Six months on the sidelines: the long road to recovery after an ACL injury

By Colleen Brown

For a girl, co-ed indoor soccer games are fast, tough and usually painful. You get beaten up by boys with 40 pounds and 6 inches on you.

I love it.

I thrive on the attention of the crowd outside the clear walls. It’s packed with almost 50 people: fans for my game, plus the next two teams and their fans.

My team’s down a goal late in the second half. I’ve got the ball on my foot, heading straight for the net. A big, mean defender who’s been targeting me all night steps in my path. He has a grin plastered on his face and I want nothing more than to blow past him. Blood rushes in my ears as I pick up speed. Cheers from the crowd and shouts from teammates blur into background noise.

He comes in with a low sweep at my ankles, trying to trip me. After touching the ball past him, I tense and release the muscles of my right leg, jumping 8 inches off the ground in full stride over his ankle. It’s a move I’ve perfected over the years. I float for the briefest of moments, left leg outstretched, reaching for the ground.

I touch the turf and my ankle holds, but there’s a horrible crack.

I’m screaming before the rest of me hits the turf, clawing at my knee, the ground, anything to make the pain go away. My knee spasms with bursts of pain so intense I can’t find air to breathe.

The referee, my parents and coach are hovering over me. I can barely hear them speak as I spit saliva, curses and rubber pellets out of my mouth. My left leg hangs down, swinging limply as my dad and coach carry me off the field, red-faced and crying pitifully.

It’s deathly quiet in the cavernous room. All around me, people are staring, muttering their condolences and names of their favorite orthopedic surgeons.

The game goes on without me.

Another day at the office

Sports are an intrinsic part of my life. Growing up, I was always on a field, tennis court or in the ring with my horse. It was the winter of my junior year in high school, during a game of indoor soccer, when the impossible happened. I was invincible, the star of my team, riding the high that comes from pure adrenaline and doing what you love. And that’s when I tore my ACL.

The ACL, or anterior cruciate ligament, is the cornerstone of the knee. It crosses through the center of the knee, stabilizing movements and limiting dangerous over-rotation. Tears usually result from rapid twisting motions, awkward landings or violent hits. About 150,000 ACL injuries a year occur in the US, according to the American Orthopaedic Society for Sports Medicine. The ACL, unlike a muscle, cannot heal itself. With today’s medicine, there is only one sure fix: surgery. After a torn ACL is removed and replaced, complete recovery requires six months to a year of intense, painful physical therapy.

The UNC-Chapel Hill Ambulatory Care Center is an orthopedic center where athletes, students and other patients are operated on for a variety of injuries. I met with Dr. Alexander Creighton, an orthopedic surgeon kind enough to let an inquisitive journalism student with no medical experience whatsoever into an operating room.

After donning a pair of scrubs and an extremely unfashionable hairnet and mask, I was allowed inside. The patient, who must remain anonymous due to medical regulations, was already under. I could hear his pulse monitor beeping like in emergency room dramas. Massive hospital equipment lined the walls. In the center sat the operating table, overhead lamps and two video screens broadcasting a camera feed. It looked like a cross between an operating room and an alien abduction chamber.

There were four people in the room: an anesthesiologist, two assisting nurses, and fourth-year fellow, Dr. Hannah Dineen, who was busy inserting a camera into the patient’s leg.

There are two main techniques to replace the ACL. A graft can be taken from the middle third of the patellar tendon, which stretches over the knee cap, or from the hamstring muscle. This patient had chosen a patellar graft, the exact same surgery I had.
With the overhead lighting dimmed and lamps spotlighting the patient’s exposed knee, Creighton made a four-inch downward incision starting at the middle of his knee cap. Unlike his TV stereotypes, Creighton did not hold out his hand and demand “scalpel.” Dineen peeled back the skin of the patient’s knee like an orange peel and held it open to expose the patellar tendon. They used a tiny surgical saw to cut through the bone in order to remove the section of the tendon. The room filled with the rancid smell of seared bone. I had to hold my breath as smoke and minuscule shards of bone flew into the air.

