My Right Knee

ENTRY ONE

On Saturday, November 8th, 2008, my Ultimate Frisbee team returned one year later to the scene of its first ever tournament in Chester County, Pennsylvania. Unfortunately, this ended up being a rather devastating experience for me. I was injured within the first half of the first game when a reckless opponent defending me dove toward a disc that he could only get to by colliding with my body. He landed full-force on my right leg and I fell. You’re not supposed to do things that will cause major physical contact with others in Ultimate, but this guy did and the consequences have been and will continue to be life-changing for me.

Here’s what happened to me in that moment, as determined by my doctor after performing surgery on me. The weight of this other player’s body drove my femur through my knee joint, exploding and crushing my cartilage and causing a level 2 strain of the ligaments on the inside of my leg around my knee (just short of tearing them). It then shattered and cracked half of  my tibial plateau, splintering it off of the rest of the bone and vertically fracturing the top two inches of the column of my tibia. As soon as it happened, I fell to the ground and knew immediately that I was experiencing the worst pain I’d ever felt in my life. I immediately began repeating “Call 9-1-1.”

Flash forward six days and I’m lying in a hospital bed at Lenox Hill Hospital on the Upper East Side of New York City struggling to get my bearings as I regain consciousness after a three and a half hour surgery. I am not aware of it at the time, but my surgeon has informed my wife that the surgery was a success, though I am far from out of the woods.  They have restored my joint physically, but its integrity is fragile. I will not be able to bear weight on the leg for months and I will need a fair amount of luck as I work to regain the full use of my right leg over the next few years. My cartilage (meniscus) was repaired to the best of their ability, but it was “spotty” and there is no way to predict how well it will heal. Even in the best case scenario, I will experience problems with this knee for the rest of my life, almost certainly suffering arthritis in this joint. Other good news from the surgery includes the fact that my bones are extremely healthy and “dense,” meaning that it was unnecessary to transplant bone material from my pelvis to my tibia.

Approximately thirty minutes after my injury, I was in the emergency room of an outpatient clinic in rural Pennsylvania explaining what I remembered of the accident to medical professionals while they pushed my knee around in excruciating ways before getting an x-ray that confirmed that I had a displaced fracture of my tibial plateau (where the tibia meets the knee joint, the half on the outside of my leg was completely severed from the main tibia) and had a vertical fracture in my tibia as well. I asked how bad the injury was. From the x-ray it was not clear to me that my situation was particularly bad or good. I told the doctor that I didn’t want any sugar-coating, just wanted to know as accurately as possible the exact nature of my injury and its severity.

“It looks like you’ve imploded your knee and fractured your tibia. On the scale of knee injury severity, this is about a 9 out of 10. You’re going to need surgery very soon or else you’ll be at risk for an extended multiyear recovery and may end up with a permanent limp that could only be rectified by knee replacement. It’s going to be extremely painful, but if you get the surgery soon, I think you stand an excellent chance of walking without a limp, at the very least.”

The physician’s assistant who had excused himself before seeing the x-rays, saying that he was going to get me the names of some orthopedic specialists I should check out back in NY, decided to give me only one name after he returned and reviewed my knee scans.

“This is the doctor you need. There is nobody better for knee trauma in NYC. I worked with him before coming here. Your injury is extremely serious and he works on injuries like this all of the time. You should contact him right away.”

So confident was the PA in this claim that he made sure that my medical orders upon leaving the emergency room included specific mention of this surgeon as my best bet for a successful recovery. That would turn out to make a huge difference for me. Why?

If the PA had simply advised me to see out one of the many excellent orthopedic surgeons in NYC, there is no telling what would have become of me. Upon returning to NYC, all three of the orthopedic surgeons I contacted based on their being “in-network” options for my health insurance were unavailable to perform surgery on me within the first week. By specifically referring me to Dr. W, not only was I able to get surgery within one week of the trauma, I was also able to qualify for what health insurance companies call a “clinical exception.” Thanks to the PA, my family was not penalized for seeking treatment from an out-of-network physician.

In the moments leading up to my 9am surgery on Friday, November 14th, I was exhausted and worried. It had been a strenuous week. On Tuesday morning, I met with the man who would become my orthopedic surgeon. He sized up my injury, told me that it needed to be operated on immediately and that it was something that only he and a handful of other physicians in the city were truly qualified to handle. He sent me for a CAT scan, which took a few hours to complete, and then to my primary care physician (on the other side of NYC) to clear me for surgery. Cab rides without a broken knee aren’t exactly comfortable, so you can imagine. Incredibly, my EKG tests were inconsistent, and so I was referred to a cardiologist for a rigorous four hour stress test the following day, Wednesday. More cab rides and, of course, a whole new set of health-related anxieties. They had to administer drugs to dilate my arteries so that my heart would experience the effects of exercise. Not comfortable, but there was a cool moment where I got to see a fascinating series of images and videos of my heart at work. I passed the tests with flying colors; they blamed the strange results at my PCP’s office on equipment. On Thursday, the day before my surgery, we learned that we would qualify for full coverage by our health insurance because of my clinical exception.

