Pt. IV: Tales from a Surprising Knee Surgery (Leaning In, Looking Forward)

Relieved to be back home, I was able to return to our second floor without gasping for breath or feeling that strange chill of too little blood flow to head and extremiities. It signalled a new phase, I hoped, and was pleased to feel able to further right my world by tidying a bit like an ordinary person. I lay down on my blue quilt, staring out windows that framed dark green pines towering above my view. It felt luxurious. As if I had stepped into an unreal, happy vignette. Could this be a better life? Marc made a pleasing meal and we watched a little TV, but then I was ready to turn in. The balm of sleep at last!

The same day following my return home, Naomi and her partner, Adam, came by. He’d flown in from Colorado the night before; it was an earlier planned visit like my daughter’s. And it also happened that my brother and sister-in-law were coming for a couple of days on their way back from an L.A. photography workshop. I had expected before surgery to be in good shape by March, not limping along, poorly recovered. And I wasn’t confident about having visitors yet. But it was a happy occasion to be with my family. Everything worked out well enough. I sat alot rather than head out for energetic jaunts as would have been usual.

Mid-week we had a bigger family meal before folks flew out. Naomi and Adam generously shopped and prepared food. My lovely sister-in-law pitched in. It was a bit tiring yet relaxing, ultimately a replenishment–such is the presence of palpable love. They were pleased I was upright, independently mobile, and interactive despite the sore, knotty knee. Despite troublesome weeks. I didn’t bother to try to pretend it had been otherwise. We could all see progress being made. Even if I was still very pale and bleary-eyed.

A physical therapy session also took place the day after I returned. I was grateful the therapist was easier on me after I explained what happened. The following sessions we got back on track. I did more work, faster, than I had before. I nearly hit the 120 degrees of flexibility. That felt triumphant.

I saw my orthopedic surgeon, Dr. G., two days after the discharge. He knew about the hopsitalization and noted I’d had challenges. I had wanted to share my litany of horrors. Tell him how I had sometimes just hung on. But he had done this work for 35 years and simply examined my leg and knee and declared everything in good shape–the incision well healed, and the blood clot properly addressed. He was done with me in ten minutes. I wanted to be angry with him and to feel “dismissed” although I knew this is more typical than not.

This surgeon has garnered many accolades; when a friend recommended him before an imminent retirement (he retired since that check up), I’d booked my apointment. Dr. G. didn’t create the steady stream of complications. I was medically “unlucky”, experiencing problems a small percentage do. There are risks to any major surgery. In the end, he told me I was ahead of the usual schedule with great knee flexibility and stamina at just five weeks. I could drive again; I could take longer walks. It thrilled me to hear and I sailed out of the office.

I saw Dr. Patrick, my cardiologist, the next week. I was informed I’d be on the Eliquis, a blood thinner, for several months at least but no aspirin (as it is another blood thinner). I imagined the blood in my veins rushing and roiling like a spring creek with such a thinning out…Then we decided to change an old beta blocker to a newer one to see if the break-through arrythmias diminished. Rather than report on all of the next ten days, the summary: the opposite effects occurred than what was to happen–of course, one more thing— and I returned to my old medication without further issues. Chronic pain, exhaustion and general stress can upset the heart. I dearly hoped mine would calm down. And it has.

As I write this, it has been another five weeks since the transfusions and critical repair. Nothing else terrible has happened. The longer I feel better, though, I also wonder if something else is about to go wrong–then pull myself back from that precipice. The worst times of moaning and crying are receding little by little. The experiences are embedded in my brain, but in time they will just be another small portion of the remarkable landscape of memory.

I awaken not feeling worry but anticipation of a decent day. I do check my knee as soon as my eyes open–is it too hot, painful or sensitive? The answer has been “negative” so I get going. I remain anemic; the numbers I want to see are distant. But the hemoglobin was last at 9.2, an improvement though not the 11.2 that’s a low but acceptable number. Red blood cells are still lagging; I have another blood test soon. I’ve been assurred it takes awhile for them to repopulate after such a loss. I am tired after doing chores and breathless when I climb stairs or take walks–some days. But this is less so than three weeks ago, than even last week. Some nights that healing knee desires to bend more, to stretch better and turn and twist–then twinges and shocks awaken me. But I know healing is happening without my full knowledge. The bone, sinew and blood are reparative in action, doing complex work every moment. This generates heat, soreness, swelling even as the prognosis improves.

I still talk to my knee. I apply lotion, smooth out tight bands of muscle, the long reddish scar. I say: you are something to behold; you are a miracle of rejuvenation; a testament to God’s powerful creativity; a blessing to this body.

