If, like me, you're not a boater, you probably think the Santa Cruz Harbor Patrol is only purposed with maintaining order in the harbor and helping boaters in distress in and near the harbor itself.  You may have seen Dan Coyro's picture at left of the Harbor Patrol boat towing a capsized boat after the 2011 tsunami that wreaked havoc on our small harbor.  Although I spend a huge amount of time in the ocean, I have to admit, I certainly never gave the Harbor Patrol much thought.  

But then, as I started working on my next novel, currently titled The Swimmer (you can check out the beginning in my Work in Progress section), I knew I needed to do some research on ocean rescues.  My scenario is very dramatic and I thought the chances of my swimmer being rescued were nil but I needed to describe an attempted rescue in the book.

I met briefly with one of the members of the Santa Cruz Fire Department's Marine Rescue Unit, thinking these were the people who would attempt such a rescue.  Over the years, I'd seen them doing physically demanding training exercises at night along West Cliff Drive.  

I was hoping to understand how they'd attempt a rescue of a swimmer trying to commit suicide in Monterey Bay at night, expecting lots of information about their jet skis, search patterns, rescue swimmers, etc.  And while they have all that, apparently, if we're looking at a rescue more than a couple hundred yards offshore, especially at night,  it would be the Harbor Patrol that would pursue the rescue, possibly in coordination with the Coast Guard.  I was told that the Harbor Patrol boat had all sorts of cool high tech equipment including thermal imaging, side sonar, sophisticated radar and more, and that I should contact the Harbormaster to find out how they approached ocean rescues.

I spoke with Latisha Marshall, the Harbormaster, and she gave my contact information to Blake Anderson, the assistant Harbormaster.  Blake would meet with me to explain rescue strategies and show me their rescue boat.  

I sent Blake a link to my scenario and when I arrived, he greeted me and introduced me to Latisha.  Blake was more than prepared to answer my questions.    I laid out my scenario and apologized, saying I understood that the likelihood of saving my swimmer was just about zero.  But Blake interrupted me and said he wasn't so sure.  Over the next thirty minutes he told me about some remarkable rescues.  One was led by Don Kinneman (Senior Deputy Harbormaster) and was later recounted by Santa Cruz's resident ocean science guru, Gary Griggs.  Griggs writes a not-to-be-missed biweekly column for the Santa Cruz Sentinel titled Our Ocean Backyard.  

Griggs describes ocean disasters, impacts of climate change, pollution, and much more.  You can find archives of his articles here.

In the early 70s, Griggs did a study of ocean currents in Monterey Bay.  He dropped floats containing postcards at various points along the coast and followed where they were found.  Ironically, in the summer of 1972, I found one of the floats in the rocks on the south end of Four-Mile Beach.  Grigg's current research would play a significant role the first story.

Amazing Rescues
In one of the rescues, Don Kinneman led the search for two brothers whose Hobie Cat had capsized.  Two very distressed women had entered the Harbor office just before dark.  The first was the wife of one brother and the second was the fiance of the other brother.  The brothers were supposed to have returned hours before.  Don put together a crew and  following the lead of the Coast Guard, searched southeast of the last known position (accounting for drift from the northwest winds).  But after hours of searching they were forced to return to the harbor about midnight.

Frustrated with their lack of success, Don didn't give up.  Having studied Gary Griggs' results on currents in the Monterey Bay, he pulled out charts, and plotted where the currents might have taken the brothers.  Don, and Cary Smith, another Harbor Patrol Officer, went back out and after starting a sweep search in the projected area, found one brother clinging to the side of the overturned boat 10 miles offshore.  He was hypothermic and likely near death so they raced back to shore and then returned to search for the other brother.   A mile further out, on a pitch-black night, they rescued the other brother.  If you think about the vastness of the Monterey Bay and the odds of finding a swimmer 11 miles out, this is truly miraculous - or beyond miracles, perhaps Don Kinneman is a rescue force to be reckoned with!

Gary Griggs gives us a nice footnote to the story that Blake didn't relate.  Don, and Cary were invited to the brother's wedding a few weeks later.  For his first toast, the groom raised his glass to Don and Cary without whose help, the wedding would have never happened.  

