What I learned from recovery from knee surgery
Everything we learn, even the most abstract concepts, we ultimately encounter through the medium of our human bodies and make metaphors for based upon our physical experience of the world. Perhaps this is why I’ve often found physical experiences — yoga, dance, illness, injury — offer such profound opportunities for learning and for new insights into life. Earlier this year, I went through a surgery and recovery process. I hope you find in it something that speaks to you and helps you offer more understanding or compassion for yourself or for someone you love who may be going through a time of healing and transition.
Finally choosing to heal an old injury
I’ve been complaining for years about a nagging knee injury that I got in high school. When I was 16, playing in a varsity soccer game, I made a stop suddenly when trying to defend against an attacker, and felt a pop in my knee. I was on crutches for 3 weeks, did no physical therapy, and made a full recovery — or so it seemed at the time. As early as my freshman year of college, I remember going for the occasional run and getting such soreness and stiffness in the lower front outside of my injured knee that it made me hesitant to run again. At first, I attributed it to overexertion, but eventually, the pattern became unmistakable. The pain and stiffness always started in the same place, in the same knee I had injured, always from repetitive movements like jogging or walking (rarely from dynamic movement like soccer or dance). Sometimes my knee would act up simply from walking downhill.
Every time I’ve done my new years’ planning over the last handful of years, “heal my knee” has been near the top of my list of priorities — and yet year after year I had struggled to make any progress at all.
The on-and-off nature of the symptoms made it hard for physical therapists to diagnose, and after receiving several completely different explanations, I had begun to lose confidence that an answer could be found. The only path that seemd likely to provided clarity was imaging, but that too, felt overwhelming. Getting an MRI would require persistent follow up over months to go through all of the steps insurance required before they would pay for it. Last year, I finally decided to get serious about it. I had a full-time job, I had good health insurance, and I planned to be in one place long enough to go through what could be a long and tedious process with the medical system. Breaking up with my boyfriend and moving out of the apartment threw a wrench in things. I managed to get an X-ray and a referral to an orthopedic specialist by the time I went back to the east coast in May, but I had to put a hold on things until I got my own place in the city again in July. I finally saw the orthopedic surgeon, who immediately referred me for an MRI, and also guessed the issue — that I had developed a cyst in my knee as a result of tearing my meniscus in high school. Sure enough, the scan showed a large cyst and a small tear, which the surgeon explained had acted as a channel through which the regular movement of my knee had pumped fluid into the cyst.
The good news was that the problem was totally fixable and it also explained all of my symptoms, the bad news was that the solution was surgical.
Hearing the news, I felt a complex mix of emotions. I felt vindication and relief to be told that this problem I’d been living with for years was not “all in my head”, that it had an observable physical origin and that it was fixable. At the same time, I felt fear and overwhelm at the prospect of undergoing surgery and a lengthy recovery process. I felt especially vulnerable at the idea of going through this single and living alone. Speaking with my Mom and with a few close friends helped me move through these big feelings and remind me that I was loved, supported, and that I could go through this.
Community Care and Asking for Help
Over the next month or two, I tried to emotionally prepare for surgery and recovery as I simultaneously navigated decisions about logistics. Should I get the surgery in San Francisco, so I could recover in my own space around my own community, or in Maryland, where I could stay with my mom (in a one-level house) and have her take care of me? What type of surgery should I get? Should I get a second opinion? I opted to get the surgery in San Francisco partly because state board certifications and regulations make coordinating medical care across states annoyingly complicated, and because I believed it would be better for my mental health to recover in my own apartment and in connection with my community here. I tried to frame the experience for myself as an opportunity to learn about and build trust in my own resilience and to strengthen my connection to friends and community by letting them help me. As much as I find it difficult to ask for help, I saw this experience as a great opportunity to practice doing just that. I know that I appreciate the opportunity to show up and help a friend, and I have come to believe that being able to offer and receive mutual aid deepens relationships and helps build stronger, more resilient communities, through what is sometimes called community care.
I’m deeply grateful to the many friends who came over while I was recovering from surgery and kept me company, who helped me do laundry, water my plants, and who cooked me meals (you know who you are!). I also found that while my mobility was limited and while I felt helpless and dependent, I was especially grateful for those times when I was able to help and be there for a friend, whether to hold space while someone processed feelings about work or a breakup or whether to be a soothing voice on the other end of the phone to help a friend endure chronic pain. Although February and March were not without their disappointments (scheduling my birthday party two weeks after surgery turned out to be too ambitious), there were so many times I felt deep gratitude for the abundance of warm, kind, helpful, loving people in my life.
