Currently less an injury per se and more a "situation" right now, the point of jotting this one down is as a reference point of sorts, perhaps for my future self, perhaps for a potential audience, if that ever happens. Perhaps to raise context as to what was physically happening with me over this stretch... Whatever I'm doing it for, I guess there's just a piece of me that doesn't want it forgotten. Not that I'd ever fully forget this episode in life, but I do believe there are nuances, wrinkles, tidbits and thus possibly infinite lessons passing through right now that I'd one day forget, and on the flip side there could be wisdom berthed right now only realized later down the track, if only by penning something today...
The genesis of my "situation" in some ways began as far back as late January of 2020 - just prior to a global pandemic. Up to that point, I'd been burrowing through the internal files to recognize certain aspects of myself of which I myself didn't quite fancy... Put plainly, understanding why I didn't really like myself and what to do about it. This was a work in progress, which still is but that's not really what this is about. The point is that at that point in time I was generally very healthy and flying, in a physical sense and only a few mental health whoopsies to contend with. I was competing and doing things I very much loved in the athletic domain which rounded out some major senses of myself.
When I could compete, I felt more complete and real.
Late January 2020, there was a day when a small wet patch on a hardwood basketball court inflicted the most significant threat to this sense of self I'd ever faced. A high-grade partial tear of the anterior cruciate ligament in my right knee. There were some factors that were unfortunate and other factors that were just bad luck around my course of action. On one hand, my sense of denial (in retrospect) yet optimism that this injury could be rehabilitated sans surgery, with my already decent physical shape and clinical knowledge could serve me well here to dodge a mighty bullet. I was advised this was a feasible course of action. On the other hand, my insurance (or lack of) was going to make a snappy ACL reconstruction tricky from a financial sense, plus a shutdown of hospitals, elective surgeries and all the other jazz kinda married me to the decision that a conservative management of my knee by way of aggressive rehab without surgery was the way forward now. The timing was terribly perfect and in some ways looking at it, it was the perfect storm of my own optimism and "challenge accepted" attitude, with a less-than-ideal financial position and Covid-19 forcing my hand that surgery wasn't happening.
The rehab was going well. I remember regaining a lot of range of motion quickly, building strength, integrating new skills that I'd not been that good at before - all without gyms and other facilities for a time. Pistol squats, squats, lunges, hopping, bounding, sprinting, landing and running all were doable tasks over a time. Then basketball drills, agility, speed and the rest. Once gyms re-opened, I could access a barbell, I could load and get more specific. Training was escalating but I was patient, smart, yet bold with my "DIY reconstruction" of sorts. I'd follow the best standard guidelines for good ACL rehab, but also knowing myself and swallowing the risks that I'd maybe not prescribe to a patient also.
I needed to right this. I pushed.
In basketball, the skill and capability of acceleration, deceleration, landing on both feet is integral for everybody, I feel. Many can get away with being not great at it but when you're under 6ft tall and not exactly the fastest, you do need the dexterity and solidity of excellent fundamentals to survive. One day I was working these qualities; footwork and craft some might call it, when the intensity isn't high but you're getting the nuanced skills and more intricate movements just right. Weakside finishing was the drill. To really do it right you have to essentially land blindly, so land without looking or really noticing - like your body just takes care of it without your mind being conscious of it. The blind, instinctive and natural foot-to-ground qualities are kinda the last hurdle for major lower joint issues. If you can be stable, sturdy, powerful and automatically elastic, and with confidence, then regular playing comes next. This drill this day proved how far away I really was.
I went up under the rim, taking off of my left foot to launch upward and finish a lay-up with my right hand outstretched on the weakside, head and eyes looking upward at the rim to see the ball ricochet tightly off the backboard to slip into the hoop for a perfect completion. Totally blind to the lower half of my body whilst in mid air. When you take off of the left leg, you naturally land on the right leg, so this was the true test of the drill this day, not how tight my weakside lay-ups were, but how automatic my lower limb apparatus were for landing. Actual game readiness. I'd done this drill before whilst rehabbing, it was not a new test for me. The specific landing and such still wasn't feeling as natural as it historically had and I felt like this was a normal barrier to cross for it to become reliably sturdy again in real time and real speeds. I still had to kind of "think" about sticking the landing rather than just landing, still, but this was the normal course and I needed to push the boundaries to get back to where I used to be. This day though, I wouldn't say I was pushing that hard, all it took was the right height, enough distraction to take away from thinking about my landing - the ultimate goal, really - but something (in hindsight) I wasn't ready for. Landing upon a fairly benign weakside lay-up caused a buckle that shuddered me in a way I only felt the first time I'd wrenched it. Massive episodes of pain and injury are rare for me, but when they happen, be it a collision or a rolled ankle, I don't scream loudly - I wince deeply. I remember keeling over, still standing and wincing deeply under my breath, concealing and dampening the vocals of pain from a jolt through my right knee that quivered the rest of me, causing my hands to shake and the light headedness of anxiety that happens when you realize this was real.