Most of the two-hour surgery was spent cleaning out the inside of the patient’s knee. They removed his torn ACL and other bits of delicate-looking pink flesh with a tiny cauterizing tool, burning his flesh away until it blackened like the skin of a seared pork chop. Another tool was used to hollow out the patient’s spongy pale yellow bone marrow. My continuously shocked expressions must have been amusing for the two other fellows observing the surgery.

After hollowing out a cavity, the new ACL was pulled into place with thin sutures, then screwed in. Dr. Creighton tested the strength of the graft, then Dr. Dineen stitched together the patient’s patellar tendon and the skin over his knee.

That was it: the surgery that put me in a world of pain and helped bring me back to sports. It was both fascinating and disturbing in its normalcy. It’s easy to forget that while an ACL injury is a life-changing experience for one person, to these doctors and nurses, it’s just another day at the office. It was clinical and gross and altogether fascinating. I wanted to be able to say good luck to the patient. He’ll need it in the coming weeks.

The road to recovery

The hardest part of my ACL recovery wasn’t the physical aspect, it was the emotional. Being forcibly grounded was traumatizing, like clipping a bird’s wings. Wanting to learn more about other athletes’ experiences, I met with Yuri Jean-Baptiste, one of the physical therapy trainers for the UNC-CH women’s soccer team, at the Stallings-Evans Sports Medicine Center. The center is state of the art, decorated in muted grays and Carolina blues, with therapy tables, whirlpools, ice baths, strange-looking machines and ESPN on every flat screen.

He explained how athletes are prevention tested for injuries the moment they step on campus. They have a regimen of workout plans and preventative therapy techniques to help lessen the risk for injuries. But despite all the world-class technology and training UNC-CH has to offer, last year, there were six ACL tears on the women’s soccer team alone.

Jean-Baptiste tore his own ACL, which he said gives him a unique perspective in helping current athletes.

“I think that especially in today’s society a lot of the time the athlete tends to identify themselves with their sport, position or place on the team,” Jean-Baptiste said. “So when that’s taken away that’s a huge mental, emotional blow to them.”

I ran into UNC-CH junior Kirstyn Waller in the lobby of the sports medicine center. Waller’s a member of the women’s rugby team, and had her own ACL surgery just five weeks ago. She’s no longer on crutches, but still wears her post operation knee brace. It’s is a heavy contraption that immobilizes the leg completely straight from upper thigh to calf. The brace is heavy and clunky and trust me when I say it’s horrible to sleep in.

“I was already really emotional with the whole process,” Waller said. “I was weeping as I woke up from surgery. I don’t even know why.”

Waller’s progressing well, but she’s got five more months of physical therapy before she’ll be able to step on a field again.

Recovery starts on an exercise bike, slowly pedaling until you can’t bend your knee any more for the pain. Everything is tight with inflammation and scar tissue. Your hamstring, quad and calf muscles have completely wasted away. Patients have to relearn how to walk, how to move up and down stairs. The goal is to bring their reconstructed leg back to a point where it’s just as strong as their healthy leg.

UNC-CH first-year Emily Pender had a similar experience in high school. Pender tore her ACL while rebounding during a basketball tournament the summer before her senior year. She’s completely healed, tall and strong, and plays center for UNC-CH’s women’s club basketball team.

“I guess I just landed wrong,” Pender said. “I would try and play every day. I would practice my walking in my hotel room and then go see my coach and try to prove to him that I was walking fine. Then when he left I’d limp away.”

The drive athletes have to get back in and play is what makes ACL injuries so terrible. They’re fixable, but the cost is six months of pain and frustration.

“It’s the young girls that hit you the hardest,” Creighton said. “High schoolers who have hopes for playing in college, or who just want to play.”

Girls like me, like Waller and Pender. Thankfully, it’s not an injury that will keep you out of the game permanently.

But it does come at a cost.

