Literally and figuratively, I’m torn.
My injury turns out to be a complete proximal tear of the hamstring tendons, with several centimeters of retraction of the muscle away from its former attachment to my ischial tuberosity (Gray’s anato-mese for “sit bone.”) If you were to Google that (and believe me, I have), you would learn that this level of injury typically triggers a surgery recommendation, although this may be mitigated somewhat by “age” and “activity level.” The tendons will not, however, grow back on their own: the gap is too great. The last two-and-a-half a weeks have been a fever dream of ice packs, emails, texts, tests, and calls to various offices of surgeons and physical therapists, trying to get clarity on the best path forward for me, not for a data point on a statistical chart, or this guy Bob who had a similar injury and was still able to downhill ski without surgery, or that lady Judy the amateur triathlete, who first opted out of the surgery but regretted it and was glad when she later decided to do it. Or that other dude who had the surgery but couldn’t sit for a few years afterwards and wishes now he’d given rehab a more concerted effort.
The first surgeon we met said surgery for me is optional. I might do very well without it, she thought, although when we pushed her to get off the fence, she said “Ok, I’d lean towards surgery because you’d have more reliable strength. But it’s like 60/40.” She works in the practice that treats the Boston Celtics and is arguably the most experienced of the handful of surgeons in Boston for whom repair of a proximal hamstring tear is a sub-specialty. She’s co-authored a paper on non-surgical treatment of proximal hamstring tears showing decent outcomes, although not a return to maximum strength, and not for all those studied. Just to keep the pressure on, she urged me to make a quick decision, by the end of the week. Her experience is that the surgery is much better performed within three weeks of the initial injury, and the window for dancing into her O.R. would close quickly.
The second surgeon, two days later, a specialist in women’s sports orthopedics, agreed that my case is “gray,” spending nearly an hour with us answering our questions. She demurred when we asked her, too, to take a side. She acknowledged with a rueful smile that she’s a surgeon and she likes “to cut,” yet she felt reluctant to say that she thought it would necessarily lead to a better outcome for me. We showed her a video of Nia technique, the movement classes that I teach, and she said, “Yes, you’ll be doing that,” either way. We pressed her about non-surgical rehab: with no compensatory issues to the rest of me, my joints, my back? “None of the longitudinal studies suggests that would be an issue.” Like the first surgeon, she explained surgical risks, the usual: infection, stiffness, anesthesia complications, some skin numbness. But also (and not uncommon with this procedure, which involves putting hardware in your sit bone): “sitting intolerance” – not good for a writer and graphic designer who spends hours a day working on a laptop at her moniter, i.e. on her bum. I’m sitting fairly comfortably right now, she observed, and quite mobile compared to many with my injury. What I’d gain from surgery is explosive power, but surgeon #2 wondered if I need this extra oomph, which would allow me to drive to the hoop, or pole vault. As my friend Nora summarized the dilemma, “so surgery makes you a Mazerati, but maybe you are great with being a Bentley.”
Other opinions were sought and given: An orthopedic sports doc who’d never seen me was emphatic over the phone that I should do the surgery. My primary care doctor, Jeanne, who has treated me for over a decade for the occasional UTI or chest cold, went back and forth, but ultimately landed on the side of non-surgical rehab. The recovery from surgery begins with an arduous crutch through six weeks in an immobilizing brace, something not easily accomplished living in a four-story home with two active dogs and a husband who has to go to work. You cannot drive for up to eight weeks. Pain, according to the surgeons, is “relatively light.” Relative to what, I wonder? I won’t be perched on one ass-cheek with a four-inch incision in the other thinking, “wow, this is so much easier than a knee replacement.” After this initiation, you work up to something resembling mobility four months out, “returning to sport” between six and twelve months down the road. My primary care doctor felt I’d only want to submit to this squeeze if I had a high degree of confidence the juice was worth it. Non-surgical rehab is typically a four-month process–unlike surgery, you don’t get knocked back down the stairs to the basement level of pain and non-functioning of the original trauma, minus five more weeks of loss in strength.