My oldest Oregon friend, Brenda, toughened by her challenging life– yet possessed of a great tender heart– checks in often. She was so anxious about my state of health that she contacted me daily. She has endured many surgeries and survived difficult illnesses. But she recovers enough, gets back on her feet. She still works full time–counseling prisoners. She possesses soul, gusto, and is one of my heroines. “We’re still here; we’re in that crazy company of long-term survivors. We’re older, crustier; we have to be here for each other.”

I’ve been kept safe during tidal waves of fear and confoundment by indomitable forces of caring. I even am fortunate to have three newer women friends who have visited, checked in, brought me homebaked muffins, full dinners and flowers, and who continue to cheer me on. None of them are free from crises; none are defeated by difficulties yet. We fall and rise and fall. One friend–a serious adventuress– has gone walking with me despite having been hospitalized for a respiratory virus and lingering asthma. We look for opportunities to enjoy ourselves. Being seventy-ish is certainly not the end of good times. Age is barely noted as we embrace each day. Today we are hiking at a state park. I am not sure how well I will do–but we’re heading out. I know I will love every moment.

It is good to be beloved by friends and family. To know that the universe which holds a world so often harsh and cruel is also redemptive and restorative. That there is a synchronicity and symbiosis we must respect. That amazes. We are here to do the work we can do and to find it beautiful and valuable enough. For me, living is predicated upon the connection I have to a boundless energy of love known as Divine Creator, Almighty God.

I can walk the greenery-lined paths now, bracing for hills, keeping eyes on sky and trees. I’m a little clumsy; my right leg can oppose my intentions in an instant. I’m pleased I can climb up and down steps one foot after another; manage a shower in record time; get up, sit down; do daily tasks that were not long ago too taxing. And driving my little red car with the sun roof open to the bright air! I’m able to meet a friend for croissants and a mocha, or just take care of business. Self sufficiency is a tonic to the soul.

Spring blossoms send me into quiet elation. I’ve been down to the river to view its turbulance and tranquility, to hear nature’s wild, harmonious music. I’ve sat in a sliver of sunshine on the balcony, watched pine and maple branches shimmy. I’ve wondered over our hummers at the feeder–such powerful, tiny bodies that put mine to shame. They don’t quit; even rain and wind don’t deter their flight and daily endeavors. If in need of rest, they sit on the feeder under the eaves and simply rest, watchful but calm. What a delight it is to be on the periphery of their world, to watch and learn.

Loss can sharpen the human need to value life more. And to share it more generously. From the depths can arise a new semblance of wholeness. The good thing about being unwell is what it feels like to get better: scrubbed of illness and with it, so many trivialities. Extraneousness and superficiality are poorly tolerated.

I’ve embraced an extreme passion for life ever since childhood. My young friends could find me a bit too intense. I often felt like a poet-vagabond in a world of constructs that meant nothing to me compared to constellations spanning the beyond. I thought I might burn out by thirty, the flame within was so hot. But intensity also fuels a stubborn desire to keep on despite the odds against success. I will keep exploring the soul’s mysteries, remain present within depths of mind and heart. To celebrate the perfection of bones, the heavenly earthiness of blood, skin and nerves. This tent I live in has been torn and repaired often. There is enough common sense combined with courage to utilize, after all. Hope remains a golden wellspring. I was born to the revelations and nuances of this journey, and one day–not today, I pray– will take my leave convinced this human life is a miracle to be believed.

I would very much hope the same for you.

(Click on photos for captions, if desired.)

Pt.lll: Notes from a Surprising Knee Sugery (Slipping Away, Heading Back)

The appointment was just a check-in regarding the blood clot and attendant ER visit. The atmosphere became easier, calmer when Dr. S. entered the chilly room. He asked specific questions about all post-surgery events, listened closely and checked my electronic medical file. His accented warm voice gave me pause a few times so I leaned in to better understand him. He seemed to possess two sought-after qualities: compassion and investigative skills. As a consequence, I felt safe sharing authentic experiences.

He was openly irritated that I’d been unable to meet with my primary care doctor after surgery, considering the crises. He spoke of the great responsibility to patients and how that can be misplaced amid hectic days and administrative work. But he and a few other like-minded doctors in the clinics kept open appointments for patients unable to see their own doctors, those who needed help sooner not later. I thanked him for this viewpoint and his availability but he demurred; it was his life work, what was necessary. He looked away a moment.

As the time came to an end Dr. S. asked me to remove my mask. He edged his stool closer, studied my face.

“You are much too pale, Mrs. Richardson. Your eyes do not look good. You look quite anemic. Please go to the lab immediately to get blood work done. I will let you know the results today.”

His adamance gave rise to anxiety that I set aside. It was a blood draw. I had had many recently. He might find I was a bit anemic; it had shown up sporadically over the years. And I had lost weight after surgery though was doing better with food.

