Live from Landstuhl

While we are stuck up here at Landstuhl, I thought I would write about the journey we have had with Nathan's knee, also known as The Knee That Has Consumed Our Lives. Just a warning, there are a lot of words to follow and no pictures.

This little (sarcasm!) recap is not for the faint of heart!

Surgery -1 Day

On January 4th, we drove up to Landstuhl for Nathan's Pre-Op appointments. We first met with the surgeon, Dr. Ahmed, and then we had to check in for Nathan's surgery. They assigned him crutches and we met with the anesthesiologist, where Nathan opted for a pain block (numbed leg post surgery) in addition to general anesthesia. Afterwards, we bought an ice pack at the Ramstein BX, ate lunch at Macaroni Grill, took a nap in our awesome and insanely cheap hotel room, watched Mission Impossible 4, and then went for dinner at Chili's. Nathan's surgery was scheduled for 6:15am the next morning, which meant we had to be up at 4:30am in order to check out of the hotel and get to the hospital in time. After watching a soccer game and reading a little from Unbroken to calm his nerves, we went to bed.

Surgery

We were up early and at the hospital by 6am. We waited in the APU (Ambulatory Procedure Unit) waiting room for a little while before the nurse brought us back into a room. They gave Nathan a gown and socks and took his vitals/double checked which leg was being operated on. The socks they gave him had grips on the top and bottom sides of the sock. The nurse said he calls them 4-wheel drive haha. At about 7:30am, I said goodbye to him and he was off to see the anesthesiologist. I grabbed coffee at the Java Cafe and then hung out in the waiting room, reading and sleeping a little. Dr. Ahmed came in after the surgery was over, around 11:00am to show me the pictures they took inside Nathan's knee. His ACL was, indeed, ruptured. This might sound weird, but it was a relief. It was good to know that the surgery was a necessity and to see the reason God lead Nathan to undergo this invasive procedure. Dr. Ahmed said everything had gone well and that the nurse would come in to get me once Nathan woke up. I went down to the pharmacy and picked up his prescriptions. About an hour later, he passed by the waiting room door in a wheeled hospital bed pushed by a nurse. I grabbed my stuff and followed them into a room in APU. Nathan actually ended up sharing a room there with one of his coworkers, Sergeant Adam Gradyan, who had a hernia operation just a little after Nathan had his knee surgery. Before being able to go home, we had to wait for a few release requirements. They proved a little hard to meet due to the effects of the pain block he had received and the nausea the general anesthesia induced. Nathan was not happy to be held there. He kept telling me he just wanted to go home and the nurses to leave him alone. During that time, they came in to fit him with a brace. Their cut off for admitting him over night in the hospital was 8pm. We were both relieved when he finally met all requirements around 5pm. By the time we got home, it was 7:30pm and Major Gipson had driven over to help Nathan get up the stairs to our apartment. That night began a routine of icing his knee every 30 minutes and taking medication every 4 hours with a snack.

Surgery +1 Week

The first week we joked was much like having a newborn. Meds every 4 hours, ice multiple times an hour, and Nathan could do nothing on his own. On Saturday night, we realized his pain medication was going to run out by the next evening and he had no refills. He was still in horrible pain and even taking his meds wasn't providing much relief. I made a bunch of frantic phone calls trying to remedy the problem. We ended up going with the prescription dose of ibuprofen, but the pain luckily decreased on it's own on Sunday afternoon. We unwrapped his knee and removed the dressing on Sunday. I had prepared myself for his knee to look much worse than it did. It was swollen and he had incisions & stitches, but it wasn't too ugly. He was able to take a shower, although it was agonizing. On Monday afternoon, we went to his first physical therapy appointment in Heidelberg. He met with Captain Froehlich, the therapist, who assessed his initial range of motion. Nathan aced it. He was able to straighten his leg out to 0 degrees and bend it to 90 degrees. Just for a reference, that is the average goal 10 days after surgery. Nathan was only 4 days out of surgery. My man is super disciplined : ) He followed the exact orders of Dr. Ahmed and kept his knee elevated on pillows that were under his ankle, which most people don't do because it's uncomfortable. That week I subbed two days, which I had accepted prior to Nathan's surgery. We didn't realize how dependent he was going to need to be on me. I felt horrible leaving him alone for most of the day. He told me pitiful tales of crutching his way to kitchen to get food and having to eat while sitting on the kitchen floor because he couldn't carry anything back with him into the bedroom since he needed to use both crutches. It was awful, but it's a good thing he's so determined. Sometime during that first week Major Gipson brought us paella from the Spanish restaurant we love in Schwetzingen. He and Heather have been so great to always be helpful and available to us.

