Not Down Or Out

It could be worse. I might not be laughing.

Month: November, 2011

Stimulation Package

Recovery is all about performance and endurance and feeling the burn. We were still working on the gas situation when the staff’s shift changed. Up until that point I had experienced mostly nice nurses. There was one woman who woke everyone up at shift change (the only night I slept rather than dozed) so that she could examine us. She turned on lights and poked and prodded me like I was a piece of meat the “doneness” of which was in question. On the day after my surgery I had a nurse who had decided to offer tough love.

We walked several times that day. She picked up the pace. She lectured me about my slightly elevated triglycerides. Too much pasta, she declared. I had a theory about all the blood work being done since my admission. If a woman is admitted with a hemoglobin count of 3.7 when her count should be at 12-16 and you add 8 packs of blood, then whose blood is to blame for the high triglycerides and who takes credit for the low cholesterol? Maybe my wonderful, anonymous blood donors had something to do with my test scores.

You learn quickly not to mess with a nurse. The nurses rule. They control everything that means anything to a recovering patient. Food arrived while you were being tested? Hot food cold and cold food hot? If the nurse wants to, then she can microwave or replace something–if she wants to do so. Need some privacy for time spent in the bathroom? She can stand outside the door and tap her toes or walk away and leave you in peace and quiet. Desperate to get unhooked from blood or I.V. or medicines? You need him to free you. When you feel like you might POP, it takes a nurse to get a doctor to order a dose of simethecone. After nodding during lectures on how I needed to use a contraption to expand my lungs and coughing up some stuff I won’t describe, she got me a “scrip” for the equivalent of Gas-X. Of course she explained that it works best on the small intestines and doesn’t help gas caught in the large intestines, but I was getting frantic by that time. I’m not joking. Do you remember the old-fashioned Barbie dolls that could turn at the waist? They had an unhealed “incision” 360 degrees around their middles. My body wasn’t that limber and I was getting advice to walk, to twist side to side, and to bear down. These alternatives were all reasonable, but painful. But the medicine helped. Thank you, nurses everywhere, for listening to your patients.

Once the gas crisis had been resolved we could work on the remainder of what I will spare you by simply calling it the “Stimulation Package.” It was not fun but I was happy to be alive and grateful. Really grateful. Grateful to the doctor who diagnosed me, the director of internal medicine who accepted that I might actually pass the tests I had to pass to undergo surgery, the many kind doctors who came by during rounds and explained things to me, the dozens of caring nurses, the practical nurses who measured my every emission and devised ways to help me in and out of beds, the staff that brought meals, pricked my fingers, took my blood, tested me, cleaned my room, and just took a little time to smile and ask me how I was. There was a nurse who found me a fan when I was hot. There was a nurse who found me a snack to eat in the middle of the night on my first night when I arrived after dinner. There was a practical nurse who taught me how to get in and out of my bed unassisted even though he was there to watch. I am overwhelmed with gratefulness for my surgical team.

I was the beneficiary of countless prayers from family, friends, and friends of friends. That was medicine I needed and appreciated in the dark hours of the middle of the night when I could not close my eyes.

I did not do much crying. I think my reaction to diagnosis and treatment was normal for me. I listened and understood, but I was not so much afraid as challenged. I can handle anything, I said to myself. I have my faith, my family, and my friends. As my personal trainer from a few years ago told me, I have a freakishly strong upper body. You can defy people’s expectations. You can surpass your own. But it is so much easier when the people who surround you are so wonderful.

One of my surgeons came by to examine my incision. The morphine drip was no longer necessary. I was moved back to the floor on which I stayed the last two nights before surgery. I had somehow accumulated two bags of “belongings” that I had to carry as I was wheeled to the ninth floor. I had no money, no glasses, and came with few belongings, but I had acquired two wash basins and kidney-shaped dishes, and a few dozen bags of pads I no longer needed once I was no longer hemorrhaging. I had a toothbrush and toothpaste, a brush, a magazine, my cell phone, and my clothes. I didn’t have much, but it seemed like I had packed for an even longer stay. I heard that I should be going home the next day.

My family had overcome the shock of the previous day’s very long and tense wait. Back to normal, they let me know what they thought of my having told the surgeon to talk to me about the outcome of my surgery before talking to my family. My family has earned the right to lecture me. My mom gathered her chicks for battle against my cancer. My sister dropped her cares and rushed to be there. My brother somehow got the time off to fly up and remind us “why we had the boy.” My Aunt Joan worried. My sister-in-law Lisa and my aunt’s friend Bernie offered to give blood for me. My cousin Susie, who must have felt the weight of having seen her brother through his own battle with cancer, called and listened to every detail, even those she had to draw out of me with skills a journalist would envy. I am, as my mom reminded me, an altogether too secretive person.

