Pt.II: Tales from a Surprising Knee Surgery (Into a Land of Unreality)

The fourth night home from the surgical center, my heart went into A-fibrillation, the arrythmia that can be an aggravation or a deadly event. I was exhausted, felt ill and my chest hurt so I called 911. Breathless as the heart rapped out its syncopated, galloping beats, and pain radiating everywhere from the knee. The medics couldn’t get me downstairs from the second floor with a gurney and so carried me to outdoor steps, whereupon they asked if I could get down them if they held me under my armpits. I half-walked to the ambulance. Marc followed us in his car.

The hospital ER was quiet, oddly; I was seen quickly. The staff seemed almost listless. But the ER doctor gave me the correct medicines for both nausea and A-fib; things got manageable. I felt more safe to return home after four hours. However, the last moments left a sour taste.

The RN said there were no wheelchairs with feet rests that could be lifted so my legs– the operative one being stiff– could be held straight up. He said in an offhand manner, “We can improvise with a broom on the wheelchair I have, like this”–he showed me how he’d try to rig it, absurdly– “and you can put your leg on top of the broom that you sit on. Or walk to your car.”

I was shocked. My knee stabbed with pain as I walked down the corridors and to Marc in the car. I grumbled about such inefficiency in the ER. Shortly, the RN opened the car door for me, slammed it shut and left without another word.

I was to call 911 two more times in the first 6 weeks due to A-fib. Luckily, things settled before greater intervention was required. My thudding heart went awry in response to pain, nausea, new medicine and lack of sleep.

That night in emergency I had also presented a newly sore, strange looking interior of my mouth, thinking it might be thrush. I had had thrush decades prior after taking three antibiotics for a resistant dental infection, so I knew antibiotics are a common cause. My ER doctor, though, had thought not. But I had been given an infusion of strong antibiotics during knee surgery and again the day afterwards. Antibiotics can wipe out good bacteria, and the effects include fungal infections. I spoke with my dentist. Amazingly, though she was on a CO. ski trip, she concurred with me. She prescribed a strong anti-fungal…though it would likely cause more nausea with GI disturbances.

In the end I declined to take it–enough stomach troubles!– but worried. I could taste nothing, my tongue was so tender that drinking water felt wrong. This was more reason to eat little to nothing. Applesauce. A piece of banana. I lost 6 pounds in 10 days. How was I to start healing if I felt badly every minute? Not to say weaker.

I have a friend, a retired medical professional; she offered a suggestion. She said to try steeping black tea bags several minutes, soaking a cloth in the tea, then wiping my mouth and tongue gently. Black tea, I learned, is anti-fungal and antiseptic. I gave it a try 3-5 times a day. In four days the thrush was gone. I tried to eat, my tastebuds still off. But matters improved each day.

I took anti-nausea medicine longer. The pain from the surgical site robbed me not only of energy and much coherent thought, but my appetite. It was an act of will to drink fruit smoothies, eat more solid food. I had begun to stop the tramadol, the moderate pain killer. (It had created intestinal blockage as noted before; my gastroentrologist helped me get through that.) So, Tylenol was the best I could do. It barely alleviated discomfort. I was becoming slightly accustomed to the deep burn of hurt in knee and leg. But I learned to use a walker when I had to get up.

My life was literally rearranged during this time. I now slept in the living room on a twin bed we moved there. There was no way I could daily get to the second floor and primary bedroom, or back down those stairs. So Marc slept nearby in a recliner. Every night. If I awakened, he heard me stir and was at my side. If I needed to use the bathroom, he was up and at my elbow. If I bolted up in bed at four a.m. racked with tears of agony and despair, he held me. If I began to protest, told him to get needed rest, I was just a mess but I’d be ok, he did not move. He knew I wasn’t going to be okay. Not like before all this had transpired. Not for a long time, perhaps.

It was disorienting at first lying in that bed in the main room, watching night cloak the space in soft shadow and then rays of sunlight seep and spread. And watching juncoes, wrens and sparrows pecking at the suet block under the balcony roof. It was the thing I waited for each day: to observe nature at work. I was thrilled when I got a close up view of a flicker. I gazed through dark emerald pines and bare maples, glimpsed purplish mountains beyond– if it didn’t rain. It nearly always rained part of the day. It even snowed a few days, transforming the view with radiant white. It all comforted me, especially the watery drumming on all like a lullaby.

