I always joke about how I can write a book about my knees. I joke about how I will have empathy coming out of my ears when I begin practicing as a physical therapist (PT). I joke that I will need a total knee replacement in 10 years, but, if you have ever had any type of surgery, you know that behind the scenes in those brutal hours of recovery, joking is the last thing you feel like doing.
Before I tell my story, I am always hesitant because I know good and well there are people out there struggling with amputations, cancer, paralysis, skin eating bacteria, chronic pain disorders, and worse. What I have gone through is but a fraction of what they have gone through, and seems pretty minuscule to their troubles. However, through some time working in clinics before graduate school and working as a student PT in school, sometimes, all you need to do is share a piece of your story. That piece may be the piece another healing individual needs to complete their rehabilitation puzzle. It may be a piece that they had been searching for. An “Ok, so it’s not just me,” moment. A reassuring “It’s ok that your extremity still feels numb there after the surgery” or an “It’s ok that you are angry at the universe or whoever you believe in for doing this.” It’s ok. Or more commonly realistic, it’s GOING to be ok.
Elisabeth Kubler-Ross created a model for the five stages of grief. She states that when something is lost to someone, they may go through some of these stages, or all of them, not necessarily in the exact order shown here. Denial, anger, bargaining, depression, and acceptance are the five stages those that have lost a loved one, had a traumatic experience occur, or a major personal change may go through. It’s interesting that at different injuries at different points in my life I have recreated stages of this model, some more emphasized than others, some I stayed stuck in way too long, and some I skipped altogether. I am no psychologist or psychiatrist, but through the work I have done one-on-one as a patient and as a therapist, I am beginning to learn the reasoning behind the psychology courses I was forced to take before and during graduate school. As with any moments of grief, we tend to need our own type of therapy. Some like to talk to someone, some like to surround themselves with friends, some read a good book, or write down their thoughts. Writing this injury bio has been therapeutic in many ways for me. I have smiled, cried, laughed, and fumed throughout my time typing this. In clinic, I can use my injuries as leverage to assist my patients in seeing any positivity they possibly can. And when there is nothing I can say, nothing they can relate to, I have simply sat and listened, sometimes grabbed a tissue for them, cried with them, or cried for them after my shift. With HIPAA in full force, I obviously cannot disclose some of their stories that have made my heart melt, beat, or break, but I can disclose mine.
Age 16: I had just learned to drive, received my first beat up ’89 Volvo, conquered a tonsillectomy, and was full force in the middle of my last high school soccer career in Anaheim. I was going through a toxic breakup and to be honest, I was completely checked out of high school. Passing my AP exams was overshadowed by going out after the basketball games, buying new cleats, and avoiding drama created by the girls in the class below me. Besides a stress fracture in my foot side-lining me earlier for a small portion of soccer season confining me to a boot, I was pretty solid in my stats and strength. I was recruited by a local junior college to play and had already begun the pre-registration process where I had decided to: skip Varsity softball in Spring, finish the season with my Gold level soccer club, play soccer for 2 years while receiving my AA, then transfer to a 4-year university and play some more (heck, play as long as I possibly could). Four-year universities also had offered me promising opportunities as a right wing on their soccer fields, but I decided playing under a previous trainer at a local junior college (JC) was the best decision financially and comfort-wise.
My mom always told me that growing up as an athlete, especially during soccer, I would fall so hard that every time I hit the ground they thought, No way is she getting up from that. I resembled a baby deer learning to walk or run for the first time. Body type: long, lean, lanky, unable to control my own limbs. As I grew and learned control-over the ball, my body, and my kinesthetics, I realized it wasn’t weakness, but it was drive and determination where victorious collisions or goals were born. I would run full force into my opponent, slide to make a cross at the flag, or get air during a header, just to pop up before the ball even hit the ground. I later was termed a “gazelle” on the pitch, likely due to my extensive ballet training growing up, and gracefully heightened strides. I remember so clearly bounding away on my long legs with strides that were usually always slower than my opponent, but usually always longer. That is the stuff my day dreams were made of, along with actual dreams I repetitively have at night, to this day. At this time in my life I was living the dreams daily. Now, when I wake, it takes me near a half of a day to get it off my mind, at least. I remember a former teammate coming up to me when she joined my club, only to explain “I know you, you gave me a concussion, my dad has it on tape.” Oops. Of course I felt bad, but I prided myself on my aggressive nature and scrappiness along the right sideline. Although I lettered in cross-country and softball along with soccer my entire high school career, soccer was my one true love. I had played since age 7, club since age 12, I had worshiped members of the Women’s Soccer Team that won the Cup in 1996, and I had Mia Hamm, Brandy Chastain, and Tiffeny Milbrett plastered all over my walls. 5 am wake up calls on Saturday mornings, 4-5 game tournaments, and traveling non-stop in club was my life. Soccer was my everything. It was my release. It was my first love, a love so strong I had never even imagined life without it. It was a way of relieving debilitating migraines as a teen, it was my way of getting out aggression when I had a terrible day, it came easy to me, and I put my all into each practice and game I played. I had worked my way to a starting position from a newcomer on the bench in both clubs I had joined, and had learned the meaning of hard work, perseverance, teamwork, and grit. My hard work had paid off, and a promising soccer career including a reserved position at the local JC and at least 6 more years of playing was on the horizon.
I had a stint in physical therapy around age 12 for bursitis and tendinitis of my knee due to a fall I had in soccer, where I saw a PT in action for the first time. It was then I realized that could possibly be the career for me. My PT shared a tiny clinic with a respiratory therapist, and although I was sometimes the only patient she had at a time, I felt a sense of closeness and connection with her that I thought would make for a rewarding future career. Little did I know this minor injury was the beginning of a life-long passion and the seed that was planted in my psyche as my calling and my sense of purpose in life.
Halfway through my high school season, in between Winter and Spring of 2007, my life was changed. We were playing at Western High school, a game that should have been easily won. Since I deemed myself invincible, had never been majorly hurt, and being young and stupid, I decided to go head-to-head with a keeper who was at least twice my size. I knew in my head I wasn’t going to be able to kick the ball out of her grasp, but I thought I could at least shake her up by throwing my body into her, a tactic that usually worked and intimidated my opponents. I stand at 5’7″, but my height was no competition for her brute muscle mass and force. My parents and spectators claim it sounded like metal on metal. I was convinced I had broken my shin. Everyone waited. The whole field got so silent that I swear I could hear the whistles from inside the basketball court 200 yards away. Then the pain came. Then the thoughts came. Ok, so my leg is broken, if I get it casted now I will be good to go for my freshman college season. I screamed and cried and writhed on the ground until the athletic trainer and coach came, took off my shin guard and sock and helped carry me off the field. There was minor swelling, no cuts, no bruises, just pain. No diagnosis. I was sent home with orders to ice and to be honest I don’t really remember if I did. We made a doctor’s appointment with an orthopedic physician with Kerlan and Job. This is an ortho group my mother had basically closed her eyes and pointed to in the phone book, covered under our insurance, which turned out to be the physicians for major sports teams in Los Angeles (LA) and Orange County (OC). Looking back, this was one of the first events where I realize God was looking out for us big-time. I was randomly put under the care of the best of the best in my region. A week later I cancelled the appointment. I wasn’t walking the right way, definitely wasn’t running correctly, but I was limping and acting like everything was fine. I was already embarassed enough that I had actually shed tears on the field, an incident very uncommon for the type of player I was. I was in a great amount of pain, but slapped on an old flimsy knee brace, limped around until I got some speed back, and committed to playing in a game a week later against our rival school, Magnolia High. I wasn’t cut open, I wasn’t bleeding, I had no bones popping out, so I figured I was alright, but my stubbornness and naive nature is what cost me my soccer career. I look back now and wonder where I would have been if I had kept that doctor’s appointment, gotten the first injury taken care of, rehabbed and gone on to play. But that is in the past and there are times like these where I have to move on from it even though it mentally pains me to this day, 10 years later. That next game I went in conscious of my injury, but determined to not allow it affect my game. Almost halfway through the first half, I remember being in between two opponents. As the three of us fought for the ball, I heard an audible “pop” in my left knee. Wearing the knee brace on my previously injured right knee, I lied on the ground half-laughing half-panicking thinking, There is no way I have injured my other knee too, no way. Thus began my first and longest stage of grief: denial. The athletic director came to drive me off the field in a golf cart and our athletic trainer performed the anterior drawer test for an anterior cruciate ligament (ACL) tear. It was positive. “I think you tore your ACL,” he explained. I really don’t know what I was thinking, but once again, my immaturity, my drive, my love, my passion, my stubbornness and my denial kicked in, and I told my coach I wanted to go back in to play. I had no clue what an ACL injury entailed, had no idea what that ligament even did, and even after having teammates go through the same injury, I saw nothing but the field and the net behind the goal . Soccer was my true love, and love makes you do very crazy, insanely stupid things. I didn’t even feel great pain in that left knee, whether it was adrenaline or my high pain tolerance, I will never know. I did some slow jogging down the sideline to warm myself up to get subbed back in, and back in I went. For about 10 minutes. I went to try to cut left and change directions right and my whole body went left. There was not a whole lot holding my knee in place. Something was wrong. I subbed out. I left the game disheartened and frustrated, we made another appointment at Kerlan and Job with the same doctor and I grudgingly agreed to an MRI on both knees. I don’t really remember being on crutches more than a day after these injuries, I remember more pain in the right knee, I don’t even remember worrying about my soccer career being ended or even put on hold. But I do remember the day of my MRI reading.
