Since the age of thirteen, I've had a disease I still can't spell (and I'm determined to keep it that way). Google tells me it's "Ankylosing Spondylitis." It's basically spinal arthritis, but it affects all of the major joints in my body. It arrived alongside puberty and has been my form of a "dark passenger" ever since. Atypical to this form of arthritis, it started in my toes and knees and then worked its way towards my spine, taking up residence in my hips in my early 20s. By my 30s, I was told I was "ready" for a right hip replacement. Degeneratively speaking, I might have been ready, but psychologically and emotionally? Not so much. Fear of the procedure and possible complications made me put off the operation far longer than I should have. I ended up spending several years using what I took to calling my chair on wheels (rather than wheelchair). I wasn't confined to it, but had to take it with me wherever I went because I couldn't stand for more than 20 minutes. Frequently, I'd push around my own empty seat until I needed it. In early 2000, I could no longer cower from the inevitable.
I still vividly remember that beautiful spring morning, driving to the hospital for the operation
at the crack of dawn, watching my house fade away in the side-view mirror, wondering if I'd ever see it and my family again. Needless to say, I made it back, and now I was faster, better, rebuilt. They had the technology!
This piece was originally written for the February 2001 issue of ArtByte, a sadly short-lived New York digital arts and culture magazine, edited by Mark Dery at the time. The article was surprisingly well-received. I rarely get congratulatory phone calls when I publish articles. This one inspired a few. The best was from cyberpunk sci-fi pioneer Bruce Sterling. He was particularly tickled by the piece because he saw in it the beginnings of a trend: aging cyberpunks beginning to be borged for real. "Chairman Bruce" (as he was known in the cyberpunk twilight of the 20th century) loves irony, and as you'll see, this experience offered no shortage of it.
It's fun to read this now and find references to NYPD Blue, the Sony AIBO, and a more innocent (pre-9/11) era when an artificial hip didn't set off airport metal detectors. Today, I have a full performance of security theater to look forward to whenever I travel, complete with invasive crotch groping. We live in strange times, a "cyber" future that even astute speculative fiction writers like Sterling could scarcely have imagined.
Like Wired after its sale to Conde Nast, I am now officially "post-hip." Last year, after decades of trying to shake off the pain of severe degenerative arthritis in my right hip (and nearly every other major joint in my body), I had a total hip replacement ("THR" in the trade). With months of Steve Austin/Six Million Dollar Man jokes under my belt, and after enduring such forehead-slapping questions as: "Will you set off metal detectors?" and "Is the Sony AIBO going to hump your bionic leg?," I was suitably hardened for anything the operating room might decide to throw at me.
Over half a million people have major joint replacements every year, but my visit with the bone saw had special poignancy. Since the early '90s, I've frequently written about neural prosthetics, plastic muscles, foreskin farming and other state-of-the-art cyborg technologies. I've also participated (online and in print) in nosebleed postmodern theorizing about our "cyborged" bodies and the growing border war between meat and machine. In the introduction to Beyond Cyberpunk!, the 1991 hypermedia book I co-created, I wrote: "Our tech is getting smaller and smaller and soon it will disappear inside of us." Somehow, I managed to overlook the fact that this "disappearance" was already a reality for many, and little did I know that I would soon be host to some incredible shrinking tech of my own.
I'm here to tell you that fantasizing and rhapsodizing about it are worlds away from having a hunk of metal and plastic literally hammered into your own body (and having a major part of you hacked away with power tools to make room for it).
As my wife and I made the final, nerve-wracking decision to go through with the surgery, I started to feel like one of those liberal D.A.s on NYPD Blue who's just discovered that the baby raper he helped exonerate has moved into his own apartment building. I was now going to become a real cyborg - not one of the metaphoric borgs academics have discussed to death, a softwired creature of computer interfacing, gender dysphoria, and postmodern mythology, but a hardwired one, a literal borg: part man, part machine - a biomechanical being. The very thought of it - the risks involved, the cold, hard fact of putting my hardware where my hip once was — scared the stuffing out of me.
Hip replacement surgery has become surprisingly safe and commonplace, but because arthritis has fused my sternum (constricting my chest), and thanks to the fistful of immuno-suppressant drugs I gobble down daily, I am at a higher risk for post-surgical pneumonia, a complication that could kill me. I am also predisposed to something called "heterotopic ossification," a horrifying side effect, where pieces of bone begin to form in the muscle around the implant, which can cause as much or more pain and limitation than the excised hip. Browsing books on hip surgery and doing online research on the subject only cranked up my fears to "11."
