This is one of the most bizarre but true statements you are likely to read all year. I had a good time getting my bilateral hip replacement, thanks to the top to bottom excellent and attentive care at the Hospital for Special Surgery. After so many years of dealing with crapification in pretty much every avenue of life, it was almost a shock to encounter an institution that functions at a consistent high level.
And I have to say it is depressing to compare my experience with that of my mother at St. Vincent’s in Birmingham, where an excellent ER is paired with a mediocre hospital. Nurses see my mother only once a shift. Her aide had to change her diapers. I’ve only gotten one call from the doctor as to what is up with her. The neurological eval and shoulder imaging preliminary to a cortisone shot have yet to happen. The nurse on duty lied about her occupational therapy session, which may reflect inaccurate reporting by the occupational therapist (the nurse said my mother had no shoulder pain when working with the OT; both the aide who was present and my mother said she complained).
For those of you who have not heard of it, New York City’s Hospital for Special Surgery performs only orthopedic procedures and defines its mission as treating musculoskeletal ailments. It has been rated #1 in the US for the past 11 years for orthopedics. It is also the only hospital in New York State to have received the Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times.1
The Hospital for Special Surgery performs more hip and knee replacements than any other US hospital. As a academic medical center, it has regularly developed improved techniques that have become industry norms. For instance, the Hospital for Special Surgery pioneered the use of epidurals (as opposed to general anesthesia) for hip replacements. It does not have an emergency room, but I was told it will from time to time receive patients from other hospitals who need advanced orthopedic interventions once they have been stabilized.
I had been putting off the procedure as long as possible, as in 3 1/2 years after a fall so hard that had I not been weight training for 30 years, I would have broken a bone or two. For the first nearly 3 years, I could still function adequately and was unduly optimistic that there might be a solution other than an operation. I was also resistant to surgery because I had developed a significant functional leg length difference (the damaged leg perversely was longer, to the degree that I had a significant limp). Hip replacements are normally very successful, but the number one reason for a redo in the first year is a leg leg difference. I wasn’t happy that the doctors I had seen were fixated on the lousy and worsening condition of my hip and weren’t interested in looking at what was creating the leg leg difference, which could not be just the busted hip (deteriorating hips if anything produce leg shortening, not apparent lengthening). If they weren’t willing to look at the whole picture, how could I have any confidence they’d get the leg length difference right?
I wound up at the Hospital for Special Surgery via Michael M. Thomas, who was a second generation Lehman partner at the time of his exodus in the early 1970s. Thomas has a resume that it would take most accomplished individuals several lifetimes to accumulate, such as having written nine novels. I first learned about Thomas through his acerbic and astute New York Observer column, Midas Watch. From the start of an archival piece:
One reason I love the Yale alumni magazine is that each new issue provides another compelling reason for any alumna or alumnus with a particle of common sense not to give a dime to Dear Old Eli.
I was chuffed in the early days of the site to learn Thomas was a reader and even more so when he invited me to lunch. We continued to lunch about once a year. Thomas is a great raconteur and knows where far too many elite bodies are buried.
Thomas referred me to Dr. Vijay Vad, who specializes in non and minimally invasive procedures and had helped Thomas a great deal many years ago when he’d had severe back pain that had stymied other specialists. Dr. Vad was willing to treat my hip and likely slowed its decay. But from our first session, he insisted I’d need a hip replacement in one to three years, which was not what I wanted to hear.
At the start of this year, Dr. Vad gave me two surgeon names, which I ignored. When I returned in March, Dr. Vad pressed me on the need to get my hip done in 2021. I sputtered that I had a leg length difference, no one seemed to be taking it seriously and I wasn’t about to get an operation unless I was confident the surgeon had sorted out how to address that.
Dr. Vad said, “You need to see the robot guys” and gave me two different names. Around this time, I had also gotten two referrals from IM Doc, one at UCSF, the other at Stanford. The idea of trekking around the West Coast, when every flight seemed to diminish my hip function, seemed daunting.
I called the first of Dr. Vad’s names. The conversation with the assistant, this on a day when I was aware of being uncharacteristically measured, got bizarrely confrontational when she refused to believe my insurance worked the way it did . She then made up some nonsensical reasons for not wanting to accept payment at the time of service before falling back on “The doctor doesn’t want to do it that way.” That might even have been true, so why not start with that?
Since there are politer ways to say no, even an arbitrary-seeming no, I decided I didn’t want to see a surgeon who thought it was OK to deal with patients the way she had.
I then called the office of Dr. Seth Jerabek. His assistant also went a bit on tilt over my insurance but got over that quickly enough.
When I saw Dr. Jerabek in April, I started out by saying “I assume you have some sort of speech you give.”
He said, “Not really. I’m one of the guys here who does difficult cases.”
I wondered if that included difficult personalities.
I explained what I understood about my situation (he’d already gotten an MRI and a fresh X-ray) and had him look at my walk. At that point the other hip was getting noisy and unhappy too, so I suggested doing Bad Hip 1 first, seeing how my gait changed, and then making any leg length adjustment on Bad Hip 2.
He said, “That’s what I would have recommended.”
I gave him a list of questions that he answered.
He then showed me a full body X-ray, front and profile, of a man whose hip he had done recently. He said he measured everything before deciding what exactly to do.
I walked out having decided the surgeons on the West Coast might be different but were not likely to be all in better and I really was not keen about running all over the US. So I booked the procedure and went to New York for the pre-op. That was the weakest point of the experience with the Hospital for Special Surgery; I ran into some bureaucratic issues. But the doctors and techs were good. The internist I saw, Dr. Hollomon, who later visited me most days in the hospital after the surgery, gave me a partial waiver from the usual “No dietary supplements for two weeks before the surgery” and let me continue with ones that didn’t affect clotting. 2
As Bad Hip 2 deteriorated rapidly, I became more and more worried about how I could rehab without a “good” leg. I sent detailed e-mails. Dr. Jerabek called me several times to discuss further, which was surprising in a good way (as a friend said, “A doctor who talks to patients?”).
