Relearning

My leg has a new geography, inside and out. I explore the new contours of my left knee, as well as I can through the boot and around the bandages. I wonder what the scars will look like. I can feel my muscles object when I try to move them. The pierced places are stigmata, but with pain and resistance instead of blood.

It needs time. The hurt is deep, and it's not just in my knee, it's in my head and in my heart too. The nice people from physical therapy assure me that it will hurt when I bend it. At first, it will be very bad. But it will get better. I fear that pain. I don't have strength for pain. I'm a wimp, I admit it. Stubborn resistance, I'm a fearless expert. Smoking? Quit it. Beat the hell out of it. Never met a substance I couldn't conquer. But pain is something else again.

My hand feels around my knee, nervously. I wonder what has happened in there beyond the injury to the bone. I felt things like rubber bands snapping when I fell. I can't help but wonder what ligaments and tendons I've destroyed, never to find again.

I talk to my knee sometimes. I have to be conscious to speak nicely to it, so that it will understand that I'm not upset with it, I still love it, it's still a welcome and treasured part of my body. My new favorite curse is "BASTARD! Not you." The "not you" part is directed to the nurse, the therapist, myself, my knee. The bastard part is for the pain. Misbegotten unwanted slug of agony burning inside my skin and bones. But it's there because it needs to be there. Can I learn to accept it, to even embrace it, to help it move on? Where does pain go when it dies?

Today, I can move my knee joint about an inch before it hurts enough to make me cry. Yesterday it was half an inch. Maybe tomorrow it'll be two inches. Maybe not. The PT folks aren't here on the weekend, so any progress will be made on my own initiative. I feel weak. I feel afraid. I feel paralyzed. I have to move past that, but I don't know how.

I will have a rich terrain of scars on my left leg when this is all through. Two long incisions from the fasciotomies. An incision from the bone reconstruction. Holes where the pins for the external fixator pierced my thigh and shin bones. Holes where the drains came out of my flesh. I joke that my stocking-modeling days are past, but the truth is I've always been vain about my shapely calves and nice ankles. The left one will be shapely in a whole new way now.

How I wish I knew where to begin. I want my life and movement back. Two more months of contemplation upon the proposal of walking before I can begin again.

Flakes of dead skin fall away from my leg, a fatality from the stretching of the swelled flesh and the dryness of the hospital. A hideous dandruff, I wonder what it will feel like on some distant day when I can get into a shower, or better still, bathtub, again. Showers are still pretty frightening, even with all the security of the hospital staff and the safety bars and such. And of course, the injured leg can't be washed yet.

An aide washed the foot on my injured leg the other night. It was the first time it had been washed since the accident. It was covered in flaky, corroded layers of betadine and dead skin and who knows what else. As she washed the foot, ever so gently and patiently, I nearly cried. I was sorry that someone else had to wash my foot, I still can't reach it, but it felt so nice. Such a simple thing. I will learn to enjoy and appreciate such simple things from now on, I promise. Things like wearing shoes, and being able to walk. Things like standing on two good legs.

The swellings on and just above my knee are rather frightening. I remind myself that they were much worse, not so long ago. It's a small comfort. Tentative touching and probing of the knee yields weird sensations, like warning lights. Fear. I must get past the fear. When I had my second daughter, I read a lot about fear and the connection with pain. Maybe if I understood the processes of what was happening inside my leg, I'd be more willing to face the pain without the fear.

I am trying to allow myself to feel hopeful. So many people wish me well. So much love. I allow that love to move into my knee and my leg bone and the right leg and foot too, mustn't forget that one, it's doing double duty. I don't fear scooting around on one foot. I don't fear falling, I am confident in my balance. I scoff at people who think they should deflate the bed to let me out. My right toe touches the ground and I'm safe, that's all it takes. I must stop fearing the pain. I must take that fearless ferocity that I've bandied about for so many years and put it to this task, to this work, now that it really matters.

And all the while, the geography will change, evolve, and flow into recovery. Or so I can hope. So I can choose to believe.

Two forward, one back

Well, I'm still here in the hospital. And they're still telling me they're transferring me. At this point I'll believe it when I see it.