As Blake finished this story, which clearly reset my expectations about my swimmer's rescue, Laticia jumped in.  "Why don't you tell Steve about that rescue where you were awarded the Rescue Professional Hero Award?" she suggested.  

Modest Blake reluctantly agreed to tell the story.  

He was on duty one evening and heard what seemed to be static on the radio.  The operator had concluded that it was just static.  Somehow, Blake thought he heard something else.  At first it was 'mile buoy' and then 'water'.  Since no one else heard this, Blake went on instinct.  He found a crew member and they motored out to the mile buoy - just in case his hunch was right.  Not far beyond the buoy, they found an overturned Hobie Cat.  They continued their sweeping search and located the victim another quarter mile away.  Once again, this was another successful rescue in what I thought of as a near impossible situation.

The Harbor Patrol Boat

Moving back to my scenario, I asked Blake to take me through the entire process from the time a 911 call is placed.  He explained how they would be alerted and that once the Fire Department confirmed a rescue was needed, they'd contact the Coast Guard and would begin the search. Blake described the complex process of coordinating the searches (you'll find a dramatized account in my novel).  He then suggested he take me out on the boat.

Today, the Harbor Patrol Rescue Boat is a 21-year-old 28' RIB (Rigid Inflatable Boat) with twin 250 HP Yamaha outboards.  The 'cabin' is tricked out with  two displays which show charts, side-sonar imaging (looking at the bottom up to 40' down), thermal imaging, radar images, and much more.  They have a camera where they can record interactions with boats or rescues.  The boat has a top speed of almost 50 knots (nearly 58 mph), so it can get to distress situations remarkably fast.  The soft sides make it easier to come alongside other boats and to bring victims on board.

The Harbormaster staff includes 4 deputies who are 'offshore certified'.  As Latisha and Blake explained to me, this is a rigorous training and certification program where part of the final exam is done in the boat at night with blacked-out windows.  The candidate must show navigation and rescue skills using only instruments.  

I put on a PFD and Blake led us slowly out of the Harbor.  One screen showed the thermal imaging while the other used the side-sonar to show the bottom of the harbor entrance.  We headed toward the wharf, my eyes jumping back and forth between the thermal imaging and the windows.  A few hundred yards into our trip, I saw a kelp bed ahead of us, just offshore from the Boardwalk.  It looked like any other kelp bed.  But on the thermal image, I spotted 6 white balls moving around.  As we got closer, I could see that this was a family of sea otters - well hidden in the kelp, but visible through thermal imaging.  

On our way out to the mile buoy, we passed some swimming sea lions.  Again, I would never have seen them visually but the thermal imaging clearly saw their heads as they periodically rose above the water. 

Several hundred yards from the buoy, I could see the buoy on the thermal imaging screen.  I was a bit surprised, but Blake explained that the system spotted temperature differences and the buoy was warmer than the ocean.  Several large white objects were moving on the buoy - sea lions.  I realized just how powerful this imaging tool was.  And apparently, the Coast Guard boats and helicopters are similarly equipped.

On our way back to the harbor, Blake talked about other work he and the Harbor Patrol had undertaken.  Over the last few years, they've become instrumental in cliff rescues.  As most of us know, not only do people fall off cliffs into the ocean or get knocked off by unexpected waves, far too many beach walkers fail to pay attention to the tides.  Incoming tides have trapped many on virtually inaccessible cliff faces and in caves.  

While it's the Fire Department's cliff rescue and marine rescue teams that usually perform the actual rescues themselves, they need to locate the victims first.  With high cliffs or high wave conditions, this can be nearly impossible.  But once again, it's the Harbor Patrol and their thermal imaging to the rescue.  They can locate people and help guide the rescue teams to the victims.

Blake also talked about the Harbor Patrol's recent involvement with law enforcement.  I won't go into detail here, but they now do training for police departments, SWAT teams, and Federal agencies.  