I also found it fascinating to observe my experience as I identified what help I needed and tried to find a way to ask for it. I started reading Non-Violent Communication, and it drew my attention to how much difficulty we often have in even identifying their needs, much less going about getting them met in a clear and respectful way. To speak for myself, I have often been largely unaware of my own needs, unwilling to look at them closely out of embarrassment or shame or out of the fear that once I acknowledge them, I won’t be able to get them met. However, this experience of going through recovery from knee surgery and having tangible, practical needs that I couldn’t ignore or deny gave me an interesting opportunity to practice clarifying my needs and getting them met in a thoughtful and respectful way. Language from Non-Violent Communication helped me frame and articulate some of what I found myself learning and doing even before I began reading it. One thing I quickly realized was that I could be flexible about how my needs were met (yes, I did need to do laundry periodically, but I didn’t need help from a specific person or on a specific day). This allowed me to be responsible for getting my own needs met (since I could keep making requests until the need was satisfied) rather than demanding that one particular person meet my needs. NVC points out the common hazard of getting too attached to a particular strategy for meeting a need and thinking of that strategy as the need itself, instead of what it is — a strategy for meeting the need. It also points out that while people tend to respond defensively to *demands*, most people find joy and meaning in being able to help and satisfy *requests*, and I found this to be consistent with my observations. Unsurprisingly, I found that friends responded far better to open requests that offered them the opportunity to help me out rather than to asks that perhaps conveyed that I was expecting them to do something or depending upon them for help.
Learning to trust gradual change
The recovery process also forced me to slow down and get up close and personal with the experience of gradual change. Trusting gradual change doesn’t exactly come naturally to me. As a kid, I grew accustomed to learning new things very quickly, and to the idea that if I didn’t do something right away, I wasn’t going to do it at all. In my mid 20s, I learned to intentionally craft and maintain habits and that experience began to teach me to trust in the power of gradual change. But even despite all I’ve experienced and internalized about intentional, gradual change, I still sometimes find myself reverting to old patterns of thought that tell me if I can’t see significant progress right away, no progress is being made— old patterns that default towards rushing and doing too much out of fear that that’s the only way anything will get done. I struggled with these thoughts while I was recovering. I noticed myself getting impatient with the lack of progress, and momentarily succumbing to irrational fear that this was my new reality and that I would be on crutches, unable to bend my knee forever. Rationally, I was able to trust in gradual progress, but I found it harder to viscerally feel and believe that trust in my body. And yet, I saw this experience as an opportunity to try to rewire my brain to better understand and trust in gradual progress. Every day when I did my PT exercises, when I iced my knee or noticed my pain and discomfort, I paid careful attention to how my experience changed hour to hour, day to day and week to week. True, the process wasn’t entirely linear, I would inevitably sometimes do too much, or too little, or get poor sleep, and briefly set my progress back, but I could clearly see a positive trend line over several days and certainly over weeks.
Letting my body teach me, listening to my body to find balance
It was sometimes tempting, in my moments of doubt and uncertainty, to seek guidance and reassurance from the authority figures of my surgeon and his nursing staff, and yet the weeks of slow recovery taught me that my direct experience in my own body was a rich source of information that only I could fully access. In a very real sense, I realized that my recovery depended upon listening to my body and letting it teach me. During the first week after surgery, when my leg was fully bandaged, my greatest discomfort came from loss of circulation in my foot, which was bound tightly and frequently elevated. I rightly intuited the issue, but briefly deferred to a nurse who suggested more pain medication (which didn’t help) before the surgeon gave me advice that conformed with my intuition… that the bandage was too tight, that I should unwind it slightly, and that putting some weight on the foot would help restore circulation.
After my bandages came off and my PT exercises began in earnest, I had to learn to redefine what I categorized as “helpful” pain or discomfort. It turns out that the pain of muscular fatigue and of stretching into a new range of motion feel somewhat different when the muscles are very weak, and I had to learn that this pain and discomfort wasn’t a bad sign to be afraid of and take as a signal to back off, but that instead was a necessary part of the process of getting my knee moving again. As my muscles became stronger and more accustomed to movement, the feeling of fatigue became more familiar, more similar to other sensations I’d experienced from regular workouts when I was healthy. I had been warned several times by friends who had gone through rehabbing an injury not to overdo it because it can cause further injury that significantly sets back recovery. I was also regularly reminded by my PT that not doing enough also had its pitfalls — my ability to bend my knee was not going to come back on its own — I needed to continually try to move it in order to loosen it up and regain mobility. My project, then, became about balance, trying to find the sweet spot between effortfully pushing myself enough without pushing too much, between listening to my body and giving myself rest when I needed it, without coddling and over-protecting my injury. The perfect balance is a platonic ideal that can never be reached, and it is forever a moving target. All I could do was strive towards it and aim to keep my oscillations within a band that I hoped to gradually narrow as I learned to better cue into my body’s signals. No one could tell me exactly how to do this, all they could do was tell me, in the imperfect way of language, what signals to listen for and vaguely how I might adjust when I received them.
