Sylvia's Journal

While I am getting used to my freed new ankle, the reality of my upcoming travel to Afghanistan has begun to set in – practical things so as how to carry things when on crutches and only allowed 50% of my (usual) weight on the left side.

The good thing is that business class travel has been approved and a ticket is being purchased. I should have no worries while on the plane – but it is the spaces and times in between that concern me a bit. I have asked for wheelchair assistance and trying to imagine if I ever saw a wheelchair at Kabul airport. And would I be parked for several hours in a wheelchair outside a gate? Would there be someone to push me to the bathroom if I need to go or leave my stuff with? And what stuff should I hand carry – not the usual heavy backpack probably. I have all these questions one never thinks about when both legs are working.

Packing for my trip is also going to be a bit of a challenge. Usually I make multiple trips up and down the stairs, carrying stuff this way and that. I have to be a lot more organized and, with this in mind, have started to make lists. It’s winter in Afghanistan, which is always a more complicated packing task and also makes for a heavier suitcase than usual.
I feel I am making some progress on the healing. Only occasionally does my ankle hurt, mostly my leg is stiff and weak. I am practicing walking, with 5 to 10% of my weight on the foot (presumably my level of comfort will tell when I am going over 10%). And each time I get up I have to decide, scooter or crutches?

We started 2014 with a whopping snowstorm which has left us 2 feet under. A front loader was needed to clean our driveway; ordinary snow plows attached to a truck no longer sufficient. It made for a cozy time inside and productive workdays thanks to the power lines holding the weight of the snow. The cove is a cauldron, waves of 4 to 6 meters and a very high tide submerged parts not usually submerged. We hope we didn’t lose more land – we won’t find out until spring, when the storms subside.

The pink cast was sawed off by what looked like a stick blender with a small circular saw. I couldn’t see any safety device that would keep it from going through the cast, the cotton layers underneath and then in my leg.

The young assistant who did the sawing giggled at my nervousness, assuring me that it was safe. But I was not convinced, especially when I could feel the pressure of the metal on the cotton, pushing into my leg. Her supervisor, I assume, came to check in on her and took over the job, maybe she was too careful. The supervisor pushed harder on the saw and I could feel more pressure on the cotton. I forgot to breathe, Axel discovered from across the room, documenting the whole process on his iPhone.

And then out came the shriveled leg with its skin looking like old parchment. The purple markings of where to cut where still as clear as they were on surgery day. The place that had felt like it was jabbed by an icepick for the last 6 weeks was unblemished – the jabbing had been done from the inside by nerves frantic looking for new pathways. The loss of sensation on the left side of my foot has diminished only slightly. We were told it was to be expected and would continue to diminish over time. I know the self-healing power of nerves from watching Axel’s limp left arm and hand come to life slowly over a year after the accident.

I have now entered phase 3 of the ankle fusion process: six more weeks in an orthopedic boot with increasing levels of weight bearing: 25% the next 7 days; 50% the week after and then gradually to full weight bearing.

This means the crutches and knee scooter are still important aids apart from the boot – no standing or walking without a boot until mid-February. It also means that I will have to travel with crutches to Afghanistan, 8 days from now. It was not quite what I had planned but it is too late to turn back, unless the business class upgrade that I requested is disapproved by our benefits manager. In that case I will stay home and continue the healing here.

Four more days, and soon I will be counting the hours till cast off. The last 8 days went fast, as expected, because of the Christmas distraction.

The day before Christmas Eve everyone arrived from Dorchester and Easthampton. Furniture was pushed to the walls to make room for the Christmas tree plus Faro and the two dogs, allowing just a little opening for me on my scooter.

We celebrated Christerklaas, starting at 11 PM on Christmas Eve, one hour earlier than usual. Despite last minute signs and groans about not being able to do much this year, everyone pulled through with poems (or prose in some cases), fantastic constructions as fake presents pointing to the real thing.

The gifts and poems this year were about cooking, knitting, and feasting the eyes this earth’s amazing landscapes, plus some chocolate on the side. The center piece for Faro was a shiny black baby grand piano, various trucks and books for opa and oma to read to him (we are currently quite taken with David Wiesner (Tuesday, Flotsam, June 29, 1999).

