On Friday, Sept. 16, I fractured my left femur just above Elmo, my replacement knee. Four days and two surgeries later I found myself in a rehab center I call The Fortress, doing my best to save Elmo and prolong my mobility.

I’m documenting my adventures in remobilization–self-indulgent and probably only of interest to me–and I hope that sometime it helps someone else. If you don’t want to read it, skip these posts. I’ll still love you, and post some glass stuff or something along the way.

I didn’t see the stairs. Even when I was falling, frantically trying to catch myself and looking down to see what I was falling into, I didn’t see the stairs.

Dammit. I keep flashing back to the moment of falling. Surely there was something, ANYthing, I could have should have done. Look down. Feel with my toes, hear a shouted warning, echolocate…anything, but I’d find those stolidly uncaring stairs before they found me.

Back up a sec.

My friends Kaitlyn and Aaron asked me to have dinner with them at a nice little Thai restaurant near the Beaverton Central MAX station. There are multiple pokestops there, the hunting is good, and we just enjoy each others’ company.

After dinner I walked out to their car, saw them off, and walked toward mine, clutching a box of cherry tomatoes they’d picked from their garden. The parking slots had been full where I usually park, so I’d parked on the other side of the tracks, shortcut over them to the restaurant.

I have this personal assignment to walk at least 25 miles/week, courtesy of Elmo, my 14-month old replacement knee. I’d been walking longer and longer distances, kinda in celebration of just being ABLE to walk. It was heavenly, so that night I took the long way ’round to the car.

I was carrying my phone; it was a new Android phone nearly as big as an iPad Mini. Rather than shoehorn it into my purse and then try to pry it out when it rang, I’d taken to carrying it in my right hand.

In the gathering dark I didn’t see the stairs, painted blue and blending in with the night.

Gut-dropping freefall. Hard bounce directly on Elmo. Faceplant.

My glasses squished to my face, and I was covered in cherry tomato goo. I turned slowly, onto my side, and my leg screamed. Now I saw those damn stairs, snickering in the moonlight.

My left leg bent oddly to the right, above the knee, and a circle of dark slowly grew on my jeans.

OMG. Elmo. Please please please don’t let it be Elmo.

I saw no one, called Help! Help! Help! (was going to say “I’ve fallen and I can’t get up,” but decided this wasn’t time for jokes)

A wonderful man (Bogdan, if you read this, ten million thanks) ran up, called 911, stared at my leg, shaking so hard he nearly dropped the phone. A woman offered a backpack to prop up my head, but I couldn’t move. Bodgan found my phone about 25 feet away–apparently I flung it as I fell–my purse maybe ten. The cherry tomato box had bounced off into the distance.

The dispatcher asked Bogdan if I was conscious, and he had trouble answering; I reached for the phone.

“Hi. This is the victim, Cynthia Morgan. I think I’ve fractured my leg, above a year-old replacement knee. I’m shocky, racing heart, the pain is bearable but I can’t move without a flareup.”

“Hold on, Cynthia, the ambulance is on its way. You should be able to hear it now.”

I did. Five or six paramedics flooded the plaza with equipment, spent some time interviewing me and figuring how to get me into the ambulance. It wasn’t easy–I needed something called a scoop stretcher just to make it onto the REAL stretcher. It pinched some personal parts and felt like I was falling out the bottom, but we got there.

They offered me fentanyl for pain but I declined. Some part of me thought it best not to go overboard in case this was just a wrenched muscle. No sense looking like some stupid, tomato-covered wuss when it turned out this was nothing.

Hope springs eternal, right?

I asked to be taken to Kaiser Westside, the wonderful hospital where I became attached to Elmo. Surely they’d have a head start on telling me this was nothing, really.

Let’s not talk about that ambulance ride.

The paramedics were wonderful, treated me with toe-tipping care…but let’s not talk about that ambulance ride.

Kaiser was full up–lots of emergencies that night–so the paramedic, about 18, waited with me. Now, with the adrenaline from the fall wearing off, I NEEDED that fentanyl, and the paramedic’s eyes filled when she told me that, once inside the ER, I needed to wait for the doctor.*

She held my hand, talking softly, until the doctor could come.

She’d wanted to be a paramedic since childhood–“because their whole job is to save people”–and indeed had been working for ambulance companies since the age of 13. She pestered and pestered them to let her work the front line, but couldn’t certify as an EMT until she was 18 years old.

That was a few months ago. Tonight she said simply, “This is what I will do for the rest of my life.”

She got a paper towel for my sweaty brow, and proudly said she was my advocate with the hospital. “I won’t leave you until I know they’ve got you sorted out. Even if it wasn’t my job, I wouldn’t leave you, so don’t worry.”

And she didn’t. The doctor arrived and things got painfully busy, so I never noticed her slipping out to go back into the night.

I wish I knew her name.

The doctor looked worried. By now the adrenaline was wearing off and my leg was throbbing, ripping, spasming with pain. “We need X-rays,” she said, trying to buffer the trip to X-ray with morphine.

