Sylvia's Journal

I dreamed about hardware, screws and such. This was not surprising given the last images I saw on the internet about ankle surgery before I went to sleep last night. I was doing research on the options that my orthopedic surgeon gave me if, indeed, his diagnosis of what is wrong with my ankle is correct.

I knew I was not out of the woods yet but I also had been living under the illusion that, eventually, everything would get better and we could resume our old lives where they had been interrupted. I so badly wanted to believe the doctors when they said, it will take a year, that I took it quite literally; expecting, with a child’s kind of hope that, sometime in July 2008 or this summer, everything would be OK again. I now know that that was just phase one; yesterday I joined Axel in phase two and, as he already knows, things look a little different there.

In the morning I spent an hour at the office of my orthopede, who is aptly named Dr. Wood. I had made an appointment some time ago when it was clear that all was not well with my ankle. I had gone in with some expectation that maybe an operation was needed to free a pinched nerve and put things right that were a little out of alignment; nothing a good doctor could not fix. I had also expected that I could then make an informed choice about what to do next, a weighing of pros and cons between two simple alternative (nothing or a routine operation).

What I had not expected was a diagnosis that contained the word necrosis. This, I knew from my classic education, came from the Greek word nekros which means death. Necrosis is the name given to unnatural death of cells and living tissue, according to Wikipedia. Bone cells inside my injured talus bone are dead because the blood supply was compromised. The symptoms and the X-ray were enough proof for the doctor to give the diagnosis of AVN (avascular necrosis of the talus) with a great degree of certainty. I will have an MRI on Thursday to confirm his diagnosis. Then we will meet again on August 4 and decide what next. This is when I will take Axel along. I would have wanted him by my side yesterday, had I known what was coming.

In the meantime I get to agonize over which of the four unappealing courses of action to choose: (1) do nothing and end up with an arthritic ankle and increasing discomfort in walking; (2) surgery that includes drilling holes in the bone to release some of the pressure and make room for small blood vessels to re-grow and fill the space; (3) fusing, which requires cutting of bone so the edges literally fuse together which would reduce the pain but limit my ankle movement (this option leaves me with the most questions such as, can I still fly? row? ski? walk on the beach?) and (4) total ankle replacement, a complicated and risky undertaking that may require repeat replacements after a certain number of years. Last night I started to read up on all these options; none had any appeal and some were plain scary.

After I left the doctor’s office I drove into Boston to my class in a (mental) fog with those four scenarios bumping into each other inside my head. I vacillated between despondency and denial. Two voices were talking to me at the same time, trying to out-shout each other; one saying, hey, you are still alive, it could have been worse, it’s not a death sentence while the other conjured up images of me hobbling for months, first with cast (back to wheelchairs and ramps), then the plastic boot, with the possibility of remaining a hobbler ever after.

At the end of the day, after my afternoon class I drove out of Boston into a dark and ominous fog, this time real, which contained a violent rainstorm that blocked everything from sight. The outside (natural) world matched my inside world: sheets of rain blocking my ability to see anything at all beyond the end of the next car and the sides of the road; no sign of anything better in sight. My stress levels were going up so fast that my ability to think straight was severely compromised.

I talked with Axel over the phone. He promised me that the storm had passed over Manchester quickly, dumping lots of rain, but then leaving everything sparkly clean under bright sunny skies. I took it as a metaphor and worked my way through the inner and outer downpour into Manchester where I was not only greeted by blue skies but also by a rainbow. If that was a promise to Noah, eons ago, it could be one to me, of something I cannot yet fathom and which requires some faith and trust that all will be well in the end. It’s just that I haven’t gotten to the end yet.

Amidst this bad news, some good things happened as well; the teaching at BU was fun, I had a wonderful lunch with my colleagues Cary and Wolffy who are co-conspirators in the BU course, and Sita returned safe and sound from London (UK) last night.