And the world was a carpet laid before me
The buds were bursting and the air smelled sweet and strange
Seemed about a hundred years ago."
These were the lyrics playing in my ears as I stepped out onto the pavement two days ago. I was on a mission to deposit my trash in the shabby wooden dumpster outside my apartment building, a place I had not left in over 48 hours. With a crutch held firmly in one hand, another crutch in the other, two weighty garbage bags held by the index finger on each, I was well aware this was hardly a "walk through the wood," but at least it got me out of the house. I was also adorned with a pair of headphones transmitting four-four rhythms from my iPod to my brain. On this particularly brief and garbage-themed outing, these rhythms belonged to The Rolling Stones and the first half of the album Goats Head Soup. The second song on the album, which I think should have been the first, is called "100 Years Ago," and it began to play immediately after I dumped my rubbish and picked up my crutches once more to reenter the lair in which I spend twenty-three hours and fifty-five minutes a day.
There's really not much to see or delight in on the block in front of my place, a block made up of a thousand working class African Americans and one white boy on crutches. Yet I was so pleased to be breathing ... air -- (was about to write "fresh air," but couldn't in good conscience describe the air enclosing my dog-feces laden strip of Crown Heights as "fresh") -- that I stopped before my front door to breathe some more and let the wind play across my face. I leaned on my crutches as Mick Jagger's 1973 lyrics played along. "The buds were bursting and the air smelled sweet and strange. It seemed about a hundred years ago," he sings, describing the time that had passed since the world seemed fresh and full of possibilities, and life devoid of worry. Youth is always too easily associated with innocence, promise and possibility, but this time I couldn't help but share in Mick's sentiment, and quietly thank him and my iPod for timing the song just right.
It seemed about a hundred years ago when I was able to walk out my door and not worry about crushing a nerve; a hundred years since I exited my apartment wearing my running shorts, or letting my mind wander to a concern other than surviving the five-minute walk to the subway. In reality it's only been eleven months since an accident left a crater in my metatarsophalangeal joint. But eleven months of foot disorder in New York City... well a hundred years might actually be lowballing it.
I urged myself not to delight too long in this self pity made up of seductive breezes and 70's rock. "We are going to get out of this," I thought, using the team-oriented plurals I often employed when talking to myself. "We are not going to accept a fate in which a dent in the cartilage will have us longing wistfully for the rest of our life. We will run again. We will act again. We WILL plug up that hole now filling precariously with scar tissue."
There are options, after all. Opinions. Some very expensive foot and ankle surgeons have posited the following very expensive ideas.
1. a PRP, or platelet-rich plasma injection. This recently developed procedure involves taking blood from the arm, putting it through a centrifuge, extracting the chunk that contains mostly platelets, and then plunging a syringe full of it directly into the toe joint.
The idea here is that the platelets, which contain "alpha granules," which in turn contain dozens of "growth factors," will stimulate healthy cell generation at the source of the damage. It's been used quite a lot in sports medicine over the past fifteen years, especially in the elbow and knee. The feet and toes, not so much. Since fifteen years is not enough time to convince the medical world that the PRP really works, the $2000 dollar procedure is generally left untouched by insurance companies.
Articular cartilage cannot be regenerated, but the doctor is hoping this procedure will prevent the need for another surgery by producing a cartilage-like patch over the hole. It being my own blood, it involves little risk.
The only risk I'm worried about is that it won't work - especially after all those needles and psychological trauma and after yet another week or two added to my bed-rest sentence.
We won't know until about two months after it's done. At that point a test called T2 mapping will tell us whether or not the healthy cells are taking hold. If they are, we'll carry on with physical therapy and keep fingers crossed that it holds. If they are not, we go on to option 2:
2. an osteochondral autograft. This is an operation in which articular cartilage is removed from the side of the knee and plugged into the toe. By replacing articular cartilage with articular cartilage, we hope to give ourselves a much better chance of the joint going back to normal.
Of course, "going back to normal" is a phrase my doctors still refuse to utter. I thought I'd throw it in there for good luck.
This is of course a more complicated procedure, and will put me off my feet for a further six weeks. Having just gone through foot surgery three weeks ago, I am loath to go through it again - especially one that jacks up my knee on top of it. And, as the best doctors money can't buy good news from said, "with surgery, there is always a risk of complication."
And so we are desperately hoping that option 1 is the one. If for some reason it isn't, and neither is option 2, there is at the very least... option #3:
3. Give up most of my original hopes and dreams and go back to school to study medieval agrarian history. Get a series of degrees in equally boring topics which will put me in a position to teach at Oxford when I'm 57. Settle down in the English countryside with a dog and a few framed maps. Take my wheelchair into the woods every other weekend, where I will cry while listening to "100 Years Ago" on whatever technology Apple has developed by then. Perhaps by then medical scientists will have devised a way to replace articular cartilage, but knowing me I'll probably have spent the money needed for such a procedure on the ample-ass-friendly wheelchair and all the Apple stuff.