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5.05.2009

Bow Before the Impotent Agony of Knee the First

The night before surgery was like any night before a big tournament, I was ready to go, telling my body to slow down and my brain from running itself in circles. The weekend and day prior had been a frenzy of preparation to get the house clean, laundry done, and groceries stocked. With four refreshing hours of sleep I reported to the SurgiCenter at 7:45 AM and then went through the standard pre-operative preparation. I had my vitals taken, an IV was established, and they shaved my knee. The anesthesiologist made the fact that his nurse anesthetist was going to knock me out and breath for me sound mundane, while my orthopedic surgeon was pumped to start rearranging the internal geometry of my knee. A bag of ceftriaxone was hung along with some dexamethasone for nausea.
From my highly positive physical exam the plan was to visualize that I indeed was missing an ACL then clean out the meniscus rubble. My surgeon would then use a central piece of my patella tendon to replace my ACL, boring a hole through the bones proximal and distal to the joint. Shortly after chatting with my surgeon I was wheeled into the OR, the nurse anesthetist introduced herself and slapped some oxygen on my face.
I started waking up to someone really far away telling me not to fiddle with the oxygen in my nose. My right knee was a huge, uncoordinated, painful thing down at the end of the bed. As I regained a semblance of consciousness I pieced together that my surgery was done and that the annoying thing in my nose was a nasal cannula with oxygen. A shot of morphine and an antiemetic allowed me to down some ketorolac and hydrodone-acetaminophen. My pain got a lot better and I started to perk up, the nurse brought me something to drink and some toast. As the medications tenacious hold slipped away, they transferred me to the next level of recovery and brought my saintly girlfriend, Lan, to come talk to me. She showed me the arthroscopic pictures, evidence of the beating I had given my knee for the past decade. In my intoxicated state she also almost convinced me that we weren't dating.
Not a desirable region for a high coefficient of friction
Before picture, showing torn meniscus
A little high powered elbow grease
After picture, everything smoothed out

Getting me from the gurney to the easy chair demonstrated profoundly that my knee was impotently pissed off. The slightest vibration was nauseatingly painful but from my hip flexor down my leg hung like a limp noodle. With the added fortification of some cranberry juice and apple cinnamon muffin we attempted the next stage in the right knee saga, getting home. Fumbling against the vestiges of the anesthetic and gravity I was deposited in a wheel chair and moved out to the car, where I was able to prop myself unceremoniously in the back seat, my right knee like so much extra unwieldy baggage.
Yes there's a piece missingSomeone done put a patella tendon in there
Before picture, there's supposed to be an ACL between those two lines there
After picture, voilá a new ACL

At home Jarred had swung by with faux pansies and some milk shakes, and he helped get me inside. I had to figure out how to urinate again and will have to optimize the technique necessary to get the appropriate orifices over the correct waste receptacles with one leg that's a painful, rigid, brittle log. For the next 24 hours Lan watched over me. I spent the remainder of the day dreading having to move, but forcing myself to pump my calf to prevent a venous thrombosis (no thank you 6 months of warfarin). I drowsed in and out of consciousness as the stress, medications, and lack of sleep collided. We emptied the two Jackson-Pratt drains that drew a mixture of blood and synovial fluid from somewhere deep under the bulky immobilizer. Toward night I hopped up the stairs and with Lan's help got myself arranged in bed. I managed to sleep some more.

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