I remember thinking…In roughly 48hrs I will be in surgery. I paused to let that sink in. Where did the last five weeks go? I had been so consumed with preparing my patients and colleagues for my absence, with being diligent about my strength and conditioning program pre-surgery, with making sure that all of my other commitments were taken care of, that I hadn’t really taken a moment to process that the final countdown was in full swing. It was the Friday before my surgery. I stared blankly at the Tetris-like stack of medical equipment that stood tall in my living room. I had crutches, a shower chair, bedside commode and my PT table ready to go. Me, overly prepared? Pshhh, I have no idea what you’re talking about! In Santa Barbara, there’s a non-profit organization called The Loan Closet where you can borrow medical equipment for free. Yes, free! Imagine a library where the books are medical devices, and you can check out whatever you need for a few weeks and return them once you’re healed. It’s amazing! This is also why I might have gotten a little overzealous when I picked up my crutches and then somehow walked out with a carload of equipment. You know…just in case…Better to be safe than sorry, right?!
I worked my last PT shift at the hospital on Saturday and then spent most of Sunday meal prepping in the kitchen. I used nearly every pot and pan in the process, but it was totally worth it, minus the cleaning part of course. Cooking is therapeutic for me. It helps me calm my nerves; it allows me to refocus. It was exactly what I needed that day. By dinnertime I felt 90% ready and 10% anxious for what was to come the following morning. As with all surgeries there’s always a risk for complications, but I felt confident in my medical team and reassured myself to think positively. Before getting into bed, I organized everything I would need in the morning: medical release forms, insurance card, photo ID, and my crutches. In a strange way I felt like I was preparing for my first day of school all over again, except this time my classroom would look more like an operating room. I think that’s it. I think I’m all set.
Alex and I reported to the surgery center on Monday April 25th at 6:15am. After exchanging good-byes, I was escorted back to the pre-op area and asked to change into my glamorous surgical attire (aka hospital gown and grippy socks). Next, I was greeted by my surgical nurse. She walked me through the pre-surgery checklist, set-up my IV painlessly, confirmed my medical history, had me initial my right leg with a sharpie (Yes, to confirm my operative leg. Yes, I laughed when she handed me the marker), and then introduced me to my anesthesiologist.
“Good morning Christine, I’m Dr. Smith. I’ll be your anesthesiologist today. I hear you’re a physical therapist so I’m going to go into a bit more detail with you about the general anesthesia and nerve block option than I normally do with most patients. I figured you might be interested in that since you’re a medical professional yourself.”
“Thank you, Dr. Smith. I appreciate that.”
“So you will be under general anesthesia for the entire surgery. You’ll take a nice nap for about an hour, and then I’ll wake you back up once the procedure is finished. The part that I want to discuss with you is the nerve block. That’s optional, and if you choose to have it, it can be done before or after surgery.”
Dr. Smith went on to describe how he would perform the femoral nerve block and explained that it typically gives patients 16hrs of pain relief post-op. The downside was that it would delay quad activation as a result. I was aware of this prior to my discussion with Dr. Smith, and was hesitant to receive the nerve block for that exact reason. Early quad activation is critical post ACL reconstruction as patients who have poor quad control early on progress much slower in therapy. I was willing to be in more discomfort short-term if that meant my recovery could be more streamlined long-term. I decided to wait on the nerve block and revisit the option if needed post-op.
A few minutes after Dr. Smith left the pre-op area, I could hear a familiar voice coming from across the room:
“Rachel, is that you?” I called out.
“Yes! Where are you friend?”
“On the other side of the curtain, come on back!”
It was my friend and fellow therapist, Rachel Meek, who had come to observe my surgery. Her early morning hug helped settle my nerves. I handed her my phone and gave her a quick tutorial on how to take photos. She had agreed to be my photographer in the OR (you can thank her for the photos in this post!). Within a few minutes, Dr. Yau arrived in the pre-op area. He, too, initialed my right leg with a sharpie and asked if I had any questions before surgery. I consulted with him about holding off on the nerve block. He agreed with my decision to wait, reinforcing the point about quad activation potential. Alright then, let’s do this… Just moments before I was escorted into the OR, Rachel and I were the only ones left in the pre-op area. She turned to me and said:
“I think it’s important to take a pre-surgery selfie.”
“Haha, I’m so glad you’re here. Thank you for capturing this moment.”
