The nurse gently removes the bandage, revealing a scar, red, raised and firm to the touch, running from mid femur over the knee to the upper tibia. Staples, holding the surgical incision together, brought to mind a zipper without the pull.
I could read Liz's mind as she looked down at her leg. "As if my legs aren't bad enough, now I have this ugly scar making them worse." To her, the scar represents some unsightly disfigurement used to portray evil in horror films, comic strips and fairy tales. At a minimum, it meant no more shorts or above-the-knee skirts.
My heart, goes out to her, as she prepares to face another challenge. Her knee had been a problem for some time, but to some extent tolerable. Recent activity at a local gym had aggregated the pain in her knee, forcing her to try different medications, massages and physical therapy that did nothing to help alleviate her pain. At best they provided temporary relief, but nothing to allow the normal functioning of her knee.
In the end, she saw a doctor who correctly identified it as a quality of life issue. Did she want to lead a normal life of activity or avoid activities that caused her severe pain? In the end, it was an easy decision -- if it meant an end to the pain, she was all in.
Surgery was three weeks ago, and everything had gone well. Today's visit was all about taking off the dressing and getting a first look at her bionic knee.
The nurse, her name badge said "Amanda," gave an approving look as she moved Liz's leg, observing the tissue surrounding the incision site, looking for signs of infection or unusual swelling.
"That looks really good, Liz," Amanda says, pushing back in her chair. "Any pain or difficulties moving your knee -- outside of what's expected?" She flashed a smile only a nurse can give.
"Not to the knee," Liz's attention remains fixated on her knee and the scar, "but there's an area around my groin where they tied the tourniquet to shut off the blood supply to my leg that really bothers me. I'm hoping that gets better with time."
I am sitting next to Liz, having been part of her consult, surgery and recovery process. I don't know if I'm much help. She will be the first to tell you how I get light-headed whenever knives are involved -- in movies, opening a frozen pack of hash browns and a chocolate bunny injury that involved a deep cut to Sean's finger and a flash of bone. It was bad enough for me to calmly drive him to Urgent Care and confirm that he needed stitches. Unfortunately, I had driven to the wrong clinic.
I blame it on my extra-ordinary ability of feel the pain of others.
I know you can laugh and think I'm joking, but I'm not. I'm not suggesting I have any kind of super power, but I've always felt like someone's pain was mine -- like one of our international students deciding to have surgery on a very sensitive area of the male anatomy. Just thinking about the procedure makes me want to sit down. My son seems to think I'm not a very empathetic guy, but he is wrong.
As if knowing this amazing ability of mine, Amanda -- still smiling -- reaches into a nearby drawer full of bandages and other medical necessities, and discretely takes out a staple remover. Her slight of hand to minimize what she is going to do reminds me of numerous examples of a doctor or nurse playing hide and poke with an eight-inch needle that is about to be plunged into your backside.
"This is the worse part of today, Liz," Amanda assure us, as the remover grabs the first of twenty-five staples and quickly pulls it from her tender flesh.
Nursing is one of the most demanding professions in the working world, requiring long hours, physical effort, and a high level of skill and professionalism. I know, because I'm married to one. This year, Nurse's Week kicked off on Saturday, May 6 and continued through Friday May 12.
It's unfortunate that nurses don't get more recognition for their work, other than an occasional card, some flowers or maybe if they're lucky, a tumbler with a heart on it. Not much respect for someone who has to watch a patient die, work weekends and holidays, clean up piss and shit, or tolerate verbal and physical abuse from patients and sometimes doctors. And in many cases, go home and take care of the family, before doing it all over again 12 hours later.
I mention this, because I was given a "certificate of nursing" by Liz before her knee replacement, and while it was appreciated and given as a good will gesture of knowing what was involved, I had no clue of what was coming.
And I had it easy -- I only had one patient, I was in the comfort of my own home and bed, meals were pre-cooked and ready to eat, and "real" help was only a question away. But it every way, the time I spent taking care of, and helping Liz through the first month of her recovery, was a testament to her profession.
Sleepless nights? Check!
Lots of lifting and attending to basic daily activities? Check!
Monitoring medications that were needed at specific times? Check!
Being concerned with my patient's well being? Check!
Finding my own time to eat and shower between patient care? Check!
Causing physical pain and suffering, even though you know it's the best thing to do? Check!
Tolerating the use of enough cold and ice to think I was living in the Arctic? Check!
Did I mention sleepless nights? I was so tired that I couldn't sleep. Have you ever experienced that?
I can remember as a teenager, driving back from California with my best friends being so tired I couldn't think straight. It was so bad, I had to pull over even through we were only an hour away from home after driving for two days straight. And coming back from a snowy Packer football game (a loss to the Atlanta Flacons in the playoffs) at four o'clock in the morning and trying to talk. The words were coming out, but they weren't making any sense.
During the first week after her surgery, I would sleep for a short time then wake up, even though I was dead tired. So I grab a book to read until I can't remember what I just finished reading. Then toss and turn some more. I think part of the problem was having a baby monitor next to my bed so I could hear her sleeping in the room downstairs. While the monitors worked really well -- I could hear every concerning squeak and thump coming from her bed -- I was always worried I wouldn't hear her when she wanted me. And I had turned on the alarm (every three hours) so I wouldn't miss her shout when it was time to get more ice and another round of "guess which pill I have in my hand."
