I'm baaaaaack!!! Five months ago, I had surgery on my left knee. I wasn't hoping to come back any time soon, but alas, 2005 just wasn't a good knee year. On December 31, 2005, Seth and I went skiing at Stevens Pass. I had scheduled a private lesson to work on jumping and tree sking but we arrived early enough to get in a warm-up run. The sweet powder between the runs called and we dove right in for about 200 meters of fabulous skiing. Then I met The Stick. It was craftily hiding under the snow and as I skiied around a large, snow-covered rock, The Stick jumped out and THWACKED!!! my ski from below. Surprised, I gently crashed into the soft powder to evaluate my situation. Seth asked: "Why don't you just stand up?" but something wasn't right. I slid down a few feet to a slightly flatter location. When I tried to stand up, my right leg refused to support any weight. We traversed onto the nearest groomed run (the bottom of a black diamond run), I skiing on just my left ski. Just as we emerged on the groomer, a ski patroller came by so I hailed her. She offered to call for a snowmobile, but I chose to ski down on one ski. She escorted me down the mountain to the first aid office. Seth took my lesson and I spent the day twiddling my thumbs at the lodge. After years of enjoying the New York Times, I was stunned by the depressing quality of the Seattle Times and the Post-Intelligencer.

The Diagnosis: I made an appointment with Dr. Larson and got an MRI through UW Sports Medicine. The radiologist's report was clear:

Radiologist says:	which means:
Anterior cruciate ligament: Completely torn	I need surgery if I'm to ski again.
Medial meniscus: Increased signal... consistent with a meniscal tear	Minor cartilage damage.
Other soft tissues: Mild joint effustion.... Baker's cyst	Swelling.
Marrow and osseous structures: ...bone contusion with a possible minimally displaced fracture	I bruised my bone.

Thankfully, the "possible minimally displaced fracture" was not actually a fracture, just a bruised bone. I would still need surgery to fix the ACL but it didn't have to happen immediately, whereas a chipped bone fragment in my joint would have required immediate surgical attention. I took care of a few other things in my life (PhD defense, trip to Australia with Seth, trip to Norway with Jana, trip to Boston to see my brother and mother) and postponed surgery until April 4, 2006.

Surgery Day: Having been there a mere 5 months earlier, I knew what to expect of the University of Washington Surgery Pavilion. Fewer people than last time seemed to want to know my name and whether I had any allergies. So after my finger was hooked up to an optical meter of blood oxygen, I had a lot of time to hold my breath and see how low I could drop the numbers (my best low: 94%, my baseline: 99% to 100%).

The IV: Finally, a 4th year med student came in to put in an IV. She thought she could, she thought she could, she thought she could... a sweet girl. First, she tried to anesthetize the area with a lidocaine injection. She put the needle in my skin and realized that she was holding the syringe too low and couldn't reach the stopper to actually make the injection. She tried to slide her hand up the syringe and in the process wobbled the needle out of my flesh and stabbed me elsewhere. She got it right on her second try. Now came the time to put in the IV, which thankfully went smoothly (IV needles are much bigger than lidocaine needles). The last step is taping the IV in place so that it doesn't fall out. She'd thought ahead and left a sticky piece of clear plastic laying on my bed for this purpose -- and then forgot and placed her forearm on it, sticking it to herself. Oops. Apparently thinking ahead to just such a scenario, she had brough a second complete IV kit, dug out a second plastic sticky, and affixed it to me. About an hour later in the OR (operating room), after the IV needle had done much uncomfortable wiggling, a resident showed her how to tape it more securely.

The Anesthesiogists: Dr. Chris Kent came by to discuss anesthesia. I told him: "My biggest concern about this surgery is that you'll try to knock me out," and listed the three surgeries and three anesthetic combinations I'd had previously as explanation of what I liked and what I didn't like. Apparently I was convincing, because he didn't argue and gave me only the briefest warning about spinal headaches (which occur in about 2% of all spinals, he said). He agreed to give me no sedatives and left to tell the other member of the team. Jasper Chan, a 3rd year resident, came by shortly thereafter. He told me that lidocaine was fairly short-lasting and recommended bipivucaine for the spinal.

