Familiar territory: back in the waiting room

So here I am, back in a hospital surgery waiting room.

A quick update: almost a year after MG's accident, we're getting ready to head into another series of surgeries. This time, however, it's not so much life or death as it is quality of life.

Old  joke: what's the difference between God and a surgeon?
God knows he's not a surgeon.

Over the last year, we've dealt with a lot of doctors and surgeons. I suppose it's human nature to just assume all doctors know all the same stuff. Yet I know car mechanics know all the same basic stuff, too, and recognize the difference between a good mechanic and a not-so-good mechanic. I strive to find the good ones to work on my car.
The same is true with doctors/surgeons. The same is true with all of our professions. Most of us are competent in what we do. Some of us are better than competent; some are brilliant. Unfortunately, not all human beings are created equal in that sense.
We've been fortunate to have access to some brilliant doctors
 - the trauma surgeon at UAB, Dr. Melton, that saved MG's life, taking care of the multiple internal injuries that included two punctured lungs, a lacerated liver, and ruptured spleen;
- and the trauma orthopedic surgeon who put her pelvis back together, Dr. Lowe, who continues to guide us through the orthopedic recovery issues.
Are they arrogant? Maybe; they certainly have reason to be.
Now we'll find out about this new doctor we're dealing with, Dr. Susan Mackinnon. I have a feeling she's earned her arrogance, too.
I will say this in her favor: she liked my boots.
I mean, how can you not trust a doctor who stops in the middle of an examination of the nerve damage MG has suffered and says to me, "nice boots!'" (brown ostrich made from the skin of the shin, just for the record). She immediately proved to me she's a woman of taste and substance.

When it comes to MG's nerve damage, after a few tests several months apart we were told to accept it as it is, that it's pretty much just the way it's going to be. She has drop foot, very little control. The longer we go without improvement, the worse our odds for seeing any improvement.
That's what we were told, and I was ready to accept it.
Fortunately, MG was not. And during one of her many days of lying flat on her back or nights when she couldn't sleep, she did what anyone in the 21st Century would do: went to the internet.
MG found this doctor in St. Louis, Susan Mackinnon. Her biography says she "is the Sydney M. Jr. and Robert H. Shoenberg Professor and chief of the Division of Plastic and Reconstructive Surgery. She performed the first nerve transplant in 1988 and is considered a leading expert in the field of peripheral nerve surgery. ... In addition to her work in nerve transplantation, Mackinnon has developed a number of nerve transfer techniques in which healthy nerves are rerouted into areas left paralyzed by damaged ones ..."

Never the shy, reticent type, MG got in touch with Dr. Mackinnon's clinic at the Washington University Medical Center in St. Louis, and they asked to see her medical records. Our Birmingham neurologist was gracious enough to send everything to Dr. Mackinnon's office, and shortly thereafter Dr. Mackinnon's office called and said they wanted to see MG. The appointment was set for April 4.

That brings us to yesterday, April 4. I'm not sure what our expectations were. I know mine were that maybe Dr. Mackinnon would do some tests and say she'd get back to us. As hopeful as MG was about going to see Dr. Mackinnon, once we actually got to St. Louis I could tell she was tempering her hope.
And of course, Dr. Mackinnon breezed in, followed by a few neurosurgeons who have come to learn from her (this is a teaching hospital), including one from Egypt that she referred to simply as "the Egyptian."
Basically, the good doctor looked at MG, did her assessment using her techniques she invented, and said the worst case scenario is they could do a tendon transfer and restore some control of MG's left foot; best case they would unblock the nerve blockage and see if MG couldn't return to some level of normal control.

The amazing thing was how simple the tests were that Dr. Mackinnon did. Maybe I'll go into it later, but let me just say it was so simple yet made so much sense I had to ask Dr. Mackinnon my typical question of doctors like this.
"I don't mean any disrespect, Dr. Mackinnon, but what makes you different? Why haven't we been told about this by doctors in Birmingham or anywhere else?"
Here's where the ego came in.
Dr. Mackinnon was quick to tell me she didn't mean to sound egotistical, but that next month she was getting some award as for being the most innovative surgeon in America for this year; that she had done more research into nerve repair than anyone in the world; she laid out all the government grants from more governments than just the United States to fund her research; told me why patients came to her from all over the world; why the US Government sent injured Special Ops soldiers to her instead of forcing them to use military doctors; why doctors like "the Egyptian'' came to study with her.
The Egyptian looked bemused that she referred to him as "the Egyptian." I don't think he'd been with her long enough that she remembered her name. One of the doctors in training told us he'd only been with her since Monday. (Oh, and when the Egyptian left the room, I looked: he didn't walk like an Egyptian - shout out to The Bangles).