My life is now not entirely my own. I owe bits and pieces of it to the many people who have gotten me through this–I’ll think another day about my lack of medical insurance and how much of my future the hospital and doctors “own.” Let me just share one more thank you. Barb, you were an anchor and I know that you were going through a rough time on your own as your mom struggled with grave medical issues and your family struggled with their roles in caring for your mom. I cannot imagine more generosity in my darkest moments. I am grateful for your friendship. In the prayers I said for my own recovery I thanked God for you.

Thar She Blows!

I woke in the OR’s Recovery Room to the staccato order to “wake up!” I had been moved to a hospital gurney and was wrapped in a blanket. The back had been raised so that I very nearly sat up. To say that I was groggy was an understatement. I was overwhelmed by the return of my senses. Every word spoken by the surgical nurse was an assault on my ear drums. I was numb over most of my body, but my bottom lip was raw from where a breathing tube had crushed it against my teeth while I was unconscious. The nurse asked me how I was doing. I know I nodded, but I wanted to go back to sleep. I stared at her and had the distinct impression that she was about to say, “Use your words.” I was not a toddler, but I felt like one.

“I’m fine.” I said, although it was way too soon to come to that conclusion. My joints were stiff and yet my arms and legs felt as loose as jelly at the same time. It reminded me of Harry Potter’s broken arm after it had been “mended” by an inexpert sorcerer. The story of my life had paused for my surgery in a manner entirely different from a night’s sleep. A gap had appeared. My worst fears had not been realized. But I was not the same person either. I was slower. Deliberate. Lost. Fuzzy. “Fixed.”

The area surrounding my incision was numb, but more so even than when I was a young person and had too much to drink. In those times, my lips could be open with drool pouring out and I would not know it. The numbness was what I imagine I might have felt had I lost a limb. I knew where the top of my body had been sewn back to the top part, but I could not have found it.  I thought fleetingly of a sobriety test. If someone had said, “Put your finger on your incision.” I would have fared no better than if someone spun me around, handed me a stick, and told me to break a pinata.

I vaguely recall the surgeon telling me his findings. There had been a tumor the size of a four-month pregnancy in the uterus and another in the right fallopian tube. But it did not appear that the cancer had spread to other organs in the abdomen. He thought they had removed all of it. I might not need any further treatment. We would wait for the pathology report. I nodded, but this had no meaning for me yet. I was somewhere between insensibility and closing my mouth while breathing. It was not my finest hour.

No rest for the weary. An orderly wheeled me to a room on yet another floor. We sailed down the hallways between the Recovery Room and my room. Every jolt of the tires over a threshold rattled me. I knew who I was and where I was, but I thought of my Grandpa K, who, after months of hospitalization, asked us to remind him why he went to the hospital in the first place.

Post-surgical treatment is much harder than what precedes it. When we reached my new room the nurses asked me to get off the gurney and walk over to my bed. It was not painful, but it was difficult. I had no idea how much stress my incision could bear. I guarded my stomach with a pillow that I clutched with one hand that sported new needles and tubes. My other hand and arm still felt useless because of needles that had been left for future use. Each step was feeble and rewarded with the nurses’ words of encouragement. Climbing into bed proved to be more than I could manage. I sat in a chair so that I could feel the floor beneath my feet.

My family came to see me. My mom, sister, and brother were there. My mom seemed focused on how long the day had been. They had risen early, driven downtown, waited a long time due to the delay caused by my having started to bleed and the length of time I was in recovery. My mom seemed inordinately upset about the fact that they had to pay for parking. People who live in the suburbs are not used to paying for parking. My sister and brother laughed about “why we had the boy (my brother).” Apparently “we” needed the boy to drive on expressways and city streets and to parallel park. Not that he had to parallel park. They circled back to the fact that there was a charge for parking.

What followed was a long night focused on one goal and only one goal: passing gas!

I did get into that hospital bed. It was an obstacle course. The bed and its rails had to be lowered. I had to climb up at the place the mattress folded. Someone had to help me swing my legs up onto the mattress. Plastic sleeves were applied to my legs. They massaged my legs to prevent blood clots. I had a morphine drip that I could activate a certain number of times per hour. Another tube ran from my catheter to a bag attached at the side of my bed. There was a TV remote and a call button. I had a cell phone and a hospital phone. I had a big cup of ice chips. It wasn’t as demanding as my desk at home, but it felt like command central. Lying in a bed had become a production.

