Going home

The day after my surgery a physical therapist stopped by my hospital room to display my choice of walking aids: crutches, or a walker. I said I was a little worried about the crutches because of the flooring we'd used when we'd renovated the camp: the wood-look floor could be slippery. Since I wouldn't be weight-bearing on the ankle for three months he suggested I take both, and benefit from the added stability of the walker while at the camp. Dave should remove all the area rugs that were now trip hazards.

"So, let's see you use the walker," the therapist said.

"Now?"

Nothing phases these guys. He got me right up out of bed, hooked all my bags to a movable pole he'd push along behind me, and told me to walk to the door and back.

"Relax your shoulders, move the walker forward, and hop toward it," he said. The choreography was elementary—the trick was performing it while my foot felt radioactive with pain. I held it out in front of me where I could ensure it would come to no additional harm.

I am nothing if not determined. When my college dance students would say "I can't do it," I'd tell them their choice of words would not be honored in my classroom. They were, however, allowed to say, "I'm currently finding this movement a challenge," a response that would both improve their humor and result in some added tips and tricks from me. So I had no doubt that I'd make this walk, no matter what. But it wouldn't be pretty. Even before the edge of my roommate's bed I was wracked with the kind of sobs that make relaxing one's shoulders a challenge.

"That's good. That's enough," the therapist said, but he'd told me the door was the objective and I was only two-thirds of the way there. So I pushed through those final few hops before my return trip. This is how surgery and sleep deprivation sap you: just days before I was lifting weights and doing sprint/walk cross-training and swimming quarter-miles, sometimes all on the same day. By the time I got back into bed after this herky-jerky attempt at walking on one leg, I was completely spent.

Because of his practice in the Canadian border town of Ogdensburg, some thirty miles to the west, my surgeon conducted his rounds in the evening. I braced myself when he came in. I knew our country's health insurance philosophy as concerns hospitalizations: cut 'em and turn 'em loose. The summer before, post-Cobra, Dave and I had spent months shopping for affordable health insurance; we now spent half of his monthly pension check on a major medical policy whose attributes my memory couldn't distinguish from the sea of coverages we'd applied for.

All afternoon I lived in dread of being sent home. I even hated to hear how well my nurses and doctors thought I was doing: my vitals were great, my overall health commendable. And I'm thinking, how could I possibly survive the hour's ride back to the camp, let alone the hobble from front door to bed, which was so much longer than the one I'd pushed through that day?

My fate would turn on the words of Dr. Luc Perrier. I was sure my vitals were fluxing all over the place as he made his determination. With that French accent I was unwilling to yet label charming or hateful, he said, "So try to get some sleep tonight and I'll see you tomorrow." Charming it was: because he did late rounds, I'd have another full day to gear up for my next challenge. I let out the breath I was holding and thanked him. As he signed my chart with a flourish he repeated what he said in the ER: "But don't forget to cast me as the handsome doctor who saved your life in your next novel."

That extra day would end up making all the difference.

Making "handicap accessible" camp

We weren't the kind of family to spend a summer vacation pitching tents and cooking over a fire, yet I grew up with a healthy respect for "making camp." Five kids, two parents and an Old English Sheepdog would pour out of two cars and stake our claim to what space we could, divvying up dresser drawers and unrolling bags onto sleeping porch cots. My older sister always claimed the cot nearest the screened-in wall that overlooked the lake; if we knew what was good for us, the rest of us didn't even try. Since youth I was drawn to physical obstacle—I'd wanted the top bunk in the room I'd once shared with my sister—so I chose the cot wedged deep beneath the angled beams. A night during which I escaped whacking my head was a night well-executed.

I'd use these skills when returning to the lake after my ankle fracture and subsequent hospitalization. The day after surgery my departure seemed imminent. Even as I was still hooked up to a variety of bags and machines a social worker stopped by my room to ask if my summer home would allow single floor living for awhile. Thanks to my Lifespan Design Studio friends Doug and Ellen, the answer was yes.