But then I got to fondle the hardware. During the initial visit with my orthopedic surgeon, he brought in an implant for me to play with. It was a gorgeous, awe-inspiring piece of modern machinery — almost Zen-like in its shining simplicity and austere precision. The cementless implant technology my doctor's clinic uses was co-developed by them and has been implanted into thousands of patients.
The description of it reads like something from a William Gibson novel. I now sport a Duroloc® 100 acetabular titanium cup with sintered titanium beads for in-bone growth adhesion. I have a bleeding-edge Marathon® polyethylene liner with irradiated cross-linked polymers for tighter bonding and longer wear rates. My Prodigy® brand stem has a 28mm cobalt-chrome head and a cobalt-chrome
femoral component with sintered cobalt-chrome beading for bone in-growth fixation. Where 2001's HAL 9000 was fond of telling people that he was made at the H.A.L. plant in Urbana, Illinois, I can now boast that part of me was manufactured by DePuy Industries of Warsaw, Indiana.
Geeking out with the doctor, discussing the details of the hardware while absent-mindedly gliding the sensuously smooth cobalt-chrome ball around inside the polyethylene cup, I felt a growing reassurance. The doctor, a third-generation member of an orthopedic dynasty (with books on Amazon!, I comforted myself); the world-renowned clinic; the smart-looking hardware — it all started to hum like well-oiled machinery, machinery to which I found myself increasingly willing to submit. In the midst of my newfound courage and enthusiasm, I looked over at my wife and realized, by the green cast to her cheeks, that the she was more in need of smelling salts than tech specs.
As if to drive home the irony of my situation with all the subtlety of an operating room bone hammer, I had to endure several unpleasant procedures other patients usually get to skip. Because of my higher risk of mutated bone growth, I had to have my hip irradiated the morning of the surgery. There I was, at 8am (closer to my bedtime than my morning), strapped to a slab, having my thigh sketched on with markers by a team of X-ray techs. Then, the slab started moving upward and I was raised into a room-sized X-ray machine in a scene unsettlingly reminiscent of Bride of Frankenstein. Once inside this giant, Soviet-looking contraption, I was asked to remain stock-still, while the machine creaked and twisted around me. Along the rim, in an obviously feeble attempt to entertain the children unfortunate enough have to endure this frightening device, marched a parade of little worn cartoon stickers of The Jetsons, featuring everyone's favorite mechanical domestic, Rosie. The semiological significance of this gave me something to bite down on as the flesh around my femur received a full-on assault of gamma radiation. I also had to brave the terrifying experience of being intubated while I was still awake. Most patients can have their head tilted back to establish an airway while they're doped beyond memory. Because of my fused-forward neck, I had to be semi-awake while they shoved tubes into my throat and my body tried to heave them up. I have the most bizarre alien abduction-like memories of masked and hooded technicians frantically struggling to overcome my gag reflexes. They also wanted me to be awake in the recovery room before they removed the air tube. This felt a little bit like drowning, which mercifully, lasted for only a few seconds.
In Donna Haraway's landmark 1985 essay "A Cyborg Manifesto," she suggested that severely handicapped people often have the most heightened understanding of their relationship with technological augmentation. Being handicapped, I can vouch for the truth of Haraway's statement - in spades. Recovering in the hospital, I discovered a huge cyborged population she had apparently overlooked: the elderly. The average age of a joint replacement patient is 63. At 42, I was the ward's resident whippersnapper. Sitting in our wheelchairs, our patient-controlled morphine pumps clicking away, our catheters sluicing liquid into alarmingly-full urine bags (they don't empty those things nearly enough), I was stunned to hear all of my fellow implantees' war stories. Most everyone on the ward was on a second, third, or fourth replacement. One patient was on her sixth implant (two shoulders, two hips, and two knees). She's eighty and has made plans to live past a hundred, so she takes all of the risk, pain, and rehabilitation in stride. For her, it's a worthwhile investment to buy a few more decades of life. My hospital roommate, in his 70s, had basically stopped off for a knee replacement before he and his wife took a trip around the world. Both of them had been plagued with recent health problems (quadruple bypass surgery, ovarian cancer, arthritis). "I'm just here for a little tune-up before we hit the road," he joked.