At that point, Dr. Mackinnon said, "I have a opening tomorrow if you're ready to get started."

Let me back up. What Dr. Mackinnon believes is that there is a nerve blockage just below MG's knee. There may be two more further down the leg, but it's apparently a fairly quick and simple procedure to "decompress" the blockage. It's outpatient surgery. And there is a chance that if this point of blockage gets unblocked, the blockages further down the leg may unblock on their own.
She believes this may restore blood flow almost immediately. And that the nerve damage from the knee down to the foot can grow back much more quickly - months, if not weeks.
How quickly will we know? I don't know. In defense of our doctors in Birmingham, they told us nerve repair takes a long time, that nerves grow back at a rate of about a millimeter a day. But Dr. Mackinnon is absolutely confident that her technique can speed that up - not the rate of recovery per day, but by shortening the distance that needs to be repaired, speeding up the overall recovery rate.
She insists she does it all the time, and it works, and she knows more about nerves and nerve damage than anyone in the world.

Months ago, I wrote a blog called "Hell on heels", about MG's love of high heels and the disappointment in never wearing them again. We have never gotten rid of her heels. We put them away, in the closet, but never got rid of them. Our good friend Jerry said we were going to all get together and sit around like grown-ups and MG could put on her heels. She wouldn't be able to walk in them, but she could just sit there wearing them, for old times sake.
And now, maybe ....
I tend toward fatalism. I want good things to happen, and believe they can happen, but if you don't expect them to happen then it's so much better when they do and hurts so much less if they don't (which is probably a lie, because even as much as I tell myself "it won't happen,'' somewhere down deep inside I must believe it can happen or else why all the effort?)

Quick general update: a few weeks ago MG hurt her hip. We thought maybe she re-broke her pelvis, and her physical therapist sent her immediately to the only orthopedist she could find in his office seeing patients that afternoon. He had never seen MG's condition before, but said he thought the arthritis was so severe we're also looking at a hip replacement.
We went back to our trauma orthopod, and after a thorough new MRI, he agrees that maybe we should discuss hip replacement now. In the last few months the arthritis in MG's left hip has increased dramatically, and there is a lack of blood flow to the bone in her hip, causing that bone to die ("avascular necrosis").
 We knew MG would need a hip replacement eventually. Like most people, we thought we'd try to put it off for as long as possible. However, a friend who had a hip replacement at a relatively young age (37, I believe he told me), said he thought about putting it off as long as he could, but then realized, "If I put it off 20 years, how miserable will my life be until then? And I could get hit by a bus before that even happens. So I decided to go for quality of life now, and I'll worry about what happens when I'm 60 if I get there." That made some sense to me.
So now we're set to meet with a hip surgeon (not a really cool, "hip" surgeon who wears Nehru jackets and ascots and drinks martini's while listening to Coltrane; that, would be a "hep" surgeon) next week to evaluate where we are in that process.

Meanwhile, another old joke:
 A doctor dies and goes to heaven. St. Peter meets him at the pearly gates and checks him in. After he’s registered, St. Peter says to him, "Look at the time: you must be hungry! Heaven Cafeteria is serving lunch, why don’t you get yourself something to eat?"
The doctor goes to the cafeteria and notices the long line. He immediately cuts in at the front, only to hear loud protests. "I’m a doctor" he says, "I’m a busy man, I don’t have time to wait in line."
The others say, "You’re in heaven now, we’re all the same here, get to the back of the line and wait your turn!"
A few weeks later, waiting patiently on line for lunch, the doctor notices a man come dashing in wearing scrubs and a lab coat, stethoscope around his neck. He butts in at the head of the line and no one utters a peep. "Hey," he says to the guy in front of him, "Who does that guy think he is?"
"Oh, that’s God," says the guy, "He likes to play doctor."

I hope any doctors who read this don't mind.
I know the Great Physician.
But I also know some great physicians here, too.