When the Shit Hits the Fan.....
Juno, a.k.a. Mrs. Maddaus

When the Shit Hits the Fan.....

That is my girl Juno.

Juno is a seven-month-old female Cane Corso or Italian Mastiff. She is big, and she slobbers. A lot. She and I are very connected through training, feeding, and a lot of love. My wife Lea has nicknamed her Mrs. Maddaus (you get the picture).

Two weeks ago, I was on my usual after-dinner walk with Mrs. Maddaus, and the back of my left knee was aching like hell. Then, a sudden loud snap that could be heard 10 feet away and a sudden excruciating pain in my knee. I had to hobble home straight-legged for four blocks.

I went to an orthopedic urgent care the next morning (Saturday) and was told it was just a tendon pull or some shit like that. Thankfully, I just happened to be coaching an orthopedic surgeon on Monday, and she immediately informed me that it was a meniscal root tear.

A meniscal root tear occurs when the posterior attachment of the meniscus to the tibia tears off, leaving the tibial plateau exposed to the forces of the femur. If unrepaired, it deteriorates into the need for a knee replacement over 6-12 months.

An MRI confirmed the diagnosis. Having had both of my shoulders replaced over the last year at Barnes in St Louis, I ended up there again for an arthroscopic meniscal root repair 10 days ago. I was discharged the same day and flew home the next day.

The postoperative care? No weight bearing on the left leg and crutches for 6 weeks, and afterward, slowly progressive weight bearing and walking.

No more Juno walks. No more Juno training. No more 30-minute elliptical workouts in the morning and Peloton HIT classes in the afternoon. No more sex (still thinking about workarounds on this front). Plus, I had just fully turned the corner on my recovery from the shoulder replacements. I was back lifting weights and had recovered my muscle mass again.

This is all bad enough, but the best (worst) is yet to come: my utter dependency on everyone for nearly everything.

The nail in the coffin that drove home my sudden dependency was pounded into my skull the first morning after my return home. I fumbled my way upstairs to start my morning coffee routine. I ground the beans, loaded the coffee maker with water, and fired it up. Yes. Success. "I can manage this," I thought.....

But then, as I looked at my favorite mug from Jocko Willink sitting there, begging me to fill it up and do what is printed on the side - "Get After It," I realized that I was completely screwed. There was no way I could get the mug to the other room to my reading chair on crutches. Someone had to help set me up.


At first, I was relieved to have caught the real diagnosis, thanks to my orthopedic colleague. I even remember thinking how grateful I was that modern technology has kept me moving, working out, and living the way I want to since my orthopedic history is like a manila file packed with 20 years of repair receipts of an old junker car: 5-level lumbar fusion, bilateral hip replacements, and two shoulder replacements.

But now, with the stark reality of my new orthopedic issue being rammed down my throat, again, I started to feel sorry for myself. Seriously sorry for myself. I started to resent my body, especially my knees. Until now, I had felt that they were the good guys—the only joints in my body that would not disappoint me.

The situation is a stark reminder of the truth of this proverb shared by Sahil Bloom in his recent newsletter:

"Do not think there are no crocodiles just because the water is calm."

So, yet again, I had to pull out the resilience protocol that has been the scaffolding for dealing with all of the many, many crocodile fights that I have had in my life: Accept, adapt with muscular patience, and look for opportunities to learn and grow. It is a lot easier to type the words than do the protocol. The protocol works every time, but it has a schedule of its own, and like all things, you actually have to do it.

Acceptance of Reality

When the shit hits the fan, psychological acceptance is the absolute first order of business. Without it, not only do you suffer, but you are not able to make the best decisions that are based on a realistic appraisal and not ones rooted in emotional turmoil and misery.

Acceptance of reality is a crucial and foundational life skill for psychological health and mental freedom (proven by extensive research). When the shit hits the fan, and our life is suddenly thrown into disarray, fighting the new reality by complaining, judging, feeling sorry for oneself (like me last week and a little bit still every day!), or thinking, "Why me?" only serves to stoke the fires of suffering since:

Pain X Resistance = Suffering (memorize this formula!).

