Weekend Reflections

Long Story Long

I had knee replacement surgery on the morning of April 18th, and was walking without a walker or a cane on the morning of the 19th when the Physical Therapy began.

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I even ran the next day after challenges from the Nurses Station observers, when they weren’t playing cards.

The pain started once the original surgery drugs wore off days later. So the continued PT adds to my pain, but as I tell myself it’s no worse than the pain before surgery. But at least now there’s hope for something between “less to zero” pain.

We drove 6 hours from Lenoir NC to Franklin VA because that where Dr. Patel was located. After getting gel shots in both knees (bone on bone in both) from the doctor 1 hour away – who had done my torn meniscus surgery back in 2014 – to avoid surgery – I finally came to my senses and inquired about getting both knees replaced after the gel worked in the right knee, but not in the swollen, ugly, hurtin’ like hell, left.

These knees had been bothering me on and off for 6-7 years and then went to permanently on last summer.

The doctor in Cornelius NC recommended someone closer to home – than himself – but before they could get me some names – my wife’s request on Facebook brought me the name of Dr. Manish Patel – from the VP, head of Nursing at a teaching hospital in the Petersburg VA area. She needed a knee replaced herself and after doing her homework she had chosen him. So I leveraged that. It was one of those “what do I know?” compared to “what does Cindy know?” – and she won. It wasn’t even close.

I have been VERY CONCERNED ABOUT COMPETENCE a few times in my life – one time after an accident I had on the beach at Maui – that I wrote about in my quarterly newsletter in the Spring of 2000 and then covered again in a Blog Post in 2010 – here.

But I went with “That’s What She Said” – as opposed to me continuing the search for a name – a fish in the sea. But I didn’t stop my due diligence.

I Googled Dr. Patel, looked at a video explaining his approach – where they don’t cut any muscle or tendon, watched a few of the testimonial videos of patients – older than me – walking without crutches, walkers or canes – at the 3 day mark. I read about his unique approach – no cutting, less recovery time and less pain. Less Pain? Did someone say LESS PAIN?


He was in Franklin VA – just west of Suffolk VA. Google Maps told me it was 6 hours away. But … LESS PAIN.

So on a Saturday afternoon, March 16th, I sent him an email.

He responded 20 minutes later with some questions.

I responded to him.

He called me 10 minutes later with some more questions.

Then next Monday we agreed on what I needed to do locally and tentatively booked a date.

My left knee hurt so bad that I looked forward to April 18th as if it were Christmas and I was a kid again.

The Back Roads

We drove on the 16th the 6 hour drive. We drove the back roads because it wasn’t for work or to rush a grandchild to the hospital – and that’s just the way I am after way too many decades of driving bumper-to-bumper rush hour traffic in Chicago and then Charlotte.

We spent a “whole lotta time” on US 58 in both NC and VA. Some beautiful scenery on the way – obvious – even when one is in some pain (6-7).


We stopped in South Boston VA for lunch.

The Hotel

Dr. Patel has a deal with the Hilton Garden Inn in nearby Suffolk for his out of town patients. Beautiful place.


Nancy would be staying there while I was in the hospital – and I would do 3 days of PT (Physical Therapy) from there – and stay close “just in case.”


We saw Dr. Patel on the 17th.


And then pre-checked in with the hospital next door, getting all of the administrative paperwork out of the way early.

In Pre-Op

I met the team of nurses preparing me. I got undressed (modesty and vanity were checked in at the front door BTW) and into my gown. And then I met the surgery team.


We joked, talked about what would happen, how long it would take, what music they were going to play while I was under, etc. I got the shots that would relieve me of ALL PAIN  at the moment – and to come – and I drifted off while talking about Son Volt and their new album which I had bought for the drive through the NC/VA country-side.

In Recovery

I woke with one fuzzy memory of “coming to” just as the anesthesiologist had forewarned me about.


I was feeling NO PAIN. And my baby, Nancy, showed up. And I drifted off again.

Back In My Room

I came to in my room – although I had some memories of the ceiling tiles changing in between the tops of door frames.


Some from the surgery team showed up to check on me – and I had Nancy get their names and roles as I told them, jokingly, that I wasn’t going to let Dr. Patel take all of the credit for this miracle taking place.

And then I met the staff of nurses and specialists who were going to take care of me and Nancy got their names too.

Back In the Hotel Again

I was released on Easter Sunday and got some sun on the hotel grounds.


The original meds were wearing off a bit – and it was back to the real world. But I was still taking pain pills. I did two days of PT and then saw the doctor on Wednesday – and then was chauffeured home Wednesday afternoon.

Back At Home

Here I am with my almost BFF – Igor the Incision.


As a friend remarked – Igor is temporary. And so is the pain.

It Takes a Team

I know we didn’t get but half of the people on the front lines I met face-to-face let alone the dozens and dozens – or hundreds more behind the scenes that I would never meet – both at the Southampton Medical Group and at the Southampton Memorial Hospital.


Thanks To All! 

Instructional Analysis

As I almost always do – I observed everyone as they did their work in front of me – when they weren’t playing cards – and I tried to imagine their performance-based T&D needs – and how they might best get it.

As a Standalone Job Aid? Because their background, their incoming K/Ss would be sufficient for them to simply follow some written Instructions.

Or as a Job Aid covered in Training? Because their background, their incoming K/Ss would NOT be sufficient for them to simply follow some written Instructions.

Or in Training for memorization purposes because when they need it they need it and there’s NO TIME for referencing a Job Aid when they need it. Or for those interpersonal and technical skills were they actually have to get plenty of Practice with Feedback to hone a skill.

That’s how I roll – as I Practice my craft – on duty and off duty.

However I am quite cognizant that my observations capture nothing but surface level behaviors – and certainly no cognitive behaviors – and even if I questioned them I would never get to the nuances needed by learners/Performers climbing these Learning Curves –  which is why I prefer doing both Analysis & Design using a Facilitated Group Process of Master Performers, Other SMEs, Supervisors and Novice Performers – as I have been doing since 1982 as a consultant.

My business partners and colleagues wrote about that approach to ISD Analysis & Design way back in 1983 and were eventually published way back in 1984:

CAD – Training Magazine – 1984 – 6 page PDF – the first publication about Curriculum Architecture Design via a Facilitated Group Process – published in Training Magazine in September 1984. Original manuscript (30 pages) – How to Build a Training Structure That Won’t Keep Burning Down.

Models and Matrices – NSPI PIJ -1984 – 5 page PDF – the first publication of the performance and enabler analysis methods for ISD using a Facilitated Group Process, from NSPI’s (ISPI’s) Performance & Instruction Journal, November 1984.

I believe that what we wrote about waaaaaaaaaaaaaay back in 1983 is now known as Design Thinking (in ISD) and Agile (in ISD) today.

And waaaaaaaaay back in 1983 these approaches were not even new back then.

Reflection Summary

There are many ways to do Knee Replacement Surgery – just as there are many ways to do ISD… or ID… or ADDIE, etc.

Unless we focus first on the Performance and then on the User – we won’t serve them well.

Unless we focus first on the Performance (of Surgery or Instructional Systems Design) – and then on the User (Patient or learner/Performer) or – we won’t serve them well.

And if we don’t look beyond the obvious – the Topics with Face Validity as but one example – we’ll never impact Performance.

Now … it’s back to the meds for me.

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