Preface This report is GROSS. People with weak stomachs or low tolerance for gnarliness should not read any further. Then again, I cringe at most episodes of the X-Files. And typing this in, or experiencing the events described here, or even reviewing the accompanying videotape didn't bother me at all.
before you read this, you might want to read the story of the accident that was the source of all the trouble in the first place.
NEW! answers to some Frequently Asked Questions about knee injuries and surgery. note: this is not official, this has no basis in medical fact. these are just from my own experiences.
ok. on with the show!
Nat: Thursday Dec. 4, 5:45am. Woke up to the radio. Never wanted to cut funding for National Public Radio so bad. Snoozed, then reawakened and got up. Roxie was snoring in front of the door. Jenine picked her up and tossed her onto the bed. Roxie was most surprised: "Hey, I'm cute! What gives?!"
Note from Jenine: I set the alarm 15 minutes early so we could snooze a bit. For some reason, this makes me feel like I'm cheating the clock. I had been told not to eat or drink anything after midnight. To hold off dehydration I'd had 3 large glasses of water before going to bed near that time. I had to get up 3 times during the night to pee. So it wasn't the best night's sleep for me, and I was pretty much ready to get up and get a move on anyway.
Photos:
Pre-surgery Knee
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Showered, packed and left (no breakfast) for the hospital. Cold as all buggery outside, but the car heater made it bearable. Talked about nothing much - scrapping the concept of money, a flat pay rate across professions, etc. Arrived at the hospital bang on time at 7am, and checked in.
Photo: Arriving at the hospital
They're all very polite and courteous here. This is a far cry from the "doctor knows best" school that I remember. Here everybody chats with you, they tell you what they're going to do, give you choices, and generally try to make you feel comfortable and relaxed with what's going on.
We went to the preparation room, with about eight beds in it. Patients get changed in a little bathroom, putting on a fasten-at-the-back hospital gown and a pair of draw-string button-at-the-side boxers. Jenine got the fasten-at-the-back thing wrong, and it wasn't until just before the anaesthetist showed up that we realized she hadn't fastened the top tie. Complex stuff, hospital clothing.
Photo: Lovely in a hospital gown. (ew)
Mary, one of the preparation room nurses, connected Jenine to an IV drip and asked her a bunch of questions. Jenine told her about her uncle's heart operation where he'd had seizures coming out of the anaesthetic. The nurse said that wasn't something they could predict - they were more interested in "malignant hyperthermia", where the patient's temperature rises when they're anaesthetized. This can be treated now, apparently, but in the old days it could be fatal. Because it's inherited, they wanted to know if maybe a grandma or grandpa had died on the table. None had, so all was hunky-dory, and the interrogation/examination continued.
Photo: Arm with IV.
I took photographs all through the time between check-in and when Jenine was wheeled to the operating room. We had a half-hour wait between 7:30 (when Mary finished) and 8:00 when the anaesthetist arrived for his pre-drugging talk, which we spent talking and kissing and holding hands and generally making the older female nurses coo and go "oh, aren't they sweet?". Once went so far as to get Jenine's camera and take a picture of us together.
Photo: j.j and gnat.
The anaesthetist was Italian, with an accent, but very up on general affairs - knew there was a center for space research in Boulder, and so on. He explained Jenine's options for staying awake through the operation, as best he could, and let her choose. The options were: spinal or epidural. A spinal goes through the vertebrae wall into the big bundle of nerves, uses a smaller needle than the epidural, and gives 3.5 hours of paralysis to the legs. An epidural goes into the vertebrae, uses a bigger needle, and (with this guy) has a 1:300 chance of going into the nerves and giving her a headache. Or something like that. He was hard to follow. Jenine went for the spinal and the nurses were duly asked to slip her the "don't care" drugs via the IV.
They were good. The doctor who would perform the operation came in and checked she still was alive and wanted to go through with the operation, and just as they were wheeling her out, she had a giggling fit (hopefully recorded on film). If that's anything to go by, she won't be able to focus on the monitors they will try and let her look at.
Photo: Dr. Martin checks out the X-rays.
Photo: Prepping for anaesthesia with Frank.
Photo: j.j already stoned with 'happy juice.'
I'm typing this from the cafeteria - I put Jenine's stuff back into the car and registered myself with the woman who notifies the waiting friends when the operation is over. I had two bagels and an orange juice for breakfast, and am now faced with potentially another two hours before I get to see her again. Hopefully it won't be that long. --Nat, 9:15am
12:45pm Jenine
The surgery was a piece of cake. Box of fluffies. I couldn't see much, I was lying on my back, and there was a big blue blanket over me. They set the video monitor next to me and I had my glasses so I could see. But the arthroscopic camera only showed views inside my knee. I didn't get to see any of the gross stuff going on on the outside.