My dad had come straight from work to the office and my mom was with me too. We sat in the physician’s office as he placed the MRI scans on the illuminated screen. “Well, I wish you would have come in after your first injury,” he stated sadly. My stomach dropped. My heart began beating furiously. “You have a partially torn PCL (posterior cruciate ligament) in your right knee, with a very large bone bruise. Your left knee has a complete rupture of the ACL and a medial meniscus tear.” Now looking back with my current knowledge it all makes sense. PCL tears don’t always swell. A partial ligament tear is more painful than a complete. ACL ruptures can occur from weakness, poor body mechanics, overcompensation, and can be contact or non-contact. I guess I will never know if, had I not ran onto that keeper the week before, would my ACL have torn due to compensation, or did I have the poor body mechanics and weakness in my hips then, which I now suffer from today? Regardless of the chicken or the egg concept, the anger stage started to creep in. What came next I don’t remember perfectly. I do however remember my doctor telling me the brace team would be coming to my home to fit both of my legs for braces immediately, and that I needed a surgery soon on the left knee’s ACL and meniscus. Then I was crying, then my mom’s eyes were misting over as well due to my visibly distraught state. She stated, “You don’t have to wear them both at the same time Wooskie, we will figure it out.” My father sat in his chair with a sullen What do I do? expression. My physician explained to me that he wanted me in 2 months of physical therapy to strengthen the right knee with the Grade II PCL tear, in order to allow me to put weight on it after my ACL reconstruction. “Why can’t I just have both surgeries at the same time?!” I cried to him. “Do you want to be in a wheelchair? No, you must have a good leg to put your weight on,” he retorted. Contrary to this answer I despised, his patience throughout this visit and every subsequent visit after that is something I am thankful for still to this day. A surgery date was chosen, physical therapy prescriptions were given, and still, in my head, this was not happening. I was not going to go to physical therapy. I was not going to have a surgery. I was going to play soccer forever and there was no way anyone would take that away from me. I was angry at everyone and everything around me for this injury. I felt like a child holding onto my favorite teddy bear refusing to let go. I didn’t want to wear braces to school. After some debate, I decided I would miss my Sadie Hawkins dance senior year versus Prom. I do remember that was one of my very first sacrifices and it really stuck with me, not in a bad way. I cried the whole way to the PT clinic, where my mom was to make my first appointment. I refused to even get out of the car. I was NOT going to physical therapy. But then, I did.
I couldn’t even tell you when and where some motivation came from, but my mom always tells me that somewhere in this process after finding out about the severity of my injuries I came home and sat myself down on the computer researching alternate schools to go to instead of a junior college. If I wasn’t going to play soccer year 1 or 2, then I could start off at a Cal-State, rehab through year 1, and walk on as an athlete in year 2. I researched Kinesiology programs in the area and decided to apply to California State University of Fullerton, Chapman University, and California State Polytechnic University, Pomona. I applied to all schools while rehabilitating that right knee. I met my therapist who I was a complete brat to my first couple months. I did not want to be in PT, I didn’t think I needed it. I HATED being looked at as an injured being, my self-esteem and pride diminished, my sense of purpose and identity was completely lost. I was no longer “Marie the soccer player,” I was “Marie the injured soccer player.” Still unmotivated and in denial, I did my best to strengthen what I could in that pre-op timeframe. ACL reconstruction came and went, and I found myself home from school for 2 weeks, laid up in bed, with my exercises to do, my continuous passive motion (CPM) machine, and movies to keep me company. Some of my friends stopped by the night before the Sadie Hawkins dance; they came with hugs and laughter while dressed in their best matching attire. I love them all for that and for the light that they brought to me. Before I knew it I was up on two feet again and back in PT. Getting my left quadriceps muscle to work again was our first task. Since I had been given a femoral nerve block (a motor and sensory block) and used my patellar tendon as a graft, the muscles from my hip to my ankle were completely atrophied and immobile. I could not even lift my leg from a seated position. My mom had to hold my leg up for me to use the restroom because any bend would have me shrieking in pain. One day I remember looking down at my Frankenstein-esque leg, covered in bruising , edema, and bloody steri strips, willing the quads to contract with my eyes, but nothing happening. I was on the verge of tears when my PT attached an electrical stimulation machine with the NMES contract-relax setting on my quad muscles. “Tighten your quad when you feel the machine on your leg, and relax it when it stops,” he said. Nothing. I tried about 10 times, still nothing. I left about 2-3 therapy sessions like this in complete depression and frustration. If I couldn’t even get these muscles to move, how was I going to walk again? Run again? Make it to Prom in 2 months, wear heels? Dance? I wore metal and plastic braces with velcro straps on both legs some days to school over my skinny jeans, some days on the leg that hurt worse so they wouldn’t clank into each other. I don’t remember ever being too self conscious about them, at least not as bad as I thought I would be when I was first informed they would be an accessory of mine for a long, long time. Luckily, I was an athlete, in student leadership, a member of the National Honor Society, worked with special needs students, and most of all, I had amazing friends. I think in high school your self-esteem sometimes takes a hit with or without two large knee braces on, but it was there that I found some strength. It was also there that I realized I had met people who I wanted to be around for a very long time.
At around week 3, I got a voluntary quad contraction, meaning I did it myself!! I was ecstatic. Something in me changed that day, I was no longer so cold, so angry, so depressed, but that little contraction sparked a fire in me that I think carried me through the better part of my life. I rehabbed as hard as I could, determined to get back out on the soccer field, back to my one true love. Love makes us do crazy things, but it also motivates us and picks us up when we have hit our lowest points. I started running a full month earlier than expected, and I was doing agility drills and soccer drills with an aide who happened to be a soccer keeper at a university in LA. I rehabbed for 9 months with my PT, and he showed me a tough love I can’t even describe. He had also had a previous ACL reconstruction due to a sports injury, so he could relate to my fears, triumphs, and struggles. He was my sports psychologist, my personal trainer, my motivator, my coach, and most importantly my friend. He would yell at me from across the clinic, “Get to it Marie, I am not doing soft tissue massage on you until you rub those knots out with the foam roll for 5 minutes!” Or, “Stop cheating, if your knee never gets straight then your walking pattern will be off and you will have problems later in life! Increase the ankle weight (eye roll, but ok)!” My rehab consisted of many differences compared to the usual ACL rehab. For one thing, I had two injured knees. They thought I had either jumped off of a roof or gotten in a terrible car accident before I came in to give my subjective history at my evaluation. With patellar tendon ACL reconstruction, you aren’t allowed to do resisted extension (straightening), and with a PCL injury, you should avoid resisted knee flexion (bending). This served for an interesting rehab as I was allowed to do resisted leg curls with one leg and not the other, leg extensions with one leg and not the other, and was constantly switching the weight resistance from knee to knee. Two months out of rehab I remember asking my doctor questions like “Will I have to wear my brace to Prom? Can I wear heels? My friends are going bowling on Friday night, can I do that?” Some answers I liked, some I didn’t. But I had crawled out of the “woe is me” phase of grief, gotten past the 2 months of denial, and my anger and depression had subsided. I had reached acceptance. Nine months of therapy post-op, and two months of therapy pre-op, I was released to go back to sports. My new ACL was considered my “good knee” and my PCL deficient right side was considered my “bad knee.” The physician determined no surgery would be needed on the right knee at my last appointment, stated that my gait pattern looked as though I was finally walking the right way, and I jumped for joy (literally, which made it even better).
