Monday, June 11, 2012

My Left Knee: Surgery and Hospital Food

Every time an upper level low pressure area was racing across the country from west to east my knee would flare up and remind me it connected my thigh and calf, at times causing me unbearable pain. Most folks don’t think about their knees, they just want them to work like they should, when they need them to work. Most of you step, walk, squat, and jump without a care. On our frequent trips to the Valley to set up a new restaurant we were consulting on, my knee would be killing me after the 6-hour drive each way, and this was cruising uber comfy in a ‘Sclade. I would limp around the whole time I was down there. It got so bad that I would pack Lefty in pillows to pad the knee during the drives. Just standing up became painful, much less actually moving.

It was first injured playing football in high school; a tear of the medial meniscus cartilage. I spent every Thursday of every week of the entire 15-game championship season (Texas 4-A State Champs, 1968; Go Raiders!) getting it injected inside the joint with searing Xylocaine, and then getting it drained of multiple syringes full of synovial goo, using a needle the size of a garden hose. That was followed by a healthy dose of steroids straight into the joint. Every Thursday after practice, every week, all fall long.

It got so bad later on in college that the flap of torn cartilage would cause my knee to lock-up (professionally explained to me as “like a towel stuck into a drawer when you want to move a dresser”), producing intense pain and literally stopping me in my tracks. It once dropped me in the middle of oncoming traffic on the Drag at UT when I was shuffling across the street against the light. The longer it went on, they said, the more damage was being done, and the better the chances were of developing arthritis later on. I had the first procedure in 1970. Back then, in those pre-laparoscopy days, it meant two sizable incisions, and suffering in a hip-to-ankle cast for six weeks. Once healed, it was pretty much “good as new”.

After working in the restaurant business for years, Lefty once again got angry and resentful. As a chef you are on your feet for 10 and 12-hour shifts, briskly lunging, walking and spinning in tight little circles endlessly at your cooking station on the line, while trying to maintain balance on wet floors; ditto for bartending. Waiting tables adds a heavy tray of plates, the need for perfect balance, and quickly walking many miles nightly. Manage a restaurant and you combine all of these into one Herculean task guaranteed to erode knees. Knees and restaurants do not make good friends. The second operation on the Lefty came in 1983 or so, Johnny Genung did a laparoscopic procedure to do some surface polishing and removal of scar tissue. I was back working 60 hour chef shifts after four days of rest.

After several decades in the resto biz I turned to plants, a previous avocation. I did several years of landscape design and installation on the side with my own company; it’s another industry that is very unforgiving on knees. Not only is the knee’s role in using a shovel bad for the joint, but so is carrying heavy pots of plants and countless wheelbarrow loads of materials across uneven terrain and sideways along slopes, and kneeling while planting. Knees and landscaping; a bad combo. 

After a stab with a knee brace, and then resorting to a cane and a handicapped permit, I finally broke down and decided to confirm what I already knew was in my future. I went to see old restaurant customer and orthopedic surgeon Johnny Genung, who, after xrays, showed me that my left knee was bone-on-bone. The cartilage was gone and one bone was wearing a sizable groove in the other. “No wonder it hurts”, he said, “it’s just plain worn out.”  The combo of football, restaurants, and landscaping had been the perfect storm for a knee shot to hell.  A surgery date was set, all of the research was done and questions asked, preliminary lab work was performed, attended the class for pre-surgery hip and knee replacement patients, and I was ready for the install of a new prosthetic knee. I was getting ready to be assimilated by the Borg. “All resistance is futile”.
My leg was pre-scrubbed with anti-microbial solution the night before and again that morning, and I took what would be my last morning constitutional for some time to come (foreshadowing alert). I wanted to be as empty as possible when I got there, and hadn’t been allowed anything to eat or drink past midnight.

Here is a shot of the knee pre-surgery. The last scar-less foto of Lefty.

