Total Hip Replacement: A Personal Perspective

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Chapter VIII. Moving to an In-Patient Rehab Hospital

I had chosen a rehab hospital in Orlando. I felt that if I would be cooped up for up to two weeks in this facility, I wanted to be close to friends who could help me. If I had rehabbed in Gainesville, two hours away, it would have been an unbearable inconvenience to these kind people. This, of course, required some logistical planning and some potentially uncomfortable traveling for me. As I had mentioned in the previous chapter, I debated with myself over the wisdom of being transported in a private automobile, but eventually made the decision to do so. Had I known that I would be able to progress through rehab in record time, I might have stayed in Gainesville for those few days. However, I had no way of knowing that at the time. With a friend, R.D., driving, I arrived at the rehab at around 5:00 on the fifth day after surgery.

Where did you come from and what are you doing here?

The rehab hospital was not used to patients arriving via private car. It took my friend what seemed to be quite a long while to find somebody inside who could bring either a wheelchair or walker out to the car. Finally, a physical therapist arrived with a wheelchair. She wheeled me into the room that was assigned to me and left. I thanked my friend, stating that I was now an inmate, and I would await further instructions from the keepers.

Well, I waited. The only people who visited my room for the next three hours were a couple of nurses or aides who told me I was in the wrong room. That was rather irritating. I began to sense that there were some significant deficiencies in administrative areas. I would have expected that at some point within three hours after arrival, someone would have come to the room to tell me when the physical therapy sessions and meals would be held. But, no. Nothing. Therefore, I finally gave up on waiting and rang the nurse call button.

When the nurse arrived, I expressed the concerns I mentioned above. Here I was and no one seemed to know. That brought a small flurry of activity, when it was determined that a patient had walked in the back door instead of the front. Yes, patients were usually transferred there on stretchers. I was semi-ambulatory. So what? They had been given all my paperwork, and there was no excuse for not knowing I was there. What also became clear to me during the course of the instruction diatribe I was given was that my rehabilitation would be impeded by some of the CYA policies in place in this hospital. The view presented to me by that evening nursing staff was that it was a real kindergarten atmosphere, which was contrary to what I had gleaned when I evaluated the place before surgery.

I made it clear that I had progressed to a point at which I was almost completely self-sufficient and that what I did not need was handholding. This inspired the charge nurse to ask a question I would hear again and again: “Might I ask you a question? What are you doing here?” I stated that the reason I was there was to build strength, endurance, and range of motion for my affected limb, not to be coddled and monitored at every moment. I do not think my point got through.

I was very unhappy that first night, feeling that I could do better for myself at home with a visiting physical therapist. As it turned out, I probably could have done as well. The rehab was geared toward a significantly older age group, a slower progressing group prone to slips, falls, and accidents. Accordingly, activities were less ambitious than they could have been for a younger person.

Getting to work

In the morning, after being visited by a physician’s assistant, a physical therapist, and the rehab physician, another Dr. B, I felt a bit better about the place. The physician’s assistant, after discussing my state of recovery with me, asked the musical question, “What are you doing here?” I laughed. It was good that people were starting to notice that I did not intend to malinger there. I had originally been told that I would probably be spending up to two weeks in the rehab. That would have been hard, if not impossible, to take. In discussing my specific situation with Dr. B, he estimated that four to seven days would be sufficient. That was somewhat encouraging.

Dr. B was a sincere, pleasant man. He remarked that I had progressed quite well at that point, just six days after surgery. Five weeks later, during a follow-up visit with him, he would tell me in absolute terms that he had never seen anyone progress so fast through rehab and be at the stage of recovery I was at that time. I gathered from the start that Dr. B was simpatico, a doctor who I could talk with about my recovery and general health issues related to it, and get good information in return. I had no choice as to who my rehab physician would be, so I am fortunate to have drawn Dr. B’s lot.

The physical therapy was good, although I felt I could have been pushed quite a bit harder. I think the physical therapist assigned to me was happy to have someone closer to his age to talk with than the usual patient there, although I was still probably at least twenty years older than he was. In the mornings and afternoons during free periods, I would do high-speed wheelchair laps around the floor to get an upper body and aerobic workout. This was my idea. I suppose I was getting anxious to be more active. Surprisingly to me, the physical therapy did not include any significant aerobic workouts.

Most of the inmates were progressing slower than I was with respect to the physical therapy, so they tended to get more attention. Quite a bit of attention was paid to occupational therapy issues, such as functioning in the kitchen on one leg, getting around obstacles with a walker, or taking a shower. I received a little instruction on how to use a “sock helper” device, which was truly useful. Otherwise, I cannot say that I got much out of the occupational therapy. Most of the occupational therapy I needed was covered by the background reading I had done before surgery. Of course, we are all different, and you might find that hands-on occupational therapy enhances your post-surgery life tremendously. The people who conduct those occupational therapy sessions are experts who can help you to the extent that you need help.

By the end of the day, it was clear to me that I would need to negotiate with the doctor to get me into the early release program. The molasses pace was dragging me down. Therefore, when the doctor arrived at dawn, I made my proposal. “How about getting me out of here in three days?” I asked. After thinking about it for a minute, the doctor said he thought that it would be possible to do so. I would only have to show that I could ascend and descend stairs safely and the results of my blood tests in the morning would have to be acceptable. I was relieved and happy. There was a light at the end of the tunnel.

And so it went. During my discharge day, I met with the case manager and others to set up my home care and order the necessary durable medical equipment, such as commode chairs and my walker. The hospital preferred to use one particular company that provided not only the equipment, but also home nursing and physical therapy. I was told that the equipment would be delivered to my home, with the exception of the walker, which would be delivered to the hospital so I could use it to get to in which I would be taken home. Then, after appropriate discharge counseling, I was free to go. I was ready! The rehab hospital made certain that a follow-up appointment was scheduled with my personal doctor as soon as possible (for the usual CYA purposes). They also scheduled a follow-up with the rehab physician in approximately four weeks. At that appointment, I would be scheduling the outpatient physical therapy that would constitute the third phase of my rehabilitation.

My friend R.D. arrived on schedule and I was on my way home. We stopped at the post office to pick up my held mail, and then got some groceries and the drugs that had been prescribed for me. R.D. helped me arrange some things around the house when we got there. I was ready for my first night at home!

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