My three sisters had knee replacements on the same day, in the same hospital. The same surgeon made the incisions, the same anaesthetist put them under. The first was at seven in the morning, the next at eight, the last after ten. There was no muddling of the parts, no group discount. Three sisters: two left knees and one right knee. Femurs and tibias cut, worn-out knee joints ground away. Some say it’s a little like carpentry. Three custom-made prostheses hammered and ‘glued’ in place. Three button-like kneecaps stitched on to the front where three patellae were removed. The hospital nurses called the three sisters the ‘Katoomba gang’.
Snow skiing falls as teenagers had torn ligaments meant to stabilise two sisters’ legs. For the third, a rambunctious knock from a flying dog crashed out a knee already wobbly from childhood netball injuries. We’d all been horse riders, had our share of bumps and falls. We all knew how to get back in the saddle. They walked bandy as bronc riders, hobbling, and in constant pain.
I’d seen my sisters’ legs deteriorate over many years. They put off the surgery as long as possible. The orthopaedic surgeon told the eldest sister she should have had her knee replacement surgery twenty years ago. ‘You weren’t old enough to operate back then, and my sisters weren’t ready’, she’d replied sharply.
Preparations for the operation occurred in three different towns. My youngest sister, Felicity, was in Armidale, NSW, swimming and bike riding at 6am each morning over summer, before work as a nurse manager. The eldest in the family, Penelope, a radiographer in Toowoomba, visited the gym regularly. Rebecca, the middle sister, is a retired social worker and general practice manager in Newcastle, who did yoga and as much Pilates exercise as her sore knee allowed. Three sets of menisci worn out, beyond repair, three spongy discs no longer cushioning their bones. Grinding pain of bone on bone.
Anxiety levels rose as the date of the operation approached. All my sisters have contact with the medical system in their professional lives and knew the risks of failure; they’d seen post-operative infections, breaks, falls, the ones that didn’t work.
Prosthetic implants are extraordinary bio-technology, whether they are knees, hips or shoulders. Three-dimensional customised knee joints were printed in Memphis, Tennessee USA, according to MRI images of the three knees. Once ‘printed’ someone wrapped them, perhaps walked to a post office, handed over a parcel marked, Australia. Presumably, they were flown to Sydney, then freighted to Newcastle, stored somewhere, till the morning of their operation. All those hands bringing the prosthesis to their knees.
According to the Australian Institute of Health and Welfare rates of orthopaedic surgery, particularly knee replacements are increasing annually in Australia. It’s partially to do with an aging population, partially to do with being a wealthy nation, where people can afford to pay for quality of life. Knee joints are a swinging hinge joint, not swivelling, like shoulders or hips. It’s a place of movement, weight bearing, and rich with nerves, blood vessels and ligaments. Knee replacements are reputedly more painful than hips, recovery times longer.
I flew from Victoria to Newcastle the day before they were due to be discharged. My knees are, touch wood, reasonable. Jokes weren’t flying as fast as usual, their faces were drawn, pale. This had knocked them about. The scar up the front of their knees was nearly twenty centimetres long, a strip of waterproof tape covered a deep red incision, like an airstrip under lights. Their legs were swollen and tight.
Staff knew to look for the sisters in any of the three rooms for observations. They gathered in each other’s company whenever they could throughout long hospital days. They were quickly encouraged to walk, to learn how to use their walking sticks, to negotiate stairs. They took their raft of pain management medications, including anti-inflammatory rectal suppositories for fast-acting pain relief. They winced, groaned, laughed nervously when I asked if that would be one of my jobs. It wasn’t. They rested in between walking practice, the exertions of showers and toileting.
In hospital they waited for the meal trolley, drolly accepted the institution’s routines. They complied, shifted from being robust professional women, resilient mothers, the women in charge of their households. ‘So quickly institutionalised’, Rebecca remarked. They were now being cared for, rather than being the carers. Having their legs cut open, the damaged bone sawn away, took away their usual chutzpah.
We’d lived our own separate lives for the past thirty or more years, across three states, caught up briefly each year at various family occasions. I drove them away from the hospital as a nursing mother might push a newborn in a pram for the first time. They grimaced at bumps and turns. They all looked out at the busy world that had continued while they were in the white hospital landscape. The greens looked so green, the sky bright blue. On the way home we passed a swamp, up from the Williams River, where milky grey cygnets were tucked beside long-necked parents, black and elegant. They nested tight. So did we.
Creeping carefully from the car at Rebecca’s they breathed out, like horses may when they are let loose from a stable onto an open grassy paddock, before they gallop with their tails in the air to the farthest corner. My sisters gazed around, but didn’t gallop off. They walked like wing-clipped swans, with bow-legged swaggers.
They each decided to name their prostheses. They wanted to be able to curse it when it stabbed in pain, to rub it gently when it ached, encourage it to stretch to new angles. Dorcus, (after an old family nanny), Ruth (after a memorable night nurse) and Beckham (as in bend it like Beckham), were called upon to ‘get going,’ ‘leave off,’ ‘go to sleep’, in many shades of colourful language.