As you can see, I was impressed.    Between 2015 and 2018, the Harbor Patrol saved over 217 lives.  I never suspected that the Harbor Patrol was so critical to the safety of our ocean-loving community.  And I wondered why.  Why didn't I know this?  How is it I could have underestimated their contribution?  I hope that this blog and my accounts to surfing buddies and friends will help get the Harbor Patrol more recognition.

The good news is that the Harbor Master recently received a Federal grant that will allow them to replace the aging Harbor Patrol Boat with a new $550,000 craft so that they can be even more effective.  

If you see the Harbor Patrol while surfing, boating, kayaking, stand-up paddling, or during other ocean activities, give them a wave.  And if there's an issue on the ballot that involves funding for the Harbormaster or Harbor Patrol, give it due consideration.  This team might one day save your life or the life of someone you love.
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This post is intended for those of you contemplating hip replacement or those of you who might be caring for someone who's going to have hip replacement surgery.  I'm hoping to set your expectations for the recovery.

Many of you know the story of My Miraculous Wife - the blog post I did several years ago where Karen made an amazing recovery from major hip problems to actually do the Big Sur 21-mile race.

A few years went by and we were back to our active lifestyle, dancing Salsa and Swing, hiking, surfing, stand-up paddling, kayaking - you get the idea.  

But then, Karen started having hip problems again.  Our dance sessions and hikes got shorter and finally stopped.  Walking was limited and even sitting was painful.  This time, Karen's orthopedist showed us the arthritis in her left hip.  Parts of her hip were bone-on-bone, and the best spacing was less than a millimeter where there should have been four millimeters.  A very painful cortisone shot did nothing to help.  Hip replacement surgery was the only viable option.  

A few of my surfing buddies had recently had hip replacements and were now surfing as well as they did before the surgery.  Other friends had had the procedure and raved about the results.  We were hopeful.

We discussed their surgeries and recoveries with all of the people we knew, then contacted the doctors and asked for patient referrals.  It quickly became clear that the anterior (front) approach had the best recovery times and the fewest complications.  We decided to go with Dr. Nicholas Mast of SFHips in San Francisco.  Although that would require a longer drive, from what we could see, his patients had the best recoveries.  We met with Dr. Mast and his staff and got briefed on pre-op procedures and post-op plans.  We scheduled the surgery for early April in Novato (the earliest available appointment).  

Weirdly, the one physical activity that Karen could still do was downhill skiing.  She couldn't walk well (I had to carry her skis to the slopes), but boy could she ski.  The week of skiing before the surgery helped her get stronger (she had gotten pretty weak in the preceding months), and likely aided her recovery.
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Overview of the Procedure
Your hip consists of a ball joint at the top of your femur (femoral head) that moves in the hip socket (acetabulum) which is part of your pelvis.  The socket and the femoral head are covered in cartilage which helps lubricate the joint.  

With an arthritic hip like the one in the photo at the top of this blog, the hip joint has deteriorated.  The cartilage has worn away, lubrication is gone, and bone spurs develop.  Movement becomes restricted and painful.

In the anterior approach hip replacement, a 3-4 inch incision is made in the front of the upper thigh.  The thigh muscles are pulled away from the joint and the femoral head is removed.  The hip socket is resurfaced to make it smooth and an acetabular cup is installed along with a lining.  A ridged spike-like prosthesis with a titanium ball on top is inserted into the femur.  Clamps holding muscles are removed and the muscles go back into place.  The thigh is stitched up with dissolvable sutures and a sealed bandage is applied.  

Hip replacement is one of the most successful major surgeries performed today.  Nearly all patients report getting their lives back.  

The Surgery and Time in the Hospital
We spent the night in Novato and made our way to the hospital.  Surgery was scheduled for 10:30am but pre-op began two hours earlier.  We met with Dr. Mast and with the anesthesiologist.  Dr. Mast was personable and reassuring and talked about recovery times of his patients who often were walking over a mile within a week.  He told us about one patient who went to dinner and a movie with his wife the day after surgery.  This was very encouraging!

At 10:30, they wheeled Karen into surgery.  About 11am, Dr. Mast came into the waiting room and spoke with a woman waiting for her husband who was now in recovery.  He said that her husband could go home that afternoon.  Then he turned to me and said that Karen was next. 

