To Be Upright, To Be Fallen

Six weeks since the operation! According to all the info leaflets, this is a landmark for hip replacements. The risk for dislocation is reduced, the joint should be more stable leading to resuming everyday activities (including driving), and it’s possible to use one stick rather than two crutches. I feel that I have ‘achieved’ some of this (why ‘achieve’?). I’m managing stairs, being in the house on my own (with the help of my trolley and grab sticks), going out for a walk every day, having a shower, doing more exercises. So this is all good. And yet I’m still having to use two crutches, as the other hip, the un-operated one which was the worse one to begin with, is still very painful and stiff, so I need support for both sides. And I get some pain in the operated hip, particularly in the mornings, and if I’ve been sitting for a long time. Hopefully this is ‘normal’, recovery pain. I’m seeing the surgeon again in a few days, so will find out how he sees my progress then.

One of the reasons I’m stiff in the morning is due to still not sleeping well at night. I can lie on my left (un-operated) side for a while, but then feel a pull in the operated hip, so need to move onto my back again. I’ve become aware that my mattress feels a bit lumpy (I hadn’t noticed this before), and a combination of this and the movements has meant that my lower and mid back have become quite stiff, leading to a pulling in the groin on both sides, and a stoop in the morning that takes a bit of exercising to sort out. This stoop is putting extra strain on the hips until I’m able to stand upright properly. I’m thinking of ways to do deal with this. Getting a new mattress is tricky at the moment, so maybe a mattress topper would help.

Reflecting on the embodied experience of ‘healing’. of trying to become ‘normal’, I’m thinking about language, the embodied nature of language, and how this relates to our physical experiences in way that connects to mental states, ideas, and our sense of morality. Philosophers George Lakoff and Mark Johnson have talked about this in their book Philosophy In The Flesh:

‘Reason is not disembodied… but arises from the nature of our brains, bodies and bodily experience. … It is the striking claim that the very structure of reason itself comes from the details of our embodiment. The same neural and cognitive mechanisms that allow us to perceive and move around also create our conceptual systems and modes of reason. Reason is not, in any way, a transcendent feature of the universe or disembodied mind.’ (Lakoff & Johnson: 1999, 4)

Based on this view, they have explored the way we conceptualise, perceive, and understand the world, and how this is shaped by our bodymind experiences, ‘[b]ecause our conceptual systems grow out of our bodies, [therefore] meaning is grounded in and through our bodies’ (Lakoff & Johnson: 1999, 6). The embodied mind, in attempting to make sense of the world, creates metaphors that are inherently linked to the experience of the sensorimotor system. Lakoff and Johnson offer the example of the metaphor ‘More is Up, as in “Prices rose” and “Stocks Plummeted”. In the More is Up, a subjective judgement of quantity is conceptualised in terms of the sensorimotor experience of verticality’ (Lakoff & Johnson: 47) Similarly, a physical experience, such as the difficulty in lifting a heavy object, is related cognitively in the mind to the experience of the difficulty of coping with responsibilities and problems. This cognitive connection is repeated until it becomes established as a pattern, and the conceptual metaphor arises:

  Difficulties are Burdens
Subjective judgement: Difficulty
Sensorimotor Domain: Muscular exertion
Example: “She’s weighed down by responsibilities.
Primary Experience: The discomfort or disabling effect of lifting or carrying heavy objects. (Lakoff & Johnson: 50)

In this way, the physical experience of being ‘upright’ equates to a moral sense of character: ‘she’s an upright person’, ‘stand tall and proud’, ‘be an upstanding citizen’. The other side of this is to be non-upright, to be physically affected in a way that results in being bent, curved, stooped, crippled, ‘weighed down with responsibility’, limping, stumbling, and ultimately, falling and fallen. All these terms have ‘negative’ connotations in our language relating to character: ‘she stumbled into a life of crime’, ‘she stooped so low’, ‘limping through life’, ‘falling into despair’, and, of course, being a ‘fallen woman’. Language we use to describe physical disabilities and ‘abnormalities’ are cognitively linked to being a person of alterity – not the ‘norm’, not ‘proper’, not ‘whole’ and moral. It’s no wonder this is reflected in attitudes in society, when people with disabilities have been hidden away, a source of shame, marked with some form of sin they must have committed to lead to a deformed body. And reflected in works of art, where such a figure is often isolated, morally questionable, afflicted in body, mind, and soul. And even if not physically, they can be morally disabled, hence the ‘fallen woman’. The embodiment of the sinful, immoral woman who does not stand upright, who trips and falls into a life of deprivation and promiscuity. These women need to be redeemed, reformed,, to feel penitence and rehabilitated through being purged of their immorality, to stand upright again. If they’re lucky enough to survive this – I come back to Hans Anderson’s versions of the stories of the Little Mermaid and Red Shoes again, in which both women characters have their moment of realising their sins, a blast of redemption – and then die. There’s no happy ending for the Fallen Woman.

How do we decouple language relating to a ‘disabled’ body and embodied experience from being cognitively connected to these kinds of judgements about the person? To reclaim stooping, limping, tripping, and falling as being ‘normal’, a result of a physical condition rather than some form of reflection of an inferior character? Positive images of disability are hugely important, and yet often so lacking. Perhaps the increased interest and viewing of the Paralympics is leading a greater understanding of the able-ness of supposedly non-able bodies. But theatre, film, television, visual arts, and literature still abound with reinforcing images of physical ‘impairments’ leading to a character being pitied or despised.

