Wednesday, January 15, 2014

Ballad of the Fleshy Thigh

We’ve all been there. We wait breathlessly for that BIG MOMENT, the instant that will change everything. A wedding, a graduation, the birth of a child . . . these events draw bold lines through our lives. On one side of the line is the way we used to live, and on the other is a completely new way of seeing life. Giving birth to my first child was a real mind-blower.  One instant I was writhing in agony thinking I want; I need; me, me, me . . . and the next a tiny, pink, screaming human being was placed in my arms. In the blink of an eye I had become someone’s mother. It wasn’t about me anymore. It was about him — what he wanted and needed. And two years later, it also would be about her, my daughter, an even tinier, pinker, louder human placed in my arms.
Being felled by a killer infection was another BIG MOMENT, though not a joyful one and sure as hell not one I anticipated breathlessly. Let’s be real. If I’d known what was coming I’d have doubled-down on disability insurance, taken a trip around the world, and dumped the soulless hottie in advance. Plus, I would’ve cleaned my house and caught up on the laundry, since nearly dying when your house is a mess is akin to being in an accident while wearing old underwear. But no. Advance notice wasn’t an option. In fact, part of why mental heath providers came up with the term “catastrophic life event” to describe this kind of thing is because no one expects it will happen to them. You know, kind of like the Spanish Inquisition.
So there I was, mostly dead in a hospital bed, knowing on some level that my life had just been divided in two: everything that had come before this illness and everything that would come after. In the beginning, I didn’t worry about the “after” part. I only wanted to live. Each day was a battle to survive, even if the war was waged semi-consciously in the depths of my own mind. But as time went on and my awareness increased, the fears tried to take over. I pushed them back. Seriously, why worry about the theoretical difficulties of my future one-legged life when I could barely sit up in bed? Why fret about whether I could continue to make a living as a writer when I referred to my cell phone as a “television?” Why get myself worked up about my bills when I couldn’t remember the name of my bank, my street, or the publishing house I’d been with for a decade?
I remember telling my loved ones that being critically ill had reduced the million-and-one details of life into a single pinpoint of truth: I am still alive and so are you. The rest didn’t matter. Material things can be replaced or released. Situations can be altered. So what if I wouldn’t be able to come up with my mortgage payment six months down the line? So what if I missed my next book deadline, and the one after that – and the one after that? So what if my health insurance only paid some of my humongous hospital bill? There wasn’t a damn thing I’d ever be able to do about any of it until I got well.
And slowly – s-l-o-w-l-y – I did start to get well. After months of hospitalization and dozens of surgical procedures, I finally got the green light for what I had decided would be the BIG MOMENT to end all BIG MOMENTS: A skin graft.
In the early hours of February 12, 2012, the trauma surgery resident and his entourage came into my room to examine my amputation site. I held my breath. Nearly every morning for the prior two weeks (since I’d returned from my near-death sabbatical at Dr. Kevorkian’s Party Palace) doctors had checked the wound to see if it was healed and dry enough to close with a layer of my own skin. And every time the answer had been an unqualified “no.”
But on this morning, the surgical resident’s eyebrows shot up with surprise. “It’s looking real good. Let’s see what Dr. O’Toole thinks.”
I peered into the hallway, expecting to see the orthopedic trauma surgeon who headed up my treatment team. He wasn’t there. I listened, but didn’t hear his voice. I turned to the resident. “Is he here this morning?”
“Nah,” he said, pulling out his iPhone. He then took several flash photos of my amputation site from a variety of angles and forwarded them to Dr. Robert O’Toole.
I kid you not. Which got me thinking . . . if texting photos of our scantily clad bodies is called “sexting,” what should we call this? “Diagnexting?”
So as we all waited for the chime of an incoming text, I wondered . . . could this be it? Dare I hope? Am I finally on my way out of this damn hospital?
The resident read Dr. O’Toole’s response and then smiled at me. “He says you’re ready. We just have to reserve the O.R.”
I wanted to dance. I wanted to cry. I wanted to call everyone I knew to tell them the BIG MOMENT had finally arrived! I was so freakin’ excited!
Then, doctors started giving me the particulars of the surgery. I learned exactly where they were going to get this so-called “skin flap” and exactly how they planned to get it. My enthusiasm came to a screeching halt. It turned out the “split-thickness skin graft” procedure required large segments of skin of varying thicknesses to be peeled off the top of my healthy thigh with something resembling a cheese slicer.
Oh, holy shit. That sounded painful.