At dinner time, Marc and I were chatting when I noticed there were two voice messages on my phone from 2-3 hours earlier. I’d forgotten to turn the sound on following my appointment.

The message shook me. Marc watched my face and put down his fork.

“Mrs. Richardson, I have been trying to get in touch with you. Your blood work indicates you have seriously low hemoglobin. You are in danger. You must go to the ER immediately to get blood transfusions. Please do this now; you could pass out or far worse.”

I played the message for Marc. We abandoned dinner, put on shoes and coats and left for another ER visit. I was, this time, frightened; we didn’t speak much on the way. I had told him Dr. S. was special. Now I sensed it was no mistake I saw him and no one else, and also when I did. I prayed for strength as my body trembled. I insisted Marc take me to the very best hospital, though it was 10 minutes farther and the highway was busy.

Inside, the numbers of people waiting to be seen was overwhelming. They stood in clumps; they lined the hall in various states of dress and degrees of composure. I couldn’t think of how long we’d wait. After I checked in and gave the details, I had more blood drawn. Then we were directed to an area to wait to be called. We passed large groups and lonely individuals in cordoned-off areas, many coughing or moaning, leaning against each other, some lying on gurneys shielding their eyes from the flourescent glare. I wondered how many had Covid or worse. Heart-rending children’s cries pierced me. As minutes ticked by, I was starting to feel more light-headed, oddly out-of-body. I leaned my forehead on a chair’s back as Marc held on to my shoulders. My operative knee complained much more; there was nowhere to prop it comfortably.

In an hour a nurse came for me, and in the ER room action was immediate. The lab results were in. My hemoglobin was noted after Dr. S’s initial lab visit as being 6.5. At the ER it was at 6.2. The standard range for this is 11.2-15.7. A doctor said I was bleeding internally. There were too few red blood cells to carry oxygen from lungs to my other organs, then the carbon dioxide back to the lungs to be exhaled. Hence, my sense that I’d fall down. But I was in a bed; I was hooked up to fluids and the nurse was calling for two bags of blood from the blood bank. Transfusions ASAP.

A blood bank… I mused. Where people’s donated/deposited blood is kept safe for withdrawal for the next patient in need. A precious commidity. A treasure to protect. A crucial lifeline, yes? I fell into a dreamy state punctuated by spikes of alarm.

I have rarely been so worried in an ER. I wasn’t sure about getting someone else’s blood; it was foreign to my body, a desperate act. I signed papers agreeing to it as well as a consenting to intervention for cardiac arrest if needed. The dimmed lights added to the sense of being captive in between states yet soothed my body. My mind drifted. Marc stood by; we had run out of talk. But I chatted with the nurses, joked sardonically–“Third time in an ER in just over 4 weeks, I’m setting my new record!” They were calmly focused, repeated it was a critical situation. I would, however, feel better in a few hours, they insisted. If all went well.

I was in that cave of a room for about 24 hours. I was taken off aspirin and Eliquis, a blood thinner for the blood clot in my calf. Another ultrasound showed the clot was no bigger and hadn’t moved. Within a couple hours a donor’s hearty blood was mixed with my unwell blood. I was informed that some people cannot tolerate other blood, had allergic reactions. A nurse had to wait with me for fifteen muntes to ensure my safety. I sighed–I so often had reactioons…but waited to feel it enter my arm and bloodstream. There was a burning sensation, then a coldness that eased as it mingled and coursed through me. It would be okay. I began to doze. More doctors and nurses came and went. I woke up when at one point there were 8 physicians and medical residents crowded in the room. St. Vincent’s is a teaching hospital. I don’t recall what they said. I was floating; words sounded empty of value. I was at last transferred to an intermediary care unit until it was determined if I needed full admittance. The hope was that I’d be treated in a more limited capacity. It turned into 4 days.

A private room; a shadowy, clean, quiet room. Safety of a sort. A nice recliner for Marc to doze in. The nurse assigned was soft spoken, moving gracefully about. I was told I could not eat or drink anything as next on the agenda was an endoscopy to view my stomach, and after that, if no bleeding site was found, a colonoscopy would be scheduled. I have had both several times in my life due to digestion illness since my teens, so this was not unnerving. It was imperative to find and repair the bleed–but it was more to cope with and I wondered how I could manage it. I could sleep a month. Of course, in a hospital nobody really sleeps.