However, my mind-set had changed slightly. I was now almost halfway into my first year of college, I had gotten a new job at a restaurant, and was enjoying life after high school. I had immersed myself into my studies, my friends, social events, a new relationship, and getting stronger and stronger. I was ready to go back to soccer, but not sure if I was ready to go back at a Division 1 school as a walk-on. So I joined a women’s league that played weekends, mostly Sundays. I accepted the fact that my soccer days with women my age and at my skill level was likely over. I braced up my right knee, which was now my “bad knee” according to my physician, and got back on the field. I don’t remember ever being super afraid to play. I played for almost 3 years in weekend tournaments, Sunday games, and pick-up softball games during the week if a team needed a fill in. I was always sore, always limping at work or school for days after since there was no practices, but I tried my best to keep up with my rehabilitation between seasons.
Three years later: I had gone through a long relationship that had finally ended. I was emotionally spent, and stepped back to realize how unhealthy my lifestyle had become. I felt stuck, I felt sluggish, and I felt weak. I would attempt a workout, only to realize I had completely cancelled it out with the junk I was putting into my body. I didn’t feel myself. I didn’t remember how to be alone. I would sometimes walk by the soccer fields at CSUF and my eyes would blur from tears welling up wishing I had gone that route with life. I guess my big question was just WHY. WHY had this happened to me? WHY did God take away my one true love, soccer? WHY had he allowed me to experience so much physical pain at such a young age? WHY had he pulled me away from my relationship with someone willing to drop everything and marry me? I had lost an individual I loved and started re-reflecting on the sport I had loved and lost as well. I felt incomplete. I felt inadequate. I was in a transition from undergraduate to graduate school and I felt absolutely stuck. My life was always on a fastrak, and here I was WAITING for something to happen. My schooling to be complete, my knee to feel better between workouts, my partying ways to get old and boring. It caused me anxiety, worry, and fear. I didn’t like the person I had become; I was hurting, and I wanted soccer to come to my rescue as it always did. I tried to distract myself, but no person, place, or material thing was satisfying the needs I had. I finished my undergrad coursework in 2011, walked for graduation in 2012, still in the middle of taking prerequisites for grad school, still going out at least 3 times a week, and working 5-6 shifts at the restaurant. Later that year I attempted to retry the old relationship that had ended, only to have it end again almost a year later. I felt like I was walking the wrong way in life, almost aimlessly, unhappy with the road I was on. So I decided to make a change. I could feel a different life calling me and I was not about to let it go to voice mail.
Fall 2013: I began running longer and longer distances. I was integrating strength training into my cardio work outs. I was running 2 miles at a time, then 3, 4, 5, then 6. My knees would tap out around that 6-mile mark so I made sure to stretch or ice or foam roll after. I lifted heavier and heavier. I was squatting near my body weight, while losing fat, then gaining muscle. I was at the gym almost every day. I adapted what I like to call my version of a “modified paleo diet,” complete with cheat days and cheat nights. But it was working. If I wasn’t at the gym, I was running around Anaheim at 9:45 pm at night. I contacted an old teammate to play on a new women’s league team in the OC. There was an A, B, and C division, grouped by skill level. When I had played my prior 3 seasons, I was in the C division. I had decided to start slow with a lower division to get my momentum back. Although I had recruited and played with members from my old club for that prior team in the seasons past, I jumped at the opportunity to play with a higher division and girls fresh out of club or college. I remember feeling so ready and so excited to show off my skills! I ended up playing almost all of the game but I remember it was one of the most exhausting games I have ever participated in. Everything hurt after. My left knee was killing me. I couldn’t even squat below 90 degrees and it swelled up the size of a softball. I iced and rested, iced an rested. I walked with a limp for a good 2 weeks. Then I made a doctor’s appointment, with a new physician since sadly, my dad’s new insurance didn’t cover the old physician group. Once again I got an MRI request, then was informed that I had a grade II (partial) tear of my lateral collateral ligament (LCL) and my medial meniscus was torn again in the left knee. “It’s also possible you have a partial ACL tear in your knee you were operated on, which is not super apparent in your MRI, but more so with your physical examination,” the new physician informed me. But I had rehabbed! I thought. I went through some anger and frustration, but deep down I knew that more than linear training was needed to get back to soccer. I could run 4 miles in a straight line but I hadn’t done any agility or proprioceptive training. I previously had a stint back in therapy for some pains during my old seasons and I did not want to go back to therapy or under the knife. But I did. I scheduled a menisectomy for my left knee and rehabbed some more in a new PT clinic. My latest MRI revealed degeneration to the left knee joint, so I was well aware that osteoarthritis was already forming in my 24-year-old knee. I took 2 weeks off work but came back stronger than ever. I told myself soccer was off the table. I hung up my cleats, I cried some more, but I knew I was only hurting myself. I remembered my first physician warning me that if I wanted to keep playing, I ran the risk of arthritis, more injuries, the inability of playing with my future children, and pain for years to come. My left knee was “looser” according to my new physician, so he used some thermal shrinkage to tighten it (not under my consent, I was not thrilled about that). I focused more on my rehab, strengthening my weak hips and weak core and I ran and ran and ran. I ran through tears of sadness or frustration, in the rain, uphill, downhill, at the beach, down the street. Low back pain was something that had more recently been a factor in my athletic performance, but as I got stronger, the pain diminished there as well. My passion for rehabilitation was increased. The fire was burning stronger than every before. I integrated interval training with sprints into my training. I continued to lift weights, continued to move on from my past relationship, and looked towards graduate school.
I had applied to a slew of schools the year prior to surgery #2 and was rejected. I cried some more and felt inadequate again and almost gave up my career as a physical therapist. I picked myself up again and kept up with the healthy eating, more nights in, solo outings in order to get comfortable being alone, and surrounded myself with dear friends, while changing my habits. I got a new job as a PT aide to strengthen my resume and gain experience, retook the Graduate Record Examinations, and retook 6 prerequisites that I had passed but wanted all solid “A’s” for a GPA booster. I doubted myself every day. But the fire never went out completely. The motivation and passion I had to help people in a way that my prior therapists helped me never left my mind. It was always there, just as the scars were on my knee, as a reminder that this is what I was meant to do. I researched schools, I visited schools, and a year later I reapplied. I was interviewed and accepted into Loma Linda University. I still ran, I still worked out, but no more soccer. I was asked to play, and it killed me to say no, but I had taken up softball as my backup sport and played every Tuesday night in a league in Anaheim. I stepped back and realized I had found new releases. New outlets. I stepped back and realized that God’s plan with all these injuries fired me up so much that I almost went crazy achieving a life-long goal of getting into a doctorate program. I realized that if it weren’t for my breakup, for my injuries, for my passion for soccer, for rehab and for wellness and clawing my own way out of darkness and sadness and if it weren’t for the amazing people in my life, I wouldn’t have gotten into the program at the school of my choice. When I think about the support system I have, I reflect most importantly on my parents and brother who told me “I believe in you,” when I was actually researching alternate careers and Master’s programs behind their backs, while not completely believing in myself. I realized my anxiety stemmed from the things I had settled in previously. So I promised myself I would never settle. I have always set a goal and achieved it, so why should anything from now on be any different?
