Saturday, September 5, 2009


I woke up this morning in my own bed for the first time since Wednesday morning, and now I can start to chronicle the last few days. I'll do it in fragments both because it's easier in my current state to write short bursts than sustained narrative, and because my memory of the last few days is choppy and inconsistent. But I'll start at the beginning.

Day 1 -- Wednesday

The alarm went off at 4:30, but I'd already been up an hour. Everything was done and up to date but still it was a harried chunk of time until the car arrived. I had a little coffee first (I view the no food or beverages dictum as more of a suggestion than a rule), and then we were off to Lenox Hill.

Things went smoothly and efficiently, with no real waiting. Once I was changed and situated in my corner of the pre-op ward, the parade began. Lots of nurses asking lots of questions. Lots of forms to be filled out. Lots of repetition. The visits had a reassuring humdrum quality to them, at least until round 2 started.

Round 2 included visits from the anesthesiologist (a very good person to know), a neurobiologist (that was unexpected, more to come about him) and finally the ortho. The ortho was reassuring and said a couple of things that made me feel better. First, he said that this is the least aggressive of the spinal surgeries he does, and that a simple laminectomy (or as I later heard it called "a one-level lami" )with a small cyst removal was straightforward. He also said that my thinness was a distinct advantage and would make the surgery easier for both him and me. The anesthesiologiest had a dry sense of humor, which I always appreciate.

It was the neurobiologist though who struck me, both in the simple fact of his presence and involvement and then because of his personality. He was short and squat and bearded, and a little too chipper and hyper for that hour of the morning (the other guys had a better approach; neither sepulchral nor solemn, just a little quieter and more in tune with the occasion.) He chattered on about how he always works with this doc, and how the insurance would work. Those two facts could not have been less interesting to me at the moment. What was more interesting was his role: he'd be monitoring my brain, spinal cord and nerve function throughout the surgery, and that made perfect sense to me.

Shortly after the last visit it was time to go. I was wheeled out of there in a wheelchair, and Nick came along as far as they let him, then we said goodbye and the nurse and I went on to the OR.

I was awake a long time in the OR before they put me out, long enough to take in the room (I like to look at labeled cabinets and drawers and shelves see what they keep. I didn't recognize most of the stuff, until I saw a box marked "drill bits." I stopped reading labels after that. The other thing I saw that struck me was a radio labeled "Ortho Spine Radio." It took me a minute; my first thought was that spine surgeons had their own radion station and I wondered what kind of stuff they broadcast, music to drill by, tutorials - yes, of course that's not what the label meant.)

There were so many people in there; the anesthesiologist, dr. brainwave, the PA, nurses everywhere and finally the ortho. Huge room with tons of equipment and staff. I made a lame joke asking if all this attention was for me, and that they needn't bother. The brainwave guy was prancing around putting electrodes all over me, and humming and whistling. I liked the anesthesiologist better; he chatted quietly with me and made a few wry comments. The ortho told me again that this would be straightforward and all would be fine. He'd go in, clear the lamina from the spinal canal, excise the small cyst, close up and be done.

From there it fades to black. I awoke many hours later in the recovery room. The surgery had taken longer than expected; closer to two hours than one, and I was out for hours after. The first face I saw when I woke up was Nick -- nothing in the world beats that. He'd obviously gotten the report on the surgery before me, and he brought me up to date. I heard what he said as though I were in an echo chamber. I had a hard time processing and remembering what he was saying.

The best laid plans, and all that. Apparently the ortho was shocked when he opened me up, because he found things that neither the MRIs nor xrays showed (so much for the great value of imaging studies.)

The tiny cyst turned out to be enormous (in his words he keep taking it out and it kept coming and coming.) There was a badly herniated disk. And strangest of all (at least to me) there was a bone fragment; apparently a piece of bone from my spinal column had broken off and was just kind of floating in there. He told Nick that he couldn't imagine how much pain I must have been in, and that he was astonished at what he found. The nerves apparently were also very much affected; whenever he went anywhere near the nerve the lines on the monitor were off the charts (ok that's not a technical description but it's the best I can do) and he used steroids just to calm the nerves.

