After a three month break, it was time to catch up with my knee surgeon again. Every time I go I like to have a short list of ideas to present to him so he can look at me as if I am mad. This time, my latest theory had been in place for a while before I arrived.
‘How’s the right knee?’ he asked, as usual.
I told him I thought it was better than the last time I saw him, but it is not OK. I made sure to remember to tell him that I still can not straighten it properly and that although It is OK at the moment, there is always some pain and I still can not walk without a limp.
He examined the knee and pushed down on it, and then the healthy one, declaring that for some reason, some knees are reluctant to fully straighten after an operation of this kind (that wasn’t in the pre-op pre-amble) and it tended to happen more to women than to men. He did not know why. My left knee indicated that I was very flexible, so I was probably noticing the lack of flexion more than most in the right.
‘What if,’ I said , launching into this appointment’s mad theory, ‘we hit it again with the cortisone before it swells all the way up again? Sort of slam the inflammatory response out of it?’
He nodded and got out a referral sheet. Then he mentioned the Cynvisc again as an option.
This to me said one thing: he thought the pain is being caused by the pre-existing arthritis not the operation.
‘This pain,’ I said, ‘the pain that I have now, was not there before the operation. There was pain, but not this pain,’
The expression on his face told me he did not believe me.
He wrote me a referral for cortisone and anti-inflamatories. As he was doing this he talked about what exercise I cold be doing now (walking, swimming, cycling) but also of not wanting to do more surgery or more drastic surgery (knee replacement) and then he stood up. The consult was over.
I moved into the reception areas with him and he handed my case notes to the receptionist.
‘P.R.N’ he said as he did so.
I waited to be told when my next appointment was. The receptionist said, ‘Dr does not need to see you again for now. You account will be paid by Medicare so there is nothing to settle up.’ She smiled.
My heart felt like a stone. I had sort of blithely assumed that this relationship would continue until my knee was better, but the Dr had clearly reached the end of his bag of ideas. I hobbled towards the lift.
Driving back to work, I felt pretty upset, like I was a problem that had been cut adrift. I had failed to bring him any good news and was being punished. What the hell did PRN mean anyway? Was it some sneaky Dr code? I remembered a few years back in England when someone revealed that Drs were writing NFN on some patients’ case notes, which stood for, ‘Normal for Norfolk.’ Was PRN some kind of version of that?
‘Patient Real Nutter’
‘Pain? Right. Not!’
‘Proven Rationality Needed’
Or maybe just simply, ‘Patient Returned to Normal.’
That had to be it, right? I was just as normal as I was going t get and that was it. I was being cast loose. Well I did not feel normal.
I googled it when I got back to work.
P.R.N stands for Pro Re Nata: used medically to mean, ‘as the circumstances arise.’
Which I guess means that he has not turned his back on my completely, but he certainly won’t be expecting to see me again anytime soon.
No wonder there are so many people in Perth with limps.