Surgery +2 Weeks

Nathan continued physical therapy at home and twice a week at the Heidelberg clinic. He was recovering very well. He had his two week follow up appointment on Thursday, the 19th. He met with a colleague of Dr. Ahmed and was given the thumbs up on his progress. And then it happened. We had driven home from Landstuhl. It had been a rainy day. Nathan crutched his way from the car to the entrance of our apartment. I unlocked the door and then continued up the flight of stairs to unlock the door to our apartment. I heard Nathan give a little yelp and I asked if he was ok. He said he had slipped a little and maybe pulled his hamstring, but that he was ok. He made it up the stairs and into our bed without much of a problem. He talked to Sean for a few hours and I made dinner. We ate together in the living room and then he got up to go into our bathroom. Immediately he was in extreme pain and noticed extreme swelling just above his knee. He made it to our bed and we iced/elevated it. Nothing seemed to stem the pain or the swelling. We assumed it would resolve soon though.

Surgery +3 Weeks

Friday morning Nathan called up to Dr. Ahmed's office and spoke with his nurse, Virginia. He let her know about the incident from the afternoon before and asked her if he should be concerned. She recommended we continue icing and elevating it. We did just that over the weekend to no avail. Nathan called up to Dr. Ahmed's office again on Monday morning since we had not seen any change. They again recommended we just ice and elevate it. By Monday afternoon, we were starting to worry that something serious was going on and by Monday evening we were tossing around the idea of driving up to the ER at Landstuhl, an hour and a half away. Part of us was concerned about possible blood clots or infection, but the other part was afraid we were making a big deal out of nothing. We asked for God to make it clear to us what we should do around 8:30pm, and by 9pm Nathan said he was sure we should make the trip to the ER. I drove; Nathan was in agonizing pain the entire way. We made it into the ER around 10:30pm and within minutes found out that he had a fever, indication of an infection. Nathan had a tiny smile on his face as they wheeled him into a room. He was happy that our trip there had not been pointless. Once in the room, they gave him strong pain medication and the doctor ordered him to have blood drawn and x-rays taken. They had the on-call orthopedic surgeon come in around 2am to assess Nathan's knee. He wanted to withdraw some of the fluid to see what it consisted of and to have it tested for infection. He plunged a gauged needle into the most swollen part of Nathan's knee. Over and over and over. The surgeon wasn't able to extract any fluid for the longest time. Finally he hit the spot and the syringe filled up with blood. Nathan said later it was the worst pain he has ever been in. The surgeon said just based on looking at what he had extracted, Nathan didn't have an infection and that it looked like normal blood. Eventually all of the tests they had run to test for infection had come back from the lab and indicated Nathan was not carrying an infection in his knee. They did mention that his white blood cell count was a little elevated, but not above the threshold for infection. They released him at 5am with the diagnosis of hemarthrosis, or blood pooling in a joint. The explanation seemed valid enough. When Nathan's crutch slipped out from under him and he put his injured leg down to steady himself, he pulled his hamstring and the blood from that pulled muscle had pooled in his knee. Ice and elevation and time were the cure. They told us to notify Dr. Ahmed and said that he would probably want to see Nathan later that week, when the blood cultures were finished incubating. I drove us home after getting no sleep and we made it home safe and sound at 7am. I made plans to have someone take over facilitating my Bible study group that morning at PWOC and Nathan and I prepared to go to bed. At 8am, after I had had 45 minutes of sleep, Nathan's phone rang. It was Virginia. She told Nathan they had received word that he had been in the ER the previous night and wanted to see him right away. As in drive back up to Landstuhl right then. I just about lost it. Nathan tried many times to explain the tests that had just been run on him in the ER and that I had had only 45 minutes of sleep, but Virginia was insistent that we come up immediately and kept emphasizing the possible necessity of emergency surgery in case of infection. We surrendered to the insanity of it all and slept for 2 hours. When we woke up, Nathan's commander's wife, Theresa had called and left me a message saying they were going to get someone from the squadron to drive us up to Landstuhl. We were so grateful. Sergeant Gradyan (Nathan's surgery roommate from a few weeks earlier) showed up soon after and the three of us made yet another trip to Landstuhl. We met with Dr. Ahmed and ascertained that he had not been informed of all the tests that had been run hours before in the ER. He said hemarthrosis seemed to be a good diagnosis and said he would let us know later in the week if anything grew in the blood culture that had been taken. We were able to get his pain med prescription switched from Percocet to Vicodin, which turned out to be much better for Nathan. After we made it back home and I took a nap, I had a meltdown. We were out of water and had no food in the house save for mac'n'cheese. Oh and I had had like four hours of sleep. Lack of sleep has always lead to my inability to control my emotions. Fortunately I have an understanding and patient husband who convinced me that no water and mac'n'cheese for dinner were not reasons to lose it. Later that week, we received word that nothing had grown in Nathan's blood culture. We had a follow up appointment with Dr. Ahmed the following Wednesday, one day shy of 4 weeks post-op. The swelling in Nathan's knee had not budged, he was still in lots of pain, and he had been unable to do much therapy. Dr. Ahmed decided to aspirate (removed the fluid) Nathan's knee. Nathan was immediately nervous and asking if there was any other option since he could recall his experience in the ER all too well. Dr. Ahmed said they had some numbing spray and that he would be gentle. There wasn't much choice. So I stood in there with him while Dr. Ahmed removed enough fluid to fill almost 6 big syringes. It was mostly cloudy, yellow fluid with a little bit of blood. A lot different from what had been removed while in the ER over a week prior, but much less painful. Dr. Ahmed explained that something had bled in Nathan's knee, not his hamstring, and that his body had responded by pushing fluid down there. They extended his convalescent leave another 2 weeks, to February 16th, since he was due to go back to work five days later, on the 6th. We had another appointment the following Wednesday to follow up yet again.

