Avulsion for once

May 7^th to June 4^th

Yes I’m changing the span a little, figure if I make each period appropriate to the time between visits to the clinic I can keep it straighter in my head.

So the next four weeks pretty much fly by. In a nutshell I spend less and less time in the boot and more and more time in my sandals.

When I got leave to go FWB I was spending most of my time in the house wandering around barefoot. I figured that was the easiest thing to do. It was certainly a lot less painful than wearing my runners and it let me start building up the stabilizing muscles around the ankle to help with my balance - always a precarious thing.

Basically I was wearing the boot only for traveling on transit or for navigating foreign terrain. I managed to drive a 6 hour return trip during this time and I went to see Nine Inch Nails on the NIN|JA tour - I couldn’t give up the opportunity to finally see Jane’s Addiction and I’ve only missed one NIN show in the past 10 years (their appearance at the Virgin Festival). It was worth the mild discomfort and walking two kilometers in a crowd of 18,000 people.

I bought new, larger, shoes for work to accommodate my slightly larger right foot - which was larger to begin with. I now have feet two distinct sizes different.

I was in either sandals or runners for doing yardwork and occasionally making a trip to the corner store, about 800m round trip, several times. Being crutch free isn’t quite as entertaining on the subway and people find it much easier to ignore you and not give up their seats, but by this time I was just about sick of that. I welcomed the standing and used it for all it was worth to build up my strength. Getting the muscles to profile better, making them stronger, seemed to go a long way to getting the swelling as much under control as could be expected.

I attempted to be as cautious as possible when out in unfamiliar terrain but I was pretty arrogant in familiar areas - luckily it didn’t cost me anything.

There really wasn’t much to tell other than I went through a gradual withdrawal from the boot up to my sixth appointment. I was getting a little anxious though. My surgeon had that habit of looking at me and saying “How old are you? Lets just leave it for another week.” I wanted to be free of the boot for my birthday and barring that I wanted to be free from the boot when I went to a conference in August in Indianapolis. That was my worry, that I wouldn’t be in shape enough by mid-August that I could spend 8 hours a day wandering through exhibit halls or visiting areas of Indy.

I didn’t have to worry though. I saw the surgeon for nearly 3 minutes. He looked as the x-rays, glanced at my scar, felt the profile of the tendon, asked about pain and then told me I was good to go to two shoes.

I was a little numb, I was thinking he would say something about going gradual or something but when asked he simply said if I needed to rest the foot just to put the boot back on if I felt the need - not that I couldn’t have thought of that myself but I’m glad he told me. I asked about cycling and he looked at me as if I were crazy. I qualified my request by saying that I’d only be riding the stationary and I’d start out as easy as I could, he was reluctant but he did agree.

Of course he didn’t know that my stationary bike is a Kinetic trainer built to mimic road riding as closely as an oil based trainer can and that my lowest gear I actually planned on riding was 80 inches. Still I got the go ahead and I nearly pulled the second shoe out of my backpack at that very moment. Instead I waited until I got to the office with my next appointment not until September.

April 24^th to May 7^th

I take pride in my ability to adapt my body to changes. I learned to skate by watching the greatest hockey team ever (The Candiens of the early seventies). I’d watch how they’d kick and slide and imagine myself doing the same, trying to actually feel my muscles perform the actions.

I learned to golf pretty much the same way, ended up with a not too poor swing by watching Niclaus and his ilk.

I learned to swim by watching Bruce Robertson.

Okay, maybe my father had a lot more to do with those things than I typically give him credit for, in fact I may not have tried most of the things I did if he weren’t there.

But I did learn to drive stick by watching NASCAR in the early ’80s!

I do train well through visualization, pick things up naturally. But partial weight bearing?  - DENIED!

I couldn’t for the life of me figure out how to get the timing down, it either felt like I was feathering it or I was simply plopping down on the boot, worse I couldn’t get the crutches to the correct length to handle the transitions. It was a mess.

So I pretty much gave up. I spent pretty much all of 4 days trying to get the whole partial weight bearing thing to happen before I gave up and tried to go to a single crutch, which turned out to be a different fiasco.

I was getting way to much torque on the crutch and I ended up stumbling on it more that walking, so I gave it up too.

So on the 23^rd I crutched back to the office and tried the partial weight bearing thing on the way, it really wasn’t too bad but it didn’t feel like enough and dealing with the wonky sidewalks was bad enough, when I got back to the un-even floors of the office which are disguised by the geometric designs on the carpeting I nearly lost it. I tried again on the 24^th and spent the weekend getting from point to point in the house and even going grocery shopping, but by the middle of the trip through the grocery store my crutches were in the cart.

The next week I spent trying to keep myself on the crutches but I only really had them with me for times when I wanted to go fast or get people out of the way when getting off the subway, or keeping people out of the way when others were getting off the subway (really people - you wait until everyone gets off the train before you try getting on - or you get whacked in the shins by an aluminum crutch)!

Over the course of Week 6 I went from partial weight bearing to carrying my crutches most of the time, that first weekend in May, my second weekend in the boot, I mowed the lawn - the first mow of the season and to top it off I use a reel mower instead of a rotary. It was interesting to say the least. Still it worked out very well and proved that I was well on my way.

By the start of Week 7 I was using the crutches only if I was really tired but I was already noticing that my “Crutch Conditioning” was beginning to wear off. I couldn’t handle the crutches for as long as I had on week 5.  I was down to being able to cover maybe 200m at a time before resting where 10 days earlier I was doing a full kilometer or more without rest.

There wasn’t much pain and the scar has solidified so that there was very little red. I’d get some swelling and occasionally I’d pull a pillow in to bed to help me sleep, but I only tried to sleep with the aircast on for about 3 hours before I gave up on it. Once I had the aircast I slept without weight on my leg and was able to sleep under the covers for the first time in 5 weeks. When I slept with my leg raised I was down to using a single pillow and I would take to boot off as soon as I sat down on the couch.

