The decision.

It’s our first evening in Chennai, technically. We arrived in the wee hours this morning. I am awake from jet lag and 2 cups of chai with dinner and pain and anxiety. I’m sure you read this and think I’m anxious about having surgery, but really it’s because getting a total knee replacement was suddenly not my only option.

The doctor ordered a 3T (Tesla) MRI, which shows the density of cartilage in a joint with nifty color coding. Clue: red is BAD. I had these two spots with a ton of red...all red, actually...but overall, my knee was okay. The doctor was dumbfounded. Yes, I had moderate damage, and in those points they could feel severe, but overall, my joint was not in need of replacement. He suggested stem cell injections for the potholes, and a tibia surgery that would split the bone and spread it a few centimeters to add another contact point that would help stabilize my kneecap. That alternative surgery was only a grand cheaper than a total knee replacement, and while my doctor insisted I could feel a reduction in pain two days post-op, I wasn’t so confident. We got into a discussion about cytokines, pain pathways, and the inability of the brain to utilize this information and determine the extent of the issue.

Some background: I had endometriosis since shortly after I started menstruating, probably around 14. I remember my pain was never like other women described, but I figured I just conceptualized my discomfort differently. After I was in a car accident at 19, I attributed my pelvic pain to back pain from that collision, but really, it was this. It didn’t come to a head until I was 26. TWENTY FUCKING SIX. Twelve years and I did it. I broke bones and didn’t shed a tear. I put my body through physical hell for most of my late teens and early twenties, out of the desperate need to live and keep going. With a bum knee since I was 15, endometriosis for the that and then some, it’s no surprise that my brain perceives pain differently.

So when a surgeon that I respect and has been so patient with me tells me that I should not proceed in the plan I’ve been working toward and meticulously laid out to cure said pain, arguably after a remarkable lack of sleep, I broke down. People, I broke down like I was watching the opening sequence to Up on my surgeon’s forehead. I had to make a hard decision; the main pro on the lesser treatment was objective approach as the less intense option. If I were a doctor, I’d encourage the same. But the risks of it not shutting down that pain pathway were too high. Sam and I talked about it for hours and I spoke to some friends and family, deciding that after all this planning and struggle, the lesser option with no guaranteed success was not for me. It takes an average of 6 months to see results with stem cells, and it didn’t account for the issues on the underside of my kneecap that could just reinjure the cartilage.

I sat in the dark and looked deep into myself. It’s the closest to praying that I come, because who needs to speak with words to whatever it is inside each of us? The quiet sense of surety filled me. Acting with my heart has never led me astray, and I know in my heart that this is what is best for me, the future I’ve worked so hard for, and the man I get to spend it with. Pain has been snuffing out my soul slowly and surely for the last two years and when I have the choice to eradicate it as best I know how, I cannot take a lesser choice.