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Wednesday, November 18, 2009

Pre-op experience (2nd surgery)

I will make a quick update on my status, then also recount a little of my pre-op, drawing some interesting contrasts between the two big downtown Grand Rapids hospitals. I have the unusual perspective of going through two similar brain surgeries on two consecutive months.

First, my status. I'm bored. There is still a lot of rehab in front of me. I underestimated (or simply forgot) how long the hours are I must confine myself to the couch. It was only a month ago I was recovering for the first time, and already I have forgotten what these long stretches are like. (It's amazing how the mind can block out things like this.) But fear not: I am doing my part staying horizontal. No scolding please!

I am entertaining myself with John Hailman's "Thomas Jefferson on Wine." Very well researched, but also accessible for the lay reader. Also in my stack is Dan Brown's "The Lost Symbol" (half-read), C. S. Lewis's "The Great Divorce" and Pierre M. du Bourguet's "The Art of the Copts," all of which I will finish in the next week in between sessions of composing "The Couch of Eros." I have plenty to do. I just need to remain in one place.

I had my first "outing" since the surgery as well. Same as with the first neurosurgery, MJ took me to a bookstore. The first time, I bought thank you cards and a Blu-ray disc of "Casino Royale." This time, I went straight to the DVD section. I bought a Blu-ray disc of "Quantum of Solace." I told MJ that despite times being tight I am allowed to purchase one James Bond DVD every time I have brain surgery. She couldn't argue with that even though the special edition of "QoS" was a whopping $39.99. I will watch it several times to help the healing of my pituitary gland.

One final status update before the hospital story: my Diabetes Insipidus is indeed real, and when I forget to take the hormone nasal spray it upsets my body's equilibrium. This morning I felt fine until I suddenly found myself going to the restroom 4 or 5 times in one hour, draining off massive amounts of liquid. This led to an intense thirst to offset the relative rise in sodium in my body, and—to MJ, she tells me—it looked "scary" how quickly I was glugging down large glasses of apple cider and ice water to quench this sudden uncontrollable thirst. An hour later (and after taking the nasal spray) I am stable again for the next 18-24 hours. But this is likely how the rest of my life will be if I don't stay on top of the hormone replacement therapy. But I'll still take this over a brain tumor. Believe me, I'm as happy as a razor clam.

Some readers may remember the story about my pre-op moments at St. Mary's hospital in downtown Grand Rapids a month ago. I was nervous about the remote possibility of an emergency craniotomy and waking up with Frankenstein stitches across my forehead. The kindness of the pre-op nurse and the pleasure-dealing anesthesiologist doling out fentanyl put all that to rest, and I experienced a joyous time, laughing it up with the nurse, MJ, and a friend. Under the influence of this serious drug, we dreamed of buying a boat and raising llamas. My first pre-op session was great. Just delightful.

This time, at the other main hospital downtown, everything was off. We arrived on time for the pre-op CT scan, but were told (incorrectly) we were in the wrong place. So we were escorted to a different part of the hospital, checked in, waited, waited, then were scolded for not being where we had originally shown up (despite our repeated explanations to the staff of this looming error). My IV was started sloppily and painfully. Early lab tests were done out of order, and I sensed some in-fighting between the different departments of the hospital. (This could also have been my imagination.)

When they wheeled me into the pre-op area, I had to use the bathroom but was told to wait. Just as I was allowed to get up and use the facilities, the anesthesiologist arrived. I told him I had been dying to go and could he wait just one minute until I got back. He was an older gentleman, unlike the young and passionate whippersnapper from the first surgery, and this second anesthesiologist did not like the idea of waiting. But he did.

As I returned, he sighed with his displeasure and rushed through a series of questions about possible allergies to medicines.

"No allergies," I said. Then—as sort of a joke—I added excitedly, "Especially not fentanyl!"

As a "good" kid all my life, I never dabbled in street drugs or even alcohol. Once, in high school, our class had one of those guest lecturers at an assembly warning us about "peer pressure" and drugs. He was speaking of parties, how they got out of hand, and how good kids like us found ourselves staring down the wrong ends of crack pipes. The lecturer opened the floor and asked us to speak freely about the pressures we felt. The first boy to speak—someone across the room whom I barely knew—said, "We could all go to the kinds of parties Ale goes to. Then there'd be no problems!" The assembly erupted in laughter. It was the first time I detected there might have been some serious lurid fun I had been missing.

Serious fun I had now earned the right to enjoy.