I have two hospital-caused infections. Neither represent a significant threat to my own health or that of visitors with normal immune systems. I had to laugh at the irony of today's "word of the day" being "Nosocomial". (nosocomial means hospital-caused, as in infections or illnesses)

Yesterday they took the external fixator off of my leg. That was my sixth trip to the OR. I now have a big black boot on my leg that gives me a false sense of security because I still can't put any weight on it, and now the pin sites hurt like a mad bastard.

I'm so freaking tired of this.

I'm still working on the pomatomus socks, one is finished and the other is 1/3 of the way down the calf. That's about it for knitting. I blame the meds. It's hard to concentrate on knitting when you're in this much pain or groggy from the oxycodone. I've learned to do sudoku, though, so it's not all a wash.

More later. Too tired now.

10G and beyond

It was some time between two and three AM when I finally arrived on the 10th floor. I remember several people telling me "welcome to 10G!" in cheerful voices, and I think I commented on how friendly everyone was. I was taken down the hall to an empty room and transferred, somewhat painfully, into a bed. Blood was taken, sheets were adjusted, pain meds were given, a bedpan was brought and finally, gratefully used. Since I was scheduled for the first available slot for surgery, I couldn't have anything to drink but more trusty ice chips were brought. Since I've been here, I've learned to appreciate chipped ice more than I thought possible. There's nothing like it when you're in the recovery room, slowly regaining thought and feeling and realizing that a sirocco has blown through your mouth, leaving nothing but a faint residue of camel dung. Ice chips are nothing short of miraculous.

My elder daughter Lena arrived around 3:30 in the morning and sat with me while I faded in and out of consciousness. My leg was bound tight in the temporary cast and all I could feel was a deep, dull, endless ache that was beyond anything I'd ever felt or could even begin to describe. I think they were giving me dilaudid, or maybe morphine, but whatever it was, it only took the slightest razor's edge off the pain. Lena got her little stickers out of her purse and put one on my hand, and one on my injured toe. We talked and she stayed a couple of hours. Then it was time to go to surgery. I called my husband and my mother to let them know I was going in.

In the pre-operating room, I signed forms giving permission for everything from blood transfusions to anesthesia. My surgeon came in to talk to me. His name is Dr. Tarkin, and he's quite the character. He oozes self-confidence, but he was very pragmatic with me at that time. He discussed some of the consequences of the surgery, early arthritis, knee replacement, mobility difficulties younger than usual. He described what he'd be doing, and told me not to worry, that it would all be okay and that I'd be almost as good as new when he was done. We were off to the OR, where they have the most beautiful bright green tiles all over the walls. Being wheeled into that room was like diving headfirst into a vat of seafoam gelatin salad. And that was mostly all I knew for a while.

When I woke up in recovery, I had no idea what had happened, and it took me several hours to find out the full extent. There had been complications, compartment syndrome, and the planned rebuild on my bone could not be done. What had been done was two emergency fasciotomies, deep incisions into the meat of my calf with suction and drainage put in to relieve the pressure. I had no idea that I was within hours of losing my leg, or even my life. I found that out later. I was also the proud recipient of an external fixator or x-fix, a device that kept my leg still and straight so there could be no further damage to the crumbled bone within. Two pins are fixed into my shin bone, and two into my thigh bone. The pins are connected to an apparatus that looks like a capital A. The whole thing is ungainly and awkward, and somewhat hard to look at.

In the following week, I went on to have three more surgeries, the final one on my birthday, nine days after the accident. But I've gone on enough today about pain, and sadness, and worry. 10G became my home, and the staff like my family, with all the quirks and dysfunctions and foibles of any family. The people on 10G, the orthopedic trauma ward, are a unique bunch. They deal with high patient turnover. People aren't usually here as long as they're on medical wards. They deal with severe pain, disfigurement, external fixators, and difficult families. They have, for the most part, great senses of humor and a great deal of compassion for their patients. I've been the recipient of more kindness here than I can describe.

The day after the inital surgery, Bob and my younger daughter Anna were visiting. The burly young folks from Physical Therapy had come by to get me out of bed and into a wheelchair. It was one of the hardest things I've ever done. Someone brought me lunch, and I tried to eat a little bit of my salad. I was sick to my stomach, and I was fading in and out of consciousness sitting propped up in the wheelchair. I looked over at Anna and she was crying. I asked her why she was crying and she said she wasn't. I began to figure out at that point that things had been more serious than I'd known.

