"'Guidebook says human legs bend down at knee'; 'It's okay, Mama. Anyone-a complains, I bend legs up for free.'"

My surgery took place on January 9, 2018. I was happy that I was able to schedule it for after the Christmas Holidays...getting around a Weihnachtsmarkt with three kids in tow is hard enough without being on crutches. I had to check in at around 6am so I packed my bag with toiletries, pyjamas, clean clothes for when I left and a kindle loaded up with books.

In preparation for my surgery I had appointments with my knee surgeon (and his Oberartz, the supervising surgeon) and with the Anaesthesiologist (who, funny story, was having an exchange student from Phillips Academy in Exeter-just a few towns from where I grew up- coming in a few months, what a small world). The Anesthesiologiest had talked about risks, my history with anaesthesia (not good, I had a septoplasty done in 2013 and normal people wake up in 1 hours-I took six hours to awaken and was extremely nauseated). She did give me the option of remaining away for the surgery and just using a nerve block for my leg, but despite my less than stellar history with anaesthesia the idea of being awake while someone used a drill on bones in my leg was quite horrific. So we agreed upon a nerve block in my leg with general anaesthesia. I would also receive a pill to take upon checking in that would make me more relaxed for when the started the anaesthesia. Personally, I also used Hibecleans in the shower before my appointment because it is shown to reduce the risk of acquiring hospital infections.

I got up early and left the house to catch the bus before any of my children awakened. I checked in with my paperwork at the Emergency department (I'm not sure if this is always where one checks in, or if because I was there early in the morning) and was given the medicine to take once I was dressed for surgery. I was given directions to my room and made my way over. I packed away my things in a little cabinet assigned for my bed (it was a double room). There a nurse gave me the gown and stylish mesh underwear I would wear for the surgery. She also got me some water with which to take my pill. I then laid in the bed and waited for my transport.

The person who came to bring me down to surgery was quite nice. It was however very awkward to be a person laying in a bed getting wheeled all over the hospital (my room was on the 9th floor in a side wing and we went almost all the way back to where I checked in in the main wing on the ground floor). It was also difficult to maintain any sort of normal conversation in a second language when I was also feeling somewhat anxious about surgery. I was mostly confident and at peace, but of course there was a part of me that wondered what would happen with my kids if I were to die. I honestly think that is pretty normal for anyone having a surgery, even a "safe" one. I was praying to God to continue to give me peace and to help guide my surgeon's hands. I made it to the prep room which was interesting. There were at least 10 other people in the same room with just small screens about 4 feet high separating one bed from another. My surgical prep technician was also nice, he was also not from Germany but had moved here less than 10 years before, learned German, and gone to school to be a surgery prep technician (not sure if there is a more correct name for what he did). He changed my blankets and propped different parts of my body up on cushions to make them accessible to the surgeons. I believe he was also the one who cleaned my leg, but I am not certain.

After not so long I was wheeled into the operating room. The three surgical nurses introduced themselves and told me that the doctor was on the way. I think was had a bit of a pleasant chat but my memory is a bit fuzzy. I remember being concerned that I wouldn't be able to communicate well when I woke up from surgery because of my previous experience I was pretty certain I wouldn't be able to coherently form German sentences (since in my opinion I am not fantastic about that when I'm awake and clear headed). I believe that I had an IV but I think it may not have been inserted until after I inhaled the anaesthesia by mask. I don't think I counted down very far before I was out.

After no time at all I was awake again. With my previous surgery I don't remember the operating room at all, but this time I woke up still in the operating room and saw the nurses and doctor before I was wheeled out. I even remember noting the time on the wall clock as I entered the recovery room. I was amazed at how awake I already felt. I also remembered to speak German. The Recovery nurse came over right away to check in. I was able to explain that I had fairly bad pain in my foot. Since my surgery was on my knee and I had a nerve block for it I thought it was likely my bandage. I remember reading a story of a woman who kept complaining of foot pain after a surgery in the US. Because of the pain medicine culture there without much questioning she was given stronger and stronger pain meds. The next day when changing the bandage she was starting to have tissue death because the bandage was so tight (I can't find the article right now but I will link when I do). Instead of investigating her pain, she was just given meds. That is however, another topic, but I imagine this was in my head. The nurse had to call up to my floor to request permission to loosen the bandage (since if it was completely undone they would be the ones replacing it). It felt like a long time before she came back, and the pain was quite bad (I was instructed that I could press the button to receive extra meds in my nerve block, but the area of pain was below that). I realise that it was likely less than 20 minutes, but of course time is slower when one is in pain. She came back with bandage scissors and cut the bandage open till just above my ankle, the pain almost immediately disappeared. I believe I was in recovery less than one hour before I was transported back to my room.

I believe it was still before noon when I arrived in my room. I asked for my personal effects (since I was not allowed or able to walk with the nerve block. I was able to text my husband and let him know he could come visit. I was going to speak to my doctors later in the afternoon about how things went and how recovery would go. My husband and kids came to visit me and we decided that Rosalind would stay at home with him. We had discussed with the doctors potential having a private room so she could stay with me. She was 2 but she was (and is) very mommy attached and still nursed a few times at night. However, her reaction to seeing me in the hospital bed made it clear that that wouldn't work (she seemed frightened of me or the bed or the tubes and wires).

The doctors came in late afternoon to let me know that the surgery had gone well. They said there was a possibility of meniscus tears needing repair that weren't seen in the MRI but that wasn't the case. They simply harvested part of my hamstring tendon and sewed that together (they double it up I believe) and then anchored it to my bone with screws. They said the rest of the knee looked good so they were pleased. We discussed trying to get me out sooner rather than later, perhaps staying 2 nights rather than three. It would however be dependant on how I progressed. This is interesting to note, because in the US ACL repair is an outpatient surgery, you are released shortly after you wake from anaesthesia though you must have someone to drive you home. I have a few thoughts on why they do it differently here (I can't be sure if I am correct). For one, everyone has health insurance and health care in general is much less expensive. As a prime example my copay for this surgery was just €10 per day that I spent in the hospital. Had I opted for a private room it would have been somewhere between €50-100 per night. That's it. That is the only payment I made for a surgery that is upwards of $9000 in the US. Secondly, the pain medication issue. As referenced in my previous post about the injury I was only given high dose Ibuprofen after the initial injury for what in the US certainly would have 'warranted' Vicodin at least. I believe that the doctors are wary of giving opiod pain meds to patients, especially for home use. By keeping patients in the hospital longer they can better monitor pain levels in the early days when the pain level is highest and give you stronger meds under close medical supervision. In fact my nerve block was left in over 24 hours to reduce the need for pain meds even in the hospital. Third I think that in an effort to contain medical costs, they don't want you to go home and jump right back into your normal routine to soon. How many people do you know who started back to work before advised, started lifting/walking/or driving after a surgery before the doctor advised? I know quite a few because we are both eager to get back to normal and often forced to to get back to work/regular activities because a lack of support system and/or lack of paid sick leave. By keeping you in the hospital longer they prevent you from going straight home and wrecking their good work. They also underscore the importance that you rest and allow your body to repair. The first two reasons I completely agree with, the last I have mixed feelings, in general I think it's the right decision, but in the specific case of ACL surgery there is some evidence that early movement results in less pain in a year. I will touch on that in my next post where I will regale you with details of my hospital stay and continued recovery.

References: Futurama Season 4/ Episode 3 "A Leela of Her Own"
https://amino.com/blog/acl-surgery-cost/