When I was accepted into graduate school, a physical therapist that I worked under said “School is going to be the most terrifying, exciting, scary, fun, rewarding experience you will ever have.” She was absolutely correct. Moving and living in Loma Linda, immersing myself into a strong faith-based yet slightly different religious culture from my own, and meeting individuals that I admire for their beautiful souls, has changed me for the better. I have to say that the year 2015 was my best year of life thus far. I learned, I grew, I “changed” as some would say, I deepened my faith, and I made irreplaceable friends. This was all part of the plan, I realized. The pain and trials and heartbreak brought me here, to fulfill my role as a therapist, and it was an absolute dream come true. I could now give back what I so desperately wanted to give future patients what my own therapists had given to me. Every time a classmate would ask me if I wanted to play a game of intramural football or soccer, I would decline, stating I didn’t want anymore surgeries during grad school. I stuck with softball, it was safe. I still got that sinking feeling when we walked onto the softball field to play and I could see the soccer players running back and forth and bumping into each other on the next field over. My legs twitch every time I see a pitch and every time I watch a game and every time a ball rolls towards me on the ground that I kick back. My heart breaks a little to not be able to play a contact sport or move the way I used to, but softball was great.
I had some goals in graduate school that I wanted to achieve, they were as follows:
1. Become a class officer
2. Go on a mission trip
3. Join an intramural sports team
4. Make Dean’s List at least 1 quarter
5. Become a Gross Anatomy Teacher’s Assistant
6. Be a participant in a research study
7. Go to more than 1 school event
8. Participate in service for the community
I was so uninvolved in undergrad, being busy with relationships, 2 jobs, supporting myself (almost completely), and being social on top of school, I missed out on so many opportunities. I was determined to not let that happen again. I achieved almost all of these goals by year 1, minus the mission trip, but year 2 I started to sink into an unhealthy lifestyle once again. My workouts completely fell off. I stopped my rehab exercises, I always chose a nap over a workout, and I worked a little too hard to make Dean’s List almost every quarter. I wasn’t sleeping enough when I could, and I overbooked my schedule to the brim. I got very sick and was hospitalized in Winter 2016 due to a brutal viral illness that they think may have been exacerbated by my genetic predisposition to autoimmune disorders. My perfect schedule was derailed. I missed 2 and a half weeks of the end of the quarter, including finals. I was the most fatigued and sickly I had ever been in my life. When I was admitted for my 4-day stint in the hospital, they initially thought it was lupus or even possibly lymphoma. I lost 10 pounds in 1 week and did not completely regain my usual energy levels back until March 2017. That thing knocked me on my butt big time. I was allowed to stay with my class, but I had to take 9 finals when I came back from Winter break and begin the new quarter at the same time. I thought that experience in itself was rougher than any knee surgery or injury I’d ever had. But I made it through with the help and prayers from friends and family here in OC and especially my classmates in LL. I was back on track! I applied for a spot on a Haiti mission trip specifically for our PT class of ’18, and got chosen! Things were looking up and I was more than halfway through year 2. After losing energy for almost 4 months due to my illness, I was finally feeling myself again.
Fast forward to Spring quarter 2017. We were at the tail end of our studies which run year 1-2, and almost ready to spread our wings and be released into the wonderful world of clinicals that spanned year 3. I was fundraising for my Haiti trip, and had almost met my goal with donations and fundraising to have my trip completely paid for. I was DYING to get out of Southern California. I felt like I was jumping out of my skin at Loma Linda. I was ready to be free of the stressful exams and quizzes and use what I had learned in the clinical setting. Not to say my courses weren’t intriguing, I especially loved all of the movement in labs and anything orthopedic. Funny I had my gait analyzed by a professor who specialized in movement. My walking pattern was torn apart. I wasn’t walking the right way. I was compensating big-time due to my prior injuries and acquired weakness the past couple years. I shrugged it off, and continued to plan to fix it and work out more once classes were complete in June. Year 3 was coming together quite nicely too. I had been approved for my first clinical rotation 4 weeks after our 10-day break in June in Anaheim, 10 minutes away from my parent’s home. I was going to move out of Loma Linda, back to the OC, live rent free, be a student clinician by day, and hop the fence (that’s how close it was) to Angel stadium at night. After this rotation I would head to Haiti for 10 days, where I would help at orphanages, rehab clinics and hospitals while spreading the word of God and tending to the physical needs of less fortunate. I could start working out again, have time to sleep enough and eat healthy, meal prep, lose weight, and strengthen my lower extremities. Not to mention my social life would flourish once more and I could head to the beach or dinner or a ball game whenever I pleased. I just had to get through my Ortho Comp exam in May, a practical exam running around an hour to an hour and a half, putting us in a real-life patient scenario in the Orthopedic setting. Then I would be home free. I wasn’t even worried about passing my written or practical finals that ensued after that comp exam, I was confident in my test taking and skill level and was almost completely checked out. My second clinical was approved at LLUMC, right next to school, so I decided I would live in Corona with family through my long rotation there, and through my 8 weeks back at school October through December. Then, hopefully back to the OC for my 2 orthopedic clinicals from January till June, then graduation, a cruise vacation out of the country my parents promised as a graduation present, boards in October, then work my dream job as an Ortho PT. I strategically had planned year 3 out as to set myself up for a job, to save money, and future successes. I had shifted my mindset from “My boyfriend is school” to an interest in dating seriously again. Years later, I began to form new goals, goals to settle down and goals beyond the walls of the classrooms I had been in for 22 years. Everything was set. I practiced for weeks for my Ortho Comp Exam, and the night before slept around 3-4 hours due to nerves and excitement. I felt like a kid that was going to Disneyland the next day, I felt like I could smell freedom, I knew that a huge weight of stress would be lifted once the exam was done, and I COULD NOT WAIT.
The exam came and went and it went so well. My confidence was at an all time high and instead of nap, I went out to celebrate at In N’ Out with some of my classmates. That evening I had a softball game and then we were going to eat and celebrate being done immediately after. I was exhausted, but I dragged myself to the game, eager for it to finish. I had a good 6 fans or so that night, much more than usual, but they were my “die hards” out there who wanted to come support and celebrate that night. We were short a girl that evening meaning 3 girls only. Meaning once we batted, we were almost up to bat again because it alternated boy/girl/boy. In inning 3 or so, I hit what I thought could possibly be a double or a triple. Rounding first, approaching second, I felt a crack/pop in my left knee. I wasn’t super concerned at first because my knees both pop and crack all of the time. But as I stood up tall after touching the bag at second, my leg shifted and gave out from under me. I felt immediate swelling. I called for a pinch runner and limped off the field. I left the dugout as soon as I entered it, limping down the 3rd base foul line with tears filling my eyes. The approaching clinicals, my Haiti trip, my finals, all of my plans flashed before me. I was in full on panic mode and all of my friends immediately rushed over to assist me. Depression and anger had already set in, no denial. One friend did the anterior drawer test to check for ACL laxity. It seemed positive to her. Another flagged down a field rep to get me ice. Others sat with me and rubbed my back as I bawled. The field rep tried to console me and I remember being so annoyed with him. He had no idea what I had been through, I just kept crying and repeating, “I cannot go through another ACL surgery. Meniscus maybe, not ACL, please not ACL.” I knew something was wrong. Every game, my mom would text me “PLEASE text me when your game is over. I wish you would wear your braces. Be careful, you need to be good for Haiti, etc.” This call is going to devastate her as much as it will me, I thought. Two of my girlfriends out there drove me to our labs where a teacher happened to be finishing a night of teaching international students. He did the ACL test and thought it was negative. “Meniscus if ANYTHING. Look at you walking around on it! Walking up and down stairs!! You are so tough, everything will be alright.” More crying. I remember stopping at Rite Aid with a good friend out there and she went in to get me Advil and a brace while I made the call back home that I had messed up my knee running the bases. I then started to bargain with God. “God, if it’s just a menisectomy I will be forever grateful. I’ll work out again so that I don’t put my loved ones through another surgery with me. I’ll be healthier I promise.” I was BEGGING Him for that. As the week went on, I ditched crutches but still couldn’t straighten my knee all the way. With meniscus tears that is sometimes the case, but I remembered learning of one tear, that is rare, but possible. It is called a “bucket-handle” tear, and is the most severe type, where the meniscus tears, and actually flips up into the joint space like a bucket handle between the tibia and femur to prevent the knee from extending, thus, locking the knee. I would get catching and sharp pains in that knee when I would walk and of course thought worst case scenario. I was definitely not walking the right way. All of my quad muscles had atrophied causing me to use my already weak hips and hamstrings. If this tear was in a red-white, or a white-white inner vascular zone of the knee, there was a lower chance of healing, even with a repair. A professor even allowed a 3rd year student to do a free evaluation for me, to check it out. She for sure thought it was a meniscus tear, not a bucket-handle, and the ACL seemed intact. Good news! I was starting to feel a little bit better.
