My Left Knee

The Accident

In 1971, I was 18 years old and a freshman in college studying architecture at the University of Illinois in Chicago. We soon had a major design and construction project that would be built entirely in a large, double to triple height section of the Architecture and Art Building. We were creating several small "cubes" or living spaces out of plywood. The goal was to learn the basics by fulfilling all roles including the end client since we were going to experience living in our cubes. We were required to test the functionality of the cubes by using them to study and rest in. In time, many of us spent the night in our cubes.

One evening, I was walking along the top of a cube (we had bridged them with wooden planks) when it gave way and I fell into it. The accident resulted in torn cartilage in my left knee. My leg would not straighten and allow me to walk normally.

At first, doctors didn't operate and simply tried to force my knee back to functioning again, a pointless experiment that caused me unnecessary, tremendous pain. Eventually surgery was performed to remove the cartilage from my knee. During recovery, I wore a full leg cast covering my thigh and knee and ending at my ankle, and I used crutches to get around. I recovered because of my youth and I went on to engage in physical activities as normal, including bike riding, swimming and running. However, the injury came back to haunt me in the future, due to the operating techniques used then that would never be used today. Even though it has not yet occurred (as of this writing), knee replacement surgery is inevitable.

Decades Later

At 25 years old, I moved to New York City. After many more years had passed, my knee began to give me considerable pain doing things I had previously done without problem. Over time, I had to let go of running, bicycle riding and even swimming by the early 2000s. My knee would swell up as my body inserted fluid into the joint in order to lubricate itself with limited effectiveness. At times I was in so much pain that I could barely walk. Only with extreme attention to its way of communicating with me did I manage to recover and keep the appearance of normal functioning.

I went to more than one orthopedic surgeon. They all agreed that the operation I had in 1971 was the cause of the problem. As one surgeon put it, they wouldn't use those techniques today since they have learned the result in cases like mine. Medical capabilities have advanced considerably.

Still, I almost agreed to surgery around 2008 or 2009. One surgeon was fairly eager to operate (he made a lot of money by doing as many operations as possible) but he knew that he had to emphasize that the decision was mine in case something went wrong and lawyers discovered he had tried to talk me into it.

Somehow, I felt that I was not yet at that point of having the surgery. In addition, I became educated about knee replacement issues and side effects. In some cases, the new knee wears out or has problems and a second surgery could be required 10 to 15 years later. In other cases, the metal used is susceptible to an infection that would require emergency surgery. There were many pros and cons, and I decided to wait. In the meantime, I received injections that relieved some of the pain.

Mt. Sinai

Not long ago, I went for an evaluation of my knees at a new orthopedic surgeon's office in Manhattan. He is part of Mt. Sinai, a huge hospital complex with additional offices all over the city. I have problems with Mt. Sinai, particularly their billing office, based on constant instances of incompetence that I have experienced involving treatment with several other doctors at Mt. Sinai. The hospital, which is really a medical industry corporation, is an example of medicine solely as a business with tentacles in everything. Unfortunately, there are not that many choices for medical care that don't involve simply another huge medical complex that operates the same way. The other hospital systems in NYC and around the country are using the same business model and making themselves almost unavoidable if you need care. Mt. Sinai at least has a fair to good reputation (in some departments). But it's also an impersonal behemoth focused on money and it has no problem creating records that are false but generate additional income.

Forms

The staff in all departments never like that I refuse to sign certain forms that would allow them to bypass my insurance, increase my costs by allowing out of network staff to treat me, and otherwise make me responsible for unknown and unanticipated costs. I am one of those patients who reads forms and knows that I don't have to sign some of the forms that doctors and hospitals push toward me before anything else occurs. The doctors and hospitals, all of whom accept my insurance, cannot refuse to see me if I don't sign their forms. Most people think they have to sign and their lack of knowledge is taken advantage of. A while back, I checked with AETNA, my carrier for my Medicare Advantage plan, and they advised me not to sign certain forms.