The second weekend, the weekend I mowed the lawn,  I actually started moving around the house in sock feet. The first couple of times heel walking but it didn’t take long for me to adjust to a more or less regular stride. I had most of my range of motion back so it wasn’t too bad, I just didn’t have any power and if I set my foot down wrong there was considerable pain - so I just didn’t do that.

On May 7^th, the say I was to go back in to the clinic I got up, got my breakfast wandered around, read the paper went down to my home office, fooled around with Assassin’s Creed for a bit, wandered back upstairs had my shower got dressed and then put on my boot. I carried my crutches with me when I left the house, didn’t even use them to get down the porch steps, though I did start using them when I got in sight of the bus stop and kept them in my arms until I got down into the waiting room for the clinic. When they called me in to the ward I carried my crutches with me, say for a while after taking my aircast off while I waited for the surgeon he showed up, glanced at the scar, noted that the holes in my heel had completely disappeared, tested my range of motion (over 80%) and tested my strength (illiciting another ‘whoah’) he then pronounced me good enough to go full weight bearing in the aircast and told me to come back in a month.

Which I did.

Sorry, no pictures…

April 10^th to April 23^rd

So two weeks until the next visit and I manage to get a note that says I can work full time as long as I’m sensible. At least that’s what I ask them to have it say.

Its not a difficult time, I’m getting a little annoyed at not being able to ride and a little annoyed at not being able to drive and a little annoyed at how expensive taxis are and a little annoyed at having to continue to use crutches and a little annoyed with explaining what happened and a little annoyed with the winces and a little annoyed with the sympathy and a little annoyed by the people who so very studiously avoid looking at me when I get on the subway.

But I love how guilty they get when I do make eye contact with them, and I love getting that seat across from them where I can make eye contact at every opportunity and I love the fact that I’ve got two crutches that I can use to block the morons who think that people getting off the subway shouldn’t keep them from getting on the subway. There are many bruised toes over these two weeks!

And its fairly uneventful. Again my wife and I go out to a restaurant for lunch and again we’re sat as far away from the door as possible, but that’s become par for the course, an almost non-event.

I do come across one thing to warn people about - dress pants and aluminum crutches are less than good together. The pockets tend to gape when you’re swinging your crutches forward and of course if it isn’t the butterfly nuts getting caught in them its your thumbs. Nearly ripped my thumbs off a couple of times but that was nothing compared to getting the wing nuts caught and landing right on the ball of the bad foot. That was nearly as painful as the ultrasound.

I also manage to tumble on the subway platform. Every once in a while the subway platforms suffer from seepage. I was always careful around it and this time I was past it, or so I thought, but my right hand crutch shot out from under me and I started to go down, what was interesting is that I managed to take out some woman who was attempting to pass me on the right, despite the fact that I was close enough to a bench to bang my right forearm down on the seat. I don’t know what she was thinking but I hope she woke up long enough to survive the rest of her trip into work, though sometimes not.

I did get a day or two of telecommuting since I tried to avoid taking transit when it was raining, but it was a spring during which it only seemed to rain during work hours. Really annoying when you think about it. Nothing wrong with the day when it starts out, rain during the day making you dread the trip home and then the roads and sidewalks are dry when you leave despite all that worry.

I also get a lot of people telling me their stories. Heavy people with tales about their bad knees, slighter people with tales about compound fractures, older people with war stories and younger people with tales of woe about ingrown toenails. I’m a pretty approachable guy in most cases but I really don’t encourage people to tell me their life stories. I should have started carrying my pictures with me. “See, this is the incision just after my first cast came off…”, probably would have kept them quiet for a time.

The fifth appointment came around just in time to keep me from going insane with all of this, all of it and the promise of getting into an aircast at last. A chance to do a little weight bearing and the first proof that things were actually healing.

Again the visit to the clinic chews up the morning but my boss is pretty understanding about this, he’d gone through some pretty impressive surgery himself two years earlier so he understood. Again I get to joke around with Ricky Gervais who cuts off my cast and the surgeon takes a look at things, cups my foot by the ankle, presses his other hand against the ball of my foot and asks me to push down like I would an accelerator. So I scoot all 6 feet and 200 lbs of surgeon six feet across the floor. Okay it wasn’t quite like that but I surprised him enough that he let out an involuntary ‘whoah!’ when I pressed down with the ball of my foot and did manage to scoot him far enough he had to drag himself back.

He examined the points where the sutures exited my foot, checked the success of the healing on the incision and then compared the flexibility of my feet. I was back up to about 2/3rds of the range of motion I had originally and he said that was good enough for the boot. $150 later I was crutching down the hall all PWB and proud and the orderly told me that the next time he saw me he wanted to see me only using one crutch, and that on the left side.

Well, I had a surprise coming for him.

Pictures

This is how the incision looked as I went into the boot, nicely scabbed and flaky. Yum!

The took the cast off and I got a good look at the progress of the scar along my calf and ankle. I was a little disappointed, there was still quite a bit of redness and the scar tissue looked really shallow, but it was becoming obvious that the gathers that I worried about having to break up during physio were smoothing out all by themselves, certainly helped take a load off my mind!

My heel where you can see the two holes from the traction suture, all nice and clean.

There were just a couple of little scabs left on the bottom of my foot and the skin was already growing overtop, it looked really good underneath and I was no longer worried about the suture trying to crawl back out, by this time it had creeped up and out of the skin and into the meat of my foot.

Slipping into something comfortable and was it ever welcome.

