elmo1

 

I didn’t see the stairs. Even when I was falling, frantically trying to catch myself and looking down to see what I was falling into, I didn’t see the stairs.

Dammit. I keep flashing back to the moment of falling. Surely there was something, ANYthing, I could have should have done. Look down. Feel with my toes, hear a shouted warning, echolocate…anything, but I’d find those stolidly uncaring stairs before they found me.

Cynthia! Back up a sec.

On Friday night, Sept. 16, 2016, I fractured my left femur just above Elmo, my replacement knee. I lived in a wheelchair, facing hip-high amputation of my left leg, for about two years while I fought health care bureaucracy, cost-conscious HMOs, and myself to figure out a way to walk again. (Spoiler alert: Elmo won!)

I documented my adventures in remobilization in 49 blogposts. They’re awfully self-indulgent, occasionally icky, and probably only of interest to me, but on the off-chance that they help someone else with a catastrophic injury, I’m keeping them together here. If you don’t want to read them, that’s OK; I still love you. If you do, you might want to start from the beginning, on the archive page that lists all 49 posts. Anyway, this is post #1. Enjoy.

Friday night, my good friends Kaitlyn and Aaron asked me to dinner at a nice little Thai restaurant near the Beaverton Central MAX station. There are multiple pokestops there, the hunting is good, and we just enjoy each others’ company.

After dinner I walked them to their car, then took off across the quad to my car, clutching a giant box of cherry tomatoes fresh from their garden. The parking slots had been full where I usually park, so I’d parked on the other side of the tracks from my usual haunts (important–I’d never been that way in the dark before).

I try to walk at least 25 miles/week, courtesy of Elmo, my 14-month old replacement knee. I’d been walking longer and longer distances, kinda in celebration of just being ABLE to walk. It was a glorious night, slightly nippy but beautifully clear, so I decided to walk the long way ’round.

My boss Ron had been texting and calling all night about a critical deadline, and my new Android phone was ginormous. Rather than shoehorn it into my purse and then have to pry it out in a rush, I carried the phone in my right hand.

I didn’t see the stairs, painted dark blue to blend in with the night. My hands, filled with phone and tomatoes, left me no way to catch myself when my left foot stepped out into…nothing.

Gut-dropping freefall. Hard bounce on my knee. Faceplant onto concrete.

My glasses drove into my cheeks, and the tomatoes exploded. For a second, I wasn’t sure what had happened: I’d THOUGHT I was walking upright, but here I was, face-down, on the concrete.

I tried to turn onto my side, and my leg screamed. Bewildered, I looked down.

Yellow stair risers, snickering in the moonlight. Three of them. Just three. Beneath, my left leg bent oddly to the right, under a growing circle of dark on my jeans.

OMG. Elmo. Please please please don’t let it be Elmo.

Called for help (thought about yelling “I’ve fallen and I can’t get up,” but decided this wasn’t time for jokes)

A wonderful man (Bogdan, if you read this, ten million thanks) ran to me and went pale. He called 911, staring at my leg and shaking so hard he nearly dropped the phone. A woman offered a backpack to prop up my head. Bodgan found my phone about 25 feet away–apparently I flung it as I fell–my purse maybe 10. The cherry tomato box had bounced off into the distance.

The 911 dispatcher asked Bogdan if I was conscious. Bogdan was shaking too hard to answer, so I reached for the phone.

“Hi. This is the victim, Cynthia Morgan. I think I’ve fractured my leg above a year-old replacement knee. I’m shocky, racing heart, the pain is bearable but I can’t move without a flareup.”

“Hold on, Cynthia, the ambulance is on its way. You should be able to hear it now.”

I did. Five or six paramedics flooded the plaza with equipment, asking a lot of leading questions like, “Do you know where you are?”

Buddy, I’m lying on the ground in this stupid Madame Recamier pose, wondering why the hell my left foot is facing UP like that. Where do you THINK I am?

