A View From The Couch – December 16th, and 17th, 2022

“I don’t know why I waited so long.” “It’s the best decision I ever made.” “I wish I had done this years sooner.”

These are quotes from people who underwent total knee replacement surgery before I did, knowing that I was considering it. As I lie on the couch eight days after my procedure with my knee elevated and on ice, I doubt any of these people were saying these things a week after leaving the hospital. I told my surgeon an hour before they wheeled me into the operating room that I wasn’t sure my knee was bad enough to warrant the intervention.

“This is the perfect time to have it done,” he told me then, just as he had told me a month earlier. “You’re not yet in serious pain, and you’re not yet severely limited in your activities. But you’ve suffered some trauma, your x-rays show deterioration compared to three years ago, and it will only get worse.”

I had known for years that a visit to an orthopedic surgeon would mean a recommendation for knee replacement surgery. I had been told twenty years ago that my right knee was shot, but as long as I could cycle and hike with only moderate discomfort I wanted to avoid the weeks of pain and disability that come with surgery. But for the past three years the pleasure of a long uphill hike was tempered by increasing pain coming back down, and last winter I found myself unable to hold a turn on a descent while cross country skiing. One day this summer I had to apply a little too much force to free my right foot from my bicycle pedal and a sharp pain shot from my thigh to my ankle. For three days I could barely put any weight on that leg. At that point knew I had to see the orthopedist.

My knee problems started over winter break my senior year of high school, when some friends and I got together for a pick-up football game. As I caught a pass over my right shoulder a defender dove into my right leg, pinning my foot to the ground as he rolled his body across my leg. I felt something tear in my knee, and when I tried to stand and walk my leg was unstable. After a few days the swelling and soreness went down and I didn’t think about it until one afternoon when I was throwing a baseball with my father. As I stepped to pitch my best left-handed curve ball, I planted my weight on my right leg and twisted, and the knee locked. Two days after Christmas my meniscus was removed through a three-inch horizontal incision on the inside of my knee.

From that point on my knee popped and clicked with every step, but was generally stable until one day ten years later when it collapsed on me while I was playing racquetball. The surgeon who examined me said there was an additional meniscus tear and I was lucky, he had just purchased an arthroscope and could repair the tear with a new, less invasive procedure. But in the recovery room I learned that there was a new three-inch vertical incision on the outside of my knee. The tear had been more extensive than he thought, so he had to resort to an open procedure. Since 1977 I’ve been going around with very little soft tissue in my knee.

After this most recent surgery, Oxycodone helped me ignore my pain from Thursday afternoon, when I was sent home, until Sunday morning, when I was finally able to tolerate a straight leg raise with only a reasonable amount of agony. I put away the strong pain pills at that point, and have been able to hobble around with a cane since then. My instructions are to spend most of my time with my foot elevated above my heart, knee straight, ice bag on the affected joint, and take it easy. But, I’m supposed to be up and around for fifteen minutes of every hour, bearing weight on the affected leg as much as I can tolerate, and do light physical therapy to improve the flexibility in the joint. At first getting off the couch was hard, but it gets easier every day. My sisters were here for a week, and I could not have managed the first three or four days without them. Now I feel pretty independent on my own, although I will not be able to drive until I am six weeks post surgery. I’m grateful that King Soopers delivers and that I have friends to drive me to appointments.

In my mind I believe all who tell me I will be glad to have had the procedure, but right now, as slow as it is to get around, how awkward it is to take care of even the simplest of tasks, and how much my knee aches, it just doesn’t seem possible that I could be back on the bike in two months and hiking by the summer. My pain is temporary, and the most severe part lasted only for a few days. I am still put out by the inconvenience of it all, but it will pass. I have been thinking throughout this whole experience of people who are permanently disabled, living with chronic pain, have suffered disfiguring, crippling injuries, and otherwise suffer their whole lives physically, emotionally, and socially. I have felt sorry for myself this past week, have been frustrated, discouraged, and depressed. But I have a full recovery to look forward to, and each day I can see progress toward that recovery. The most courageous people on Earth are those who manage to face life each day permanently coping with such obstacles, and still find reasons to live and help others likewise find their own reasons to live and serve others. They have my complete admiration.

I was given a spinal to numb me from the waist down, and a drug called Versed to induce what they call “conscious sedation.” While I may have appeared conscious to the surgical team, I have no memory of the procedure. A friend who underwent a hip arthroplasty tells me she asked the surgeon to show her her hip joint as he removed it from her body. I certainly don’t remember interacting with anyone while on the operating table, and was told not to expect to remember any of it. But apparently patients on Versed can be pretty chatty. I was given the drug once before when I dislocated my thumb in a snowboarding accident, and as with this case, I did not remember their resetting my thumb, but afterward the nurses joked with me about some of the things (quite embarrassing, actually) I must have said while I was sedated. I wonder what confessions and narratives OR nurses, anesthesiologists, and surgeons are privy to that ethical considerations prevent them from revealing? If Versed relaxed any filters one might apply when more fully conscious, things might be said under its influence that could be offensive to some. I imagined as I sat in the recovery room a scenario where I began spouting my political views just as the surgeon, who might have had opposite views, was in the middle of a delicate and critical part of the operation. What if I had said something insulting about people with views opposite mine? Would it cause him to slip and make a mistake? Of course, this would never happen, I knew.

Versed had placed me in a deep, relaxed state where I imagined myself on stage with Ray Wylie Hubbard, Gaby Moreno, and Nick Forster, singing Ry Cooder’s “Across the Border Line.” It was from this wonderful fantasy that I was thrown into the reality of feeling nothing from the waste down except the pain of an overfilled bladder, and no ability to do anything about it one way or another. I guess it’s not the most embarrassing moment of my life, and surely not the last time as I age that I’ll share the experiences of a three-year old learning to get along without diapers.

As I lay in the hospital awaiting discharge instructions I got emotional thinking about all the people who had cared for me throughout the day. I had arrived at 5:00 am, and it was now after 3:00 pm. Education and healthcare are two fields where it is difficult to recruit and retain employees, and there is a need for people of all levels of education, training, and expertise. What is common to both fields and all positions within them is the need for compassion, kindness, and a desire to serve humanity. I was treated very well across the board during my stay. The world is full of self-serving, selfish jerks, but the people who dedicate themselves to education and healthcare do it because they care about people, and care about making the lives of people better. I thought about this constantly during my hours at the hospital, and am so appreciative of the care I received. What could matter more than having a smart and healthy society?

Most of the things I worried about before surgery have not been as bad as I had feared. I worried that I would not be able to cope around the house after my sisters left. It has been easier than I thought it would be. Sleeping is a challenge, since my knee aches at night and I can’t find a comfortable position in bed, but I know this will pass. I cannot yet bend my knee enough to get a sock on my right foot, and I worry that it will be very cold on January 22nd when I go to my surgical follow-up visit. Maybe I’ll have achieved that goal of a 90-degree bend by then. And six weeks is a long time to depend on others for transportation. My front porch steps don’t have a railing, so I’m going to wait a few days before making my way out to the mailbox, and there are certain other activities I’m advised to refrain from for several more weeks (drinking beer and wine) and other physical pleasures for even longer (not sure exactly why). I thought I’d have lots of time to play guitar during my recovery, but it is not yet comfortable to rest my guitar on my right thigh, so the guitar remains in the case. I’m grateful for New York Times word games.