Family support is a precious jewel. How am I so fortunate? When I developed a severe arthritis flare up in my left knee on January 2, I was sent home from the ER with a prescription for analgesics and a referral to Swedish Orthopedic Institute. The PA there looked at my x-rays and told me now may be a good time to do an MRI and consider total knee replacement. His comment came as no surprise. In 2008, a surgeon who had just shaved up the “bucket tear” on my meniscus said to me “you’ll need a knee replacement in 15 years”.
Day by day, the swelling and pain grew worse, I called the Orthopedic Institute back and asked if we could do the MRI. Alas, I needed a new referral from my primary care doc who I had never met before and who had no openings for 10 days. I called my new insurance company – having switched because the previous company doubled my premium after one year for the same benefits. I pleaded with the person on the phone: “I am in constant pain. The ER doctor gave me a referral, I need to see an orthopedic surgeon”. But clearly there were rules to be followed, and obviously a great shortage of overworked doctors and medical staff in the American health care system.
Reality dawns clearly, a truth beyond words each moment. We samsaric beings inevitably personalize it with ego-based interpretations, likes and dislikes, hopes and fears. Wringing our hands over our personal misfortune or rejoicing in ephemeral pleasures. Only the wise attempt to ride the horse with no name through the desert, observing pleasure and pain without affixing a solid self-identity to experience. I’m not there yet, but still trying to mount the horse. January 8, I dreamed that I was sailing across a stormy ocean, then flying up to the top of Avatar sized trees and resting in the boughs. Something was afoot on the subtle plane of consciousness. A hint of a possible opening perhaps.
The next morning, in desperation, I contemplated my options when suddenly I remembered that my wife was on sabbatical and living next to Buddhist Tzu Chi Hospital in Taiwan . If I need knee replacement, having a support system would be key. I called her that afternoon and asked her what she thought. She said she would check with her friend, the wife of one of the orthopedic surgeons. Minutes later, she called back and said, “just come”.
Four hours later a neighbor drove me to SeaTac Airport in order to catch a non-stop flight to Taipei. At the curb, I spotted a pair of crutches and asked the attendant if they belonged to anyone. He said, “please take them”. Once inside, a Port of Seattle staff immediately approached me and arranged for a wheel chair and a special no wait lane to get my boarding pass, then wheeled me through security all the way to the gate and eventually all the way down the ramp to the door of the plane. So far so good.
The flight was an uninterrupted meditation on pain for the first four hours. Somewhere 32,000 feet over the Bering Sea, with a deep sense of humility towards the inevitable difficulties of the human condition, I limped back to the galley and asked the stewardesses if there was any place that I could put my leg up. They quickly gave me an empty row of two seats in the very back where I was able to elevate my leg and somehow survive the 12 and a half hour flight, even nodding off a few times.
After passing customs and finding the purple MRT train, which began moving as soon as I sat down, then swinging on crutches slowly for a half mile through the underground mall at Taipei Station to meet my wife, we boarded the train to Hualien. My appointment with the doctor wasn’t for another 36 hours, but after all the activity, my pain level had surged to 8/10. Upel called her friend and got my appointment moved up by a day.
Buddhist Tzu Chi hospital, true to its name, is guided by the principle of compassion demonstrated by Master Cheng Yen, a living bodhisattva who founded Tzu Chi, and Shakyamuni Buddha, the founder of Buddhism. As I waited for an x-ray in a crowded hallway, one barely conscious man was brought in on a wheel chair and was obviously shivering. Another waiting patient reached out without hesitation and adjusted his hospital gown so that it covered his legs. This spirit of kindness and warmth was evident everywhere in the hospital, even in the bathrooms which had spiritual aphorism posted in strategic places.
A decision to undergo elective surgery is complex. For me, it brings home the reality of death and impermanence and reflections on the Four Noble Truths. A conservative estimate of the life span for knee replacement prosthesis is 15 to 20 years. I might live another 30 or not? Multiple surgeries? Live with more pain now and postpone functional improvement for an imagined future? Even the wisest and kindest medical experts (I asked several) cannot tell you what to do. Only the individual can make such a decision, ideally empowered by valid information.
Now I wait and reflect, observing pain – in my better moments – without ego attachment, empty of solid existence, only appearing due to conceptual imputation. Alternately, in the midst of frequent episodes of delusion, I unconsciously grasp at having a 24 year old body forever. Each moment holds infinite possibility for enlightenment or suffering. Our own mind determines which path we follow.,
This life has great meaning. Following the words and advice of great masters of enlightenment, I cling neither to the world, nor fall into the pit of nihilism, but walk the middle path between extremes, endeavoring to awaken the bodhisattva ideal (infinite altruism) in every action of body, speech, and mind.