Operated

Left knee trilogy

June then October, 2022

The Red Hot Chili Peppers’ Other Side was playing the first time I was wheeled into the operating theatre: a large, round room, full of gowned and masked specialists, all busy arranging and sorting and doing whatever they do before the show. I was not expecting any music, let alone loud, American alt-rock. Thursday, June 9th, 2022, was the date of the osteotomie for my left knee. The resulting incision was closed up with fifteen staples.

Revolver’s Get Around Town was playing the second time I was wheeled into the operating theater. Because of the previous operation, I wasn’t surprised by the music, but I didn’t recognize the song, and after asking, in my pre-surgery-drug-addled French, the nurse showed me the music video on her phone. It was a pop song, upbeat, which was good, because I was not pleased to be there. Thursday, October 13th, was the date for a second osteotomie, again the left knee. The incision grew a few centimeters, now twenty-one staples.

No music playing when I was wheeled in to the operating theatre for a third time. This surgery had not been scheduled. A routine blood test showed a leucocyte count of 10,7 Giga/L (last test had been 4,9) This indicated sepsis aiguë (acute sepsis), an infection in my left leg. I was immediately admitted to the clinique, and surgery was the next day. It’s just as well there was no music in the OR – it wouldn’t have been appropriate; I was surprised, yet resigned to the necessity of the surgery. It was Monday, October 24. This time Dr. Maury performed what he called a nettoyage, a cleaning. This final incision, even longer now, was closed up with a line of stitches.

~

Backstory

April then June, 2021

For the past few years there was increasing pain in both knees. In late April, 2021, when back from Switzerland, I went to see orthopedist and trauma surgeon Dr. Etienne Maury, at the Centre Chirurgical Orthosud, in St. Jean de Vedas, a bit west of Montpellier. His practice is in a new medical office complex, adjacent to the also new Clinique St. Jean. Dr. Maury was short and slim, looked mildly aristocratic and not very medical in jeans and a tucked-in, button down shirt.

Dr. Maury asked the usual questions about pain and mobility, then after bending and stretching, poking and prodding my knees, he said I might need surgery, but he needed more information. He gave me prescriptions to get various images of state of the knee; by the time all was said and done, I’d be x-rayed (radiographie), MRI’ed (IRM), CT’ed (tomodensitométrie), and ultrasounded (écographie).

In the weeks ahead I brooded on the situation. I wasn’t happy about the prospect of surgery, being out of commission for many months. Exercise and sports had helped me through covid, and indeed, for all my life: sports had mitigated or offset a variety of sins: drinking, divorce, depression, life. After a swim or workout in the weight room or even a round of golf, the world wasn’t so bad. I didn’t look forward to being sedentary for a few months, but what choice was there?

We met again in mid-June, after all the diagnostic information came in. Dr. Maury recommended an osteotomie for both knees. I could do one knee at a time, or get them both done at the same time. I chose the former, starting with the more problematic left knee. We scheduled the first surgery for October 6, 2021. With a surgery date set, I returned to Chur (in canton Graubunden, southeast Switzerland) at the end of June.

~

Schedule collision 1

Summer into Fall, 2021

Since March of 2020, I had been working at home, courtesy of covid-19. Working from home meant either working from my apartment in Chur, or working from our apartment in Montpellier. My boss, Adrienne, didn’t care either way, so I spent most of my time in Montpellier. As I spent more time in Montpellier, and it was uncertain how long covid would last and therefore how long we’d continue to work from home, it didn’t make sense to continue maintaining two apartments, especially given the cost of living in Switzerland.

In July of 2021, I floated the idea of working full time from Montpellier: I would no longer work for Hamilton Medical, AG (Switzerland), but instead become an employee of Hamilton Medical France, SARL. Everything about my job stayed the same, except that I’d be paid in euros, my health care would come from the French government system, supplemented by a mutuelle from Hamilton, and most of all, I’d be back in Montpellier, full time.

Adrienne, my boss, and her boss, Ralph, agreed with my proposal. We spent the next few weeks negotiating my new contract and by early September, we had signed all the papers. Because I would not be renewing my Swiss visa, I had to wrap up all my affairs by the end of the year. I made plans to leave Switzerland as soon as possible: packing, arranging for movers, all the administrative minutia when you change companies, move out of an apartment, and leave a country.