The Aircast. It was most welcome and about 90% of the time it was comfortable, but because my toes peeked out over the end it was possible for me to situate the tongue in such a way that it put pressure right on my cuticles, which I can report is most not comfortable. It was thicker than my fiberglass casts so I was limited to wearing my dress pants or my wind/river cargo pants with the zip off legs. Thankfully April was a warm month.

March 27^th to April 9^th

There wasn’t much going on this week, simply getting things done that I had promised myself I would be able to. Not being allowed to work was liberating and I did manage to get a fair bit done that I had intended. Figured out how to cook as well which was a nice change, even barbecued. As long as I had a chair handy I could stand without the crutches and even move dishes back and forth between the counter and the table. This of course also means I could do dishes.

Once Monday rolled around I was able to go back to work since I had been able to hand in a note from my surgeon. Basically it was worded to say I could work as much as I felt and that I had to elevate my foot and walk around.

I’d gotten pretty good with the crutches to by then, or so I thought. My wife and I decided to meet some friends for lunch, its a pub I like but don’t frequent often and as such I screwed up the directions, getting off the subway nearly two stops too far but I crutched my way back and we had a good time. In all it was probably near to two kilometers, needless to say lunch took a good long while.

Being that we were within walking distance of our friends place we decided to walk back and guess what - it was another 2 kilometers. We stopped often and they were exceptionally patient and even gave me the last beer in the house. We stuck around for a while and chatted, it was pretty good fun and I think it helped considerably in the end. Not only was my conditioning for crutching showing marked improvements but there was significant improvement in my abdominal area, I was getting ripped!

On the bus on the way home a woman who had gotten on at East York General started talking with me, asking about my condition and telling me about her issues with her knees and how things weren’t progressing well. I impressed upon her the excellent service I received at St Mikes and she seemed to think my advice sound. I hope she managed the trip because I think it might have been worth it for her.

I really was getting along quite well with my crutches and as I was returning to work on a near full time basis I needed to make a covering for my toes so as not to offend anyone in the office. I was also lucky in that I was able to fit my dress pants down over the fiberglass cast, though I had to wrap the cast itself in a compression wrap so that the sharpish ends of the fiberglass wouldn’t catch on the fine fabric and rip it to shreds.

I had to get around well because my office was not built to be completely accessible. There were no power assisted doors and the washrooms didn’t have handrails or any other assistive device installed which made figuring out how to handle carrying lunch using crutches and opening doors essential. Luckily the city had yet to implement the mandatory 5 cent fee for plastic bags so most of the time I was able to get lunch to carry away in a bag.

The leg itself felt pretty good. For the first couple of days after my appointment there was a fair amount of tightness in the calf as the tendon and muscle stretched back out. There was also a lot of popping and snapping going on along the incision as scar tissue broke up and started to slide. Sometimes it hurt a little, sometimes it didn’t hurt much more than the original injury but it was neat to feel that pain and figure out how and where it was coming along and just what layer of tissue was giving way.

Finally the Thursday morning appointment rolled around and the cast was removed again, there was little in the way of scabbing left, most of it simply stuck. I picked and peeled scabs while I waited for the surgeon to come through and take a look at his work, even sat there and flexed it a bit, trying to pull the foot into neutral simply on dorsiflexion alone. I even put a little weight on it to see how it felt that way and it wasn’t too bad but it still hurt enough to make me really cautious.

Finally after I had cleaned up as much scab and callous as I could the surgeon came in, I was able to brush the small pile of dead skin and blood onto the floor without anyone noticing. We lifted up the foot, flexed it back and forth under muscle power and with his own hand, the foot actually flexed into neutral and I was able to hold it there without assistance. He poked at the heel and examined my fresh x-rays and determined that this was as good a week as any to take off the button.

Now imagine what I was thinking. This is heavy duty suture he’s put in place and its been in my leg for three weeks. It runs up through the bottom of my heel, through the calcaneous, out and through the Achilles, back down through the calcaneous and back out through the heel. I’d spent much of the previous week trying to imagine what it would feel like to have that suture get pulled out through all of that.

Two little snips later (which actually stung a fair bit) and the surgeon starts to give instructions to the orderly about how to place my foot and cast it. So I asked, first does the suture stay in? Second can I have the button? And yes, the suture stayed in, it wasn’t going to offer any issues and if it started to push its way out they’d cut it back far enough it wouldn’t be able to do that. And yes, I could have the button.

So Ricky Gervais set my foot up as close to neutral as we could manage it and I left the clinic with a nearly flat foot, sutures creeping back into my heel and a button in a bottle.

Yes, I could feel the suture working its way back up through the various layers of dermis and into the deeper tissues of my foot, it was very weird, like there was something burrowing in my leg.

Creepy, but I was more free than I had been in a long time!

Pictures

The incision as it looked on week three just after the cast had come off.

This is what things look like after three weeks. I’ve picked off the loose scabs, the dry skin and most of the callouses. Its jagged, a little angry and scary looking. The gathers are what I fear most, if those don’t absorb in some way they stretching that skin back out would be a painful and terrible day.

A pretty good shot showing the relationship between the button hidden in the surgical sponge and the heel.

This does show the relationship between the button on my heel and the point at which the Achilles mounts to the calcaneous. Right under the deep scar still on my heel is the tendon and the suture pins that hold everything in place. This angle also provides an excellent visual representation of the way the incision was altered after the discovery that the diagnosis was wrong.

What the button looked like fully dressed. The pressure on the sponge was enough to crush the structure - it didn't bounce back.

This is a detail shot of how the button looked before it was removed. The sponge had folded over during the previous application of the cast so I had to hold it out of the way. The pressure on the sponge was so great that it actually crushed the sponge flat and it didn’t return to shape after being release, it had solidified. It wasn’t that much fun having the surgeon pry around under the button to snip the sutures one by one, but nothing moved when he was done!

