Friday, October 21, 2016

Post-Op Follies (What a bargain! Two Tumoriffic updates in just twenty-four hours!)

I sit now in a hospital room at F'in' Famous Cancer Hospital, recovering from the day's procedure. Shortly after I posted this morning, K, my parents, and I stepped out into the pouring rain to go to the hospital. (We left B behind to try and workout technical issues loading the just-released Civilization 6 onto his computer--definitely a better use of the time, in my opinion.)

The traffic downtown on Lexington Ave. was horrendous, and we got to F'in' Famous a bit late. We hopped into an elevator and checked in on the 6th floor. The preop nurses were extremely pleasant. 

The IV placement was, for me, the worst part of the whole day. The IV tech was quite good, but it took her two tries. I don't like needles to begin with, and I still have memories of the metal IV needles they had when I had cancer as a kid. You had to be really careful to avoid infiltrating them.* (Shudder!)

I was a little taken aback when I learned that due to my mild hearing impairment (I wear hearing aids) and my mild visual impairment (I wear glasses), I am technically considered at high risk for falls. (This seems a bit odd, since, yesterday morning, I was hiking around a hilly park with my dog, Ginny.) In any case, a high risk patient like me is not supposed to venture even to the bathroom without someone escorting them to make sure they don't fall. The patient gets a pair of New-Jersey-yellow tread socks instead of the standard gray ones they had already given me. That way, they can spot me if I wander out into the hallway alone and give me a shot of haloperidol so I behave.

Anyhoo, it was a very long wait to get to the OR. I would complain, but some poor soul was probably on the operating table way longer than expected due to some awful complication. Still, I was getting hallucinations from my acute caffeine withdrawal. (Slight exaggeration.) 

The anesthesiologist came by. I don't remember his name, but I think it was "Dr. Snooze." He explained how he was going to get an itty bitty little breathing tube through my practically unopenable mouth** so he wouldn't have to cut a hole in my neck for ventilation during surgery. I was quite grateful. I've had one before, and they're no fun after the novelty wears off.

Dr. Nariz came by, chatted, and met my family. He has a degree in public health, so is really my kind of doctor. He was followed by various others--house staff, OR techs, and OR nurses. It was like being on a receiving line at a wedding.

Unlike last time, they didn't dope me up in the preop area, so I got to be awake for the trip to the OR. As they wheeled the bed through the doors towards the OR, I waved to my family and made driving motions. Once in the OR, I got to see the 'skull clamp' (I did not make that up!), which looks quite medieval. Finally, the big moment came, and, wham bam, they injected me with midazolam. I told everyone that I enjoyed meeting them, and then, I was out. 

The team promptly put my head in the skull clamp. Despite the gruesome name, this is not some Torquemada toy, but a device to keep the head absolutely stable. For endoscopic surgery through the nose, they use the equivalent of a GPS device to see where they are. It's like a Google Maps for behind my face. You really don't want them to take a wrong turn.

It was a quick procedure. I think any barriers to the relevant area had been removed by the Clivus Dudes in August. (Maybe I should demand a discount!) It was probably no longer than a vanilla colonoscopy (or a chocolate one, I suppose). Dr. Nariz and Dr. Skully scraped out a little tomskull, and they were done. I was wheeled to the recover room.

Apparently, at some point after I woke, Dr. Nariz came by and asked how I was. He tells my family that I replied, "I feel like a million dollars--all green and wrinkly." (I stole that line from a comedian a long time ago.) I was still under the influence, so I don't remember. 

Gradually, I undrowsified. Once I proved I could drink apple juice without yorking it, K was allowed to let me finish the rest of her precious, precious coffee. Something clicked back into place in my brain. It took a while for a bed to open up, but one did, and the staff took me to the 7th floor.