Sometime in the middle of it all I received an email from Dr. Maury reminding me that because my surgery required a variety of custom components, he was still waiting on additional scans. Since I was in the French medical system, the scans would be free if I went just over the border into France, to Mulhouse. If I got the scans in Chur, it would cost Chf 1,500. I got the scans in Switzerland on September 8th and immediately sent the images to Dr. Maury.

The next day I figured it out.

With two concurrent events – surgery and leaving Switzerland – it became clear I had not thought this through. There was no way I could coordinate leaving Switzerland by the end of the year after an October 6th surgery in France. I contacted Dr. Maury, told him the situation. We agreed to cancel the surgery, and set a new consultation for April, 2022.

~

Schedule collision II

Spring, 2022

For the past twelve years we had been vagabonds: moving every few years, having to rent furnished apartments or townhouses, searching for landlords willing to rent to Americans with an unusual and very limited income. Now, my being employed at a French company opened up some doors for us: no longer a visa holder working in Switzerland, I was a bona-fide French resident working at a French company. With that, Annie started looking for a place of our own. Right after the new year she started looking at homes, driving around Montpellier, talking to agents.

On Tuesday, February 1, Annie looked at a house with real estate agent Laura. On Friday, February 4th, we made an offer, which was immediately accepted. However, unless we could arrange financing, a complicated affair for Americans, (even as residents working in France), the deal would not go through. We hired a Jean-Francois, a coutier, a loan broker, to find us financing.

Meanwhile, at my April 8th appointment with Dr. Maury, we picked up where we had left off the previous September. He sent me off for a radiography and TDM to see if my knee was in the same condition as six months ago. We met again on April 25th, reviewed all results – we were good to go for surgery. We set a date for June 9th. After that he wrote me a stack of ordonnances, prescriptions, of things I would need to get or do prior to the surgery.

On Friday, April 29th, four days after setting the surgery date, Banque Populaire of Nice took us on as clients: we had financing. However, we needed to set a move in date, and the current owners wanted to be out of the home by the beginning of July. We set a move in date of Monday, July 4th – less than one month after my surgery. This time there was no postponing one event or the other. There was nothing to do but commit to both, and make the best of it.

~

Preparing to move, preparing for surgery

Spring, 2022, continued

The weeks became busy: packing up for the move to the new house, meeting with the anesthesiologist, contacting overseas shipping companies to move our possessions from Maryland to Montpellier, wrapping up projects at work (I’d be out for a few weeks), making plans for summer visitors, working through all the loan paperwork, blood tests, French and American taxes.

I got started on all those ordonnances.

One ordonnance sent me to the pharmacy where I was given two large bags containing several levels of pain medication, anti-coagulants, bandages, anti-septics, a pump that went into one of those marsupial pouches, and among many other things, a bright yellow-green hard plastic used needle disposal bin. I’d go back a few days later to get a full leg nylon with velcro strap leg split, and crutches.

For all that stuff, I didn’t have to pay anything.

Another ordonnance was for kinésithérapie, physical therapy. Luckily, just down the street was Korps Pôle Santé, which specialized in physical therapy and sports medicine; it would turn out to be the perfect place. I brought the ordonnance, and after talking with Sebastian Sanchez, who would be my trainer, we set up a schedule to 2-3 meetings per week until my surgery. The goal was to build up muscle mass in my left leg.

Muscle mass is a relative term. At 193cm(76 in), I’m not the big boned type; on a heavy day I’m 87kg (190 lbs). With a LOT of work I can develop something of a back and chest, but I am forever doomed to birdy legs. Nonetheless Sebastian loaded me up with all sorts of sadistic squats, cruel leg presses, god-fucking awful lunges with some sick variations, and I’m going to kill you and everyone in your family power jumps onto or down from a box. Several times I almost died. Sebastian also explained that right now we would not focus much on range of movement or flexibility; with a twisted smile, he said these would be a part of the post operation recovery, in addition to all the strength work.

For all that physical therapy, I didn’t have to pay anything.