Edited by Hannah Smoot

Being transgender in Alamance County: Zayden, Ben and Lily

By Kenzie Cook

Zayden Isaac sips on water in a coffee shop somewhere in Chapel Hill, a long way from his home in Graham, North Carolina. The dim lights dance around Zayden’s face as he tells his story of self-discovery, coming out and transition just weeks after his 18th birthday.

Back in his hometown of Burlington, Ben Xhemaili sits in his living room while his parents are out shopping and his little sister sings karaoke in her bedroom. His eyebrows draw together in a mix of concentration and sorrow as he recounts his struggles of the past two years, just a couple of months shy of 18-years-old.

Across the state, Lily McGilvray pauses “Chill with Bob Ross” on Netflix to share her own story a couple of months after her 21st birthday. Emotions swirl in her eyes as she retells both her hardships and her blessings.

Each transgender person has a different story to tell, and Zayden’s, Ben’s and Lily’s stories are unique to people from deep within the mostly conservative Alamance County. While both Zayden and Ben seem to have somehow known who they were their entire lives, Lily has barely just discovered herself in college. Some transgender people are lucky enough to face little-to-no struggles while coming out and throughout transition, but others must live every day feeling unaccepted and abnormal.

Zayden, Ben and Lily each has an entirely different look than they had just years earlier. Lily had a full beard and several more pounds. Now, she had a slight figure and a face as smooth as silk. Zayden’s case was the opposite. Three years ago, he wore his hair down past his shoulders and coated his eyelashes in mascara. Now, his face was fresh and his haircut was close to his skull. Ben, whose hair was once long and styled with curls, now wore his cropped short. All three individuals have experienced major changes physically, mentally and socially; and, although their stories are quite different, they share one thing in common: all are happier now that they get to experience life as their true selves rather than hide behind their physical bodies.

Alamance County, where these three people are from, is not notorious for accepting LGBT youth. The schools rarely let transgender students use the bathrooms or locker rooms that matched their identity well before the North Carolina government ever enacted House Bill 2. Lily had already escaped to Barton College before coming out, but Zayden and Ben were just beginning high school when they first revealed who they really were.

Zayden

In December 2013, Zayden, then known as Leslie, stared in the bathroom mirror, trying to figure out who the person staring back at him was. The long hair didn’t fit, the makeup didn’t make sense and the feminine clothes were a catastrophe. He knew who he was and this was not it. It was his freshman year of high school, and it was time for him to finally accept who he was. He decided to chop his hair off, replace his clothes with those from the men’s section and stop wearing makeup.

“I liked it when people assumed I was male; and I knew with my hair being as long as it was, everyone would always just think I was a butch lesbian,” he recalled. “While that’s absolutely fine for some people, it wasn’t for me and it made me really uncomfortable when people called me a lesbian, because that implied that I was a female who was interested in other females, and I wasn’t a female.”

The road to coming out was long and confusing for Zayden. He knew who he was, but he wasn’t sure the world was ready to know as well. At the start of his freshman year, he came out as a lesbian, and his parents and church were surprisingly accepting of it. Zayden didn’t tell anyone he was a transgender male until partially through his sophomore year. This was met with hardly any backlash or surprise, but Zayden still struggled with getting his teachers and parents to acknowledge his true identity. It was not until his junior and senior years that people finally started calling him by his new name, Zayden, or in some cases his nickname, Lee. Peers and teachers started using male pronouns when referring to him, but he still had to use the girls’ bathrooms and locker rooms at school.

“My mom calls me Lee but avoids using pronouns when talking about me,” he said, laughing slightly when asked if his parents were accepting of who he is. “She’ll say ‘Lee’ ten times over in a sentence just to avoid using a pronoun.”

During his junior year in high school, his first year after coming out as a transgender male, Zayden started going to the biweekly meetings of Trans Talk Tuesdays, hosted by the LGBT Center of UNC-Chapel Hill. Although he found slight comfort in being surrounded by people similar to him, he felt he didn’t quite belong in the group.

