Two Knee Replacements, with Discharge

In January 2014 I had the first of two knee-replacement surgeries. I had prepared for it by watching the surgery on YouTube, having lots of sessions about it, discussing with my surgeon how I wanted it to go, strengthening the muscles around my knee, and arranging for one-way counseling sessions after the surgery. I was able to do it with a spinal instead of a general anesthetic, and without sedation, and to watch the surgery (and talk with the surgeon) as it happened.

As an RC leader, I have lived my life with a minimum of drugs that numb pain, but I had never before faced such a big surgery. I knew that the pain would be intense and expected that I might have to take some narcotics. I did not object to anti-inflammatory or non-narcotic pain-relieving drugs, like Tylenol and Toradol, but I wanted to keep the narcotics to a minimum to avoid the negative effects on my mind. And I wanted the chance to feel and discharge everything fully. The surgery certainly gave me that chance!

After the surgery, I spent two nights in the hospital (a normal period to stay). Many Co-Counselors came in to counsel me, and I tried not to use narcotic drugs. Though I discharged intense pain for many hours on the first night, I ended up taking a low dose of narcotics for about twenty-four hours.

Afterward it became clear, from many sessions on the experience, that heavy early recordings1 of “this is horrible, it’s never going to stop, there’s nothing I can do to stop it, and no one will help me” undermined my ability to feel the pain and stay with discharging it instead of using drugs. So between the two surgeries, I spent many of my Co-Counseling sessions working on these early recordings. Having the first surgery, and feeling the pain as much as I’d been able to, allowed me to discharge my early material2 in a much fuller, more alive way than before the surgery. Also, the huge contradiction3 of so many people supporting me through that first surgery let me feel that my counselors were with me in a way that I hadn’t been able to feel before. These have been permanent gains for me.

My rehabilitation from the first surgery was fast but very painful. I basically cried my way through six hours a day of rehabilitation for the first three weeks and then three hours a day for another couple of months. I didn’t use any painkillers after the time in the hospital. The surgeon was surprised by and pleased with how well I had done, but he couldn’t hear me tell him how important discharge had been. (He thinks I have a high pain threshold. Ha! It had really hurt!)

In the following months, I continued to discharge many hours on the surgery and on the pain of rehabilitation.

With my second surgery, I felt that I had been given a big gift—the opportunity to get to do something hard a second time knowing exactly what would be involved. My main goal with both surgeries was to do everything possible to have the strongest and best-functioning knees I could have. I knew that having minimal drugs during the surgeries and pushing hard without drugs in the rehabilitation were important. But after the experience of the first surgery, I wanted to use the second one for some additional goals: to see how far I could push myself to face something difficult, to work deeply on early material, and to discharge a lot right after the surgery and see how that affected the pain in the months of rehabilitation. I could see that the second surgery was a window of opportunity for a lot of deep, powerful work on early material and pain.

Before the second surgery, I talked with the surgeon and the anesthesiologist and asked them not to give me any narcotics during the surgery. The surgeon wanted to use a small amount of morphine in a cocktail of drugs (mostly anti-inflammatory and local-anesthetic) that he was going to inject into the knee before sewing up the wound. After we discussed it, he agreed to reduce the narcotic to the minimum amount, which I agreed to in order to move the surgery forward.

The second surgery went well. It was very similar to the first. But I asked the surgeon to consider discharging me the first evening if I was doing okay, and he agreed. (This is very, very unusual.) I worked hard to be in shape4 to go home by evening.

After the first surgery, I’d had trouble with low blood pressure on the first day and been unable to get out of bed. I prepared for that before the second surgery by taking iron supplements for a month (to build up my red blood cell count in preparation for losing blood in the surgery), by eating and drinking a lot the day before, by eating a lot of protein and vegetables and drinking a lot of fluids right after the surgery, and, of course, by discharging lots of fear. After the second surgery, I had no problems with blood pressure and was able to get up and out of bed during the first day. I participated fully in physical therapy that afternoon, including walking more than a hundred feet down the hall (with the help of a walker).

As the spinal anesthetic wore off in the early afternoon, I kept discharging on the pain and issues related to the surgery. Like the first time, I was urged to take a lot of painkillers and other drugs, and once again I declined. I said that I wouldn’t take them until I needed them, that I had other ways of reducing pain. Only one health practitioner that day (out of many) was interested in what that other way was.

