Fusion in Fission: My Tumultuous Recovery from Major Surgery in 2020
Part One
The drive to the hospital that February morning was dark and quiet. My husband, Alec, and I left our apartment at 4:30, the only car on the road for miles. For a moment, the air almost held the electricity of leaving for a road trip as a kid, when your parents load you in the car before the sun rises, suitcases piled in the back seat and excitement building in your belly. But the moment was fleeting. I was going to have my ankle sliced open and fused together. Not quite the same amount of fun as an 18 hour drive to Florida.
I didn’t sleep at all the night before. I sucked down the last of the horrid pre-op protein shakes I had been given weeks prior, the chalky texture coating my tongue. I showered unencumbered, a luxury I didn’t know I had been taking for granted, and washed my leg with Hibiclens, a thick orange antibacterial soap, thoroughly, as I had been told to do. I had been warned at each pre-operative appointment about the danger of infection when bones were cut open. I was given pamphlets and flyers, stern lectures from nurses. As I dried my body, I longed for lotion, but that was another no-go. I felt as though I’d been preparing for a test, and tomorrow I’d be handed the Blue Book and a No. 2 pencil.
Early into my restless evening, my surgeon called to make sure I was ready. “I’m nervous, but doing okay,” I’d told him.
“Good, that’s good. I was going over your CT scan, and I think I’m going to use a rod in your fusion tomorrow. My fear is that your ankle is so thin, you’d be able to feel a plate and screws through your skin. It won’t really change anything about the operation, just make everything more stable.”
“Okay, that sounds good,” I replied. What the hell did I know?
I climbed into bed, my sheets freshly laundered, another pre-op instruction from the hospital. And then there was nothing left to do but wait for morning. Alec dozed lightly next to me, and I was glad he was able to get some sleep. I turned on The Office at a low volume, hoping to feel comforted instead of terrified and anxious. Five episodes later, I gently shook Alec awake, washed with another round of Hibiclens, and we were on the road.
As we turned out of our neighborhood, our visible breath finally dissipating as the car warmed, a sight in the middle of the road made both of us gasp. A mama possum, her babies clinging to her body, crossed right in front of us. I had seen plenty of possums in my life, usually of the roadkill variety, but I had never seen a mama and her babies outside of a nature documentary. As she disappeared into a yard on our right, I mused that such a sight was one benefit of being up and at ‘em at 4:30 in the morning. For a few minutes, Alec and I had something else to think and talk about other than our destination. I’ll always be a little grateful to Nature for such a welcome distraction.
“I know what you’re going to say,” Alec started, breaking the resumed silence on the highway. “But you can still decide not to do this. You have the power here. If you decide you don’t want to have this surgery, it isn’t too late.”
He wasn’t telling me not to go through with it. He was reminding me that ultimately, it was my choice. The door was still open.
“I know,” I said. Silence for a few more miles, and then, “That’s kind of the scariest part. It being my choice. When I had the foot surgery as a kid, I had to go along with it, because the doctors and my parents said I needed it, and when you’re a kid, you don’t have a choice. It was easier. And now I just have to decide if this is right for me. And I don’t know if it is, not one hundred percent, but it’s what I’ve chosen. Going into this as an adult is so much harder.”
My right foot had been turning inward since I was a young child, a symptom of the progressive neuromuscular disorder Charcot Marie Tooth (CMT). I walked uncomfortably on the side of my foot, where a massive callus formed. At eight years old, I’d had an operation to pull the tendons straight. For a while, my foot stayed flat on the ground, and I walked with the aide of leg braces. But like worn out rubber bands, my tendons couldn’t hold anymore, and my foot began turning inward again as I grew. As an adult, a fusion was the only option if I wanted my ankle to stop rolling. Even though my right quad muscle had deteriorated and I’d been unable to walk or stand for a few years, the twisting of my foot and ankle had become a big problem. My foot never laid flat on my wheelchair’s footplate, and the constant turning made my veins puffy and angry. I began waking up with ankle pain, and eventually it just stayed that way. My choice in getting an ankle fusion was to trade one pain for another, in the hope that it would eventually be worth it.
