Two and a Half Hours

The smell of burnt hair intrudes through the mask and into my nostrils as I creep closer to peer in at the near lifeless body. Unknowingly, the body conducts a group of machines attached to him like a well organized symphony, beeping and hissing at every command he gave. I check the time, 8:13 am. Overhead plays Tim McGraw’s “Live Like You Were Dying,” and I think to myself how odd. The wall of blue moves aside and at first I see what looks like creamed corn. Excitement overcomes me and I step in for a closer look.

Using a gadget that resembles a soldering gun, the layers peel back with ease and it begins to look a little like chopped raw steak. Almost there, just a little bit deeper to go. After a few more minutes of excavating the opening, an almost off white object was seen. It was elevated up and looked like a miniature Frisbee; attached at both ends were bands of tissue and muscle drenched in blood. The bands were clamped on both sides and then flipped over. These tiny clamps act as anchors keeping the formerly under surface up and exposed to work on. The room starts to resemble one of those alien autopsy scenes, exam table in the center of the room lit up with bright lights; Blue human shaped beings hovering around, with mouths covered uttering unclear words; Unidentifiable tools coming in and out of view, first clean then dirty.

An area about the size of a quarter is painstakingly carved out leaving a pink hole that slowly begins to fill in with blood. In goes a few pieces of gauze to stop the bleeding. It is then I realize the dull pain brewing in my lower back. Almost an hour and a half has gone by and we are only half way there. A few minutes go by and finally the bleeding stops; now for the tedious task of covering this hole. The familiar scalpel is replaced with a needle and suture material the same width as a strand of hair. A translucent tissue like material is stretched taut over the hole, and sewn shut. Almost entirely sealed, the doctor stops to prepare the next process. Out come the cartilage cells!

Weeks sometimes months of correspondence with insurance companies via phone, fax and mail sometimes lead to denials, appeals, peer to peer discussions, or even attorneys are involved to get an approval. Then a lab in Boston, MA begins the two to four week process of multiplying the patient’s own cells. When cells are grown and collected, they are flown overnight to be put back where they started. Two, sometimes three vials are needed. Each vial is about two inches in height with just a centimeter in height of “new” cartilage cells. Surprisingly they are shipped in a box you could fit a baby in comfortably. If that wasn’t enough, the process of growing the cells alone, costs about thirty thousand dollars. I can see why the insurance companies do not want to foot the bill.

Ever so carefully the surgeon picks up the vials and mixes the solution for its long awaited reunion. Pulled up in the syringe it is escorted into the nearly sealed opening and released. The last sutures are put in the patch and a glue-like substance is placed finalizing the cells travels. Clamps help flip the kneecap back over and are removed; the surgeon leans over and to my surprise pulls up a saw. This just got even more interesting.

Put your hands below your knee and feel for the bump at the top of your shin. Now imagine sawing a little groove on either side then chiseling it so you could pick up the bone and make the bump higher. Well that’s what happened; and as he was packing in the bone chips and putting in three inch screws to hold down his masterpiece, the surgeon had turned into a carpenter. With this done, the process of piecing the mangled flesh together begins. Slowly the tissue comes together like a reversed time lapse video, only the top layer remains somewhat open. He calls for the stapler, and I’m expecting another intricate machine to be pulled out. Instead a handheld device is given to him, which he uses with ease. The tool pulls the ends of his skin slightly up and the ends of the staple are bent under and into the skin. Soon the patient’s knee emerges adorned in shiny new surgery accessories.

I was so caught up watching the surgery that I didn’t even notice the nurse scurrying around checking the equipment. It seemed that as they were finishing up, she was making sure the only thing that went into the knee, were the cells. Bandages are placed and the brace is locked and secured. A long stretch followed by a semi strip down signals the end. He glances over his shoulder at his audience gives a thumbs up and a wink, then proceeds to leave the room. I glance at the clock, 10:43 am. My back is screaming at me now but that will have to wait. I’ve got to hurry back upstairs to start clinic.