I'd really done it this time.
I remember hobbling the short distance home through the park on the sunny mid-afternoon with my basketball in hand, wearing some stupid looking funky shorts that Billy Hoyle chumps get chastised for. Usually my actual skills once out there protect my self-reservations about being a grown adult, on a mid-afternoon of a school day, in stupid shorts still playing the children's game on my own. It'd cross my mind every time I'd walk to the court alone. The narrative of men and women with actual jobs thinking "adults don't do this, time to grow up". The fact that once I'd reach the court and start, these fears would wash away because there was no fumbling once I'd get going, an earned and more respectable mastery would surface and be detectable, even to the lay observer. I'd feel defiant in these moments. Hobbling home in stupid shorts definitely shattered these defenses this day. This day, I was the 'too-old-for-this-shit' man-child clinging on to the children's game with reprisal by injury, left to limp home licking his wounds.
"See, that's what happens at your age..."
Everything felt pointless.
I organized the routine check-ins to physio and GP for the required referrals and new plan of action. A CT scan confirmed a full rupture, a meeting with a surgeon was hasty but still Covid-19 and my insurance was not, so I had to wait again. It was okay, I was at peace with waiting, just so long as a date for surgical intervention was set and I just had to concentrate on getting stronger for it. Once again, my "challenge accepted" attitude was setting in and I looked at it like I'd dominate this recovery, so I wasn't afraid and the more dire concerns of those around me kind of bounced off of me through my self-belief that "I've got this..."
Again, the rehab was going well...
I'd restored range of motion, strength bounced back pretty quickly yet the joint was pretty loose this time. So I'd play it safer to just doing much more controlled things, but I aggressively worked away and chased key movements, skills and other gym shenanigans that I personally was confident at, felt safe with and was on the more exceptional side of things compared to your standard ACL pre-hab. I wanted my "normal" to be above average. I wanted baseline to be excellent and beyond, so I trained that way - intelligently of course. The thing that became a thing was one day at the track I was doing some skipping as a warm-up into a drill. To be fair, I'd not done much skipping for a little while so some small aches and pains around this shouldn't be a shocker when you're just getting back into it. Checks out all the usual balances as to what it could be. I don't fear pain when context suggests it ought not be feared. It's a feature of myself I like, to have that 'pain-and-self' literacy. Anyways, this day it hurt to skip on my right ankle and it just wasn't really dissipating with warming up, altering movement and so on. Up to that point, it was a mild annoyance in my right ankle but nothing world shattering. I could play and work through and usually it would acutely get better when exercising, and afterwards there'd be some repercussions, but nothing major. Before my knee injury after playing basketball and the day after it would feel especially tender, like the joint was jammed but with movement and stretching it would settle. The clinical reasoning in my head suggested that if anything it was arthritic symptoms, perhaps some bone spurs... Fairly benign issues that weren't too problematic considering all else.
But this day, with the skipping, I'd just decided that the ankle thing was annoying enough, still, that I'd get it looked at. "You're already out, might as well check-up everything whilst you're at it" type rationale. Plus I hadn't played basketball properly in over a year, so I was certainly not doing the main culprit which would consistently piss it off the most, so there was something to be said about that. My money was on bone spurs as I noticed limited deep dorsi-flexion (up to my standards) when squatting and such, like a jam and not a stretch. When seeing the physio and then sports physician, they erred the same.
"Probably just boney spurs to be filed down, pretty basic but we'll get you in for an MRI just to actually see it first and go from there"
Nothing to worry about.
When a sports doctor who should be too busy worrying about Olympic swim teams over a 30-something old basketball player leaves a voicemail on your phone, it's usually not for outstanding courtesy and customer service. Do not get me wrong, he was a very nice and good practitioner but even so, expected and un-remarkable news is still usually left to the clinic receptionist for a person with a diary like his. But, Dr. wanted to see me ASAP. This was an oddity to me, but I still wasn't that worried. I just thought maybe it really was excellent customer service and rapport building - both important clinical pillars, I feel. So I just booked in to when he was next available so we could have a chat and go over the results of my scan. My main thing was this ankle interfering with the impending knee surgery, that was my biggest concern really, considering how much I was putting into my knee and my wanting for this whole chapter to be on the home stretch and over. At the time I just wasn't sure if he had bad bed-side manner so to speak, or I just was dramatically under-phased by the news that passed me. I felt like he was overblowing things, he probably thought I was too apathetic about it all. Dr. told me that they found something "very bizarre" in my ankle, completely unexpected.