Two good friends who are both ER docs leaned away from surgery unless it’s absolutely necessary. “Before MRI’s, these injuries weren’t typically addressed surgically,” said one, adding, “the most invasive response isn’t always the right one.”
“You have to trust your body,” said the other.
Amen. I’m trying.
The third surgeon we consulted, who attends to the athletes of the Patriots and Red Sox, expressed a clear opinion that I should go for the procedure. No fence sitting for him. Otherwise, I might find myself cramping up a few hours into a 5-hour hike, he said. That does sound unpleasant. He wedged me in to his schedule as a favor after I asked a friend with deep ties at MGH to connect me to a highly-recommended physiastrist, which said friend generously did. But the physiatrist wanted me to have a consult with her surgical colleague before she’d see me. (Are you following any of this? I hardly can, and I’ve been living it.) The Pats/Sox surgeon was charming and direct, generous with his time. We were able to overcome an initial gaffe when he rolled his stool my way and said, “so this has been developing over time and you’ve had several shots to try to address it?” Umm, nope. Not me. “I tripped on a carpet,” I corrected him. (Note to self: put a big red X on left butt cheek before going to the hospital if I elect for surgery with him.) Even though he was a strong advocate of operating (and I appreciated his rationale: “You are a movement teacher, and you like activity. If you were 69 and just wanted to potter in the garden, I’d have a different recommendation”), he also was willing to listen to my concerns. He took seriously my desire to avoid surgery if there isn’t a truly clear case that it’s necessary. Which I appreciated. I felt he heard me and collaborated. We arrived at a compromise: I’ll work for two-and-a-half weeks with a crack member of his PT team, someone who is “the real deal” at rehabbing this injury. And after that, we’ll reconvene in his office in Foxborough, adjacent to Gillette stadium so maybe we’ll get to see the Super Bowl trophies in a display case on our way to the appointment. By then, I’ll be armed by PT with better information about what makes the most sense for me, living in this body, the person who is Holly, and unique, even if her injury has been seen before in other bodies.
I have also heard from countless friends, movement teachers, family members, all offering gifts of perspective, names of physical therapists or acupuncturists, suggestions of books, herbs, tinctures, essential oils and other resources. My refrigerator overflows with soup–lentil, chicken, kale and sausage, white bean, minestrone, sweet potato–an epic tale of nourishing kindness told in broth and vegetables. I am so fortunate to have access to the best healthcare providers and insurance coverage; more importantly, to have the support of the dearest, wisest, most caring friends. Not to mention John, who has been a pillar of emotional support: my knight in shining armor, advocate in consults, precise note-taker, dispenser of hugs and schlepperof my glasses, phone charger, ice packs and other detritus up and down the stairs of our four-story home. He is constantly telling me how great my attitude is. Which helps, because it takes discipline to keep my thoughts positive.
Yet all the while: my body feels like a healing machine. It’s almost startling how much progress I have made since that initial first week of sickening pain. The horse-kick bruise is gone, the ache is basically nil, every day I am able to do something that was out of bounds yesterday: pick up an envelope up off the floor, put on my socks, zip up my boots, walk up and down stairs, then do it again carrying a laundry basket, potty squat, drive, walk down the street and drink in the fresh air and sunshine, greeting the beautiful woods and trees I have so missed. My “real-deal” PT, Emily, asked me on Thursday if I could demonstrate a few Nia moves for her. It felt like coming home. I was careful with kicks as I’m not supposed to overstretch the hamstring while it is scarring in. I showed her a deep curtsy (on my good leg, but the injured one needs to come along for the ride) and she raised an eyebrow: “And that feels okay for you?”