Surgery +4 Weeks

The first few days after having the fluid removed from his knee, Nathan felt a lot better. He was able to do a little more therapy than he had been, but the swelling soon returned and even started to move into his calf. The only thing that has freaked me out throughout this entire knee thing has been his fingers leaving indentations on his calf when he touched it. Downright scary. On Monday, Nathan called up to Dr. Ahmed's office and made an appointment for Wednesday. We assumed they would drain it again, but also hoped they would start to look for the cause of the constant swelling and for a different solution. On Wednesday, we drove up to Landstuhl and Dr. Ahmed again drained more fluid from Nathan's knee. He said he was beginning to be concerned because the picture was confusing. The fluid was continuing to come, but there had been no sign of infection or any other kind of complication. He sent the fluid down for another culture and ordered Nathan more blood tests. The blood tests revealed a white blood cell count that indicated infection. Dr. Ahmed said it was still highly confusing and that he was going to have to treat Nathan's knee as infected from here on out. That meant he was going to put Nathan in for emergency surgery to clean out his knee that evening and that Nathan would have to remain in the hospital for 5 days. Dr. Ahmed's assistant, Sergeant Gomez (nicest guy ever!) immediately called the Fisher House to see if they had room for me. The Fisher House is on the base, right across the street from the hospital. They only had room to accommodate me because a little girl's surgery was cancelled and so her family didn't need the room anymore. I am so grateful that God provided me a room there. Otherwise I would have had to try to get a room at Ramstein, or drive all the way to and from home every day. Or I guess I could have just left Nathan at the hospital alone. Nah. I never could have done that. Not in a million years. At 6pm they had Nathan in x-rays and by 6:30pm we were in the pre-surgery holding room. We could see straight across the hall into the operating room. It gave me the chills. It was bright and white and looked extremely cold. And there was a lady cleaning up a massive amount of blood on the floor. Creepy. So we waited in that room almost an hour while they prepped the operating room and the anesthesiologist got Nathan set up for general anesthesia. He was ready to get the anesthesia going because he had been in extreme pain all day and had nothing to eat, except for breakfast early that morning and a handful of Cheez-Its around noon. The man was suffering. When they finally took him into the operating room, I went down to the Food Court and got Burger King. They had told me the procedure would take about 30 minutes, so I figured by the time I went down and came back with my food and ate in the waiting room, they would be in to get me. Nope. About 2 hours later, Dr. Ahmed came in with more pictures of Nathan's knee. He said the good news was that everything went well in cleaning out his knee and that the best news was that his cartilage was in great shape, which was a concern due to the prolonged fluid in his joint. He said that was the one thing he couldn't fix, so it was good it wasn't damaged. Then he said he had bad news. I had no idea what he could possibly say. He hit me with a whammy. He showed me a picture of Nathan's ACL graft. He said it was extremely loose and therefore useless. What he was about to say next was slowly coming to my brain. He would likely have to redo the knee surgery. I sank. I did not want to break this news to Nathan. A little while later, the nurse came to get me and said I could go into the room where they let the patients wake up from surgery. She said it was alright for me to be in there since they would be moving him soon and he was the only one in there. As soon as I walked up to his bed, Nathan said, "They removed my graft." I thought he was still a little crazy from the anesthesia, so I just kind of brushed his comment off with a soft "No, they didn't" hoping to push breaking the bad news to him when he was more coherent. The nurse said, "Oh yeah they did. That's what the surgeon told us." I thought she must have misunderstood something. Nowhere was "graft removed" in my conversation with Dr. Ahmed. The nurses wheeled him up to 10 Delta, a unit in the hospital for surgical nursing care. They got him set up and brought him dinner. I stayed with him for a while before he fell asleep and had to tell him his graft was useless and that they would likely have to redo his surgery. He took it much better than I had expected and we didn't talk about it too much. Since I had nothing with me, I had to ask the nurse before I left for contact lens solution, the one thing I can't do without. She brought me sodium chloride syringes (for IVs) and urine sample cups haha. It worked really well!