After Dave and I purchased the camp from my parents and determined the best way to save it was to pull most of it down and rebuild, we went back and forth on whether to include a first floor bedroom. It would increase the footprint and the cost, pointed out my eighty-year-old father. "Don't do it for your mother and me," he said. "When we can't do stairs we'll stop coming to the lake." I thought of my grandmother, and the many years my uncle parked her wheelchair on the porch so she could continue to take in the view she so loved. My dad may not want that bedroom, but I did.

Once architect Doug was in on the project, he was all for the downstairs bedroom—so much so that he added a wheelchair-width doorway into the room and another into the downstairs bathroom. Because they embrace the philosophies of universal design, Doug and Ellen encourage the kind of forward thinking that allows people to stay in their homes despite future health challenges. The wall sink I wanted to re-use for reasons of nostalgia, Doug pointed out, would perfectly suit someone approaching the sink in a wheelchair.

I had thanked my dad for his input but told him Dave and I planned to add the downstairs room. "Anyway, you know me—I'll probably use it first, after breaking my leg or something." From then on, no matter where Dave and I slept in the camp, when referring to that room my mother called it "Kathy and Dave's room." It could accommodate my folly, but would never touch her aging.

Six years later, my father now deceased after negotiating the camp stairs until the end of his life, I was facing that exact circumstance. Our foresight made the summer home an even more welcoming environment than my permanent residence in Pennsylvania, a three-floor town home that kept me fit while in full orthopedic health but which now provided an imposing challenge. An added bonus at the camp: my cousin had purchased a classy commode for her aging mother to use while visiting one year and had left it behind "for our use." How we'd grumbled to see it fill up so much of the newfound closet space in our rebuilt camp. It was the first thing I told Dave to set up.

Dave drove home with me strapped into the back seat of our Ford Contour, facing sideways with my leg propped up on a pillow. When we got to the lake Dave pulled onto the lawn so he could deposit me right beside the front porch. He pulled my walker from the trunk, snapped it into the open position, and helped me pull myself from the car.

Now what?

I faced the first of many challenges to come: the step up onto the front porch. I stood there with my walker, the clock ticking—gravity was creating an inferno in my foot—with no clue how to negotiate it.

Now that I've had a bit more experience I think I'd turn the walker around and push down on it while hopping up backwards, but I wasn't feeling like such a monkey that day. The youngster who once loved the obstacle course and scrambling into her cot beneath the lowest beam was now completely stumped by a four-inch step. Through some sort of ugly push-me-pull-you Dave and I got 'er done, but I was already realizing how hard the next few months were going to be. I was so thankful for the design of the camp: bedroom, bathroom, kitchen, porch: everything I'd need, close together on one floor.

As I made my way to the couch on the porch to prop my leg up so I could eat the take-out we'd picked up on the way home, Dave honored my new reality by helping "make camp": one by one, he pulled all the area rugs from my path. Perhaps the opposite of the "red carpet" treatment, but in my new reality, just what the doctor ordered.

Secret to Happiness?

That a flower grows from a single seed is a useless metaphor when it comes to reaping happiness. Those of us hoping to buoy our spirits must sow and sow and sow, throughout life, so that when fate nudges us toward the edge of despair we can reach back toward a rich and varied garden from which we might graft renewed happiness.

My husband Dave understands this. When his spirits sink he goes for a run or plays his guitar or reads stories from the Bible in which the stakes were more dire. I tend to write. Or seek water: either a bracing swim or a long, hot bath. I'll go outside for a long walk. Read a novel.

None of my spirit-saving options were available as I lay on my hospital bed, a little loopy (not nearly loopy enough, in my opinion) with my newly stabilized fracture propped on a stack of pillows. I had to cast around for something new.

Granted, some happiness flowed toward me from outside sources. Since I was eight hours from home and an hour from my summer home, I loved the fact that I had any visitor at all. Mine was Emma, the young woman who hired me to teach the Healing Through Writing workshop at the hospital's rehab program, who crossed the lot with a co-worker to say hello (see Emma? You never know when you'll suddenly emerge in a leading role in someone else's life). All the family and friends who played "whisper down the lane" and then called me while I was in the hospital—then reminded me later that they'd done so—all that was precious.

