Too Calm

When Fun Turns to Tragedy
Or 
What You Don’t Know Can Hurt You

“Okay Doug, you’re all set. We’ll see you Monday the Thirteenth.”knee surgery

“Okay!! Okay for what? What happens on the thirteenth?”

“Surgery!!!!!”

     Thus was the manner in which I learned I was to undergo my very first surgery. I mean, I knew I probably needed it with the way my knee had been folded backwards a mere two weeks previous, but to actually hear the words was a bit of a shock. Aside from twenty minutes of plastic surgery to repair a compound fracture of my nose during my senior year in high school, I had never had any surgery. Let alone major, invasive, re-constructive, orthopedic surgery.

      “Hold on a second!!!” was my first response. “I’m pretty sure I’ve got a few questions that I may need answered. Any chance someone is going to explain to me, in any detail, just what ‘surgery’ means??”

      “Oh! The Doctor will be back in just a moment to answer any questions and fill you in on the details.”knee surgery knee surgery

     This was November 1, 1995. I had just found out my right knee, which suffered a severe hyperextension and dislocation on October 19th, was to be reconstructed on Monday, November 13th. Before even leaving the Doctor’s office that date had been brought up to Friday, November 3rd. I now had forty-eight hours to ponder the severity and implications of the impending surgery. Come Thursday that date was again pushed back. This time to Monday, November 6th. A date that will remain forever etched in my memory.

     To think, it all began with a harmless trip across home plate in an otherwise meaningless softball game. We came back and scored 18 runs in the last three innings to win the game. In that fateful last half inning I was on third base representing the tying run, the winning run was on second and the batter launched a double off the center field wall. Simple! We just won the game. All I needed to do was jog home and the other runner would come sprinting across just behind me. I simply wanted to touch home plate, turn around, high-five the guy behind me and commence with the celebration. However, something went drastically wrong with that perfect scenario as soon as my right foot made contact with the plate. Plastic cleats on a plastic plate proved a lethal combination for the health of my knee. I remember my foot making contact and immediately slipping causing my knee to straighten and lock-out. I’m sure the chronological time-continuum of what happened next occurred in a matter of seconds, but with the intense focus I now had on what I knew to be imminent disaster, I felt you could have timed the event with a calendar. It seemed to take a lifetime as my foot slid the seventeen inches across the plate and, although I didn’t know exactly what was going to happen, I did have confidence that it was not going to be any fun. All my focus was now directly on my right leg and, more specifically, my right knee. I had this eerie feeling that I was screwed. Something real bad was about to happen and there was not a thing I could do about it.knee surgery    

     My foot twisted slightly with my toe pointing outward at the moment it met the dirt on the other side of the plate. My foot and my leg up to the knee came to an abrupt halt while momentum and inertia carried the rest of my body forward. With my leg already in an extended position there was absolutely nowhere for my knee to go except backwards. With the toe pointing outward, the knee not only folded backwards but the lower leg also spun around approximately 210 degrees. In a flash, I was crumpled behind the plate clutching my knee and screaming at the top of my lungs every profanity I had ever heard. I recall the rest of the team jumping around and yelling about the exciting comeback – with some people almost stepping on me as I continued to scream and live out my own private little nightmare. Just then I heard someone’s voice say, “Hey! I think Doug is hurt!” “Gee! Do you think so? What was it that gave me away?” Focus then went from the celebration of the victory to the health of my leg. The team huddled around asking what was wrong. Not quite sure what had actually just occurred I didn’t have an answer for them. With tears of shock streaming down my cheeks, I gathered my composure and in just a matter of minutes went from shock to denial. I sat up, slowly straightened my leg and exclaimed, “It’s okay! I think I just twisted it.” I pulled up my pant leg and saw no blood or protruding bones so I figured I must be all right.