Two weeks after the injury, I saw an Orthopedic MD covered under school insurance. My MRI stated “ACL intact,” but “bucket-handle tear of medial meniscus.” My nightmare confirmed. I cried some more in the physician’s office, and even more after she said, “Had I not seen your MRI, I would have said you have an ACL tear, there is no end feel at all in that knee (meaning no stopping point when she did the physical ACL test).” She asked if I was a runner, I said yes, although I hadn’t run distances in a while, and her response was, “I don’t think you should be running anymore, your joints should be like a smooth marble floor, and yours are like a gravel road.” I honestly wanted to punch her in the mouth. Are you kidding me?! I was told I had pre-arthritis at age 24, but no one had ever said I couldn’t run!! How the heck else was I supposed to relieve stress?! I was at a loss for words, she scheduled me an appointment a full week later with an ortho surgeon, and sent me on my way. I screamed and cried the whole way home to OC. I was physically in a ton of pain, and mentally a walking disaster. I knew at that moment I had to start coming to terms with the fact that Haiti probably wouldn’t happen. Why after why started to begin again in my head. Seriously God, I am trying to go on a trip to help people here, and you are going to take it away?! and, You know I need my legs for my profession, why would you allow ANOTHER injury?! were common arguments I had with God. Some days after I couldn’t even bring myself to pray. The weeks that followed my injury, I would go back to my studio with the intention of studying, and just knock out asleep. I am not sure if it was the depression I sank into or my body healing itself or both but I fell into a dark hole while still planning for the mission trip, and still attending school.
I went to see my new physician the next week and he stated “I’m an aggressive surgeon and would not do surgery on any meniscus tear except bucket-handle. We can also do an in-office scope to determine possible healing time and check out how severe the tear is.” This would also confirm that he needed to do a meniscal repair versus a menisectomy. The repair involves suturing the flipped up meniscus back to the joint, and no weight bearing allowed on that leg for 4-6 weeks after surgery. A menisectomy (which I had in 2014, was a simple “clean up” I liked to call it) of the torn edges of the meniscus meant the tear was clipped off or smoothed over, and you were walking in a couple days post-op. Bucket-handle tears are considered semi-urgent injuries, and usually need to be fixed quickly in order to prevent further degeneration and locking of the joint. I think the fact that I was so emotionally jaded from the whole thing is what assisted me in agreeing to have my knee anesthetized, then a probe shoved into my joint with a camera, all while being wide awake and watching it all go on. He went in, saw the meniscus tear, then turned a corner in the knee stating, “You’re not gonna like this but your ACL looks pretty loose, actually it looks partially torn, actually it’s barely hanging on by a few fibers.” I wasn’t super shocked because I had heard previously that my knees are super loose, and I possibly could have partially re-torn my ACL. Still, it definitely wasn’t music to my ears. He advised to have the meniscus surgery ASAP, then wait to do the ACL after school ended the next year. He thought I could be “functional” with a torn ACL, as I had been for years in the opposite knee with the PCL, since it felt physically stable when he tested it. It was then that I knew my year 2 and 3 was probably going to be rearranged indefinitely. I cried to him and my mom as I told the physician my situation. The next week started the 2-week run of finals, then I had 10 days off, then a 4 -week clinical in Anaheim, a 10-day mission trip in Haiti on a 3-week break, then straight back to the clinic in Loma Linda for my first long 10-week rotation. The longest break I had between then and June ’18 was 2 weeks for Winter break, and even then, ACL recouperation is a lot longer than 2 weeks. “I don’t have any breaks!” I told him, feeling defeated, once again. This was a Friday, and he offered to come in Monday, Memorial Day, just to do the surgery. While I was very thankful for his urgency, I informed him, “I have a final that next day, that won’t work.” I mulled over the idea in my head as many times as an office visit would allow. I remember my mom looking at me and saying, “Marie, if there is anyone who can do this, it’s you.” I thought she was nuts at first. Then I busted out the trusty old planner and decided very reluctantly to have the surgery done Wednesday. He only had afternoon available so I took what I could. “Ok, this is happening, ” I kept repeating over and over and over again to myself, as if to convince myself the knee was going under the knife a third time. Back home, my 25-year-old brother sat and cried with me saying “It’s just not fair this is happening to you Marie, it’s not.” But on the bright side he had a great point, “I know you are upset about missing Haiti, but you chose a career with a LIFETIME of helping others, and other opportunities will for sure come up.” I tried comforting him and just felt pretty rotten all around because I couldn’t even convince myself it was going to turn out alright. How was I going to pull off a surgery in the middle of finals week? How was I going to rearrange my clinicals? How was I emotionally going to deal with missing a mission trip I had been hand-selected to go on, and be ok with it? My stubbornness, drive, and passion for what I was doing is what got me to do it. My love was now school, my degree, and most importantly my future career helping others. And love makes you do crazy things.
I studied all weekend and tried to keep life as normal as possible. I studied through the Monday holiday, which was never fun, but I was used to sacrificing fun for school. Tuesday I took an exam, and got the okay to move my Wednesday exam from the afternoon to the morning, in order to have my surgery that afternoon. I went into surgery, came out, and the physician said he was able to repair it, although there was only a 50% chance of it healing due to the vascular zone (white-white zone, virtually avascular, none/little blood flow) it was located in. He initially wanted me non weight-bearing for 6 weeks, and I argued it down to 5 weeks, with week 6 weight-bearing with the brace locked in extension, in order to begin my clinical and stay on track with my class. He agreed to this, and although Haiti would have to be missed, at least I was on track to graduate. I would take my 3-week break early, then be in a 4-week clinical while the rest of the class took their break. The day after surgery, I was at school at 8 am for 2 quizzes. The nerve block had not worn off yet, and I wasn’t feeling terrible. Thursday night, the pain set in. I had stopped my Vicodin in order to be able to study for a Friday final. I tried to go to school and study with a friend but was in excruciating pain so she had to take me home. The next morning I called the post-op nurse and asked if it was normal to be in this much pain. I told her it felt like I had been hit over the knee with a baseball bat (I’m not that dramatic, if you can’t tell by now). They were shocked to know I had stopped the Vicodin after less than 24 hours. Apparently I should have been overlapping that and Advil. So, I got back on the narcs, took Friday off, and went back to the OC to prep for 5 finals the following week.
That Saturday back home I had a breakdown. I could not sit anywhere comfortably, the pain was ridiculous, I wanted to be in my comfort zone in Loma Linda studying next to classmates, and I felt that I would fail my finals. I felt like a hysterical child who desperately needed a long sleep. I admitted I didn’t think I could do it to my parents, I admitted to feeling like my drive was gone, that I felt broken, defeated, angry, frustrated. They sat with me and calmed me as they have done and still do each time my emotions take over. They are “the real MVPs,” I always think, or, my “day ones” I like to call them. I took one last Vicodin and drank a coffee and sat on my parent’s couch for a 10-hour day of studying. I then did the same thing Sunday. I have no idea where I got the motivation from. Looking back I can’t really describe how I did this, regular finals weeks were rough enough on me before. As I stated previously, I had been hospitalized in December. I thought that was the lowest point I could reach in my adult life. Teachers, classmates, friends, family, and strangers have always told me “You are SO strong, I would never have been able to handle what you handled. How did you come out of it?” What people do not realize, is that I did not make it out of that first black hole alone. A completely other entry would be needed to explain the help I had from those surrounding me. That support system then took up their shields and swords for me again. I felt so weak, I never liked asking people for help, but I needed it badly. In Loma Linda, where I lived alone, I did not drive myself that whole week of finals. I had a different classmate in what I called “shifts” take me to and from school, walking up my stairs to grab my backpack, lunch, water bottle, etc. for me, walk in front or behind me so I didn’t fall up or down the stairs, assist me in and out of the car, carry all of my “luggage” up to the classroom, then back to the car and home. They would then take me home and set up my ice machine for my knees once I was back in my place, and set up my study environment for me in a way that was comfortable. I never had to ask. I had ’round the clock assistance if I needed it. Texts poured in daily. I had classmates I wasn’t even close with offering help. Food delivery, assistance, and hugs. I cried a lot. Sometimes because I was so thankful. Sometimes because I was in pain. Sometimes because I was scared. Sometimes because I was angry. Sometimes because I was mourning the inability to get out of this state and get to Haiti to help people. Sometimes in front of others, but mostly not. I CLAWED my way through finals. Ran off of 4 hours of sleep a night, stopped taking narcotics, became severely dehydrated and couldn’t eat because of the amount of NSAIDs I was then shoving into my system, squirmed through each exam because I could not get comfortable, and crutched my way everywhere on 1 limb. But finals were done!