I showed up at Seton Hospital on 35th at 6 am for my 8 am surgery appointment, and was ushered into the chilly catacombs of the surgical wing, issued the requisite backless gown and TED hose (that kept me from getting a deep vein thrombosis), non-slip booties, an IV and a shot to pre-zonk me, with a bewildering array of folks telling me what was going on and asking me questions. I don’t remember much after that, except noting that the surgeon, the imitable Archie Whittemore, marked his initials with permanent marker in huge letters on the correct knee to be replaced; I wanted to make sure they installed the new knee on the correct leg.

I woke up in recovery to them trying to install an IV in the other elbow. I have a reputation as a difficult stick when it comes to getting my blood. I would have made a lousy junkie had I ever been so inclined. There was a growing crowd of anesthesiologists, phlebotomists, vein-puncturists, or whatever they were, discussing the best available vein to tap into, and before I knew it, there were 8 or 9 milling around in the group, and they had 2 different imaging machines looking at my circulatory structure. I was the sensation of recovery. I zonked out again, and they found the vein. I vaguely remember them telling me we were off to my room, being in an elevator and then a hallway, with out-of-focus fluorescent lights whizzing by overhead, then getting the inflating boots placed on my lower legs, and the CPM machine that involuntarily moves my leg while I lay there. All else is a haze.

The "good arm" I.V., the one that didn't have the allergic reaction to latex:

There were friends (R, and Jules and Di) that dropped by to bring me my stuff, but I don’t remember what we talked about, or them getting me a drink of water or chewing on ice pellets, or the TV being on, or much of anything else for the remainder of that day or night. I do recall telling them that my betissibles and my nether region seemed awfully hot and sweaty and that I wanted some baby powder from my toiletries to give me that “fresh” feeling down there. They politely turned away so I could apply the powder with some degree of dignity and when I reached down, I discovered a one-foot cube of green surgical towels crammed between my legs and tightly up in my crotch, against my junk. This seems like something the nurse might have known was there and could have removed. At least there was a good reason to be sensing that clammy feeling, and it was easily remedied. I powdered anyway.

Me, a "FALL RISK" ??? I beg to differ......

Friday dawned with extreme hunger. I had been thinking for many hours about the breakfast that I had pre-selected the night before with the “food service coordinator”. I had been through several tubs of jello in the interim, along with some orange juice, ginger ale, graham crackers and peanut butter, and it definitely did not satiate my aching cavernous maw, which had been running on empty for the last 36 hours or so.

The first meal arrived with a modicum of fanfare. OJ, coffee, milk (which I detest), hash browns, scrambled eggs with green peppers and cheese (“Denver Scramble”), and fruit salad; if I had not been starving, it probably wouldn’t have tasted as good as it did.

I screwed up when giving my lunch order, thinking I had ordered turkey and dressing. I blame it on the little magic button that dripped happy morphine juice into my I.V. I should have known they wouldn’t give me something that would plug you up like dressing does; opiates are notorious for causing constipation. What I got instead was an overly-bready whole wheat, turkey and cheese sandwich (scant turkey and cheese), with chicken and rice soup, a crisp green salad, apple crisp, and ice tea. If satisfied the cravings temporarily.

Here’s a shot of the incision a day after the surgery.

The left arm IV was hurting bad. It was the difficult poke from the recovery room, and now I knew what it was for. A drain on the side of my new left knee siphoned blood drainage down a tube, into a unit that looked like a 10” round reverse Oreo (white discs on each side, dark stuff in the middle), with a tube from that going into my arm. As weird as this sounds, they were taking drainage from my knee, pumping it through “a filter” (the Oreo), and then sticking it back into my body via the hole in my arm. Gotta be honest; it kinda creeped me out. A lot. By the way, I had not refused a transfusion if required, so maybe this is standard operating procedure. Weird.

