Fractured

The patient is a very pleasant 54-year-old female
with chief complaint of left knee injury.
She fell.
Bryn Mawr Hospital operative report #1201883, June 26, 2017

* * *

Genesis. Humpty Dumpty. Harry Potter. The tale begins with a rupture: the exile from Eden, the irreparable fracture, the lightning-shaped scar. A jagged seam from which the story spills. 

* * *

June 12, 2017, text to friends

Hey, dear ones, just wanted to update you on my adventures. I broke my kneecap at 4 o’clock this morning, and I’m now at Yale New Haven Hospital, in a leg immobilizer and with a shiny new pair of crutches, awaiting meds and discharge…I’m cleared to return to the conference if I promise to see an orthopedic surgeon when I get home. Tell me everything you know about bones and their ability to heal (well, one thing, anyway; I need some kind of boost at the moment).

* * *

On a muggy June Sunday, I tugged my roll-aboard from the New Haven train station to Yale University. I was back, three decades after graduating, for Thread, a conference for people who make their living telling stories. With an hour until check-in, I wandered up Chapel Street, down York, a once-gritty New Haven now boasting kombucha and organic oatmeal.

Landmarks uncapped memory: Viva Zapata, where I drank half a pitcher of sangria and stumbled home with a man I didn’t really want to kiss. The paths of Old Campus, where I wandered on Saturday nights, eating chocolate covered peanuts as if they could cure my loneliness. The Yale Daily News building, where a sophomore copy editor blistered my first article with bright red ink.

The next morning, nudged from sleep by a full bladder, I slid from my semi-loft bed to the slightly lower window seat. I hopped. And then I was curled on the wood floor, breathing hard, my left knee torched with pain.

In the bathroom, I nearly passed out in a humid wave of shock. Somehow, I managed to wipe, flush and hobble back to bed. Over the next 90 minutes, my knee swelled and purpled; when I touched, it felt nothing like my other knee. No hard hat of bone. Just a small, sickening chasm.

* * *

From Wikipedia

The patella, also known as the kneecap, is a thick, circular-triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint…Babies are born with a patella of soft cartilage which begins to ossify into bone at about three years of age…In 2017 it was discovered that frogs have kneecaps, contrary to what was thought.

…In the Western world, “patella” originated in the late 17th century from the diminutive form of Latin “patina” or “patena” or “paten,” meaning shallow dish. The use of this term in Eastern medicine, however, predates the Western etymology. As early as the 13th century, traditional Ayurveda practitioners in the Indian subcontinent referred to the kneecap as “patella haddi,” literally “farmer’s bone” because of the grueling life of a patidar.

* * *

 At dawn, I called 911. Five hours later, I was still at Yale New Haven hospital—X-rayed, brusquely diagnosed (“Yep, you broke your kneecap”), outfitted with a leg immobilizer and injected with anti-coagulant, which I was instructed to shoot up twice a day to prevent a fatal blood clot. On my new crutches, my knee throbbing in its foam-and-Velcro carapace, I wobbled out of the hospital, into moist waves of summer heat, and called a cab. 

* * *

June 12 journal entry:

Things I am grateful for:

• I did not drive to New Haven—because, clearly, there will be no driving for a while, especially not in my manual-shift Honda Fit.

•   I have enough upper-body strength to use crutches (though maybe I’m not using them right, because I already have raw, blistery patches under both armpits).

• The Americans with Disabilities Act insisted that my alma mater put elevators and ramps into every neo-Gothic building, including the accessible room to which the housing staff swiftly transferred me; my bathroom features a shower bench, a grab bar in the toilet stall and a door that swings open at a button’s touch, with a guttural moan, like something out of Hogwarts.

• I did not break my leg, just the patella (that shallow dish, that farmer’s bone).

• The resident did not say, “You need surgery this afternoon. Sign here.” Instead he said, “If it were me, I’d go back to the conference.”

* * *

I went back.

