- Michelle Riband
Reflections from an Operating Table
On Thursday afternoon, I found myself lying naked under turquoise waffle weave blankets and the crisp glow of fluorescent lighting. In a calm, drug-induced reverie, I watched as the medical staff prepared the operating room: the anesthesiologist dialed up my sedative and the technician wheeled in a table with 30 shiny tools. Temporarily paralyzed from the waist down, I felt nothing as the surgeon's assistant picked up my limp, iodine-stained leg and bent it a few times. Three other people in scrubs shuffled around the room rhythmically, as if performing a play they had rehearsed hundreds of times. Then, for the final scene, the surgeon marched in and the nurse drew a curtain to prevent me from witnessing the slicing and drilling that would ensue. Settling in for the next two hours, I grabbed my phone, pressed play on my favorite indie folk playlist, and started to write this article.
To cut to the chase: this is an article about knee (and foot) surgery. Knees are sensitive joints and extremely prone to injury in sports with hard impacts and sharp lateral pivots, like skiing, football, and volleyball—or, in my case, high-speed sledding. As a quick refresher of high school biology, we have four ligaments in our knees, two that cross to form an "x" in the center (ACL and PCL) and two that run vertically down each side of the knee (LCL and MCL). These help the joint flex while providing stability. Meanwhile, our two menisci act as shock absorbers to protect the thigh and calf bones.
Being the fearless sledder that I am (or was), I was bombing down one of Switzerland's longest sled runs (7km/4.3mi long with 711m/2,333ft of vertical descent) on a beautiful bluebird Saturday when I hit an unforeseen jump, caught some air, and landed on my left heel. A sharp pain ricocheted through my knee.
With swelling and bruising all the way down to my toes, I was forced to be bed-ridden while looking longingly at the snow-capped peaks beyond the window. After ten days, the inflammation subsided and I was able to get an MRI or Magnetic Resonance Imaging, an incredible technology that uses strong magnetic fields and radio waves to move around the proton particles found in each hydrogen atom in your body in order to detect and take images of different tissues. The machine is a human-sized tunnel that you lie in, motionless, while it makes jarring car alarm and machine gun sounds. In my case, the scan showed a completely snapped ACL (Anterior Cruciate Ligament), sprained MCL (Medial Collateral Ligament), torn medial meniscus, and bone bruising. I was distraught.
Now the eighth member of my family to have hurt a knee, I knew what I was in for: surgery and 6-12 months of physiotherapy before being able to return to full strength. Injuries can take a big emotional toll and I took this news particularly hard. Being active is an important part of my identity and venturing into the great outdoors is how I manage stress. I had also just mapped out my whole years' worth of activities: ski touring, kite surfing, backpacking, mountaineering, learning tennis, competing in my first sprint triathlon... Instead, I found myself trapped inside, getting suffocated by my duvet and hours of back-to-back Zoom calls for work.
To add to the mix were the complexities of my nomadic lifestyle. In October, I moved to a new apartment in Berlin—a bright loft in a refurbished red-brick building that was once a brewery. After a ski trip to Switzerland in January, I was eager to return to my budding friendships in Germany, but was panicked by the prospect of confronting my injury in a foreign language and medical system while living alone. Many jaw-clenching phone calls and emails later, my insurance company agreed to cover the surgery in Switzerland where I am now being taken care of by my parents and resident canine psychologist. Even better, I got an appointment with one of the leading orthopedic surgeons in western Switzerland and, three days later, was lying on the operating table.
Undergoing my first surgery has taught me a lot—not in that patronizing "everything happens for a reason" or "this is the world telling you to slow down" kind of way, but in the "oh fuck, this is way more stressful, scary, and mentally draining than I ever realized." Only six days post surgery, I have a lot more humility and perspective on what it actually means to be "of sound mind and body." I hope you can relate to or learn from some of my observations:
You can't press rewind
Replaying the accident in your mind over and over and over again, while analyzing all the different choices you could have made is normal, but ultimately achieves nothing but frustration. No amount of agonizing will change the outcome. Grieving for what is lost—time, freedom, autonomy, travel plans, or self-confidence—is part of the road to acceptance, but you just have to keep moving forward, one step at a time.
Close relationships count
Having the immediate support of your family or significant other is critical. Ultimately, they're the people who will go the extra mile for you—taking you to appointments and doing everything for you while you recover, from helping you get in and out of the shower to bringing your dinner plate to the table (since you can't walk on crutches and carry anything at the same time) to doing all of the shopping, cooking, and cleaning.
Having a broader support system of friends and coworkers also helps you avoid feeling isolated and falling down negative spirals. It's hard to admit weakness and ask for help, but other people have no way of knowing where you are mentally unless you tell them. The road to recovery can be long and you'll need all the cheerleading you can get along the way. So, don't feel guilty about relying on others in your moment of need. You'll have their backs next time!