Frank the anaesthesiologist (Puerto Rican, not Italian) was really nice. Getting the spinal was not much fun. It hurt. But once it was in I was pretty much numb from the boobs down. Couldn't feel a thing. The happy stuff he gave me in the prep room was still making me kind of silly. Frank said he hoped he didn't have to give me any more anaesthesia because it would just make me sillier than I already was.
Dr. Martin had an assistant doctor during the surgery. I think his name was Dr. Thumper. I'm not sure about this because I was pretty drugged up at the time. He didn't say much. But it was clear that two sets of hands were needed. There were also two or three nurses, one of whom was Gina. Gina got blamed for everything that went wrong. Fortunately for her and me both not much did. Gina was cute and funny.
After Frank gave me the anaesthesia (a painful, unpleasant experience involving getting poked in the back really hard several times), he began to check me for sensitivity. For this he used his finger and "a little tool." I thought, "aie! He's gonna poke me with a stick!" No, it was worse than that. Frank had what was, for all intents and purposes, a miniature stun gun. Too electrode ends and a little trigger. He demonstrated it (gee, thanks) so I'd know what to feel for. Ow! He zapped me near my shoulder. Then he zapped me near my midriff. Nothing. Shoulder, Ow! Leg, Nothing. Etc.
Frank also fitted me with a blood oxygen saturation sensor. That's a little cuff that goes over your index finger, and measures blood saturation by peering through your fingernail. Go figure. Frank also put a hose in my nose to deliver oxygen. I didn't like that much, and felt I could breathe just fine by myself, but it was his call, and he seemed really concerned that my silly boisterousness would turn to belligerence and he'd have to knock me out. I didn't want that, so I shut up.
Dr. Martin is so cool. He kept up a running commentary telling me everything he was doing. First, they opened up the knee and pulled the graft off the frontal ligament. I didn't get to see any of that. Then the scope went in my knee. GRUESOME, dude. Totally cool. The first time I said, "that's so gross!" they asked me if I wanted to be put out. I said, "no way!" Dr. Martin inspected the meniscus, poking and pulling and prodding at it. This showed up really well on the video. Then he began removing bits of the old torn ligament. GROSS! This took a long time. Oh the humanity! Oh the horror! The violence! Dr. Martin says, "you think that's violence? You haven't seen anything yet."
That's when he got the chisel. He carved away parts of the bone in the knee. I could feel every hit of the chisel as the vibrations carried through my bones. When they finally got to my shoulders, I felt it. And then, of course, there was a sound. It was pretty cool. The chisel was followed in the coolness category by the two drills, one small one large, to make holes in the bone and place the ligament, fastening it with in itty bitty screw. He cut away some cartilage with the chisel, too, and I was surprised to find it was fairly solid matter, more like bone than the soft squishy meniscus.
In the video you can see lot's of fuzzy stuff: the torn old ligament. Dr. Martin brutally clears this away, scraping the area clean. You can see white, smooth bone, one shaped like a butt. Shiny, tau, healthy ligaments can be seen wrapped around the bone. Yellow lumps of fat lie about, Dr. Martin wouldn't suction those out for me, damn him.
Weirdness: I reached my hand under the blanket and felt something that felt like, well, it felt like there was a whale on the cart with me. It was cold and smooth and round and huge. It was my butt. My stomach was an equally bizarre discovery. I couldn't feel anything at all. It was like touching someone else.
At one point they laid the arthro cam on my stomach and I tried to grab it through the covers and point it at something more meaningful than the ceiling. This can be noticed by slight nudging of the video view at this time. I wasn't any more successful than that.
About 3/4 of the way through the operation, Dr. Martin noticed that the "audio in" light was not on. As a result we didn't get ANY sound on the video. I was SO bummed. None of Dr. Martin's explanations, none of my silliness. No Frank or Gina. You know, I knew something had to go wrong with the video tape. So I wasn't so broken up about it. It was a drag, but it happens.
Towards the end of the surgery, Frank began checking me for returning sensitivity with his "little tool." There wasn't any. Frank began to get concerned, though he tried hard to keep that concern out of this voice. "Um, this is going to last for a LONG time. I gave you a lot of anaesthesia." I think he had over-estimated the amount I had needed based on my weight. He had seemed surprised at how massive I was when I told him, and I think he ups people's weight by 10% or something because he figures they all (especially women) lie. Well, I don't. I told him 170lb and I meant it. Surgery ended around 10:30. Frank calculated I would be numb until about 2:00. Wrong. I didn't regain full control over my legs until midnight that night.