Kissing my wife before departing for my surgery was the first moment that I considered that this might be it for me, my last moment on Earth. In the operating room, after some encouraging words from my doctor, I found myself drifting off. If falling asleep as a result of anesthesia is what dying is going to be like, the only part of it that is genuinely upsetting is that you lose consciousness before you think you’re going to. I had no idea they had even begun administering the drugs when, all of a sudden, my visual perception began to stagger and then everything went black. You do not die, the world dies. Was it Ayn Rand who made a remark to that effect? Whoever said it was onto something.

It was surreal to return to the field where my team was playing in my crippled condition. I took a seat next to a teammate who had come to cheer on the team but was recovering from recent surgery on one of his knees (to repair his ACL after a hockey injury). We chatted about the hardships that lay ahead and he texted me the name of his orthopedist. Teammates checked in with me as they took breaks from playing, some keeping their distance, most of them essentially unaware of the implications of my injury. I detected disbelief when I mentioned that I needed surgery within a week. I couldn’t believe my situation and they seemed shocked about it, too, but also casual and some even a bit uncaring. Their responses, taken together, were unsettling. I started abbreviating my explanation about my condition. Within an hour of getting back to the field, my pain medication began to wear off. I started inquiring about a ride home that night and had great luck on that front, as there was space in a car that had already planed to return that night. I was very relieved that I wouldn’t be asking people to bring me back to NYC who would then have to turn around to return for the continuation of the tourney.

I watched teammates walk to pick up frisbees while I had to ask folks for help pulling together my stuff, all within feet of my body but unreachable. It was starting to sink in that my life had just taken a turn. Players kept standing in front of me and obstructing my view of the action; it drove me crazy having to remind them repeatedly to not stand with their asses in my face. A team captain rallied the team to cheer for me, which was sweet of him, but the amazingly frustrating social reality of being immobilized, crippled, was shaking me to the core. People ignore you.

The car ride home that November evening was about four hours long, but I’m still not home nine weeks later. I’m not myself. My whole life, I’ve been a runner.  I was always the fastest kid in my class. I ran everywhere, for fun and for exercise, simply because I loved feeling my body in motion, loved pushing myself to go faster. Will I ever feel that again? I feel it in my dreams and I wake up wondering if I will ever be at home in my own body again? As of January 10th, I’ve lost 25 pounds, most of it muscle. I’m a video producer and photographer. I need to be able to get myself into position to get a shot and lift gear to set up for a shoot. I wonder when I’ll feel comfortable doing that. My recovery prospects keep me up at night.

Since the surgery, I’ve spent practically the entire time on my back. For approximately five hours a day, every day, I use a machine that lifts my leg and bends it to begin restoring flexion in my knee joint. I’m at approximately 95 degrees of flexion as I approach January 14th, 2009, which will be 8 weeks since my surgery. I should be further along than I am, but I feel like I’ve come up against a hard limit that only more intensive physical therapy will be able to address. But I’m not there yet. No weight bearing until the end of January. In some respects, my recovery has been “fabulous,” “exceptional,” “phenomenal,” according to my doctor. But I feel completely stuck, on my back, every minute… it’s excruciating. Sometimes I stay on my crutches even though blood pools in my foot and my lower leg swells and my still inflamed knee throbs… simply because it’s a different physical position, it’s me not on my back. Of course, I have to relent and lie down, which always feels like a defeat as relieving as it is. I feel defeated because I don’t want it to feel so good to return to the physical position my injury prefers. So much about my recovery remains beyond my control. I blow circuits everyday facing this fact.

I can barely bend my right leg , and I can’t put any weight-bearing pressure on it. Everything is exhausting. Getting dressed, taking a shower, going to the bathroom, sitting down, getting up, sleeping without moving, preparing food and moving it from one place to another.

Pain is my friend, sometimes. I can stop myself from feeling the worst of my pain by not pushing myself during my passive movement therapy. But doing so will make it harder, if not utterly impossible, for me to achieve a healthy, athletic range of motion in my knee. The pain is hot and intense, usually involves my kneecap. Every time I feel it at its worst, which is always during my workouts, is a result of a choice I’ve made, and to that extent it’s a victory. That pain signals my refusal to comply with the demands of my injury. It’s my rebellion against stubborn scar tissue. It’s how I know that I’m doing everything I can to be whole again, even if, in the end, that may be out of my hands. But the pain that I feel after my workouts, the kind I wake up to and the kind that makes it impossible for me to concentrate for long, is simply demoralizing.

I want to run again. I will run again. I will.

Throughout this ordeal, my wife and family and a small group of friends have been exceptionally supportive. There are nights when I have panic attacks about my situation. I can’t move. It’s the scariest condition I’ve ever experienced. I’m determined to run again, but time has moved so slowly since the surgery that I’m a bit disoriented, emotionally and physically. I imagine making progress, but day by day, I’m stuck, unable to detect physical improvement, disgusted by my loss of muscle. But through all of this, people in my life keep me grounded, help me regain my sense of myself. I am humbled by the love and support of my genuine friends. An injury like this provides revelations about the people in your life, and not all of those are uplifting, but they’re real. And all knowledge, even that which gives rise to sadness and disappointment, is liberating.

