Chronicle and Reflections on my Knees

We can ignore even pleasure. But pain insists upon being attended to. C.S. Lewis

For several years, I’ve been aware of the dark cloud on the horizon, hovering about 24” above the ground and detectable wherever, and whenever, I walked.  The cloud first appeared in the summer of 2015 when I experienced severe and sharp pain in the left knee as I stepped down from a cinder block in the back yard.  I had to crawl across the yard, dragging the left leg, to get into the house.  Eventually, with rest, ice, and elevation, the pain eased, and life carried on as I pushed that awareness into the background of a busy life.  A few months later a similar event occurred while walking to my vehicle after being on my feet for a long period of time, shooting a video of a wedding 70 miles from home.  My son-in-law had to assist me getting to and into the car and I drove home alone, in great pain.  I was told at that time by the doctors a knee replacement was certainly in my future, it was just a matter of when.  The insurance company would not pay for it until certain physical damage parameters were met.  Those parameters did not take “pain” into consideration.  The cloud on the horizon now had a name and despite a few rounds of physical therapy and a regimen of cortisone/steroid injections every three months, the cloud grew larger … and darker.

By May 2017 I had chronic pain in both knees and underwent arthroscopic surgery to clean up the meniscus of the right knee.  Apart from a hernia repair back in the 1970’s I had never undergone any surgical procedures.  This procedure was quickly recovered from and gave me considerable relief.  Within 12 months, though, the pain had returned, and I began receiving quarterly injections in both knees.  Ultimately, the effectiveness of the injections dwindled to about three weeks, instead of 3 months.  The problem, of course, was that I could not receive them with anything less than a three-month time interval. 

Physical pain can certainly motivate us to action but there are other kinds of pain that can be just as effective, if not more so.  Silently I suffered the pain of discouragement each time I was confronted by another activity that I could not do as I had done in the past.  Walking, particularly up and down sloping ground, or over the uneven ground in the yard, or up and down stairs; even getting up from a sitting position was difficult.  It was painful to be observed walking as a decrepit old man when in all other respects, I am healthy.  It was painful when “Grampy had to sit and wait because he has trouble walking.”, during an outing with the grandkids.  And so, I sat and waited while everyone else fully enjoyed the activity.  It was painful to know that Linda was graciously curtailing walking activities when we were out enjoying ourselves because she knew it was painful for me.  It was painful to hear her tell folks … even strangers, “I do all the work around the house because ‘he can’t’”.  It was even more painful to stand inside where it was cool and watch through the patio door as my sweetheart worked hard in the hot sun and humidity to mow the lawn or pull the weeds and carry them off in the wheelbarrow.  It was painful for me to know, or at least sense, that perhaps I was a burden or an inconvenience to someone who had to adjust to my needs.  I sometimes wept silent tears of frustration and even embarrassment over these things. 

My pain was insisting on being attended to and I had to listen.

Change happens when the pain of staying the same is greater than the pain of change. Tony Robbins

In the Spring of 2021, I made the decision to have the surgery done. I joked with people telling them that the biggest obstacles were courage, COVID (in the hospitals) and calendar.  With a full ministry calendar, that issue was the greater one to overcome; but I found a window of time beginning on August 30, so surgery was scheduled.

Once the date was established, I adopted an outward attitude of “I got this”, and I was prepared for a relatively brief time (6-8 weeks) of being out of commission and back to the preaching ministry and the driving ministry (Lyft and Uber).  With two small blips on the radar, I breezed through the pre-op physical, the CT scan of the leg and the pre-surgery Physical Therapy class. 

The first blip came during the pre-op physical with my regular physician.  A routine EKG was taken, and the doctor told me that there was a little irregularity to my heartbeat, but it was nothing to be concerned about.  Nobody had ever said anything about an irregular heartbeat until that moment.  The second blip came during the pre-surgery PT class in the form of a wake-up call and a chill down my spine when I learned that post surgery, Linda was going to have to give me two weeks of daily injections of a blood thinner in my abdomen.  That may not sound terribly alarming to most people.  For me, it triggered an immediate mental inventory of all the potential slights, offenses, and “issues” that my girlfriend might be keeping tabs of.  She might view this as her opportunity for payback!  Added to that was the fact that even though she had never given a shot to anyone before, she seemed so nonchalant about the whole idea!  I sought help from our family doctor, in the form of any recommendation he may have about a topical anesthetic to numb the area before it got poked.  He said with a chuckle, “The only thing I could recommend is a rolling pin.”  That did not sound like medical advice to me!

