It’s done

Finally had surgery for the thing.  Here’s a recap of the last few days.

Day before (1/11):

8:30 – last solid food.  Though it was slightly tempting to have a celebratory Twinkie, I opted for steel cut oats and bananas.  Going without food the rest of the day was a lot easier than I thought it would be as I was permitted “clear liquids” like black tea, Gatorade and all the tap water I wanted.

17:00 – consumption of the evil liquid.  Since the doctor wasn’t insisting on squeaky clean (as would be needed for a colonoscopy), I just had to consume a single 10-ounce bottle of magnesium citrate.   Iced, it wasn’t as bad as I’d heard (though, mind you, I wasn’t sucking down a gallon).  I waited.  And waited.  Read the wikipedia page, waited some more for something to happen, then finally went to bed.

23:45 – The magnesium citrate daiquiri begins the final act in its magical journey through my digestive system.  Oh, my.

Day of (1/12):

6:00 – arrive at the hospital for check-in.  Surgery was scheduled for 7:20, estimated to take 1:43.  If I’ve learned anything from business travel, it’s that the more precise an estimate, the less accurate it is.  This applied here.  My spouse was given a pager that would go off whenever my status was updated, allowing her to check the leaderboard showing my progress.  For surgery performed on kids, they’ll give a halftime update to the nervous parents.   For old farts, they cover the basics.  The patient is fine with the doctor not diverting his attention. 

6:30 – I was led back to a pre-surgery prep room and given a series of questions that I’d been asked at least a half dozen times.  They had me put on The Gown and don compression hose on my legs for prevention of deep vein thrombosis.  Though they repeatedly warn people not to bring valuables or electronics, they checked twice more, just in case I brought something.  My street clothes were put into a vinyl hang-up bag for post-surgery.

6:45 – Two IV taps were installed.  The guy doing these was amazingly good at his job – no pain or blood drips.  I’d later find out that the staff adored him for his sensei-skill.  The anesthesiologist came by for a pre-op interview, confirming answers to the questions I’ve been asked and very patiently answering all of mine.  I was pretty impressed with their thoroughness in identifying potential complications.

The induction phase starts with a shot of Propofol, also referred to as “milk of amnesia” or “forgive and forget medicine.”  The latter is especially good for people like me who are squeamish at intubation (necessary because the general anesthesia causes one’s autonomic nervous system to go trippy) and catheters (because pee happens).   I don’t remember anything after this.

10:40 – I woke up in the post-op room.  For me, this was very meta dream within a dream.  I knew I was groggy and disoriented, yet was patiently awaiting my “reboot.”   Soon, I was feeling coherent enough to start taking in the surroundings.  The intubation (now out) left me with a sore throat and a very, very dry mouth.  I clumsily groped around to determine whether it had converted to the more invasive “open” – there were four blobs of gauze – it was laparoscopic.   Attached to me were an oxygen sensor (tip of index finger), blood pressure cuff (right arm), supplemental oxygen (the thing in my nose), catheter, IV, and a pneumatic device that pulsated my lower legs.  Every half hour, the blood pressure cuff kicked on, ensuring that I’d remain awake.

The nurse showed me the button for the patient-controlled analgesia device.  I love the concept: each press of the button administers a small morphine drip into my lactated ringers IV, dulling pain.   To prevent obvious abuse, the device locks itself out for eight minutes between shots.   The bag is also limited to fifty shots.  The nurses check the meter to determine how rapidly you’re consuming it.  So yes, there is no way you’ll overdose.  Despite this, I was still irrationally  terrified at the prospect of being addicted.  I avoided pushing the button, until later, when I knew I was about to have some serious pain.

12:30 – The room they had planned for me hadn’t freed up yet.  I was not in a condition to care much, but … family members aren’t allowed to visit in post-op.  A phone call was arranged, and my spouse, bless her heart, managed to sneak in my iPhone.  The Internet Gods were smiling as the phone found a free wireless access point with three bars.  I was now able to text and play Disgruntled Avians, Lethargic Post-Op Edition!

… mostly.  Operating a touch screen device with an oxygen sensor on a fingertip is pretty hard.   Since it appeared I wasn’t getting out for a while, my spouse went home to attend to the kids.

During next few hours, patients were shuttled in and out of post-op.  It was hard not to listen in and realize how fortunate that I am.  For example, the 74 year-old woman put next to me has some Serious Shit going on involving a radioactive implant to deal with her lung cancer.  In addition to having post-surgery delirium, she was also hard of hearing.  When the staff needed to administer an aeration treatment (because she was oxygen deficient), they’d have to shout instructions.  Nothing improves coherence more than volume.

16:00 – I was finally assigned a room!  They transferred me to the new bed using something akin to a human spatula … just as my family arrived.  Thinking that the kids really could do without being traumatized by seeing my immobile, pale posterior wafting in the air, I suggested they “give us a few minutes.”

