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!

On My Own … breathe out as you go down the mountain

25 days after the operation, and I’m in the house on my own. My friend Rebecca, who’d been staying with me for a week, left yesterday afternoon. At the time I felt fine – I can manage on my own, I can climb stairs, get in and out of the house, sort myself out. But after she left, I was in the house and would be spending the night alone for the first time since I got back from hospital. I had a sudden wobble of vulnerability. Will I really be all right? Can I actually manage? How will I cook and wash up? What happens if I fall over? I wanted to go upstairs and hide under the duvet. So I did some breathing and visualisation, and felt better. There’s always a way of coping, and I would have to manage at some point on my own, so now is as good a time as any.

A little later in the evening, my friend and colleague Jane came round, having kindly gone to a shop selling equipment for people with disabilities and the elderly, and got me a trolley with trays on it. This is because being on two crutches, I can’t carry anything, so this is to help me be able to cook, move plates to the living room (the dining room chairs are too hard to sit on), and carry things back to wash up. This was really important – I couldn’t think of even how to boil some pasta, and then carry the pot to the sink a few feet away to drain it. So this trolley is making it possible for me to be on my own, even though I’m still figuring out how to push it whilst also having my crutches.

This is the trolley in my living room with my breakfast things on – mug which had coffee, and a bowl which had museli. The process of making breakfast and bringing it into the living room made me grateful for those years of practising sequences as part of training in satipatthana, or mindfulness. Make the coffee in the machine. Put empty bowl and spoon on the trolley, and move trolley to where the museli packet is. Put museli in the bowl. Move the trolley to the fridge. Open fridge and take out milk. Pour milk on the museli. Move the trolley to where the coffee machine is. Put mug with coffee on the trolley. Move trolley to the fridge. Put milk in the coffee, and milk back in fridge. Put crutches on trolley, and push through to living room, lifting over a couple of raised bits between rooms. Put trolley near chair. Take crutches off trolley, sit in chair, put crutches aside. Take mug and bowl off trolley and put on table. Have breakfast. Then reverse, putting things on the trolley, taking back to the kitchen, near the sink. Put mug, bowl and spoon in sink. Balance on the edge of the sink while washing items. Take crutches, walk back to living room, and sit in chair.

Phew! When I was doing this, and pushing the trolley, all I could think of was Julie Walters doing the two soups, or Waitress, sketch as part of the Victoria Wood television programme. If you haven’t seen it, do a search. This was me – how long does it take to make, eat, and wash up after breakfast?! Pushing the trolley makes me feel like I’m thirty years older, but it does mean I can find a way to manage on my own.

Having to think so carefully and plan every movement to do the simplest tasks does remind me of the years spent training in satipatthana, with a focus on every-moment mindfulness. How unthinking we usually are about what we do, particularly when it’s a habitual action. Walking up the stairs is something that happens without us thinking about it – we just go up the stairs. At the moment, I’m having to focus on every step up, making sure I put my feet and crutches in the right order, and using breathing to help with the movement. Needing to work at such a level of minutiae of everything certainly helps focus the bodymind, and brings me back to a sense of simplicity (not simpleness) in just doing the next thing. John Garrie Roshi used to tell us Zen stories. One I’m thinking of at the moment is of a monk who went to a monastery to meet a great master. The monk was given a bowl of rice when he arrived. He was told the master would see him, and ran to greet him, saying: ‘Master, tell me the secret to enlightenment!’. The master asked: ‘Were you given something to eat when you arrived?’. ‘Yes,’ replied the monk, to which the master responded: ‘Then go and wash your bowl’. That’s it – enlightenment is just doing the next thing. After the sequence I needed to figure out to eat breakfast this morning, I then needed to wash my bowl. I don’t think this has made me enlightened, but it has helped to reassure me I can be on my own in the house. Another favourite story Garrie Roshi used to tell us was of a monk who ran up a mountain to meet a famous teacher. ‘Master!’, he said breathlessly, ‘please tell me the secret of enlightenment!’. The answer came: ‘Breathe out as you go down the mountain’. So I’ll be doing a lot of breathing out as I go about everyday activities and figure out new ways to do them. I’m sure there’ll be the occasional stumble, but hopefully the experience of the mountain will help to just put one foot in front of the other, and remember to breathe.

An image from ‘Zen Comics’ by Ionna Salajam

Getting Up, Walking Slow

My three feet

Place hands, palms flat, either side of thighs on sofa. Push down on hands, moving body to the edge of the sofa. Move the right arm over to the left side of body, just beyond left hand, beginning to twist to left. Continue turning to the left, lifting right buttock off the sofa. Continue turning to left, using hands to gradually lift body up, until facing the back of the sofa. Move the left hand to the back of the sofa, while the right hand grabs the stick. Slowly push down on the stick, while pushing back from the sofa, as body unfurls to standing.