In the final weeks before surgery, I drove for LYFT and UBER as much as I could to build up a financial hedge against the lost income during the post-op rehabilitation.  I spent some time establishing at least a modicum of order in the garage.  Linda prepared the house as she took up the throw rugs (and threw them somewhere?), rearranged the bedroom, secured bath and toilet fixtures, and dusted off the old walker hanging in the closet downstairs.  She graciously agreed to allow me to commandeer the dining room of our home and convert it to a sewing/embroidery work area as we moved equipment and fabric up out of the basement.  This would help keep me occupied during rehab and help by getting me up on a regular basis to change the thread in the machine!

Finally, the day of surgery arrived.  I presented myself at the hospital at 5:30 am, was placed in a chair and, with Linda following behind, was wheeled to the surgical area.  Jeske’s Law made an early appearance as the nurse appeared to start an IV in my hand.  “Are you good at this?”, I asked.  “I think so.”, she said.  A few minutes later she apologized and said she would have to try another location as she had run into a valve and could not get through it.  I knew she could not get through it … I felt it each time she tried!  She succeeded in her efforts at a new location. 

The anesthesiologist arrived with her little spiel about how they were going to keep me sedated and what the risks were.  She looked at the afore mentioned IV and pronounced it too small for her purposes, indicating that I’d be getting a bigger one in the other hand.

The surgeon breezed in and out, barely saying more then three words, scribbling his initials on my thigh and then he was gone.

A nurse arrived to shave my leg and I remember thinking I was glad it was a woman.  Since women are experienced at shaving their own legs, she would likely do a good job and not nick me (although I once knew a girl from Greece … well that’s another story).

Even with all the activity, time moved so slowly as we awaited in the small room.  Although I had not eaten or drunk anything in almost 12 hours, I had to urinate at least three times in 90 minutes and worried about what would happen in that department during surgery until one of the surgical nurses came and went over a few “details”.  She assured me that they would not use a catheter, but would, instead, allow me to go just prior to taking me to the OR and they would put me in a Depends, “just in case”.  “Oh great”, I thought … and sarcastically so.

The time to go to the OR finally arrived and as they pushed the bed out of the little room, I grabbed my girlfriend’s hand and said, “See you on the other side.”  Her hand was warm and reassuring … I hoped mine was so as well.

Upon entering the OR I was greeted by a cheery crowd and the room was cold.  They all introduced themselves and may have told me about their role in the upcoming drama, but I could not begin to remember anything of what they said.  It was dawning on me that I did not have my Depends on!  I sat on the edge of the operating table and was about to say something when the nurse standing in front of me lifted my “skirt” and declared “He’s not wearing a Depends.”  Momentary confusion filled the space as another nurse looked to confirm that detail.  Someone behind me said, “I’ll go get one”, and a moment later I was being assisted in stepping through the leg openings and someone was pulling it up around my waist.

I was told to sit on the edge of the table as they would be administering a spinal injection as part of the anesthesia.  I watched as a nurse pressed the plunger on a hypodermic needle that had been stuck in the IV tube.  She said it would relax me.  I have tried hard to remember anything after that moment in the Operating Room.  I can’t.  I don’t remember getting the spinal injection although I did later find a band-aid on what I suppose was the spot.  I don’t remember lying down on the table.  Did I just slump over, and they had to catch me?  Did they miss and I fell off the edge and needed to be picked up off the floor? I simply do not know.

The next thing I remember was hearing the voice of my girlfriend in conversation with someone.  And there was also someone asking me if I wanted a sip of water and whether I had any pain.  Linda says that as I came out of the anesthesia, I embarrassed her in front of the medical folks tending to me by asking her repeatedly if she wanted to make love. She says it’s true so it must be, but I have absolutely no recollection of it, and it seems so far out of character for me so it’s hard to believe.

When I was sufficiently recovered and had stood on my own and taken a step or two, we left the hospital at 6:30 pm and headed for home, settling in, and prepared for the challenges of the days ahead …or so we thought.

“It’s a dirty job, but somebody has to do it” Nick Stone played by Mike Connors

(Warning: Some parts of this section may be deemed rather gross and such an assessment is probably correct.  If you are squeamish about such things, skip it.  It is, nevertheless, part of the experience and thus plays a role in what I have learned as a result).

