The Old Man and the Knee

Essentail Fishing Equipment

 My initial attraction to the world of fly fishing may have been ,at least in part, stimulated by the shiny rows of polished fly bins, the beauty of fishing art pieces tastefully displayed around the fly shop, and the jewel-like intricacies of the CAD/CAM produced billet aluminum fly reels I encountered at a well known Montana store. Adding to my fascination was the physical challenge presented to me when I stepped out back with the owner, a world renown fly fisherman. He laid out a paper plate some forty feet away and repeatedly gently laid the piece of brightly colored yarn in the bull’s eye of the plate. When first he offered the rod to me, I barely escaped death by suffocation as I repeatedly wrapped the fly line around my neck. The gauntlet had now been cast, and I was not about to back down. At the time, we were vacationing in the Paradise Valley area, and I lucked into a guided trip on Depuy’s spring creek the next day. The beauty of the water and that first trout I somehow managed to catch insured that I would remain a fly fishing addict for the remainder of my days.

At $9700, the machined titanium Zane reel by Hardy may be the most expensive fly reel available.

Over the intervening years, I have tried not to be an equipment snob, at least outwardly. Hidden somewhere in my fly fishing heart lies a modicum of lust for the shiny, expensive, famous maker gear. I suppose that deep down in the reaches of my psyche, my modest upbringing has left me feeling second best at most of life’s endeavors.  Some obscure recess of my inner self seems to attempt to rationalize this desire as a method of, in some way, perhaps equalizing that perceived deficit. My subconscious rationalizes that although I may not be the best,  perhaps my equipment may cause observers to conclude that since I am using elite equipment,I must be an elite fisherman.  Most of the time, my higher powers of reasoning prevent purchases of outrageously expensive gear, but somewhere in a darker corner of my unconscious mind incapable of rational thought, I still want that $800 rod and that $1500 reel. Rarely would it be true that there is a direct relationship between equipment cost and number of fish caught. Most modern fly fishing gear, especially rods, can perform significantly better than nearly all users. I must keep reminding myself of that fact.

I have never considered my body to be another piece of fishing equipment.  I have always assumed that it will always be there, working seamlessly and dependably in the background, enabling me to put to practical use my rod, reel, fly line, and flies. And for some forty years, it did just that, barely missing a beat in fishing or any of my athletic pursuits. However, it is axiomatic that the only constant in life is change, and over the past years, my body has begun a slow steady decline in its reliability. As is true for all mechanical devices, my musculoskeletal system is wearing out. Biomechanical engineers tell us that the average person makes approximately one million step cycles per year. So, a sixty year old has made some sixty million walking cycles. For some of us, those numbers are greatly underestimated. Although an accurate number is impossible to determine, I suspect that in my own case, it would be more accurate to revise that figure upwards to perhaps ninety million. Imagine any mechanical device asked to perform that number of cycles without failure! Even our incredibly miraculous bodies will begin to fail under such demands. My suspicion is that our bodies may have been designed to last some forty years. Man’s ingenuity through the application of science has greatly extended our life expectancy. Unfortunately, the basic skeletal framework upon which our bodies are built is frequently unable to keep up.  In particular, the phenomenally constructed bearing surfaces in our joints, despite their fascinatingly complex design features, often fail over time. In the knee joints this failure, which we call arthritis, leaves us to walk on rough, sandpaper like surfaces, instead of the amazingly smooth, resilient surfaces with which we were born. In contradistinction to the many advances in medical science over the past decades, we are no closer to understanding how to reverse these changes than was the English physician William Hunter, who in 1743 noted that “From Hippocrates to the present age it is universally allowed that ulcerated cartilage is a troublesome thing and that once destroyed it is not repaired.” Unfortunately, little has changed. The best modern medicine can do for sufferers of arthritis is to replace that tissue which cannot be repaired with something man made. This technology lags several orders of magnitude behind natural tissue, but it is currently state of the art.  This admittedly crude treatment can nonetheless be miraculous for those whose quality of life has been stolen by this cruel disease.

Basic knee anatomy illustrating the bearing surfaces, or articular cartilage. This how w are able to walk without pain or friction.

The pain developed slowly at first. I noted that I could no longer run, or play racquetball, or even take long walks.  In addition to simply deleting those and similar activities from my life, I underwent a number of treatments, including multiple arthoscopic surgeries on my knees and a number of injections in both knees, as well as oral medications. But, true to Hunter’s observation, the arthritis inexorably progressed despite the temporary relief afforded by these measures. In the ultimate irony, I was an orthopedic surgeon who specialized in knee surgery with severe, debilitating arthritis in my own knees. At least I was able to fully empathize with my patients.  Eventually, I was left unable to perform my duties. The weight bearing activities of a surgeon, including prolonged standing during surgical procedures, making hospital rounds, and seeing patients in the office, became impossible. Eventually, I was forced to abandon the surgery I love so much and for which I trained half of my life. Replacement of both of my knees followed.

