"oh cool, I didn't die!"

the operation

I was informed of when, and of the fact that, I would be having surgery by e-mail. Those who know me well appreciate how apropos that was (I am a full-on computer geek, and I think people badly misunderstand and fear the HIPAA privacy laws as they relate to use of e-mail for health communication). The best possible way for me to be notified of my surgery was via my Blackberry while sitting in a waiting room to get the last pre-op hurdle cleared.

That's exactly how it happened.

I was notified that I was going to have surgery about 38 hours before I was subsequently put under anesthesia. Stunning as it was, I was ultimately grateful for the short notice. I did not enjoy myself much during this time period. I was full of doubts and I had a morbid fear of anesthesia. My surgeon had instructed me to stop eating solid food, specifically saying "no last supper mentality, please."

I quietly prepared to die. I'm a hospice nurse, death is a companion, it's not like I suddenly had some traumatic revelation, I just wanted to help those who would be left behind if I died. I got my papers in order, I spoke lovingly with the people who mattered to me whom I could contact. It probably ended up being a good thing that I didn't get in touch with everybody who matters to me because that would have been exhausting.

I treated myself as well as I could the day of surgery. I got a solid, profoundly restful, eight hours of sleep the night before (mostly because I slept so poorly during the sleep study the night before). I called a door-to-door luxury car service to take me to the hospital, I followed all of the hospital's instructions precisely, I wore comfortable clothes, I did everything I could to make the trip easy for me.

It worked. The only difficult thing about the pre-op morning was another patient, a mother-daughter pair that was a walking textbook of familial dysfunction. One or both of them had clearly been a psychiatric in-patient for some time, I could tell from the way they interacted with the hospital staff.

I moved away from them in the waiting room, but their loud, self-obsessed expressions of displeasure their experience that morning were difficult to escape. I decided it was a good opportunity to practice patience and tolerance.

I was called back to a pre-op area for undressing and getting vitals. This part of the experience was oddly reminiscent of something from Schindler's List. It's not that it was in any way abusive or disrespectful, it was more about the assembly line nature of the processing--the staff was transparently failing to see any of the patients as individuals, we were obviously just tasks to be completed. It wasn't bad, it was just odd to be treated that way. It doesn't happen to me much. I'm sure they do it that way to save money and they probably shouldn't change it for that reason because it is ultimately not important, but it was weird.

They walked me back to the recovery room, which also served as the pre-op waiting area, and put me on a recliner. One nurse came over and said "It's going to be a while, why don't you pick out a couple of magazines?" while she was holding them in front of me.

So, I read a History channel magazine about their "WW2 in HD" series, and it was oddly comforting. Here I was, undeniably fearful of not waking up from anesthesia, and I was reading about these guys landing at Omaha beach, some number of whom were also probably similarly doubtful they'd see the end of their day. I looked up and giggled about that for a nice moment.

Then, guess who was wheeled up to and put in the bed next to mine? Yes, of course, my friend from the waiting room, the mother of the mother-daughter pair. I learned she was in for biopsy of something suspicious on her ovaries, and she looked like she was dying, so my heart softened for her, plus her daughter had not accompanied her to the recovery room.

Her daughter, obviously acting in accordance with their family script, took this opportunity to go to the Emergency Room at the hospital to get her back pain treated--she has 5 herniated disks, ya know (spend much time around her and you will know so much more than that). She did not inform her mother of this decision, she just took off when they took her mom back for processing.

Nice. She's a drug addict, too.

I figured all of this out when she finally came back, after leaving her mother worried for two hours, complaining that they only gave her one Percocet. I guess she had anticipated that showing up for an emergency pain episode while her mother was getting her ovarian cancer biopsied would be worth more than a single measly Percocet. What she doesn't know, that I do, is that this is one of the oldest gambits in the book in Emergency Rooms everywhere--family members showing up in pain in the ER as a way to pass the time while someone was getting something done elsewhere at the facility.

And they were next door, going at it again, while I waited 3 hours for surgery. Yay.

The daughter actually backed into my recliner, through the curtain between us, while she was trying to explain to the Recovery Room staff why they hadn't been able to find her for an hour after she promised to be standing by for whatever Mom needed. Her mother was asking for her from the moment she was put in the bay next to me. Mostly it was a nice reminder for me that as imperfect as my family can be, it's nothing like this.

I passed the time by trying to appreciate the sights and sounds around me. A couple of the nurses were shapely and attractive, nicely fitted-out in their scrubs, and if these were going to be the last women I ever see I wanted to make sure I drank them in. I wasn't lonely or bored, I concentrated on what was happening now and stayed patient while everyone stopped by and apologized for delays.

I was happy to meet my anesthesiologist, a nice Irish fellow about my age, good-looking and personable, he approached me as a colleague. I told him I was sure I was not going to wake up from the anesthesia even though my parents have both tolerated general anesthesia well. I knew it was just a thought I was having, and if there was anything that can prove the powerlessness of thoughts, this experience was it. If I could have willed, or caused, my death by believing it was going to happen, certainly I would have done so this time. It wasn't that I was convinced that this thought was true, not at all, but it obsessively played on my consciousness.