There were other ordonnances for which I didn’t have to do anything, but rather things were brought to me. About a week before the surgery, a medical technician delivered a cold therapy machine, an apparatus that I would use after surgery. The machine circulated cold water through a sleeve that wrapped around my leg. There was a plastic water reservoir that was kept in the refrigerator. After surgery, several times a day, at least, I’d insert the cold water plastic tank into the device, attach all the tubes, wrap the sleeve around my leg, and let it run for about twenty minutes. Repeat as needed. In the months ahead, I’d appreciate having this cold water circulator, as well as ice packs, cold compresses, ice cubes wrapped in a towel, and even just a really cold shower – anything to deal with the inflammation and pain and heat.

The last ordonnance was for a squad of nurses for post surgery care, lead by Nicholas Perez, along with Laura, Charlotte, and Gail.

~

Tonsillectomy memories during the first surgery

1969 and June, 2022

Five days before surgery I started on a pre-surgery anti-biotic program. Three days before surgery was my last kine-therapy until after the surgery. The day before surgery I got one more covid test. Thursday morning, June 9, we were at the clinique early, and went through a check- in process. The administrator asked if I wanted a private room – there was very little price difference – yes. By 0845 I had shaved my knee and shin, showered with Bétadine, then dressed in the paper-fabric blue shirt and pants, and put on the lunch-lady hair net.

I was taken into a waiting room with eight other patients, all of us sitting in chairs that could be wheeled around, recline into a gurney, and looked like the chairs used in executions in the United States. I was the last to be wheeled out, and was transferred onto a regular gurney, covered with blanket, then wheeled into the rock’n operating theatre.

Dr. Maury greeted me, and said everything looked good to do, and there as nothing to worry about. While Dr. Maury made some drawings on my knee, the anesthesiologist, Dr. Peccoux, stationed right next to me, asked me how I was doing.

The last time I had a general anesthesia I was nine years old, having my tonsils out. I still remember the mask going over my face. I had the split second thought that I was like a fighter pilot in a Phantom F-4. The air from the mask was very cold and dry, and the doctor said, “Count back-”.

I woke up with my throat on fire, sore and bleeding.

I didn’t like the sudden transition of consciousness to being under, then waking up in a different room, feeling like shit. So about fifty years later, I decided that this time I would try to fight it for as long as possible, try to be aware of the moment I was getting knocked out, feel myself going under, make it a gradual, analog rather than binary experience. Dr. Peccoux held the clear mask over my nose and mouth, he was still speaking to me, as if he expected me to listen and respond, I tried to-.

The next thing I knew I was being wheeled out of the OR. Dr. Maury, walking next to the gurney, asked me how I felt. My tongue and mouth were sticky, stuck blob. I made a sort of slorching sound, ‘Pas mal’.

~

Busy

Summer, 2022, specifically between June 12 and September 21

From my calendar: return home from Clinique St. Jean; begin twice daily nurse visits; begin twice weekly kinetherapie; apero with Iberio and Marie Cruz (we bought their house); return to work; pack up the apartment; move the apartment; unpack at the house; Chambers family visit from USA; Annie and Catherine fly to Montreal; Kurt and his sons visit from Laos; Caroline visits from Switzerland; staples from the incision are removed and the knee is healing well; Blake and Andre fly to Maryland, but only make it to Paris; Annie, Catherine, and cousin Aline fly to Maryland; Blake and Andre finally make it to Maryland; sell stuff on Craigslist; sell stuff at yard sale; sell guns at Hafners; take an unbelievable amount of stuff to dump; eat a lot of Mexican food; the girls return to Montreal; Andre returns to France; Blake, Julie, and a couple of local guys load up the container; give away gun safe to Herb; Annie and Catherine fly back to France; Blake returns to France; follow-up appointment with Dr. Maury.

There was a lot more going on; those are just the highlights. Not all words are equal. For example, an activity like pack was about a hundred times more work than an activity like visit.

Throughout all this I was on crutches, or supposed to be. Often I’d limp-walked for short distances, lift, push, pack, torque that knee. When I could I’d ice my leg or lay on my back, legs in the air, to reduce the inflammation. In addition to the almost chronic pain, it was frustrating that I could do so little, never really carry anything since my arms and hands were occupied by the crutches.

~

Do over

September – October, 2022

Dr. Maury was frowning, which was unusual.

We were back from the United States, school had started for Catherine, I was back at work, and all our worldly possession were in container number CSNU165114-1 aboard the container ship LA TRAVIATA, which had left the port of Norfolk on September 12.