By 1:30 AM enough of us were yawning to suspend the festivities. We have exhausted young parents in our midst now – no matter how late they go to bed, Faro will wake them up at about 7:30 AM at the latest. We had only made a small dent in the pile of presents under the tree and the poems dangling from its branches.

We continued late the next day, Christmas Day, when everyone had emerged from their various quarters and Faro was fed and ready for his nap. Axel and I gave each other ‘non-thing’ presents – a massage and a two day trip to Maine with a visit to Axel’s favorite museum in Rockport and maybe a side trip, if we can swing it, to one of Axel’s Afghan student who came up from New Mexico to visit his American parents for the holidays.

Tessa, Steve and the dogs have returned to Dorchester, leaving us to enjoy a few more days of Faro and his parents before they too return to their home, after a visit to the New England Aquarium on Sunday morning. By then, I am sure, time will slow down again, but then I will be down to 48 hours.

In the meantime my office has moved from its prime Cambridge location on Memorial Drive to Boston’s northern suburb of Medford – a shorter commute for me in distance; no longer require traversing the Tobin Bridge into the city. Next week I will start experimenting with the best route.

Twelve more days was the first thought that came to mind when I woke up. The twelve days till cast off include some days that will go by very fast, like next week.

I continue to work full time from my command center, holding several balls up in the air – each ball requiring much reading, much thinking, much organizing.

Outside working hours I relax knitting and sewing things for Faro – it’s nice to have a small object like him for my projects – none takes long enough to get boring. All will be wrapped up for Christmas. Faro’s needs and non needs (non things) can be crossed off the list. My hunch is that most of his wishes are non things, like learning the alphabet, the names of birds and things in the sky other than moons and seeing his oma and opa on Skype.

I try to catch him on Skype at dinner time. We go over food groups and he gets to practice whatever new words his parents have taught him. His mind is like a sponge, with terabytes of space on his developing hard drive. On the outside I see him growing in height, weight and sprouting more hair every day. I can’t wait to see him in a few days.

In the meantime I am learning to navigate frozen ground and made a few outings in spite of the winter weather. I can in and out of houses and up and down steps with the help of strong helpers and my own hardening biceps. The left leg however is showing signs of atrophy – how quick the muscles lose their tone.

The plastic sleeve that is supposed to keep my leg dry under the shower, and is based on an entrance that should be (and was) narrower than my thigh, is no longer providing a waterproof seal. As a result I have to shower with my leg up against the shower stall wall, ballerina like.

I ventured down into the basement where supplies are kept that were no longer available upstairs and Axel was away. With the help of an old wooden lacrosse stick, serving as a crutch, I was able to hop across the cellar floor and get what I needed. It is amazing what one can do on one leg when there is a need.

I am working on my early spring travel schedule which kicks off with a month long trip to Kabul. Subsequent trips to Uganda and Malawi are somewhat in conflict and I am negotiating with various stakeholders that are not beholden to one another.

I have scheduled three PT sessions as soon as my cast is off in the first week of January. I will be on my own for over a month after that. Although I am familiar with the PT place in Kabul (they still should have my card in their files) I don’t think I will go there this time as my time is all accounted for by four different assignments.

I have just reached the halfway mark of my non-weight-bearing left leg condition. Every morning I calculate the days remaining till ‘cast off.’

The nerve action in my left foot is subsiding a bit which makes me think that the persistent nerve cells have found passages through the altered terrain of my left ankle. One particular point remains tender, as if an icepick is applied on it over and over again. It chafes on the cotton wads that protect my foot and leg from the unforgiving cast. But I don’t want to know what’s going on there – 18 more days and all will be revealed.

I have learned to be quite self-sufficient, showing once more our species’ resilience and adaptability. I can get up and down the stairs, dress and undress, shower, make meals all by myself. Still, Axel is doing double duty, especially when it comes to getting things for which one needs a car. I had had some illusion that by now I could drive myself to work, getting my scooter in and out of the car by myself – but that is not going to happen.