For the next three days, I hitched over flagstone paths, up and down curb cuts and through automatic doors. My new colleagues bussed my dishes, carried my coffee, dragged over an extra chair so I could prop my foot. They walked beside me at my painstaking new pace.

They told me stories: one woman had torn her calf muscle, skiing. Another crushed two toes on a Queen Anne chair while taking care of a friend’s cat. A third had a football injury and crutched through high school. Who knew there were so many walking wounded? It felt like X-ray vision: peering through people’s seemingly intact facades to their shattered, healing selves.

In one of our morning lectures, an instructor quoted Lutheran minister Nadia Bolz-Weber: “I only preach from my scars, not my wounds.” In my afternoon seminar, we talked about the “bones” of a story. A tale can be lean or flabby, fractured or fleshed out. If “dismember” means to divide limb from limb, then “re-membering” is a return, a convening of lost and disparate parts. Piecing the body together. Fusing fragments into narrative.

The story says: I lived to tell you this.          

* * *

June 21 journal entry

My kneecap, according to the MRI report, is deranged. And confused. No, actually, contused (it’s hard to decipher the faint print)—meaning capillaries have ruptured. Repairing it will involve three tunnels drilled in the larger chunk of my broken kneecap and internal sutures to lash the smaller, crumbly piece in place. After surgery, I will be in a brace, a fancy one with bells and whistles (or, at least, dials and hinges) that must stay on, twenty four hours a day, for the first six weeks. The surgeon says this in italics: You will not take it off. Not to shower. Not to sleep.

In the doctor’s waiting room are framed jerseys from Philadelphia’s major league teams: the Phillies, the Flyers, the Eagles. My surgeon gets professional athletes back on the gridiron, the pitcher’s mound. I only want to do what I did before: Run half-marathons. Walk upstairs with both feet. Kneel in the garden. Spoon my sweetheart at night.

* * *

 The Friday before surgery, I spoke to three different people at Bryn Mawr Hospital, including someone from Billing (“Most people prefer to put the $50 co-pay on their credit card rather than pay that morning.”) and someone from Pre-Surgery: Have you ever had cancer? Heart arrhythmia? Sleep apnea? Hepatitis? Have you been out of the country in the last three years? Have you been treated for anxiety or depression? Are you allergic to latex? To intravenous dye? To penicillin? Are you still menstruating?...Hmm. When was your last period?

My surgery was June 26, the second anniversary of the Supreme Court decision on marriage equality. I introduced Elissa to every member of the surgical team as my “spouse.” No one flinched, though the pre-op nurse looked sheepish when she handed me the pee cup for a pregnancy test.

An hour later, I was in my hospital peignoir of striped gown and dotted robe, body cleansed with warm anti-microbial washcloths, left knee autographed twice in black Sharpie with my surgeon’s initials. In the operating room—chilly, abuzz with people in baby-blue shower caps—I recited my name and birth date for the fifth time that morning. The anesthesiologist announced that she was going to undrape my left leg, and then everything went dark. 

* * *

The patient was identified in the preoperative holding area…After smooth induction of a femoral block and general anesthesia, tourniquet was applied and the left lower extremity was prepped and draped in usual sterile fashion.

A midline incision was made, carried down to the level of patella…We encountered the patella avulsion fracture. The patella tendon was still attached to the avulsion piece. We irrigated copiously. 

* * *

I didn’t cry when I broke my kneecap. I didn’t cry when I hobble-hopped down the spiral stairs of Trumbull College because trying to sit in the EMTs’ ambulance chair sent white-hot hatchets of pain through my left leg.

I didn’t even cry the morning following surgery, when the femoral nerve block wore off and, contrary to everyone’s advice, I took only half the prescribed dose of oxycodone and spent the next two-and-a-half hours writhing like a junkie, trying to crawl away from the pain like an animal gnawing my knee like burnt metal rods being shoved down my calf checking my watch every seven minutes because nothing, not The Hamilton Mixtape, or counting my breaths 10-9-8-7-6, or sending my knee rose-colored light, or blue watery light, or fucking golden angel light or gritting my jaw until it pulsed in time with the pain in my knee—radiating hotly, dangerously, relentlessly. None of it helped. Until finally it was 9 a.m. Hallelujah. Thank God. And I swallowed two whole pills and went to sleep.

