"Not the Worst Case Scenario"

I would have canceled the appointment but I have extreme guilt about canceling on doctors last minute. It had been feeling progressively better over the past 72 hours and I’m aware that my health anxiety makes me a bit quick to see a doctor, which has lead to unnecessary tests and overdiagnosis in the past. I’ve been trying lately to let my body chill and figure itself out, which has been working ok.

But because the cancelation window had passed, I made the too familiar drive up Hwy 93 to Boulder to see the orthopedist. I guess at the least he could verify what my physical therapist and I already were confident in given my symptom presentation - Hoffa’s fat pad impingement following my fall at High Lonesome.

Upon arrival, the medical assistant said x-ray would be coming to get me: “oh, no need,” I interjected, a bit too quickly, “I’m not worried about bone.” After a barrage of all the ligament tests, the doctor suggested we take a peak with ultrasound to see if we can pinpoint whether it was fat pad or bursa.

Lying on a table in the exam room I’ve been in far too many times these past few years, cold gel on my skin, he asked suddenly if I had any prior imaging of this knee. I laughed, “sadly no - this is the ONE body part I haven’t fucked up.” My laugh quickly dissipated upon seeing his expression. “Wait, why?” I continued, suddenly stiffening with urgency. Turning the ultrasound screen towards me, he slid the transducer over my patella - “see that disruption in the cortex here? I don’t think we are dealing with a fat pad or a bursa.”

I’m not a doctor, but even I could see the very clear break in the bone.

MRI scheduled for the next morning, I spent the next 24 hours in varying degrees of disbelief. I googled “can ultrasounds show bone fractures?” (the answer, for some superficial bones, is yes! Dammit Dr Google you aren’t making me feel better). I convinced myself the doctor had no idea what he was doing (a quack, I swear). I mean, if I had broken my kneecap when I fell at mile 28 of HiLo, I would certainly have known that, right? I certainly wouldn’t have been able to run 72 more miles on it, right? Dr Google backed me up this time: “inability to bear weight” was a main symptom of a patella fracture. For once, the internet provided me with a bit of comfort.

I texted friends and family. “There’s no way,” they all said. “You biked dozens of miles with us in Sunriver immediately post-race,” my sister said, “I’d be shocked if you could do that on a broken kneecap.”

I didn’t remind her that I biked hundreds of miles on a femoral neck stress fracture post-Cascade Crest two years ago, so her words didn’t exactly reassure me.

“I have a really hard time believing it is [broken],” I texted a friend right before the MRI, “but knowing my history and my luck, it absolutely will be.”

Two hours later, I guess I should have patted myself on the back for knowing myself:

“You know how I was just celebrating finishing a 100 miler without breaking a bone?” I numbly told my boyfriend over the phone “turns out, I broke a bone.”

Isn’t it ironic, don’t you think? A little too ironic?

Or maybe it’s not irony, but just really shitty luck.

A patella fracture is something you don’t fuck around with, it seems. Before the MRI, the doctor told me that if it’s a horizontal fracture, it’s most likely surgical. If it’s vertical, then it’s a 6-8 week immobilization in a straight leg brace (which sounds almost as bad as surgery). But…I could bike without pain. I could elliptical without pain (but with a lot of self-loathing). After 2.5 weeks, I was starting to go up stairs without pain. My brain couldn’t reconcile these worst case scenarios with how I was currently moving through the world.

Luckily, “it’s not the worst case scenario,” the doctor confirmed in my follow-up the next day, “in fact, if you are going to break your patella, this is about the best case scenario you can get.” He explained that the fracture was just above my patella tendon and given I’d been moving on it for 3 weeks already and it was improving, they weren’t going to immobilize me and surgery wasn’t indicated. “Just don’t fall on it,” he warned. I’d like to say that’d be easy for most people, but…we all know my track record.

So 6 weeks of no-impact and no falling (sorry, climbing and outdoor biking), and I’m already halfway through. Seems pretty light compared to other sentences I’ve had, but he warned it could be 3+ months for it to be pain-free. Knees like to linger, I guess.

Naturally, my first inclination is to find a way to blame myself. Should I have DNFed after my fall? Sure, the knee hurt for 20 more miles, but there have been plenty of times I whacked my knee and it hurt but structurally it was all fine. It wasn’t the kind of pain that would stop a race. By mile 50, the pain had substantially lessened, and after mile 70, I don’t even think I thought about it - running on it was completely fine. (or, as things go in 100s, everything else started to hurt worse)

My friend Caroline quickly yanked me off the self-flagellation merry-go-round: “hey what if you just tried to embrace that it was just really bad luck and nothing you could have done would have changed it?” (other than not falling on my knee)

Oh hell no - that’s way too scary for me. If I can’t self-flagellate, then I have to admit that life is sometimes beyond my control. That I can fall 100 times in trail running and be fine, and maybe one of those times, I am going to hit my bone in a way that breaks it. That I can fly over the handlebars at 40mph on my bike and walk away unscathed, but I can break my toe kicking a bench in the sauna. For all the times I’ve been lucky, once in a while the luck will run out.

Of course, the doctor bringing up that we should do another DEXA scan didn’t help my shame. To me, the implication of this was “your kneecap shouldn’t break in a fall like this unless your bone density sucks.” I was perhaps slightly rude in my response, reminding him that my DEXA scan two years ago was 100% normal and that I had gained weight in past year as well. But of course I then started to think about what others would think - was everyone else going to think like that doctor? Would anyone just let me escape with “just shitty luck” instead of trying to pin it on my eating disorder history? “I bet your kneecap would have broken too if you took that fall,” my inner 12 year old wanted to retort while stomping out of the room with righteous indignation, jelly sandals clacking on the linoleum floor.

Just this once, though, I’m going to try something different. Instead of the guilt and shame and self-flagellation that has ruled my life over every misstep and injury, I’m going to try to believe that accidents happen. The universe has terrible and cruel timing sometimes. That breaking a bone two 100 milers in a row isn’t a sign that maybe I should find another hobby.

But maybe it *is* a sign that someone needs to invent kneepads made for running. If anyone would like to discuss this, hit me up. I’ve got some idle time ahead.