Just over thirty minutes later, he was back and said that everything went perfectly.  Karen would be headed to recovery and would probably be there about an hour.  He said that since she wouldn't be out of recovery before noon, she would be staying the night.  That was exactly what we expected.  

Unfortunately, Karen was in recovery two and a half hours and once in her room, she continued to have numbness in her legs, so she wouldn't be getting up to walk yet.  Apparently, people recover from anesthesia differently.  However, once the numbness subsided, Karen did walk - with a walker - but she easily (from my perspective) covered the 150 feet required for discharge.  Pain medication (we had chosen Tramadol) kept her comfortable and surprisingly, not at all loopy and it didn't upset her stomach.  

The next morning, we had a visit from the occupational therapist who showed Karen how to get on and off the toilet, get into and out of the shower, and some clever tricks for getting dressed.  A bit later, the physical therapist came by and invited Karen to walk to the physical therapy room about 500 feet away.  He and many of the nurses commented on how amazing Dr. Mast's results were.  No other surgeons compared.  The physical therapist showed Karen how to get in and out of bed and how to climb stairs using a cane.  We walked back to her room and prepared for discharge.  Basic instructions were:

- No restrictions on movements other than no lunges.
- No baths, swimming, or hot tubs for 4 weeks - showers are okay.
- For the first week, walk five minutes every hour.
- Wear TED stockings (Thrombo-Embolic-Deterrent) stockings to prevent blood clots
- Taper pain medication as appropriate. 
- Take an anti-inflammatory (Celebrex) for 30 days, and aspirin for ten days. 
- Use ice consistently to reduce pain and swelling. 
- Start physical therapy two weeks after surgery.
- Remove the bandage after 4 weeks.  
- No driving until she stops the Tramadol.
- No risky physical activities which could involve falls for 3 months. 
- Follow the instructions for exercises from the PeerWell application.   

Home Care
We made the lengthy drive home, stopping every hour so that Karen could walk for five minutes.  Once home, Karen had no problem climbing the stairs (using the cane and handrail) to the second floor of our house, home to our living room, kitchen, dining room, and bedroom.  

Karen was exhausted, so after dinner she spent the evening in bed, getting up to walk every hour.  The only significant pain she had was in and around her left knee which was hugely swollen.  With the anterior approach, no muscles are cut.  Instead, there is a 4-inch incision in the skin and the muscles and ligaments are pulled away from the hip so that the surgery can proceed.  This places major strain on the knee attachments.  

We set up a mattress in the living room in front of the television so that Karen could watch TV when bored.  

At this point, and for some time to come, I needed to be present to help Karen get into and out of the shower, get dressed, and to supply her with ice packs.  I also provided massage of her thigh, knee, and lower leg multiple times a day.  

Over the next few days, Karen did as the PeerWell application instructed with exercises and meditations.  In addition to a guided recovery, PeerWell tracked her progress and reported back to Dr. Mast's office.  Remembering Dr. Mast's words about the patients with amazingly fast recoveries, Karen increased her walks of five minutes an hour to ten minutes, then to more.  However, it seemed the swelling and pain in her knee increased.  She had expected to stop pain medication (others had done so at this point), but it wasn't possible.  

We called Abigail, one of Dr. Mast's PAs (physician assistants), and she said that for the first week, Karen should really be reclined or lying down fully, except for the five minute walks.  And, she emphasized keeping the walks to five minutes.  As we later discovered, this is what the patients with the best recoveries had done.  Dr Mast is a great surgeon, and as you'll see, Karen's recovery was remarkable, but Dr. Mast may be a bit over-enthusiastic about the pace of recovery for some patients.  ​

For the next few days, Karen remained prone most of the time, doing the five minute walks.  She could sit to eat, but needed to keep her leg elevated without too much bending at the hip.  After day 7, she began increasing her walking time, very much aware not to increase too much too fast.  

Pace of Recovery
On day 9 after surgery, I came down from my office to find Karen grinning from ear to ear.  She asked me to watch and then proceeded to walk the length of our hallway without her walker.  I was very impressed.  She still used the walker to get on and off the toilet that day, but by day 10, the walker was history. And, so was the pain medication.  Karen had begun tapering after a week (the setback from too much walking early on probably delayed that), but by day 10, she was done.  However, we still iced after walks and before bed.  

