Knee Replacement 7: Bone-sawing Day #1

Handing in the permission slip from my dentist at Heiden Orthopedics and confirming that all my lab results came back without any alarming data, I’m rewarded with a pre-surgery packet and some instructions on using two sterilized sponges that come in silver-sealed packages. I’m to shower the night before, scrub my knee with the sterile sponge, dry off with a clean towel, and then get into clean sheets. Next, lie there and worry. Forget about sleep.

It doesn’t say that. But that’s what I did.

It wasn’t the surgery I was worried about; however, it was the potential of not getting surgery. After the uncertainty of the last fourteen months—the fickle platelet count, the bone-marrow biopsies, the infusions and removal of organs (covered in previous posts)—it was easy to envision a mission-infused orderly running down the hall, bursting into the operating room just as the bone saws were coming out of their sheaths, waiving a sheet of paper with row upon row of neatly printed numbers.

Wait! Wait! You can’t cut on him, he will bleed out!

Dr. Heiden would peer over his safety goggles and shake his head.

No platelets, he’d mutter, sliding the bone saw back into its sheath, no surgery.

Maybe I’d watched too much MASH in my formative years—Hawkeye, Hotlips, Radar and the whole gang—but I was more afraid of getting shut down and shipped out than the more reasonable fear of a man of Olympian might sawing off my femur. Humans are funny.

Sleepless, I found myself back in the shower at four in the morning, where, as proscribed, I used the second sponge in a goodie bag to scrub my knee again until the skin glowed red. Strange to think that the bones under that red skin are about to be buzzed off, yanked out, and chucked in the trash. By the end of this day, my left knee—admittedly cranky and unreliable, but still it’s mine and has been with me for 63 years—will be gone. In its place will be a football-sized, immobile goiter with an eight-inch, blood-encrusted zipper in its place.

A fun vision to contemplate.

The Interstate through Parley’s Canyon and up over its summit is empty at five in the morning, and we arrive at the Park City Hospital early. The front door is locked, flanked by construction cones and tape. A paper sign, directing us to the temporary entrance around the back of the building, is taped to the glass. In a small booth that looks like a bank teller’s, a smiling woman apologizes for the inconvenience, and in minutes, another smiling person—some people are morning types, a trait I’ve always envied, and never shared—guides us down a hallway and situates me on a bed with wheels, while my wife Bel settles into a chair beside it.

Over the next hour, I’m transformed from a person into a patient. This metamorphosis is accomplished with a gown that ties in the back, or in my case, doesn’t, and leaves my ass hanging out, some sporty socks with rubber bottoms in a traction pattern (should I want to knock out a few wind sprints while I’m waiting), a nurse who shaves my knee, slides an IV needle into my arm, and clamps a little spring-loaded cuff on my finger.

An anesthesiologist explains the nerve block that he will administer and will last for a few days, and then Dr. Heiden comes in and we talk, but I can’t remember what he said because I’m waiting for the orderly to bust in, waving the pathetic platelets paper. And then it will be, Sorry, pal, your blood’s not good here.

I do remember his smile as well. What was it with these people? Don’t they know it’s still dark out!? And then he’s gone, and I realize that there will be no orderly with the pathetic platelets paper and I’m not going to be sent home for being less than a real, red-blooded American.

Wait, I’d better start worrying about the surgery itself. Oh shit. The bed is moving and I’m kissing my wife and she’s wishing me well and I’m in a very bright, very cold place with large lights and purposely moving people. And then…a nice young woman is asking me if I’d like a drink, and it’s no longer bright or cold, and I’m saying a cup of coffee would be nice. To my amazement, the nice young woman is asking how I take it, and, oh yeah, welcome to the recovery room.

The coffee is incredible, as in the best I’ve ever tasted, and I ask for more, and she brings it. This drill is repeated two more times, and each time I compliment her profusely on her amazing brew. She smiles knowingly and soon, as the effects of the fentanyl they’d administered for surgery slowly abate, I figure out why: it’s just Folgers.