Upon completion of finals, I sat with my closest friends in the program one last time, not even having the energy to celebrate or rejoice, but feeling more as if I had gone through a war, which frustrated me even more. All I wanted was to be home, sleeping, and I hated that feeling. I was used to being lively, energetic, the life of the party, loud, outspoken, dancing, moving. This was the end of YEAR 2! The end of the “stressful part” of school, and yet I was so emotionally fragile any little thing would bring tears streaming down my face. I then got a surprise that my best friend back home paid movers to get all of my stuff from Loma Linda back to OC. The year didn’t end how I expected, but it ended. I went home for 1 day and cried more, thankful that God allowed me the strength to get through this fight armed with soldiers to assist me. My mom and I had scheduled a trip to visit family in New Mexico in December, cancelled it due to my sickness, then rescheduled it for June, then almost cancelled it again. “We need this trip,” I told her, ” I need this.”
Two days after finals had ended, getting wheeled through LAX was probably one of the most humbling experiences of my life. I had to surrender complete control, an action I was never good at, and allow a stranger to take care of me. Through all of my surgeries, I have refused to even get a handicap placard. Since I was non weight-bearing, I hopped on one leg through TSA, got a complete body search in security, but we made it in one piece. I remember writing a piece from my previous post “Just Get me to NM” on the plane and bawling my eyes out some more. That trip was good for my mom and I. I was just so darn tired, mentally and physically. Although her and my family had to make accommodations for me constantly, I felt a sense of normalcy as I was able to be a tourist in a place I hold so dear to my heart. Getting back from NM, I was already 2 weeks into my 5 week NWB (non-weight bearing) period.
Back in Orange County, my friends from home would come to visit, meet up with me for dinners and outings, and check in on me as much as their busy schedules allowed. These friends I have known for around 6-14 years, and the comfort they provided me can not be overlooked. Just having them by my side at an Angel game, telling the Uber to drop us of as close to an entrance as possible, assisting me in and out of cars, they were lifesavers. The 5 weeks came to an end and I attempted walking once again. It was very painful at first, and being locked in extension made it even tougher. I was exhausted all over as my body struggled to get the energy it needed to use my weakened limb once again. I remember I started to walk with 1 crutch on a Friday, and my clinical was to start on a Monday. I was not allowed a crutch during the clinical at all, for liability purposes, and I was struggling to move without it. Once again, I was discouraged. Wondering if I had pushed it too hard too early as I always have done, wondering if I made the right decision trying to get this clinical squeezed in. Regardless, I moved in with my aunt and uncle in Corona and started my clinical close to school.
I was a patient and a student physical therapist at the clinic that had taken me in just weeks before my clinical was to start. I was on my own track, given my own course module on our online system for school, and of course, given precautions due to my injury. Still rocking that huge post-surgical brace locked at 0 degrees in clinic, I was prepared to be eyed and asked a thousand questions by my patients and staff. When I think of that first week in clinic, one word comes to mind: pain. What people don’t realize is that after surgery, you fight through pain while you are immobile. Usually you are given narcotics to aid in this pain after being cut open. Once you overcome that pain, you go through it all again once you attempt to gain normal range of motion, but more with the help of NSAIDs like Advil. In the case of lower extremities, you go through another round complete with difficulty sleeping and constant soreness when you begin walking. Then, as you progress to sport-specific or athletic activities you are sore again. I’m not talking a couple days of soreness, I’m talking months and months. Mentally, it takes a toll, and physically, sometimes all you want to do is sleep. My calf and hamstrings were so tight from keeping my leg straight in the brace and standing for a 9-hour day. My hips were still weak and my core was mush from so much sitting. My clinical instructor was also the PT that evaluated me after surgery, and I am forever grateful to him for dropping me as a patient so that he could take me on last-minute as my teacher for 4 weeks.
Day 2 of week 1 in clinic I had my post-op visit with my surgeon. He didn’t waste any time delivering bad news. “I know I said you could wait to have your ACL done later, but I think you need to have it soon, your best bet would be Winter break.” This is not real, I thought. I was pissed. “WHY didn’t you just fix it while you were in there?!” He explained to me that once I was under anesthesia, and all muscle guarding was off, my ACL was non-functional, but I hadn’t signed or verbally consented to have it done. There was so much laxity when my quads/hamstrings were inactive and turned off from protecting that loose ligament. If that ACL tore, it could and likely would take my meniscus with it. The meniscus I was still anxiously praying to heal and the meniscus I had just stayed off of for 5 weeks. I understood what he was saying, but did not like what I was hearing. I just worked my ass off to plan my year as to not fall behind, and now you’re telling me I will fall behind, regardless of my plans. The phone calls, the E-mails, were all in vain, I thought. I immediately was overcome with exhaustion, and my day in clinic hadn’t even begun yet. I was given the ok to unlock my brace while walking, but this “good” news was overshadowed by another surgery looming in my future. I met with the director of my program the next day to discuss options. I made calls and asked opinions of PTs and new grads. I calculated surgery recovery times to the date. My next clinical was to be in a hospital, and I had a choice: risk working with patients and transferring them with my brace on, possibly tearing my ACL completely and re-tearing my newly repaired meniscus, or have the surgery after this current 4-week clinical was up. I could also try to make it through the hospital clinical (with a list of precautions and “can’t do’s” from my doctor) AND 8 weeks of school in Fall, where for my Neurology track I would be expected to transfer classmates/mock patients, then have surgery in Winter. I flipped and flopped ideas in my head over and over. I stressed out about it for days, left countless messages with my doctor’s nurse since he was almost impossible to get a hold of, and decided the earlier the next surgery the better. I could overlap therapy for the meniscus and ACL, saving me time and money (my copay is $40 a PT session!).
Weeks 2-3 I started to walk slightly more normal. I was still stiff and in pain, but it wasn’t unbearable and I was taking NSAIDs only 2-3 times a day. I knew when I was walking my knee was giving way, I was walking the wrong way to avoid pain or weakness, but I couldn’t tell if it was a torn ligament, or weakness, or both. My physician had confirmed it was likely both. However, it was in this clinic that as I healed myself, I realized that I was receiving therapy by assisting others. 2 out of my 5 days a week I would come in for my own therapy at 8-9 am, then start clinic at 10:30 am, to end at 8:00 pm. I was exhausted. Some days I would get back to Corona around 9 pm and not even have energy to eat or ice my throbbing knee before passing out. But I had a fire lit in me because I was working towards what I loved. Like I keep reiterating, love makes you do crazy things. It ignites something in you that you cannot explain or put into words. My patients kept me going. They gave me life, hope, and energy. I was on the verge of tears multiple times in the clinic because I so deeply felt the pain and frustration they were going through. Lifting other’s spirits lifted my own. Confirmation that helping others to heal, decrease pain, and increase strength every day, is my calling. I know my CI (clinical instructor) had empathy for me, and I don’t think I would have made it through this clinical without his and the clinic’s support and understanding. I remember receiving tough love from my first PT back in 2007, and now I was receiving it from my CI 10 years later. It was as if my therapist #1 had been slightly reincarnated into my current teacher. I always tell people “tough love is the best love.” I’m not sure if it is due to my stubborn nature or the fact that I am so strong-willed but sometimes I need someone to say, “Stop it! You are going to be fine, you’ve done this before and can do it again.” It’s the best kind of love, and people who give it are the best kind of people.