Rebuilding trust in body and mind
As my recovery progressed, I found myself meditating on trust. I watched my body and mind gradually rebuild trust in my ability to do simple things, take steps, bear weight, go upstairs, lower myself to sit. At the same time, I realized that I would gradually need to rebuild trust in my cognitive abilities, too, my ability to work, to focus, to plan and practice self-discipline. In both cases, I recognized that trust is built by gently approaching new tasks, isolating the component parts, and exploring them slowly, with curious attention. Once the body or mind learns that it can handle this slow, isolated effort, it opens up the realm of what it allows and considers possible. But forcing it or overdoing it has the opposite effect on trust, fracturing whatever confidence or belief in ability might have already emerged. Twice within the span of a week, I found myself being told about the same learning framework and decided I ought to take note, especially as my knee recovery provided such a vivid illustration of it. The framework outlines four steps that we move through as we learn — unconscious incompetence, when we are not aware of the faults or incompetence in how we do something, conscious incompetence, when now we *are* aware of how bad we are at something (not a comfortable place to be), to conscious competence, when we can do the thing competently, it requires conscious effort and awareness, to finally unconscious competence, where we have so fully learned and internalized the new skill that we do it well without effort or even being really aware of it. Understanding this framework helped me accept the uncomfortable “conscious incompetence” stage as a sign of progress, with the trust that I would gradually move into the later stages.
Before I got surgery, I worried that the recovery process might put me into a dark mental spiral, since I came into it already burnt out from work and since movement is usually such an important part of how I maintain my mental health. As it turned out, I did have slow, low-energy, and emotional days during recovery and I didn’t feel like my normal self, but I also brought to it a deep acceptance. I went into the surgery prepared to honor my own needs. A week later, I was able to listen to myself enough to acknowledge that I needed to prioritize my physical and mental health and that I did not want to go back to my job as an employee. After briefly discussing the potential of reengaging as a consultant, I resigned. While my inner critic quietly whined that quitting my job while recovering from surgery during a tech industry recession was a stupid thing to do, and worried about becoming completely lost and aimless, a wiser part of me trusted that I knew what I needed, and that if I gave myself this time, that I would ultimately heal faster and more fully and make better of a transition that I knew would have been coming anyway. Moreover, I knew I’d been through enough transitions that I could trust myself to pull myself out and put my life back together. I trusted myself to recover my mental energy and a more genuine motivation for work when I was ready, and practically, that as I was able to walk again, I would walk myself into a more positive and energized headspace. This deep trust spared me a lot of worry and self-judgment (though not all) that would have otherwise compounded my misery. There would be pain and grief, yes, but there need not be a lot of suffering.
As I write this now, I’m two months out from surgery, and I am walking more than I did before I went under the knife. My energy and my desire to engage with the world is indeed returning, with a joyful, grateful eagerness, and I am excited to see what future path may be born out of that state.
Walking is such a fundamental, simple thing, that brings me so much joy, especially in this spring season that renders Northern California heart-meltingly beautiful.
Approaching this next season with intention
So what’s next? How am I approaching this new season? As I’ve moved through these past months, I’ve found myself almost allergically resistant to rush, hurry, and the kind of pressure and self-criticism that led to the burnout that caused me to leave my job. Instead, I’m taking advantage of the opportunity to first establish a solid foundation of health, and to cultivate an ecosystem of habits, practices, mindsets, and relationships to help me maintain it. I want whatever I do next to be fueled by curiosity and delight, rather than fear.
I’m taking the idea of moving from unconscious incompetence to unconscious competence and applying it not only to my knee recovery, but to notice and gently refine other areas of my life where I might better care for myself and build habits of acting from curiosity and delight rather than fear — whether by better cooking and managing my kitchen, preparing for better sleep, or improving my self-management habits. By investing a bit of time and curiosity now, while I have it, I hope to instill habits for better sleep, eating, exercise, body rest, and brain rest that will become effortless, automatic supports moving forward.