Dr. Maury looked at the latest images of my knee, fiddled with it a bit, then returned to images. He told me to go get some more x-rays, and we scheduled a follow up appointment. He shook my hand and nodded encouragingly as I left, and his being friendly was also unexpected.

It wasn’t a surprise, then, when at our next appointment he said that after reviewing the latest images and consulting with his colleague, he was not happy with the results. He wanted to re-do the osteotomie.

I confessed to him that I had not been an ideal patient, and explained all the things I had been doing since surgery. He didn’t think that had anything to do with the state of my knee.

For some reason the prospect of a second surgery did not bother me. Unlike before the first surgery when I was relatively mobile, now I was already on crutches and in pain, so what if there’s a bit more of the same thing? We set a date, and he wrote some more ordonnances.

~

Flashback: squashed tendon, a rear-guard financial battle

Spring, 2011

It happened during a time when we had been, and would continue to be, downwardly mobile.

Having left California in August, 2010, we were in Montreal trying to figure out what was next. During a game of squash, my achilles tendon snapped. Since Americans were not welcome in Canadian hospitals unless it was life threatening, we made our way to Burlington, Vermont, to the university hospital there.

Every aspect of the health care was excellent: we saw an orthopedic surgeon, the remedy a simple surgery, a date set for the following week. The surgery went well, and especially interesting was that during the surgery, the anesthesiologist had put some sort of tube around my waist and inflated it (of course there was a local anesthesia for the tendon work then something else to keep me calm and happy). As with my knee, the anesthesiologist was sitting next to me, and as the surgery wrapped up, he deflated the tube and said I should start to feel something in a few seconds, and he was exactly right.

Every aspect of the financial experience was soul sucking. Since I wasn’t employed, I had private insurance. Because companies work to maximize the amount of money they bring in (such as my premiums), and minimize the amount of money they payout (such as my medical claims), it would be a Herculean task to extract even the slightest amount of money from the insurance company.

I knew this from the moment I limped off the squash court. From my journal that very day:

19.April.2011, 0930: Tendon injury during squash game at YMCA in downtown Montreal.
Iced it right away for twenty minutes
1400:called a few doctors offices (CLSS) in Montreal. They said I would need to go to a private clinic where I could pay.
1700: got an appointment at and went to the Action sport Physio – Centreville, in Montreal. Was examined by a physical therapist (Renee) who advised me to seek immediate treatment with an MD. She believed the tendon was ruptured, and would need casting and/or surgery. She massaged the injury, then hooked up some electrical device to alleviate the pain. Was loaned some crutches.
1938: called the insurance company to advise them of the situation and ask if there was any problem with my plan to go to the emergency room at the hospital at UVM in Burlington. The woman I spoke with said as long as everything we did complied with the terms of our insurance policy, there would be no problem. I told her was in fact the reason I was calling: to ensure our actions were covered by the insurance policy and that I was doing everything according to their protocol. She essentially repeated what she had said before, then stated she would forward all information to someone who could handle this.
2113: I called again to confirm that everything with out plan had been reviewed and was okay. Again spoke to a woman who said she could not confirm anything. I would have to call back during business hours, 7-6 Central Time.

After the surgery the hospital began sending me bills, I forwarded them to the insurance company, then the insurance company sent me statements that their coverage for procedure coded NT2BPD was $31.19, although the hospital charged $1,400. So continued this administrative ménage à trois between me, the insurance company, and the hospital. I was definitely the one with the red ball in my mouth. The insurance company excuses: the injury took place outside the United States, the injury was treated in state where I was not a resident, the provider was out of network, and did I really even need the operation? This dragged on for a number of months.

The tendon event (outpatient surgery, a before and after doctor’s visit) cost over five times what we had to pay for my knee trilogy: three hospital stays, three surgeries, many doctor consultations, post surgery care, many blood tests, many images made, lotsa drugs.

~

Nurses and sepsis

October, 2022

I know the moment that it happened, when I created the condition that lead to the sepsis. It was a sort of a ‘hold my beer’ moment. I survived, luckily.

