One More Surgery

The only thing left to do now is heal.

It’s been over a month since my last post.  I haven’t been able to write, either mentally or physically.  Too much has occurred in the last month for a single post, so I will likely have to break this into pieces, but I think my head has cleared enough to finally put it all down.

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Nearly five weeks ago, I visited my surgeon following the last day of strut turns, excited to be done and eager for her praise at my Wolverine-like healing powers and unflagging resilience.  She looked at my foot, still a little crooked and not quite flat, and broke the tragic news that I would need a new prescription to continue to move the heel down.  I was devastated when she handed me the print-out at the end of my visit- 12 more days.  Still, I was managing the pain well, even putting tentative weight on my foot, and told myself a few more days would just make sure it was perfect.

That was a Thursday, and within two days the sky fell.

In order to flatten my foot, the ankle movement required the top of my foot to lift and the rear of my foot to lower; the slow and steady incremental movements each day were designed to gradually move the bone into position while simultaneously stretching out the tendons and soft tissues which have not moved for a decade and a half.  By Friday, my achilles tendon was tired of this and had washed its hands of me.  My heel swelled to three times its size, trapping the nerve that runs near it, and spurring suddenly overwhelming pain that burned and stabbed in ever-increasing waves.  By Sunday, I hadn’t slept in days and had turned to writhing around screaming as my primary coping mechanism.  I learned what happens when pain reaches a level beyond what any human can bear- you don’t die or even faint, you just keep feeling more pain, more than you think your body is able to feel, until… well, there is no until… you can just always feel more.

Patrick drove me to the emergency room once he’d managed to coax me into rolling out of the fetal position to make it down the stairs.  It was a twenty minute drive, a thirty minute wait once we arrived, and another twenty minutes to see the doctor once we’d been given a room, so whatever good the pain meds were doing had completely disappeared by the time I saw anyone.  Luckily it doesn’t even occur to anyone you might be faking it when you roll in with a giant pin cushion for a foot.  (I’m always surprised at how much shock seasoned medical professionals display when they see this thing.)  It took five minutes for the iv dilaudid they gave me to dull the intensity of the pain to a bearable ache.  Fearing the pain had suddenly intensified due to infection (my arch nemesis), the doctor ordered a full blood workup and a fancy x-ray from a mobile machine that wheeled right into my room.  We reached my surgeon as well after some frantic texting and she gave me the day off of more strut changes, so we went home generally satisfied that  the pain would abate and we’d done our due diligence to ensure it was nothing more serious.

Monday I was back to turning struts, and Monday night I was back to not sleeping as I held my leg in the air unwilling to rest it even on a pillow for the pain it caused.  I called the surgeon Tuesday morning, utterly exhausted and unable to cope with more pain, and she urged me to come in to the office

A cartoonists rendition of an Achilles tendon lengthening stolen from another site that will likely sue me for this.
A cartoonist’s rendition of an Achilles tendon lengthening stolen from another site that will likely sue me for this.

where they would fit me in around their schedule somehow.  Once there, she reviewed the blood work results and assured there was no real sign of infection, and that the pain was simply the achilles refusing to stretch any further.  We decided the only option was to lengthen to tendon or I’d never be able to lower the heel further.

To lengthen the Achilles tendon, three incisions are made up the back of the heel.  The tendon is partially severed on one side, then the opposing side a few centimeters up, and then the first side again a few centimeters further up.  The surgeon then pulls down on the heel to stretch the tendon out and the remaining tendon between the severed sections gives way and twist sideways to add enough length to allow movement again.  As we did not need my ankle to move in the future, Dr. Workman considered severing the tendon completely, but she decided against this simply because my ankle would appear deformed afterward, which would obviously ruin my promising future as a middle-aged cellulite model.