But let's face it. Happiness can't be applied from the outside, no matter how thick someone tries to slather it on. For that reason, strategies that connected with some inner desire worked the best. What I needed the most was hope—and the offer of it pulled me through my days, time and again, no matter how false.

Like the fact that I had an orthopedic surgeon whose sports medicine history suggested I might once again play ice hockey (okay, got me there, I'd never played hockey—but that my ankle would withstand its rigors, should I want to, connected with me). That the nurses promised my surgery would be soon, and that the post-op pain would be more manageable (to which reality said Ha! and Ha, again!, yet the promise of which helped me believe). That the spinal would be great because of fewer side effects (even though it shut down my urinary tract completely, which apparently is not uncommon—some dozen unsuccessful trips to the commode kept me up all night and in significant bladder discomfort and ankle pain; I finally had to be catheterized).

For me, though, my first inklings of happiness grew not from a flower I'd planted but from a wind-blown weed: I coveted something of my neighbor's.

Now, the big reveal. I found a goldmine of hospital happiness in this product, which cost Dave all of 87 cents:

Which meant more: that Dave wrapped up his business back home the morning after the accident and drove straight up to a hospital located just shy of the Canadian border, or that he stopped on the way at my request and arrived bearing the gift of Cherry ChapStick?

I'd like to say it's a toss up. But I suspect it's the ChapStick.

All day the curtain had been drawn between me and my new roommate, who was recovering from a hysterectomy. Local to the area, she had entertained a revolving door of well-wishers. Their attentions were not the focus of my jealousy. Through a crack in the curtain, I noticed that she kept applying ChapStick. I was in a situation in which there was so little I could do to achieve my own happiness—but I, too, could do that.

I'm sure I'll forever associate the flavor of cherry with this ankle break. Six weeks out I carry it still, in my pocket, ready to comfort me with its fragrant, waxy warmth.

Ironic, isn't it? Turns out happiness can result from outside application, especially when slathered on thick. The happiness wasn't the application itself, though, but my relationship to it.

At a time when I felt acutely my own powerlessness, applying ChapStick was one pleasurable thing I could do for myself. It may have done nothing for my ankle, but as for its ability to improve my spirits, I was able to attach to it the one thing necessary to make it work: hope.

Readers: When you faced tough circumstances, what helped you raise your own spirits?

General, or spinal?

"So I wondering if you want general anesthesia or a spinal?"

It's the morning after my big break and the Korean anesthesiologist has come to call. I'll call him Dr. Lee. He's mostly hidden by his paper surgery hat, gown, glasses. If something goes wrong, I think, I'll never be able to pick him out of a line-up.

I consider his question. My mother had slept through childbirth five different times while blanketed by the bliss of general anesthesia. I'm thinking that sounds good, but hey, he's the expert.

"Which do you suggest?"

"General anesthesia good, very good, you fall asleep, wake up, all over. But sometimes side effects not so good. With spinal you feel nothing, you wake up. Either one good."

I'd had general anesthesia before for other procedures, and had never suffered side effects. I'd had a spinal for my C-section—an injection of opiates right into the spinal fluid. I remembered lying on my side, "curled into a ball" to the extent that a nine-month pregnancy allows, trying to heed the warning to lie still lest the doctor nick something he shouldn't with that needle, even while my entire mid-section was wracked with contractions.

Now my brain was addled with trauma, lack of sleep, no food or water, and pain meds. I simply wanted this show on the road, in the least dangerous way. "I'll have the general," I said.

"Hmm. You sure? Spinal really very good. Also it last beyond when you wake up, which help with pain."

"So you're recommending the spinal?"

"No, no, general very good also. You fall right asleep, no problem."

Dr. Lee would be no help at all. But sleep? That sounded like the antidote I'd needed all night. I craved it. I settled on the general anesthesia.