I completely understand how someone could be given the wrong medication by a nurse in the middle of the night. I may have done it for all I know.
But it wasn't all bad, because the best part of being a night nurse? After struggling to get my arms in my robe and stumbling down the stairs (with both eyes closed) I would walk into her room where I could see her smiling face, caressed by the glow of a subdued night light.
At moments like that, I think I would have done anything for her. Well, maybe not eat brussle sprouts or beets, but pretty much anything else. There is a sense of purpose -- in the dead of night, or when you're drying her hair or helping her put her socks and shoes on -- that a normal job doesn't contain. There may be excitement that comes with many jobs, maybe even real accomplishment, but when it comes to feeling like you're making a difference in someone's life, I think nursing has them all beat.
It reminds me of when our sons were born and being able to comfort someone in distress. You realize, the little baby you hold in your hands, crying desperately for that bottle of warm milk, needs you. Or the little boy, with tears in his eyes from a skinned knee, needs a hug and your assurances that everything will be ok. Or the young man who calls late at night, his voice sobbing with pain after breaking up with a long time girl friend, needs you to tell him the pain will get better and that he will find love again.
And in Liz's moment of need, I was determined to be there for her.
"If I could do this for you, I would..."
My words fall silent as she grips the bed covering searching for relief.
"Just twenty seconds more," I say, hoping to provide some near term relief. We are finishing the third set of the prone hang, an exercise designed to increase the range of knee extension and activation of the quadriceps muscles. The physical therapist claims it is especially useful after reconstruction of her knee.
I think it could be especially useful as a torture technique -- Where did you hide the chocolate chip cookies? -- I'm not telling! -- WHERE ARE THE COOKIES? Go to hell! Then another five minutes of the prone hang for you! Tell me now before you die!
Everyone says the physical therapy part of any surgery is the worst. It's true. In fact, her doctor said his part in the knee replacement would last about two hours, hers would last for months. The real success to getting better comes from going to your PT sessions and doing the exercises they give you to do at home.
They have names for different positions that remind me of yoga positions:
Supine knee extension stretch. (Big toe pose)
Standing tandem balance. (Feathered peacock pose)
Single leg stance with counter support. (Extended puppy pose)
I can imagine PT patients talking in the waiting room, comparing notes and various techniques.
"Mine has me doing the supine 90/90 sciatic nerve glide with knee flexion," the middle age woman declares, her eyes wild with excitement.
In response, another woman trumpets, "I did the gastric stretch against the wall. Try that sometime!"
"Oooo. That sounds painful, if not impossible at my age!"
Liz has scooted up the mattress and is preparing for the last exercise of the night. Unfortunately, it's one of the worse and maybe why we do it last. I reach for the wide belt -- snapping it quickly like I learned in dominatrix school -- loop it around her ankle and give her the other end to hold. I gentle raise her foot and leg into a 90 degree position and she grabs the other end of the belt, pulling it forward.
The goal of this exercise is to bend her knee past the 90 degree mark, then past 120 and eventually to 130 degrees. Liz says a normal knee bend is anywhere from zero to 140 degrees, with a functional knee bend at 120 degrees. A bend of 80 will get you up a flight of stairs. A 130 degree bend will get you in a bath tub. At 115, you can ride a bike.
My watch shows thirty seconds, and I relax her knee. "Oh my God," she moans as she turns her head to the side, her eyes holding back tears. I thought these stretches were supposed to help, not facilitate another round of surgeries. "Can you please rub the hamstring on my upper leg? It is SOOOO sore."
I press my knuckles beneath her tail bone and run them down her leg, stopping just above her knee. Then again. With medium pressure, I use a long, slow, gentle stroke to help relieve the muscle fibers that are causing her so much pain.
"Does that help?" I ask.
"Not really, but thanks anyway."
Failing at nursing without attending school shouldn't be a surprise, but I still feel a little disappointed I can't relieve her pain. I know the surface of her body, but underneath the skin remains a mystery, much to to my dismay. My watch reminds me to start again, so I gently bend the knee forward and tell her to pull.
"One more time -- you can do this."
Another round of "this" and she'll be doing the corpse pose...
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I am sure I haven't earned my certificate of nursing, despite what Liz thinks, because my time "on the floor" only lasted a few weeks. And even when I was helping, I was usually asking her what to do. The last thing I wanted to do was mess things up and send her back to the hospital.
I've discovered two things during the last six weeks: Liz is a strong fighter and determined to get her knee back to a functioning level. She's a great patient and listens to her doctor and therapist.
The other thing I know is how difficult it is taking care of someone. It' a lot of work, and mistakes can be hurtful if not deadly.
It did allow me to fulfill my promise however, made thirty some years ago when I stood in a candle-lit church with the rain coming down, standing with her in front of God, family and friends and answered the question being asked by the pastor:
"I take you to be my wife.
To have and to hold from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, to love and to cherish, till death do us part, according to God's holy law.
In the presence of God, I make this vow."