     A couple guys helped me to my feet and I tested my knee with some weight. Of course, in that situation you’re only testing the strength and integrity of the muscles and the tendons. The ligaments serve the purpose of keeping the joints of the body from folding in the wrong direction. As long as I kept my knee bent slightly forward I would not realize that there were no longer any ligaments attached to the bones to keep it from folding backwards or to the side. I was able to walk off the field and make it to the dugout, but as I reached over to pick up my glove I must have straightened my knee too much. It folded backwards and I collapsed to the dirt dugout floor, once again screaming in agony. I knew something was seriously wrong.knee surgery knee surgery

     Two guys helped me to my car and I was able to drive home although the pain got worse every minute and by the time I made it to my door I could barely take a step. Once inside I put one ice pack on top of my knee and another underneath it. I was hoping I could at least make it through the night but the ice made very little difference. Within a half hour I asked Mitch to take me to the emergency room.knee surgery knee surgeryknee surgery

     It took a short time before my turn arrived, then Dr. Auerbach came in armed with a series of probing questions designed to get to the heart of my injury. Then the hands on, practical examination began. He started pushing and twisting and jerking my leg around causing more discomfort. Occasionally I had to let out a little scream, which drew the attention of some ER staff nurses and the orderlies on duty. Eventually the diagnosis came back that I may have torn the meniscus but there was definitely no ligament damage. Ironically, the meniscus is the only soft tissue in my right knee joint left unaffected by the accident. I was given an immobilizing splint and a pair of crutches, (I say given – their cost showed up on my ER bill), and granted a release from the emergency room. They also gave me the number for the John Muir Orthopedic group and suggested I make an appointment to see them for a more extensive diagnosis.

     While explaining to my clients that I would be unavailable for training until further notice and why, one of my clients suggested I call Dr. Torsten Jacobsen. Dr. Jacobsen had put both his and his wife’s knees back together. I set up an appointment for the following Wednesday.

Knee Construction Model

     During that initial consultation the Doctor had me lying on my back on a table with my right leg hanging over the right side. He then pushed and pulled and twisted my knee in a few different positions. Although there was no pain it sure didn’t feel right. My lower leg was moving in directions and into positions I just knew it wasn’t supposed to. He then twisted and pushed and my knee moved about an inch. I went, “Oooooooh!” The Doctor said, “Uuuuummm!” He put my knee back to normal then did it again. I went, “Oooooooh!” The Doctor said, “Uuuuummm!” We went through this one more time, and then I finally said, “What? What does all the oooooh’in and uuuuuumm’in mean?” He then told me he thought I might have torn the Posterior Cruciate Ligament and possibly the Posterior Capsule of the knee. An MRI a few days later confirmed his original diagnosis and revealed a whole lot more damage as well. Shortly after that I heard those fateful words that opened this story, “Okay Doug, you’re all set! We’ll see you Monday the thirteenth.”knee surgery

     Never having had any major, invasive surgery I had no idea what to expect so how could I express any anxiety over what turned out to be the most traumatic personal event in my young life. While leaving the Doctor’s office that day on November 1, the office staff was commenting on how calm I was. My reaction was a simple – “Whatever!”knee surgeryknee surgery

     I guess I was bright enough to have some foresight that this procedure would incapacitate me at least a little bit. I figured I should probably stock up on groceries, making sure to have plenty of simple things to eat that didn’t require much in the way of preparation. Little did I know . . .!knee surgery

     The fateful day had arrived! I had made arrangements to get dropped off at the Surgical Center joking that I’d meet some friends out that night to celebrate the success of my surgery. After filling out some detailed paperwork and reluctantly parting with my ridiculous $2,400 deductible, I took a seat to wait my turn through the Sawmill. I got about halfway through a three month old Sports Illustrated when a well-smiled nurse full of pomp and gayety came, literally, whistling through the door to tell me, “It’s time!”knee surgery

     Sometimes when you find yourself in a foreign situation with something of paramount importance on your mind you have a tendency to pass through the experience with a limited tunnel vision. Being acutely aware of this I made every attempt to take in as much as possible as the nurse wheeled me through to a preparation area. We had a great conversation as she shaved my knee and commented on how calm I was. I saw a theme developing where I began to realize that most people have some apparent anxiety over the anticipation of surgery. It didn’t seem to bother me at the time so I went on joking with the nurse and taking in as much about the experience as possible.

