Major Surgery: the gory details edition part one
I’m afraid that, shot up with babble-juice, I subjected some of my brave and noble visitors at the hospital to more detail than they really wanted. I wasn’t complaining, but in addition to being powerfully unpleasant, my stay at the hospital was really quite interesting in some ways. In my drug-addled state, I was geeking out on how surgery had changed since my last experience with it in 1992. So thank you, visitors; I hope you will forgive me because your presence there certainly helped me.
Geeking out on all the medical stuff
Anyway, a small subset of people have expressed actual geeky interest in the gory details, and since my mind is clearing up for increasingly long periods now (about a half-hour out of every three that I’m awake) I’ll write them here. What follows has been typed up in small installments over three days, when I am coherent enough.
Consider yourself warned, everyone else; if you would rather not know, skip this post and the one following. This is all about the squishy stuff.
I’m just middle-aged if I plan to live to a hundred and four, but it isn’t like I ever grew up in the first place. Physically I’m overweight but very active; seldom drive, bike most everywhere in all seasons, never take the elevator, etc. I do strength-training, sit in a chair without a back, lift weights at my desk. This is no virtue; I have a chronic muscle pain condition that only responds to exercise, so I do it constantly. Have always joked about my unhealthy diet; exercise covers a multitude of sins, doesn’t it?
Not necessarily. Story continues below the fold
Never get medical checkups
The day (Friday) before it happened, I was in my doctor’s office for a routine checkup. We had some concerns and he scheduled me for tests on Monday, including a CAT scan that would certainly have found the failing diverticula along with the thing it was looking for. You see what happens? Go to the doctor, next day you’re courting the grim reaper. It isn’t worth it.
That afternoon we had a graduation celebration at the college where I work. I rode my unicycle into a few people’s offices to visit, helped myself to the grille, just enjoyed the festivities. That evening, I came back to campus to ride around on my uni including a couple assaults on the steep ramp along the South side of Milner library. That is some heavy-duty exertion for a guy my size, and something didn’t feel quite right in my gut. I shrugged it off; a guy my age has no business eating bratwurst. Or at least not a bratwurst, a burger, some potato salad, some chips, an apple, a Diet Coke and a cookie.
A beautiful afternoon on my birthday
Then Saturday, my birthday, about two ‘o-clock Diane and I were riding on the Constitution Trail to visit our favorite bike shop’s open-house. The shop has new owners, a really great couple. It was a beautiful sunny day, there were kids on unicycles, people with every kind of cycling interest, free bratwurst on the grille, bag-tosses, sales, etc. Big doors wide open, lots of high-end stuff out for drooling over. Diane was looking at helmets and I was looking at a cutaway carbon mountain bike frame, marvelling at how light and rigid it was.
In the space of about ten minutes, “something not quite right in my gut” had developed into kidney-stone level pain. Left side, down low, it could be an old hernia repair that gives me trouble sometimes. Didn’t feel like a stone, though, and when I used the shop’s bathroom there was no blood in my urine. Diane confirmed for me that the pain was nowhere near my appendix.
“Ride home, get the car, and come get me,” I said. My bike won’t easily fit in her car, but the shop owner agreed to store it for me.
Denial ain’t just a river in Egypt
This is the part where it gets embarrassing. I’m having major abdominal pain, so I told Diane to take me right from the bike shop to the hospital, right? Nope; I wishfully thought it must be some kind of gas pain, or bowel spasms and that it would “pass”. I wasn’t going to spend four thousand bucks on a false alarm, no sir! Never mind that every other time I’ve had that level of pain, it turned out to be something really serious, so I asked her to take me home. (A little hint, darling; your man is only semi-rational most of the time. Torturous pain throws that right out the window and I can rationalize anything; gas pains, a survivable apocalypse, voting Republican, anything.)
In the ER
That afternoon I sweated through waves of pain, hoping for that holy bowel movement or whatever that would save me. Eventually Diane went to bed and slept soundly. About 1:30 am, a glimmer of common sense appeared in my mind and I realized I had to wake her up.
Only problem was, she wouldn’t wake up. I spoke loudly, nudged her shoulder, turned on the light. Went downstairs and posted on my blog, then came back upstairs and called in the nuclear option: I wiggled her toe. She bolted upright, gasping for breath. “What?!!”