This working from home business has some nice side effects:

-I don’t have to get up at 4:30 AM three days a week and enjoy the luxury of sleeping till 7 every day and seeing my husband before the end of the day.
-I don’t have to do the Christmas commute from hell, which is the entire month of December, passing three major shopping centers to and from work with no alternative routes available.
-I can knit while listening to presentations or participate in teleconferences. As a result I have knitted a pair of socks for Faro to wear in his tiny Dutch clogs and nearly finished a sweater.
-I have been given several writing and review tasks which I have completed in record time as there are no distractions from commutes, in person meetings or walk-ins for gossip or chats with colleagues.
-I am not snacking on cookies, donuts and chocolates which are usually parked right outside my office.

I celebrated my 62nd birthday with a full day out of the house. Among the gifts I received were a neon pink cast and a box of Godiva truffles. The cast will stay on until the 31st of this month; the truffles are gone. I put myself on a diet of no more than 4 truffles a day. These are the things one never buys for oneself (a) because it’s such an indulgence and (b) they would blow a weightwatcher’s point allotment for the entire week. Not that I am on WW right now – I am on a vacation of sorts – but the cream and butter content is not good for my brain, I just learned from watching Daniel Amen on TedX.

The neural activity in my foot, according to the doctor, was a little odd but then again, the ankle was severely traumatized, what with the three enormous deck screws sticking out of the joint. I imagine the nerve cells frantically trying to find a new passage now that the previous one is blocked. Sometimes they appear to be sending out SOS signals to the other ankle, as if to check whether their comrades on the right side have some suggestions.

My new cast is lighter and smaller but no longer soft to the touch which makes the scooting less comfortable. On Tuesday I scooted around my office and even on the streets of Cambridge, leaving my shin rather sore. Scooting on brick or uneven pavement turned out to be a bit hazardous. City dwellers do well to get the all-terrain version of the scooter, as the small wheels get stuck in small ridges and with the center of gravity so high, a forward wheelie is too easy. I caught two of them in the nick of time.

We celebrated my birthday with Tessa in the restaurant of a colleague’s sister. We splurged by taking one thing from each category on the menu: snacks, cocktails, appetizers, main meal, dessert, cookies, wine and then the restaurant added sea salt caramels to complete the experience. Tessa paid half the bill. It is nice when your kids start to take you out.

I manage to be mostly back on a full work schedule from my recliner base. I moved my kidney shaped desk on wheels out of my office and am holding court in the living room with work, knitting and reading all within easy reach. Axel attends to my wishes by cooking and serving meals, though I can handle breakfast on my own, including making tea. I just can’t transport things all that well and eat in the kitchen, standing on one leg with the other resting on the scooter. 

One advantage of scheduling my surgery and recovery over several holidays is that the days go too fast. I usually don’t like this but now, moving fast towards December 31 is of great interest to me. It is a bit like meals on a long flight – the distraction makes you forget about time’s passing.

And so I have come out on the other side of the Thanksgiving Holiday, not just thankful for a great, and noisy, 5 days, but also closer to December 3 when the first post-op phase ends and the second one, the full cast phase, starts. I hope that cast will be slimmer and lighter. I also hope to find out whether full sensation has returned to my left foot, something I am not entirely sure about. There has been much neural activity in my left foot but also some parts that still seem to be numb. That, I believe, is not as planned.

Tomorrow the stitches will come out and I can stop self-injecting myself and switch to aspirin to stave off blood clots. That will be a relief. My belly shows the bruises of injections not done all that well.

Tomorrow will also be the first day I am going to work, right after the new cast, since I am in the neighborhood and I have a willing chauffeur. I will get to show off my new cast and knee walker, a contraption still very few people know about. I don’t think knee walkers (or scooters) existed when I had my other leg in a cast, now more than 6 years ago.

On doctors’, family, colleagues’ and friends’ orders I closed my computer over the holidays, hence no blog postings and no email readings for several days in a row. I knitted (and am still knitting) various items for Faro and made two Oshkosh type pants out of one of Tessa’s old jeans and Axel’s rib cords from the 60s.