I had a roommate. Like me, she was uninsured. The hospital was in a hurry to get her out. While I tried to drift back to sleep, she called her daughter trying to get her to come pick her up. She asked the nurses for extra medical supplies so she would not have to buy them. She ended up being discharged at about 10 p.m. in a taxi. I kept thinking about that saying about guests smelling like fish after a few days. I worried that I, too, might be kicked to the curb as soon as I was able to leave.

A couple of hours after others were settling down for the night the nurse had me up and walking. It was not all that painful. But I felt shorter in the front than in the back. Standing straight took effort. I feared that I could rip open at my new “seam.” I shuffled from my bed to the bathroom and back several times with a nurse or orderly watching my every move, measuring whatever fluid leaked from me. I sat in my chair until I was tempted to nod off. However, as each hour passed, it felt like my stomach expanded. There was pressure building. I felt like a tire rather than a balloon. It was going to take quite a bit of gas before I popped, but the tension was unrelenting. I would have begged for relief if I thought it might be forthcoming. Every nurse who passed through my room that Friday night and Saturday morning urged me to walk, then marveled at my “loco”motion.

I would have given a fortune for a dose of Gas-X. When I called my mom she told me to ask the nurse to insert a tube to help the gas come out. Yikes! Of course, when she was a child it was common to tell a sick person, “Come over here and I’ll give you something to cry about.” I got up and walked around the hallway while my nurse dragged my morphine drip. Things were not yet so painful that I wanted any more invasive procedures.

The Cutting Room Table

My doctor chose to have a surgical oncologist perform my hysterectomy. The surgeon taught a pair of female surgeons. The three of them came for rounds several days before my surgery. At the time, I continued to receive transfusions of blood. My hemoglobin at admission was 3.7. A normal reading would be 12-16. The reading had to rise to 10 before my surgery. While blood dripped into veins so parched that they collapsed when tapped, my blood pressure cuff operated every fifteen minutes. My blood pressure had been sky high ever since the diagnosis. I kept insisting that my blood pressure was normal when I was not facing cancer and major surgery. No one believed me.

In anticipation of a CT scan scheduled for that afternoon, I was instructed to drink two glasses of icy cold contrast medium. The milky white fluid was tasteless but filled with iodine–a substance some find irritating. I had consumed one Big Gulp-sized dose and had a second at the ready when the surgeon approached, held out his hand, and identified himself.

The surgeon took my hand and gave it a firm shake. I reciprocated, forgetting for the moment that I was tethered to a blood pack. An entire cup of contrast medium and ice chips splashed down my torso and pooled in my lap.  My teeth chattered helplessly from the chill.

The surgeon did not acknowledge my discomfort. He asked me to climb into my bed and let him examine my stomach. The young doctors reached for paper towels. I lifted the wet hospital gown and let the remaining liquid run onto the floor. While the surgeon watched, I backed up to the bed and hitched my behind up onto it. I managed to lie on my back even though needles lodged into veins at my wrist prevented me from leaning on my right fist or grasping the bed’s railing as I reclined. I dragged the wet gown up to my waist to bare my stomach for his examination. I was cold, sticky, and miserable.

“We’ll perform an abdominal procedure rather than a laparoscopic one,” he announced. I knew this might slow my recovery. “We’ll enter at the bikini line.” Never having worn a bikini, I was not comforted by his choice of entry points. This would be a painful incision that would leave a long scar. I had never undergone major surgery before. I was still whole.

I shut my eyes and tried to imagine myself someplace else. Cold liquid dripped over my stomach and down onto the bed.

One of the young doctors helped me to sit up and rang for the nurse. I stepped down from the bed and into a puddle of the splattered medium. The surgeon looked down at the mess and addressed me formally, “I am . . . sorry that I . . . that you spilled that drink on yourself.”

I closed my eyes again, then opened them, and smiled broadly. “I was just excited at the prospect of meeting you.”

The surgeon frowned.

The two female doctors lowered their heads to conceal broad smiles.

The hospital moved me to another floor and room after my CT scan. A technician arrived before I had settled into my new space. It was time for my echocardiogram. There was something oddly gratifying about watching my heart pulse on a black and white screen. The technician’s fascination with the organ was evident. He searched and searched for a defect and appeared to find none. Yet another test was passed.