The previous nurse was ending shift at 6pm, so I don’t recall her stopping in at all.  Erin, who started her shift at around 6pm, took some time to introduce herself and her tech, Bryan.  She was very personable and a great communicator, but she won bonus points for bringing me a glass of ice water.

Since I had expressed an interest in walking around later in the evening, she brought me this device:

Its purpose is to encourage slow, deep breathing.  Done right, it encourages one to expel any accumulated fluid in the lungs, reducing the risk of contracting pneumonia.  On my third whiff, I hacked up an unexpected phlegmball.  Even hugging the pillow, coughing seriously hurt as it stressed every muscle in my abdomen, especially the ones with incisions.   I made nice to the PCA for three shots in a row… and then fell asleep.

20:00 – With encouragement from Erin and logistical help from Bryan, I was able to get out of bed and stand.  I coughed up another, smaller phlegmball.  It hurt, but I was elated to be vertical.  Then, buuuuuuuuuuurp.   Massive man burps are a side effect of the gas used to inflate my abdomen.

21:30 – After a few more shots of the PCA (and ensuing nap), I summoned poor Bryan again to help me up and out.  Getting up required disconnecting the two pneumatic tubes powering the apparatus on my calves, hoisting the bag o’rine onto the IV stand, and gingerly standing by in case I make a sudden exchange of potential for kinetic energy.   Once I cleared of the door, he let me wobble down the entire length of the hallway.  Being up let out a torrent of burp storms as my body expelled more CO2 gas used in the laparoscopic surgery.  It’s the small things that bring huge relief.

Day one (1/13)

03:00 – With help from my Pandora One feed, I managed to filter out the hallway noise and sleep in 40-minute bursts between room visits.  By 3am, I was pretty uncomfortable lying in bed and decided it’d be best if I try walking around again.  Bryan showed no irritation at being asked, again, to help me get going.  The chatter of the IV cart’s wheels dispels an otherwise quiet evening on the floor.  I mustered five laps — about a third of a mile — before calling it done.

05:55 – I am summoned from the middle of a great dream (involving my spouse, warm climate, and body paint) by a phlebotomist who’s come in for a blood sample.  So begins the entry of random people doing maintenance on things: the biohazard needle tub is purged, laundry emptied, TV remote waxed, and so on.  I abandon hoped of getting any more sleep.

Erin comes in, cheerful that I’ve used far less of the PCA than expected, and was walking around.  After listening to my abdomen, she suggests that my digestive system is waking up and that I might be ready to consume actual food-like stuff when the cafeteria opens at 7am.  In the interim, she brings me the Best Jello Ever.

07:00 – During the shift change, Erin introduces Kevin, the nurse who’ll be taking over.   I know the information is in The Computer, but hearing them discuss my condition in front of me pleases me.  She wishes me good luck as Kevin sticks around to make his assessment.  I like him immediately because he asks good questions and clearly has the Organizational-fu to get things done.  He sees no reason that I can’t go home today if I’m up to it.  Before leaving, I’m upgraded from “clear fluids” to “full liquid diet.”  This confers privilege of cream of rice and vanilla pudding.

During the next several hours, a lot happened:

• Bolstered by potentially getting out, I did ten laps around the floor – 2/3 of a mile.  This was harder because of all the carts jutting out into the hallway.  Still, I did it and I overdid it.  This was the last I used the PCA during my visit.  Nappy time!
• My surgeon high-fived me on the way in.  Surgery went quicker than expected.  What they found was a ganglioneuroma (versus adrenal adenoma – these are apparently indistinguishable with imaging and much rarer).  Since it was inseparable from the adrenal gland, they removed the entire thing.  There was some adhesion to the kidney.   The staff pathologist they consulted thought it was probably benign.  (Otherwise, they would have removed the kidney (!), too.)  The full pathology will take a week.  [1/23 update: benign.  Because it was a rather rare thing, four pathologists looked at it.]  Given my progress, he said it was my choice if I wanted to stay another night or go home today.  He offered to write a prescription for watching the NFL playoffs.  I accepted.
• The catheter was removed by the tech.  As part of the final tests, they needed to ensure that my bladder was “properly voiding itself.”  What the tech didn’t tell me is my room was soon going to become Grand Central Station as a new patient was being moved in.  Urination anxiety + post-operative coordination with a small container/IV/drooping gown + the cacophony of a new patient requiring a translator made this the toughest ordeal of the visit.  I had to finally seek out the cavernous, handicap-accessible toilet in the hallway.  I’m pretty sure I didn’t expel as much as the tech wanted me to, but she was getting pretty tired of me.
• Discharged at 3pm!  Kevin did a fantastic job of ensuring I had what I needed to go home and that I understood the instructions and contact points if things stopped progressing well.

Sleeping Friday night was a little rough, but I was soooooo glad to be in my own bed.  And: nurses rock.