I already had an early morning appointment scheduled for the coming Thursday, less than two days away, so she directed me to meet her at the surgery center instead and plan to stay the night.  I begged her in tears not to make me turn the struts again until after the surgery and though she hesitated for fear my bones would condense before we’d finished the repositioning, she finally relented with pity clearly written on her face.  Though still in tremendous pain, I went home relieved that we had a plan to make this stop.

Tuesday night was another night of agony and no sleep, and around 9am Patrick made the executive decision to take me back to the emergency room, presumably because he was tired of listening to me wail.  This meant canceling work for the both of us that day- a big deal as Patrick doesn’t get sick time- but I don’t recall feeling guilt for more than a few moments as I couldn’t focus on anything but the fire surrounding my foot.  Relief came in the same fashion as before- iv dilaudid.  As we prepared to head back home, they gave me one more dose for the road in the hopes I’d make it back to my oral pain medications in time before the iv wore off.  My surgeon texted as we were leaving the hospital and directed me to head straight to her hospital to be admitted; her plan was to start me on iv meds to get out me out of pain until the surgery the following morning, but I convinced her to let me go home and see how I fared.

I slept very little that night, which was fine as we had to be up and on the road to the hospital by 4:30 for check-in by 5:30.   I had taken my last dose

Three tiny incisions along the Achilles closed with dissolving sutures.
Three tiny incisions along the Achilles closed with dissolving sutures.

of pain medication at around 3am and didn’t bother to bring any more with me as I reasoned I’d be out cold by 7 anyway.  The pre-surgical prep went quickly, but I was in severe pain by the time a trio of anesthesiologists came in to announce that they would be performing a nerve block.  I couldn’t hold my leg still as it shook on its own, so they held me down as one doctor ran the ultrasound over my thigh and another injected the medication directly into a pair of nerves along my inner and outer thigh.  The second injection stung sharply and a nurse caught my hand mid-air as I inadvertently swatted at the needle as though I was a toddler getting my first shot.

Instantly the pain was gone.  I invited the anesthesiologist who wielded the needle to move in with us.  I described in enticing detail the lovely pine wood bunkbed he could share with Georgia and promised to buy him whatever toys he wanted.  The rest is fuzzy as the iv meds took over.  I vaguely recall greeting Dr. Workman in the operating room and asking everyone if they felt well-rested and ready to rock.  The anesthesiologist came in and I professed my undying love for him.  I only know this because Dr. Workman told me all about it many hours later.

After some confusion in recovery about whether or not I was to stay the night, I was wheeled into a double room with an elderly roommate who assured me she was just about to leave and then stayed most of the day.  My leg was numb, I was well-drugged, and the nurse handed me a menu with directions to order whatever I wanted as much as I wanted.  I felt the kind of happiness I imagine those last floating survivors of the sunken Titanic felt when that little boat of rescuers finally paddled up.  I was awash in joy and I ordered a five course meal with four desserts.  I was gorging myself on chocolate pudding when Dr. Workman came in with her assistant, commenting under her breath that she’d forgotten to put me on a calorie-restricted diet.  Her assistant held a sheet of paper with a new

My flat foot recovering in the hospital.
My flat foot recovering in the hospital.

prescription on it, a prescription to turn the six struts multiple times over two weeks.  Rather than hand the prescription over to me, however, Dr. Workman had him read each strut turn aloud and she systematically turned each one in ordered increments, going around and around my ankle, until the entire two weeks of repositioning was completed in fifteen minutes.  I ate my pudding the whole time, thankful for my numb limb.  When she had finished, my foot was flat.  It was done.  All I had left to do was heal.

I spent two nights in the hospital instead of one because the nerve block that wears off in 8 to 24 hours just didn’t.  I never got all the feeling back, but I did start feeling pain again the morning after my surgery.  Thankfully this was simply the initial swelling and surgical pain that follows any procedure; by the next morning I was off of the iv medication and back to oral meds at reasonable doses.  I could wiggle one toe and had some feeling in the top of my foot, though the rest of my foot was numb.  Good enough.  They sent me home.

The only thing left to do now is heal.


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