Cholesterol – normal. Thyroid – normal. Blood pressure – normal. Chest x-ray – normal. Abdominal and chest CT – normal. Electrocardiogram – normal. Diabetes – no. Hemoglobin – still an issue, but rising. That left cancer. No big deal, right?

I underwent surgery on Friday, October 7, 2011. Thursday was a long night. I made a list of my blessings and the many “angels” in my life. In particular, I was grateful for my friend Barb. She had been to visit me every day since I was admitted to the hospital. I had seen a priest and accepted the last rites. I had informed my family that I had a Do Not Resuscitate order in place in the event that my heart stopped during surgery. I was certain that there was an afterlife, but afraid that if I were to die my mother would never get over it. She had already buried my father and her parents. Her sister had recurrent breast cancer. I was grateful that my sister and brother had flown in to support our mom during my hospitalization.

The emptying of my intestines prior to surgery began after lunch and continued throughout the night. I felt certain I watched my life pass before my eyes with every flush. The fact that the nursing staff would not allow me to walk to the bathroom without assistance meant that someone observed every painful moment. In the hour before surgery I started to bleed yet again. Bright red blood spread across the sheets of my hospital bed like evidence at a crime scene.

An orderly wheeled me to the OR. I was frightened, but there was no alternative to surgery. This was cancer. It was unpredictable. It was dangerous. At that moment it held the surgeon’s knife at my throat. I had to go on with the operation or (I imagined) face what could be a painful death. I was tired of the uncontrolled hemorrhaging that I had been experiencing, particularly the hemorrhaging that had brought me to a doctor’s office earlier in the week. I had to undergo the surgery.

The OR staging area was lit with natural light. My three surgeons, dressed in pristine scrubs, sat in a row with their smart phones out. In the corner, a group of young orthopedic surgeons boasted about procedures they had recently seen. They were somewhat cocky, somewhat vulgar. I was glad to have the classier team waiting for me to be prepped for surgery.

The anesthesiologist came from an Eastern European country. She was dissatisfied with everything about me. “Do you have sleep apnea?” she asked. I shook my head. “Because if you do, then your heart could stop when the surgeon lowers your head and raises your lower limbs.”

She studied my arms which were bruised and swollen from transfusions, I.V.s, blood tests, and constant squeezing from a blood pressure cuff. “You are a hard stick,” she accused. “We will have to keep your arm straight out to one side during surgery,” she complained.

She found a place to lodge a port for her medications. I could feel the invasion to the base of my teeth. She tipped my head below my shoulders, asked me to open my mouth, and studied my throat for signs of a blocked airway. Yet another test passed. It appeared that my only “complaints” were slightly elevated blood pressure, slightly elevated triglycerides, and uterine cancer.

A surgical nurse asked me to tell her my name and my birthdate. She checked each of the products that had been ordered for me: antibiotics, anesthesia, blood, and painkillers.

Moments later I was moved to the OR. Surgeons and anesthesiologists gathered around me. The attending anesthesiologist introduced himself. I could not recall a time in my life when doctors had ever been so polite while maintaining so much emotional distance. I had not shaken so many hands in twenty or more years of practicing law. We all knew each others’ names, but very little else about each other. Yet I trusted them with my life. I have never had to trust anyone as much as I had to trust them.

The attending anesthesiologist started the medicine flowing. My eyes closed instantly and I entered into my first sound sleep since having been admitted to the hospital. It was nothing like falling asleep. There was no counting back from 100. There was a moment of clarity and then dreamless darkness.

I’m Proceeding without a Map or Destination

On October 4, 2011, my doctor informed me that I had uterine cancer. He wore a long, white linen coat over green scrubs–very stylish. The coat had a turned up collar that Ming the Merciless of Flash Gordon fame might have worn. His hair was perfectly tousled. I wanted to hear him say that I was going to be okay, but people in my profession have given people in his profession cause for choosing their words carefully. He spoke cautiously about the significance of this diagnosis. I needed to undergo a hysterectomy. The type of cancer I had generally grew slowly. In its early stages it could be overcome with surgery alone. The doctor was patient and articulate, but the word “cancer” drowned out every word that followed. I imagined this was Michael Kors on Project Runway. He did not care for my backless hospital gown accessorized by a bag of saline and another of blood, each tethering me to a rumpled hospital bed in which I had found no escape through sleep. Any moment Heidi Klum would walk in and say, “Auf wiedersehen.”

Years of legal training helped me focus. The thunder that pounded inside my head abated. My heartbeat settled back into a more sober patter. I answered honestly that I had no questions. In fact, I had one question: How will I break this news to my 74-year-old mom?

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