My board, which kept me updated daily with all kinds of useless information:

That afternoon there were threats of catheterizing me if I didn’t pee. I countered that I could pee just fine if they would only let me go to the bathroom a few steps away; peeing in a bottle while laying down was just not calling my bladder into action. I was cruising the halls 100+ yards at a time with my walker (I did it the first time the same day of surgery); I didn’t see what the problem was. When the orderly came in to give me the heads-up about an impending catheter, I told him to just make sure I don’t fall while I walkered to the restroom 10 feet away, and he said sure. What he didn’t know was that I was expressly forbidden from doing just that by my evil therapist. I got in there, the gates opened up, I peed for about 5 minutes straight, the catheter was averted, and the therapist was none-the-wiser about my bathroom subterfuge.

That evening’s dinner was actually excellent; the best of my stay. Slices of tender, juicy pork loin slathered with onion gravy, fresh vegetable medly, crispy roasted new potatoes, fresh ripe strawberries with whipped cream, OJ, served with iced tea. I almost felt redeemed. There was a guy in my pre-surgery class that was attending the class at Seton, but was actually having the surgery at St. David’s. “They are supposed to have much better food over there”, he told me.

The next morning brought “Breakfast Burrito”, which was actually scrambled eggs with tortilla points, bacon, oatmeal, fresh fruit plate, OJ, and coffee. The much ballyhooed salsa never materialized.

Saturday’s lunch was the worst meal of the stay. A skinless, dry, tough, under-seasoned chicken breast, matched with peas and pearl onions, roasted new potatoes, a dry semi-leavened brownie, grape juice, and iced tea.

I was much more inspired by the excellent chicken with beech mushrooms that I persuaded R to bring me from Asia Café that afternoon (with hot chile-ma la oil!!!!).

Saturday’s kitchen again disappointed with a roast beef sandwich (actually slices, with a whole wheat roll standing at attention next to it), undercooked potatoes swimming in a quasi-pasty cream sauce that were supposedly “scalloped”, and a dry pear crisp (the raisins were a special request meant to help overcome the opiates’ lure on my lower intestinal tract).

Breakfast the next morning brought the ubiquitous scrambled eggs, BACON!, oatmeal, poppy seed muffins, OJ, and coffee.


My IV’s were removed and the one on the left side looked VERY angry. “Looks like you have a Latex allergy”, said the nurse. “You should have told them not to use Tagaderm.”I replied that had I known I had a Latex allergy, they would have been the first to know about it. It would later blister-up, looking like I had decided to brand my arm with a 4-inch red hot tile.

It was day four and I still had not had a bowel movement. The knee pain was managed efficiently, both by the morphine button that I got when the epidural-like block wore off the afternoon of surgery (it was supposed to last until the next morning; do I get a price reduction on the cost I wonder?), and by the dose of two Norco pills every 4 to 5 hours, doubled when a solo pill proved ineffective. When I got home I was scooting around on the walker pretty good, and well past ready to escape Seton, bowel movement or not. On the morning of day 4 I successfully made my escape to the opulent Rancho Winslow for several weeks of convalescence.

The last shot of the knee before escape from Seton Hospital:

Cut to the morning of day six, when the trumpets sounded, I got a funny feelin’, and little poop angels descended to coax the first post-operative action from my posterior. Halleluiah! I was taking daily doses of Metamucil, had doubled those, was eating as much fiber as possible, and finally resorted to dried prunes and slippery elm herbal cleanse tablets; nine prunes on the day before. Word to the wise. If you are on opiates for pain, plan ahead, eat accordingly, and be one with your digestive tract and your poop fairies.

A note on the 5-star accommodations at Rancho Winslow:  I could not be more comfortable if I were being pampered at the Ritz. The bed is comfy, the house air-conditioned, the grub excellent, the dogs all tail-waggy and grinning (although Toby, a huge lummox of a chocolate lab, has a distinctly disagreeable wet dog eau) and the friendship and helpfulness bar none. Chris even got up at 5 am to take me to the hospital on surgery day. A special shout out to Di and Jules for all their help in assisting me with ungainly chores, like tugging on those accursed TED compression stockings that I have to wear for the next three weeks, and carrying my chair from room to room. And to R for all her help and visits. Chris and Di offered the convalescent stay to me when they heard a date was set. I didn’t even have to beg (but I sure would have).

Mick Vann © 

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