Old habits die hard.
I’m thinking of that cliché on my sixth day of post-op recovery from rotator cuff surgery. For some reason I’m reverting to my days in the oil patch and trying to calculate the NPV (net present value) of this surgery, which is extremely uncomfortable and will have me laid up from most physical activity, including golf, for at least four months.
If you are sitting around trying to calculate the NPV of shoulder surgery you start to understand why oil is a business (like banking and newspapers) from which no man ever recovers.
I retired from a business where financial analysis matters almost as much as the ability to read rocks. NPV is a tool used across the spectrum of project management in the oil and gas industry to determine investment feasibility. Like safety, it is part of the culture. And once it’s part of the culture, you start applying it to all sorts of things. Even shoulder surgery.
NPV, simply stated, is a way to measure investment value over long periods of time accounting for external factors such as cash flow, discount rates, the time value of money, and other financial dynamics. So what does that have to do with shoulder surgery? Plenty.
A little history first. This is my third rotator cuff surgery in six years. The first was back on the West Coast in 2014 (a weightlifting injury). The second was in 2017 after I injured my other shoulder diving across the finish line to win a “friendly” relay race. The third injury happened back on the West Coast during a visit in 2019, when I slipped and fell down eight stairs using my left shoulder as the leading edge.
I put off the third surgery for as long as I could using physical therapy, bands and small weights. It was fine for a while. Then it flared up. I got a shot of cortisone and an MRI, which showed a tear in the subscapularis muscle and a dislocated bicep tendon. I could still do most of the things I needed to do — household chores, golf, etc. — so I thought maybe long-term management with cortisone shots would be the easiest route.
Then I learned about osteoporosis and avascular necrosis — two ugly side-effects of long-term steroid use. And as a closing argument, the doc said that deferring surgery for too long would leave the muscle complex irreparable.
The trade-offs were pretty clear. So once more I went into the hospital, got knocked out, and woke up two hours later with my arm in a sling.
My back-of-the-envelope NPV analysis says it was worth it — about six weeks of minor pain and discomfort and a few months of physical therapy will build years of shoulder stability. To quote Ringo Starr, getting there don’t come easy. But to quote Mr. Starr again, I get by with a little help from my friends.
Thank God for that! The caretaker of my heart and my head and my body, my beloved Kit, has gone. Her gifts of compassion and love could raise the dead, but now she just tends to my heart with her spirit and memories. Darby the dog is good for a laugh, but not such a good cook. So there’s a void there.
That’s OK. Now I’ve got a team: cousin Don, who drove me to hospital, picked me up and came to sit with me every morning the first week; cousin Pam, who is my disciplinarian; the Gilberts, who sweetened me up; the Galligans, who made me a gourmet meal and made me laugh; brother-in-arms Greg, who is always checking in from the West Coast; my other brother-in-arms Bob, who provided the world’s best get-well card; brother-from-another-mother John, who stimulates me every day with sparkling, challenging conversation; Jessie and Breton, who cheer me up and give me hope; neighbor Mary, who hand-delivers chicken soup; “Uncle” Ted and “Aunt” Bunny, who took care of Darby and gave me the world’s best prescription. Calls and texts from Herb, John, Linda and others. These are not small things. They are grace notes.
To adapt another financial accounting concept, this is what’s called “goodwill” — intangible assets that add great value.
It’s cold here in North Carolina this month and Covid is running rampant. I dreaded this surgery in many ways. Without Kit, it felt like I was stepping off a gangplank into cold, dark waters. That was part of my reticence, along with the long road of hard therapy that follows. My fears were unjustified. I came out of the surgery embraced in a web of care and compassion. Yes, it’s a struggle, but a minor one compared to how it could have been otherwise.
I’m posting this because I wanted to lift these things out of my head and heart and put them on the page, which gives them form and weight. They are intangible in some ways, but also measured precisely in the soul. And just when you think you are laid bare to all the physical and emotional pain around you, people lift you up. The healing isn’t easy, but it has begun, to quote Van Morrison. Net present value, indeed.