Post-op.
I was so COLD. It was freezing in the operating room. The worst part about the last bit of surgery was that I was freezing. I was shaking uncontrollably. Frank and Gina would bring warmed blankets and cover my shoulders and arms. But they didn't help much. By the time I got to the recovery room my body temp was around 94 F.
In the recovery room they wrapped me with something called a "bear hug." It's a thick balloon blanket that's filled with warm air. Yum. I quickly fell asleep. I still couldn't feel anything below my breasts. I woke up occasionally when the nurse was near me. One time I made a funny noise in my sleep, like a snort, and it woke me up. I remember trying to apologize for making the noise, but I don't think the nurse heard me. Hell, she might have not even have been there. I was pretty out of it.
4:00pm. At midday, they finally wheeled her in to her room. At 10:30, the volunteer had told me that "she is in the recovery room, and the doctor will be out to see you shortly". This talking with the waiting friend/relative is standard practice, in the New Age of Medicine. Well, this was apparently a day for throwbacks because I sat waiting for half an hour before asking which definition of "shortly" they were using - the definition I knew and loved, or a new and interesting one which puts "shortly" right up there with terms used in geology.
Photo: Trying to be warm after surgery
Jenine: Dr. Martin had gone looking for Nat, but couldn't find him. Crossed waiting rooms or something. Whoops.
Nat: I should have guessed - would the best doctor in the field, with many years of experience and schooling behind him be at fault, or would the nearly dead unpaid volunteer 'find-the-friend-of-the-patient' crone be the one who fucked up?
The doctor had apparently moved on to new and more profitable patients, discarding the concerned friends (that would be me) of the ones he had already done enough work on to be paid for. The bastard. I made a mental note to shit in his cat, and went off to locate her room and read some more.
A veritable squadron of nurses, lead by "hi, my name is Barbara and I'll be your nurse tonight", threw her from the stretcher to the bed and tucked her in. (My reaction to this: wheeee! The nurses say, "she's having too much fun." I had the same reaction when they rolled me over on my side to give my still-numb butt a rest.) Jenine's first request of me was to put her fluffy slippers on. The spinal didn't just chop off feeling, it actively made her feet feel ice cold. She was shivering like a topless Eskimo, despite having a very warm body (mmm, warm Jenine body).
We talked about the operation, how it went and so on. She was conscious all through it, apparently, and giggled and laughed with the doctors. The cut and thrust of verbal intercourse, however, won't appear on the video, as the morons didn't have the batteries on the sound unit charged up. Right there, I would have been a little worried - do you trust the complex reconstruction of the most intricate parts of your knee to people who can't work a P.A.? Anyway, it was apparently a success.
Jenine: My room was so nice! We had a private room, it was almost like staying in a hotel. They even brought in a cot for Nat to sleep on. And Barbara, my day nurse, ordered enough food for the two of us whenever she could. Nat had a comfy rocking chair to kick back on and quickly had the laptop hooked up and the two of us logged in. Not three hours after my surgery ended I was on Nerdsholm telling everyone how it had gone. Well, I called my mom first, you gotta have priorities, you know.
I hated not being able to move. I mean, the numbness was cool for a while, but I was so uncomfortable and I couldn't do anything about it. My feet felt like they were frozen. I had phantom aches and pains in my lower legs and feet. Then, while I was still paralyzed, the feeling in my knee began to return. It felt like there was a fire burning under my kneecap. Didn't like that at all. I begged Barbara for something for it. First thing she tried was morphine. She said, "this doesn't get rid of the pain, it makes you not care about it." Wrong. Two shots later I still cared. I cared a lot. She gave me two percosets, even though she felt that hooking me up to the "PCA" was a better idea.
Photo: Post-op knee with bandage and cold cuff
Photo: Logged into the MUD before the anaesthesia even wore off
PCA: A machine hooked up to the IV whereby I could shoot myself with morphine for an instant fix whenever I wanted to. I didn't much like this idea, but ended up having it anyway. Didn't use it much, as it didn't do squat for the pain. But it was helpful for getting to sleep later.
They had also fitted me with a vaccum blood sucker. It was a long tube inside my knee attached to a vaccum pack. This sucked out any blood draining in my knee. They had to empty it a couple of times, but said that the drainage wasn't too bad, they'd seen worse.