Cheese Slicer

The resident added, “Unfortunately, many patients say that the skin harvesting site is more painful than the surgery itself.”
Now, that was hard to believe.
“Luckily, your upper thigh is quite large.”
“Excuse me?” I wasn't sure I could handle any more of this conversation. Not only had I just learned I’d be carved up like a Virginia ham, but I had been informed that I was built like one, too.
“Uh.” He laughed nervously. “What I meant to say is that you have ample flesh on your thigh. We’ll be able to harvest the entire flap from one location. Patients with smaller thighs sometimes have to have segments removed from other locations as well.”
Well, damn. I knew there was a reason I’d always been blessed with fleshy thighs!

My Sliced-Up Fleshy Thigh, at the Gym
Four Months Post-Surgery

Two days later, on Valentine’s Day, 2012, I had my final surgery at University of Maryland Medical Center. When Dr. O’Toole checked on me the next morning, he said everything went extremely well and the graft looked perfect. But he cautioned that skin grafts don’t always take. Healing can be uneven and additional surgeries are often required, he said.
I remember thinking – not this girl, Dr. Bob. That graft is going to hold and I’m gettin’ the hell outta here!
It wasn’t long until I found myself in a familiar pickle. My insurance company wanted me moved from Shock Trauma, and they were going to ship me off to a nursing home unless I could prove I was ready for physical therapy at my local hospital.
I remember sitting on the edge of the hospital bed talking with my sweet and kind University of Maryland physical therapist. Despite the meds, my pain was so severe I thought I was going to throw up. And though what remained of my left leg was swaddled tighter than a Russian newborn, lightening-hot flashes of pain raced through my body. But that was nothing compared to what was going on with my Virginia ham thigh. The surgical resident had been correct – that sucker hurt worse than anything I had ever experienced in my life.
I glanced down at my right leg. The top of the thigh was covered in a rectangle of sticky, yellowish gauze rimmed in blood. Nurses had already explained to me that the substance was called “Tagamet,” and it accelerated healing by bonding to the exposed flesh beneath. As the wound site healed, the gauze would dry out and peel away, the nurses told me.
All I knew was that every time I inhaled or exhaled – every time I coughed or moved or got up to use the bedside commode – the substance would tug at the raw flesh underneath. The pain would leave me breathless. Blood would seep out around the edges. It would hurt so much I thought I would faint.
And now my insurance company wanted me to get up and jump around on this excruciating mofo?
I looked at my physical therapist. “Exactly what do I have to do to qualify for the rehab unit?”
She smiled at me apologetically. “Well, I have to be able to document that you stood up, held onto the walker, and took one step forward.”
I was having Déjà vu, big time.
           So, I had a choice to make. I could admit defeat and let them ship me off to another nursing home, or, I could just take a deep breath and get up, grab the walker, and get this shit over with. But my mind would have to be stronger than the pain, at least for a few seconds, and I wasn’t sure I could pull it off. This pain was the real deal, and everything I’d been through had left me physically, emotionally, and psychologically depleted. But maybe if I reached deep enough, I’d find just a little more strength left.
It was a very BIG MOMENT. I grabbed onto the walker and hoisted myself up on a numb and weak right leg. Rivulets of blood ran down my shin. I trembled from head to toe. The pain was so awful it knocked the wind from me.
But I did it.
Nearly two years have passed, and I look back on that version of myself with bittersweet compassion. I was brave. I was stubborn. I would do anything to get out of the hospital and through rehab so that I could go home. That had become the BIGGEST MOMENT of them all, because I believed that once I got home the worst of this nightmare would be behind me.
It’s a good thing I was naïve. If I’d known the truth – that getting “the worst” behind me would be a minute-by-minute, day-by-day battle that would continue for years – I might have chosen the nursing home.
I might be there still.


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