On day 11, Karen went downstairs for the first time using a cane and we went for a walk outside.  After 10 days cooped up inside, Karen was ecstatic to be out and about.  We walked to the end of the block and back several times that day.  Karen used walking sticks (we'd bought them for hiking some years before).  These are a better than a cane for walking as they allow for a more natural, even gait.

At two weeks, Karen had her first physical therapy appointment.  After testing, the focus was on range of motion.  Karen couldn't put on her TED stocking, socks, or tie her shoes by herself.  The physical therapist gave her exercises and thereafter, Karen just used Peerwell for meditations and progress tracking.   She also made a remarkable discovery - if she pulled the TED stockings over her knee, it greatly reduced knee pain and swelling - we should have done that from the beginning.  Since her surgery was on her left side and since we have a car with an automatic transmission, Karen was able to drive.  She was a bit nervous - an accident or sudden stop might be painful, but she was pleased to have more freedom of movement.

On day 15, Karen stopped using the cane going up stairs.

On day 17, she could walk downstairs with alternating steps.

On day 18, she could walk upstairs with alternating steps.  At this point, we were doing several 20 minute walks a day on flat sidewalks - adding up to over 3 miles.  Karen was cautiously increasing her distance every other day.  

At three weeks, we went for a hike in Ano Nuevo.  The total distance was almost two miles with a massage break at the halfway point.  The uneven surfaces were much more challenging and tiring than walking on flat sidewalks.   She took the next day off to recover.

At four weeks, the bandage came off and we did a wound inspection via video conference with Abigail, Dr. Mast's PA.  Everything looked great.  At this point, the Physical Therapist showed us how to start massaging the scar.  We also started doing tougher hikes with more elevation and Karen started doing short rides on a recumbent stationary bike.  

At five weeks, Karen could tie her shoes but with difficulty.  

6 Weeks and beyond
At 6 weeks, we started doing more significant hikes and Karen tried disc golf - this involves a dramatic twisting of the body with substantial pressure on the hips and a lot of walking.  We also cautiously restarted our Salsa dancing at Salsa by the Sea at the base of the Santa Cruz Wharf.  

At 9 weeks, Karen began doing daily yoga sessions (via videos)  in addition to the physical therapy exercises and  regular treadmill and stationary bike workouts.  Her flexibility increased steadily.  For all intents and purposes, Karen was back to where she was a year before the surgery - actually, better!

12 Weeks - All Clear!
After 12 weeks, Karen started biking.  We're also very confident about some more difficult hikes - falling is no longer a major risk to the prosthesis.  We're dancing regularly at full speed with dramatic moves and fast turns,  and are back to our previous active lifestyle.  Karen continues to work on getting stronger and on increasing her flexibility. 

This past week we played disc golf at Kirkwood Ski Resort.  The course is physically demanding, even if you're in great shape.  We played the entire course complete with significant climbs at altitude, scrambling over rocks and cascading creeks, and making challenging throws on one of the most difficult courses we've played.  Next week, we'll be doing more disc golf there, then cooling off by kayaking and stand-up paddling on nearby Silver Lake.  

It's great to have our old  life back again!

Lessons Learned
First, Karen believes, and I agree, that she waited too long for the surgery.  Constant struggles with pain as our active lifestyle declined could have been avoided with an earlier surgery.

Choose the best surgeon and talk to his/her patients about their experiences and recoveries.  If Karen needs another hip replacement, or if I do, we'll go to Dr. Mast again.  

Don't be in a rush to get off the pain meds.  There's no competition with other patients who may have told you they were done with meds after two days.

Last, and most important, be patient with the recovery.  Go slowly and you'll get there faster.  

I have to admit it.  Even after the testimonies of my friends, I was worried about the hip replacement for Karen.  It's a major surgery!  But with an excellent surgeon, great support staff and physical therapist, and Karen's amazing work ethic and never give up attitude, My Miraculous Wife has done it again!

If you liked this blog, please check out my novels.
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