Monday of my last week in clinic, I got through to my physician’s scheduler. FINALLY. After countless calls and even showing up in person to his office leaving him a very long note: You either give me a list of precautions for my clinical, or do the surgery, they got back to me. “He can do the ACL surgery this Friday, if not, you will have to wait until end of September, or the beginning of October.” Sheesh. After getting the okay from my faculty, it was decided I would miss my 10-week clinical from Aug-Oct, push all clinicals back including doing one after June graduation, and take boards in October 2018 versus July (October being my plan already). My first clinical would start in January when the rest of the class started their second one, it would be moved from an inpatient setting to outpatient, and I would have to be moved to the Inland Empire just as my current rotation had been moved, in order to be a patient at the only clinic I was covered at in Loma Linda for PT. My previous first clinical site agreed to take me instead for my second one, which I saw as a silver lining. Being behind my class was and continues to be the most difficult part for me. I am extremely thankful for a school that is willing to rearrange my year, allow me to graduate on time with my cohort, and make accommodations finding me new clinicals, but man, the competitor in me hates the fact that I’ll be behind. Once again, I’m sidelined, benched, out of service. Concurrently, I spoke to my CI and clinical director and they allowed me to miss my last day, a half day, to have yet another surgery. I remember walking through the halls of the facility I was working at on my 30-minute lunch break telling the scheduler over the phone, “This is really happening huh? I’m having another one.” She confirmed my disbelief and told me when the anesthesia team would be calling for my pre-op phone appointment. I had such a terrible sinking feeling the next few days. I’m not sure if it was the rushed surgery, disorganization, or the thought of getting cut into once again, but I felt so weak. Physically I couldn’t even go up and down stairs without a railing still, I was smack dab in the middle of a 4-month rehab for meniscus, I had just started to feel normal again without a crutch and was still walking the wrong way by limping, but I needed to be fixed. I was no longer as distraught about missing the Haiti trip, and I was almost accepting of the fact that this needed to be done. I finished my clinical a day early and prepped for knee surgery #4.
Before surgery #3, my physician had asked if I wanted to get the metal screws removed from my knee in that surgery in order to better prep him or whoever surgeon was going to perform the ACL whenever I decided to have it. They likely needed to be moved out of the way for the new ACL, since metal screws are no longer used in this type of reconstruction. I asked about the cons, and when he stated “fracture of the bone,” I said “Nope! Leave them there, I will deal with them when the time comes.” Well, now was the time. In pre-op, the physician came in to discuss his planning. This surgery was going to be trickier than most, and possibly longer. Turns out metal screws are not used anymore, and taking them out is an ordeal. Those screws also possibly could have been the reason my MRI was so hard to read and the ACL tear was blurred or skewed. He stated that he was going to remove the screws, either manually with an ice-pick like device or another newer tool, then, depending on the size of the void left in my bone, he would then fill that with cadaver bone or leave them be. We decided on using my hamstring tendon as a graft, since I had already used my patella tendon in surgery #1 for my now destroyed graft. His logic was, cadaver grafts have a higher re-rutpure rate. Building off of that, he did not want to take from my quadricep tendon, and jeopardize 2 extension (knee straightening) mechanisms in 1 knee, so 3 of the 4 graft options were ruled out. Since the hamstrings help to bend the knee, the PT rehab would have less resisted bending and hamstring stretching, but I would be up and moving in a reasonable amount of time (usually 2 weeks) as long as the meniscus looked healed from the prior surgery. He said if my hamstring graft wasn’t strong enough, he would add cadaver graft to it as well. I would be back in PT in 2 weeks, and I was almost excited to have my new knee, but nervous for the extensive surgery ahead.
Surgery was supposed to last 1.5 hours, and it went a little over 3. Upon awakening, I requested over and over to talk to the physician. My heart rate was through the roof from the stress and anesthesia, and when I heard how long the surgery had gone. My physician came in, explained to me twice what had happened, and it was surgeon talk I didn’t understand especially in my Dilaudid-induced state. “Locked in extension for 6 weeks” was my after-visit summary, “WBAT (weight-bearing as tolerated).” I do remember him stating that my meniscus he had previously repaired was healed, and I was ecstatic. I shook his hand with tears in my eyes and thanked him for fixing my knee. Then trekked back to the OC for recovery.
After the anesthesia fog wore off, I later called my doctor in panic mode and demanded to speak directly to him due to my delayed rehab plan and brace status. What was this locked for 6 weeks nonsense? I was supposed to be functional weeks 6-8 according to him! I was upset and frustrated once again. I have to be ready to perform Neuro tasks and transfers by November in school!! I did the surgery now to give myself ample healing time. I was placed in the Ortho track for the first month back at school in October in order to allow even more healing time! I had missed or foregone way too many events and vacations to count. Haiti, multiple concerts, a San Diego trip, a birthday in LA, a 1 week vacation with family to the east coast, a weekend at the river, and a weekend country concert in Vegas are a few of the events I had to say no to. I’m not even allowed to drive for 6 weeks either, so meeting up with family and friends is impossible, unless they come to me. Upon speaking to my doctor, he stated that he did not need to even remove the metal screws from my knee. He worked around them, placing dissolving screws where my new ACL was anchored. He did not have to use cadaver bone or tissue. However, upon pulling my new ACL through, a suture pierced it. He stated over the phone that had never happened to him in surgery, but reassured me that it would be alright. He reinforced the graft with 3 different anchors. I prodded and asked if it was mistake, will the new graft be as strong, what can I do for rehab, etc. He answered all questions confidently and ended with a “Just take it easy for 6 weeks.” SIX WEEKS. Are you kidding me? I had “taken it easy” for 5 weeks while I watched everyone enjoy their Summer after surgery #3, then struggled through a month-long clinical, and now you want me to sit around for 6 more weeks and TAKE IT EASY?! I saw red once again. The only thing that kept me going was that my meniscus was visibly healed in my post-operation photos I was given, and I had to trust that he had my best interest in mind. I knew it was a tough surgery, and not all ortho surgeons would have willingly agreed to do it. Still, why could I not have had a normal surgery, a normal rehab? I understand him not wanting to stress the graft with flexion, but really? SIX weeks?! “What-ifs” flooded my head for days, and still do. What if my knee is stuck and they have to do a manipulation under anesthesia to it after 6 weeks? (basically the surgeon numbs your knee and cracks it into flexion) What if my quads are too weak when I go back to school in October? What if I re-injure the knee? are a few of the thoughts I cannot keep at bay. What if, what if, what if. It’s terrible. I have to get myself out of my own head every single day. Every day I have to get myself up, and pull myself out of the “what if” pit. I have never been so terrified. I have never been so fearful, and THAT is what I am struggling with. I have always considered myself a confident, outspoken, brave individual. I don’t ever remember being afraid after surgery 1, 2, even 3. I knew I was rehabbing fine and believed the doctors and PTs when they said I was on track and would be alright. I still am struggling to sleep comfortable in a bed with my leg locked straight and the anxious thoughts that take over every single night.
On the other side, I get spurts of clarity, and pure motivation. It is then that I feel the prayers I have prayed and prayers of those around me in action. I hate myself for ever questioning WHY is this happening? Shouldn’t I have faith that it will all turn out fine, like it always has? I have sat and bawled and screamed at God asking “Why exactly are you allowing this? I am going insane here, and you allow me to go through another surgery, another set back, uncertainty, more pain, more anxiety?” Still some nights I can’t even bring myself to pray because I am so frustrated and angry. But some nights I can. Sometimes I feel as though God is a million miles away, and other times I feel his hand on my shoulder.