If I complain to myself in my head, or to others, or wish for things to be other than they are, or if I fight the reality that I am now nearly 100% dependent on everyone for everything by struggling to try and still do things for my self - these are all forms of resistance.

Resisting the new reality will only make me suffer, and it will also make others (family, colleagues) miserable, too, since they have to deal with a complaining and pigheaded surgical personality and a pain in the ass who can't accept any help. Of course, it goes without saying that I have never behaved in such a fashion. 🤥

This acceptance business is particularly difficult for us surgical types who are inculcated with the habit of "fix everything" during residency, a habit which is reinforced over and over again in our careers.

Of note, acceptance also includes the reality of our physical and emotional pain. I know only too well the toll of trying to get rid of physical pain with narcotics. It did not go well. The physical and emotional pain of the event are not going away until they go away. The more you resist them, relentlessly looking for fix-it solutions that are, at best, a bandaid, the more you suffer.

A side story to help illustrate the power of acceptance. My daughter Anne is taking a calligraphy painting class, and I found her painting a piece with all these fancy brushes and paper. She looked miserable. I asked her what was going on, and she said that she had painted this piece so many times and thrown each of them out (she has, like me, perfectionistic tendencies). Now the damn thing was due the next day. A few wayward tears trickled out of her eyes and rolled down her cheek.

I asked, " Does your mind feel like a clenched fist?" "Yes." The rate of tears trickling down increased. I suggested unclenching it and accepting the situation. Once free of the resistance, you will be able to paint freely, even with the background hum of the situation's tension. Instantly, her face relaxed as she started to see what was happening with her mind. She painted the calligraphy picture in 2 hours and got an A on it.

The powerful habits of discipline, self-sufficiency, being strong when you feel weak, and the fix-everything habit are great, until they are not, and they start to work against you. The ability to discern those fuzzy moments when it is time to toggle off our usual habits and flip to the other side of taking care of ourselves, not pushing too hard, having patience and compassion with our struggles, and to let others help us is the land of wisdom, and it requires practice and intentionality.

Adapt With the Neutral Zone and Muscular Patience

For me, adapting means giving myself the time, patience, and self-compassion to allow the emotional and physical pain and turmoil to subside. William Bridges, in his beautifully written book The Way of Transition, describes entering the Neutral Zone during this difficult time of adjustment.

There is simply no way to hurry the emotional and physical process up. Wouldn't it be nice if I could put all these shitty difficult emotions and pain sensations in a garbage bag and drag the stinking mess out to the garbage (actually, someone would need to drag the bag for me currently) and be rid of it?

Alas, no such quick solutions are available. I had to adapt to the hard road ahead and tolerate the misery without trying to conjure up quick fixes. I have even allowed myself to cry on two occasions—I wasn't whaling, just crying silently with a few tears trickling down my cheeks—and it sure felt good to let the emotions out.

In this case, the Neutral Zone lasted about 8 days. Yesterday and today, I woke up with more of a bounce in my mental step. Of course, this does not translate to more of a bounce in my actual steps, but I am moving much better, especially since the skin that was rubbed off the side of my chest from the crutches is now healing.

Next up:

Solve Problems

Now that my mind and emotions are clearer, I can solve the myriad of problems facing me in a more deliberate, positive, and focused way. Some examples:

Bathing. What a nightmare. Bring crutches into the shower? They get wet. There is a step to go over to get into it. Hopping around on one leg risks falling. Then there is the damn brace and getting it wet.

Solution: Take a bath instead. I learned to set my crutches on the counter, hop over to the edge of the tub, take off the brace, swivel my body to the tub and plop my ass on the edge, slightly bend my injured knee (allowed), and using both arms and my right leg as robotic arms, slowly lower my jalopy of a body into the tub. I have practiced this several times with horrified monitoring by my wife, Lea, and now have been declared fully trained, competent, and able to bathe independently.

Juno. This is actually one of the most distressing and disappointing things about this situation. I was heavily into training her, and through the process, we had become so bonded and connected. It is lovely.