     Roughly an hour later than expected The Good Doctor came in and asked how I was doing. We talked for a moment then he went to prep and the nurse wheeled me into the operating room. I made every attempt to look around and take in all that I could. There were orderlies working to set up the necessary tools and instruments for the procedure, two nurses assisting me onto the operating table, the Anesthesiologist preparing his equipment, a massive machine next to the table I was on with all kinds of lights and bells and buzzers, my IV drip that made the trip from the preparation area with me, the Assistant Surgeon, and ultimately The Good Doctor himself. Next I was introduced to the Anesthesiologist who told me that soon the last thing I would remember would be him telling me, “This is the last thing you’ll remember”. One of the most wonderful feelings ever lasted about two and a half seconds after he said those words then . . .knee surgery

      “Doug! . . . Doug! . . . Doug! It’s time to wake up!”knee surgery

     Someone was gently shaking my arm, calling my name, and generally bugging the crap out of me. I recall never having been more relaxed and complacent and could not understand why someone had this compelling need to disturb my peaceful tranquility. As I rose to consciousness and opened my eyes I became aware of this tremendous pain in my right knee and immediately recalled where I was and why I was there. Then it all came apart! I began shaking uncontrollably! A common reaction to the anesthetic I was told. I was freezing; every muscle in my body was shivering and shaking violently, which didn’t help the discomfort my right knee was experiencing. It was at this very moment I had an acute awareness of having never been more miserable in all my life. Two nurses were trying to hold me down, a third was covering me with plastic and shoving a heating element under it, all the while The Good Doctor was standing beside me calmly asking, “How are you feeling? Is everything okay Doug? Is there anybody you’d like me to call? My first reaction was to scream out something to the effect of, “I don’t know! Go call your wife, tell her you love her! I don’t care. Just make me stop shaking!” But somehow in the midst of the most miserable moment of my life I found the serenity and the clarity to calmly call out my Parents home phone number and suggest that he call them as I knew they would be concerned for my well-being.knee surgery

     I find it peculiar that during these intensely heightened moments of our lives we find a truth that transcends the drama and grants us an awareness we would otherwise never possess. For it was during this time of intense discomfort, when I was no longer unusually calm, that I had the peace of mind to calmly ask the Doctor to call my parents. Perhaps my subconscious knew the best way to get his probing questions off my back so the nurses and I could concentrate on the greater problem at hand of controlling my violent shaking and miserable discomfort was to give him something else to do.knee surgery

     Suddenly, there was a huge needle in my left thigh and I didn’t seem to mind. A warm rush went through my leg, the shaking subsided, my throbbing knee calmed down, and life was once again moderately tolerable. The Doctor soon left and it became quite clear I was going nowhere for the night.

     I recall trying to lift my right leg just to see if it was possible. As the quadriceps contracted the dial on the pain meter shot off the chart. “Okay!” was my only reaction. I now had a firm understanding as to why everyone was so surprised at my initial calm. This was pain like I never knew existed. Childbirth I’ll never experience but broken bones, torn muscles, and drilled teeth, had nothing on the severity of what my right knee was going through. I learned later that four and one half hours of drilling, hammering, and cutting, with tools similar to what Norm Abram’s uses on “This Old House” accounted for the discomfort I was experiencing.knee surgery

     I managed to sleep off and on throughout the night, yet every time I came to there was a nurse asking me if I needed to use the rest room. She always had more water for me to sip and seemed unusually concerned with the schedule of my bladder. At about six thirty the next morning I finally had to go. She may have been happier than I was. Figuring I was already hooked up to something or that she would bring a bedpan I had no reservations about expressing my need to go. Well, she was all excited and began searching for a pair of crutches. “Crutches!! What the heck do I need crutches for?” Remember the pain when I attempted to just lift my leg off the pillows? Now this nurse is under some delusion that I’m actually getting out of this bed just to take a leak.