Nicolas Perez was in charge of the team of nurses who visited me after all surgeries. Having worked for Air France for many years, his English was excellent. Along with Nicolas, there was Laura (gold colored eyelids and gold Converse tennis shoes), Gail (subtle tattoos, sportif), and Charlotte (archetypal young French woman). The routine was the same: clean the incision and put on new bandages; anti-coagulant shot, check vitals. They cleaned my staples like playing the xylophone: soak a gauze in Benedictine, then with forceps brush it back and forth across. The post-surgery care in June and July, after the first osteotomie, was routine and uneventful.

When I woke up in the clinique after the second surgery, in October, in addition to the incision being longer and with more staples, there seemed to be more blood and fluid seepage from the incision than last time. There were two tubes draining away the blood and anything else.

A week after I came back home, near midnight, many hours after the evening nurse visit, the bandages were too red and a bit loose. Annie said I should call Nicolas, but I had seen the nurses change it dozens of times, I could do it myself. What could go wrong? The end result was similar to the first time I tried to make a paper origami crane when I was eight years old: something unrecognizable.

The next morning Gail asked me what the hell had happened. I told her I had been moving around too much, and the bandages had come loose. She fixed everything up, and told me to never, ever, do that again. Don’t get a French woman mad.

A few days later I was getting yet another blood test. For some reason, I did not go to the lab near our house, but instead to the lab at the Clinique St. Jean, which was right next to Dr. Maury’s office. Catherine was along to keep me company.

After the blood was taken, the technician told me to have a seat and wait in the lobby. This was unusual in that usually I could leave the lab right away, and a few hours later get an SMS with a link to download the test results. I didn’t think much of it; the protocol must be a bit different here.

After about twenty minutes I heard, “Monsieur El-duh? Monsieur El-duh?” To the French I am Black El-duh.

Dr. Maury was in the lobby and calling me over, not the lab technician. What was Dr. Maury doing there? Observation: if your surgeon, and not the lab technician, wants to talk to you after a routine blood check, things aren’t routine anymore. I later learned that when the blood test indicated a high white blood cell count, the lab technician noted that the referring physician was Dr. Maury, and that his office was in the next building, and she immediately called him.

Despite the fact that I told him I felt fine, right then and there I was admitted to the hospital and surgery was scheduled for the next day. Catherine went home and brought back all they stuff I’d need for my third hospital stay in the past five months.

In the end, it was my DIY bandage change that nearly landed me in the ICU.

~

Pain and the 3:17am hospital blues

Still October, 2022

If after the first surgery I felt not pessimistic, and the second surgery resigned, but hopeful that it was all behind me, after the third surgery I felt dark and numb.

Once again in my own room in the Clinique St. Jean, I had the same tubular apparati as last time: double drainage tubes from the incision, a a clear plastic ball pump that was carried in one of those fanny marsupial pouches, with a catheter going into the leg just above my knee. It was now October, the days were getting shorter, my mood matched the changing seasons.

The family was busy at the house, and only Catherine found time to visit. The container that had started in Hagerstown had made it to Montpellier, everything intact, even the two surfboards tied down on top of everything. Credit the two guys who helped me and Julie load. Now everyone was busy unloading and putting furniture and boxes in all the rooms.

Pain makes you tired. Being tired makes it hard to get past the pain. Night intensifies the pain. Depending on the degree and duration of the pain, you come to see your life divided: everything before fades into a dim memory, and represents very little compared to, say, the last 72 hours.

With pain sometimes you have to choose between something very bad and something worse. Really there’s no choice – just try to get to the bathroom without passing out. Typically it’s sometime around 3:17 A.M. Can’t sleep, so turn on the light and elevate the bed. Sit up slowly, arrange all tubes and attachments so I can move. Pause for moment as that movement has already sent waves of pain down my left leg. Swing up to a sitting position on the edge of the bed, and wait again for the waves to subside. Wrap all the tubes and lines around the crutch handles so they don’t drag on the floor. Now, making sure I’ve got a good grip on my crutches, as slowly as I can, stand, putting my weight on my right leg, as the waves of lava cascade down my left knee. It’s like those film clips of a high-rise building being demolished by a series of explosions and each floor pancakes down onto the next floor. I get dizzy, as if I stood up too quickly, but after about two minutes I can start to hobble to the bathroom; at least this time I don’t have to sit down. Repeat two more times that night.

Once back in bed, too tired to sleep, I survey the room: some books, but if I can’t concentrate I don’t want to read; my digital pacifier phone, journal, bag of prunes (I learned from my first surgery, that, courtesy of opioid narcotics, things stop moving through your system, so that passing what felt like a bowling ball is really the size of a pea).