"Great, what else?"
He basically said it was most likely a cyst or a tumour of some sorts, both rare occurrences and my one was particularly large, as he showed me the image. This blob of plain white took up a third to half the size of a key bone in my right ankle. Where all other colours were a normal translucent version of grey, this huge patch of full solid white just taking up a concerning portion of space compared to how these images usually look. Big white blobs on these scans are alarming to anybody, so his alarm and my nonchalance was probably vexing.
"Okay.. cool" I said
"No, not cool. This sucks" He said
Like he was trying to snap me out of it with his tone, emphasize that things need to be done quickly and priorities need to be re-shuffled now as we don't know what this is, so get on the page.
"I've got a knee reconstruction booked in soon, so will this be something to be dealt with after that..?
"The knee is truly on the back burner now. This needs to be dealt with immediately"
Looking back, I appreciate his energy of concern, but my style is a very detached one with many things, like I don't allow the seriousness to overwhelm me in order to solve the problem. This works well for me sometimes, others it is just unproductive apathy. I'm thankful he cared and set the context right, otherwise who knows, honestly. So I took that news and left with gratitude, but still cavalier. It wasn't until more voicemails reached my phone, personally from Dr. telling me he'd ran into a specialist whom he wanted to refer me to. Then another voicemail soon after prompting me to ignore the previous one - "there's someone else you need to see!" and so on and so forth. The inundation of instructions, the immediacy, the phone calls bouncing me around from office to office to try and reach the person whom apparently can best handle this rare freak-size growth taking up my ankle bone kind of prompted my attention and urgency for the matter. To this day I still probably don't appreciate the bullet that might've just zipped by me. The man-child without a basketball to hide behind, in a way.
When I finally got to meet with my surgeon, it was kind of more of the same in terms of the sheer contrast of my position to how the professional saw it. He was kind of grave, I was feigning grave through naïve detachment. Costanza says that every Doctor should have a "get the hell outta here!" protocol for patients - by way of dismissing a patients concerns for their absurd assumptions of the worst by aggressively yet jovially telling them...
"get the hell outta here! you really are crazy to think that, you know... you're outta your mind!"
The more aggressive and dismissive, the better the patient's news. I was always wondering when my "get the hell outta here!" was going to come.
"This is very rare. It could be a benign cyst of sorts, or could be a cancerous tumor. We need to test and find out. But if we don't remove this growth soon though, your talus bone could completely shatter under you at any time or progress into something worse, if not already" my surgeon said.
Get the hell outta here...
We chatted logistics about what things I needed to do first. Get a biopsy, a thallium scan and other stuff that ought to be for persons beyond my years and beneath my health status. The sooner the better. We sat in the office and chatted, but mostly he to me as I didn't have much to add or enquire. My real-time emergent understanding of it all, the thoughts of a zippy knee recovery, back to basketball and back to my normal was a sliding door reality that had seemingly slid away, unsure to ever be again. Surgeon was probably saying a fair bit which didn't register. I heard him, but didn't register him. I was just processing how less-complicated the greatest threat to the major sense of myself was only a few days earlier, now it's just a damaged ACL in my right knee in the grand scheme of things.
I remember walking the hallway to my exit from the surgeons offices. It wasn't the standard clinical sports-mediciney scenario that I'm more accustomed with. I remember doorways with the names of doctors, surgeons and specialists, littered with acronyms and letterings beyond the names, with expertise that are alien to me and, in my mind, also ought not apply. Neurosurgeons, oncologists, gastroenterologists and whatever else - serious folk doing heavy shit for people on a "life" scale. Serious medicine. There are older people around me entering and exiting various offices. Bandanas, canes and walkers, frail, probably managing their diminishing health rather than enhancing it, it seemed. Yet I'm here too. It was a like a moment of awareness about some of the inevitable obstacles we're dealt in life, but usually obstacles reserved for the older or super unlucky. Maybe it was a little from column A, a little from column B in my case. Either way the vulnerability immersed itself within and despite all notions of how indestructible you think you are, how many trends you'd buck as you grow and for me, having the game of basketball as a personal defensive shield to justify myself and my truest and realest joy, it felt like now I truly realized that you never really can outpace this stuff. You might evade it, if you're lucky. But things are coming for you, Nick, just like they do for everybody and hoops probably can't protect you so much from here on out.
A man-child, no longer with a basketball to hide behind...