My leg is sheathed in a white compression sock, through which I can see a ten-inch dressing, laid up and down my leg, over the incision. It doesn’t look huge, and I’m not in pain. In a strange, swirly fog, I find myself listening to a young Asian man instruct a circle of nurses on their new computer system. It’s an odd thing to listen to, life proceeding in its mundane way as I seem to float up and into it.

Buoyed by the coffee, I rise up into more consciousness, and wonder where the cheering crowds are? By getting through this surgery, I’d accomplished a major goal; I guess I expected a bit more fanfare. Maybe some balloons and welcome back signs, like you often see for return missionaries at the Salt Lake City airport? A cheerleader or two, perhaps?

Instead, a nurse wants to know if I’m ready to urinate.

A curtain is drawn around my bed, and I stand on one leg to release coffee-smelling piss into a bottle, which makes everyone happy, and then I'm wheeled to a pleasant room where my wife is waiting. No balloons or signs, but I feel ridiculously happy to see her. In fact, I’m very happy about a lot of things. The room is beautiful and has a mountain view. The nurses are attentive and healthy. They give me a menu—really, an actual menu—and I order glazed salmon and a large Waldorf salad. The food arrives soon, and it’s hot and amazingly good, and I’m thinking, all right! That wasn’t so bad. I feel pretty damn good.

Presently, Dr. Heiden returns and reports that everything went well, expressing his pleasure. Then he hands me a small plastic bag with a screw in it, explaining that he’d taken it out of my tibia.

I stare at the screw, which has been in my leg for twenty-five years, a remnant from an old ACL surgery. Oddly, it looks brand new, as if he’d just bought it from Home Depot an hour before. No pitting, no corrosion. It’s a bit of a let-down. But then something else strikes me.

Just one? I ask, remembering that there’d been two, one in my tibia and one in my femur.

I tried to get the other one out, but it sheared off. We were able to snug the rod in next to it, though, he says.

So, it stays in?

Yeah, it wasn’t in the way. He shrugs and continues: The whole thing went really well. You’re going to do fine. I’ll see you in two weeks.

I thank him, and then two physical therapists come in, a tall, young, bearded man and a bouyant young woman. Fit and trim, rosy-cheeked, they look like they just swung in from a round of disc golf. They are here to assess my ability to perform basic self-care. I swing my legs off the side of the bed, and we start seeing if I can put on my underwear. Yep, got that one. Next, a pair of shorts. I stand and can put weight on the newly built leg, at least long enough to slide my other leg through the shorts.

I’d prefer that you do that while sitting, she says. But that works.

Now the bearded man hands me a pair of crutches—the kind with the forearm cuffs instead of the ones that go all the way to your pits—and says it's time to go for a walk.

As we move down the hall, he shows me how to move both crutches forward with the bad leg, which is crutch technique 101, and then the more advanced move: Syncing each crutch strike with the landing of the opposing leg. I get that one, too, and he leads me to a room where a five-step wooden stairway awaits.

Good leg goes to heaven, bad leg goes to hell, he says.

This mnemonic device, meant to help me remember how to go up and down stairs, will prove to be surprisingly useful when I’m drugged up and navigating my house (which is all stairs).

When we get back to the room, he shares another maxim that will resonate for weeks to come: Remember, thirty percent of the people who have the surgery you had will fall in the first month. Don’t be in the thirty percent.

I don’t need to know what happened to those poor souls who biffed it to know that I don’t want to be them.

Armed with new mnemonics and maxims, freed of the little socks with the rubber tread bottoms, and after signing some papers that I don’t read, I complete the transition from patient to person.

And with that, I’m wheeled to the exit as Bel drives up in my truck and I hoist myself into the passenger seat. On the way home, we call our kids to share how well it went, and I am truly grateful it happened, feeling optimistic about the days to come.

Which was good, because if I’d known how hard it would be, I would’ve cried all the way home.