The Anesthesia: Jasper asked me to lie down and curve my back to widen the gaps between the vertebrae. He explained to the 4th year med student how to find L4. For my meniscus surgery, the nurse anesthetist had had me sitting during the injection. Jasper had me lie on my right side so gravity would preferentialy pull the bipivucaine towards my right side and numb that side more than the other -- and it worked. As the pre-surgery prep was finishing, I started to feel slightly woozy and really sleepy. I noticed that my heart rate was 45, well below my normal resting rate of 60. "Why is my heart rate so low?" I asked Jasper and Dr. Kent. They glanced at the monitor displaying my vital signs and one of them commented: "Oh, your blood pressure is low, too." The bipivucane seemed to be moving up my spine. "Are you feeling nauseated?" They sat me up a little so gravity would keep the anesthetic down and gave me some ephedrine (a stimulant) to increase my blood pressure and heart rate. My body tried to vomit a few times but nothing came out (I hadn't eaten nor drank for 12 hours, as instructed). When the ephedrine kicked in, I immediately felt better and my heart returned to a normal rate.

The Surgery: Jasper put one of the monitors displaying from the arthroscopic camera just to my right. I could follow fairly well because I had already read about the procedure in "Techniques in Knee Surgery":

Both Dr. Larson and his assitant Dr. Ivory Larry made occassional comments for my benefit to fill in the gaps and confirm my guesses. The staff had tried to make a movie of the surgery to give me to take home on a CD but unfortunately they didn't get the equipment working until the end of the surgery. The drilling wasn't nearly as creepy as I though it would be, probably because the drill was a lot smaller and quieter than I'd imagined. Everything went smoothly.

Modern Frankenstein: My new ACL is an allograft, that is, a a tibial tendon taken from a cadaver and processed to remove cellular markers that could cause my body to reject the implant. Because an allograft does not require using one of my own body parts, the overall injury to my body is less than if the graft were taken from my own hamstring or patellar ligament. The processing of the tissue results in the implant being just a bunch of collagen (protein) fibers, not living cells. These fibers form a matrix which my body will repopulate with my own cells, to create a living ligment that can be repaired by the body like any other ligament. It's kind of amazing that my body will bring back to life what once was dead.

By the time the curtain came down and I could see my leg, the surgeon was gone and only two surgical assistants remained. I watched them lift my leg up and pull a long stocking onto it, for compression and thus reduced swelling. I knew the limb was mine but because I couldn't feel it (not even proprioception, which I had had during my previous surgery) it seemed foreign. They velcroed my leg into a splint that would hold it almost straight (at 10 degrees) for the next week. I was lifted onto a slightly wider bed with wheels and Jasper wheeled me from the OR to the recovery room.

The Recovery: I saw Daisy (previously featured in my meniscus story) in the recovery room, but Holly was assigned to be my nurse this time. She had another patient as well so I mostly occupied myself by reading a Scientific American that she'd found for me. She kept asking me not to drink too much since bladder muscles are some of the last to reawaken after a spinal, but I nonetheless managed to fill my bladder. I figured a catheter was simpler than hobbling to a toilet with my IV and electrodes on my chest so -- like last time -- the nurse peed for me. When I was able to walk, they called my dad and let me go home. Since I had been given no sedatives whatsoever, I was allowed to sign my release papers myself. Usually, the person picking up the patient signs.

The Timing:

• 7:30am -- arrive at UW Surgery Pavilion.
• 9:30am -- surgery begins
• 11:00am -- surgery ends
• 1:00pm -- I can walk
• 1:30pm -- go home

Conclusion: I can (again) recommend the UW Medical Center as a great place to take your next surgical vacation.

More on my surgery:

• Diagrams and arthroscopic photos, showing how the graft is fixated to the femur and tibia to create a new ligament.
• Post-op rate of recovery after ACL surgery with allograft.
• My drugs.

...and on my previous surgery:

• Five months earlier, I had surgery to repair a torn meniscus in the left knee.