Four Freight Trains – 32 Staples

I glance at the orange nurse call button several times. I sense the pain killer they injected was wearing off. I had resolved to avoid the dreaded label of “high-maintenance patient,” but the pain is escalating and I was told to stay on top of it to make it easier to manage. The knee incision site now stings and burns. I calculate the relative pain scale possibilities and assign it a 5 or 6. My index finger wanders toward the device at my bedside. A beep emits when I press the button and soon a woman’s voice asks if everything is okay.

“My pain is increasing. It seems the local anesthesia is wearing off. Can I get some Tylenol?”

“Yes, someone will be in to help you in a few minutes.”

After a couple hundred normal breaths, my breathing becomes focused and deep, using my “Qi breath” to push the pain down my leg and out through the bottom of my right foot. But the pain accelerates and I cannot stay ahead of it. My pain is now comparable to when I cut my fingertip off in a mortar mixer decades ago. Since then, I have always used that reference point as an 8 on the dreaded pain scale. When my appendix burst while fishing in Alaska last August, that was an 8 that spiked to 9 if I made wrong moves.

Ten minutes after I had first pushed the nurse button, my shaky finger finds it again and gives it a firm punch.

“Can I help you?”

“Yes, this is Dave Such in Room 217. I called ten minutes ago. The pain is getting worse. I need Tylenol and maybe something stronger.“

“I will send someone shortly.”

Both my hands now grip the bed-rails with white knuckles and my breathing becomes deep and audible as I lean forward into the pain. Someone is fanning the blue flame of a propane torch up and down my incision. The pain oscillates between an 8 and 9 with every breath. For me, a 9 is when stars appear and I struggle to keep from passing out, and a 10 is “lights out.” My knee is on fire. Now I appreciate their advice about staying ahead of the pain, yet I lie here helpless. I consider my last resort for help – getting out of bed will sound alarm bells and cause one or two people to burst through the door within a few seconds. I discovered this excitement earlier today by accident. I start to move my good leg in that direction when a cheerful voice appears at the opening door.

“I hear you need some pain meds.”

My body language quickens her step. Soon I have 1000 mg of Tylenol sliding down my throat and the nurse asks for a few seconds and she will be right back with a stronger pharmaceutical. In less than fifteen seconds she returns with a tiny paper cup containing two small white opioid pain pills, Oxycontin, I believe. I send them down the hatch, and continue my focused breathing for another five or ten minutes. Whatever was added to my stomach is now dissipating into my bloodstream. My grip relaxes and my breathing slows.

I think of the days not that long ago when patients may have been given a shot of whiskey and a piece of leather to clench between their teeth. That was when the word excruciating[1] meant something. I suppose many of them reached a 10 and subsequently passed out, a blessing for them. Yes, I am a wimp compared to earlier generations.

In fact, I was completely unconscious, pain-free, and maybe having pleasant dreams (without even a strip of leather between my teeth) when they cut open my knee for the second time in two months on Monday afternoon, February 6, 2024, fourteen hours after I returned to Denver from South America. This was an exploratory drain and irrigate operation similar to what we call an “open, clean, and close” inspection in the turbine business. That afternoon, they removed over a quarter cup of puss and cleaned it up as well as possible. Fortunately, the plastic and titanium pieces they installed two months ago were left in place. I am now held hostage in Room 217 with a constant stream of heavy-duty antibiotics being pumped into a vein on my left wrist, waiting until they can identify the type of bacteria that threatens my life and narrow the antibiotics.

I am familiar with the progression of bacterial infection in susceptible joints like the knee. The doctors merely tell me it is a very serious condition. “You have a better than fifty percent chance of beating this with antibiotics alone.” They measure their words with caution, but I can read their hand. I ask for no further explanation because I know. I saw a coworker struggle with infection after his elective knee surgery. He was given several rounds of strong antibiotics that could not control it, and they eventually amputated his leg. Further efforts were unsuccessful. One day we were invited to his funeral.

Although I hate the idea of massive doses of antibiotics, I know they are poisons that are designed to save my life. It is a biological freight train that will mow over the good with the bad. I resolve to obey all my instructions, including the mandated inactivity.

After four long days in the hospital, my eldest son, Marcel, drives me home. It feels like a jailbreak, but I have a PICC[2] line inserted into a vein on my right bicep, and a supply of portable antibiotics to be pumped into my system from the comfort of my own home. I also have a vacuum pump sucking negative pressure through a four-foot plastic tube inserted through the knee dressing.

After a couple days of self-care, I am given permission to rid myself of this knee dressing and associated ball and chain. The slow and painful adhesive removal took over a half hour. (After my first knee surgery, the dressing reacted to my skin and during removal, it tore off a layer of skin. That may have been the pathway for the bacteria to infect my knee.) As I laid the dressing to the side, I see the incision and the method of closure. I count 32 stainless steel staples running the length of the stitch – over seven inches.

This incident has been the fourth freight train to knock me over in the last six months. The triad of compounding blows to my system are these in order of ascending severity. First is pain and the energy required to deal with it. It hurts, but for me, severe pain has generally been short-term. Second is the mandated inactivity that takes its toll deteriorating muscles, mind, and energy – enervation and atrophy. I feel I am shriveling up, and quite frankly, I have a sore butt and an aching back. One of the nurses told me that for every day in the hospital a patient requires a week of recovery. However, the most severe offensive to my body is the barrage of high-powered antibiotics, which are literally “anti-life” that must kill before I can heal. These are not nearly as bad as chemotherapy, but can exhibit long-term negative consequences, my biggest concern.

Fortunately, I see an end to this triad, this death gauntlet, and the end that I see is life. That is my hope, as it must be.

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[1] The Latin root of excruciating means “as painful as a crucifixion.”

[2] PICC = Peripherally Inserted Central Catheter