and part of me was gone and that was hard for me to grasp. So, I can imagine how awful it is for women who have breast cancer and they are losing something that is overtly more visible, that you have a piece of yourself cut off.

Herwaldt:So you not only mourned the losses in terms of things you couldn’t do but there was really a sense of separation from part of yourself.

Richards:When I actually thought about them actually sawing my bones…

Herwaldt:That was fairly violent?

Richards:It was very violent. When I’m saying that, I don’t attach any feeling to that now but I did. What would they do with that bone? They just throw it away. It is part of your body and they just throw it away.

Herwaldt:I just thought of this. I haven’t thought of it for years. My grandmother, my mother’s mother, had very bad peripheral vascular disease and had an operation to try to revascularize one of her legs and eventually had an amputation and I remember my grandfather insisting on having the leg in order to bury it because that was my grandmother’s leg. It strikes me in a sense that that is sort of a similar thing. Although, obviously you could see that part of her leg was missing but in a sense for you, probably for a lot of people, part of something that is precious to them, your body, is gone.

Richards:Yea, and that I couldn’t see it either. I mean, that fact that these are in there. Every time I see those X-rays now when I see those things in there it is shocking.

Herwaldt:So does it bother you when you see your X-rays and see the metal there?

Richards:Not like it did. Not like when I first saw it. When I first saw it I was a little stunned by it.

Herwaldt:Did it in some ways feel like you were disconnected from yourself or disjointed?

Richards:It was really real to me when I saw it and that ball joint… Here is a big old X-ray that are your real bones and here is the fake thing and you see that joint and you know that you have that metal in there but you never can see it. You see this X-ray but you can never see that that is in there. It is very strange that that is in there.

Herwaldt:Did you, before this happened, did you ever imagine your skeleton or your inter-organs or anything like that.

Richards:Never. Never thought about it.

Herwaldt:Occasionally, it seems really strange to me when I think about, oh, I actually have a skeleton. I have one of those. Obviously, I’m a physician so we train looking at skeletons.

Richards:Yes, you would think that you would think about that more.

Herwaldt:So, that wasn’t something that you had imagined but sort of were forced to, I guess, with the arthritis.

Richards:Right.

Herwaldt:You mentioned in the essay. You said that your hips failed you and then later you said they abandoned you. Did this really seem like, in a sense, moral or personal failure or weakness? That it was not only like physically there was a defect and you were weak because of the pain but did it seem like you were no longer upstanding?

Richards:I don’t know what you are finding but it would be interesting to me to know what other people feel about that because I think a lot of people feel that illness if there fault. I don’t know if that is a cultural thing or not and I wonder about that. I wonder what people in other cultures think. But, yea, I did. I felt like it made me a weak person not just physically.

Herwaldt:But morally?

Richards:I don’t know if I would use the word morally. Was I morally weak? I don’t know if I would say it that way but maybe it touches on that.

Herwaldt:Was something wrong with your character or that you somehow couldn’t handle the usual responsibilities of life so you were weak?

Richards:I don’t know if I thought about handling the responsibilities of life. Yea, I was weak in a lot of ways anyway. We all have our own weaknesses. I think for me the thing that got me was that I had so much conflict in my life and the conflict created the stress which, and I really believe this and I don’t know if this is valid or not, that stress will get whatever weak point we have. We all have physical weak points. You have yours. I have mine. Whatever. My kids are going to have theirs. The stress will attack your weakest point especially if you have stress over a long period of time. So, I felt like I didn’t handle things right. I think it all went back to… I didn’t make very good choices. It lead me a certain way and caused all of this conflict in my life and then that lead to this. So, yea, it was my fault. It was my fault that this happened to me. It was my fault. I think a lot of people think that illness is their fault. I don’t know if you are finding that.

……………………….

Herwaldt:I think that is an issue in a lot of peoples… It is not just people who get cancer who have to grieve. That to me is really fascinating. The fact that something that physicians would say (snapping) “well we can fix you, sure, we will just plop those new hips in.” For some people, like you pointed out, like your roommate Francis, that works but for other people that doesn’t work. I don’t think medicine should be a one size fits all and we have to be able to somehow be with our patients. Not that anything we can do is going to fix it or take that grief away but is there a way that we can walk through it with patients or at least say to patients “you might experience this. I am not going to say that you are going to experience this but you might experience a sense of grief at losing your hips.”

Richards:I remember the day that I went in for the… Like two days before the surgery you have the…

Herwaldt:Preop evaluation.

Richards:I was furious that day. I was so angry that I was going to have this done. I had made a decision to do it because I could have just stayed limping along like I was but I was so angry. I remember saying that to a nurse. I said “you have to forgive me but I am mad as hell.” That would have been a time, that preop thing. They go through “this is going to happen to you and here’s the video and this is what the hips look like.” They sit you in front of a TV basically. They don’t talk at all about the emotional part of what you are going through.

Herwaldt:Do you think it would have helped you if someone would have addressed that?

Richards:If someone would have just given me a little opening to just spill some of it. You know, I was trying to get it myself by telling them I was angry.

Herwaldt:Did you tell the physician or just the nurse?

Richards:I don’t remember.

Herwaldt:The reason I am asking, did you thing or do you ever now find yourself sort of scripting what you will say to physicians to get them to take you seriously?

