“The rapidity of joint destruction and consequent irreversible impairment of joint function…makes its diagnosis and early treatment an orthopaedic emergency. Cartilage destruction starts to occur as early as 8 hours after infection. Early administration of antibiotics helps to slow down the process, but even if intravenous antibiotic therapy is started within the first 24 hours of infection, significant glycosaminoglycan destruction and collagen disruption occurs.“
It was Friday, July 19th, 2007
You’d just nailed your last cedar shake to the front side of the garage of the home you’d been framing all summer when you told your co-worker, Charles, that you were going to head up the hill to the toilet. You climbed down the scaffolding and began your march up the rocky dirt driveway.
Hmm, ouch. Weird.
You must have remained in a crouched position too long. Your knee hurt to bend. Nothing serious. A little heat. Walk it off.
Walk it off.
Walk it off, dammit!
You hobbled around the construction site for a half hour before you notified Charles, “Dude, I must have done something to my knee.”
“Did you fall?”
“No, not at all. It just started hurting all of a sudden.”
He told you that if you didn’t feel like you could work, just let him know.
“Nah, I can work.” It’s fine. “But maybe I should do something light—sit down for a while.”
He put you to work on a few short pieces of siding along the back deck. It was an easy-enough task, but you couldn’t concentrate. You botched the job three times, measuring and cutting the template backwards, or too short, or crooked. All you could think about was the rapidly augmenting pain in your knee. You started sweating.
Weird that you could blow out two discs in your low back and not realize it. So you must have tripped or tweaked your knee somehow and simply didn’t remember.
Each time you botched a measurement, or a cut, your awareness of how much you were sweating increased.
“I hate to do this,” you finally said to Charles. “But I can’t focus. I think it’s getting worse.”
If there’s one thing you never do, it’s call out sick. But you had to. You called Wife. Told her you needed her to come pick you up—that you were taking the rest of the day off—that the two of you could even leave early for her grandparent’s house two hours up north in Anacortes, WA.
Your boss arrived on the site before Wife could arrive to pick you up and saw your limp. “Uh-oh! Someone get hurt?”
You didn’t know what had happened. Couldn’t explain.
“Get some rest, kid.”
But you weren’t, and both men began to realize it when you tried to climb into Charles’ truck, using both your hands to carefully—oh so carefully—lift your ailing leg into the cab. Charles drove you to the large grocery store at the side of the highway, where Wife knew to pick you up.
“Do you think you should go to the hospital?” Charles asked.
“I didn’t do anything to my leg,” you growled. “It’s probably just a stress injury.”
“Really?” Charles watched you bite your lip as you eeked your way out of his truck, scarcely able to bend your leg enough to clear it past the door.
Wife found you whimpering on a handicap cart in the grocery store.
“Are you sure you’re going to be alright?” she asked, after getting you into The Rig.
You snatched the bottle of ibuprofen from her hand and threw six pills down your throat.
The medication seemed to alleviate the pain, but you could barely hop on one leg, so you stayed put while Wife packed your bags for the weekend with her grandparents, mother and mother’s boyfriend, siblings, aunts, uncles—everyone in the family.
The following day in Anacortes, you woke up and were happy to sense that your knee was on the mend. Everyone in the house the night before had asked you what was wrong, why you wouldn’t get out of your chair, why you were hobbling so heavily when you did…
Just some kind of stress injury. You were trying to keep off it.
So when the group, that morning, wanted to dive into town to check out the flea market, you thought it would be fun—provided you moved carefully, which you did. But after about an hour at the market, a fire lit in your knee. You began to sweat again, to tense every fiber of your being against the threat of the occasional, sudden, acute pain.
“I think I should go back to the car,” you told Wife, whose face was wrought with worry. She held you by the arm as you worked your way through the crowd at a glacial pace.
You continued to try and walk.
Ow! Ow, fuck!
Wife could see that your mouth and eyes were rimmed with red, your jaw set firmly. Frustrated.
“I’m so sorry,” you said. “I can’t walk. You’re going to have to bring the car.”
“I’m not going to leave you alone like this.”
You laugh to yourself when you remember. Wife carried you on her back for almost a half-mile—all 190lbs of you.
You were returned to the house and left in a chair. Wife’s Uncle slipped you a couple Vicodin. “You look like you need these more than I do.”
It was Wife’s grandfather’s birthday that day—her grandfather was the former C.E.O. of a very large and prosperous Washington bank. The birthday was a very serious affair. You did not want to spoil it by calling more attention to your injury. So you waited—doped up on Wife’s Uncle’s Vicodin—and did not budge from your seat for hours.
When the late hour arrived and it was time to retire to the guest house, you slowly pushed yourself out of your chair, into a standing position. One attempted step later, darkness came stampeding in. You gasped, hit the ground, and started shaking. You soaked through your clothes, felt nausea punch at your stomach with its giant fists. The room became so, so dark.