Intermission

So here I am in the hospital, still. Tomorrow will be three weeks since the accident. I'm supposed to get transferred to a skilled nursing facility today and I'm not sure if I'll have internet access there. I plan to continue this saga either way, but I might not be able to post subsequent chapters in a timely fashion.

Believe it or not, I'm still knitting. I finished the neon circus monkeys and the first hundertwalker, cast on for the second hundertwalker, and am about 2/3 of the way through the first of a pair of Pomatomus (from Knitty). Only I couldn't figure out chart B and instead of muddling through and making it work for me, I just gave up and decided to do the foot in stockinette. It's all good. Needless to say, I don't have pictures and am not sure when I'll be able to take or post any.

I've also been trying to do some reading. It's unexpectedly hard to read in the hospital. It may be the pain medication, but I just can't seem to concentrate as well as I'd like. I'm reading Paul Campos' "The Obesity Myth" and it's fascinating. Best of all, my mom was looking at it the other day and she wants to read it when I'm done. I also started Terry Pratchett's "only you can save mankind". It's very good. My mom got me the updated edition of "double yoi", Myron Cope's autobiography, and I've been enjoying that a few essays at a time.

People call and visit. I get cards and emails. I cry sometimes, from pain and depression and from dreaming that I can walk. Or dance. Or that I'm at home. It all seems so impossible sometimes. I'm worried about the pain meds too. Oxycodone is addictive. I try to make sure that I'm actually in pain before I take it but the problem is that if I do that and wait beyond the four hour time point, the pain gets ahead of me and it's hard to get it back under control. This morning's doctor told me that it's okay to just keep taking it, that it's more important to control the pain. My nurse last night (Kurt, who is awesome) actually came in and asked me if I was ready for them, because he saw how distressed I was from waiting on the earlier dosage. I guess there's a whole science of pain management now. I have the feeling I'm going to learn a lot about that.

So I suppose I'm off into the unknown and I'll find out more when I get there. I'll update again as soon as I can.

ER is nothing like you see on television.

Pulling up to the emergency room of the largest and supposedly best hospital in the area should engender a sense of comfort and hope in most sick or broken people. Unfortunately, that was not the case for me. The ride from Forbes to UPMC was mostly uneventful except for my feet dangling off the stretcher. Once the guys got me there, though, it was a slightly different story. Apparently some of the stretchers don't go with some of the vans, and the wheels on the stretcher got hung up on the bumper of the van, nearly dumping me out into the road. One attendant literally screamed for help from anyone passing by and a security guard came over to lend a hand, but I was terrified out of my wits and considering what came later, it's a damn good thing they didn't dump me.

They got me inside without further ado and left me in the hands of UPMC's emergency room. First I was wheeled to a room with four other beds in it. It smelled very strongly of poo. They moved me almost immediately to a non-poo smelling room where NFL network was showing on a television in the corner. I notified the nurse, without much hope, that I needed to use a toilet. She helpfully offered a bedpan but I declined, citing the need to attend to my feminine hygiene product. I bravely waited, hoping that before long I'd be able to avail myself of a normal, porcelain flush toilet. (Little did I know that almost three weeks later, such a luxury would still be unknown to me.) All my statistics and contact info were again taken and then, a flurry of activity led to my being moved to the hall near the poo room. There were a great number of alarms and beeping noises and loudspeaker announcements calling for immediate help and weeping relatives being led away by concerned looking staff. I think someone actually died in the poo room during that time frame. I still hadn't been given anything for pain and it was starting to get ahead of me.

I was sent for x-rays. In the x-ray room, I was contorted 100 different ways to get every possible angle on my legs, hips, back, and so on. They wanted to make sure nothing else was broken, I imagine. It hurt more and more every minute, and hurt more and more each time they made me move or turn or twist. I nearly vomited from the pain but imagining the pain of vomiting added to the fact that I already had to pee proved a very effective deterrent. I was taken back to the poo room, now ominously missing one occupant, but mercifully also missing the smell of poo. Directly across from me was a despondent looking young man with a basin and an expression of angst unseen since the late 90s. He periodically threw up into the basin, moaning. Next to me, thankfully beyond a curtain, was what sounded like an older woman begging someone named Tommy to "make it stop, I want to go home, please make the hurting stop" over and over again.