I fetched and carried ice bags, drinks, walking sticks, which were regularly left behind in their push to get going. I cooked meals, washed clothes, arranged bedding, massaged feet and legs for circulation, tried to pre-empt their needs, scuttled between tasks. In our nighties we shuffled to meet for cups of tea in someone’s bed each morning to compare night stories–who had slept, who had had the night terrors, whose nightmares made them jump and jerk sore legs till they cried. Potent analgesics played havoc with their heads.
Several of their adult children continued to expect that their mothers would still be available for the usual support and listening to their telling about their lives. I wanted to guard my sisters from these demands, but they taught their children again; the roles changed from cared for to carer. The children listened, they started to ask how their mothers were going.
Tiredness caught up with us all, disrupted sleep and constant preoccupation hammered us thin. I slept in one morning, and was surprised to see them all facing me from their designated spots on couches in the living room at 7:30, as if they’d been there all night. I started to apologise, shrugged.
‘First warning!’ Felicity, the nurse manager, sprouted. We laughed till we ached.
This was the longest time that we had spent together in years. We reminisced, we told stories that the others didn’t know. We shared and compared memories and old experiences. Between them there’d been five marriages. We’d raised twelve children. We’d each had vastly different lives, in country towns, in cities, with mortgages, with successes and failures, most of the usual bumps and lumps of life. Our mother had ingrained messages in us; don’t fight, get over your disagreements, love each other as she loved us. She drew persistently on her Catholic faith. Her invocations prevailed during those intense days together. We all moved through the corrugations, the ups and downs of pain and healing, the forward and backwards convolutions of recovery, as our mother would have wished.
After four days Rebecca’s leg swelling was particularly tight and painful. Fearing possibilities of deep-vein thrombosis, she arranged an ultrasound at the Maitland hospital. We all went in the car together. Three of us had a coffee at the hospital cafeteria, while Rebecca limped to the x-ray department, determined to do it alone. She grinned when she returned, ‘Just a Baker’s cyst. No DVT.’ We were all relieved. A benign but painful fluid collection behind the new joint made it difficult for her to bend her knee to the ninety-degree target.
We decided to visit our parents’ ashes, interned nearly twenty years ago in a columbarium in the bushland garden behind the modern Catholic Church near Toronto, NSW. The church and the columbarium overlook a quiet, picturesque bay in Lake Macquarie. Memories of their funerals twenty years ago in this church, only four months apart, were still raw. At Dad’s funeral, Pen had escaped the crowds and sat in the car; I had reconnected with old school friends; Fee remembered minding her young children, and Bec was in a daze of exhaustion. We each recalled our various experiences, juggling nostalgia and the demands of the present. Now three hobbling women, a Pentecostal Christian, an atheist and an agnostic, and me perhaps leaning towards Buddhist ideals, reminisced. We were so far from our childhoods, yet unearthed stories now took on new hues. Recovering Catholics, we bristled, never quite over the experience. We thanked Mum and Dad for all they’d offered us and scooted homeward.
I imagined that perhaps Chrome-Cobalt and Titanium turns purple when it burns in furnaces, a strong colour that suits my sisters. On the way home they all said they want to be cremated. I am the only one who wants to be buried. In the ground alloy prostheses persist for centuries, like dental records. I imagined a story about reclaiming prostheses from cemeteries when mining the raw materials dwindles to a stop. Metals are already recycled from crematoriums in Australia, shipped to the Netherlands for smelting. With an expectancy to work for ten years, perhaps up to twenty years if you’re lucky, the prosthetic implants may, or may not, last out my sisters’ time.
It was difficult to leave them. I felt like fine-drawn eggshells were about to crack in my chest, ruptured in the separation. We cried over farewell hugs. Leaving home, arriving home to Victoria, my sense of familiar was torn between two places.
Caring work sits right at the top of my list of things to respect. I am full of admiration for those who care for loved ones year in, year out. My ten days were nothing compared to the physical and emotional load carried by long-term carers.
My sisters expressed huge gratitude to me, and to their loved ones. It’s what we do; I wouldn’t have missed it for quids.
They have booked a camper bus to come to my sixtieth birthday party later this year. They’ll fly to Melbourne and drive to our place in the country for a long weekend. They are calling it the bionic bus. Already I can’t wait to see them, wish I could drive with them, a quadruple of Thelmas and Louises. I’ll join them in bed for morning cuppas. I can’t wait to see them dance on their new knees, steady, like ocean liners, slow to turn, gracious and wildly lit at the same time. It’s our love that shines.
Deborah Wardle is a third year PhD candidate in Creative Writing at RMIT. She has fiction and non-fiction works published in Overland, The Big Issue, Palliative Care Australia and Fusion and Meniscus journals to name a few. Her short story, ‘Love Letters’ was shortlisted for the Josephine Ulrick Prize in 2016. Deborah relishes her ‘long apprenticeship’ in the art of writing stories that reflect human and non-human responses to global warming.
