Earth Experiences #5: The Follow-Up Appointment

Or "How I Failed My Knee Replacement Surgery"

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It’s been two weeks and six days since my knee replacement surgery. I’ve been doing everything I was instructed to do: attend physical therapy, do PT exercises at home every day, walk, wear my compression socks, take my medications as instructed.

Yesterday at PT, I rode the bike backwards and forwards with full rotations for five minutes. I did one-legged leg presses. I asked my PT if I was “winning PT,” and she said, “Absolutely! You get the gold!”

Today, I had a follow-up with my surgeon’s PA. She was rude and cold the second she came through the door.

“Are you still taking your meds?” she asked.

“No,” I answered. “I stopped them after the initial prescriptions ran out. I did refill the Oxycodone, but I only use it as needed, and that’s only been twice.”

She dropped her head to her chest like I had just told her I’d run over her puppy.

“You’re supposed to stay on them,” she said.

“Then why did my prescriptions expire?” I asked.

“You’re supposed to call for refills.”

“I thought that was only if I needed them. I don’t want to stay on narcotics for very long.”

“You need them to successfully complete your PT,” she said.

“Okay,” I answered. “I wish I would have known that was a ‘must do’ instead of a ‘do as needed’ instruction.”

“Show me how far you can bend your leg,” she said.

I proudly straightened it out.

“Great,” she said. “Now let me see how far you can bend it back.”

I sat up in my chair and pulled my foot back as far as I could without pain. My guess is that it was at about 85 degrees.

“Can you go any farther?” she asked, shoving my foot back hard with her hand. My estimate is that she shoved it back to about 100 degrees. Searing pain shot through my entire body and tears filled my eyes.

“I guess I can,” I laughed because humor is how I combat any kind of pain.

“How many times a week are you going to PT?” she asked.

“Twice,” I answered.

She dropped her head again like a disappointed parent.

“You need to be going three times a week.”

“Okay,” I said. “I’m happy to go as many times as you think I should, but I think my insurance only covered eight visits. My PT thought it was better to work with me longer rather than crunch all my visits into a shorter time, so she scheduled me that way. And she’s always instructed me not to push myself into pain, so that’s how I’ve been working through my appointments.”

“I’m writing you another prescription for PT,” she said. “Eight more visits. I want you in there three times a week. And take your Oxy before you go so you can push yourself harder.”

At this point, I was in a ridiculous amount of throbbing pain, and I felt like a total failure. Her tone was condescending and rude, and I had come into this appointment thinking I had done everything I was supposed to do.

“Can you come back in on September 10?” she asked.

“I can’t,” I said. “We’ll be in St. Pete that week, caring for my stepdad who has Alzheimer’s.”

Once more, the head drop.

“I’ll stay with Bobby and you can stay home and go to PT,” Julie offered.

“No, that’s crazy,” I said.

I turned back to the PA. “Can I schedule three sessions in St. Pete?” I asked.

“No,” she said. “You can’t.”

She tapped something into her computer, turned around and said to me, “You’re dancing right on the edge of needing a manipulation.”

“What’s that?” I asked.

“It’s basically a second surgery, but it’s non-invasive. We put you to sleep, then we forcefully move your knee into the position we want it to be in.” She used her hands to indicate how forcefully she meant. “And then you’re basically starting from scratch with meds and PT and recovery.”

I’d begun this appointment feeling good about the progress I’d made. I had come prepared with a list of questions whose answers would frame how I’d continue my progress. They were:

1. Is my incision at any risk of splitting, or is it okay to bend it as forcefully as I need to? (I’ve been worried about pushing too hard too fast for fear of backsliding. It still looks a little unhealed and fragile to me.)

2. When I try to lay on my side, I still have a lot of pain. Is that normal? Can I injure something if I continue trying?

3. Is there anything I can do to put the entire surgery at risk or should I push as hard as I can? (I've never had anything artificial put into my body. I don’t know what the recovery protocol is on that.)

But seriously, doesn’t this look like it could still pop open if I bent it too far? Wouldn’t you be worried, too?

I’d been waiting for this appointment so I could clear myself to keep moving forward with speed and strength. I’m a competitor. Give me a goal, and I’ll crush it. Tell me you want my knee at 110 degrees by week four, and I’ll kick my butt with my heel. I’m not afraid of pain. But no one told me that I was supposed to reach 110 degrees by now. I did everything I was instructed to do, but I can’t reach a goal that no one has set for me.

When I’m angry, I cry first, so I was full-on crying now. I was being reprimanded and threatened with another surgery. I was being told I scheduled my PT wrong when no one ever told me what was right. I was being told I should not travel to take care of my stepdad when I’d already committed to it months before.

I was being told, basically, that I’d failed my post-operative recovery.

The PA noticed my tears and said, “Sometimes you need a little tough love.”

If I was a woman who could endure conflict, I would have said in response: “No, actually, sometimes what you need are clear post-op instructions and goals. I did everything I was told to do. I cannot be expected to know how to do this on my first go-round without guidance. It’s your job to inform me, and it’s also your job to have some compassion with your patients.”

But, of course, I didn’t say any of those things because I am an Olympic-level conflict avoider.

I am now scheduled for a follow-up on September 16, and if I fail that examination, I have my “manipulation” scheduled for September 18 with my surgeon. You’d better believe I will show up to that September 16th appointment with my left leg wrapped around my head. Twice.

That’s five and a half weeks after my initial surgery.

If I was supposed to be at 110 degrees at five and a half weeks, someone sure as shit should have said so before now.

And if someone dropped the ball, PA, here’s a thought for you: How about some kindness instead of rudeness and blame? How about remembering that I’m a human being who just went through a major surgery that I’ve never had before? How about thinking about the fact that you see multiple knee replacements every day, but I have only had one? So, maybe begin with some compassionate education instead of an accusatory berating?

Sheesh.

And here’s another question for you, PA: Want to meet me on the pickleball court in October? I’ll show you just how competitive I am.

Kindness, people. It’s not that hard.