Act 3, Scene 2

1:01 PM 5/23/2007 Blasted! Eric ( Nobbe) this morning found a fleck of a scab on the stump but says that in two weeks for sure we can make the mold for the button-on leg. If patience is a virtue, I am a saint. Saint Edward the Gimp. Set aside a holiday for February 29.

Act 3: Nobbe

My attention and patience now turns to Nobbe orthopedics. Nobbe has a well-earned monopoly in Santa Barbara to supply equipment and other necessities to the halt and the lame. They have been in business here since forever and have never had serious competition. This is because of the conscientious way they go about their business. The point man that has attended to my needs (shoes for diabetic feet seven years ago, post--toectomy) is Eric, a most pleasant and capable fixture at Nobbe. As an example of his service: I wear a boot protector, a cumbersome device that fits over my stump to protect it against unwanted encounters. The thing is highly effective, but requires an expert in the ins and outs of its straps and buckles in order to make it work properly. It is so designed that one need only unstrap the part that goes across the waist and the entire boot accommodatingly removes itself. Inevitably, every nurse who has no experience with this boot will unbuckle the entire device and try to put it back on. They never get it right -- so that it works, but only sort of. On the way back from the rehabilitation center Kay and I decided that we must at least try to see if there was anyone at Nobbe able to restore the boot -- it was scarcely doing its job after several bungled attempts at re-strapping it -- to its proper configuration. As it happens, we just caught Eric between appointments. He came out of the car, unbuckled the entire apparatus and re-buckled it as it should be buckled. That job done, I returned home with assurance.
At our appointment, two weeks ago Wednesday, Eric fitted the stump out in a shaper sock, which is a kind of double knit sock made of Ace bandage material. It is supposed to squeeze out the edema from the wound. Last Wednesday, Eric pronounced himself well pleased with the progress the stump was making. So much so that next week, he will take a casting for fitting a button--on leg. The first prosthetic will evidently be a training limb of some sort. If I get right everything I've been told, we will then proceed to intensive therapy attendant on getting a permanent prosthetic. Everyone tells me that getting one of these devices to function involves a lot of work on my part. Estimates of my capability with this thing vary widely. The surgeon made it sound as if it would be a walk in the park to walk down for the mail unaided. Another doctor claims I might need a walker for the rest of my walking life. Others say that I will be able to make do with a cane. I am used to a cane and would be happy to be able to get around using one. I guess we shall have to wait and see. For now, I am filling my dance card.

Act 2: the RISB

Except for the lack of a sauna, the Rehabilitation Institute of Santa Barbara (RISB, or RizzBee), could pass easily for an upscale spa. It has a capacity of only 20 patients at any given time, this for the sake of better focus on each patient. It includes a spacious room full of all sorts of gymnastic equipment, a commons in which all of the patients eat their meals, all of which (the meals) are very well prepared and a staff equally so. The commons has among its many amenities a 21 inch computer at which I was able daily to check on, and to reply to, my e-mails. The nurses all were highly competent and accommodating as were the many therapists.(Nurses make up a strange lot, about which more later. Or perhaps not.)
The doctors at RISB are among the vainest creatures on earth, and I do not except George Steinbrenner, say, or Diane Keaton. Come to think of it, how can it be otherwise? Jerome Groopman in How Doctors Think pours syrup over the word, but, bottom line, it is vanity. "[Dr. Richard Selzer] showed the young Terry Light [a medical intern] that a surgeon has to have a high level of confidence to operate, or, as Selzer had written, the 'audacity to take a knife to another human being.' A certain bravado goes with being a surgeon, Light admitted." Aluminum siding salesmen need bravado; surgeons need the confidence that sprouts out of vanity. This came home to me during one appointment with my surgeon, when he raised both hands in front of him and said simply, "magic." And you can bet that he believed it. I wouldn't have had it any other way.
By this standard, the two doctors who prowled the halls at the RISB were the souls of diffidence. One or the other, and for the most part both, were on call most hours of long days. One was an epidemiologist, the other a specialist in the things physical rehab does. (It bears an inkhorn label.)There was much confusion concerning my medications; neither seems to have heard of Byetta so that I ended up taking both Lantus and Byetta and inherited a prescription for a three month's supply of Lantus, which I paid for – it’s quite pricey -- and did not need. However, both of the physicians seemed more than competent. One spoke to my nephrologist (whose services are strictly precautionary). This resulted in a downshifting of some of my prescriptions for the next order cycle. The wizards giveth and the wizards taketh away.
With as many as 20 patients in their charge, the doctors were kept quite busy with a lot of people complaining about one thing or another, with very little patience to spare waiting their turn at a receptive ear. I wondered at the energy and equanimity shown by these two wardens. My fellow internees constituted a mixed bag worthy of a novel (for which I don't have the time). At one point, I found myself in the nostalgic embrace of Old Brooklyn Heights with the long-since retired director of publications for the Jehovah’s Witnesses who (the Witnesses) had colonized the Heights even before my reluctant emigration. I was divertingly attracted too by a Kerr-like (Think Tea and Sympathy) woman whose charge was a brilliant Japanese girl whose problem (the girl’s) I did not inquire about, I having grown prematurely polite. And that is but a small sampling of my encounters at the RISB.

It begins

The photograph is of Ella Fitzgerald seated in a wheelchair; where her legs were are stubs. She is smiling as if ready to break out with her trademark scat. I show that to the doctor on whom I depend for my primary care. He tells me that's what happens with diabetes. "The surgeons get you a snip at time." Seven years ago, a vascular surgeon whom I have come to trust – he is a Bohunk from Minneapolis -- snipped two toes from each of my feet, and "revascularized" each of my legs. Late in February, Kay noticed a familiarly ominous redness on one of my toes. The fact that we had paid little attention to a similar symptom the first time we saw it almost led to an amputation seven years ago. So off to the doctor we went. Without hesitating, he said go directly to the emergency room. A Doppler check and an MRA later, and I am listening to the surgeon spell out the options. What began as an ingrown toenail had made my entire right foot septic. None of the options that the surgeon put on the table were attractive. Indeed, the only sensible choice was to proceed with an amputation. This was done on March 2. I spent four days at Santa Barbara Cottage Hospital, after which I went to the Rehabilitation Institute of Santa Barbara.

I let it be known

I am glad to see that "scooch" has made it into Webster's New Millennium™ Dictionary of English both as verb ("to move or push a short distance") and noun ("a small amount or distance"). The occasion for my finding this out came when the surgeon’s resident intern shifted me on to an examining table and asked if I could "scooch down just a scooch." It came to me that I had frequently been hearing the word for days from the several physical and occupational therapists assigned to instruct me in ways to pivot on my remaining leg from one butt rest – the wheel chair or bed, for the most part – on to another – a car seat, back on to the bed, a chair at table; whatever. The first thing to remember toward a successful pivot is to scooch toward the edge of the launching pad. The resident and I agreed that no other word would serve as well, that "scooch", served, without fuss or ambiguity, a genuine need. (I became known at the rehab center for the swift elegance of my "scooch and pivot." It gave the thought to one therapist of, as she put it, "Boris Karloff doing a trapeze act.") The surgeon has signed off. I am eager to see how scooch comes into play starting next week when I begin work, considerably ahead of schedule, toward fitting a new limb. And so it goes, scooch by scooch by scooch.

This is how I told anyone who might care that I had lost, to diabetes, the part of my right leg below the knee. This blog tell about the operation and what happened afterwords.