The heel after spending three weeks in close proximity to a surgical sponge soaked in iodine. Pretty.

My heel is finally naked. Most of the dark splotch is from the iodine that the sponge is soaked in, they gave me a cloth to clean up the foot before they recast me and man did it feel good to wash that down. The two black circles are the holes that the sutures came through, the darkness being scab tissue, you can’t see it but in the middle are the ends of the sutures. Over the course of the next two weeks I could feel those sutures sneak back inside my foot, pulling through the various layers of skin and fat and finally into the meaty bits. I swear I can still feel them move. It creeps a person out I tell you.

This is all that kept my Achilles in place for three weeks, a simple white nylon button.

It really isn’t very much different from the buttons found on surgical scrubs, it creeps me out to think where it might have come from, images of my surgeon completing my surgery with his scrubs puddled around his ankles doesn’t thrill me. Perhaps it was one of the lovely ladies though.

What would I care I was so unconscious I didn’t wake up for a day!

Its not terribly clear but the white bit mid bone are the suture pins.

The white bit near center are the surgical pins. Below the pins, causing the bump in the bottom of the cast, is the button. It still kinda freaky to me to think that’s my foot.

March 20^th to 26^th

Spend the weekend getting used to the hard cast. Its nowhere near as comfortable as the surgical splint, but its also not as bulky or heavy. I actually figure out how to have a jacuzzi, which comes in handy. I’m still using two pillows to sleep but it isn’t quite so uncomfortable as it had been. Spend some of the weekend worrying over how I’m going to get into the office, elect for cabs the first day and then see how things go.

My manager and I organize what times I’m expected and I continue to telecommute to fill out the missing time. It’s amazing how much more work you can get done when you can both remain un-bothered by people and remain in your pajamas. Still its bound to be a bit lonely around the house now that spring break is over so going in will be a good thing.

I do cab in on the Monday and work most of a workday. I do return home a little early because things are just uncomfortable. There isn’t much pain and there isn’t much extra swelling despite having my foot lowered most of the day. I also am required to move around the office a fair bit which definitely helps me keep my spirits up and blood flowing.

I plan on cabbing in on the Tuesday and returning by transit but half-way through the day I get a call from my manager who tells me that Human Resources doesn’t want me in the office because I hadn’t returned a note to them from my surgeon releasing me to work. Great, and not only am I not allowed to be in the office but I’m not allowed to telecommute.

I shouldn’t say much more about this but I will say that things resolved in my favour.

So I cab it home on the tuesday and start trying to arrange things with the surgeon’s assistant, things don’t get very far because of conflicts in hours, broken fax machines, missing numbers. I actually end up with most of another week off.

Wednesday I actually start doing some of the things that I planned on doing but got distracted playing video games. I manage to get nearly a dozen LPs ripped by the end of the week and that feels good. Not only did I do what I told myself I would do but I was able to get fairly far with it.

Thursday I go in for my second post operative consult with my surgeon and this time I remember my camera. Again I get into the clinic a little early and again I’m out of the clinic about 2 hours later with another cast. This time they actually reduce the plantar flexion to about 45 degrees. It causes some pain and a little pulling but feels good until the cramps hit after I go to bed. Still not too bad an exercise. The surgeon has the stitches removed and reviews the wound and examines the penetrating sutures for signs of necrosis but seems satisfied, perhaps even surprised.

This is also the first chance I get to both scratch and wash the foot, and that feels good, especially with all of the callouses starting to fall off.

A new cast goes on and the surgeon asks about my Percocet situation, I report that I’d pretty much stopped taking it and that I was about half-way through the APO, then I complained about the taste and got a look that basically conveyed the entire “you take it because it’s keeping you healthy” argument.

Crutch back out and this time actually take transit home, makes for an interesting experience, I’m the only person on the train wearing a cast and the only person on the train in shorts. Wasn’t too bad really.

Pictures

A little sticky around the sutures

Its not a great picture, but it does show the extent of the incision and what everything gathered up like. I was a little worried about that, that it may create some ugliness when it came time to start stretching things out, but that never happened.

There was a little seepage, but nothing special.

There was a little seepage right at the crest of the heel, which is understandable be cause under that point is whipped stitched sutures, suture pins and a traction suture, not to mention the swelling that comes with the territory of having to have your skin cut apart by scalpels and holes drilled through your bones. But at two weeks its looking as good as I hoped and though there is very little movement at least there is some.

This is the button keeping my achilles in traction.

That’s what a button will get you. When my wife first saw it when I brought it home in a specimen bottle after it was removed, she said she could imagine the surgeon standing at the foot of the bed at a loss looking around for something to help hold the sutures outside of my foot then settling on removing the button from his scrubs. I don’t think that would have happened, he would have someone else remove it so he remains sterile!

Its a simple nylon button, but it seems to have done the trick!

Cheating the First Week

March 13^th to 19^th

So I’m counting my first week from Saturday to Thursday and that happens to be because all of my appointments for checkups and inspections were on Thursdays. Cheat #1

It was spring break, which didn’t mean much for me I was still missing work but it meant my wife (who of course happens to be a teacher) had the week off, sucks for her but it worked out well for me. Cheat #2

It was a dreary cold spring and every day I stayed inside, it rained, every day I went out it didn’t. Cheat #3

What probably counts more is that I suffered very little pain in my leg, though my chest, arms and abs were burning, crutches suck for the first two weeks. The Percocet remained relatively untouched and like the morphine and the Tylenol 3 before, didn’t do anything for my pain. They did provide some minor relief from swelling and their side effects thankfully counterbalanced the side affects from the antibiotics (which tasted a lot like cat urine smelled).