I had been focusing on this moment before surgery for the past week. It was to be a guilty pleasure just like my annual purchase of PĂ©rigord truffles every Christmas after the barrage of Nutcracker performances.

Hard work, stress . . . reward.

Honestly, I was looking forward to another experience with a powerful painkiller like fentanyl in a protected environment of a hospital. Anytime I found myself filled with panic leading to this second surgery (and this was often) I took solace in the private satisfaction that I'd be getting more of this great stuff, if only for a few fleeting minutes. It kept me going, and the mere thought of it kept me calm. It sounds terrible to think of anything that way, but if anyone questions me on this, give me a call after your second brain surgery is scheduled in as many months.

"Well, you're not getting fentanyl," the anesthesiologist told me flatly (and somewhat sternly) after he had waited five minutes for me to get back from the restroom.


"I'll give you—" and then he mentioned something I didn't recognize. The way he described its effect, I think he settled on something like over-the-counter Tylenol, only milder. He injected this into my IV (which was already haphazardly inserted in my right hand), so the drug burned as it entered my vein. I felt nothing, then some nurses wheeled me into surgery.

In the surgical room, the familiar bright lights flashed and the intricate equipment bleeped and whirred. An impressive array of high definition video screens showed my brain from various angles. For a moment, I was embarrassed all this was set up for little old me. I hopped across onto the operating table, not wanting to hold things up.

"Are you cold?" a nurse asked.

I was.

"Here's a blanket that will help," the nurse said, kindly.

I warmed, and my mind drifted to MJ in the waiting room. I do love her so much, and for some reason in that moment I wanted to hold her hand so deeply. I didn't care a whit about any stupid drugs. That was such a silly thing to begin with. I wanted to hold my wife's hand. I wanted her to know how much I loved her, right at that moment.

Someone put a breathing mask over my mouth. He said, "Breathe deeply into this. Don't worry. It's just oxygen."

This, I knew from the first surgery, was a lie. It was not "just oxygen." Perhaps—technically—this was true for the first ten seconds. You breath oxygen deeply, and then suddenly a lethal gas is cranked that knocks you out. I was not about to be fooled again, because I had unfinished business before I wanted to go to La-La-Land.

Maybe because I had flashed on my wife's hand like that, I flashed on one other image, from the extraordinary 1982 film "Koyaanisqatsi," directed by Godfrey Reggio with music by Philip Glass. As famous as the film is amongst fans of (musical) minimalism, I have always been most taken with the great cinematography by Ron Fricke. The choice of shots—most notably the framing—always gets to me. In particular, one brief shot stands out for me every time: a hospital bed with a patient's vulnerable hand grasping the rail. There is all this sophisticated equipment and tubing around, but there is another hand in the shot too: it rests upon the patient's hand. From one way of looking at it, things seem cold and impersonal, as if asking how a flesh-and-blood creature could survive (or would want to live) amongst all the inhuman technology. But I always see that shot as just the opposite: in our moments of deepest dependence upon technology, a hand, a simple hand holding another hand has more power than anything else.

I needed human contact before being sent off for four hours of complex neurosurgery. I needed something personal. A moment. A connection with someone. A person. The desire was overwhelming.

"Breathe into the mask," the voice urged me. "It's easy."

"Here's the fentanyl you wanted," the anesthesiologist said from the other side.

"Wait, WAIT!" I cried. "Just wait. No fentanyl. No mask. One second, PLEASE." I looked desperately around the stark white room. There had to be at least ten people in there with various jobs to do. I was looking for one person.

My type of neurosurgery is shared between a team of two surgeons. A brain surgeon removes the tumor and an otolaryngology (ear, nose and throat) surgeon makes the initial approach as well as the closing up. It just so happens the ENT is my neighbor. We're not close, but we do know one another on some personal level. I wanted to see his face before going under. I asked for him and was pointed to a corner of the room.

He was sitting in a chair, studying the screens. He had done this particular surgery over a thousand times, and in fact had pioneered much of its use in my city. He looked confident and focussed. I waved to catch his attention.

The voice above me said again, "Breathe into the mask now."

"Wait!" I said again.

This time my neighbor saw me. I waved at him. I gave him the "thumbs up" sign. I said, "Are we going to make this a good one?"

"The best," he said across the room and pointed his thumb up back at me.

It was the human connection I craved, and something inside me relaxed. I laid back on the table, closed my eyes, took a few deep breaths into the clear mask and opened my eyes a moment later in the recovery room.

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