Now, my time is limited with her, and my training has reached a standstill. However, I have found ways to increase my time with her and to continue to reinforce the things she has been taught. I have her sit by me in my chair after Lea sets me up with my coffee in the morning. I am back to feeding her, the main way of training, by standing in front of her with my crutches and going through the commands. This at least keeps her muscle memory alive, and I hope it will not cause us to lose too much ground.

The Gym. Another nightmare. I lift weights every day (I can hear what you are thinking: "No wonder you are such a mess," - but my genetics are playing a big role). Many of the exercises require me to put plates onto bars, etc, or to stand. All of which are out. So I went to the gym, surveyed the machines, and figured out which ones I could use while sitting without putting plates on. Bingo, problem solved. I am pleased to say that I have lifted weights now for the last 5 days!

A big part of the problem-solving is slowly figuring out what I can do on my own - like the things above - and knowing and accepting which things I will need some or a lot of help with. Here is where getting my ego out of the way and embracing the help and love of my family is so important, not just for my recovery but for them, too, since they love me and want to take care of and help me. In our house, I am the fixer, the problem solver. Now, they get to be, and it makes them feel good. I have learned that it is actually a gift to them.

Next Up:

Unanticipated Opportunities for Growth

When the shit hits the fan, and you are mired in the stench of the reality of it all, it is hard to see how anything good can come of it all. But there is almost always something if you can just look for it and see the possibilities and grab them.

Our daughter Anne has stepped up to the plate to take care of Juno. I had dominated her care and training, but accepting the new reality forced me to ask her to help. Not only did she agree, but she also fully embraced the project. I have taught Anne the basics of balanced training, and she is walking her, training her with food, and navigating her bullheaded demeanor with patience and grace.

I am so proud of her for doing this, but the real win is that Juno now has a solid relationship with Anne. This is great for Juno and me since I know she is being cared for so well. The hidden opportunity was for Anne and Juno to create a real relationship and for Anne to learn about how to train a dog, something that she has found, to her surprise, extremely interesting.

Another unexpected opportunity is my relationship with Anne. She is 22 and in her last year of college in LA, and like all young adults this age, she is transitioning to "adulting" (as she calls it) and becoming independent. It has been my experience that around this age, the process of becoming independent will seem as if they have ditched you as parents. It is hard for parents🥹! Of course, most of the time, it has nothing to do with us as parents. It is only that they need to figure it out (life and adulting) on their own, knowing that you have their back.

But this situation has led to Anne and I going to the gym and the store together. It has been my experience that time spent together just doing normal life shit is what leads to a deeper sense of connection and understanding of others, and this is often the hard part during this age since they are off on their own. The new "forced" togetherness has deepened our relationship and connection. I get to chat with her in the car about random things, including all of this. She is even interested in driving around Minneapolis with me to see where I grew up and learn more about the chaos of my early life ❤️.

Another opportunity is my connection with my son Sam. Sam had a below-the-knee amputation in 2017 after a motorcycle accident. He had to be on crutches for a long time until the leg healed, and he was ready and trained to wear a prosthesis. It was hard as hell to watch him struggle so mightily with the crutches and to need so much help from me when I was staying with him. But now, after getting my face rubbed in the sand of living on crutches, I can see what he went through and how he did it without complaining in a whole new light. I really, really, get just how fucking hard it was, and still is for him.

Plus, he is now biking from the top of Alaska to the bottom of South America alone, with a prosthesis! My respect and admiration for him, already exponential, are off the charts now. After this happened, he called me and offered, totally genuinely, to come home from Columbia to help take care of me. I have a few wayward tears trickling down my cheek right now, writing about it and thinking about all that he has been through.

My injury gave us another common bond of connection that only he and I can ever fully understand.

For that deeper connection, and Lea, Anne, Juno, my whole family, my surgeon (and Barnes Hospital), for the insane technology that is keeping this jalopy chugging down the road of life, and for being privileged to write and share my experience with all of you - I am very grateful.

If you would like to share your thoughts on any of this or any stories of your own, please feel free to email me or share in the comments. I would love it and will read and respond to all!


Subscribe To The Resilient Surgeon Newsletter

Get a dose of The Resilient Surgeon straight to your inbox.

Great! Please check your inbox and click the confirmation link.
Sorry, something went wrong. Please try again.

Written by