I was in a surgical splint with my foot in a full plantar flexion, the toes almost complete en-pointe. Still it wasn’t that uncomfortable and with my body geared up to repair itself and the insulation that I got from all of the cotton in the splint I didn’t need to worry about my foot getting cold when I did go outside.

My original plan had been to only take a couple of days off from work, but then I was informed of the presence of our short term disability plan and saved myself some vacation. While I was not-sleeping in the hospital I had come up with all kind of plans for what I would do with that time off. I could telecommute so I could work from home but I could also get a handle on ripping my LPs, perhaps get the bulk of them done. I spent about 100 hours playing stalker instead.

When we came home on the Saturday we opened up the pullout couch and sat down with take-out in front of the TV and watched movies, sleeping in the living room, nice and relaxing. The worst part of course was going to the bathroom, it really isn’t that easy to sit on the toilet when you’ve only got one good foot. I eventually got around to learning the trick about kneeling on a chair.

Sunday night I slept in my own bed. As I said before I’m a stomach sleeper so it became necessary to figure out something. I needed to keep the foot elevated at night because the pulsing of the wound kept me awake but I found that two pillows supported the leg nicely, when I woke up Monday morning the splint was actually loose enough I worried about it falling off. Not that that lasted for long but it gave me some hope that things were going well.

One thing about sleeping with two pillows under your foot, its really hard to do under the covers. I ended up sleeping in my dressing gown and wearing a sock. Kept me from getting too cold anyway and it wasn’t until my second cast that I was able to sleep comfortably under the covers with just a single pillow.

Monday was a lot of the same as usual, just a little more challenging. Get up, have breakfast, watch a little television (I got hooked on Boston Commons), have lunch and then mosey downstairs (sliding on my butt of course) to log in and do a little work and then slip into a game for a while. Have some supper, watch some TV, do some email and go to bed. It all started to get easy too as I repeated that Tuesday and Wednesday.

Thursday I had to get up early. This was the day when it became clear that Percocet actually does have an affect on me, it makes me cranky but by then I’d brought myself down to two a day. But I was a bit of a bear to be sure.

Still the cab came quickly enough that we had an extra half-hour worth of wait time at the fracture clinic. Still it was pretty quick and when we went in the cut off the splint letting me see for the first time what it was they had done.

And I’d forgotten my camera again.

There was still some seepage from the wound but it had scabbed over nicely. The wound itself was puckered together like a six year old had been trying to learn how to do gathers at the sewing machine ( yes I do personally know what that looks like - I gave up sewing early in life). Still it looked good and I gave my foot a couple of experimental twitches to see what it felt like. That set off an involuntary stretch which really didn’t feel all that good, and triggered a muscle memory based flick which hurt - well it hurt a lot.

Dr Whelan came in, examined the incision and the sutures, took a look at the penetrations for the button, threw some disinfectant on the wound and then told the attendants to put me in a hard cast.

Just before he left he said everything looked just fine.

Nearly Awake

I’d heard the day nurse tell the night nurse that the doctors would be making rounds about 6:30 and when I awoke yet again at 5:30 I stayed awake hoping to catch them and hear what my complication was.

I had a decent breakfast of scrambled eggs, juice, toast, fruit and milk and waited longer.

The night nurse changed to the day nurse and I waited longer

Eventually my wife came in and we talked about what the complication might have been, deciding that we’d stick around until we were able to see someone about what had gone on, so I waited longer.

The day nurse came in to get some numbers from the pump and see how things were going so we had a talk with him about finding out what was going on, he went off to make some calls and I waited longer.

Lunch came, macaroni and cheese and I think it was the Velveeta kind, still it was hot and not too bad. But I still had to wait.

About Noon Dr Whelan himself came in and sat down asked if we had any questions and then explains.

The Surgery (from the point of view of someone awake at the time)

They opened me up with the typical off center incision they use about 6cm up from the calcaneous. As soon as Dr Whelan had opened the sheath he knew he wasn’t seeing a rupture because he was looking at the end of my Achilles, I’d suffered was is called an Avulsion.

An avulsion is a parting of the ways, literally. Unlike a rupture the tendon itself remains intact but it pulls off the bone that its attached to. In many cases the avulsion is the result of a fracturing of the bone its attached to and the tendon actually pulls part of the bone with it. Because of the porous nature of the calcaneous it is prone to this injury. When this happens the injury is called an Avulsion Fracture and requires a debridement of the mount point or even that the tendon be attached to another like the Achilles to the Flexor Hallicus or somesuch.

What this meant is that Dr Whelan continued the surgery but reworked it to be very much like the surgery that is involved in dealing with a Haglund’s Deformity.

They whip stitched the tendon to provide some extra stability, drilled two holes through my calcaneous and out my heel, dropped thick sutures through the whip stitching and out through my heel, mounted two suture pins in the calcaneous on either side of the tendon, pulled the tendon tight with the heel sutures, sutured through the tendon and suture pins and then tied off the heel suture against the outside of my foot.

I ended up with a penetrating suture tied off to a button on the bottom of my foot and two extra pins. The goal was to get the tendon to heal back onto the calcaneous and because the calcaneous is weak under specific tension like that the tendon had to be put into traction. They  rested my foot in extreme plantar flexion and put me in a surgical splint.

Dr Whelan predicted that my recovery time shouldn’t be much longer than with a regular Achilles rupture and then said I could go home, with all the caveats that entailed. Keep it elevated, don’t get it wet, take your antibiotics and don’t forget your percocet.

And no, Ontario has not approved Vicodin.

Admission

The surgery was set for Friday the 13th at 11:30 and of course I had to show up hours early and hungry to boot. We got to the hospital at 8:30, wound our way through the corridors and elevators to a very unexpected waiting area. Told to wait in the Rocking Room I wasn’t sure what to expect but the room was full of rocking chairs, I suspect as a way to help patients eliminate nervous energy and relax.