The surgeon returned in the afternoon and agreed that I could leave after physical therapy. I got home at 8:00 p.m., as the pain was intensifying quite a bit. I had arranged to have two teams of Co-Counselors (two people on each team) with me through the night (from 10:00 p.m. to 6:00 a.m.) so that I could discharge the pain and use a minimum of medication. (After the first surgery, I’d had two counselors with me the first night, but it hadn’t been enough resource. The two teams worked much better.)

By midnight the pain was about eight on a scale of ten, and I was discharging steadily on it. Once it reached the nine to ten level (a little after midnight), I did many hours of deep sobbing about how much I hurt, the fact that no one could help me (the counselors could be close and listen to me, but only I could put my mind on the pain and discharge it), the brutality of the surgery (which involved cutting into my knee, drilling into my bones, sawing off the ends of them, pounding on them, clipping off bone spurs), and how I felt that I couldn’t do it much longer. Early material connected to these topics was easily available (I had been working on it since the first surgery eight months before), but when the pain became extremely intense, most of my attention had to simply be on how much it hurt, on discharging the pain directly. I could never have done that in the hospital. It’s so great that the surgeon trusted me enough to let me go home.

My highlight of the night of the surgery was understanding in the middle of it that while I was experiencing what felt like the worst feeling of my life (the intense, unrelenting pain), I was at the same time having one of the best experiences of my life—being connected enough to my counselors, and having them understand enough about what I needed as client, that I could discharge heavily through the hours of pain.

A little after 5:00 a.m. we all ran out of attention,5 and I took ten milligrams of oxycodone (first I took five, but that did nothing, so a half hour later I took another five). That brought the pain down to a level of seven or eight. A few hours later it wore off and the pain increased again, but not to the same level as the night before. I took another ten milligrams of oxycodone (same as before—first five, and then another five when the first five weren’t enough) so that I could go to physical therapy. After that wore off, the pain did not increase again and I didn’t take any more narcotics.

The rest of that day I focused on discharging how hard the night before had been. My body still hurt all over, and lots of feelings were up from handling so much pain. I had several big sessions recounting the experience. I also spent over six hours doing my physical therapy exercises and other things to keep flexing, extending, and strengthening the knee.

I had not slept since the surgery, but my knee was too painful to allow more than a five-minute nap. I discharged and strategized about how to sleep without using drugs, and that night I had one counselor stay with me to help me during the night. I woke her up many times, and for a few hours I was able to sleep in fifteen- to twenty-minute segments. Walking with crutches helped me take my attention off the pain (it hurt less than sitting and paying attention to the pain). I walked quite a bit throughout the night. The following day was similar.

Then on Saturday, three days after the surgery, my knee didn’t hurt much. I kept discharging, had a massage, and walked a lot. Mostly my knee didn’t hurt unless I pressed on it or strained it.

The next morning, I woke up to realize that my knee had not hurt at all during the night and that I had slept well for about six hours. Since then there has been little pain unless I overuse the knee or press directly on the wound. When there is pain, it doesn’t take much discharge for it to disappear.

Now, on Monday, I’m walking without crutches most of the time. During my exercises and throughout the day I’m experiencing a lot less pain than I did after the first surgery. It’s pretty5 clear to me that the discharging I did right after the first surgery, and between the two surgeries, cleared out a lot of the pain recordings I had accumulated over my lifetime, and that this time most of the pain I am discharging is the actual pain from the surgery, without the backlog of old pain recordings.


My knee has continued to heal quickly, and I am very mobile. I’m experiencing quite a bit less pain this time with the rehabilitation process (mostly bending and straightening the leg, to get maximum flexion and extension, and strengthening the muscles around the knee). Because there’s less pain I can do more, so I’m reaching the rehabilitation goals more quickly. Twice in the first week I took a dose of Tylenol (in addition to doing sessions and applying ice packs) to cut the pain enough to be able to sleep, but that is the only time I have taken drugs since the day after the surgery.

Diane Shisk
Seattle, Washington, USA

1 Distress recordings
2 “Material” means distress.
3 Contradiction to distress
4 “Shape" means condition.
5 “Ran out of attention" means had no attention left.
6 “Pretty” means quite.

Last modified: 2017-04-06 23:03:12+00