He told me "nobody likes anesthesia," there was sort of a wistful note in his voice when he said that. I felt a little bad for him as I realized he constantly had to do something to people that nobody wanted wanted done to them. He asked me the standard questions, I gave him the standard answers. I instantly liked him.

Let me step back a minute and explain some context around all this fear of anesthesia. I am a nurse and I have had the misfortune of personally witnessing three unexpected anesthesia deaths, one during a heart valve repair, and two during caesarian sections, one emergency and one elective. All three patients were novel anesthesia patients, that is, they had never had general anesthesia before (as I), and they had some catastrophic, presumably allergic, reaction to the anesthesia agents. I watched doctors and nurses that I knew were highly skilled, with all of the resources of modernity around them, completely unable to do anything to prevent these deaths. Needless to say, that apparently made an impression one me.

Anyway, my anesthesiologist, who was exactly the time of guy I'd want to go have a couple of (or six) beers with at a nice Irish pub, was low-key, full of jokes, and apparently took to me as a person as much as I took to him. We chatted aimlessly until I went to sleep, and looking back this was as much as a comfort as anyone provided that entire day. Also, he didn't warn me when he was putting me down--a good choice, bypassing the anxiety that would have elicited. I was talking to him, looking around the OR, and the next thing I knew I was waking up after the procedure to his voice telling me "you did great!"

going to die

But, before all that, Dr. Rosen actually walked me back to the OR. He came in, drew the curtains around us, and shot a couple of pictures with his pocket digital camera. In the first one here to the left, he just asked me for a "before" picture. Those who know me can probably discern my state of mind (i.e., I am walking to my certain death) from my expression on my face. I didn't actually have an internal experience of being as distressed as it appears, but that was probably the result of my own defending myself from my feelings.

smiling on my way to die

For the second picture to the right, he asked me to smile, and I realized at that moment how I probably looked to him, and I found that (my morbid countenance, that is) pretty funny myself. Also, he said something funny, though I don't remember exactly what that was. We walked back to the OR together chatting about what was going to happen post-op. I really appreciated the opportunity to walk back there and hop up on the operating room table under my own power.

It is a laparoscopic OR, full of monitors and lights, and I was surprised by the number of people in the room. My surgical resident was there, a really nice latino gentleman with a profoundly calm and competent manner. I instantly liked him, too. My guess was he'd be holding my liver out of the way, but I was hoping Dr. Rosen would let him do something more fun than that. There were a couple of nursing students in the room. I thought I should have been told about that, but only because I wanted to welcome them and tell them how pleased I was that they were there.

I was also comforted that the OR wasn't as much of a train-wreck as the rest of the physical plant at the hospital can be. Many of you may not know that I work for the same organization that runs the hospital in which I had my procedure, I know it's weaknesses intimately. One them is spotty management of the physical plant.

But, the OR was up to snuff, at least (and it might even surpass that standard, I am not informed enough to know). I can say that throughout my in-patient stay the only sub-par service was patient transport. I sat in radiology in a wheelchair for an hour after my post-op studies while transport people sat around and drank coffee. I was without my PCA pump (patient-controlled analgesia), too. I wish these malcontented transporters would take their frustration out on the proper targets. But again, if they were that skilled, they'd be doing something else for a living (except for the kids who do this while working through school, like I did).

When I woke up, I had two unanticipated experiences right off the bat. First, I was severely nauseous and immediately wanted to throw-up. They asked me not to do that, and I tried not to for a moment, but in a moment of defiance I grabbed a surgical towel off a tray and threw up into it. It was tan-colored foamy fluid, tasteless and orderless, probably a mixture of saliva and old blood. I knew it was a bad idea to wretch, after all I had a freshly-stapled stomach I was using to propel that all up, but I had to.

I kept doing that until my stomach was empty (again the body is more wise than the doctors), and my nausea began to rapidly subside once I emptied my stomach, though it didn't go away for about 4 hours. They pushed every drug they could think of through my IV to help with the nausea, I appreciated that. Maybe that was why it went away, I don't know, but I was grateful when it was gone.

The other unanticipated thing I experienced was this odd social detachment. I could see my surgeon, the resident, the anesthesiologist all around me, with looks of concern on their faces because it was clear I was uncomfortably nauseous. Normally I would have spoken to them to offer them insight into my internal experience, but for some reason I just didn't care whether or not they understood. I answered their questions, I was fully awake and conscious, thinking normally, but for a few hours after the operation I just didn't want to initiate any social interaction with anyone. I just wanted to think and be quiet.

And it was about two hours post-op before I thought: "cool! I didn't die."

If you have an interest in seeing a picture the part of my stomach they removed, on a surgical towel, pumped up full of air, click here, though be forewarned that is a GRAPHIC IMAGE, maybe not so good for your stomach. Both my surgeon and the resident were surprised at it's size and how long it was (the ruler in the photo is six inches long). My surgeon told me he had to enlarge the hole he planned to remove it through becuase he wasn't expecting it to be that big. Let me know if you want a t-shirt with that image on it.

next - In-patient