Monday, April 21, 2014

Losing The Zen, Finding Relief

The doctor had just called and you could hear the concern in his voice.  Nearly three weeks post-op and the fact that I had developed chills with a low-grade fever and no other symptoms did not bode well.  The knee was hot to the touch and the swelling, despite being wrapped with ice and compression nearly 24/7 the past two weeks, had not changed at all.

I put the phone down, sitting on the edge of the Ottoman, about to lift myself with the two crutches that have become the key to my mobility the last three weeks.  Liz had refused to go to bed until we knew what was going to happen.  As I braced myself for the throbbing pain that I now expect when raising myself from a seated position, I stopped.  I didn't want to hurt.  I didn't want to suffer.  My fingers went to my eyes, which were beginning to burn with warm saline.  My nose got stuffy, and I sobbed.  I shook my head, thumb and pointer finger holding the inside corner of each eye, tears flowing, angry that I had "elected" to have this surgery. "There's no use thinking about that now," Liz counseled.  The TV showed highlights from the day's game at Fenway, at that moment focusing on the pre-game with the survivors from the marathon bombing in 2013.  I was too self-obsessed, too far into the realm of self-pity, anger, and frustration, that I couldn't feel compassion.  My suffering was all that mattered.  What if I did not come back from this trip to the ER?  What if I had a raging infection in my leg, and the only solution was amputation?  What had I done? I sat there, Liz consoling me, hand on my shoulder. In our seventeen years together I have broken down like this maybe three times.  "I'm sorry," I sobbed, my thoughts now turning to what she and the boys would have to go through without me.  The memories that would never be made, the missed joy and experiences simply overwhelmed my psyche, which swirled with negativity and hopelessness.  I was engulfed in an imagined future that was horrible.  There was no other way to say it: I was scared.

Nearly everything about this post-surgical recovery has gone so horribly wrong.  With another trip to the ER in front of me, I expected this time to be no different.  With Liz's encouraging words, I gained some composure and loaded myself into the car.  The only positive thought I had?  Maybe I'll get to see that damned mountain lion that is hanging out around here.  It was 11:17 PM, Sunday night, two-weeks and one day, almost to the minute, since my last visit to the ER for complications from this knee surgery.  A surgery, which should have been "simple," but has proven to be anything but.

One benefit of of becoming a "frequent flier" at the ER is that I know how to make my stay a bit easier.  I brought a backpack filled with my meds, and other "essential" items, that I could throw my jacket into.  I went knowing there was a real chance I would be spending a huge amount of time there.  I went armed with knowledge about what tests to ask for and what I wanted to avoid.  Despite these mental and physical preparations, I was not ready to hear the doctor telling me, given how the knee looked and felt, there was a good chance that another surgery to "clean out" a (very likely) infection was probably in the cards.  The last thing I wanted was to have these wounds opened up again, and someone else poke around my knee.  I just wanted my ability to walk back. I was tired of suffering.  It was 1:30 in the morning - I was also just flat out tired.  "If this is infected, and we don't treat it, you will probably never run again because it will do some serious damage to your knee." I try not to swear much in public, but, in this moment, "Shit," was all my vernacular could muster.

Growing up in Vermont, I remember "tapping" a sugar maple tree on our property and then my mom boiling down the clear sap to a dark, amber, deliciousness.  Lying in the ER bed at Winchester Hospital at 4:17 AM on Marathon Monday, this was most definitely not the image in my mind's eye as the doctor took the largest needle I'd ever seen and prepared to "tap" my knee to pull as much fluid as he could out of it.  This fluid would determine the course of my immediate future - if it tested positive for nasty bugs, I didn't want to think what would happen.  If it didn't, well, I'd likely have some relief from the pain/pressure I'd been feeling near constantly for the past two weeks.  Finger's crossed as the needle broke the skin.