Of course, my fly fishing suffered as well. I found it extremely difficult to wade the bonefish flats I so cherish. My trips to these slices of paradise soon became possible only through a combination of short term steroids and pain medications. Obviously, I could not take these drugs and perform surgery, but I did use them intermittently on a short term basis as a means to allow me do some fishing. I also limited wading, instructing my guides to allow me to fish from the boat exclusively. I actually enjoy wading over white sand bottoms, visually locating my targets, and casting to them and was somewhat distressed by these restrictions. Now, no matter how fancy and trendy my equipment, I was severely limited in my fishing. As it turns out, the most critical pieces of gear I possessed were my knees.

The similarities between  a high quality fly reel and a human knee are remarkable. The opposing surfaces of a well made reel’s drag must be exquisitely smooth, and free of even the smallest irregularities that would allow them to rub and catch against one another. Such irregular movements produce a jerky action which allows a fish to easily break the tippet and escape. The bearing surfaces present in a human knee are so well designed and constructed as to make even the very finest reels appear to be two pieces of forty grit sandpaper grinding together. Scientists have determined that the coefficient of drag of the surfaces of a human knee is less than that of two flat surfaces of perfectly smooth ice skating across one another. No manmade device can even begin approach its efficiency. For most people, these marvels of biological engineering continue to provide uninterrupted service for millions upon millions of use cycles. Just how that is made possible is beyond the scope of the present discussion, but is one of nature’s most amazing feats. Why some joints wear out prematurely is not completely understood, but it does provide knee surgeons an opportunity to restore quality of life to unfortunate patients whose achy knees have limited their lifestyles. Just as an old, worn out reel whose drag surfaces are worn away and are no longer smooth must be replaced in order to continue catching fish, so did my knees.

The artificial replacement for the destroyed articular surface of the end of the thigh bone, ready to be impacted into position.

Santiago- a real fisherman with the heart of a lion!

Ernest Hemingway’s classic novel, The Old Man and the Sea, tells a tale of courage in the face of great adversity and illustrates how triumph can emerge from apparent defeat. As I recently read once more this tale set in the seas off Cuba, I became transfixed by its power. Like much of great literature, the reader is able to draw many parallels from the narrative to his or her own life circumstances. Right away, I was struck by the fact that the protagonist’s name was Santiago. As I investigated the etymology of this common Spanish name, I was surprised to learn that most scholars consider its English equivalent to be James, my own moniker. I was easily able to relate my life to that of Santiago. Like him, I was born into a less privileged family. And like Santiago, I found contentment in my circumstances.  As I later heard it expressed so succinctly, we were poor, we just didn’t know it. So very true. Santiago accepted his lot in life and seemed to go about his business without remorse or anger. He lived not for material possessions, but to catch the largest marlin in Havana’s history. Experiences, not objects, made his life worthwhile. Maybe there is a lesson in there somewhere for me. Santiago had no fancy reel or rod. In fact, his only fishing tools were his handline and hook, his body, and his boundless mental toughness. Nonetheless, he was able to somehow bring to hand a great fish of some 1500 pounds. It may be difficult to decide which better served Santiago- his dogged determination, or his wiry, heavy labor-hardened body. Clearly, his extremely primitive fishing equipment played no significant role in his victory over the massive fish.

Attitude trumps eleborate equipment!

Santiago held onto the mighty marlin for three days and nights. His line hand was cut and bleeding. The old man felt not pain, but rather a sense of betrayal by his own body, as his hand ached and cramped. He thought not that he needed better gear, but that his hand was “unworthy”. He did not want the fish to jump, lest it see how Santiago’s hand was failing him, a source of great embarrassment to the old man.  This is how a real fisherman thinks.  He pitted his “will and intelligence” against the overwhelming strength of the big fish. No $1500 reel needed. In fact, no reel at all.

Would that I could be half the man Santiago was. When my knees grew to be “unworthy” and betrayed me, I let go of the line, as it were. Rather than ignoring the pain and forcing myself to bend the knees to my will, I collapsed under the pressure, instead electing to have surgery. I doubt Santiago would have traded his cramped, bleeding hand for a Penn International no matter how severe the pain. Yet I exchanged my dilapidated old knees for new ones crafted from stainless steel and molybdenum.  Doubtless, this will renew my fishing career. But what does it say about my self discipline? Perhaps I am not worthy.

In the end, the old man lost his prize to hungry sharks. The huge marlin was some eighteen feet in length, making it larger than his modest skiff, and the biggest fish ever caught in Cuba. Now, he had no meat to sell at market in Havana, no awe inspiring trophy to show the people at the docks upon his return. He had something more important. He had the satisfaction of knowing that he had taken on the largest fish anyone had ever seen, and beaten it using his bare hands and his iron will.

I do know a few extremely skilled fly fishermen who are able to cast, at least to some extent, using only their hands only, sans a rod. I am unaware of any, however, who can walk without knees. But I am no Santiago.  I need at least a few basic tools in order to fish. My knees, as I have come to discover, are among the most basic and essential of such implements.  I can catch a lifetime of fish using the basic rods and reels I now own. With a reasonable amount of care, this equipment should serve me well for the remainder of my life. And so should my new knees.