We arrived at the hospital at 5:30. After an anxiety-filled 90 minute stay in the waiting room, I was finally called back into pre-op. Alec helped me change from my leggings and sweater into a hospital gown and yellow socks with grippers on both sides. He snapped a photo of me on the hospital bed, the last one with my foot turning harshly inward.
My IV was inserted, my parents came back to see me. After a long, slow night and early morning, things were suddenly moving at warp speed.
“Alright, Miss Monica, are you ready?” a nurse asked as she pulled the room’s curtain back.
No.
“Yes.”
My mom kissed my head, my dad did the same. I had a hard time looking at Alec. I didn’t want to start bawling. “I love you,” I choked out in a whisper as I pulled his hand to my chest.
“I love you too. So Much.”
And then I was rolling away from them.
“Now, it’s going to be really cold back there, but they’ll put some heated blankets on you,” the nurse was saying as she rolled my bed down a series of hallways. Another nurse placed a surgical cap over my hair.
I nodded, my voice suddenly gone. I was pushed through the metal doors into the OR. The nurse had been correct. It was freezing. The white, sterile room was bustling, full of people in green scrubs readying tools and equipment. A group of them lifted the blankets underneath me and placed my body on the operating table. Everyone was talking to me at once, their faces obscured by masks.
“Can you put your arms out for me?” I did, and they strapped them down.
“Hi, Monica, I’m your anesthesiologist. I’m going to get you ready, okay?” I heard from behind me.
“I’m going to stick these on your chest to monitor your heart, okay?” A young doctor, probably an intern, lifted my gown to place an electrode and whipped his head away with cartoonish quickness, as if he was a vampire and my breast was a bulb of garlic. I made a mental note to tell everyone about that.
“We’ve got some warm blankets for you!” someone chirped, and I was soon blissfully covered in a heated cocoon.
The hospital staff continued to buzz around me as I stared at the ceiling, so far past the point of anxiety that I felt numb, as though none of this was actually happening. I actually had fallen asleep last night, and this was just a dream. The ceiling was soon replaced with the face of my surgeon, Dr. Szatkowski.
“Good morning! How are you feeling?” I could tell he was smiling at me behind his mask.
“Nervous. But okay.”
He patted my leg. “Hang in there.”
“Alright, Monica,” the anesthesiologist said from behind me. “Guess what, sweetie, I’m going to give you the good stuff now.”
I laughed and the OR was gone.
Fentanyl is a hell of a drug.
As my eyes creaked open slowly, I saw my leg in front of me, propped up on a pillow and wrapped in a massive cast. My toes are straight! I thought before my eyes closed again.
“Hey, you’re awake,” said a nurse seated next to my bed. Her name was Sparkle, and I immediately began heaping compliments on her. I loved her name, her eyebrows, her scrubs. Her. Sparkle laughed, and I remembered to ask if I could see my family.
My mom and Alec swam into vision, smiling at me.
“Hi!” I croaked.
“Dr. Szatkowski said it went really well,” one of them said. I don’t remember who.
“It only took two hours.”
“He said your bone blood flow was great. Better than he expected.”
“Oh, good!” I said, understanding nothing. “Look how straight my tots are! This is Sparkle. She’s great. She has the best eyebrows.”
“Are you in any pain?” my mom asked, smiling at me.
“Not at all! I feel good.”
“You look good.”
I held onto Alec’s hand, pulling it to my chest, and drifted to sleep again. They went back to the waiting room, and I slept.
At some point, when I was awake again, I tried to take note of my surroundings. The recovery ward was full of beds, lined up in rows and separated by curtains. Next to each bed was a computer where nurses were inputting notes. A doctor in a white lab coat walked past the foot of my bed and stopped at the patient to my right. Separated by only a curtain, I could clearly hear the conversation. Her surgeon had some bad news to deliver.