It was graduation night: as we entered the ER a young man in a tux was being led away handcuffed by police. I wondered if it would be a good deal to cosmically trade his troubles with mine. We joked with the nurse who checked us in about frequent customer credits and maybe getting my ‘regular room’.
I told them “no blood in the urine” but for some strange reason they declined to take my word for it. Then they mounted an IV, took blood samples, and gave me a shot of liquid courage. The middle-aged male nurse, a man “built like me”, joked about hospital gown designs. No obvious reason appeared (or they were eliminating everything but the least-wanted diagnosis) and an order for a CAT scan was given.
CAT stands for Computed Axial Tomography and it’s basically a spinning x-ray machine that assembles the “slices” in a 3-dimensional image that shows a lot more than a regular x-ray. It’s the next best thing to exploratory surgery, without all the blood and dramatic music. This CAT had been internally upgraded since the last two times I’d used it. It only takes a couple minutes to do a scan.
While I was away getting scanned Diane heard someone say; “52-year-old male, time of death, 3:14 am”. She bolted to the door and listened more intently. In the distance, she heard me cough. Oh, well some other 52-year-old male then.
We waited 30 minutes while the radiologist and doctor looked at my virtual innards. The doctor came in and delivered the news: perforated colon. “We’ve called in the surgeon, Dr. W., and she’s on her way.”
I didn’t even know this Dr. W., who was on call on a Saturday night. The nurse confided: “She’s really good. I hear people speak very highly of her all the time.” That helped me calm down a bit. But when we were alone I asked Diane; check this doctor out. Wide awake? Careless? Sober?
A perforated colon isn’t a case of wait-and-see; bowel material has escaped into the abdominal cavity. Usually the victim will die quite unpleasantly unless action is taken right away. I wasn’t sure what operation was needed though. Maybe something minimally invasive, fashionably laproscopic?
Dr. W. came into the room and right away I felt better. Here it was just past three in the morning, and her hair was straight, her lipstick straight, and she had a clear-headed way about her that few people achieve at midday. In crisp, logical fashion she described the problem, range of possibilities, possible fatal and nonfatal complications, and the likely outcome. When I woke up, I’d probably have a colostomy bag for several months, then need another, smaller operation to tidy up. Yes, you can ride a bike with a colostomy bag; people do everything with them. No, she couldn’t say when I’d recover; “I haven’t even done the surgery yet.” Yes, it would be OK to attempt a bowel movement before the operation, but it wouldn’t change her procedure or the outcome.
She asked what medicines I take – everybody asked that. I must have told twenty people that I take a multivitamin, some flaxseed oil (for Omega-3) and aspirin every day. Aspirin’s the miracle drug, isn’t it?
Her voice sounded pained. “Why do you take aspirin every day?”
My neurologist told me to, after my last head injury. To prevent stroke.
Her words were measured and precise as she repeated; “Your neurologist told you to take aspirin everyday.” Apparently neurologists and thoracic surgeons do not routinely compare notes.
(I later realized where I’d seen that exact facial expression and tone of voice: in the movie Jurassic Park where the paleontologist Alan Grant turns to the geneticist and says incredulously; “You bred raptors.”)
Going into surgery, and the panic attack
I’m not a panicky kind of guy. I have literally put out fires without breaking unrelated conversations. I once looked at my mangled hand after an accident and thought; “Oh good, the adducting tendons are still attached.” I’ve had abdominal surgery before.
It was beginning to dawn on me that this would not be an easy laproscopic procedure with a quick recovery. Sign here, and here, and – do you want your parts back like Mister Goodwrench? No? Sign here. Can we let students watch the operation? Sign here. Can we put you in restraints if needed? Sign here. On and on went the consent questions; you know you’ll probably have a colostomy? Sign here. Give your watch and eyeglasses to your wife.
All this while my terror was growing. They covered me in hot blankets and wheeled me down the hall, down another hall, up an elevator, and into the surgical ward.
The table was incredibly narrow, and had towels stacked up on it to be convex so I’d be arched backwards. I was starting to breathe faster and faster. My head was way back, pinching my neck. Could I have a pillow, please, some head support? Someone lifted my head a bit. The soft rubbery oxygen mask was pressed on my face; a tight seal around my nose and mouth. I tried to inhale: no air!
I flailed, I pushed. Can’t breathe! Someone held the mask just away from my face; tears streamed down the sides of my head into my ears as I began to hyperventilate. It was the last thing I remembered.
Next installment; a hospital is no place to get better.