I rode the narcotic rails that day and night: swallow, sleep, wake, eat some yogurt, swallow again. A physical ferocity I hadn’t known before, a pain that obliterated thought, gobbled time, filled all the interstices of consciousness with fire. Swallow, sleep, wake, repeat. Until Wednesday, two days after surgery, when I opened my eyes and it was morning and the volcanic pain of yesterday was just that: yesterday’s pain, a thing I could remember (re-assemble, knit into narrative) because I was not, in that moment, engulfed by the agonizing tide.

And then, Wonder Woman uncorked my cask of tears. It wasn’t the film. The film was perfect, and I didn’t even care that it cost $25.50 for two reserved stadium seats at the multiplex. But afterward, in the ADA-accessible restroom, my left crutch skidded on a wet spot, and I clenched my knee reflexively to avoid falling, and then the pain began drumming again and my throat filled with tears. I’d just spent two hours watching a woman take on the God of War, with lightning bolts sizzling out of her forearms, and now I was undone by a quarter-sized splash of water on a tile floor. I will never recover. I can’t run from anything: a wasp, a rapist. I will never feel strong and agile and brave again.

I crutched across the parking lot, surrendered into the back seat of Elissa’s car, and sobbed all the way home. 

* * *

The patient is an impatient, despondent, furious middle-aged woman.

The patient is a mother who cannot bring her sixteen-year-old daughter a glass of water, let alone drive her to the mall or take her out for avocado toast.

The patient has made three phone calls to her health insurance company in the last forty-five minutes.

The patient is parked in the red chair in her living room, cancelling Airbnb reservations in Tokyo, Kyoto and the Iya Valley where, had she not blown out her kneecap and broken her summer, she would have been soaking in natural hot springs and eating artistically sculpted sushi with her partner and daughter, a three-week trip to Japan for which they have been planning and saving for five years.

The patient cannot stop crying.

* * *

 July 2 journal entry

Things I miss:

• Scratching the back of my knee when it itches insanely at two in the morning.

• Putting on underwear without having to snake my left toes through the leg-hole as the underwear lies, crumpled just so, on the floor.

• Not having to share my bed with a camel-colored wedge pillow, a picnic cooler, a laptop, my phone, a snaggle of cords, today’s newspaper, this week’s New Yorker and a folder fat with hospital discharge papers.

• Hot showers. Any showers.

• Wearing my skinny jeans. Wearing socks. Wearing anything but the  baggy gray shorts I’ve had on pretty much daily since June 12.

• Swimming. Gardening. Running. Making love. Feeling my body move quickly through space.

• Feeling the hard, sure knob of my left kneecap.

• Never thinking about my left kneecap.

* * *

Tourniquet was raised to the level of the Esmarch…We rongeured the distal pole of the patella and created a small trough. Then using a drill bit we made three parallel tunnels and used three long Keith needles to shuttle three 2-0 Vicryl stitches in typical fashion…we used two #5 Ethibond stitches and passed the stitch first through the inferior pole of the fracture piece and then whip-stitched it in a Krackow fashion along either side of the patellar tendon and back up through the avulsed piece. Of note, this piece was robust enough to hold a stitch but would not have held a screw. 

* * *

A friend does a Google image search of “whipstitch, Krackow fashion,” which resembles the threadwork someone might use to bind a handmade book. “Esmarch” is a type of tourniquet that dates back to the Franco-Prussian War. The vocabulary of my injury is freakish and fascinating. I look up “orthopedics” and learn that it means “straight child.” Of course: ortho, like orthodontia, ped like pediatrician. The first orthopedists worked only on congenital deformities in children, trying to set a crooked story straight.

I learn what happens when a bone breaks: Inside a blood clot that forms around the fracture, cells called phagocytes—the immune system’s janitorial squad—surround and destroy dead bone fragments and any germs that may have slipped in around the break.

