My knee and sympathy seem to go hand in hand, if you'll pardon the mixed body parts.
"How's the leg?" has replaced the usual how's-the-weather talk on the office elevator, and for people I haven't seen in a while, "Why are you limping?"
I have thought seriously at times about printing up a handout with the full explanation of The Leg and The Limp and simply handing it out to anyone who asks, much the same way Jack (Hacksaw) Reynolds of the Los Angeles Rams once did when wave upon wave of Super Bowl reporters asked him to explain his rather unique nickname. (In college, he once used a hacksaw to saw a troublesome car in half, but that's another story).
In truth, I appreciate the inquiries and usually launch into a brief spiel about my trials, tribulations and five knee operations over the last two years. But actually, I can tell you all you need to know in two words: staph infection.
Little did I know when I entered a local hospital for routine knee surgery two years ago that I would become a statistic: one of thousands of people who leave the hospital worse off than when they went in.
The exact number of hospital-acquired, or nosocomial, infections is hard to pin down. Health officials explain that infections are categorized by type, not by point of origin. It's difficult to know if someone brought an infection to the hospital or caught it from the surroundings.
But there are estimates. According to the Centers for Disease Control, about 2 million people a year get infections while hospitalized -- about one patient in 20. Even with the best of prevention procedures -- which all hospitals are required to maintain -- only about one third of them could be prevented; the rest come from germs within the patients' own system, often the gut, according to Dr. Jim Hughes, director of CDC's Hospital Infections Program.
Hughes said nosocomial infections directly cause 20,000 deaths a year and contribute to 60,000 more.
Those numbers are chilling enough, but I must admit to a shiver up my spine when one doctor told me before my fifth operation last year that infections can occur in "almost any hospital you go to. It's a crapshoot, really." ::
In September 1985, I went into a suburban Virginia hospital for what was supposed to be a routine arthroscopy to remove some torn cartilage. I've been a sports writer for 20 years and have written scores of stories about athletes undergoing these relatively minor surgical procedures and popping back out on the playing field within weeks, even days. I had no hesitation about having my knee "scoped," as the jocks like to describe it.
A week after the surgery, I was recuperating at my in-laws' house in Florida. But my father-in-law, Dr. Charles Moon, an internist in Ft. Lauderdale, knew something was not right almost from the moment I stepped off the plane. A day later, I was rushed to the emergency room in an ambulance with a fever of 104, had major surgery shortly thereafter and spent five weeks in a Ft. Lauderdale hospital while they tried to save my leg, break up the blood clots that had formed and battle the staph infection with almost 24-hour-a-day antibiotics.
After they opened an eight-inch incision up one side of the knee and down the other, I was put under twice more over the next four weeks for what they call a manipulation. At first, I couldn't bend my knee. Then, I couldn't straighten it. So they knocked me out, manipulated the leg into the proper position, then finally put me in a cast and hung me out to dry just like they used to in the Laurel and Hardy movies. I wasn't laughing.
And that wasn't the end of it. When I finally did hobble out of the hospital, I spent another six weeks on crutches, four months in almost daily therapy and so many hours in X-ray I'm surprised I don't glow in the dark.
It wasn't enough, because I needed another major operation -- this time with incisions in front and back of the knee -- the next year. It seems the staph infection had also botched up the chemistry in my knee. Every time I had an X-ray, more cloudy gray areas indicating rampant calcium formation showed up. The knee joint was so encapsulated with the body's equivalent of cement that my leg was permanently bent at about a 35-degree angle.
The last operation was a year ago in September. My orthopedic surgeon, Jim Gable of Leesburg, described the procedure he'd be using as a hammer-and-chisel kind of deal to literally chip away the unwanted calcium. This time, with a little luck and a great surgeon, Gable managed to make me almost normal.
I'm told I probably will never get my leg totally straight -- it's about 10 degrees from that right now -- but I'm back on the tennis court and a terror in doubles. And while my friends keep telling me they hardly notice The Limp, I know it's still there.
But I can live with that. In fact, I have to live with it. I can do almost everything I used to do, save for those six-mile runs and lunchtime basketball at the Y that probably caused the initial discomfort. But after seeing the charts on my case, without getting too melodramatic, I can honestly say I'm simply thankful to be alive and swimming laps.
I must also say I'm mad as hell about all of this, and I don't know whom to blame. Was the hospital at fault for not having properly sterilized instruments? Was the original orthopedist (not Gable) a bit sloppy in his procedure? Did I get the infection while I stayed at home in bed, in the car going home from the hospital, on the airplane to Florida? Who knows?
I dealt with several attorneys about a malpractice suit, trying to find the answers, but we never got to court. In the course of building a case, I visited or spoke to a half-dozen orthopedists who studied my charts and poked and prodded my knee. At one point in the conversation, I was told by each of them that staph infections are a way of life in American hospitals in the 1980s, and that I had simply been one of the unlucky ones. ::
My neighborhood pharmacist, Toby Merchant of The Plains, Va., showed me the results of an informal study he had done at a local nursing home, testing for traces of potential infection-inducing organisms in two typical places -- watered plants common in most hospital settings and rings worn by the nursing staff. Five out of the six plants grew positive cultures; two of the six ring samples grew positive bacterial cultures.
He will be the first to admit that his study was hardly definitive, but when you see the national statistics, you get the feeling he is on to something.
What can be done? I'll leave that to the medical experts. They have my sympathy.
I still have my wounded knee.
Leonard Shapiro is sports editor of The Washington Post.