Richards:I assume that they don’t deal with the emotional parts of things. I do, I mean, that is one good thing about being older is that I know what questions I am going to ask them before I go in there. I am going to get my questions in.

Herwaldt:You wouldn’t address with the physician the emotional?

Richards:Well, I remember the last time, which is a year ago, so that is not that long ago, when I went to Dr. Clark for a follow-up. It is a little more than a year ago, it was probably last summer and I remember still having, and then I finally let it go, I remember still agonizing over that thing. Well, I didn’t have to have these hip replacements and that I could have done something. I was still hanging on to that a little bit. I remember saying to the resident, or whoever came in… They all look 16 to me now. I think, here is this 16-year-old coming into to take care of me. They are clueless. I remember saying to him, “you know, the part that takes the longest over this hip stuff is getting through the emotional part of it.” He must have said something to Dr. Clark because Dr. Clark—I forget exactly what he said to me when he came in the door—but he did address that. That is when he said to me that there was nothing that could have fixed these hips.

Herwaldt:So don’t feel guilty?

Richards:I was still hanging on to that little bit that maybe I could have saved them.

Herwaldt:So he addressed somewhat and Louise Sparks addressed somewhat some of the emotional stuff but it doesn’t sound like either of them really went into depth with you.

Richards:No, nobody ever talked about emotionally what would happen. I don’t think that they have a clue as to what happens. Lets say they would talk to all of their hip replacements people and get some thread that ran through them all, then they would know. They can’t possibly know.

Herwaldt:I was at a meeting on relationship centered care and a nurse was there who worked for, I’m not sure which hospital system it was, but one of the things they did was focus groups with patients like who had their carotid arteries cleaned out or who had babies in neonatal intensive care units, or lets say in your instance, hip replacements. What they did is they would talk and ask the people like “what were the things you wished you would have know before you had your hip replacement or before you had your endarterectomy or before you took your baby home from the neonatal intensive care unit.” Then they would make these brochures something like “50 things I wished I would have known,” and it was all stuff from the patients. Would something like that have been helpful to you? Some of it would be just physical stuff. Like how do you get around your house, but some of the stuff could potentially be emotional or related to job or family.

Richards:They did address some of the physical stuff. You have to get the physical therapy or they won’t send you home. They also have occupational therapist… I mean they do give you those tools so you know some of that stuff.

Herwaldt:So they were better about some of the physical things you would need to know when you went home.

Richards:Yes, and there were little booklets that said you can’t bend over, etc. The second time I was much more ready for it. It was a good thing I had a friend with me the first time because I didn’t realize how much stuff had to be at my level and how much rearranging in my house I had to do and a friend of mine did all of that for me.

Herwaldt:After you got home.

Richards:Yea.

Herwaldt:Did they ever ask you what sort of social support you had or what kind of economic situation you were in and whether you were going to need help with those things?

Richards:I don’t remember. It’s possible. If they did it wasn’t very elaborate.

Herwaldt:You learned some things beforehand but you learned a bunch of things the hard way.

Richards:Yes, because the second one was easier to go through because I knew exactly what to expect but, of course, you can’t… Okay, there was an Iowa professor, a man, he was older than I am but I knew him because I knew the woman he, I don’t know they didn’t live together, but I knew her. He called me a lot before his surgery. He must have called me four or five times. He was very anxious. He wanted it done but he was very anxious about it and this is where it would really help. If patients had, and I don’t know how you would do this, if patients had a buddy that they could call who had already been through the same thing…

Herwaldt:Yea, so it was a human being who understood.

Richards:He told me, and he took me out to dinner after he was all through and everything and he kept thanking me and thinking me. He kept saying “I cannot tell you how much I appreciated that you gave me all of this information that I wouldn’t have had.” I gave him information like, and these are things you do not get, like this is the day they give you your blood back, this is when you feel the worst, they put these things on your legs, be ready for this day because that is the down day, and all that information would be so helpful to people. Especially in a surgery like hip replacement where, you know, unless you had terrible complications you ride through that week in a way that probably repeats a lot of peoples’ experience. They take you down to physical therapy when you don’t want to be there the first time. Tell people that this is what’s going to happen. I think that if people can anticipate things that are going to happen. It is just like you are writing this project and you know from other people telling you when you start writing that when you get, at some place you are going to get stuck, you’re going to be frustrated, you’re going to think you can’t do it. I know that from having written two novels. The first one I did. The second one I did I said this is the process. This is the process of having a hip replacement. They don’t talk about those things at all. They just sit you in front of the TV and you watch the video.

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Richards:I don’t think that the people who are doing the fixing, and thank God they can do the fixing, I don’t think they think about anything else.

Herwaldt:Well, that’s all there is. Or, that is what they can deal with comfortably. I think most of us deal with what we can deal with comfortably.

Richards:The nurses are great. I think there is a disconnect sometimes between the doctors and nurses and the doctors don’t realize what those nurses are doing for those patients. Those women who work in orthopaedics are incredible. They are lifting heavy people all the time. They don’t have time to eat. I swear they don’t get a lunch. They know the patient’s emotional state.

Herwaldt:Did any of the nurses talk with you about that stuff when you were in the hospital?

Richards:I don’t remember. I don’t remember distinctly but I did have the feeling that they were very attuned to if I was having a hard time or not. They were very attuned to it.