I became a surgical patient all over again this past month. Believe it or not, I was diagnosed with avascular necrosis (AVN) of my left hip joint and it required kind of an urgent joint replacement. I had been in so much pain for the last few months and had no idea where it was coming from.

I recall making fun of myself over and over again on ICU Rounds. “I was an ER resident up until like a day ago, we aren’t used to STANDING!” I would be in so much pain from standing up all day. I recall asking the Neuro Critical Care fellows if they thought I had Guillain Barre syndrome. Maybe some sort of weird neuromuscular disorder caused by my anti-rejection medications. Or a neuropathy.

“Is it weakness, or is it pain?” they asked, reflex hammers in hand.

I DON’T KNOW! IT’S WEAKNESS FROM PAIN!!!!!! SOMEONE PLEASE HELP ME!

I told my Cardiologist— “I don’t know how you did residency and fellowship with all that standing.”

My left leg was slowly starting to kill me. I thought I was going crazy.

I was waking up 1-2 hours before each shift to stretch my legs, use ice packs, heat packs— any home remedy I could find. I continued to walk to work, but I started noticing that taking the stairs was really hurting my leg. Something was not right. The pain was intermittent, but it wasn’t fully going away. And I couldn’t take NSAIDs. Remember— heart transplant.

A few weeks later, I went to the ED (as a patient) right before work. That’s when I found out about my diagnosis. As it had turned out, the steroids that I had been on last year had been the culprit. They put me at risk for AVN. I had become one of The Unlucky Ones.

The ED resident, who I knew personally, came into the room with a long face.

“I’m really sorry, Alin. I’m so sorry, but it looks like…”

And we both looked at the films.

My reaction? “YES! OH MY GOD! I FINALLY KNOW THAT I’M NOT GOING CRAZY AND I HAVE A DIAGNOSIS?!!? OH MY GOD! WHERE IS ORTHO?”

Anyways.

I have been tackling this little mess just like the other disasters in my life— totally ready, with confidence, and a dark sense of humor. I mean, what were the chances of this happening to me as soon as I moved to NYC during a f&%*ing pandemic? Leg pain!? Really?! But honestly, who am I to complain. Post Transplant Life comes with so many potential complications. And if this is the one that is given to me this year, then let it be. I am so lucky that it is not another cancer scare (yet, knock on wood), rejection, or an infection of some sort.

And the best part is that the joint replacement is done.

On October 19, 2020, I put my life on hold temporarily and walked into the hospital with my comfortable scrubs and a hospital badge. I made sure to tell the security guard that I was there as a patient for a hip replacement that day. I don’t know why. This guy definitely did not care. But I think I was just nervous. I anxiously chuckled and said something like, “Okay then!” And walked to the pre-op registration area.

I called my boyfriend, the Coincidental Orthopedic Surgeon (Not Mine), and said “Hey, so I guess I’m here and they’re going to take me in. Make sure your phone is on because the surgeon is going to call you when it’s done. How many times have your patients died during hip replacements?”

He said, “ALIN you have asked me this 10 times already!!! Also, remember, YOU ALREADY WENT THROUGH A HEART TRANSPLANT! This is nothing!!!!”

I needed that.

(The answer was zero.)

The nurse gave me a gown and told me to get undressed. She also left a urine cup in the room and said, “Oh and we need to make sure you aren’t pregnant. Please get that done asap.”

Keep someone NPO after midnight and then tell them to pee as soon as they get to the hospital after they have already peed at home. Great.

The surgeon came into the room in his very Surgeon Way (perfectly pressed scrubs, surgical cap already on, ready to conquer the world at 6am - every surgeon looks like this at all times) and marked my left leg. He talked about the direct anterior approach, the incision, and how he wanted me to try to walk as soon as possible right after the surgery. He asked if I had any questions. I had no questions other than, “Can I take my anti-rejection medications so I don’t, like, die?”

Then, they wheeled me up to the Operating Room. The last time I had been in one of these was for my heart transplant surgery, and I forgot how fancy these places were. They are always so clean and white and … intimidating. Every single person working inside each OR knows where to stand and how to “move around the blue.” Every instrument has its place. Every fluorescent light is pointed at you.

I think I was very nervous and trying to make small talk with people. I asked one of the Orthopedic Surgery residents what she was going into and where she had matched for fellowship. Honestly, I don’t remember her answer (I think maybe a trauma fellowship). My own attendings were in the room helping with anesthesia, so it was nice having some familiar faces in there. I joked about how it was going to take a few pokes to get an IV in me and that it was okay— I was very used to it at this point.

I looked over at one of my attendings. “No pressure, this heart has been through a lot, please take good care of it…” and we all laughed.

I remember thinking about how the last time I was in this situation, my life had been on the line. My ejection fraction had been 5%. I could have coded at any second. (I could have brady’d down into cardiac arrest during induction, especially considering that was going to be my second intubation of that hospitalization.) I didn’t even know if I was going to ever see the outside of that operating room ever again. But every single person in the OR worked together so gracefully to make me feel better— the nurse who let me use her phone to call my mom so I could stupidly ask if I was “going to be OK” one last time before they put me to sleep, the resident who played my favorite radio station for me (Tupac, obviously) while they prepped me, that old school Anesthesiology attending who got my arterial line in without an ultrasound (I was impressed), the nurse who brought me extra blankets. They all kept saying that they were rooting for me, that they were really excited for me to get my heart transplant.

And the same happened this time.

Look, this wasn’t just a hip replacement. This was still just as nerve-racking for me as anything. It wasn’t every day that a 32-year-old with a heart transplant needed a new hip in the middle of a worldwide pandemic. I didn’t know what was going to happen to me once they put me to sleep. Was I going to lose too much blood? What if the sedatives weren’t any good for my heart? Would I ever be able to walk normally again? What if the replacement didn’t get rid of my limp?

My point being that … us patients can be a nervous bunch. No matter how many times we’ve been through certain experiences, no matter how much we know or don’t know … being a patient is not easy.

Thank you to everyone who makes the patient experience so much better, every single day. It’s the little things that matter.

Thank you for letting me share my vulnerability with all of you.