In addition to the standing up, the pain came in other ways. When the staples were in, once in a while a staple would move every so slightly, jab into my leg, a narrow, but intense focus of pain. Other times, after a day of hobbling around in the August after the first surgery, a steady throbbing burn set in that only went away after several ice packs, some pain pills, and a bit of bourbon. Odd as it sounds, just thinking about the pain when I stood up was almost as bad as the actual pain when I actually stood up. Maybe it was fear of the pain.

Once I’m out of the hospital, I’ll try to minimize the amount of pain medication. Pain was a sort of guardrail which let me know if I was over-doing it with my knee. Dr. Maury had prescribed Daflagen – 1,000 mg of paracétamol. When it was really bad, there was Izalgi: 500mg paracétamol with 25mg poudre d’opium. The Izalgi worked well, but I limited that to only when the pain was especially bad; I had five boxes of sixteen capsules at the start of it all, and after the last stitches were taken out, I still had four and a half boxes.

~

Your health, someone else’s wealth

Even more profitable: your injury, your serious illness

For this section I had planned some sort of ProPublica exposé: an award wining comparison of my surgeries in France versus what it would have cost in the United States, and by extension, a withering critique of the American health care system. During the gestation period for this essay (months into years), through my usual news feeds (The Washington Post, The Guardian, as well as several through Mastadon: ProPublica, NPR, Robert Reich, among others), I came across numerous articles about health care costs, uncooperative insurance companies, bankruptcy caused by medical bills, stories of denied coverage resulting in leading to a patient’s death, and the infestation of the health care industry by private equity companies.

Then there were books and articles I had accumulated over the years: Michael Crighton’s Five Patients (1969), Atul Gawanda’s ‘The Cost Conumdrum’ (The New Yorker, May 25, 2009); Luke Mitchell’s ‘Sick in the Head – Why America won’t get the health-care system it needs’ (Harpers, February, 2009); Daniel J. Kevles’ review of Alexander Zaitchik’s Owning the Sun: A People’s History of Monopoly Medicine from Aspirin to Covid-19 Vaccines (New York Review of Books, October 25, 2023); and others. The themes were the same: per patient spending on health care in the United States is several times higher than that of other first world countries, yet the health outcomes are either the same or often worse; government subsidies for already profitable pharmaceutical companies, profits over patients; again, private equity companies.  

But better writers with deep domain knowledge have already written, and continue to write about the blight of American health care.  The world will have to wait for my exposé, but a word about private equity companies. As best I can tell, a private equity fund (a vehicle to make the very rich even richer), is both predator and scavenger: it stalks, captures, then dismembers a company, picking over any last remains until there is no more money to be made.

In her review¹‘Conspicuous Destruction’, … Continue reading of several books about private equity companies, Kim Phillip-Fein summarizes the process:

Private equity funds buy up all the shares of publicly traded companies, gaining complete managerial control. (Sometimes they will acquire companies that are privately held, such as independent medical practices that are limited-liability partnerships.) Usually a purchase is financed with heavy borrowing, so that a newly acquired company is saddled with debt that it needs to repay quickly—often by selling assets or laying off workers.

She then provides a specific instance:

When the Carlyle Group purchased ManorCare, the second-largest nursing home chain in the United States, for example, the first thing it did was require ManorCare to sell its real estate. This allowed Carlyle to recoup the money it had borrowed to finance the deal, but forced the chain to pay nearly $500 million in rent annually to keep using its buildings. It was also saddled with $61 million in “transaction fees,” followed by an additional $27 million over nine years in advisory fees. To cover these new costs, ManorCare faced intense pressure to scrimp on patient care, laying off hundreds of workers. Its health code violations rose by more than 25 percent between 2013 and 2017. At the same time, it forced patients to undergo pointless therapies that Medicare would cover, sometimes with absurd consequences—as in the case of an eighty-four-year-old man who was brought to group therapy even after he became verbally unresponsive and his doctor had authorized end-of-life care. Nonetheless, ManorCare declared bankruptcy in 2018.

Capitalism meets medicine, and both the practitioners and patients suffer. But the good news is a few people made a lot of money.