It seemed like a movie set, the whole thing. I was… myself yet not myself, at all, wandering through a spiral of time beyond time, but captive by my howling body. I drowsed, half-dreamed, twitched and turned with each stimulus of myriad reminders: cut tissue; rearranged muscle, tendons and ligaments; the hammered bones, the titanium objects that made a new and improved knee. Was it? How could all this fall out convince me? My flesh felt heavier at night. Confounding. Something I wished to cast off even as I felt compassion for the animal it was. I was.

But then, hummingbirds– Anna’s hummingbird, the only one remaining through Oregon winters. They hovered at the sliding glass door, peering in while I looked out from bed or recliner. Tears filled my tired eyes when I first saw them come to their feeder. They were used to me sitting or standing outdoors near them. They usually came to greet me and hover before my face , gape at me as I gaped back: gorgeous black shining eyes, surprising plummage. They seemed a good omen. That they’d look inside and see me waving was a joy. Maybe I’d manage to heal, stand on the balcony as they came to vibrate bright air between us. Some day.

In the midst of this, half-helpless the moment my knee was ransacked and replaced, there was physical therapy. No excuses; I had to go even though I didn;t sleep or eat well. Within a week post-surgery, I attended my first session. I had no idea what was going to occur in that tidy room or I might have left.

The PT studied my leg, then grasped it carefully but firmly, saying, “This will be hard; you’ll hate me now but love me later. Your leg looks pretty good but it can’t stay straight, it must bend.”

I have known several hard times medically and violent assaults in the long ago past–but never before have I known that new level of misery. K. slowly but with considerable might began to bend my intensely resistant knee. Ot felt like it screemed. Or it was me as tears flooded my cheeks. I clamped my mouth shut. She paused and handed me a tissue box and said, “It’s ok, cry it out. You will get through it…. it’s just the beginning. “

That would become thefirst thing to get beyond three then two times a week. And the knee with swollen tissue and shocked bones began to relent under her calm extertions. There were degrees of flex we needed to reach each week, before scar tissue built up and impeded range of motion. Not a good thing to allow, sometimes requiring more surgery. She was right; I very much disliked seeing her and was relieved when assistants took her place and I could move onto the next thing. But the worst was not going to happen if I could help it. Some sessions I came close to the degrees we needed; other times I lost ground.

At almost five weeks my bent knee reached the 120 degrees angle K. expected to occur, and it was like winning a grueling event. I’d done it; we’d succeeded. I texted my family and groups of friends. I was fianlly able to see progress.

Meanwhile, there are other exercises to get done. At home I pushed myself hard and learned that taking many deep breaths helped with a prayer. But in time the therapy imbued me with not only soreness but relief and gratitude. I was getting stronger. I was no longer utterly helpless; each action tackled gave me hope. I found unexpected sources of energy and endurance. When I was depleted, it was just there more often than not. I did my exercises every day. Every single thing that hurt so much informed me: do not look back, keep going. Every momentary failure addressed me: just keep going. Each morning I awakened with greater tender swelling so I applied ice packs several times a day. And it concentrated my mind set: don’t you give up; work; recover; be brave–find the courage despite pain and uncertainty. Marc held his breath when I cried out but I shook my head at him: no comfort neeeded now, I was going to be alright.

Pray. That’s what I did every day, too. Sometimes prayers don’t manifest in words. They are formed by soul sounds uttered softly. Or in echoing depths of silence. And I talked to my knee: oh my beautiful, beautiful, blessed knee, may you be brave with me. Does it seem strange to do this? It was necessary. My hands soothed it tenderly after staples were removed and the long wound closed. I let warm water fall over it, a tiny tropical river from the shower as I sat bent over on a shower chair. I felt so old. Frail at those moments. Small, humbled, to be brought to this. But it is not true that one is stripped of dignity when challenged much. Things change and then survival reigns. Dignity is the soul coming forward and embracing the sharp brokeness until it all yields, mends, and one finds a way to become a resilient whole again. No matter what that may look like, at first. There is a complicated harmony within the body’s own mastery and the greater mind that is forgotten in darkest times. More potent than malaise, that sacred symmetry can be restored, secretly, in minute ways. And that is a wonder.