“It seemed like everyone else was struggling way more than I am,” he explained. “Plus, I’d prefer people just think I’m a guy than know I’m transgender.”

Ben

In the summer of 2015, Ben Xhemaili, then known as Yllza, faced a similar situation as Zayden. Though he came out as a lesbian the year before, he didn’t feel that term was quite right. He, too, made the conscious decision to chop off his long brown locks and ditch the mascara, and he loved the results. His parents attempted to make him grow his hair back out, but he refused. He finally felt closer to the person he really was: a transgender male.

While Ben’s journey to figuring out his identity followed along a similar path as Zayden’s, he faced a few more obstacles along the way. Zayden was lucky to be in a family that initially accepted him when he first came out as a lesbian before he knew who he really was. Ben came from an Albanian family who followed the Islamic faith, which included a strong discrimination toward anyone of the LGBT community even if it was their own child. Miraculously, Ben managed to hide his sexuality – and eventual gender identity – from his parents until his junior year of high school.

“Coming out wasn’t something I had decided to do, but rather a choice by my ex-girlfriend,” Ben explained. “I wanted to wait until I was 18.”

In the fall of 2015, Ben cowered on his bed shortly after his parents discovered a picture of him hugging his girlfriend. His father barged into the room, demanding he tell the truth of his relationship with the girl. Ben swore up and down that he wasn’t dating a girl, and that the hug was simply friendly. His dad snapped. No daughter of his would be a lesbian, especially not with an American.

Ben, who had been considering the idea that he might actually be a male born into a female body, knew immediately that if his parents could not accept him as a lesbian, they definitely could not accept him as a transgender person.

Flash-forward to a year later, to the fall of 2016. Ben’s mother helps him pick out a new name and helps him get access to hormone injections to begin his official transition. Even though Ben believed his life would never get better since he was a transgender teen in a Muslim family, over the course of a year he managed to change the minds of his conservative parents and turn his life around.

Lily

Two years after Zayden’s initial self-revelation and just a few months after Ben’s, in the fall of 2015, Lily McGilvray started on a long road to her own self-discovery. She had just started her freshman year of college and couldn’t shake the feeling that she was parading around as someone she was not. She tried to convince herself that she could just ignore it, and it would eventually go away.

“I was trying not to think about it,” Lily recalled. “But, then I started thinking about it a lot. Then, by the summer of 2016, I was certain.”

Despite her friends being mostly accepting of her new identity, coming out to her family was an entirely different experience. Her mother found out before she had the chance to come out. The doctors had mailed her hormone pills to the wrong address, and her mother forced her to come clean. Her father found out soon after, when her mother made her switch to his insurance.

“Telling my family was nerve-wracking,” said Lily. “My dad is completely cool with it, and my mom completely hates me.”

Her twin brother Justin didn’t outwardly react to Lily’s revelation. He simply changed pronouns for her. Justin explained: “She told me that she was transgender, and I just said, ‘Okay, cool. Do you want to play Rocket League?’”

Lily’s not completely out yet. At school, she still goes by male pronouns and her old name. She doesn’t plan to come out completely until she looks more feminine so that less people are confused. “My school was a Christian school until recently, so everyone here is really conservative. But I have my own bathroom and my own shower, so it’s not a huge deal.”

Back in Alamance

Transgender people across the world have different struggles, whether they are in a transphobic environment or not. Alamance County doesn’t seem to be bursting with people identifying as transgender, but that could be because it’s not necessarily an inviting place to the LGBT community and many could be are afraid to come out. Zayden, Ben and Lily prove that transgender people are incredibly brave in the face of adversity. Even though Zayden didn’t experience the same backlash as Ben or Lily, he still struggles simply by having the wrong body. Now with House Bill 2 hanging over their heads, their lives are even more in limbo, which only makes them braver. Perhaps one day, Alamance will be more accepting so these three are not alone and no longer have to struggle.

Edited by Samantha Miner