The family—your [secret] in-laws—rushed you to the hospital.
“Will you please indicate to me your level of pain?” the nurse said, holding a little scale of cartoon faces numbered 1 through 10—1 showing a smiley face, 10 showing that poor little cartoon screaming with tears jetting from eyes clamped shut.
You weakly lifted your arm and dropped a finger on 8.
“Do you have health insurance?” she asked.
Just your worker’s compensation insurance.
“Did you trip or fall on the job?”
“Do you remember doing anything to your knee?”
“Are there even any marks on your knee?”
No, no, no!
The doctor showed up an hour later. Same questions, same answers.
“Well,” he said, “The worst case scenario is that it’s septic, but that is highly unlikely. Generally, we know it’s septic if the patient cannot move the joint. Can you move the joint?”
Test those limits.
Wrapping your hands under your knee as though preparing to tear it down the middle, you held your breath, and squeezed out an inch of knee extension, refusing to produce a yelp. Piece of cake.
“Good. So it’s not septic, but I’m going to draw some samples from the site anyway, to see if you have an elevated white blood cell count. If that’s the case, then we know your body is trying to fight against something.”
You waited another hour, holding Wife’s hand, frowning childishly as she consoled you.
Your doctor returned bearing crutches, and explained that there was no change in your white count.
“I’m diagnosing this as bursitis—an inflammation of the bursa around the joint,” he said, and began handing papers to Wife. “Here’s a prescription for an anti-inflammatory medication, and another prescription for an antibiotic—just in case it is septic. If you’re not feeling better in two days, or it gets worse, come back to the hospital.”
A stress injury after all! You felt guilty about disrupting [secret] Grandfather-in-law’s birthday party over something so trivial. So what if you blacked out from shock back at the house, leaving you feeling so sick that vomiting might incidentally turn you inside out!
Wife drove you back to the house, and you crutched your way to the couch—laid down in exhaustion.
“Will you be okay here while I go pick up your prescriptions?” she asked.
You’re a soldier. Of course!
Actually, no. You’re not a soldier. You missed her during the short time she was gone. When Wife did return, she immediately fed you your meds and kept you company in front of the television until it was quite late—legitimately time for bed.
“Do you think you can make it upstairs?” she asked.
You thought about what a Herculean task that would be and said defiantly, “No problem.”
The staircase was steep and long, and you were so weak, you could only crutch at it one step at a time, with Wife spotting you from behind, step-by-step, with your heart rate mounting steadily. Cold, clammy, sweaty. Sick. Oh, god. Really sick.
“Wife…” you moaned. “Wife, I’m going to boot.” You sagged in your crutches, started to lose your balance. Wife’s arms swept around you immediately.
“I’m going to puke!” you cried.
“Get a bowl!” Wife called to her sister. She couldn’t let go, or you’d tumble down the stairs.
Oh fuck, dizzy, sick, dark.
“Maria, please don’t puke all over my grandparent’s carpet,” she implored.
Stop the ride! You wanted off.
The bowl came in the nick of time. Wife thrust it under your face, arms still wrapped around you from behind, holding you steady.
You vomited violently. The frothy contents of the bowl sloshed every time you heaved and knocked backward into your wife.
“Oh my god,” you heard her say. “I can’t believe this is happening. I’m hugging you in the middle of a staircase at 1 o’clock in the morning, while you puke into a bowl. It smells terrible!’
It was kind of funny. You managed to laugh weakly, “I’m pretty sure I puked up the meds.”
You spent the next day in bed. Every time you took the antibiotics, you puked them back up, so eventually stopped trying. Members of the family warily ventured upstairs to check on your condition. You feigned stone-cold self-composure, gave them all a thumbs-up, and even set to work reading your grandfather-in-law’s business book—just for brownie points. No one in Wife’s family, barring her mother and her siblings, knew about your marriage. To the rest of the family, you were Wife’s outgoing friend—a former trainee of the U.S. rowing team and a Yale alumna like her aunt. To a family brimming with bankers, power lawyers, and Boeing C.E.O.’s, you were welcome.
So don’t blow it!
On the second morning, Wife’s mother came into the room to check in, finding you on your back, chest heaving violently, crutches sticking out from under your arms; it had taken ten full minutes for you to rally the energy and endurance to make the short trip down the hall to the bathroom.
They took you back to the hospital.
They detected a tiny—practically negligible—elevation in your white blood cell count.
“Have you been keeping off the leg?” the doc asked suspiciously.
You hadn’t touched it to the floor in days. Hadn’t gotten out of bed but to pee.
“I’m referring you to an orthopedic specialist. You have an appointment set up for tomorrow afternoon.”
They fixed you up with a dandy leg immobilizer so you’d have an easier time sleeping through the night.
