Fall hard. Get up. Keep going.
A life lesson in knee surgeries
On a gray day in 1975, I woke up in a Eugene, Oregon hospital after emergency knee surgery. I’d landed there for a week after tearing my right medial collateral knee ligament practicing slalom with my high school ski team. Here I was, falling all over again, as pain pitched me over the edge of a metaphorical mountain. The nurse was not amused.
“Stop hitting that button!” she said, rushing into the room where I lay with my leg in a hip-to-ankle cast. “You know you’re only allowed to get Demerol every four hours!”
Her irritation did nothing to ease my agony. Fortunately, the pain lessened as the week wore on. I was able to turn my attention to visitors bearing klutz jokes.
But this was the dark age before arthroscopic surgery. I didn’t realize that the real suffering would start when the doctor removed my cast. After six weeks immobilized, my leg was scaly, shriveled, hairy, grub-like.
My initial recovery involved six months of torturous physical therapy, when my knee was forcibly bent and straightened to break through scar tissue. When my doctor was satisfied with my progress, the serious training began.
That summer before junior year I painfully moved from riding an exercise bike to slowly logging the daily miles my doctor (a marathoner) prescribed on country roads near home. I also swam and trained with weights — pushing my knee, surrounding muscles and body to build strength, stamina and agility. My knee became knobby and muscular. I slathered my thick, curved scar in sunscreen and massaged it daily.
When school started, I was ready to train and ski again with my team. I grappled with fear and developed a reputation for veering off course in spectacular crashes. Even while rarely finishing a race, I somehow managed to letter.
Despite the setbacks, I never regetted my decision to join the team. For two seasons I trained, raced and enjoyed all kinds of memorable, parent-free misadventures with my teammates in the Oregon Cascades.
Starting my freshman year at the University of California, Santa Barbara, I earned true-Oregonian panache by talking up my ski prowess around the dorm. I excitedly joined a school friend for my first time skiing Mammoth. Unfortunately, I fell hard on the top of the first run on the first day of the trip. I lay in the snow, unable to get up, yelling for help until the ski patrol team whizzed in to examine me.
“What did you do to yourself?” one of them asked before strapping me into an emergency sled.
While I didn’t exactly know the answer to that question, a familiar pain in my knee cemented my hunch.
“I tore my right medial collateral ligament,” I answered.
“It’s probably just a sprain,” he said. “We see that all the time.”
Before the ski patrol transported me to the lodge, removed my boots and cut open my right pants leg, I almost believed them. But when the doctor in the nearby town of Bishop asked me what I had done, I gave him the same answer.
Moving my knee back and forth he said, “I’m afraid you’ve torn your right medial collateral ligament.”
I fainted.
I flew back to Santa Barbara for emergency surgery and another week in the hospital, adding another scar across my old one. For the second time in my life, I was discharged with my right leg in a hip-to-ankle cast. This time I was condemned to eight weeks on crutches, plus sponge baths for the duration in the dorm’s communal bathroom.
I don’t remember much about that hospitalization, but I can still picture the record-breaking rain that sent me crutch-crawling to class with my cast covered in plastic.
As an 18-year-old with youth on my side, I was wincing through therapy by spring, swimming laps by summer and running on the beach again by fall of my sophomore year. But after this second surgery, my knee had lost flexibility and hurt when I twisted. Once called “Kicker” in junior high track, I could no longer bend my right knee back enough to touch my butt.
Fortunately, I was never good at tennis, beach volleyball or any sports my doctors warned me to avoid. Although I still skied downhill in my dreams (under lifts filled with cheering spectators), I stuck to much safer cross-country ski trips with my family over school breaks.
My future husband learned to cross-country ski on our family vacations. The two of us soon began exploring California’s winter landscapes together: Nordic skiing from Yosemite’s Badger Pass to Dewey Point; getting snowed in at a remote cross-country resort in Sequoia National Park; and learning to skate ski on groomed trails near Lake Tahoe.
I didn’t start downhill skiing again until 15 years later, when friends invited our family to to join them at a local ski area. I discovered that at small resorts, I could stick to intermediate runs and quit before I was tired.
As the decades eclipsed my two surgeries, I enjoyed an active life as a hiker, jogger, cyclist and occasional skier. I almost forgot about my youthful mishaps. But then someone would notice my scimitar of scars and I’d tell their stories again.
Living in L.A. at age 32, I let a younger neighbor — an orthopedic surgeon who started practicing in the modern age of arthroscopic knee surgery — examine my bad knee. To him, it was a relic of prehistoric medicine.
He told me that arthritis had probably entered the weak joint, but couldn’t tell for sure without an X-ray. He explained that it would reveal itself as a white shadow on the film. I listened, but dropped the issue there, continuing my active routine with no symptoms of weakness.