Light dawned: They assumed the red oozy goo splashing down my jacket meant that the contents of my head had gone south for the winter.

“Uhm…guys? Those are cherry tomatoes, not brains.”

So help me, one of them tasted. “She’s right.” They debated how to get me into the ambulance, and it wasn’t easy. I needed something called a scoop stretcher just to make it onto the REAL stretcher. The scoop pinched some personal parts and felt like I’d left my bottom on the concrete, but eventually we made it to the ambulance.

They offered me fentanyl for pain but I declined. No sense in going overboard with narcotics, not if I was to drive myself home. I wasn’t about to look like some stupid, tomato-covered wuss when the doctors scoffed at my simply wrenched muscles.

Hope springs eternal, right?

I asked to be taken to Kaiser Westside, the wonderful hospital where I became attached to Elmo. “We were going to take you to Legacy, to the trauma center,” one said doubtfully, but I overrode him. The Doc would be at Kaiser. He’d give me a bandaid, tell me to stop being a baby, and send me home to normalcy.

Let’s not talk about that ambulance ride. The paramedics treated me with toe-tipping care…but let’s not talk about that ambulance ride from hell.

Kaiser was full up on emergencies, so the 18-year old paramedic waited in a little ER cubicle with me. The adrenaline was wearing off; I NEEDED that fentanyl. But the paramedic’s eyes filled as she shook her head no. Once inside the ER, only doctors could give me drugs.

She held my hand, talking softly, until the doctor came.

She told me, eyes shining, that she’d dreamed of being a paramedic since childhood “because their whole only job is to save people.” She’d started working for ambulance companies at 13, washing the trucks, sweeping floors, whatever they’d let her do. It wasn’t until she was 18, earlier this year, that she was allowed to certify as an EMT.

Tonight she said simply, “This is what I will do for the rest of my life.”

She blotted my pain-sweat brow, and proudly offered to advocate for me with the hospital. “I won’t leave you until I know they’ve got you sorted out. Even if it wasn’t my job, I wouldn’t leave you, so don’t worry.”

And she didn’t. The doctor arrived and things got painfully busy, so I never noticed her slipping out into the night.

I wish I knew her name.

The doctor was kind, but worried. Adrenaline depleted, my leg was throbbing, ripping, spasming with pain. “We need X-rays,” she said anxiously, injecting blessed morphine before sending me to Radiology.

Let’s not talk about THAT trip, either…except maybe for the wide-eyed look of shock the X-ray tech gave me when my first film appeared onscreen. “We need MORE morphine down here, STAT!” he yelled.

That second injection did it, the bursting pain settling as I arrived back at my little ER cubicle. “Honey,” said the doctor pityingly, stroking my arm, “You are soooo broken. May I show you the X-ray?”

For the first time in my life, I regretted growing up surrounded by medicos. I could read those X-rays. A spear of bone floated high inside my thigh, its jagged edge overtopping Elmo a few inches from its normal home. It had ripped out of my leg to cause that spreading dark stain on my best jeans (which had been cut off, along with my underpants).

“Cynthia, you have an open fracture. Those are pretty dangerous because of the risk of infection…”

“But Elmo’s OK, right?” I interrupted.

She looked puzzled. “Elmo? Oh, your implant. Yes, the break was above the implant so it probably wasn’t damaged. The orthopedist on call will be here shortly, and he can give you more information.”

I waited, while ER personnel kept popping in to meet me. “Cynthia, right? We saw your X-rays. WOW. Wild. That’s some fracture.”

Nice that I can impress hardened ER personnel, but strangely, not very comforting.

The orthopedist wasn’t exactly a ray of sunshine either. “The bone coming through your skin is very dangerous; there’s a high risk of infection. We’re taking you to surgery in a few minutes to clean it out.”

“Uhm…may I have a wee bit more morphine before you start?”