The wait in the rocking room was about 40 minutes long and then I was taken in to the change room. Stripped down to my skivvies and putting everything into a plastic baggy with my name on it I got to wait an incredibly long time before a nurse came in, explained what was coming next in the procedures and then went through the question and answer session in the binder.

Eventually an orderly showed up with a wheelchair and I hobbled on board since by this time my crutches had been taken away and locked up. Again we wound our way through various corridors, back alleys and seedy neighbourhoods to end up in the pre-surgery waiting area.

This is the first area that really looks like it could do with a newer coat of paint, and some electronics that weren’t purchased from Radio Shack in 1982.

The Terrence Donnelly Day Surgery center is a beautifully built section with full sofas and gorgeous oak wainscoting, plenty of room and a very relaxed atmosphere, the Rocker Room is just off of it and nice enough on its own, even the newspaper was up to date.

Pre-Surgery

By contrast the pre-surgery waiting room is somewhat antiseptic and lonely, not that we were actually left alone. Again my binder showed up and again a series of questions were asked out of it, most of which I had answered previously. Once that was done I was sat down in a relatively comfortable recliner. The room sat 10 or 12 but my wife and I were the only non-staff in the room until I left, the nurse was checking someone in as I was leaving.

This is where I first met my surgeon Dr Whelan. He was confident, concise and put up with my flippancy well. He performed a cursory examination of my achilles and explained the procedure. He admitted that they were a little behind schedule but that the surgery itself should take no more than 45 minutes and I should be back into the recovery room by 1pm or so. Then he initialed my leg and disappeared, hopefully to do something about the caffeine from his large double double.

I can’t really tell how long I sat there after that but I do know that we were in danger of missing our tee off by the time the anesthesiologist came round and asked the final round of questions and I was lead into the surgery on time.

They popped me up on a gurney and wheeled me down a couple more corridors and then into a well lit room filled with busy people. I was asked a couple of questions again so they could complete their check boxes and then things got interesting.

There seemed to be about thirty dozen people in the room at any one time but I really think there were only six or eight. It was like watching an orchestra tune up, people were unboxing things and hanging things and polishing things and organizing things and in the middle of the room was the strangest bed I’ve seen.

The surgery bed for me was a regular face down surgery bed with jelly bollards lined up in a more or less man human shaped pattern, it was obvious that I’d be lying face down and it didn’t look particularly comfortable. It also made me greatful that I’d not only retained my underwear, but that I’d worn the good stuff.

First the anesthesiologist resident had problems getting the IV in, apparently my valves are in all the wrong places. When I asked what that meant I was told that I was just a little mutated but it wasn’t anything they couldn’t handle. Then Dr Whelan came in and in the first of many shots at my infirmity he looked at me, looked at the bollards on the surgery table and then asked if there should be more put on the table.

“So I’m fat then am I?” I couldn’t help myself and sarcasm probably isn’t the best way to address your surgeon before he puts the scalpel to you but it came out. Luckily it earned a chuckle from most everyone.

I asked at this point if they could take pictures but Dr Whelan didn’t bring his camera, then it was time for the anesthetic. I looked at the anesthesiologist as he said they were about to apply it, let myself get comfortable and almost immediately saw a tunnel with white light.

Post Surgery

I think that the hospitals have finally learned to move lights out of the line of sight of patients in post surgery recovery, it was confusing enough just to have a gaggle of white lab coats standing at the end of my bed when I first came out of the anesthetic but having the afternoon sun glancing off of the white lab coats was pretty bright.

I was awake long enough to recognize Dr Whelan’s voice, hear the term “there was a bit of a complication” and realize that the clock seemed to say it was 1:30.

I woke up maybe a dozen times after that before I caught on that someone was watching me pass out but eventually I stayed awake long enough for the recovery nurse to ask me some questions. “How are your feeling? Would you like some ice chips? How is the pain?”

It was probably about 2:30 or so before I woke up enough for them to give me instructions on how to operate the morphine pump and to tell me that they had no idea what the complication was.

The next time I woke up they asked me how the pain was, I said it was bearable so they asked me to hit the pump until the pain went away.

Cool.

I must have hit the pump 6 or 7 times because the nurse got up from her chair and came to check the machine before asking me about the pain. “Bearable”, so she hit me with an injection of morphine from a syringe. I passed out again right after that.

Eventually I was awake enough to realize that my wife was there and that I could make some kind of attempt at a conversation, eventually it was even deemed safe for me to go to the ward for my overnight observation.

Lucky, probably never again so lucky.

When I signed up for the surgery I asked for a ward for recovery, I thought it might make for a nice little adventure and I’d get to talk to some people while I didn’t sleep.

So they wheeled me out of the recovery room, down a couple corridors, through an elevator and into a semi-private room that I was to occupy alone, I had free television and I was located right next to a window, which was necessary because the room felt like it was about 3 billion degrees hotter than the sun and the only way I could keep a decent temperature was to have that window open to the nice brisk March night air (apparently during a cold snap).

They seemed to serve me dinner almost immediately and I have to say if St Michaels has a good reputation for orthopedic surgery they should have a sterling reputation for their food.

It seemed to be a nice thin shaved roast beef wrapped around a savory rice pilaf with carrots and green beans, coffee, milk and vanilla pudding. I don’t know how they got the menu without asking me but man did it smell good.

And taste like ash.

Apparently anesthetic does a lot to kill off the taste buds and was I disappointed. Of course the fact that I would fall asleep between mouthfuls, while my fork was suspended in mid air with food on it didn’t help any. Eventually I ended up with a can of ginger ale and just the vanilla pudding. Disappointingly I had to refuse the rest of the food which as it turned out was a good thing.

