26 February 2008

Pop goes the ACL

It was mid-afternoon on 16 January. Two days earlier I'd returned from the beaches of Contadora just off the coast of Panama. I was super-relaxed. The boys from Section G were in Shad, kicking the football about - a friendly yet competitive scrimmage. We'd been playing about 45 minutes and my side was behind. Seeing an opening, I put on a burst of speed and charged towards goal. Scott stood just outside the box, blocking my path. As I approached, I turned my back and readied myself to receive a pass from Nicolas. I planted my foot, and spun to volley the ball and shoot on goal.

My leg gave way beneath me and I heard a sickeningly audible "pop". I lay gasping on my back, on the floor. My immediate thought was that I'd dislocated my knee. I looked down, half-expecting to see my foot dangling lamely, or sticking out at a strange angle. But it all looked fairly normal.

10 days later...
Dr Schena tapped on the screen with the tip of his pen. "That's your lateral meniscus - shredded". Then, click click, with the mouse. "And that - see that little stump here and that little stump there?" He gesticulated at two shafts of black. "That's all that remains of your ACL".

In the hours after the ambulance swept me away from Shad to Mount Auburn Hospital, my knee began to inflate to the size of a juicy grapefruit. Over the coming weeks the grapefruit began to rot; my knee turned putrid shades of yellow, then blue, and finally black. The joint stiffened with all the fluid inside, causing my thigh muscles to atrophied. My leg turned flabby and sponge-like. It wasn't pretty.

PT: Turning the corner
Enter Lynn, my physical therapist and savior - at least when it comes to walking. She soon had me doing all sorts of leg lifts, calf extensions, and hamstring contractions. Slowly but surely my joint began to loosen.

My favourite moment was on the bike at the gym. When I began with Lynn I could only manage to rock the pedals backwards and forwards. After a few days, I completed a rotation or two. Gradually, I increased the time and speed. But it wasn't until the second week of PT that I managed to peddle fast enough so that the bike actually recognised that I existed, and offered me a workout programme. I didn't see "knee rehabilitation", and so opted for "fat burn".

Schena will fix it
Dr Schena tells me that I need a minimum of 120 degrees of articulation before they can undertake the surgery which is needed to get me running again. It involves an autograft - effectivley a donation of my own tissues - and some skillful orthoscopic surgery (For the morbid fascination of seeing what will happen during the operation, click here.)

Two asides
A couple of interesting observations extend from this episode. First, I've always taken my mobility and my legs, feet, and knees for granted. It wasn't until I was stranded, hobbling around on crutches, that I realised how much harder life is if you can't walk. You really need your friends. It sounds obvious (duh! you say), but as I sat on my bed, too physically exhausted from all the hopping to move, my mind was ferociously frustrated. For a few fleeting moments, I was the caged lion, a fox with his leg caught in the trap, a man stuck inside a disabled body. More than anything I wanted to go back to how I was. But I was helpless. I could only accept my fate.

Second, this experience brought the US healthcare debate into vivid Technicolor. This little episode has cost my insurance company almost $10,000 ($1200 for the ambulance, $600 for the orthopedic surgeon, $6,000 for the MRI scan) and will probably cost me another $12-15,000 for the operation and rehabilitation - around 50% of my 1st year tuition ($41,900). Why is it so expensive? How can the service possibly cost that much? And if I were uninsured - like 40m Americans currently are - what would I do? Again, this is not a new or controversial thing to say. But I didn't appreciate how scary is feels until it happened to me.