We traded calls the week after Labor Day and connected that Thursday after work NYC time. We made a battlefield decision to do a bilateral hip replacement. Mind you, the procedure was scheduled for the following Tuesday!
I was set to see him the day before the surgery (this was not typical; I had initially booked the time to discuss how to rehab with a not very functional “good” leg). Dr. Jerabek put up an X-ray of my hips. He explained that they normally use cementless replacements on patients under 50, cemented for patients over 70, and for patients in between, “It depends”. He said he’d tried modeling 100 cementless replacements for me and none of them fit. I gathered it wasn’t the ball and socket part so much as the top of the femur. He said he could modify a cemented one. It would be different than what I had but he thought it wouldn’t be hard for me to adapt. He suggested that that that abnormality might have played a role in my hip deterioration.
The hospital offered to call someone to let them know when I got out of surgery. This was more information than my mother needed, so I had them call a local friend who planned to and did help me a great deal while I was recovering. She was stunned that Dr. Jerabek spent ten minutes on the phone. She’d researched hip replacement (as in the devices) and they had a deep and meaningful conversation.
After the surgery I got a similar very high level of attention. I splurged for a private room which was mainly glass on two sides with views of the East River. Even though I was at the end of a corridor, away from the nurses’ station, the floors aren’t that large. The nurses normally came in less than 2 minutes of being called; the very worst was closer to ten minutes at shift change time. They were very good natured even about stupid things like having dropped my cell phone on the floor or getting me hot packs often during the night (my back was pretty bound up the first few nights). I was a bit of a dope and didn’t realize until part way through my stay that the Hospital for Special Surgery had been turned into a Covid hospital like all the others. When the nurses had a bit more time with me, like minding me when I walked up and down the corridor, I asked them about it. They lost one staffer and one patient. It was still a bit traumatizing for some of them to talk about it. I wish I could remember all their names to thank them personally.
You also get to pick your food. I had opted for gluten free as the closest approximation to no starches. My first morning, after having gotten into my room at 1 AM by virtue of being released from the recovery room way ahead of the normal schedule, I did get a lot of stuff (including their very good coffee) but not anything I wanted (cereals, gah, sweetened yogurt, gah) except a little fresh fruit. I grumbled to the nurse. She ran down the food cart and got me a couple of hard boiled eggs, which made me happy.
Later that morning, a live human being came in with a lunch and dinner menu. 15 entrees. 3 appetizers. 6 vegetables. 3 desserts. Some bread type options. Even though the food was closer to institutional that gourmet, getting to pick what you want makes a big difference. She also took my breakfast order. And a live human came every day to take the food choices.
Rather than seeing the stereotypical cavalcade of anonymous doctors, I’d have a doctor check on me 2 or 3 times a day, one a member of Dr. Jerabek’s team, usually very early, later Dr. Jerabek, and in the first couple of days, Dr. Hollomon.
Remarkably, the anesthesiologist also came by to explain what had happened. I had wanted not to be put into twilight sleep until I had decided I’d had enough (either unpleasantness or boredom). I woke up in the recovery room complaining about having been put under. I was told then “You tried helping Dr. Jerabek. He didn’t need help.”
The full explanation from the anesthesiologist was that I’d had trouble with the position they put you in (Dr. Jerabek had warned me that might bug me) and they’d had to use the twilight sleep a few times at certain junctures. When I came back to each time, I beefed. Mind you, I have no memory of this. It was Dr. Jerabek who said I finally started hyperventilating so they had to knock me out. But the anesthesiologist stopped by, as if to apologize, when I’d been the bad actor!
The social worker was tearing her hair over arranging for physical therapy for me in Alabama and at the rehab hotel until she understood that my oddball insurance made it easier. Luckily I got through to a fellow Yankee at one of the home health care agencies here and she got it sorted.
The physical therapists were also very skilled. I would see them twice a day, usually led by Hi-Chan. I was discharged to a rehab hotel owned by the Hospital for Special Surgery (Dr. Jerabek’s surgical assistant Denise leaned on the staff to wheel me across the bridge connecting the two buildings) and the handoff to my friends went like clockwork. There, Marc Friedman would see me for an hour a day and put me through my paces and then sent a list of exercises for me to do on my own. He also gave me the name of an excellent and inexpensive omakase restaurant at about a 4 minute unimpaired person walking distance, and gave me permission to go there with an escort. I went with my friend NT and we had a great time.
Finally, even the housekeeper was with the program. I got a much nicer room than I needed because it was the last one left, but the bathroom wasn’t set up for handicapped people. The housekeeper came in, saw me standing in a walker, and said “Hip replacement?” When I said yes, she came back with a heavy chair with a high and well padded seat, and then fetched a ton of ice bags and warned me about the treacherous shower, to not use it or be super careful.
Finally, reader jr, formerly of the West Village, now of Williamsburg, came by for lunch and then the next day graciously supervised my packing and helped get me into a car.
I am sure I missed some people and I hope you aren’t offended. Everyone at the Hospital for Special Surgery did a great job with my surgery and I am very grateful.
Dr. Jerabek’s short video also cites the excellence of the Hospital for Special Services. I didn’t believe it when I first saw it. Now I do.
1 The award is valid for four years, so the Hospital for Special Surgery has held this recognition since 2002.
2 I had walked into that session prepared, including the half lives of all the stuff I took. But I didn’t have to negotiate. Dr. Hollomon was sensible.