One of the MSH teams I sit on sent me an orchid by mail. The UPS driver carried the tall package carefully inside and Axel continued obeying the ‘Fragile’ and ‘This side Up’ stickers. A beautiful blooming orchid emerged – imagine that, all the way from California by mail! A second box with well wishing candles, beautifully packaged came along. Axel wondered whether I had been sitting in my chair ordering stuff, but I hadn’t and it was a great surprise and I was quite touched by it all.

I returned to work this morning, from my armchair. My computer is set up as if I am in the office, no one would know, except my office mates. But many of the people I work with aren’t in the Cambridge office anyways, so no difference to them.

After two meetings and some review work I noticed my flagging energy half way through the day. I had set myself some goals, things to complete, emails to read, to send, documents to read and phone meetings to attend, as if I hadn’t had a significant operation; funny how I fooled myself.

Axel has returned to his usual schedules of errands and doctors’ visits to deal with the various body parts that need expert attention and so I spent a good part of the day alone. I am well equipped now to take care of my needs, with my scooter and its basket full of necessities: a phone, a cup of tea or coffee, a water bottle, Tylenol or a piece of fruit.

The crutches are retired except for duty once I am upstairs where there is no knee scooter and I hobble around the old fashioned way.

I have requested a handicap placard for my car so I can park in handicap spaces or at parking meters for free, at least for the next few months. With icy winter weather coming our way I don’t want to be parked far from indoor spaces or scoot long distances. Traveling with my scooter is the next challenge, one I will tackle on my birthday 8 days from now.

I am settling into my new dependent lifestyle. I need help with just about everything as I can’t carry stuff from one place to another, nor get up and down the stairs without someone spotting me. I settle into a chair and then make my wishes known: an extra sweater, a book, my computer, a cellphone, food. Axel collects everything I need and tries to make me comfortable; a most wonderful personal attendant!

Yesterday my knee walker arrived which is giving me great freedom. I scoot around the house with great ease. The handy basket below the handlebars allows me to transport some stuff from one place to another and be just a tiny bit less dependent.

I took my last pain pill before I went to bed and hope that indeed it was the last one. Progress. I also had had my first shower this morning – the long road to normalcy has started: 12 more days with the clunky temporary cast. I will get the slimmer full cast as a special present on my birthday. I hope I get to choose a design. Then 40 more days till that one will be taken off. It seems long but the days go fast. I am hopeful.

Every morning I have to inject myself with a liquid that keeps my blood from clotting. I religiously follow the 7 AM ritual: hand washing, alcohol rub, stab myself, press and release the plunger. Axel’s cousin Erik died of a blood clot after ankle surgery some years ago; we were the same age then, early fifties. Once I have my full cast on I can switch to aspirin. I look forward to that milestone.

I took two full days off from work and left an automatic message to that effect. But still, colleagues ask me when I will answer my email again. Monday I go back to work, from my armchair.

Friends have visited, bringing books, food and puzzles. I completed the fun part of the 1500 piece puzzle and then folded the whole thing up when only black and white pieces, hundreds of them, were remaining. I am doing this for fun, no point in doing the not so fun part. Now I am free to prepare for my coaching exam in 2 weeks and pick up my rusted Dari for my upcoming trip to Afghanistan.

And now it is the eve of my surgery, scheduled for tomorrow morning 8:30 AM. I walked through the house looking for things that required me to be upright on two legs and that had to be completed. Ah, the Christmas mustard making. Two bowls of mustard seeds marinating in wine and vinegar demanded attention – if not processed now they’d marinate into slime I feared. It’s a job that no one else in our family has even attempted to finish. I processed those batches and am good to go for at least a first distribution next month.

Our friend Isabella the Reiki Master will join us to get me utterly relaxed into the operating theatre. She has done this some 4 years ago before my rotator cuff surgery with great success.

At home everything is ready: the crutches by the door, my knee walker/scooter procured on eBay and on its way, the pain pills and the blood thinner in pre-dosed injection needles on the counter, the recliner upholstered and tested, and, a present from Axel, a cute little bamboo lap desk to hold my iPad mini. All that’s left is a healthy meal (chard with lentils) and a good night sleep.