But it was a place I never thought to be. I mean, small, weak and exposed as my husband waited to aid me with every basic need. When did I ever lean on him or anyone else to such an extent? I had to surrender. It was important to have routines. Each morning, afternoon or night, the flow of warm water seemed an annointing. Putting on fresh clothing eased discomfort. It would have been easier to give and an lay in bed, not try harder. But I’d get through the movements and then, eyes closed, I held tight the threads of hope God and I had spun. The ruined knee was learning to bend, the joint and sinew had to resurrect at an invisible cellular level to regenerate stamina. Power. Gratitude mixed with common exhaustion shaped my hours more often.

Without progress I would not make it in this world. I must be able to be outside any time I can choose. To walk and breathe freely. I had to hike again. I had to absorb, face to face, flowers’ breath, run my fingers over sponge of mosses, gaze at the pines swaying in gusts, my long grey hair tossed and tangled: God lived out there as well as within. So I had to move past previously unfathomable hardships. Just deal with a new clumsiness. How strange that one leg would not do what its encouraging twin did with ease.

I placed my healthy leg against the wounded one and instructed: “Heal.” I touched my lips and cheek atop offended knee and felt its heat, which told me that though it was still dealing with invasions from surgeon and the sci-fi-like robotic assists, it was rebuilding.

And my body did its work despite worry or resignation. I felt a stirring of optimism. I told everyone I felt better, smiled more–because I really did.

Then, at not quite three weeks, I felt a more tender, oddly swollen spot on my operative leg’s lower calf and thought: I have a blood clot.

I was right. After an ultrasound I was whisked to ER once more and treated for the small blood clot with a potent blood thinner. I had hoped for a magic shot of a clot buster and then out the door. I was told I was lucky to have a clot in the calf, not above the knee, where it more easily moved up, up, to the lungd, heart or brain. I wondered about the strong blood thinner. I was already taking aspirin for a twenty year diagnosis of coronary artery disease. I’d also had a very bad experience with a previous RX blood thinner. But no one wants a blood clot to migrate upwards. The new medication would help stabilize the clot and keep more from forming. Hopefully. The only thing I had to keep an eye on was any sign of internal bleeding. Otherwise, in a few months the clot would be reabsorbed and no longer deemed any threat.

Does one feel grateful about such pronuncements? I was. I was no longer very shocked by every surprise. Given pause, sure–really, how much more? But I accepted it for what it was: another hurdle now better surmounted.

I went home feeling reassurred. I could keep up my exercises. Time slipped by as I continued on the daily work, as well, of mental well-being–reading, meditating to music, getting outside as the weather allowed, even to stand in the open air. I was busy visualizing healing and wholeness. I was open to all prayers offered. I had visits from friends and family. There were times I felt a sweep of great love fill me.

Marc was less anxious about me as progress was noted. However, I still felt wiped out every day. I often was overcome with a bone-deep weariness accompanied by breathlessness and a cold sensation of sudden weakening as I leaned against the dining room table or sat down on the steps leading to my bedroom. Why was I not feeling more energetic yet? I was sleeping and eating better. My digestion seemed ok with no apparent bleeding–I watched for it. My hands and feet got way too cold, fingertips and toes could go white and numb. I at times felt light headed, almost empty in a physical and mental way. But I was managing alright, otherwise. I checked in with my surgeon’s team regularly and spoke as needed with the GI team. (I could not talk to my primary care provider because she was too busy, no appointments open for weeks, which angered me.)

But something important wasn’t right. I needed more help. The realization filled me with a creeping anxiety. But I did not fully realize what the odd symptoms signalled. Maybe I had to believe that I was going to be well and was in denial. But the next event would be beyond anything the knee replacement experience had presented: a life threatening state.

It was fate– or more likely a bona fide miracle– that a soft spoken, attentive doctor I had never met happened to have an immediate time slot available for a follow-up of the last ER visit. And what he said and did changed everything.

(Next time, Part III of this tale)

6 thoughts on “Pt.II: Tales from a Surprising Knee Surgery (Into a Land of Unreality)

    1. Yes, toomcuh is a good way to sum it up. And writing despite the sudden tears that it has brought makes sense of the shock and degrees of hardship. How fortunate we have written language even when language feels inadequate. Thanks, Jan.

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