This is the sequence of movements I’ve developed in order to stand up from my sofa. It takes about two minutes on average. Time has taken on a new experience since dealing with the physical changes. What was once an action done swiftly and without thinking – get up off the sofa – has now become a choreography of shifting weight, finding support, turning, and unravelling, each step needing full attention and slowness in order to avoid injury or falling. I’m not sure if the time spent directing theatre and choreographing dance has helped me to develop this. Certainly improvisation has been key – I’ve found novel ways of picking things up, carrying things, going up and down stairs, balancing things, that I probably wouldn’t have explored if if were not necessary in order to undertake everyday activities.

Along with the years of training in movement, dance, and martial arts, there’s also the years I spent working with teachers in Buddhism, particularly John Garrie Roshi, who worked within the Theravada Buddhist form of satipatthana, usually translated as mindfulness. Garrie Roshi himself had been an actor and performer, and developed a unique series of exercises starting from the body and breath. Performing repetitive sequences of activities – pacing, sitting, standing, slow walking – for days at time instils a discipline, as well as deep levels of attention to the minutiae of all aspects of bodymind. And in my case, often, huge resentment and frustration at having to follow a tight structure over and over. But this intense training is coming back to me now, in having to move so slowly and carefully in everything I do. Often still wtih resentment and frustration, but in having little choice, it has also been a time of exploration of living at a very different pace, different time, than was my usual rhythm before. Working with Garrie Roshi, and later with Namgyal Rimpoche, we would spend hours doing a slow walk. Moving each foot very slowly, feeling each part of the body required to shift in order to do the movement, sensing the changing textures under the feet, keeping the breathing steady, and tethering the mind to stay with focused attention on each moment. The exercise highlights the connection between body and mind, and how easily the mind can fly away from the physical base. Mindfulness has become quite a buzz term in recent years, but often this has tended to focus on an initial stage of achieving calm and relaxation. This is fine, but within Buddhist practice, this is just a first stage. The calm is established in order to lead to the next stage – vipassana, or insight. This is where realisation can happen, an embodied understanding of impermanence and non-self with each breath and step.

I certainly don’t achieve this level of experience with each step I take, but having to move slowly, and needing to focus so strongly on posture and balance in every moment, has helped to develop concentration over longer periods of time. This also helps dealing with the pain – I have to focus all the time on breathing and visualisation to help cope with the pain. This can be a very internal process – people have walked past me saying ‘hello’ and I haven’t heard or seen them as I’ve been so focused simply on the experience of walking to enable me to put one foot in front of the other.

Stand with both feet parallel, stick in right hand. Shift weight to left foot and stick. Slowly move right foot forward. Shift weight to right foot and stick. Slide left foot until both feet are parallel. Repeat.

This is my continuous experience of walking, a sequence of actions, performed in slow time, while the rest of the world seems to move past in a faster rhythm. I feel that I exist in a separate time zone to everyone else. After the operation, will I change my time zone to the same as others? Will it be a gradual shift, travelling through different zones until I catch up? Will I always feel slightly behind? Can time be changed, learned, re-learned?

In his book The Web of Life, Fritjof Capra stated that ‘over time each organism forms its unique, individual pathway of structural changes in the process of development. Since the structural changes are acts of cognition, development is always associated with learning’ (Capra: 1997, 261). I will be having major structural changes with the hip replacements, so will this lead to changes in cognition, development, learning? Biological scientist and philosopher Francisco Varela said that ‘mind and world arise together’ (in Capra: 1997, 262). So we are not separate from the environment around us, but rather are formed by and with this environment. As I change, so will my world, and vice versa. Varela himself experienced this directly when he had a liver transplant. He kept a phenomenological record of his experiences through this (‘Intimate Distances’, published in the Journal of Consciousness Studies, Vol 8, Nos 5-7, 2001). He describes his reflection on having the transplanted liver inside him after the operation:

I’ve got a foreign liver inside me. Again the question: Which me? Foreign to what? We change all the cells and molecules of a liver every few weeks. It is new again, but not foreign. The foreignness is the unsettledness of the belonging with other organs in the ongoing definition that is an organism. In that sense my old liver was already foreign; it was gradually becoming alien as it ceased to function, corroded by cirrhosis, with no other than a suspended irrigation of islands of cells, which are then left to decay and wither away.

This makes me think how I’ll feel having a non-human joint inside me, made from metal and ceramic, nothing organic. Does this make me less-than-human? Or human-hybrid? Or more-than-human? I grew up watching the 1970s version of ‘The Bionic Woman’ with Lindsay Wagner as Jamie Summers. Will I, too, become bionic, with human-made non-human parts inside me? These parts should do a better job than the bones and cartilage I have in my current body. But what will this make me? A Dr Who cyberman? Upgraded from human to better-than-human with an artificial component to enhance function? In my fantasy, being a bionic woman will enable me to run as fast and jump as high as Jamie was able to do (pre-CGI). I wish! So what else might being a bionic woman mean? I feel that the experience of satipatthana will help me explore this after the operation, with the new body leading to a new mind and world. Meanwhile, here’s a little montage of Jamie doing her bionic leaping as an incentive as I look forward to the move into a new time zone (and hope my hair will always stay as well groomed as hers in the act of jumping!):