“We weren’t able to complete your surgery, I’m so sorry. When we opened you up, we found cancer in your abdomen and had to stop.”
“What?” came the devastated reply.
It felt like a conversation I wasn’t meant to hear, a conversation meant to take place behind a closed door instead of a flimsy curtain. He continued speaking softly to her while she wept. Still shaking off the anesthesia, she had to hear the same news a few times before she understood. Later, her children came back to the recovery ward, passing the foot of my bed one by one. I heard them clinging to her and crying, and my heart ached for them all. I thought of the possum I’d seen that morning, how I’d never know the fate of either mother, how nature ebbs and flows, carrying us along or demolishing us in its wake. I wept for the woman I didn’t know as I drifted away again. When I woke up, the curtain was open and the bed was empty.
I spent nine and a half hours in the recovery ward waiting for a room to be available. Sparkle insisted that I try to eat, and I managed a few bites of sherbet. She told me that she wished she had more patients like me. The admiration felt mutual. Maybe it wasn’t just the Fentanyl after all. My parents left after waiting nine hours in the waiting room. I couldn’t believe they’d stayed so long. Alec was now out there alone, and I was getting desperate to get into a room and be with him.
When I was awake, we texted. He told me about the waiting room culture.
Alec 6:17 pm : This guy in the waiting room just does what he wants man
Alec 6:18 pm: He’s got a YouTube video playing LOUD and it has put him right to sleep
Alec 6:19 pm: It’s like a how to guide on restoration of a certain type of GM vehicle with guitar music in the background
Alec 6:19 pm: Mouth open, head back, just snoozing
Alec 6:19 pm: And the video just keeps playing
I told him about the recovery ward culture.
Monica 8:04 pm: Ugh this lady is having a reaction to fentanyl and not breathing. It’s scary.
Monica 8:05 pm: I think they’ve got it under control.
My texts weren’t as fun.
Finally, at 9:30 pm, Sparkle rolled my bed into a room. Alec was waiting for me with a cheese danish from the downstairs café. I hugged him tightly from my hospital bed, his scratchy beard pressed into my neck, so grateful that we were together. Hospital staff brought in a cot for him, and after some conversation I had no hope of remembering, we both fell asleep.
I couldn’t pee. At some point in the night, I felt the urge to go, but when the bedpan was slipped underneath me, I couldn’t release. A side effect of the painkillers, I was told. An ultrasound machine was brought in to see just how full my bladder was. The answer? Really fucking full. I would have to be cathed. Two nurses raised my bed and asked me if I minded if one of the student nurses gave it a go. I didn’t care. Just get it out of me.
I should have cared.
With a bright white light shining down on me, I yelped as the student nurse fumbled her way through placing the catheter. Alec squeezed my hand hard. The nurse guided the student through it while I regretted letting her anywhere near my vagina. Forget peeing. I’d have let my bladder burst if it meant getting her to stop. Finally, she got it, and my bladder released. The relief of emptying my bladder was nothing compared to the relief of seeing that woman leave my room.
At 4:30 am, 24 hours after we had left for the hospital, I awoke to pain I didn’t even know was possible. Two years prior, I’d had a nerve conduction study done on my legs. My nerves weren’t responding, so they turned the voltage up high, shocking me repeatedly for 45 minutes. I thought that would be the worst pain I’d ever have in my life. On that early morning in the hospital, I was proven wrong. The pain was so immense, so all-consuming, my brain had trouble processing the information. I turned my head to see Alec asleep on his cot.
“Alec?” I croaked, as if we were at home in our own bed, and I needed him to hand me the Ibuprofen.
“Alec?” A little louder this time.
“Alec?” Really starting to panic.
With sudden clarity, I remembered where I was and pressed the button on my bed to call a nurse.