Being back home and being catered to by my parents and brother when I couldn’t even sit comfortably without pain showed me once again how truly blessed I was. They have never once complained, moaned or groaned, or shown the slightest bit of annoyance when I needed help carrying stuff, organizing things, moving, showering, etc. I cannot thank those 3 enough (the real MVPS!). You really don’t realize how blessed you are with two legs until you lose function of one. Showering becomes the most daunting task of the day, and getting from room to room is exhausting. My knee pain slowly faded but my left hip and low back were causing me more issues. Since I couldn’t bend my knee to stretch the deep muscle, the piriformis, causing this hip pain, I attempted to sit on a tennis ball and roll it over the knots in my hip muscles. I constantly feel behind because I’m losing a full month of therapy with the status I have been given by my physician. I’m always told that these situations will give me more empathy for my patients. I absolutely agree. I remember telling my mom, “If another person says, ‘Well at least you get an extended vacation!’ I’m going to scream.” This is no vacation. But it is making me stronger. It’s toughening me up (again). It’s teaching me to never take for granted the opportunities I have in life, it is reminding me of the outstanding individuals I have surrounding me, friends I have met in the program, family that called every other day, and friends I have had since 7th grade. I always think about the ability most of us are given to walk, to move freely, to go places as we please. I also think about how many take this for granted, only to miss it when it is gone. After surgery #1, I learned the hard way to never take a simple hike, walk to the car, stroll down a pier, or comfortable night curled up in bed for granted.
I am now 1 week shy of the 6 week mark. Around week 2 I started to wean off of the narcotics that fogged my brain and had visitors flooding in. Those visits took my mind off of the pain for however long they were here, and I reminisced back to when my doctor stated not to do the ACL while in school because it is so much more painful than the meniscus. Boy was he right. Friends came from out-of-state, from school an hour away, from around the corner. I don’t think some of my family and friends realize how far an hour or two visit has taken me on this journey. I have always prided myself on sitting with my fears and anxieties, and dealing with them alone or with prayer. This time around, I needed my people. My mom will sometimes ask me, “Ok, what errands are we running today?” in attempt to lift my spirits and get me out of the house. I have friends that stop by to watch reality TV, have brought me food or picked me up to go get it, or just called to chat for an hour. I really do think God sends these people to us as angels in human form. A simple text would leave me in tears because I would feel overwhelmed (once again) with the love I have in my life. End of week 2 I started putting more weight on the leg with 1 crutch, today I am able to walk short distances without a crutch, peg leg and all, and long distances with 1 crutch. I’m still intermittently medicated with NSAIDs, and in need of ice. I’m performing my own hip and quad strengthening, scar mobilizations, and patellar mobilizations on my knee until that week 6 mark where I can be cared for by a certified PT. This rehab is slow, it’s grueling, and it’s painful, but talk about a learning experience! My right knee (Grade II PCL tear from ’07) has begun hurting and feels super weak and loose. Sitting and standing is like doing a single leg squat on that leg, and the force has taken a toll on that knee. I’ve started looking through board prep books (I know, I’m not taking boards until October 2018), writing, strengthening, and attempting to occupy my time with any productivity. We got together to remember the death of a dear friend we lost at 20 years old at my place week 2 of post-op, and all 7 in attendance offered to willingly have it at my home so that we could all be together, since sitting in a restaurant comfortably for me was and still is a difficult task (let alone sitting in a car). I am undoubtedly blessed that the group that was there for me after that surgery #1, at age 16, the group that would stop by to lift my spirits, is still here. They have stuck by my side and assisted me in climbing out of another dark hole, in any way possible, 10 years later. With the major life changes and distance and newness life has thrown at us, I am forever grateful for these friends that are nothing short of amazing human beings.
I recently listened to a talk by Glennon Doyle Melton. She stated it simply as this,
“It hurts and it’s painful, and then there’s a waiting where you don’t know what the hell’s going on, and you don’t think any of it’s gonna make sense, and then there’s the rising. That’s the pattern always. But you have to stick around if you wanna see the rising. You gotta freakin stick around, through the pain and through the waiting. Cause if you leave you don’t see it.”
She then concludes her talk with,
“When I feel someone has been unkind, I know that all that just happened is that they just felt the hot loneliness, but they don’t know how to be still with it. So they treat it like it’s a hot potato and pass it on to the next person. But pain is not a hot potato. Pain is a traveling professor. And it just goes and knocks on everyone’s door and the smartest people I know are the people who say, ‘come in and just don’t leave until you’ve taught me what I need to know.'”
Just WOW. I had never heard of it stated that way. I am sitting with my pain. Physical and mental pain. But if I’ve made it through the pain before to see the rising, then why should this be any different? It’s because every day is different. I have had days where I cannot leave the recliner I am sleeping in because I am so distressed. I have had days where the pain goes down and my strength is the highest it has ever been. There are valleys and hills in this rehab, as I knew there would be. I have accepted the fact over the years that I will eventually need my knee to be replaced. I have accepted that I will not be able to play sports for many years if ever. I have accepted that cycling and swimming will most likely become my new sports. I do believe in signs, and I do believe in a master plan. On dark days, I would stumble across verses such as these:
“Those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.”
“‘For I know the plans I have for you,’ declares the Lord, ‘Plans to prosper you and not to harm you, plans to give you hope and a future.'”
Or a simple verse that brings me to tears in mass:
“Blest are they, the poor in spirit, theirs is the kingdom of God.
Blest are they, full of sorrow, they shall be consoled.
Rejoice and be glad! Blessed are you, holy are you!
Rejoice and be glad! Yours is the kingdom of God!
Blest are they, the lowly ones, they shall inherit the earth.
Blest are they who hunger and thirst, they shall have their fill.”
Or finding a note when organizing old paperwork from an old soccer trainer stating plain and simple:
“I know how much you love soccer, Marie. Trust me-I understand passion! And I believe in you-you can do it. You are such a capable kid-I believe you have big, big, big-time things in your future. This is just a small test-like practice for your future as a leader. Maybe a CEO, or a Doctor (wow), or a coach!”
I sometimes state “life is a trip.” Every single setback, every single heartbreak, lead me to where I am at in this point in life. I by no means have reached acceptance yet from this surgery. I’m working on it. I have mini breakdowns where I clench my fists and just want to put on my cowboy boots or stilettos to have a night out on the town to blow off steam. I think over and over, If I could just go on a run or a hike, this anxiety would pass. These stress relief activities I adopted after 2 surgeries are impossible at the moment. On a slick wooden dance floor spinning in my boots line dancing or two-stepping is my happy place, as are the SoCal beaches, as is a simple trail to hike, or a concert to attend. Those are all unavailable right now, and it is going to take a lot of work not only physically but also mentally to get me through the wall of fear back to those. I have terrible thoughts of falling on on a slick surface at the grocery store, twisting my knee while dancing, attempting to work out and taking a misstep, or pushing too hard or too fast in rehab. So many people say, “You worry too much,” or “You have nothing to worry about.” I try to respond as politely as I can but inside I’m thinking, YOU try having 4 of these surgeries, then let me know how you feel about the stability of your knees. I just want to get in and out of a car or sit at a restaurant without accommodations or moving at a snail’s pace. I want to go on a vacation and be able to get on a jet-ski or walk up and down hills to see the views. I’m not sure why I so frequently doubt if things will turn out alright, but I have a feeling there are many changes ahead for me. Will my rehab go as planned? Who knows. Will I feel healed and prepared in time to start school? Can’t say. I have sat back on the sidelines and missed so much, I have sat with the hot loneliness as Melton stated, and I have hated every minute of it. But I do think God pulls us backwards like arrows on a crossbow or sidelines us sometimes for our own good. It is His way of telling us to slow down, and a possible break we need before life picks up and gets wild again. I have not walked the right way or without pain for 4 months. My post-op brace is now a part of me, and instead of being excited to take it off, I am nervous as to how my weak and wobbly limb will hold up without it. However, I don’t think any of these unfortunate events are happening with no reward in sight. I know I will reap whatever I deserve tenfold once this is all over. I know He has got some great stuff saved for me. I just have to wait. Something I was never good at. My patience has been tested and tried repeatedly and I’ve got to say, it’s changed. Here is to a healthier and stronger rehabilitation. Here is to living life with nothing but passion. Here is to falling in love with new things once the old have fallen away. Here is to appreciating the hand we are dealt, and using it to help others. Here is to learning to walk the right way.