Let’s not talk about that X-ray trip, either. Except maybe for the wide-eyed look of shock the X-ray tech gave me when he saw the first X-ray and called in a panic for more more morphine.

The bursting pain settled as they slipped me back into my  little ER cubicle. “Honey,” said the doctor pityingly, stroking my arm, “You are soooo broken. May I show you the X-ray?”

A spear of bone floated high inside my thigh, its jagged edge overtopping Elmo a few inches from its normal home. It had ripped out of my leg to cause that spreading dark stain on my best jeans (which had been cut off, along with my underpants).

“Cynthia, you have an open fracture. Those are pretty dangerous because of the risk of infection…”

“But Elmo’s OK, right?”

She looked puzzled. “Oh, your implant. Yes, the break was above the implant so it probably wasn’t damaged. The orthopedist on call will be here shortly, and he can give you more information.”

While I waited, other hospital folk stopped in, “You’re Cynthia, right? We saw your X-rays. WOW. Wild. That’s some fracture.”

Nice that I can impress hardened ER personnel, but strangely, not very comforting.

The orthopedist wasn’t exactly a ray of sunshine, either, although he tried. “The bone coming through the skin is very dangerous; there’s a high risk of infection in the bone. We’re taking you to surgery in a few minutes to clean it out.”

“Uhm…can I have more morphine before we start?”

“All you want, but you’ll go through this with general anesthesia. We’ll probably be in there quite awhile and we need you relaxed. But, uhm, Cynthia, we need to talk about the bad news.”

That was the GOOD news?

“The break is too close to the implant to repair. We’ve got to remove it, and replace it with a much more extensive implant, with rods up inside your bones. It won’t work as well as the one you have, you won’t have as much mobility and probably more pain. And it won’t last nearly as long.”

Elmo wearing out was a known quantity, and when that happened they’d told me I’d have a second less desirable implant. It sounded like they were accelerating the timetable. “And after the new implant wears out, I get a replacement?”

He hesitated. “Not likely. Usually these implants remove too much bone and there’s not much left for a repeat when they wear out.”

“So you, what? Fuse the leg? Amputate?”

“Let’s not talk about that until later.”

Mindyammer. Me minus lower leg. Maybe I could wear blades like Pistorius. Like that chick in The Kingsmen. She ran and jumped and was glorious. Yeah, like that.

I tried to focus on what the doctor was saying. “We can’t do the replacement tonight, we can’t get the parts until Monday. So we’ll get you cleaned out and stabilized, and you’ll be all prepped for Monday.”

So I have until Monday to say goodbye to Elmo. All the way down to the OR, I cracked desperate jokes, kept it up until the anesthesia faded me…

No pain in the morning, though I could feel the bones playing inside my thigh like giant drumsticks. A nurse gently checked my vitals and told me the second surgery would take place in a couple of hours instead of Monday.

Two hours to say goodbye to a hunk of plastic and titanium that had literally changed my life, given me back my mobility. We were promised 15-20 (or more) years together, I’d let him down after only 14 months. I felt almost unbearably sad and ashamed.

I considered crying. Wondered (only briefly) if it would be better not to wake up after the surgery. Looked up to see Dr. Kroger, the guy who introduced me to Elmo, silhouetted in my doorway. “I’m so, so sorry this has happened, Cynthia. Just so sorry.”

I tried to apologize that I hadn’t been more careful with his wonderful gift, that I’d killed Elmo in five seconds of carelessness, and he held up a hand to stop me.

“Listen, Cynthia: I know the plan is to replace your implant, but I’ve been looking at your X-rays this morning, went over them with a traumatologist, and we both agree: We think we can save your knee. Before you say anything, though, you need to understand the risks.”

Save Elmo? Wait…SAVE ELMO?

“If we do the other implant, your recovery will be about like it was before, maybe a little rougher, and you’ll be walking, able to bear weight on your new knee the first day. But overall, it won’t last as long, and it will be difficult to do another replacement after that.”

This, I knew.

“If we do what I’m proposing, we have about a 70% chance of success with a very long, slow recovery. The bones must grow back together completely, and there’s no guarantee they will. You’ll keep that leg completely still, or it won’t heal. No weight bearing for 6-8 weeks. It will be hard, but it’s our best chance.”

“And if it doesn’t work, we can still do the second implant?” I asked, and he nodded. “So I’ve nothing to lose really,” I said slowly.

“Well, nothing except a lot of extra recovery time and pain, and another surgery, if the bones don’t heal. If they do heal, we can hope to get you close to what you had. So…it’s your decision; think about it.”

No-brainer. “Thought about it. Let’s do it.”

Mom met my gurney on the way to the OR. “You were doing so well with your knee,” she said softly, trying not to cry.

I knew how she felt.

Read the Saving Elmo series:

  1. I fight concrete…and lose (this post)
  2. Saving Elmo: The Plan
  3. Bedpans and reachsticks
  4. Meltdown, centering, and balance
  5. Mr. Desmond


*Memo: If you hurt, and they offer you pain meds, TAKE THEM. Worry about wimp factors later.