“Yes?” a voice crackled through the speaker.
“I-I need someone,” I began to cry. “I’m in so much pain.”
Alec was awake now. “What’s wrong?” he leaned over me, his face etched with concern.
“I don’t know,” I said, openly panicking now. “It hurts so bad!”
When the nurse entered the room, I was sobbing. My ankle felt so wrong. The pain was deep and shattering. I’d never felt anything like it. My nerve block had worn off, they told me. The cutting of skin, cartilage, and bone, the insertion of rods and screws. I felt it all now. While the nurses worked to figure out my pain dosage, my tears stopped, and I found myself in shock from the agony. I stared at the ceiling, unable to speak. I heard Alec somewhere above me, asking me if I was okay. I met his eyes, but I couldn’t respond. I was not okay. Finally, heavy painkillers were pushed into my IV, and the world began to swim away. For a couple of hours, I slept.
“I think you should stay here at least another night,” Dr. Szatkowski told me later that morning, standing at the end of my hospital bed. “What you’re experiencing is called rebound pain.” He went on to explain that when a nerve block wears off, your body can go into hyperdrive, feeling all the pain at once. The plan for the day was to up my dosage of painkillers and get it under control. “Hang in there,” he told me before leaving the room, a phrase I’d hear from him often over the next nine months.
The day passed by in a drug-induced blur. My mom drove an hour to see me after work, her cold winter hand on my warm cheek a comfort I’ll cherish forever. Alec gathered food from the cafeteria, and asked often about my pain. Again, I couldn’t pee. Again, an ultrasound machine determined that I really, really had to go. I had a male nurse that night who gently asked if I was comfortable with him doing the catheter. If not, he could get one of the female nurses. Images of the student nurse flooded my mind.
“No, no. You can do it!” I didn’t even feel it.
I watched the Democratic Presidential Debate, in and out of consciousness, which I discovered to be the best way to watch a Democratic Presidential Debate. I slept for a few hours between temperature checks and medication distribution. By morning I felt ready to go home. My IVs and drains were removed, my discharge paperwork prepared. There was only one thing standing in my way: I needed to be able to pee on my own.
Alec helped me out of the hospital gown and into my sweats, no small feat given the giant cast on my leg.
“Ready to go try?” he asked, bringing my wheelchair to the side of the bed.
“Yes,” I replied as I pushed the button on my bed to sit up. Alec lowered the railing and helped me gently swivel my legs over the side of the bed. Finally, I was sitting fully upright. I threw up immediately. Mercifully, there was a bucket nearby. After that false start, we tried again, and I safely transferred to my wheelchair, and then to the toilet.
My leg dangled from the raised seat, my ankle throbbing angrily as I tried to go. Alec turned on a stream of water in the sink and stepped out. I closed my eyes and concentrated as hard as I could. Just pee. Pee and you get to go home and see your dog and sleep in your own bed. Just! Pee! Finally, a trickle. And then I was going.
“It’s happening!” I yelled. I was the happiest toddler in the world.
While Alec went to pull our car around, a nurse handed me about a thousand prescriptions and instructions. Painkillers, antibiotics, calcium supplements, blood thinners, stool softeners, and more. I put them all in my bag to make sense of later. I was wheeled down and loaded into the back of the car, and after a brutal, cramped hour, I was home. My mom had snuck in and left balloons, flowers, and Hershey kisses on my coffee table. I smiled at a room that was absent of beeping machines and the smell of antiseptic. Alec helped me get situated on the couch before leaving to pick up my array of medications and our dog.
I was truly alone for the first time in days. The pain was intense, but bearable for the moment, and I figured I was through the worst of it. Alec would be home with me for the next week until he went back to work, and I had plans to be back at work in a month. I had no idea that in the next two weeks, my recovery would take a disastrous turn, or that a mysterious virus I’d read about in December would change everything. I closed my eyes and slept.
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