      “We can’t let you leave the Surgical Center until you have proven your ability to get yourself to the bathroom”, she said.knee surgery

     Her all-night badgering about the rest room was now clearly explained. Rules are rules and not wanting to violate their rules I said, “Fine! Sign me up for a few days, ‘cause I ain’t goin’ nowhere!” Although I figured there was not a snowball’s chance in Hell that I could even conceive of getting out of this bed my cries of bloody murder proved a futile attempt at not having to get up.knee surgery

     All smiles and excited for the show, the nurse came back with a pair of what turned out to be pediatric crutches for a child in their early teens. Unaware of the inappropriate size of her crutches of choice, I made slow progress in getting my leg off the stack of pillows on which it was resting. When finally I managed to lift it free of the supporting pillows I realized the pain did not continue to increase exponentially. After the initial surge of pain, when the quadriceps were contracted, it got no worse. I managed to sit up and while trying to swing my legs over the side of the bed I met resistance in the very nurse, bless her heart, trying her best to be of some assistance. Call me independent, but at this point she was just in the way. Finally I said, “Now you’re just going to have to move.” She gave me a puzzled look and I explained that she was standing in the very spot that my throbbing leg needed to go. She stood back, adjusted my IV drip, and handed me the crutches. After getting to my feet and leaning over the crutches I had to ask if this was a sick joke or another test in my ability to care for myself. The handles were up around my ribcage and the armpit supports were not much higher. Once I found my balance it was off to the races. Now there were two nurses helping me and each commented on how adept I was at the use of the crutches. Any less adept and I’d be crawling after a rapid and painful descent to the floor so my success was more out of a desire to remain upright than an actual proficiency in the use of crutches.knee surgery

     Once in the rest room the true fun began. I found myself standing in front of the toilet attempting to balance on my left leg, lean on one crutch, hold onto the wall, pull my gown and my boxer shorts aside and concentrate on the business at hand. All the while, this ever-present and perpetually helpful nurse was carrying on like we grew up together while holding my back for additional balance. I realized there was just way too much going on for me to even consider relaxing and doing what I needed to do. I was thinking, “I’ve got enough problems just trying to stay upright and relax my throbbing knee that I probably would not be able to accomplish my goal even without the further distraction of having this strange woman holding my back”. A minor brainstorm hit me that I might find more success if I was able to somehow turn around and sit down. That proved moderately helpful but did lead to a major brainstorm when I told the nurse she might be of greater assistance if she were to get me a glass of water to quench my imaginary thirst. Once gone I knew my window of opportunity would be very small. I mustered all the concentration I could manage and barely squeaked out a few drops - hardly the level of success that would guarantee comfort upon my return to bed. Victory came just as the nurse arrived with a small cup of water. I thanked her, poured the water in the sink and told her I was all set.knee surgery    

     Once back in bed I found myself with another big needle in my left thigh. Breakfast arrived moments later. I recall seeing oatmeal, orange juice and Jell-O, but I ate nothing. I was tired and slept a little longer but it then became apparent they wanted me out of there. “Nothing personal”, I was told. It’s just that one of the drawbacks to having surgery in an outpatient facility is the compelling need for “Bed-Turnaround”. After another shot of Demerol I was again on my way to the rest room to make another attempt at bladder relief and see if I could manage to get myself dressed. I stood there for a few minutes trying to figure out just how I was supposed to get my pants on when I didn’t have a prayer of reaching my feet to get them started. They say that necessity is the mother of invention. Although I had to rest a few times, it must be, because somehow I managed. Once dressed, I came out and sat in a nice vinyl recliner to await my ride home. It was at this time I began to realize Demerol doesn’t really kill the pain; it just makes you so stupid you don’t care. I remember looking down at my knee as I sat there thinking, “Man, is that knee sore! Sure glad it’s not mine!” knee surgery   

     By the way! Whose idea was it to cover the walkway to the front door of the surgical center with cobblestone? I mean, it’s aesthetically pleasing to the eye upon your arrival at the facility, but one heck of a nightmare upon your departure in a wheelchair. I thought the bump getting on and off the elevator was rough until we hit the cobblestone outside and I was bumbled down the walkway.