I often aver that my life is frequently lived under the influence of “Jeske’s Law”.  Jeske’s Law is very simple “Murphy was an Optimist” (google Murphy’s Law to make the connection if necessary).  Tuesday and Wednesday were pretty much as expected with sleep, rest, exercise and so on.  My semi-stabilized rocker recliner became my home during the day.  Although the bathroom is only 25 steps away, the door is narrow, and I can only enter with the walker by doing the sideways crab walk.  That’s awkward for a man who has just had a knee replacement.  Those plastic hospital urinals are a wonderful invention!  I used mine, it seemed like every 25 minutes, right there in the living room.  My girlfriend, at first, was scandalized by the fact that I was sitting around in my boxer shorts and “peeing in front of the living room picture window” (well, not directly in front of it).   Sweet woman that she is, she did relent as long as I turned my back to the window, and she graciously took up the responsibility of emptying the receptacle with enough frequency that any visitors would not be confronted by the sight of it.  I love this lady.

The visiting nurses and therapists made next day visits after surgery and set up the schedule, leaving instructions.  My girlfriend took charge of the medication dispensing, maintaining a chart telling her what and when so she could check things off each time.  I love this woman!

My girlfriend also settled into overseeing my exercise (torture) sessions three times a day.  She uttered words of encouragement and motivation and assisted with the lifting process when I was unable to lift the leg.  I really do love this woman!

She was even doing well at the abdominal injections of the blood thinner designed to prevent blood clots.  I was … and am … so very proud of her!

What she was unable to do was assure regular bowel movements.  We had been warned about this because of the narcotic pain killers and other meds.  Thursday morning dawned and I had not had a BM since the Sunday before.  I was feeling “full”.  We tried some MiraLAX, and it did nothing and I was getting uncomfortable.  My in-home nurse called the visiting nurses and they suggested Dulcolax suppositories.  So, off she went to the drug store and got some.  This sweet woman sat and watched an instructional video demonstrating how to insert such a thing, where it needed to be inserted.  Should it become necessary, she wanted to be able to know what she was doing.  I love this lady.  It became necessary but I managed to do it, wanting to spare her … but with a heart of love and gratitude for her willingness to do so.  It did not work, and the matter was becoming urgent.  It was late in the day, and I did not want to make this an issue to return to the hospital over.  My sweetheart had purchased some latex gloves with the Dulcolax and so I literally took things into my own gloved hands, and with the assistance of a little lubricant spent two hours on the stool, digging it out a little at a time until enough had been removed to allow free movement of the rest.  It was a sweaty, dirty job.  It was a great relief to have such a moving experience over. I was totally exhausted and ready to move on.

Friday and Saturday returned to something of the new normal routine and things went off the rails about 7:00 pm on Saturday night.

Passing on the cheesecake

I like cheesecake.  Cherry pie, of course, is my favorite dessert but cheesecake is a great alternative and a wonderful bedtime snack.  I made a trip to the bathroom and was on my way back as Linda stood in the living room and said, “I’ve got your cheesecake here.”  This man never refuses cheesecake and so, when I turned her offer down, she knew instinctively something was wrong.  So, she asked what was wrong.  I was feeling a little “fuzzy” around the edges.  No pain or shortness of breath, but some tightness and an unsettled feeling as well as a cold sweat.  I just wanted to sit down.

Linda sat down as well and began reading through the materials given us by the nurse when I was discharged earlier in the week.  She came to believe that I may be having symptoms of a blood clot and so as I sat thinking I should just go to bed and sleep it off, she gently persuaded me (almost without words) to call 911.  She placed the call and relayed my request that they come without lights and sirens.  They arrived in about 10 minutes.

It was quickly determined that my heart rate and blood pressure were much higher than they should be, and I was packed into the ambulance for the trip to the hospital.  Getting me out of the house was fun.  They had me in some sort of a chair with wheels … not a wheelchair … but not a dining room chair either.  Once at the top of the driveway they loaded me on a gurney and strapped me in with about 8 straps.  The trip down the steep driveway to the street was frightening.  Three burly men at the foot of the gurney, grunting and groaning against gravity was a bit unsettling.  Had they let go, the neighbors garage door, six houses away at the bottom of the hill and across a street awaited me.  I pointed that out to them, and they assured me that I had nothing to worry about.

The head of the crew told me that I need not be too alarmed.  The symptoms he was seeing didn’t appear to be too unusual and they would probably treat them and send me home.  I asked him to share that assessment with my girlfriend who was preparing to get into the car and follow us to the hospital.