“Omigosh, it feels great,” I said, lowering gently to the floor onto one hip, rolling over and rising back up to standing on my uninjured leg. Emily’s expression behind her glasses was difficult to read, but if there’s a spectrum from no freakin’ way to well, I dunno, maybe…, I think she was somewhere around hmmmm, which at least wasn’t discouraging. I have far to go. There is a hitch in my gait and my hamstring complains if I try to squat too deeply. Months of rehab lie ahead of me, with or without the surgery. But it’s hard to begrudge my body the chance to mend this her way, to show me her wisdom, what she’s capable of if I respect her, and listen to her, give her plenty of rest and do the hard work of retraining her muscles and movements to work in recognition of this realization: We are permanently torn, the lost connection will not grow back, something is missing, for good, if I opt out of of surgery, physically to be sure, but also psychologically, emotionally. And yet, life goes on. One of my best friends lives without a breast. She is joyful and courageous as ever, maybe even more so than before her mastectomy, although I didn’t know her well then. She models authenticity, sharing both her sense of vulnerability around that flat space that once was curved, and her determination that this is who she is, and she is whole. She is the most beautiful woman I know. People lose a kidney or a limb, and they adjust. I know people who have lost a CHILD, and yet they persist at living.
So I may be able to make it work without a hamstring attachment just fine.
And perhaps not.
It is difficult to know, and that’s a hard space to navigate. I’d like to simply trust the opinions of the experts, but they didn’t all present the same picture. My friend Lisa texted me a Benjamin Spock quote the other day, “Trust yourself. You know more than you think you do.” I remember feeling this way when parenting young children. Expert opinions abounded. I could read book after book about this form of discipline or that technique for getting my kids to sleep through the night. But in the end, these were our children and we had to parent them in the way that came naturally to us, for good or for ill. I have no doubt there are areas in which I fell short and that my kids are now paying the price: I was not nearly enough of a tiger mother when it came to practicing their musical instruments. I didn’t push hard enough over table manners or chores. I perhaps found their every thought and obsession too interesting and important. And yet: they are fabulous and beloved, even if they haven’t lived up to their potential as instrumentalists, or they leave their elbows on the table during dinner. Not a single one lacks persistence or grace in pursuing their passions. They are honorable, loyal, kind. The same crux may be at play as I ponder how best to live my life as a Nia dancer and daily trail walker with a torn hamstring: Is the best way forward for me to trust my own instincts, or give my faith to the greater experience of the experts; in this case, the undoubtedly fine team at Massachusetts General Hospital, the same folks who got Julian Edelman back in the game, for Crissake. No one would fault me for choosing the latter path. Many, in fact, would applaud. Perhaps these two paths will merge in the coming weeks, apparent tensions will resolve. My bias is obvious, but I’m trying to keep an open mind.
Throughout, I’ve been doing daily meditations, plugging in to silence and higher guidance. Reconnecting to a deeper level of being is one of the gifts of being torn open, it turns out. As I sit on my icepack, breathing quietly, images brush my mind and dissolve: me in a year, dancing and free, alongside my gorgeous friend the breast-cancer survivor, or two thirds of the way up Machu Pichu, answering John with a smile, “it’s fine,” when he asks “how’s the leg doing?” At lunch with a friend, saying “I was so locked in to the stress of making the right decision, but you know, my body was showing me the whole time.” I’ve imagined healing light scarring my hamstring nicely to my thigh bone; I’ve felt the presence of those I love so deeply surrounding me with loving care—even my dearly departed golden retriever, Hobbes, has visited my meditation, with his Zen-like calm and unconditional devotion. I’ve sought to honor the best in all the people I’ve met during these past few weeks, making conversation with receptionists and eye contact with technicians or my fellow patients in waiting rooms, giving them all an inner “Namaste.” An awareness of our interconnectedness steeps me like a teabag. In my mind, I danced with the MGH surgeon (he was slightly dorky) and perceived a quiet sadness in one corner of his heart; I greeted the divinity in my PT, Emily, which was easy, because she reminds me of Annie, with wide blue eyes behind glasses, a ready laugh, keenly intelligent, gorgeously nerdy. There have been so many opportunities to heal various wounds in these last few weeks. Even as my anxiety occasionally spikes and my heartbeat races, on some level, I know all is well, and proceeding as it must.