The procedure was not fun, the hospital stay was filled with frustrations I won't enumerate here, and the six-week recovery period was one of the biggest challenges of my life. But make no mistake about it, this is miraculous technology that it is radically changing my life. A giant throbbing knot of pain is gone from my body. I was reduced to a walker when I went into the hospital, now I don't even bother with a cane. I have more energy and enthusiasm than Richard Simmons at a fat farm dance class. I had a major joint replaced and was out of the hospital faster than it takes to get over a head cold. Good thing too because there's likely more joint hacking in my future. My left hip is also circling the drain and will probably come out in the next few years. My knees are nearly shot and my shoulders are fused so I can't raise my arms above my head. Each one of these replacement procedures will augment me and amputate me at the same time (to borrow a theme from Marshall McLuhan). And what of upgrades and repairs? I may have to go back for some of those, too.
I woke up this morning with a painful limp, in my new leg. This is not supposed to happen and it made me flush with fear. It's probably nothing, muscles and tissue still trying to recover from the surgical trauma, but what if it's more? What if it's heterotopic ossification, my leg mutating into some Cronenbergian horror with bone growing where it's not supposed to? What if it's an infection in the wound site (it's possible that something as common as the flu or a teeth cleaning can lead to site infection, and in worse cases, removal of the implant). These fears, these suspicions of an alien presence in my body, will be with me for the rest of my life, and will only be compounded by each new biological-to-mechanical parts swap. What I've learned from all this is that the subjective process of becoming a cyborg, in the hardwired sense, greatly suppresses one's appetite for high-minded theorizing about it. Where "wounds are openings to possibilities," as the French technocultural critic Jean Baudrillard once suggested, they are equally openings to infection. There's nothing like having a stinging, aching, seven-inch scar running down your thigh and a large foreign object lodged inside of it, slugging it out with your body's defense mechanisms, to make you appreciate the complicated trade-offs and mixed emotions involved in real-life bio-mechanical bonding. It is as much a world of wound management, site infection, tissue mutation, implant extraction and rejection, and reams of HMO paperwork, as it is a world of life-restoring body repair and trendy cyberpunk mythology. All rhapsodic cyborg theorists should book a date with a bone saw (or at least heed the words of those of us who have) to remind themselves that, in our cyborgian futurepresent, and in the end: it's all about the meat, stupid.
Update (posted to my website in 2004):
Over the years, I've gotten numerous emails, some from complete strangers, asking about my current "condition," and how my second hip replacement went. I really appreciate the interest and concern. I love you, too. I thought I'd go ahead and update people on how it's been going.
I got this total hip replacement in the spring of 2000. Even months after the surgery, my remaining hip (or my "bio hip" as I started calling it) was still in lots of pain, as was my back, neck, and other joints. Gradually, as the artificial hip started to make itself at home, the pain in my bio hip and back went away. I guess it was a compensatory sort of thing. I was putting all sorts of exceptional stresses and strains on other muscles and joints to compensate for the bum hip, and after it was replaced, gradually, those pains faded away. I'd also started on a new drug therapy a year or so before the surgery, and the combination of the two has been nothing short of miraculous. I now have no pain to speak of in any part of my body except for my neck (and my right wrist, but that's more likely a writer's injury than an arthritic's).
I'm actually in the best shape I've been in decades. The increased physicality has allowed me to lose a lot of weight, build muscle, and leap tall buildings in a single bound. I don't use a cane anymore, or any other gimp tech. I can even fit into clothes I wore when I was in my 20s [Cue pictures of me in the mirror marveling at myself in 80s parachute pants — wait, scratch that. I think the Hammer pants are best left to the moths in the attic.] So, in answer to your questions: I'm doing amazingly well, and at this point, I don't need the second hip replacement, or any other replacement. I'd take a new neck if they had one handy, but medical technology is not there yet.
BTW: I actually did get some of that creepy heterotopic ossification I mentioned in the piece, but thankfully, it's an extremely small patch and it has never bothered me.
If anyone reading this has a bad hip and is contemplating a replacement, I say: GO FOR IT!!!! In the article, I really focused on the negative aspects of the process, 1) because the fear and discomfort of the whole experience were still fresh, and 2), the point of the piece was to contrast my years of cheerleading cyborg technologies as a cyberculture writer with the very real and direct impact of tying on a backless hospital gown and facing the upgrades myself. Four years later, with the perspective of distance and living with the successful results, I'm here to tell you, it could have been two or three times more painful, challenging, and intense, and it still would've been worth it.
ASIDE: Do Cyborgs Dream of Bionic Upgrades? Yes they do! I get a bi-monthly newsletter, appropriately called The Joint Journal, from my orthopedic clinic. In it, they're always showing off the latest hardware and discussing new research findings and less invasive surgical procedures. Like ogling the latest Macs, I find myself wistfully thinking: "Damn, I wish I had one of those new Biomet M2a metal-on-metal jobbies! You lucky bastards, implanting metal in the 21st century!"