Shuffling in and out of the car, the hospital, and along the stairwell worsened your condition. You slept fitfully that night—deliriously—as did Wife, who stirred with worry at every moment, afraid to touch you, but staying close nonetheless.
At the orthopedic clinic, the nurses found you slumped in a wheelchair, head thrown back over your shoulders, eyes lost somewhere in your skull. They brought you to the examination room, laid you to rest flat on one of those hard tables with the crinkling tissue paper on it.
You heard the door open, a man’s greeting voice acknowledged by Wife’s.
“Bursitis, huh?” said the voice, followed by the sound of a file flapping onto a counter. “Let’s have a look, shall we?”
Two hands placed themselves on your knee and tried to bend your leg.
You saw red. Gasped, jolted with the force of lightning striking through your body and exploding through your knee… your eyes had snapped open. You were sitting upright, fists ready to smash that motherfucker’s face in; you suddenly knew how animals behaved in bear traps.
“Jesus!” the man screamed, flying away from you—the rabid animal.
You said nothing, back, chest, shoulders heaving, fingernails cutting into your palms.
“You don’t need to overreact like that,” he said angrily.
You tried mightily to strike him dead with a look. It didn’t work. You fell back on the table.
The man left, and when he returned with your orthopedic specialist, you heard him say something like, “…really don’t think this is bursitis.”
Another series of the same questions. More of the same answers.
“I’m admitting you to the hospital,” your orthopedic doctor said. “I want you under observation. I’m ordering you an M.R.I., and if the results show some kind of activity in there, we’ll schedule an operation.”
Kady brought you back to the hospital for the third time, where you were led immediately into a spacious suite—by some brusque nurses. Somehow, after the X-rays and the M.R.I., you managed to smile, to laugh, to joke around with Wife as you awaited your results.
The news came at 2am—you needed surgery.
[14 July 2006
Princeton, New Jersey
Subject: i can’t stand how i’m thinking!
I’m tired, and stiff… back was feeling—eeehhhh—you know. And we have 4 x 20′ on the water in a four that rides slightly down to starboard. I felt like I was in a bubble… I couldn’t raise my heart rate very high… couldn’t push very hard without it hurting my back and hamstrings. After the second piece, I thought, “You want to cry, you want to bail out of this boat and swim to shore. But you won’t. There are three other girls in this boat who want to be here, who need you… you’ve committed to this. You will endure this practice—this monotony—this discomfort for as long as you have to. Because you have no where else to go.” At times, I wanted to break down crying, just because I felt so pathetic.
“I’m tired, and stiff… back was feeling—eeehhhh—you know. And we have 4 x 20′ on the water in a four that rides slightly down to starboard. I felt like I was in a bubble… I couldn’t raise my heart rate very high… couldn’t push very hard without it hurting my back and hamstrings. After the second piece, I thought, “You want to cry, you want to bail out of this boat and swim to shore. But you won’t. There are three other girls in this boat who want to be here, who need you… you’ve committed to this. You will endure this practice—this monotony—this discomfort for as long as you have to. Because you have no where else to go.” At times, I wanted to break down crying, just because I felt so pathetic.
I rolled out of bed… needed to stretch… put on some clothes… and then the bed called me back. I flopped down on it and didn’t move for 20 minutes, slipping in and out of this trance-like state.
If I quit sometime in the near future… how sweet would the relief be? How much enjoyment would I feel before I began to feel immensely guilty?
I’ve been rowing for six years with this goal in mind. Suddenly I don’t want it? Like, there are so many other amazing things in life—like I can’t wait to grow up or something—that I’m willing to throw in the towel on an opportunity that so few get to dream about.”]
You’re underwater. You’ll drown!
You gasped. Fire licked down your throat, but the cool air was soothing. Your lungs drank it up greedily.
You have a way of hiding traumatic injuries from your family and loved ones, be it a catastrophic ankle sprain, or a hole blown open in your leg, or rolling a car at 60mph on a freeway.
Wife finally got you to agree to call home and explain your absence to your father, you felt immensely guilty.
“Where are you?” he and Caregiver asked.
“How did you get there?”
“Is Wife with you?”
Oh, Wife.. Your beautiful, sweet, adoring wife. She never left your side. She slept in the chair next to your bed, went out in the morning to buy fresh fruit and flowers, smiled and joked with you.
You loved her so much.
“We want to come see you,” Caregiver declared. “It’s just that Dad has been feeling awfully tired these days.”
“It’s okay. You don’t have drive all the way out here.”
“When are they going to let you out of the hospital?”
Not sure. A few days? They were trying to find out which antibiotics were going to kill the strep infection. Until then, you got to spend your time idly poking at the yellow-red goo in the drain pouch attached to your leg, and impatiently clicking your morphine button.