My late Grandpa Barney would have said, "That's a crap-house load of fluid." The doctor said, "Well, it's not a record, but that's certainly a lot of fluid." After pulling many, many ounces of what looked like blood (and not puss), I caught a small glimmer of optimism.  "The tests will take a couple of hours, and the real result will be the culture, which will take a couple of days, but we'll start you on some IV antibiotics, and I'll let you know as soon as I get any word." With that, the doctor left the room, and I settled into a fitful couple of hours, with one thing abundantly clear: draining all that blood had relieved a lot of pressure and discomfort.  I could flex my foot without the knee feeling like it was going to explode or pop.  Still, since I've been taking anti-coagulants for blood clots (the first post-op complication), the concern was more bleeding in the joint and blood simply refilling it.  As my father (a family doctor up in Vermont) has told me through this process, "Blood where it is not supposed to be, especially in/around a joint, can be extremely uncomfortable." I had experienced that the last two weeks.  It was 4:31 AM.

I spent the next hour and a half falling in and out of sleep, trying not to move my knee, thinking, for some reason, that this would limit the bleeding, and relishing the lack of pain/discomfort in the joint, even when just lying there.  I tried to meditate, to find my Zen, but fatigue and the fervent hope that no "nasties" would be found in the blood, made it difficult to settle the mind and just embrace the moment and reality.

"I know it's been a long night, but I have good news.  The first tests are showing that this was just blood so you won't be needing surgery right now.  Your INR (a measure of the level of anticoagulant Warfarin in your blood) is also therapeutic now, so, if you follow up with your PCP this morning, you may be able to stop injecting yourself with the Lovenox (a "bridge" medication that prevents blood clots from getting worse.  You inject this medication into your belly, every twelve hours.  I really don't enjoy it, and have a whole new respect for those that have to do things like this their whole lives.  I had been looking forward to stopping this routine since my first trip to the ER, 15 days before).  We'll know for sure in a couple of days with the culture, but, for now, I'm going to give you some antibiotics, and send you home." It was 6:02 AM.

The fact that a second surgery would not be needed lightened my heart.  The fact that my knee had felt fine since being drained (and remaining propped up) made me excited to "test it" as I left the hospital.  I envisioned being crutch free, triumphantly walking into my house unaided and pain free, celebrating a massive victory in what has been the slow progression back to health.  I put my foot down on the floor and stood up, hope replacing the fatigue I felt.

I nearly fell back down.  I could feel the blood returning to the knee, and, as my dad said, "it felt a rather uncomfortable." It took me a couple of minutes to stand upright on my crutches.  My head swam in a hazy cloud of an all nighter and pain.  By the time I got to the car, I was winded, teeth barred against the discomfort.  It hurt.  It took me four minutes to get the ten feet from the car to the house because of the throbbing.  But then I sat down, propped the knee up and the pain went away.  I've spent the next 13 hours sitting on the couch, watching the incredible performances at the Boston Marathon, and, unlike every other day for the last fifteen days, my knee has not bothered me one bit while sitting.  I've been flexing my foot with a smile on my face because it feels "normal" to do so - not like a water ballon being squeezed by a tantrumming toddler.  Sure, it hurts like hell when I get up, but just thinking about the fact that I will likely get a comfortable night's rest, has been exhilarating.  Knowing I have (at least a temporary) reprieve from additional surgeries is huge.

We had a picnic dinner in the living room tonight so that I could keep my leg propped.  Cooper and Jacoby were willing to play games with me lying on the couch (before Liz took them to the Marathon, Jacoby and I were trying to play a game and I kept falling asleep as he asked me the questions - "Dad?  DAD!  It's your turn!" His sweet little voice kept waking me up when I would fall asleep ever thirty seconds or so).  I eventually gave in and mumbled that he could just play on the iPad.  Cooper (who when he first saw me in the ER following last-year's Vermont 100, told me, "You could have just walked it in."), kept telling me, "I can't wait until your surgery is better," or "At least the plica is gone and can never bother you again." I couldn't agree with him more.

I wasn't proud of myself for losing my Zen last night before heading to the ER.  But, just like "tapping" the knee led to some serious relief, by allowing myself to fully experience all those negative thoughts and emotions, even if it was just for a relatively brief time, I was able to find some sort of relief from this silly ordeal that has consumed my body and mind since April 2.  A good initial lab report didn't hurt any either!

1 comment:

  1. Man, this has been a brutal ordeal! When an ultrarunner is talking about unbearable pain it must be unreal. Good luck rediscovering your zen!