Take two. Later that afternoon, another guy in scrubs came in. He strode in, shook my hand, introduced himself. I'll call him Dan. He had a red beard and mustache and the kind of stocky build and fresh face that suggested he'd been bow-hunting in the woods earlier that day. Thanks to a scheduling change, he would be my anesthesiologist.

"We're going to be taking you down for surgery soon but I wanted to meet with you first. I understand you want general?"

"Yes." With my work life blown to Hades, my loved ones scattered, and my ankle lying in pieces, it felt so good to feel confident about something.

"No you don't," Dan said. "Believe me, you want a spinal."

"I do?"

"No doubt about it." Dan smiled. "We'll take you into the O.R. and give you a little juice to relax you. We'll have you sit on the edge of the bed, bent over, and you'll feel one little pinprick for the injection. Next thing you know, the surgery will be behind you. Added bonus: complete pain relief for another few hours. Sound good?"

I'm not sure if it was his targeted argument or the thought of Dan out there in those woods, bow in hand, but something gave me faith in his aim. I said, "Where do I sign?"

I was alone when they came to get me for surgery. My mother hadn't come—while she was able to get me the help I shouted for when I fell out on that rainy hill, her grief over my father's recent death and her memory issues had made the struggles of daily life enough for her to worry about. A neighbor was looking in on her. Dave had left Pennsylvania that morning and was on his way. On the ride to the operating suite, as ceiling tiles flew past, I took deep breaths and tried to relax, hoping I wouldn't flinch when the needle went in and inadvertently cause my own paralysis.

They parked my bed next to the operating table and I inched from one to the other. I remember seeing Dr. Luc Perrier, my straight-from-the-pages-of-a-romance-novel surgeon, tying on his mask. Dan said, "Here comes the feel good juice" and I recognized the heat going into my arm...

"Mrs. Craft? Mrs. Craft?" It sounded like someone was speaking to me through a long tube. "The operation is over. How are you feeling?"

All I could think was, How many operating nurses does it take to balance a patient on the edge of a table if she's completely passed out? Memories of half-carrying wasted friends home from college parties came to mind. Maybe I should have told them that when two aspirin are suggested I can sometimes get by with a half.

Oh well. It was over. And Dan was right about the added bonus: then, and for a few additional, blessed hours, I felt nothing but relief from all that had plagued me. I'd had a great nap. They brought me a tray of food that I was able to enjoy with no distraction from pain, and a full pitcher of water. Dave arrived from Pennsylvania and I was no longer alone.

On my left ankle I sported a new wrap made of felt-like material bound with Ace bandages. Hidden within, my new permanent hardware:

That night, my post-trauma flashbacks would recur. But there was a difference in my reaction to them: with respite from the pain, some heavy-duty stainless steel on the inside, and my husband by my side, I now had resources to help hold me together.

Tomorrow: my hospital roommate's secret to happiness.

Awaiting surgery

I can fall asleep for only a few minutes at a time. Then I hit the mud, slide, hear my bones breaking...and wake up crying out. To try to outrun my repeat fate I have pressed my broken ankle into its stack of pillows, and it is now on fire with pain.

And heat.

The posterior leg splint (right) the orthopedic surgeon made for me in the ER—bent to suit my ankle and strapped onto my broken yet realigned bones with Ace bandages—is curing. It heats up to do so. Every single thing I know about first aid injury treatment says this heat is my enemy. Time's a-wasting; my foot is swelling out of control but no one seems terribly concerned about this. My foot structure (narrow heel, high arch, small bones) never handled well my active life; it turns easily and I have sprained each ankle at least eight times. Experience tells me that the immediate application of ice can be the difference between walking and not.

I ask for ice. My nurse says she'll check my orders. Ice isn't listed, so I can't have it. It amazes me that ice can't be administered unless it's prescribed by a doctor.

What the hell. Guess I'm not walking anywhere soon.

They give me pain meds every four hours but as the interior pressure builds they only take the edge off for three. The last hour is a killer.

It's the middle of the night. I'm in a double but do not yet have a roommate. A hundred cable channels and nothing to watch but zumba routines I won't be able to dance and exercise machines I won't be able to use. I try, again, to sleep. Almost there... I hit the mud. Slip and roll. My bones snap and crunch. I wake mid-stride, ankle searing.