Around that time, Bob arrived. I was glad to see him but he looked worse than me. One of the greatest things about our relationship is how much we are attuned to each other, but it made it difficult for either of us to comfort the other much. We were both very worried, and with reason. I was sent for a CAT scan next, just of the left leg, the one with the fracture. I was getting really tired of moving from the ER bed to various apparatus. Back to the poo room and a nurse kindly gave me a cup of ice chips to suck on. The vomiting young man was still there, but seemed to be doing less vomiting. The Tommy calling lady was gone. An unreasonably young doctor came in to talk to me. The more he talked, the more worried I became. My fracture was bad, very bad. Plates and pins bad. I would be down for the count for some time, three months at a minimum. My need for a bathroom was still there but I was beginning to understand that I wasn't going to see one for a while, there would be no chance of any weight put on the bad leg. I was being admitted to the hospital and would likely be operated on first thing in the morning. Until then, they'd put my leg in a temporary cast. Another improbably young doctor joined the first and in a haze of pain and plaster and heat, my leg was immobilized. And finally, finally I was given pain medication.

It was a wait for a room, so I told Bob to go home and take care of the dogs and I'd let him know what was going on as soon as I knew. Surgery at first opportunity in the morning was all that was known for sure. Some hours went by, in a dilaudid-induced fog, in great pain, and in unknown and unrealized swelling in my damaged leg. Finally, around 2AM, a room became available and I was taken to 10G.

The story of what happened

So here's the story, or at least the beginning.

Thursday night is my regular bowling league night. I'm a pretty crappy bowler with an average in the high double digits, as sad as that is, but I don't mind. I was in the league to have fun and get out of the house and get around people, and a ladies' bowling league seemed like a fairly non-dangerous way to accomplish that.

On the 17th, I had started off pretty well. I felt like I was bowling well, like I was lined up right and throwing the ball right and that I had a good chance of beating my average by a good amount. The second frame, I bowled and left three pins. I did the usual aiming and calculating to pick up a simple three pin spare and went in for the shot. After I let go of the ball, I lost my footing. I don't know how I lost it, but I was struggling to keep from going over the foul line, and I lost the struggle. In regulation bowling alleys, the lane beyond the foul line is oiled to facilitate the ball's slide. My foot came down in the oiled part of the alley. I struggled to remain upright, but lost that struggle too. As I started to fall, everything slowed down. I heard crunching, popping, felt strange sensations like rubber bands snapping in my leg, and I hit the ground. I made a slight attempt to move, to get up, and started screaming.

I have never felt anything like that in my life. I was almost okay as long as I was still, but any movement was excruciating. Then, even being still wasn't okay. I could feel my leg swelling. I wasn't sure if things were broken, pulled, sprained, strained, or just bruised, but I knew my life was going to be different from then on.

The alley manager called the paramedics and someone brought me something for my head. I managed to call my husband on my cell phone and he assured me he'd be there. So many things were going through my head. The members of my team were sitting with me, trying to comfort me.

The paramedics arrived within ten minutes or so, as did my husband Bob. The paramedics prepared to get me on a backboard while Bob gathered my things and got my coat and bowling bag and my car keys. I was panicked, completely, and could not get hold of my emotions or fear. One of the paramedics came to my side and spoke to me gently, and I felt reassured immediately. I can't explain what was so wonderful about this particular medic, but he had a natural way of calming me and making me believe that everything would be okay. His face was like an angel's face, with skin as smooth and beautiful as a baby's. He helped me stay calm.

They took me to the nearest hospital, Forbes Regional, which was of course not in my HMO's plan. X-rays were done and it was obvious I had a pretty bad fracture. A different ambulance company was called to transport me to UPMC Presbyterian for orthopedic trauma. This ambulance ride was a whole different ball game. More of a van, the stretcher was far too small for me and my legs dangled off the end. Once they got me to the hospital, they nearly dropped me out of the back of the ambulance getting me out. Not a fun experience.

Then, the real fun began, the urban hospital's emergency room.