It's pretty nice here. I don't have my own room, but my roommate is quiet, and, earlier, his rabbi was singing something in Hebrew, which was soothing. There are none of the announcements and beeps one hears at most hospitals.***

I easily persuaded my smart nurse that this fall precaution stuff was ridiculous in my case. All I had to do was show her I could walk around the unit and do the limbo, and the restrictions were lifted. Her successor and both of the nurses' assistants I have had so far have been very pleasant and professional, and a delightful NP came by. I posted the poem I wrote last night on my room's bulletin board, and several of them saw and enjoyed it. (See below ****)

The nutrition service finally brought me my first, and only meal of the day, an excellent dinner. (They do hospital food right at F'in' Famous!)

And, here I am, finishing this update from my hospital bed. I anticipate a relatively fast recovery. Unlike last time, they did not use propofol to sedate me. (Incidentally, Michael Jackson's doctor inadvertently killed him by giving him propofol as a sleeping medicine!) Propofol (a.k.a. 'milk of amnesia' for it's effect and its milky appearance) gets absorbed into the fat and then slowly leaks out over the next week or so. It takes a while to feel alright. Midazolam, which they gave to me today, is what many doctors give for colonoscopies. Half of it is gone in two-and-a-half hours. Much nicer!

Once I am out, there will be nothing to do but to wait for a while. In 1-2 weeks, they should have enough information to calculate the proliferation index. (See this morning's post for an explanation.) Then, they'll know whether any of the tissue they got is cancer. 

If they find cancer, they will send it off for testing to determine a treatment strategy. If they don't, it will be a great relief, but it won't be the end of the story. Unfortunately, the place that is the space behind my face will always be suspect. From now on, I will get more frequent MRIs, and, maybe, more frequent pruning of suspicious Chernobyl fruit back there. Years of fun ahead, but, if a misguided surgeon, using incomplete pathology, ever tells me I have terminal cancer, I'll try not to have a cow.

I expect this post will be the last one, or, at least, the last long one, until I get more news.

Be well,


* When an IV infiltrates or is infiltrated, the needle/IV catheter breaks through the wall of the vein, and the IV fluid leaks into the surrounding tissues. Usually, it's not a horrible problem, but it gives me nightmares.

** My chronic lockjaw (trismus) is yet another gift of my radiation therapy. Towards the end of my treatment, my jaw froze almost shut. I can eat solid food if I don't take big bites. It also brings me closer to some of my WASP ancestors who doubtlessly never spoke without their jaws clamped shut. (I actually had a teacher who talked that way.)

*** I'm going to take some credit for this one. When I was here in regular unit (not an ICU) in 2005, the medical director was an old friend and colleague of my dad's. At that point, not only was there plenty of beeping, nurses were called by broadcasts sent to speakers at the end of every patient's bed. A good night's sleep was impossible. My father's friend dropped in to visit, and I showed him this. He was appalled and set out to fix it.

The Night Before Surg'ry

'Twas the night before surg'ry,
And all through the ward,
The interns went crazy,
While the residents snored.

The pee bags were hung
By the bedsides with care,
While commodes were full-up,
Befouling the air.

The patients were nestled
All snug in their beds,
While Haldol and and Ativan
Calmed sundowning heads.

I finally thought I had time for a crap,
A water, a Snickers, a 10 minute nap,
When in my front pocket arose such a clatter,
I pulled out my beeper to see what's the matter.

Down to the station, I ran like a flash,
To see with dismay that my patient had crashed.
Roll in the code cart, get an EKG strip!
Get out the paddles! A dopamine drip!

So we shocked my old patient,
Three jolts, one, two, three.
The old fellow, he sat up,
And smiled right at me,

With a wink of his eye,
He leapt to his sleigh,
Signed a handful of papers,
And left AMA!

And I heard him exclaim,
Ere he drove out of sight,
Merry Christmas to all,

And to all, a good night!

['AMA,' in this case, is doctorese for 'Against Medical Advice.'] 

From my long walk with Ginny, yesterday. I am not a fall risk even though this is a fall picture!

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