My nurse came to retrieve me from the pre-op area and escorted me into the sterile OR. As they positioned me on the surgical table, Dr. Smith inserted a small amount of anesthesia into my IV. I can’t tell you how much longer I lasted after that, but it couldn’t have been more than a minute before I was sound asleep…
About an hour later my surgery was complete. As I became more alert, I was pleasantly surprised that my pain level was minimal and was relieved to hear that the procedure had gone smoothly without any complications. I glanced down at my right leg finding it well wrapped and protected in its newly acquired straight leg brace. Dr. Smith soon returned to consult with me about my pain management. Seeing as my discomfort was 2/10 post-op, I declined the nerve block altogether. I was happy to give my quad a fighting chance without the added anesthesia. I changed out of my surgical gown, kept my grippy socks as a souvenir, and transferred into a wheelchair. The nurses transported me downstairs where Alex was waiting with the car. I reached for my crutches and gracefully transferred into the front seat. After a five-minute drive, we arrived home. My next test? Tackling the four stairs to our front door. I remember thinking how lucky I felt to be a PT in that moment and knowing how to safely navigate stairs with crutches and a straight leg brace. After entering our apartment I carefully headed for the bedroom. Alex helped me prep my pillows, set up my ice machine and served me lunch in bed. I got my laptop queued up for a mindless day of Netflix streaming and glanced at the clock to determine when I would need to take my next pain pill. I was
all set for day one post-op!
Within a few hours of being home I had mastered getting in and out of bed with one good leg, figured out I didn’t need the bedside commode (yay!), and was quick to navigate around our apartment with the assistance of crutches in order to maintain my toe-touch weight bearing precautions. The hardest part? Finding a comfortable position to fall asleep in… Lying on my side, my usual sleeping preference of choice, wasn’t an option due to the heavy brace that my leg was required to wear. I had to surrender to sleeping on my back. I thought I would eventually get used to this new sleeping arrangement, but sadly no such luck. I knew I had to be patient, but I so badly wanted to be able to just roll over and tuck my knees into a fetal position! Days two through seven were of a similar nature with the addition of PT exercises: quad sets and straight leg raises like they were my job, and working on achieving full extension of my knee. I had my first therapy session day five; I looked forward that appointment all week. I remember thinking to myself…so this is what my patients must feel like sometimes in anticipation for therapy.
By day eight, I was allowed to transition to weight bearing as tolerated – super exciting! Highlights from the week included:
Monday: I started putting weight on my leg and upgraded to using just one crutch
Tuesday: I was crutch-less and walking like a pirate in my straight leg brace
Wednesday: Saw my doctor, got my stitches out, and got clearance to unlock my knee brace to 70deg to begin relearning how to walk – WAHOO!!
Thursday: I got too excited about my new walking freedom and ended up with a big fat swollen leg. That meant that I was banned to the recliner and ice machine for the rest of the evening. PTs have trouble knowing their limits too sometimes.
Friday and Saturday: Walking is getting better and I started loosening my brace to see how my leg was doing on it’s own. The latter half of Saturday I walked around the house without my brace. That was pretty awesome!
Sunday: I had my first outdoor adventure. I got set-up courtside in my beach chair and umbrella to watch Alex and his crew play volleyball. It felt so nice to get some fresh air for the first time since surgery.
By week three, I had officially broken-up with my straight leg brace completely. I was walking short distances slowly, yet independently, and was beyond thrilled that I didn’t have to sleep on my back anymore. It felt ahh-mazing to lie on my side again! The little things, right? However, my biggest challenge would be learning to adjust my expectations. I was still battling with swelling and the length of time my leg would tolerate when I was in a weight bearing position. Due to the healing processes that were occurring and the muscle atrophy that had taken place in my right quad, it was difficult for my leg to support me for any longer than an hour without needing to rest and elevate. My knee would become stiff and heavy, resulting in a less than ideal walking pattern. The PT in me knew this was normal and knew my symptoms would improve over time as my quad became stronger. The patient in me was annoyed; she wanted to be healed already. I know, not terribly surprising. I mean, I only had part of my hamstring tendon harvested to become my new ACL, then had my femur and tibia drilled into to anchor said graft, and yet somehow still had the unrealistic expectation that my knee should be close to 100% in three weeks. When I took a step a back, I realized I was missing my old self. I was struggling to adjust to my new normal and my new identity. It was humbling to say the least. It also served as a good reality check that I was too early on in my recovery process to be complaining already.
Learning to be patient while being the patient is easier said than done. I wonder, is the fact that we’re called the ‘patient’ supposed to be a friendly reminder of this? Probably, but in doing so, I also feel like the universe was straight up laughing at me while I struggled to learn this concept. I have a feeling this will be a reoccurring theme for me over the next few months. Here goes…adjusting to my new normal….