He chuckled. “I don’t think you have to worry about that; this is major surgery. General anesthesia; we’ll be in there quite awhile and we need you relaxed. Now, uhm, Cynthia…can we talk about the bad news.”

That was the GOOD news? 

“The bone is shattered too close to the implant to repair. We’ve got to remove your knee replacement, and replace it with a much more extensive prosthetic, one that replaces the bone. It won’t work as well as the one you have, you won’t have as much mobility, and probably more pain. And it won’t last nearly as long.”

Elmo wearing out was a known quantity, and when that happened they’d told me I’d have a second less desirable implant. It sounded like they were accelerating the timetable. “And after the new implant wears out, I get a replacement?”

He hesitated. “Not likely. Usually these implants remove too much bone and there’s not much left for a repeat when they wear out.”

“So you, what? Fuse the leg? Amputate?”

“Let’s not talk about that until later.”

Mindyammer. Panic. One-legged Cynthia. Maybe I could wear blades like Pistorius. Like that chick in The Kingsmen. She ran and jumped and was gloriously gorgeous. Focus on that.

I forced my traveling mind to listen. “We can’t do the replacement tonight, we can’t get the parts until Monday,” the doctor continued, “So we’ll get you cleaned out and stabilized, and you’ll be all prepped for removal on Monday.”

I had until Monday to say goodbye to Elmo. We wheeled down to the OR, me cracking desperate jokes all the way until the anesthesia faded me…

No pain in the morning, though I could feel the bones playing inside my thigh like giant drumsticks. A nurse gently checked my vitals and told me that surgery #2 was now scheduled today, in a couple of hours. “What happened to Monday?” I asked, but she didn’t know.

I had two hours to say goodbye to a hunk of plastic and titanium that had literally changed my life, given me back my mobility. I’d been promised 15-20 (or more) years together, but my clumsiness reduced that to only 14 months.

I felt almost unbearably sad and ashamed. I considered crying. Wondered (only briefly) if it would be better not to wake up after the surgery.

“Ahem.” I looked up to see The Doc, Dr. Kroger, the guy who introduced me to Elmo, silhouetted in the doorway. He looked as though he wanted to cry, too.

“I’m so, so sorry this has happened, Cynthia. Just so sorry.”

I tried to apologize that I hadn’t been more careful with his wonderful gift, that I’d killed Elmo in five seconds of carelessness, and he held up a hand to stop me.

“Listen, Cynthia: I know the plan is to replace your implant, but I studied your X-rays this morning, went over them with a traumatologist, and…We think we can save your leg Before you say anything, though, you need to understand the risks.”

Save Elmo? Wait…SAVE ELMO?

“If we do the other implant, your recovery will be about like it was with Elmo, maybe a little rougher, and you’ll be walking, able to bear weight on your new knee the first day. But overall, it won’t last as long, and it will be difficult to do another replacement after that.”

This, I knew.

“If we do what I’m proposing, there’s maybe a 70 percent chance of success with a very long, slow recovery. The bones must grow back together completely, and it’s such a big defect that there’s no guarantee they will. You’ll keep that leg completely still, or it won’t heal. No weight-bearing for at least 6-8 weeks, maybe longer. It will be hard, but it’s our best chance to save the leg.”

“And if it doesn’t work, we can still do the second implant?” I asked. He nodded.

“So I’ve nothing to lose really,” I said slowly.

“Well, nothing except a lot of extra recovery time and pain, and more surgery, if the bones don’t heal. If they do heal, I hope to get you close to what you had before the injury. So…it’s your decision; think about it.”

No-brainer. “Thought about it. Let’s do it. When?”

He grinned. “The team’s waiting now.”

THAT’s why my surgery timetable was moved up. The Doc knew me, all too well.

Mom met my gurney on the way to the OR. “You were doing so well with your knee,” she said softly, trying not to cry.

I knew how she felt.

*Memo: If you hurt, and they offer you pain meds, TAKE THEM. Worry about wimp factors later.