That same day I went admitted to the Clinical Decision Unit was, coincidentally, was the very day my oldest daughter, Naomi, flew in from the East coast for a planned week’s visit. And so, her first sight of me after 9 months was in a hospital bed with IV lines, disheleveled, wane and yes, likely frail-looking. It was not a joyous occasion as had been expected with a giant hug proffered and returned. She gently placed her arms about me. I wondered if she thought: well, mom is really old now, isn’t she?…

I wanted to pull the covers over my head. One of the hardest things about the post surgical complications was that my children and grandchildren might think me terribly diminished. It wasn’t vanity but a fear that they’d iamgine me less than before, as not the same woman/mother/grandmother. Weaker, less able-bodied and mentally and spiritually capable.

She said, in keeping with her ways, “Sprang a leak, huh, mom?” Her bleary eyes and soft voice betrayed worry and sadness. One of her four sisters accompanied her; they provided support to each other. It was Naomi and Aimee, then Naomi and Alexandra. They kept Marc company, took him to the cafeteria for a lunch break. They chatted with me, hands laid upon my foot, arm. I was getting frequent texts from the rest of my big family and good friends. My son texted a drawing depicting healing paths for my body: me, being filled with light and love. I appreciated everyone reaching out. But tossed, turned and dozed, trying to mentally prepare for the early morning endoscopy.

Which, when it was done, showed no sign of bleeding.

My stomach even looked surprisingly good; an earlier diagnosis from years ago was no longer substantiated. I should have been more pleased. But it meant the problem was intestinal. Already depleted, with a throbbing surgical knee, the colonoscopy prep was rough but manageable.

And if the second procedure didn’t illuminate the issue, I would swallow a capsule with a camera in it so a view of the small intestine could be gotten. The very thought flummoxed me.

I prayed with and without words for clarity and safe treatment, smart doctors and any one else who held my life into their hands. We needed an answer. Two transfusions might not be enough; maybe I’d not be discharged soon. A bright spot was that within 48 hours I was feeling more energy–my hands and feet warmed up, my brain was clicking away. The nurses had said those additional red blood cells infused one with new life and enouraged me with words and gentle touch.

Blood–a miracle elixer that mainatains and saves our lives every day.

I’d had little idea until I felt better how perilously ill I had become, saomething every one must experience. When you are at low ebb so long, it is strange to move past that state, like moving from shadow to light.

I’d sensed things were not right but should have known that faintness when walking across a room or even rising from a chair were bad signs. I might have admitted the increasing exhaustion with higher heart rates, unusually cold hands and feet were were clanging alarms. The oxygenated blood wasn’t reaching my extremities; it was feeding vital organs first and foremost, as it always will do. I didn’t see convincing evidence of bleeding that I was told to be watchful of while using the blood thinner. I had questions and once called the surgeon’s office; he said “Not sure this is alarming but stay aware.” Later I learned that older blood appears black or n early so. I felt as though I’d failed to be smart enough. I’d failed to face a possbility of more harm occurring, to take charge when all was starting to unravel. Perhaps I was just too tired.

How much can the body take? Much, much more than one thinks possible. Much more than I was prepared to believe or accept. When I wanted to yell “Enough!”, I instead daily learned more patience. Even when difficulty is gnawing at your last nerve, patience holds you steadier: wait until this passes, endure then wait to see what comes.

The procedure successfully located an AVM, ateriovenus malformation, a significant cause of colon bleeds. The blood thinners (I was still on aspirin until then) triggered faster blood loss. The spot was cauterized and bleeding stopped. I wept in the recovery room. More doctors, blood tests. Instructions, opinions, prognoses (AVMS can bleed more than once; stay cognizant of signs). I drank tumblers of water and paper cups of tepid tea, ate the hospital food hungrily. Communicated with family and friends with happy words.

The next day, a Sunday, I was discharged. My very relieved husband and I were practically singing “Hallelujah!” on the way out. My knee even seemed to celebrate; it hurt less than it had in awhile.

And Providence St. Vincent’s Medical Center would keep humming along, busier than ever repairing and saving others–and caring for those who did not survive. I was one of the very fortunate ones. Rescued from crisis, provided a useful solution and hope. But, too, what was next? Life had come to feel more and more perilous. I hadn’t felt that in decades, since my heart attack at 51 as I hiked blithely along a familiar path. Peril arrives on a ghost horse; you often do not hear it coming.

But then I recalled how God shows up in the smile, hands, in the basic or brilliant acts of humans. How we have such power to help or hinder, love or deny, accept or defy. Those few days at the hospital restored a part of my missing faith in our species. In the medical system.

I had learned even as a child that life held signature characteristics like inconsistency and mystery– and trouble. But tamping down a frisson of anxiety that underlay relief, I opened a car window. Encouraged a damp rush of air to sweep through my hair. Took restorative breaths of nature’s array of perfumes. I was going home, my body salvaged again.

***Next week, the conclusion of Notes from a Surprisng Knee Surgery.***