Mine vs. yours
Close connections who have gone through recent or similar surgeries are particularly valuable resources because they can give you helpful tips, like what to ask the doctor or what to pack for the clinic. That said, even the same injury, like an ACL tear (which is performed over 100,000 times in the US every year), can be treated in different ways. As a point of comparison, my brother had ACL surgery a few years ago in New York City. He was put under general anesthesia, while I was put under spinal anesthesia, where a local anesthetic is injected into the cerebrospinal fluid between specific vertebrae in your lower back to temporarily block signals being transmitted from your legs to your brain. My doctor also recommended a secondary foot surgery to release the tension in my "flexor hallucis longus" tendon and reduce the risk of re-injuring my knee. My brother was sent home the same day as his surgery and was prescribed heavy pain killers (including oxcycodone), while I spent three nights at the clinic under careful watch and hobbled out on my crutches with nothing more than some over-the-counter ibuprofen. While procedures for surgery and rehab are similar, there are different schools of thought when it comes to where to harvest the new ACL (your hamstring and patellar tendon are the most common); how many incisions to make (I will have eight scars between my knee and foot); whether or not to insert a tube into the wound to drain fluid post-surgery (which I learned is very painful); and how or when to ice, elevate, and use knee braces. So, while there's a lot to learn online and from others, information gathering can be overwhelming. You ultimately need to focus on your own experience, listening to your body and the advice of your medical team.
Fear is a thing
Being injured is scary. You feel pain, but don't know what it means. Your body isn't working like it's supposed to. You feel frustrated and anxious. There's uncertainty as you wait. Going to appointments and medical institutions is intimidating. Then surgery day comes and everything feels so intense—all the medical staff and protocol and beeping machines. There's tugging and drilling. It takes hours for your legs to wake up again. Then the pain sets in and you can't sleep. You almost faint when you stand up with crutches for the first time and you can't seem to control your body. You stare at your knee and, with all your mental energy, you say "lift!" but it doesn't move—your brain is subconsciously trying to protect your body from pain by inhibiting movement. Progress is slow, but small moments, like being able to wiggle your toes or lift your own leg out of bed, are worth celebrating!
It's ok, you're human
Hospitals make you confront the banal reality of your own humanity. Even though the medical staff tries to be discreet, you feel exposed. Your naked body is not seen as desirable or sanctimonious. Instead, you get poked with needles while wearing fishnet granny panties and a dressing gown with no back. Then, as you sit in the "wake up" room waiting for your anesthesia to wear off, the nurse lifts you onto a basin and tells you that you have to pee to show that "everything is working again" before you can go to your room and eat for the first time in 24 hours. But how to pee if you have absolutely no sensation or muscle control in your pelvic area? Well, it turns out that you awkwardly clench your abs and end up partially filling the basin and partially wetting the bed and yourself. It's humiliating, but when the nurse comes back, she congratulates you—clearly she sees this everyday—and you're reminded that, when you put aside your pride, bodies are just bodies, "gross stuff" and all.
Navigating the medical system
It is critical to get a surgeon who is experienced and comes highly recommended. This is the benefit of being treated in a place that you know (and speak the language). My parents were able to quickly pull together a list of referrals from family friends in our area, while I spent hours Googling "best orthopedic surgeons in Berlin" without any proxies of quality. Trusting your doctor brings much needed peace of mind.
Beyond the actual surgeon, there is a whole team of nurses, anesthesiologists, and physiotherapists that are there to help you in your journey. I have been beyond impressed by the genuine care of the 30+ medical staff with whom I have interacted. They have assuaged my fears, helped me manage pain, encouraged me when I took my first steps, and even given me travel tips for Portugal. Making an effort to chat and thank them has also gone a long way.
My insurance company has also played an important role in my treatment. In Germany, health insurance is mandatory and 90% of people are covered under the public or statutory system, which doesn't charge more for preexisting conditions and covers all of your dependents for free. Despite those long-term benefits, I opted for private insurance because of its international coverage, which thankfully enabled me to get operated abroad. While dealing with my insurance company continues to be a source of stress, I am supremely grateful that they pulled through for me in this moment of crisis. I have skimped on insurance in the past with an arrogant "young invincible" complex, but this injury has underscored the importance of prioritizing spending on the best insurance and quality of care.
Putting it into perspective
Clearly this experience has come with its traumas, but ultimately I feel lucky. I have had support from loved ones, high-quality medical treatments, and no major financial burden. This is also a moment in time, not a life-threatening or chronic condition. I'm frustrated because I can't walk properly and my life is on standstill, but I think about all the people who live with physical impairments everyday or the patients who go under anesthesia not knowing if they'll make it out the other side. I know so many people who have had surgeries of all types and have never been able to relate or react in the appropriate way. Learning from this, I hope to approach other people's (and my own) future medical situations with more empathy. I still have a year of recovery ahead of me and I know it'll be a roller coaster, but, in 2023, I hope to stand on the summit of the Jungfrau (4,158m/13,642ft) with a stronger knee and a greater appreciation for modern medicine, the human body, and my own mental fortitude.