I was 50 when I first felt a stabbing pain that sent me to urgent care for treatment of what I imagined was a pulled muscle. When an X-ray of my right knee revealed a white aura, the doctor diagnosed arthritis and prescribed anti-inflammatory pills. I followed up with an orthopedist who gave me a cortisone shot. She suggested I ditch the flip flops, stock up on Ibuprofen and apply ice after exercising. Really, I thought, that’s it?
I couldn’t get over how untreatable arthritis seemed to be. For the first time, I was forced to face the reality of having a chronic condition that couldn’t be healed.
Thus began my hobbled decade. Friends started noticing my limp. I became so slow I could barely make it across streets at timed crosswalks. I could no longer tolerate high heels; hurry up and down stairs; or run to catch a plane, subway, train or bus.
I began to notice other “differently abled” people facing the challenge of steep stairs, uneven sidewalks, broken elevators and other obstacles they (and I) struggled with daily.
I constantly fought pain, frustration and a growing perception of myself as aging.
Still, knowing exercise was my best defense, I tried not to complain and refused to let arthritis define me. I started getting painful cortisone shots in my knee every three months to temporarily reduce the swelling and improve my mobility. This became less effective as the years marched on with me lagging behind.
Finally, the year I turned 59, my right knee started buckling and cracking. That autumn, after the first day of a long-anticipated, weeklong electric mountain bike tour in Slovenia, our guide said it was unsafe for me to continue.
As a cyclist, I had adapted to my disability by starting to pedal with my left leg and adding the bad right leg after my bike wheels started turning. This maneuver didn’t provide enough momentum to power up extreme inclines or engage the motor of the heavy bike.
I fell repeatedly that first day, cutting myself on the sharp pedals. I finally walked my bike uphill during several steep sections of our ride. The entire group suffered from the delay.
Seeing the absurdity in my decision to sign up for the trip, the other cyclists asked why I hadn’t gotten a knee replacement long ago.
My argument was the same as it had always been: I was not even 60, and artificial joints don’t last forever.
Limping and in pain, I trailed my able-bodied husband across cobblestones and up stairs for the remaining two weeks of our vacation through Slovenia, Vienna, Bucharest and Krakow. After causing us to miss our flight connection in the Denver Airport, I finally faced reality. It was surgery time again.
At an appointment a few weeks later, an orthopedic surgeon examined new X-rays of my arthritis-riddled right knee. It was studded with bone spurs that obscured his view of my twice-repaired ligament.
He counseled me that with my prior injuries, I might not have good results. I resolved to increase my walking and stair climbing to get in shape for surgery.
Aware from past experience of the painful post-op therapy ahead, I lost myself in to-do lists and let the cogs of preparation turn. During the three-month wait, I attended a mandatory knee replacement class; got required medical clearances from an internist, dentist, anesthesiologist and physical therapist; had various lab tests; and met with my surgeon for a final appointment, where I was coached on pre-op dos and don’ts.
For my right knee’s last hurrah, I organized a pre-surgery weekend getaway with my husband and some friends at a cross-country ski resort.
Before anesthesia pulled me under at the hospital three days later, I imagined myself striding through surgery on powder-dusted trails. When I came to, I learned the procedure had lasted four hours — twice the length of most routine knee replacements.
My surgeon had to do what he said was essentially a knee reconstruction. Because my ligments had stretched around bone spurs, I needed a newly invented replacement with a pin between the two parts to stablize the knee.
Despite the complexity of the surgery, my doctor still cleared me to go home right away after he flexed and straightened my new knee to the total range of mobility. It was more movement than I had had since my teens.
After that blissfully drugged, first night at home, I wish I could say things got easier. But my recovery was slow and painful. My husband, grown daughters and mom all shopped, cooked, cleaned, ran errands and tolerated my grumpiness.
Home physical therapy visits continued every other day for two weeks. I tried to taper off Oxycodone, but had to continue for six weeks to tolerate the pain of home exercises and outpatient therapy. An ice machine circulated chilled water around the surgical knee to ease swelling. A walker, then a trekking pole, provided support. A Continuous Passive Motion (CPM) Machine straightened and bent my knee for several hours each day to relieve stiffness.
Finally, after a month greeting generous neighbors who walked our terrier a few times a day and relying on friends and family for rides and errands, life began to return to normal.
Getting back in shape, I can again picture myself as an athletic person. My pain — once characterized as a high number on a 1–10 scale — is now more like soreness from a difficult workout, treated with rest, ice and hot baths.
Today I’m inclined to agree with my doctor: I could have used this surgery 10 years ago. But the decision was mine to make. More than most patients, after two prior surgeries I understood the months of struggle and hard work involved in successful recovery.
As the before and after X-rays show, my wreck of a knee is gone, replaced by a streamlined, arthritis-proof marvel of modern engineering.
I’ve never been more prepared to power through my first post-op year into the great, unexplored territory on the other side. And I’ll gladly tell the stories of my right knee’s scars to anyone who still wants to hear them.
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