As we traveled, I noted with each turn of the ambulance what street we were on … St. Celia, I announced.  East on Hillcrest…South on JFK … East on Dodge … Bryant Street Exit.  My ride mate was impressed, and I explained that I drive for LYFT and UBER to supplement my income, and those turns were ingrained in my senses. 

There was no waiting at the Emergency Room.  They were waiting for me, and things moved quickly as I was fitted with a heart monitor, an IV tube and placed on a bed.  The details of the process that followed are not nearly as important or interesting as the result.

“The Unexpected always Happens” – Benjamin Disraeli (a paraphrase of Jeske’s Law)

I was informed that my heart was in AFIB and there was the possibility of a blood clot.  They could start a treatment of medications which would take a few hours to take effect IF indeed it WOULD correct things.  The other option was to perform electro cardioversion, shocking the heart back into proper rhythm.    The danger of that was that if there was a blood clot in the heart, it could expel the clot with no ability to predict where it would go and what damage it might do.  To be safe, a CT scan of my heart and lungs was ordered.  An hour later the result came in … I DID have a clot that had passed through the heart already and had landed in the lung.  Furthermore, while the heart was clear at that moment, there was no assurance that there were no other clots.  It was likely that the clot resulted from the knee surgery and that passing through the heart is what triggered the AFIB. 

Honesty demands at this point that I admit the confirmation of AFIB, and blood clots frightened me.  To this point, I had been rather relaxed and matter of fact about the whole thing.  This news was very unexpected and daunting.  The immediate impact and aftereffects of this news took some time to be recognized as they evolved, and I will share more about that later.  For now, however, the decision was made to admit me to the hospital and start me on blood thinners to dissolve the clot in my lungs and any other that may be lurking elsewhere.  We would treat the AFIB with medication as well.

On Sunday, at 12:30 AM, my girlfriend accompanied this knee replacement patient up to the cardiac care unit where she saw me tucked in and headed for home.  Before going to sleep, I asked my assigned cardiac nurse, as she took my vitals, what my pulse and blood pressure were.  I don’t remember what her specific response was, I do remember that they were not “textbook” values (which had always been the norm for me until now), they were high.  I went to sleep praying that God would allow me to live through this and help me to learn the lessons that I knew He wanted to impress upon me.  I used the warm blanket to wipe away a tear on my cheek as I thought of my girlfriend who had now returned home alone, to an empty bed … and I wondered how she was handling it.  “God, please watch over and strengthen her, Hairy Potter … give her some lovin’.”

Taking another run at it

Sunday, Monday, and Tuesday were all spent in efforts to assure that my blood was thin enough to prevent any more clots, while at the same time getting my Blood pressure and heart rate into a normal range.  It required a lot of fiddling with the meds I was receiving through the IV.  It was a dramatic moment when my nurse, Sara, freaked out after getting me out of bed for breakfast, Monday morning, and then discovering that my blood pressure had dropped from mid 90s to the mid-70s in a matter of moments.  She put me back in bed as quickly as she could.  That precipitated a call to Dr. Eltibi, the cardiologist to come and consult.  He came around 9AM, and I liked him immediately.  I asked him where he was from and he replied, “The Holy Land, the land of Jesus.”  I responded, “I’m a Christian… (and was going to add, I know Jesus as my Savior, but he immediately responded, “I’m a Muslim”, and he fist bumped me and said, “Glad to meet you.”  This doctor had a calm, confident demeanor and told me, “I’m going to tweak your medications a bit to see if we can get things under control.  But, if you haven’t gotten back into sinus rhythm by midnight tonight, then first thing in the morning I’m going to shock your heart to force it to do so.”  When the visit was concluded he said, “Okey Dokey, Smokey”, and fist bumped me again … and he was gone.

At 2:40 pm, my heart slipped back into proper rhythm.   Praise the Lord!

I liked the food I received in my hospital meals.  It was good, and the nutritionist fiddled with the makeup of each menu so that I could get an extra cookie and not exceed the recommended carbohydrates.  She was one of my favorite hospital staff members.  My girlfriend came and sat in the room, snoozing, or reading, each day.  There wasn’t much for her to do but just having her there was a comfort.

They kept me for another 24 hours and released me into the care of my girlfriend on Tuesday afternoon.

Thus ends the chronicle of my hospital adventures (hopefully).  Chapter II will contain some of the things I’ve learned, and ways my thinking has been challenged and changed … but that needs more time to develop and mature.