I will update this page before my upcoming birthday in early March, 2009. I’m hopeful that I’ll have made significantly more progress by then.

STATUS UPDATE MARCH 4, 2009

The good news is there is good news. There are three areas of noteworthy progress.

First of all, I am now able to walk with one crutch, placing most of my weight on my right leg. My endurance is still building, so I tire easily after about thirty minutes, but I am now able to make round-trips to local grocers, my nearby gym, and restaurants. I’m even taking the subway now, simply taking my sweet time on the stairs. It feels terrific to go outside freely. Crutching through snow on my birthday was joyful. I have a cane, which I can use only for short bursts. Not quite there, yet.

Secondly, I have been working with a physical therapist for four weeks, and as of the last ten days, I’ve been going to the gym and exercising. I’ve gained strength and feel quite a bit more like myself.  My right leg is no longer a discouraging skeletal reminder of my injury. I use a stationary bike, the dip bar, and some leg machines for stabilizing muscles, my calf, and my hamstring. I use all of the different-sized, multicolored balls to perform squats and lunges and stomach exercises. Muscle tone is coming back. The pain I feel after my gym workouts is about as bad as it gets, but I’m thrilled to be feeling stronger.

The third thing is that I’m sleeping better and I’m smiling more than I have been. I feel mentally fresher in general, especially over the course of the last few weeks, and though I’m still frustrated by the impact of this injury on my life and worried about long-term prospects, I’m generally happier.

Not all of the news is good.  I’m off the strongest of my pain medications so that when I’m working out I don’t push myself beyond limits that I shouldn’t, which means my pain level remains quite high. This is exhausting and can produce some depressing spells. It’s really hard to focus on writing a blog post or, frankly, anything mentally demanding, when my knee pain is at its worst and all I can do is ice, elevate, and try to sleep it off. I’m hopeful that as I become stronger, the pain will diminish, though the very efforts that will make me stronger lead to awful physical sensations. I have no illusions, based on what I’ve read about my injury and heard from my doctor. I’m likely to be in a fair amount of pain every day for a while to come.  C’est la vie.

My range of motion has stalled at 110 degrees. Despite thousands of repetitions of rather intense exercises, I seem to be unable to push through. The problem is I have really tough scar tissue in my knee, which has partially displaced my knee cap and is essentially in the way of my bending my knee beyond 110 degrees. Fortunately, it is just exactly enough range of motion to enable me to use the bike at the gym.  It’s good to know that my surgeon will eventually remove the scar tissue that’s blocking my progress in this regard, but pushing hard against an excruciating limit that hasn’t budged for weeks is depressing.

*****

My surgeon has been quite reassuring. He told me a few days ago that, from his perspective, I am still in the “infancy” of my recovery. He is “thrilled” with my progress, given that my knee injury was among the worst possible (and, as it happens, among the worst he has ever seen). My joint was completely destroyed, and now it is functional, moving smoothly through the range of motion I have achieved up to this point. He has options that he can use to eliminate the scar tissue, but is following the standard of care in not operating on my knee this early in my recovery. I see him again in one month. Between now and then, he hopes that as I continue to restore the strength of my leg, I will be able to make some range of motion progress. He’ll perform additional surgery, if it’s still necessary, in April or May. If I do make more progress, then I will have only one more surgery, in Spring 2010, to remove the plate and screws currently in my knee that are helping to prevent it from collapsing, which remains a risk through the rest of this year.

STATUS UPDATE August 27, 2009

I am able to walk for two miles without resting. I am not able to jog, and it’s looking like running is out for some time to come. I am not yet at the point where surgery is advisable. I need to be able to hop on my injured leg before my surgeon will remove the hardware holding my knee together. I simply can’t muster the power to initiate the hop. I can squat on the bad leg, but hopping… not there yet. So I keep going to the gym, keep biking, keep hoping.

Hoping to hop. Hopping… to running? I hope.

About six weeks ago, I started feeling comfortable sleeping on my stomach. That was a huge relief. And I’m no longer taking my pain medication daily. I only take it after extreme physical exertion. I still ice daily and take Advil to control inflammation.

I’ve regained my weight and then some. Now, fortunately, I’m heading back down, settling somewhere in the lower 170s, which is where I feel most comfortable.

I still dream regularly of running. I loved… loved… the sensation of running. Some days I wake up feeling strong enough to do anything, but after a couple of steps from bed, my leg reminds me that’s not the case. It’s a struggle to come to terms with a version of my body that is incapable of satisfying the expression of a sense of myself that for my whole life has been so important to me. I have bouts of depression, but I shake myself out of that because I fear undermining my own progress. I know my recovery and rehabilitation isn’t over yet.  I keep my spirits up by doing what I can to support my rehabilitation and focusing on my writing and my professional work. I’m back to earning pay, which is a huge relief.

There is life after this injury. And whatever disappointments I’m grappling with now, I know how far I’ve come. There was no guarantee that I would walk without a cane, and now I’m doing that every day. There was no guarantee that I would be able to walk up and down steps. I’m doing that, too.

Now I need to develop the strength to hop.

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I will post updates as events in my recovery merit.