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Luke
The morning of my release, I sat with Cassie in the fluorescent cafeteria behind weak cups of coffee. We held each other’s sweaty hands, gazing at a quietly wheezing Yarvis, my surgeon, Dr. Rosen, and Fern, a young woman from the Quality of Life Foundation with glasses and black dreadlocks wrapped into a bun.
I had taken OxyContin this morning, and was resisting taking another one, though my leg was sore down to the bone from physical therapy and the doctor palpating it to check my progress. I wanted to be able to listen, to be present. The surgeon’s jargon was making that hard, words like distal third tibia and fibula and fractured patella washing over me in a dull blur.
“Since we were able to fuse the patella, we’ll just be looking to avoid nerve damage, atrophy in the quad muscle, and possibly cartilage fusing your knee in a straight position. But you’ve been progressing pretty well with flexibility, it looks like, so that doesn’t seem to be too much of a risk.”
That last part I understood. Yarvis muttered, “Atta kid.”
“Now that your patella has begun to heal, we’ll move on from the static quadriceps exercises you’ve been doing to knee flexion. The idea is to get you partially weight bearing with support, then gradually weight bearing once we see little periosteal callus on the twelve-week serial X-ray.”
“Per— callus?” I asked, wishing I had paid better attention when they showed me the X-rays the first time.
“A mass of tissue that forms at a fracture site to establish continuity between the bone ends. So, basically, the mushy glue holding your bones together. We want it to start disappearing as your bones heal.”
“So when that disappears, I get out of the wheelchair?”
“It depends.” Everything depended. “We want you to be up now, but not fully weight bearing. We’ll do a slower incremental increase in weight, bearing twenty-five percent, fifty percent, seventy-five percent, one hundred percent with a cane, then complete free bearing.”
A cane? Like an old man. At least I could move around on my own then. “So how long is that total?”
“We’re thinking twelve weeks initially, especially considering it’s not just the tibia and fibula but kneecap as well, and you came in right after Thanksgiving? Now we’re in week, what, six? Probably another eight for physio, just to be safe. Keep in mind if you are diabetic or if you smoke, you may be slower to heal, but...” He glanced at my chart. “It doesn’t look like that will be a factor, right?”
“I quit,” I said, avoiding his eyes.
“And I’m the only diabetic in this household,” Cassie said with a wry smile. The doctor ignored the joke.
“Great. So. I wrote all this down, but I’ll just tell you now, too, because this is important. Your knee will naturally tend to slip out of place, but we have to keep these distinct parts as close together as possible while they heal. To prevent slipping, don’t experiment by putting more pressure on that leg than what the plan lays out here. Whenever you give more unexpected pressure, there will be more pain.” Dr. Rosen tapped the table. “And with that in mind, stay the course with OxyContin but don’t take more than prescribed.”
I was quick to say “Of course.” Dr. Rosen looked at me through his bifocals. My gut clenched. Maybe my answer was too quick.
“Not only because it’s addictive, but because you need to know what your pain limit is. Pain is the alert system for slippage.”
More like pain was the alert system for everything. Wake up: Hey, this sucks. Move: Hey, this sucks, too. Think: Hey, did I mention how much this sucks? “Got it. Thank you, sir.”
He shook our hands and wished us luck. We turned to Yarvis and the woman, Fern, beside us, who were muttering together over another stack of paper.
Yarvis nodded and Fern began to speak. Very fast.
“So, a little about us. After a family completes a brief enrollment process which includes signing a few forms, providing contact information for their appropriate VA case manager—”
“Is that you?” Cassie interrupted, looking at Yarvis.
“No, I just work for the hospital. You gotta register down at the VA for one of their caseworkers.”
“Right,” Fern continued. “Anyway, we’d get a rundown on your financial situation. Then we assign a support coordinator. The SC then contacts the family caregiver and begins to develop an understanding of the family’s unique situation.”
“Do you have a caregiver lined up?” Yarvis asked.
Cassie and I looked at each other. “You mean, like a nurse?” Cassie asked.
“No,” I answered. “We don’t.”
“Not yet,” Cassie added.
“But all that sounds great.” I swallowed, hoping that was the right thing to say.
Fern nodded. “Then we leverage available resources from government, nonprofit, and community organizations. The SC reaches out to the resource, describes the family’s situation, ensures a solution is available, and then serves as an ongoing advocate until the solution is delivered.”