About half and hour after the food tray was taken I started hearing from my fellow recovery patients as sounds of retching echoed up and down the hallway. One patient’s concerned loved one asked about it and that is where I got the rumour from: “retching is the best way to start the stomach muscles moving and a person will retch if they are fed while the stomach is still.”

By this time my wife had given up on me being any kind of entertaining and gone home, and frankly I’m glad she did - it must have been terminally boring to watch me lie there.

So over the course of the night I watched crappy late night television and an episode of Knight Rider or two, filled up inumerous bottles of urine and argued with the night nurse over whether or not the window should be left open. I think she managed to sneak out of the room once without me catching her closing the window, but I was on to her, sly to her ways. I slept the night in the flimsy hospital gown under a single cotton sheet and was still warm.

Through all of this I still hadn’t heard anything about the ‘complication’ and vowed to not check out of the room until I’d heard what had gone on.

Going in

I had a couple of interesting bits of advice going in to the surgery, some from here and some from co-workers and some from family.

• “Don’t go in alone.” That came from here and I took it to heart (reportedly I took it too much to heart but I was drugged!)
• “Going under the general you’ll struggle to stay awake.” Was interesting.
• “They make you eat so you’ll throw up.” that one actually came at me post surgery but it should have come before.

Don’t Go In Alone

I have counted myself fortunate in having the support of my wife as I have so yes I did have her come in despite the political pressures at her work, actually she came in spite of the pressures, politics are stoopid.

So my wife helped me sit through the really boring parts and helped me get through the nervous parts. Patient was a great word of the day, I was one and she was as well. I did have some additional help though, I asked a good friend to come down to take my wife out for tea as I was going into surgery, it helped me to think that if she needed it there was an ear to bend that was local.

Struggling Awake

Its probably true, I can see it being so. When they finally insert the anesthetic you fight to stay awake, struggling to stay conscious because things are pretty darn scary, really.I suspect unless you’ve gone under the knife for something else other that wart removal this is one of those things to get stressed about.

Or you could be curious. I did ask about doing the surgery under a local so I could watch but they said its better under general because the muscle profile is much more relaxed. I still sometimes suspect they were lying and simply didn’t want me asking a bunch of questions.

I did ask the surgeon if he could take some pictures, but he said he’d forgotten his camera. Hey, its a learning experience! I figure if you know what was done to your body you can help yourself heal by visualizing the damage knitting back up.

So of course I did the opposite, in went the needle, a little relaxation and the next thing I saw was a bright light.

They That Make You Ralllph

A general anesthetic is meant to reduce involuntary muscle use as well as knock you out and in many cases it overrides the contractions used by the stomach and intestines for digestion. Many hospitals (and I’ll include St Michaels in that lot) seem to subscribe to the idea that the digestive process starts most effectively if the patient throws up. This was cobbled together from snippets of conversation I overheard as I slipped in and out of a comatose state after being placed in the recovery ward. It may not be true but it is truthy enough to repeat.

I was lucky, I was so zonked from the anesthetic that I didn’t actually get a chance to eat enough of my food to throw up and during the course of the night while I drifted in and out of consciousness I managed to attend to some stomach exercises I learned from a friend in elementary school that he picked up from his belly dancer mom.

Advice From Me

Some things that I’d pass on that I’ve learned as well, just in the course of the play. Its not like any of it has been repeated back to me, repeatedly.

• Don’t be ‘not alone’ for too long, let people go home! (Or force them too)
• Make sure your drip lines and intravenous are correctly situated!
• Bring some entertainment

Be Alone

Yes, its good to have people there when you’re wheeled off half-naked into the presence of strangers who will have you lying butt up and unconscious, and its good for them to be around when you come out of the haze that is a general anesthetic. But don’t force them to stay, drooling really isn’t that entertaining.

If you’re in for an overnight recovery you’ll understand the boredom and those first few hours that you are recovering from the anesthetic are going to be dull, at least once the teasing is over with. Get your use out of your people, let them bring you your glasses, something to read and your MP3 player and then let them go home, even force them to go. They know you’re alright so let them get their own rest and let them relax because if they share your bed they won’t get much of either for a while after you get home!

Drip Drip Drip

If you have the good fortune to be hooked up to a morphine drip and IV (that is of course if opiate based painkillers work on you) you’ll want to make sure of two things:

1. That the IV pole is on the correct side of the bed for your sleeping patterns. I’m a stomach sleeper so I needed the drip moved
2. That the IV and oxy lines are long enough for you to sit on the edge of the bed or kneel in bed so you can pee!

Believe me, being on an IV does wonders for keeping you hydrated and all that liquid has to come out as well. I ended up getting a second bottle and I needed it before the night was through despite the night nurse emptying it every hour. And yes, using one of those bottles isn’t easy when you’re lying down, be confident. The post surgery splint should be more than sufficient for providing you enough support to kneel to pee.

Entertain Me!

Yes, its going to be dull and you may not have my kind of luck and be able to ride on the coattails of the previous patient’s television rental. Your sleep patterns are likely to be screwed up royally and you’ll be bored. Make sure that you’ve got things to do. Read, listen to music, bring in your portable DVD player but remember if  you’re in a semi-private room or a ward to be considerate of your fellows and keep the volume down.

One game I can give you is “Is Morphine Effective?” I played it three times and came out with some disappointing results.

Lastly

Just some last little bits:

• The staff are your friends
• Look for the things to enjoy
• Take a camera

Friendly Staff

90% of the time the nurses and orderlies that you deal with are just people doing their jobs. The one’s that are good at it can also see you as a human being in need of compassion. You again may not have my luck in being in an orthopedic surgery recovery ward and may be sharing your hospital convalescence with much more seriously ill people.

