Vol 56: Beside the dilly tree
Tim spent summers with his grandparents on the island of Andros during some of the happiest times of his life. He recalls as a child awakening to a warm, bright sunlight that boldly danced across the island sky and wrapped it in a deep red and golden yellow hue. The spectacular glory of this fleeting skyscape was particularly noteworthy on Sundays when he was getting ready for church with his grandfather. That’s when the birdsongs crooned their forenoon lullaby, as the morning dew was laid to rest.
Of the times Tim spent with his grandparents during those idyllic summers, Sunday was always the best day of the week. When church was over, he got to play with neighboring kids. It was the kind of island innocence and freedom that can never be replaced - tree climbing, bike riding and basketball often lasting until midnight. His backyard, a field of sugarcane, mango, guava and coconut trees, became a makeshift playground where’d they play ball and then ride their bikes to the nearest basketball court, something that would influence his later life. As a young boy, he was doubly lucky because that court was beside a large dilly tree close to his grandparents’ home. Tim never imagined that years later he’d be faced with the possibility of never being able to run or jump again.
By the time he was 32, living in Nassau, he was married and employed in law enforcement. His past medical history was significant for high blood pressure but it was well controlled with prescription medication. Tim weightlifted three times per week and was incredibly active at work, often having to run quickly and many times along uneven terrain. He still loved to play basketball with friends and he did so as often as possible.
During one of his games, his heels felt tight and painful. The pain persisted for several days but he shrugged it off and played again one week later. As he landed after jumping for a rebound, he heard and felt a snap in his heel. Tim tightened his laces and attempted to play some more but the pain was too intense. He limped off the court and sought medical care the following day.
X-rays taken at his orthopedist revealed that a heel spur had broken off and was lodged within his Achilles, the long and fibrous tendon that connects the calf muscle to the back of the heel. A steroid injection was administered to the area, which took away his pain but further weakened his tendon. Not long after that, one day while at work, as he was running, he twisted his left ankle and fell forward hearing another snapping sound at the back of his leg. The pain was immediate and severe. Tim hobbled to the nearest tree to lean on and squeezed his calf with both hands. By the following day, the area had ballooned to three times its original size.
An MRI was subsequently ordered by his orthopedic surgeon and verified that Tim had torn his Achilles. He describes it as feeling like someone had smashed the back of his leg with a car. The pain shot up and down his leg like a lightning bolt and the surrounding muscles throbbed and spasmed in anger. Unable to apply any pressure to the area, Tim ambulated with crutches for several months and he healed uneventfully with treatment including serial casting, pain medication and intense physical therapy.
Two years later, Tim became a patient of mine when he abruptly rose out of his chair and heard a loud, familiar, popping sound, but this time in his right ankle. Given his previous injury, he was referred for an MRI immediately. It confirmed a tear in his right Achilles tendon and in one of his ankle ligaments. Tim was devastated at the thought of having to wear another cast and ambulating with crutches once again so a CAM boot was alternatively dispensed. He wore the boot for one month until both tears were assessed as fully healed.
Then, like clockwork, two years later while running on an asphalt surface for exercise, he felt a snap in his left ankle. A new MRI of the area revealed severe microtears throughout the tendon. So, given the patient’s age, work requirements and severely weakened and chronically torn Achilles tendon, I recommended that he undergo surgical repair of both Achilles tendon (left one initially) to prevent any further deterioration and subsequent ruptures.
I referred him to a trusted friend and colleague who specializes in such repairs and is highly skilled in this regard. Tim underwent surgical intervention as advised and healed without issue. He was able to return to work on light duty six months following his left tendon augmentation surgery with resection of his gastrocnemius muscle and heel spur.
Unfortunately, four months later, while out with his family, a fight between two men erupted nearby. In an attempt to move away from that area to some place safe, Tim twisted and injured his right ankle. A right ankle MRI was this time notable for moderate tears and inflammation throughout his Achilles tendon.
Given his high risk for a complete rupture, it was decided that his right ankle surgery should be performed as quickly as possible. Three months later he had the same surgical procedure performed, this time on his right lower extremity. As with his left surgery, Tim required six months of healing and rehabilitation. He is now pain free and able to walk and move around freely without restriction, something for which he is especially grateful during this week of giving thanks.
The tradition of Thanksgiving dates back to the early 1600s when Native Americans broke bread with Pilgrims to celebrate their harvest. Today, that tradition persists throughout North America to remind us all the importance of giving thanks. This past week Tim reflected on his multiple injuries and his successful recovery and he’s incredibly grateful to his wife for her unyielding support. His take home message to readers is multi-layered - surround yourself with people you can depend on during challenging times, stay positive in your darkest hour, seek medical attention early and trust your gut when it comes to your medical care.
As a physician who’s seen so many strong men like Tim be taken down by pain and injury because they ignored or downplayed early signs of trouble, I add this advice – leave the machismo behind. You can’t enjoy a good Sunday run or basketball game if you’re in a wheelchair. Real men seek advice when they know in their gut that something’s wrong. Tim is walking, running and working today because he caught his injury in time but he knows how close he came to missing that window.
Holocaust survivor, Viktor Frankl, having lost his pregnant wife, his parents and his brother while imprisoned in a Nazi camp, wrote a book in 1946 entitled ‘Man’s Search for Meaning’. In it he states that the last of human freedoms is our freedom to choose our attitude to any given circumstance. In other words, we get to choose how we react to any situation because how we react is how we will be judged and it’s important that in each scenario we remain true to our character.
Tim’s most grateful that through it all, he was able to laugh and thank God for his many blessings. While others may have considered quitting to find easier employment, their convictions wavering wildly from one entrepreneurial prospect to another, Tim held firm. He loves his job and, with the heart of an athlete, he recognizes that injury is a natural consequence of a job that’s patently ripe with criminal uncertainty.
With his grandparents now long deceased, Tim still travels as often as possible to the island that brought him so much happiness. There, he finds a level of peace that he can’t ever put into words. So, with a grateful heart, his childhood beckons as he takes his own children to Andros every summer, keen to see them enjoy a similar freedom and innocence. And, like he has years before, Tim visits the court beside the dilly tree where he loved to run and jump as a child, today unwilling to test the limits of his surgical repair but, all the more, happy to watch his children play.
This is The KDK Report.