Private equity companies produce nothing and provide no services. The investors have no stake, no interest in either the domain of medicine nor the community served. There’s nothing wrong with making a lot of money, but after much reading about private equity with regard to not only health care, but other industries, I had two questions. How much is enough? What is the greater benefit to society, to the common good, of a private equity company?

~

I’m still standing

November, 2023

After Elton John, of course.

Korps Kiné in Montpellier. I’ve been in physical therapy for many months. Today Sebastian has me doing a variation on bench jumps, which the last time I did was around 1979. In high school the jumps were over the tackling dummy, when I wore a helmet, shoulder pads, and cleats. This time I was not wearing any particular gear, instead carrying north of sixty years.

There’s usually music playing at the studio, not very loud. Often it’s American pop music, other times newer groups like the Sound Defects, whom I’ve heard when Catherine sends her music through the kitchen music system. Right now there’s the Strangler’s cover of Burt Bacharach and Hal David’s Walk on By; one of the best covers, ever.

In 2023 the world of sports and physical therapy – dynamic warms ups, static cool downs, recovery, the abundance of equipment (bands, balls, balancing platforms, etc.), nutrition, and sports-related medicine – is a world away from the 1979. For that matter so are sports clothing: Goretex, lycra, Merino wool blends, and other synthetics. Long gone are the days when there was only cotton, itchy wool, and nylon, when on a wet, grey and cold October afternoon before football practice, you tucked your Johnson into yesterday’s cold, still wet jock strap.

Some days Sebastian has me do drills by myself, other times I am paired up with someone also there for leg/knee therapy, or something complementary, so that we can work together. Today Sophie is there, she arrived on her e-bike with two small seats in the back for her children. Black hair and dark skin, she could be from Sicily, except she’s too tall at about 179cm. She’s there for her knee. Sebastian has us laying on our backs, heads towards each other, passing a Swiss ball, held between the ankles, back and forth. The next time I work with Ocean, young, pretty, and blond, has a nasty scar on her wrist from a broken bone. She needs to throws the rugby ball, which I have to catch, standing on one leg on the Bosu ball. Another time I follow Nicolas, thirtish with hipster beard and tattoos on the back of his calves, circling the perimeter of the studio, squatting low, crab-walking with tight bands just above our knees.

On this particular day Sebastian had me jumping over some long rubber bands, not unlike those long ago bunch jumps. These are particularly painful and difficult one-legged jump over long, stretchy rubber bands. We’re using bands so in case my foot doesn’t clear the band, I won’t face-plant on the ground. Jump high, land softly, knee bent low, repeat twelve times, next set add more weight. Repeat.

It’s November. It’s been a long road back. It’s been 523, 397, and 386 days since each of the respective surgeries. At the beginning of physical therapy it was frustrating and felt pointless. Sebastian told me I had to get it through my head, and clearly did not yet, that not only had I had three surgeries in four months, but I was on the other side sixty; I needed to adjust my expectations. He was right, but one doesn’t go down without a fight. His other comment, several times during every session, was ‘Take your time’. Of course, that wasn’t just for that particular exercise of the moment, but for the entirety of my rehabilitation, which meant for the rest of my life. Love that guy

Little by little I’ve made my way back. Walking around without crutches, hands free is just such a wonder. Just walking.

The incision is now a scar. Some days Sebastian works me over on an examination table, bending the knee and leg every which way; again, he’s definitely trying to kill me. Then he’ll manipulate the scar tissue, incredibly painful, and he reminds me that I need to massage it every day, and don’t forget to apply the vitamin-E cream, which nurse Laura told me to get.

Jump high, land softly, knee bent low.

I’m back in the pool a couple times a week, and go with Catherine to her gym: new lifting racks and machines, along with old school weights, it smells like 1950, rubber, and metal.

It’s November, but unlike Ishmael, there’s no November in my soul. Rather, after too long away, it’s Chaucer’s westerly Zephyr, filling my sails with life, with hope. Sometimes you need to go through something, go backwards, have something happen, then get unstuck and start to move forward, make progress.

Jump high, land softly, knee bent low. It burns, it hurts, but it’s the right kind of pain.

During all this the song changes. I stop for a moment to listen. Serendipity, coincidence, whatever. In the middle of that jump up, extend, knee bent low, now playing in the studio was Other Side, by the Red Hot Chili Peppers.