Anyway. Barbara gave me 7-up and ordered some lunch for me. Turkey sandwich, banana, strawberry shortcake. I wasn't much hungry, so this sat. Also, I was concerned about how I was going to clear this stuff out, once it was put in. Come to think of it, I hadn't peed in over 7 hours during which I'd had four liters injected into me by IV. Barbara thought of this before I did and checked my bladder: hard as a rock. But, it was time for her lunch! So she left and sent someone else in to catheterize me. Whee. Now that was fun. Fortunately, I was still completely numb down there, so I didn't feel anything. Still, it was a bizarre thing. My bladder began emptying With A Vengeance. 100 milliliters, 200, 500, 800. They needed to get another bucket as the one she had started with began to threaten to overflow. Nat and I were laughing so hard, this was the funniest thing we'd ever seen. Carmel, the nurse, didn't find it as funny. But she tried. Nat took pictures, even though I yelled at him (as much as I could, I was laughing so hard I thought I was going to cry) not to. 1.345 liters later it stopped. Carmel said that was dangerously close to maximum capacity for a human bladder. I'm so glad I was numb, that must have been excruciating. Dumb Barbara, why didn't she check earlier? My bladder could have exploded! Ick.
Photo: 1.345 Liters
Barbara got back right after we finished. She noted that my shivering had stopped, too, and that most of the shivering had probably been because of how full my bladder had been. Well fuck. Anyway, I was happy to be still and empty.
One effect the morphine and percoset had was that I had "Jenine's Song" written by Nat back in early 1995 running through my head all night. I considered this a blessing, it was a damn sight better than a lot of songs that could have been stuck in my head, and it made me feel all warm and fuzzy. I was so grateful that Nat was there with me. Even when we weren't talking to each other, it was just so nice having him there.
I got hungry right around the time dinner arrived. I was still numb, but getting feeling back in the area of my bladder. Not in the area where I could consciously do anything about it, though. That would be much later. Nat selflessly sacrificed himself to check my sensitivity in that area periodically. What a sweetheart. I told Barbara I thought I had to pee again, and she outfitted me with a bedpan. I couldn't do anything with it though, considering I was still without feeling and there was a hostile nurse standing over me saying, "just pee!" Chyeah, RIGHT. I had her take it away.
My lunch looked more appetizing than my dinner, so I gave the pasta with veggies to Nat and ate my sandwich. The smell of the pasta dish was so strong it threatened to turn my stomach. I was hypersensitive to food tastes, kind of like the astronauts get in space. Then I ate the banana. By then I was in full munchy mode. I ate everything left in the room. Yum.
Dr. Martin came by to see how I was doing. He was surprised that I was still under the spinal. He told Nat he'd tried to find him, but couldn't and that he'd be by to see me in the morning. He said that the surgery had gone really well, and went over the exercises I was supposed to start doing as soon as I had control over my muscles again. He was very optimistic, said the new ligament was really industrial strength, and everything was going to be great.
Photo: Ew ew ew!! Post-surgery knee naked
I was miserable. The percoset's didn't do much for me. Dr. Martin had come in and told Barbara to hook up the PCA. He also seemed to think this would work. I was uncomfortable, still paralyzed, and I just couldn't see how I was going to get up and walk out of there the next morning. And Barbara exuded all the sympathy of an army drill sergeant. I was not a happy camper.
By 8:00 I had to pee really bad. I didn't want to try the bedpan again. Barbara had gone home, and Shari was my new nurse. Shari was way cool, I liked her. I told her I wanted to go to the bathroom to pee. My feet were still pretty numb. Nat and Shari maneuvered me to the bathroom and onto the toilet, placing a chair below my knee so it would stay straight. The pain in my knee was unbelievable. Excruciating. Miserable. But dammit, I peed.
Frank came by sometime to see how I was doing. He was surprised about my continued immobility, too, but tried to hide it. "Well, that's what we needed to do, make sure it lasted the whole surgery." Yeah, Frank, sure you don't want to zap me with your "little tool" again? Heh. Frank was nice, and he was concerned, and he did try not to let it show. Going the spinal anaesthesia route was the right way to go. I didn't have to worry about residual inhaled anaesthesia causing nausea later on. Everyone had been concerned that I would throw up anything I ate or drank, but I didn't get sick at all. The first hit of morphine made me a little dizzy and woozy, but other than that I was fine.
Pshyeah, right (Nat here). In truth, she was a little queasy from midday to about seven. She spurned food, and at one point spurned my smoochies because she "felt sick". Stab me, bitch, and finish the job! Anyway, after I peed in her 7-Up, I got over the rejection. The point here anyway, is that her memories aren't necessarily accurate in details like "felt sick" vs "didn't feel sick".