Next, the chondroblasts, a tribe of worker-cells, move in to form a collagen callus around the fracture. Over time, it will harden as osteoblast cells fashion new bone from a recipe that includes protein, calcium phosphate and calcium carbonate. The calcium makes bone strong; the protein (collagen) makes it flexible. Even though the skeleton seems the most unyielding part of our bodies, it is alive, mutable. Over a lifetime, bone breaks down. Bone grows.

Once the hard callus forms, it bulges a little; I think of the protruding rope of glue where I pieced together the smashed porcelain cup. But bones do better than ceramics; cells called osteoclasts pare down extra volume around the fracture until it returns to its original shape.

This final stage of healing can take years.

* * *

August 29 journal entry

I break out of leg jail.

The physical therapist unlocks my brace so that I can flex to a right-angled bend. I’ve been chasing this ninety-degree grail, counting backward through pillow-clenching, grunt-inducing, tear-streaming pain while the PT crunches my knee to thirty-four degrees, fifty-three degrees, a flaming almost-there eighty-eight degrees. Now I can walk like a person who is remembering how to walk, flexing my knee through each step instead of swinging in a straight-legged, tipsy arc, like Frankenstein after two martinis.

To celebrate, I make a chocolate cake, cut the four corners into moist, right-angled L shapes, and share them with Elissa and our housemates.

* * *

…We then in full extension tied the sutures over the proximal patella in typical fashion…Once this was done, we had good repair. The wound was copiously irrigated. The tourniquet was let down. Hemostasis was achieved. The wound was closed. 

* * *

I don’t know when we’ll get to Japan, but I can imagine it: yellowtail sashimi melting on my tongue, the ten thousand gates of Fushimi Inari-Taisha shrine. I am bicycling through the bamboo forest of Kyoto. I am climbing 1,015 steps to the summit of Yamadera Risshakuji Temple. My broken kneecap is a story I tell:  “Remember how I tricked out my crutches with colorful duct tape? How I only wore skirts for months?” The scar’s light shadow snakes over my knee, which bends so fluidly that I can hug it to my chest. Though somewhere around the 3000th gate or the 750th stair, or when I turn a certain way in my sleep, a twinge reminds me: Something happened here. Something broke. And healed. Is healing, still.

For weeks after my injury, I kept trying to unwind time to the moment before the break: Did I land on both feet before the left one slipped from under me? Did I misjudge the distance from window seat to floor? Was I groggy, or just clumsy?

It’s fierce, that yearning for before: the unsullied, limitless garden, the brisk second of happiness that precedes a rain of sorrow. Life only rolls forward. But in a story, I can travel all directions: ahead, backward, into, around. I can niggle the wound, the painful crevice. I can go over and over and over it until the ache subsides.

The day before I broke my kneecap, I walked 15,316 steps around the city where I drank my first legal beer, read my first Aristotle, lost my virginity, found my voice.

The evening before, I knelt on the window seat to peer through panes of pink glass into the courtyard below.

A moment before, I sat on that window seat in my flamingo pajamas, bare feet swinging above the eighty-year-old hardwood. There must have been a second, the merest shaving, the glimmer of time that passes so fast we never notice, that breath between “now” and “next,” when anything could happen and we don’t know, because we never know, how the story will unfurl, how it will change us, how we will tell it, afterward. 

* * *

The patient is a very pleasant fifty-four-year-old female.

She fell. 

* * *

The patient is me.

I leapt.

-Anndee Hochman

Anndee Hochman is a journalist and essayist who listens intimately, questions fearlessly and writes frankly about people, families and communities. For five years, she has written the weekly "Parent Trip" column for the Philadelphia Inquirer; her work has also been published in Poets & Writers, Purple Clover, Broad Street Review and other venues. Anndee is the author of Anatomies: A Novella and Stories (Picador USA) and Everyday Acts & Small Subversions: Women Reinventing Family, Community and Home (The Eighth Mountain Press). She is also a two-time Moth Story Slam winner. She lives in Philadelphia.