     That acute awareness I had tried to maintain upon my arrival at the surgical center the day before was long-forgotten in the post-surgical pain and discomfort of the morning after. The ride home proved uneventful yet turned out to be the calm before the storm. It hit me once we got home that I lived in a townhouse, split-level condo where the entire unit was fourteen steps from the ground level where the van was parked. Trial and error got me up onto the front step but also told me I didn’t have a prayer of negotiating the next step into the house let alone the fourteen to get the top. With a little help from Mark I did make the step into the house then had to stop and think about the next fourteen. A few minutes of planning and it hit me to try losing the crutch, turning around, and scoot up the steps backwards on my butt, one step at a time. It worked well but also told me I was to have great difficulty in making my way around the condo since once up these fourteen steps I would need to decide whether I wanted to stay in the living room or make it up to my bedroom. The living area of the condo was separated from the bedrooms and the bathrooms by another seven steps. I decided to try my hand at staying on the couch.

     Mark left and for the first time I was now alone and left to my own resources, which proved very limited. The intoxicating effects of the Demerol were wearing off and I had yet to get any Vicodin. As the reality of the pain began to hit me I called my roommate Mitch to see if he could take a few minutes to fill my prescription. I think it was about an hour or so before Mitch made it home with the Vicodin but it sure seemed like a lot longer. I recall sitting in the elbow of my sectional sofa with my right leg perched upon a cloud of pillows and my upper body curled over delirious with pain. The phone rang four times during that window of time. I remember speaking with, or should I say listening to, my Father, my Mother, my Great Aunt, Kerry Regan, and Dick Hatfield, who felt the need to tell me jokes in an attempt to make me laugh. I remember the calls but I couldn’t begin to tell you what was discussed. I just remember my eyes were closed and I wished I were somewhere else. Finally the drugs showed up. I read the bottle, although I’m not sure why. I had every intention of taking four or five pills and going to sleep.knee surgery 

     A long and arduous trip culminated in the arrival at the side of my bed where I remained for the next twenty-four hours. Slowly I managed to get into bed and with my leg perched on a pillow I drifted off to la-la land. The next day I came to at about 12:30pm hungrier than a post-hibernation bear, and desperately needing a trip to the bathroom. What followed was an odyssey of adventure and discovery.knee surgery knee surgery  knee surgery

     I began a pattern of exiting my bed on the left side and wearing an S-shaped trail into the carpet from there to the bathroom. Once back from the bathroom I figured since I was already up I would attempt a trip down to the kitchen for some grub. It was now Wednesday afternoon and I hadn’t eaten since late Sunday afternoon. Slowly I made my way into and down the hall. I negotiated the stairs with all the grace of a newborn calf, and found myself in the kitchen searching for some of that preparationless food I had the foresight to purchase before the surgery. The best I came up with was an Odwalla Monster C and a bag of dry cereal. The Odwalla went into my mouth and the cereal came out of the box so I could wrap the bag around the handle of my crutch. When I made it to the stairs my thinking cap went back on since I realized I couldn’t make it up the stairs backwards on my butt with the breakfast I was toting. The best solution seemed to be backwards on the crutches one step at a time. When I finally got to the bed twenty minutes had elapsed since I began this odyssey and I was dog-tired. I collapsed on the bed, dropped the cereal on the floor, the Odwalla on the bed next to me and fell back, sound asleep. Three hours later I ravaged the bag of cereal, inhaled the Odwalla, completed the meal with a few more Vicodins, and slumped into yet another restful sleep.

     Thus came to an end the initial post-surgical seventy-two hour period. After that the pain was bearable. I discontinued the use of the Vicodin and was on the road to a one-year period of recovery. The insurance scam and financial nightmare that ensued is a tale for yet another short story, but for now I can reflect on the experience of my first major surgery as an adventure I’ll not soon forget. I have recently been told I should have another surgery to replace the Posterior Cruciate Ligament to tighten-up my knee and create greater stability in the joint. The question now is not whether or not I’ll have the procedure done but with what level of trepidation will I enter the new experience.

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