I've been panting. Mouth so dry. No water—can I have ice chips?

"I'll have to check your doctor's orders." I know where that will go.

Although my thirst cannot be slaked I'm hooked to plenty of IV fluids and I can feel them pumping, pumping into my swelling foot—then redistributing to my bladder. I have to get off the bed and onto the commode about every half hour. Lifting my leg from its pile of pillows is so painful as the tissue fluids redistribute, but that's nothing compared to the sensation of the broken bones shifting, and the hot knives that thrust into my ankle once my leg is dangling off the edge of the bed. Thanks to the efficiency of movement conveyed by a previous life as a dancer, I can get from bed to commode in one graceful pirouette (one must take one's small victories).

As I perform this bravura feat my debonaire cavalier (okay, the nurse) holds the commode so it won't kick out from under me. "I'm sorry, you can't have the ice chips, you're scheduled for surgery."

I keep my eye on the prize—that more manageable post-surgery pain, which they promise like offering a horse a carrot, then yank away, time and again. They can't give me water because surgery will be later that morning. Then it won't be until early afternoon, I'm told, so sorry, you can't have breakfast. Looks like the surgery will be later this afternoon, so you can't have lunch. Good news! We've heard from your surgeon, he'll be over after his office hours, so your surgery will be this evening.

I was glad I'd taken the sandwich offered the night before in the ER; I hadn't eaten since noon that day. (Then again, the offered sandwich was ham. I was thirsty.) The night before, when they'd come to the ER to take me up to my room, I'd instinctively wanted to wrap the uneaten half and take it along like some hoarder in a nursing home but they took it away, saying there'd be more of the same up on my floor. No such luck.

Luckily, dawn brought the distraction of my anesthesiologist comedy team—and a roommate who held a small key to happiness. More on that tomorrow.

My Big Break, in pictures

Today I'm sharing a series of photos of my broken and dislocated ankle. I'm going to go out of order so you can appreciate the mal-alignment after the fracture. This first x-ray is of my ankle after the orthopedic surgeon pulled on my foot and crunched my bones back into approximate place:

Compare that to the next x-ray of my ankle when I arrived at the ER:

I know, ick. If you have a good eye, even in this "scan of a printout of an x-ray" you can see the way the bottom of my fibula (here, on the right) is snapped off to the side.

Here's an x-ray of how the dislocation looked from the side. Without dislocation, the tibia bone should center over that hump beneath it:

The next photos show you what this looked like in the flesh. Although the angle of the photos make it difficult to appreciate the way the foot is twisted down and to the outside, if you let your eye travel along the top line, you should be able to perceive an aberration. (Got to admit, I have to take a deep breath to look at these, even four weeks later):

To make me feel better—and because we know all such accidents happen in the most heroic and romantic fashion—let's review the effort on my part that resulted in this mishap. Hurricane Irene had knocked something from one of the tall trees by our camp, and it had fallen at such speed, it thrust right into the rain-sodden earth! I was talking to Dave on my cell, and couldn't see what it was through the raindrops stuck to the window screens. I had to go out into the wind-driven rain and investigate!

Turned out there wasn't as much of an emergency to report as I first perceived. The object that had fallen from the sky on August 28 was still skewered into the lawn on Labor Day weekend, when Dave and my sons were scheduled to arrive. Indeed it was still there there when we closed up camp on September 8, when Dave snapped this photo, and it was still there on September 19 when Dave returned to the lake to retrieve my car.

Who knows, it may be there still. What do you think it looks like? (If you missed Dave's answer, it's in the post that explains how I broke my ankle.) Here it is:

ER

I hit the Canton-Potsdam Hospital Emergency Room on a slow evening, I guess—or maybe that's just the kind of service you get when you arrive by ambulance. They wheeled me right into a room, transferred my backboard to a bed, and had me roll off it. Right away a nurse came in. She told me to get changed—I'd never so happy to don a hospital gown. I peeled off my cold, wet clothes, begged her to cut off my wet pants so I didn't have to jar my leg, and asked for a towel. I soon lay clothed in a dry gown and beneath heated blankets. For the first time in two hours, I stopped shivering. With these small improvements, my sense of the emergency felt behind me.