I want to be free of pain, to walk upright, without a limp, to not be looked at by people when they walk past, to not feel like the ‘other’ due to being born with a set of conditions that have led to the current state of my body. But how do I embrace all this without the operation being seen as ‘correcting’ the deformity? Of ‘achieving’ an upright stance and being more ‘normal’? I still don’t know how much the operations will really work to enable me to be pain-free and walk without a stick – I guess I’ll find out over the next number of months. But the experience I’ve had of feeling pain, limping, falling, being ‘disabled’ is now part of my life story, and has made me think about the language we use to describe these experiences, and how this connects to how we perceive and relate to people with ‘disabilities’, ‘impairments’, ‘abnormalities’.

Four Weeks Later… reflections and shadow walking

It’s been four weeks since the operation – I can’t quite believe it. Because each day has roughly the same routine, time feels like it’s both going slowly, yet the days are going past quickly. A strange phenomenological displacement of the usual experience of time when I’m busy, and the day is filled with activities mostly to do with work and thinking. So to be so focused on body, and a body that is functioning differently, changing slowly, creates a new dis- and re-location of the inner body clock.

Going back through my previous blog posts, I was looking at the one I posted just before the operation Getting Up, Walking Slow. I’m really glad I did this, as it’s showing the progress I’m already making. As it’s a slow process, and healing is happening in small degrees, it’s hard to step back and see the overall difference. But watching the video of how slowly I was walking then, and the struggles to get up from the sofa, I really see that already things have changed. Using two crutches, I’m able to walk much faster and with more ease than before. And getting out of the chair (higher than the sofa so easier anyway), is happening much swifter and in one movement, rather than the extravagant series of micro-movements I was doing before. Certainly the crutches make a difference, but it’s also the case that the right hip is feeling much less stiff and painful from before. There’s still some of this, but it’s in a different place. As I’ve been doing more walking and exercising, I’m aware of the difference between the right (operated) hip and the left. The left was the worse one, and has been bad for a much longer time than the right, but now after a 20 minute walk, I feel the pain around the whole area of that hip, and getting up after sitting for a while leads to stiffness. Whilst the right leg feels much freer, without the same pain as before. When the pain is there, it’s situated in the muscles, particularly the gluts, which is where the surgeon cut through to do the replacement. Whilst there is still some pulling in the groin, it’s much less than before. I can also lift the right leg higher, and certainly higher and with more ease than the left (though it was better than the left before the op). This means that when I’m walking up and down the stairs, my right leg is my ‘good’ leg, and leads, even though it’s the one that was operated on.

What I’m aware of is the need to build up my muscles more than has been happening. This is partly because of relative inactivity since the operation, but also that these muscles weren’t being engaged properly before, as adjustments were made to to cope with the arthritis, and also with the other hip. In particular, I’m aware that my hamstrings are very underused. I can feel this in the exercise of sitting, and lifting my foot up so the thigh comes off the chair. I’m still doing this by pulling from the groin, rather than pushing from the hamstrings. So I’m going to have to work at locating and engaging these muscles further in order to strengthen the leg. This is very important as when I have the other operation, which will be bigger as more needs to be done to the left side, I need the right to be as strong as possible to support it in the post-op recovery period.

I was a bit disappointed with the amount of physiotherapy we had in the hospital. This had nothing to do with the physios themselves who were brilliant, but I guess with the cuts to the NHS, they were very over-stretched and could only spend a short time with each of us every day, and the main goal of this seemed to be to ensure we could walk and climb stairs in order to be discharged. We weren’t given much in the way of exercises to do at home beyond this, and no follow-up physio sessions. So I was feeling a bit lost as to what the best things to do to strengthen the muscles. Luckily, my friend Sandra Reeve, who’s a wonderful movement artist and teacher who’d had a hip replacement a couple of years ago, sent me through a very leaflet with exercises that also work on strengthening the core muscles, drawing on aspects of Pilates. This has been very helpful, and given me a system of exercises to do each day. I’ve also been finding other suggestions for exercises on the internet. Having a structure of exercises, eg do 5 of these 3 times a day, is very useful, and has been helping to focus on particular muscle groups.

A big leap came yesterday, when I went out of the house for the first time on my own. The sun was shining, and I really felt the need to be outside. With some trepidation, I made it out of the door, and down the steps. These steps had been a problem, as one of them is very steep, and meant I couldn’t manage to get in or out on my own. But then I found these half steps and have two of them next to each other, which means I can get in and out myself, though it’s on a slope, so still have to be careful. I just need to get a grab rail put on the wall as well, and will feel feel pretty secure. But going outside on my own, and walking down the road and back again, felt such freedom. It was sunny and hot, and I bumped into several neighbours to have a chat. I walked about 10 minutes, and sat down on a bench for 10 minutes in the sun, before walking back. So not too far or long, but it was great, and I’ll try to do a little more every day. I felt every little uneven surface in the pavement, each small area of slope, which needed adjustment to walking and use of crutches. Again, satipatthana (mindfulness) helped with staying aware and engaged with each step, whilst also experiencing sky and fresh air.

Thinking of the previous post Getting Up, Walking Slow with an image of ‘my three feet’ using the walking stick, I took this shadow selfie of me with ‘my four feet’ using the two crutches. I like this image, thinking about reflections, of the doubled body displayed on the street, standing straighter, walking faster, enjoying the sun, four weeks after the operation. Although I think I’ll need both crutches longer than others (in the leaflets, it seems that most people go down to to one stick by four weeks, but I can’t yet because of the other hip being so bad), I’ll need to hang on to being patient for a while longer, and let the muscles get stronger. So one month down, and just two more to go before the second op!