Surprise Billing

New York State and now the Federal government no longer allow "surprise" billing except for a notable loophole involving ambulances. Congress still has not outlawed exorbitant fees for ambulances which make mighty profits off of sick people who are sometimes unconscious and don't even know they are in an ambulance. Later they receive bills for thousands of dollars for ambulance services once they awaken and begin to recover. This is what the average, uninformed American must go through with the medical/industrial/financial complex (which is enormous and similar to the military industrial complex). They have never seen a dollar they can't claim for themselves, while also understaffing and overworking doctors and support staff (sorry for the rant, but this is all true and confirmed in many articles I have read including in the New York Times). Some in America may not have to go through this because of their very different medical coverage, for example, if you are a federal government employee whose medical costs are paid entirely by Uncle Sam.

An Assistant's Diagnosis

At the new orthopedic office, I got updated X-rays and then I saw a young female assistant to the surgeon. She gave me her evaluation which ultimately has led to my deciding that she can never touch me or be a part of my medical team in the future. She said some things that were nonsensical and against the opinions of experienced orthopedic surgeons I have seen in the past as well as my own knowledge and experience. Some medical staff members don't listen to patients and believe they always know more. This belief in their assumed superiority of knowledge is accepted by many patients who don't realize they can question and challenge it when ego driven medical professionals say stupid things.

In my case, she said that the severe problems in my left knee, as opposed to my right knee which is fine, did not cause or was not necessarily related to my injury and surgery in 1971 (the scars from the surgery are still quite visible on my left knee and I always let orthopedic staff see that). She didn't offer an alternative explanation. In other words, according to her, my left knee apparently just developed the problem on its own, while my unaltered and undamaged right knee, which is obviously the crucial basis for comparison, did not deteriorate. This contradicts every evaluation I have had in the past as well as common sense. She is not actually a surgeon, and still learning, but seemed confident that she was right, even when I told her that her statements disagreed with previous surgeons. Of course, she also had no direct knowledge of my 1971 injury and surgery which happened before she was born. I should have just said to her "you're stupid and wrong, you don't know what you're talking about" and I anticipate that may be required in the future.

There is also a tendency for medical staff to give the benefit of the doubt to other medical staff who they have never known or met. So my dentist doesn't like to hear how a dentist in the past damaged my tooth because he feels it reflects on him and his entire profession, too. My orthopedic surgeons feel protective of orthopedic surgeons who operated on me literally 51 years ago because to accept the previous surgeons' mistakes as fact puts them and their current work on the defensive. But no medical staff member or surgeon is infallible. If you can't acknowledge what happened in the past, then you shouldn't be the one to correct it in the present.

I have been through these evaluations before, and I know my knee and its exact problems very well. When medical staff assume patients don't know anything and the staff knows everything, that is a recipe for mistakes and a poor result.

Meeting the Surgeon

Afterward, I saw the surgeon himself. He did not even once try to dismiss my 1971 injury and surgery as the overwhelming reason for my left knee problems. He basically said nothing that was stupid and answered my remaining questions. I was offered shots in my left knee to temporarily ease problems, which I have had years ago but refused this time since I thought it could go a while longer without them. The surgeon pointed out, however, that my knee has deteriorated considerably and it is considered quite bad off. The surgeon and I agreed that eventually I will need a knee replacement operation, which I have known for years. I have decided that my knee will tell me when it is necessary in the next couple of years or so. I hope I have moved from my apartment by then because I will not be able to climb stairs, carry things, get on the subway, etc., while I recover. I will have to live in a recovery facility for a few weeks which will greatly increase costs and leave my apartment unattended for too long. This is the situation that I am facing.

The Past Meets the Future

There are hundreds of thousands of knee replacement operations in the U.S. every year. Patients are expected to submit to the doctors' presumed expertise. However, I remember my experience from 1971 involving many weeks, and the experiments the doctors made on me then which were cruel and senseless (that is another part of the story). I was an unknown, insignificant 18 year old black kid and they could do what they wanted. The University of Illinois Chicago, where I had the accident, paid for it since it happened on campus and they were responsible. But most important, the decisions and techniques made by the doctors then are the reason why I have the problem that I have today. I want to make sure that when I get the operation, I won't be at the mercy of idiots who think the only thing that matters is themselves.

We have to advocate for ourselves. No one will do it for us. In the meantime, as of this writing, I know that surgery is inevitable, but I have managed to make it this far without it, which is extraordinary.

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