The nurse started an IV and did an EKG (I was thinking, isn't that for older people? It took me a moment to realize that I was just days from my 55th birthday.) They told me the on-call orthopedic surgeon was on his way over from Ogdensburg, a border town on the St. Lawrence River, and he should be here within the hour. I was told how lucky I was: he was the orthopedic surgeon for the Clarkson University ice hockey team. I was also told that if I'd gone to the emergency rooms of Gouverneur or Star Lake, I would have had to transfer to CPH for orthopedic specialty care anyway, so I silently offered up a quick thanks to the EMT who diverted me here, and begged forgiveness for objecting, however silently, to the disgusting cigarette smoke smell on his fingers as he tied on my oxygen mask.

My mother and neighbor Beth, who drove her, soon arrived with my purse. Beth is a real take-the-bull-by-the-horns type; she had already rifled through my wallet, given them my insurance info, and called Dave to tell him we were at the ER. She found my mom something to eat while they took me to x-ray. Thankfully, the tech was able to x-ray through the splint, positioning plates so that I didn't have to move.

When I got back to the ER the nurse pulled the splint from my foot; the doctor would soon arrive. As she put some dilaudid in my IV she explained that some of the pain was from the dislocation tugging at muscles and ligaments now held in an unnatural position. I recognized an opportunity—as gross as it was to look at my foot, I was a bio major with a graduate degree in health and physical education; I knew I'd one day want to study my foot in its current condition. I asked Beth to look in my purse for my cell phone to snap a photo. I hoped it was in there—my mother suffers from short term memory loss and she was quite stressed when I asked her to dry the rain from it and put it in my purse. I also hoped the phone would still work.

Beth pawed around in my purse and said, "Look at this." She pulled out my digital camera, which I never carry around in my purse. For once, dementia to the rescue—my mother had a hard time distinguishing my cell from my camera, so had brought both. Beth took several shots of my foot.

The doctor arrived and told me he'd already reviewed the x-rays. My ankle was fractured in three places (a trimalleolar fracture): the tibia, the fibula, and the talus, the ankle bone that these longer bones articulate with at the ankle. Later research put me right in the middle of the demographic for such fractures. According to the American Academy of Orthopaedic Surgeons:

During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of "baby boomers."

As soon as the doctor found out I was a writer he said I must cast him in my next novel as the handsome doctor who swoops in to save my life. I smiled, but knew this wouldn't be possible: the details would strain believability. Because he was Canadian by birth he spoke with a French accent, his name was "Luc Perrier," he was fit and handsome (as you can see), and, like most orthopedic surgeons I've met in my life, quite full of himself. I try not to adhere to such stereotypes in my creative writing. He marched over to my foot, picked it up by my big toe, and suspended it—I prepared to scream, but this didn't hurt as much as I thought it would. My guess is gravity itself was beginning the process he would soon complete.

"We will add something to your IV now," he said, and I turned to watch the nurse insert a syringe into the port. "Can you feel it?"

"It feels all hot going in there," I said, looking at my arm, and with that he grasped hold of my dislocated foot and pulled. I heard and felt the crunching of the bones as they realigned, but whatever anesthetic he'd given me had done the trick—it didn't hurt, at least not any worse than it already did. I now understood the orthopedic surgeon stereotype: it certainly would take some mad hubris to do something like that and believe you were helping the situation.

Before I was wheeled off for a set of post-reduction x-rays, he told me he'd admit me tonight and perform surgery tomorrow. The need for this didn't surprise me. Beth, however, followed him from the room and demanded to see my x-rays, she told me later. She doesn't think people should be operated upon without some proof of the necessity.

But even to her untrained eye, she said, after seeing the x-rays, she knew he spoke the truth.

Tomorrow: a photo montage of my ankle, inside and out, and a special tribute to the cause of my accident.