So a much different surgery than planned, certainly a more involved and complex one.

I got the private room I requested, which was a blessing. Nick was there from the moment I was brought in until he left late that night Matt came by, which was great. I have no memory of what we talked about except that he said the TV in his hospital room last fall was way better than mind, and he was right. I'd told him that if he wanted to see me he should wait til Thursday; I'd either be home -- that was the plan -- or still in there but less out of it one day post. He chose to ignore my direction (for a change) and that was perfectly fine with me.)

I was hooked up to IVs, and they gave me morphine by injection every few hours. I did little but sleep.

And pee. This became a bit of a cause celebre. I was full of fluids from the IV drip, and was given one of two choices when I had to go: a bedpan, or an accompanied trip to the bathroom with a nurse. I took option 2 at first. But after Nick left and the night wore on I had to go every 10 or 15 minutes. So I decided that there was a third way. I was not going to bother the nurses every few minutes -- they had enough to do. And a bedpan was out of the question. So I just started taking myself there, using the IV set up as a walker. It wasn't too hard, but all the nurses and docs were shocked the next morning that I did this, and was able too. If nothing else, I am as stubborn as all get out.

My bathroom prowess -- combined with my unexpectedly complex surgery -- made me a bit of a celebrity patient on the floor. (It didn't hurt that many of the patients on the floor were difficult and nasty. I could actually hear some of them barking at the nurses and techs, and one woman who came by to draw blood was a little shaken at how she'd just been screamed at by a patient across the hall.) Yes, it's miserable to be in a hospital and it's difficult to recover from surgery but to take it out on the staff is unthinkable. I found the nurses and in fact the entire staff to be breathtakingly helpful, supportive and present.

Nick stayed as late as he could, and then went to get something to eat before going to his hotel (the Carlyle, hoo hah.) The night was endless. The pain was unimaginable and even the morphine didn't help. It kept me awake all night (though that was abetted by both the bathroom visits and the nurses checking up on me.) I found that I couldn't watch TV, or listen to music, or even read a magazine. TV and music hurt my ears. For some reason the one thing I could do was read "In Fed We Trust" in small bursts. If I remember I'll send the author an email to thank him.

By the morning I was a crying wreck. I think it was the combination of pain, frustration, narcotics and anesthesia, but whatever the reason I was a leaky sobbing mess when the day shift started and my new nurse introduced herself. Her name is Mercy, and she's a tough, tiny thing who speaks with both compassion and authority. She explained how pain management works, that I needed to build up and maintain a constant level of pain relief.

She asked if this was my first major surgery. I started to mention the arthoscopic things I'd had (shoulder, hip) and the endoscopic (sinus) but she waved all of that away with a whisk of her hand. That whisk reminded me of the passage from Brave New World:

"He waved his hand; and it was as though, with an invisible feather wisk, he had brushed away a little dust, and the dust was Harappa, was Ur of the Chaldees; some spider-webs, and they were Thebes and Babylon and Cnossos and Mycenae. Whisk. Whisk — and where was Odysseus, where was Job, where were Jupiter and Gotama and Jesus? Whisk — and those specks of antique dirt called Athens and Rome, Jerusalem and the Middle Kingdom — all were gone. Whisk — the place where Italy had been was empty. Whisk, the cathedrals; whisk, whisk, King Lear and the Thoughts of Pascal. Whisk, Passion; whisk, Requiem; whisk, Symphony; whisk..."

Ok, so it's not exactly the same, but that's what her gesture called to mind. She brushed everything else aside and said that this wasn't like the others; this was major surgery. And what I didn't know yet was that my crying was a marker, a marker that showed that the pain wasn't well controlled enough for me to be sent home, and that I was likely facing a longer stay.

I'm going to take a rest now and let the painkillers and muscle relaxants kick in. Will come back later with more tales from the Adventures of Wendy.

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