Shari gave me a shot of something called Toradol. She said it had helped her when she had surgery in November, and morphine didn't do shit for her, either. She was much cooler than Barbara. I watched Friends, dozed, then watched ER as Nat logged in, talked to people and worked.
Shari came back at 10:00 to check my bp and temp. I had since gotten back to a nice and normal 98.6, and my bp was steady at 110/70, my normal. My pulse rate had been at a somewhat alarming 50 bpm all day. Frank had first noticed it and asked if I exercised a lot. Well, no, not really. But there it is. It stayed between 45 and 50 all day. I had to pee again, but there was no way in hell I was getting back up, even though the toradol had reduced my pain level by more than half. I told Shari I'd try the bedpan again. It was much less of a problem this time, seeing as though I had feeling in the appropriate areas by then. Still no feeling in my toes.
Jenine, December 5th, 12:00 am
I woke up at midnight. Shari was due in for another visit, and I had to pee again. I dozed and woke until about 12:40 when she showed up. I said, "yay! I have to pee!" and she got the bedpan. The toradol had also started to wear off, and I was getting squinky with the pain. She promised another shot at 1:30.
I got the shot at 1:30. Then Shari came back shortly after 2:00, and shortly after I awoke, needing to pee again. From then on, every time she came in the room I was already awake and would say as she walked in, "yay! Guess what?" And she would get the bedpan. I think that around midnight she turned my IV push rate down. After Shari would leave, I'd dose myself with morphine and fall back asleep. Nat didn't have it so easy. And he doesn't function well when his sleep is interrupted. To say he had a rough night would be understating it. Me, I had a great time once I got the bedpan system figured out, and the toradol kicked in.
Shari came in at 4:00 and again at 6:00. That was her last visit before Barbara came back. I missed Shari almost immediately. I had to beg Barb for another shot of toradol, she didn't seem too hot on it, she's more in the morphine and percoset camp. But she got me the shot, and two percosets as well. Whee!
Dr. Martin came in around a quarter to eight. I told him I couldn't lift my leg like he told me to. This was normal, he said, the quadriceps shut down after the surgery, and the key was to keep trying, forcing the muscles to work. I did that, and practiced the other exercises he'd given: twirling my foot around, and tightening muscles individually. He wrote me prescriptions for toradol, percoset, and physical therapy at the school health services.
Frank came in one last time to see how I was doing. What a nice guy. He really cared.
(Nat) Yeah, right. He was more worried you'd sue or die or both. Self-interest, honey, that's what motivates these buggers.
Around 10:00 Diane from physical therapy arrived. She checked my range of motion in my knee. I got full extension, and 58 degrees flexure. Every degree of that past about 10 hurt like hell, though. Oh, rehab is just gonna be peachy. Diane tied a belt around my waist and showed me how to get up on crutches. She also showed Nat how to help me get my leg in and out of bed. Then she took me for a wheelchair ride to show me how to navigate steps. Up is easier than down, I'll tell you that right now. I did not realize at the time how non-trivial getting up and down stairs with one non-functional knee is.
Photo: Checking range of motion with Diane
Photo: Standing up
, note the belt around my waste that Diane was going to use to hold me up if i fell. hehehehe. RIGHT. After this we got final instructions on the use of the cryo-cuff from Barbara. The cryo cuff is a soft cast around my knee that is filled with ice water to keep the swelling down. We had to bring it home with us, I'm wearing it now. I hate it. Barbara unhooked the IV and took out the blood sucking tube from my knee. Removing the IV wasn't so bad, pulling off the tape hurt more than anything else. The blood sucking tube was another story entirely. Barbara intentionally didn't tell me exactly how much tube there was in there. When I felt pain and motion a good 8 inches from the entry hole, I screamed. I averted my eyes, and kept screaming. Nat watched in horror as inch after inch of bloody tube was extracted. Then *pop* it was out. Didn't like that at all.
Nat: this was the grossest part, I swear (the tube coming out). If I'd known it was coming, I'd have caught it on film. No such luck, though.
We checked out at 11:00, 45 minutes before our deadline. Getting into the car is a neat trick. I sure like being wheeled about in a wheelchair. I can put my full weight on my knee, if I'm motionless. It's going to be a great new knee. I can't wait to start my physical therapy and making it all that it can be. I don't mind the pain, or the pills I have to take to stave it off. I don't mind the inconvenience of the crutches. I have a ligament! I'm whole again!
Photo: Bye-bye!
Jenine, January 5, 1996
