Dr. Gerard, the specialist that Nancy's physician had referred, diagnosed a very badly-worn, arthritic and weakened knee that was in an advanced stage of inflammation and deterioration. In fact, Gerard was surprised that Nancy was even walking on the knee, let alone playing sports on it like the tennis game she had been playing when she had injured herself.
"A replacement seems like your best option," Dr. Gerard had said at that time.
Nancy grasped Brett's hand tightly as she tried to exude confidence.
Nancy was no stranger to injuries. At 35 years of age, she had always been an active woman. She played tennis and other racquet sports, skied, jogged, cycled and danced. Scrapes and bruises, then, were an everyday part of life at home, but surgery was something else.
It certainly seemed, though, that surgery was the only real option, so she and Brett decided to move forward with it. A new knee had been implanted in early August.
Now it was two weeks after the surgery and Nancy had become frustrated with the constant, throbbing pain that wasn't going away and the loss of strength in her knee. She had expected some pain and discomfort but as the days passed it had become obvious that there was something wrong. So here the two were, back in Dr. Gerard's office listening to the results of an arthroscopy that had been done earlier in the day.
"I hate to start like this," the Doctor began, "but I really do have some good news and some bad news to share with you," The bad news is that there is a runaway infection in your knee. It has made the recent implant a failure. It is also attacking the lower part of your femur which had anchored the top bond of the prosthetic knee."
Nancy and Brett listened patiently but nervously to the somber tone of Gerard's voice.
He folded is hands on his desk and spoke in a gentle way as a man in his position should when he is delivering shocking news. "The bottom line here is that you are in the 5-10% of patients who have an unsuccessful result from this procedure. Now the good news is we have two procedures to stop further deterioration but both have serious consequences for your future. That is why I will be leaving you today with a very big decision to make."
Brett looked to Nancy. She held her head high and brave, but he knew better. "What kind of decision?" she asked.
"The first option is to re-enter your knee, remove the prosthetic and implant a new one. That would, however, have to be done at a trans-section point above where the infection has spread. I would estimate that that new trans-section would be at least 3 inches above our first cut and would result in your right leg being that much shorter than your left leg. In all likelihood, the surgery would likely leave you with reduced range, flexibility and strength than what you had hoped for when you chose the replacement therapy."
Shocked at what she was hearing, Nancy was hard pressed to squeak out the words, "If that's part of the 'good news,' I hope your other option is a lot better."
"Well Nancy, and Brett - because you're a part of this, too - it's a matter of priorities and values, I suppose. I know that neither choice is an easy one to make. The second option involves transecting, or cutting, your femur above the infected area and creating a healthy, robust residual limb that would allow you to adapt easily to a prosthetic leg."
"Wha-?" Nancy stammered. "You're saying that the only two ways to fix my knee are to leave me with a short leg or none at all? Is that what I'm hearing you say?"
"I'm afraid so," replied the Doctor. "Without one of those two options, the infection will become a crisis sooner or later. Then I couldn't promise that I would be able to save any of your leg or, for that matter, maybe even your life. I am so sorry to tell you this. Now, the hardest of all this that I must tell you is that you need to make your decision by Monday morning. Without knowing how fast the infection is spreading, for sure, I can't advise any longer than that. Truth be told, it's gone too far already. We have to act.
"I'll be scheduling a Monday afternoon surgery. Here are some booklets on both procedures. I will also suggest that you do some research on the Internet. On your way out, pick up a prescription at the front desk for a pain-killer that will get you through the weekend, and please ring my office no later than 8 AM on Monday, okay?"
Devastated by what the two had just heard, they sat quietly for several minutes after the Doctor left. Then they hugged. Nancy cried a little and began asking questions: how will the kids adjust? What would you think if I had one leg? Could you still love me? How will we stay active and fit?
Brett was relieved that Nancy's questions were more about "what ifs" than "why me?" The 'why me' would come later. What was important now was to make the best choice for Nancy.
Taking his wife's hand, he kissed and licked her ring finger and spoke to her soul, "I love you more than anything in my life save perhaps our kids," he winked, "and I know I'll love you no matter what you decide."
Again, Nancy's first thoughts were not of her but of her family. "It's lucky that the kids are going on a campout first thing in the morning and that we can talk this through in quiet. Let's go shopping and get enough stuff that we don't have to go out all weekend if we don't want to. I need to ask lots of questions about this but tonight, let's take the kids out to dinner then down to the beach for a swim and NOT tell them about this. Then, I think these drugs will make me pain-free enough to want to ravish you and be ravished by you."