Try to lighten the load of the staff as much as you can, if you treat this as an adventure its easy and they get to do something they rarely do, impart knowledge and wisdom.

Enjoy It

Yeah, Huh? But that’s what I view as the single greatest strength I had going into this - a positive attitude and a willingness to attempt to learn something, to gain from it. You’re in a hospital for surgery, hopefully a unique experience in your life, take it for all its worth. Get desert with breakfast, ask about the drip machine and ask your fellow recovery patients about why they’re there. Is there a difference between Vicadin and Percocet? and why isn’t Vicadin available in Ontario?

Lights! Camera! Cut!

I regret not doing this, and I think my surgeon may be as well.

I wanted to know what they were going to be doing inside my leg and I really am a proponent of visualization. I learned how to swim, skate and drive stick through visualization (severely disappointing my father). I would swear that you can also speed healing as long as you know what needs to stick back together.

And you can gross people out!

Attitude is Everything

“A positive attitude may not solve all your problems, but it will annoy enough people to make it worth the effort.”  ~Herm Albright, quoted in Reader’s Digest, June 1995

I thought by now a practical note about something rather than more anecdotal monologue-ing  would be good, a note about what I was actually ‘going through’ rather than what happened to me.

When my Achilles blew I knew immediately what had happened and as I lay on the floor of the group exercise room convincing my personal trainer that I had indeed blown out my Achilles and writhing in a pain I just couldn’t understand because it was so different I also came to realize some things.

Firstly pain is an excellent catalyzer for thought. The right kind of pain can actually help you focus on things and get them sorted. The first images that flitted through my mind was the torture scene in the Firefly episode “War Stories”. Not because I was thinking that I now knew what kind of pain Nishka was inflicting but because it was one of those things that allowed me to focus on the important things. To paraphrase a quote in that episode from the famous Xiang Yu “To meet yourself you must deprive yourself of safety.”

I realized while I was writing on that floor that I could approach this in two ways. I could try to deny it or I could embrace it. I could wail and rail against the perceived injustice which is really simple the inconvenience, or I could see this as a new experience, something to be savoured and enjoyed.

Well since I am a bit of a gourmand savouring seemed like a good deal and cynicism is easier for others to take if you happen to be good hearted about it.

It was all a new experience. I’ve never felt a pain like that, never had an injury like that and so I dove into it, examined what the wound felt like and how it appeared. I experimented with how much movement I could get out of the injury and what I could do to move around on my own.

I’d get to see what it would be like to have a relatively important trauma, to experience how a person is treated in hospital, get a chance to get first hand experience of what the Canadian medical system offers so I could make arguments with first hand knowledge, get an understanding of what kind of bureaucracy is involved in a hospital and maybe get to have surgery.

If you don’t like something change it; if you can’t change it, change the way you think about it.  ~Mary Engelbreit

I decided that the best approach was to think “I get to have” rather than “I have to have”. There are a lot of ways of viewing something and I’ve experienced an appropriate amount of grief in my 40 years to understand that the five stages of the Kubler-Ross model exist for every loss, they just don’t have the same impact all the time and each stage has a different amount of importance for each different loss.

Denial - This was eay to overcome, there was no way in reality I could hope to deny this out of existence, the pain simply was too real.

Anger - Oh yeah that was there too, I mean come on, I had plans and really wanted to not have my life screwed up, surely this didn’t need to happen now! But it did, its done, why should I be angry about something I had no real control over?

Bargaining - So yeah, perhaps the higher power could be appeased with some sacrifice out of my life and this could be a partial, or maybe just a sprain or a pulled muscle? But in turn who honestly doesn’t sacrifice the things they don’t want or need first and then work their way up the scale never quite approaching a sacrifice that would be just as inconvenient or painful? The only way to not be hypocritical when bargaining is to offer something of equal value, and where is the value in that?

Depression - yeah, this thing happened and damn if it weren’t going to screw up my life, I really did have plans, there were things I really wanted to do that required two good legs and who wants the inconvenience of crutches and isn’t this typical that it would happen to me what am I going to do with my life now? Well I guess I could simply live my life, other people have more taken from them and they do well enough, I can’t be that strong?

Acceptance - Yes, this happened to me and how I deal with it will model my life from this point forward. I could carry my hurt, anger and depression with me or I could offload them as excessive baggage and look at this as another challenge. I’d been working out at the gym, challenging myself physically. I’d done several ultra-marathon rides in the past and on each encountered challenges that didn’t show up before. Why not simply take this as a chance to travel a new road, perhaps in the process I could become better in other ways too?

Nothing contributes so much to tranquilize the mind as a steady purpose - a point on which the soul may fix its intellectual eye.  ~Mary Wollstonecraft Shelley, Frankenstein, 1818

This is when I got up into a sitting position, all of the above had taken the amount of time it takes for the body to decide whether it is going to fall into shock or deal with the trauma by desnsitizing. Minutes may have passed but it felt like eternities in seconds.

Life was going to be a new adventure. I knew there were things I was going to have to experience and I knew that there were challenges I was going to have to face and I knew that I was going to survive, and that is the key.

Why do we fall, sir? So that we might better learn to pick ourselves up. - Alfred Pennyworth

Keep on Keeping on

Its a trying and traumatic thing, every major injury is. Every major injury is a loss and this one doubly so for most of us. It not just marks the loss of mobility and the possibility of being forever scarred and possibly hampered by disability to some degree, but for some of us it also marks the demise of our youth.

I took to joking about it “Why did it happen?” people would ask, and the only honest answer I had was “My warranty ran out.”

But this isn’t really an end. If you approach it as a challenge, and this is supported by a lot of the posts I’ve read here, if you approach this as a challenge, take it as an adventure, then you’ll heal faster and suffer less and frankly have a much better time.