Surgery +5 Weeks

Thursday marked the first day of Nathan's stint in the hospital. I went home late that morning to get clothes/toiletries, clean the house: do the dishes and move the laundry from the washer to the dryer, and to get the materials for teaching the preschoolers Sunday night and the materials for the women's Bible study I lead Tuesday mornings. Those things I left with Sasha so that she or someone else could sub for me. She's such a gem! While I was home doing all of that stuff, Nathan texted me and said Dr. Ahmed had come by to talk to him and said that they had, in fact, removed the graft and that his knee surgery would have to be redone once he had recovered from this "infection" and rehabbed his leg. So, The Knee That Has Consumed Our Lives is projected to continue consuming it for the next several months. The last few days here have gone by pretty fast and have been rather pleasant. I spend the day with Nathan. We can fit side by side in his bed and we just watch movies/The Big Bang Theory, read from the Bible and the book we just started: Crazy Love, and talk about anything and everything. The past two nights for dinner, I have driven down to Ramstein (about 20 minutes away) to get us food from Chili's. Nathan really enjoyed his chicken fried steak with mashed potatoes, gravy, corn and bread after eating mostly hospital food with a few supplements from Burger King : ) I stay until after midnight, then go to my room in the Fisher House to shower and sleep. Yesterday Nathan noticed a sign on the wall near the nurse's station that states visiting hours are from 10am to 8pm. We laughed. They have never said anything to me or even looked at me funny. In fact, if I have not arrived yet or have gone out to get food, Nathan said they ask where I am heehee. The Infectious Disease doctor comes by every day to tell Nathan there still isn't anything growing in his cultures. We aren't surprised. They put in a PIC line (long term IV that runs up your arm, across your chest, into one of the large veins near your heart) in his left arm and started him on general antibiotics. They say he will have to have antibiotics run through his PIC line every day for the next several weeks. It could be anywhere from a few to 6 weeks. They received approval for him to get his antibiotics at the Family Practice Clinic in Heidelberg during the week, but we will have to drive up here on Saturdays and Sundays for it. We are supposed to be released to go home tomorrow. We are really hoping that happens.

I have to say, God has really used these last almost six weeks to change both of us. It has been amazing to see Him so clearly stretch us and and take care of us. To be so near us. We have been praying we will not forget what He has taught and shown us once all of this is finally over.