I’ll be away from the interwebs for a while. I’m having surgery later today. My surgeon – THE surgeon – will use his skills to work to restore my quality of life. Once his work is done, the rest will be up to me and how my body responds to the surgical pain or any nerve damage the mysterious growth in my pelvis may have caused.
I’m strangely calm about everything. I think it’s because I know I’m in good hands all around. I have an experienced surgeon leading the operation. He has chosen the other doctors on the team because he has worked with them on many cases and he trusts them. My aftercare is well planned, with every aspect of what could go wrong thought out and contingencies defined. More than anything, my friends and family continue to support me and they will be with me as I go through this.
My hope is that when I come back to writing, it will be with positive news. I hope the mysterious growth will no longer be a mystery and I hope that my pain – if not eliminated – will be significantly reduced. I’ll see you all on the other side of the mist.
Exactly two years ago tomorrow, on a beautiful summer afternoon, I suddenly felt intense pain in my lower abdomen. It was such incredible pain; I could barely breathe. My body shook uncontrollably. I could not stand up straight and ended up on my bed in the fetal position.
I was fortunate not to be alone. I had plans with a friend who had arrived at my place about thirty minutes before the worst of the pain set in. I was fortunate because my friend didn’t panic. He called our local telemedicine service to speak to a nurse. After working through a checklist of questions, she transferred him to 911 because I was showing signs of going into shock. He elevated my legs as instructed while we waited for the ambulance to arrive, and kept talking to me to keep me alert.
Firefighters arrived ahead of the paramedics. They went through the same checklist the nurse had. Then they tried to talk me through getting my breathing under control; it was shallow because breathing deeply hurt. When the paramedics showed up, they had a minor struggle trying to get the stretcher through my front door. The firefighters pushed furniture out of the way but they still couldn’t get it into my bedroom, which was fine with me because it was already crowed enough with three firefighters, two paramedics and my friend all standing around.
The paramedics examined me while I lay on my bed. They took my vital signs. I had a mild fever, but after going through their checklist – which meant confirming I wasn’t pregnant for the third time in about twenty minutes – they partially carried me to the stretcher. Just having my feet touch the floor caused more pain to shoot through my abdomen. I wanted to pass out, but the paramedics kept talking to me to keep me conscious. I wish they hadn’t. Being rolled to the ambulance on the stretcher was agony and the bumpy drive to the hospital was even worse.
It didn’t take long for me to go through triage in the emergency room. Lower abdominal pain on the scale I was experiencing gets you seen by a doctor quickly. I struggled to get undressed and into the hospital gown. The nurse caring for me immediately suggested that I might need a strong painkiller to help me. I refused. The doctor came to see me and tried to convince me that a dose of Oxycodone would help reduce the pain so she could examine me. I still refused. I told the doctor that I wanted to have a clear head so I could clearly communicate with her. She relented but gave me an intravenous anti-inflammatory medication to take the edge off my pain so she could touch my abdomen. However, when she started the examination I almost wished I had accepted the Oxycodone because the pain was excruciating – picture cartoons where cats are so scared they jump up to the ceiling and hang on for dear life.
The doctor sent me for a series of ultrasounds (full abdominal and trans-vaginal) after her brief examination so she could rule out appendicitis, a burst ovarian cyst, or ovarian torsion – which just means a twisted ovary – as the causes for my pain. When the ultrasound results came back, she was surprised, which made me nervous. She said the imaging revealed something unexpected that she hadn’t even thought of. According to the ultrasound results, I had a tubo-ovarian abscess that measured 9cm x 3cm. If you’d ever met me, you wouldn’t believe there was enough space for anything but my vital organs in my lower abdomen; or that I wouldn’t have felt something that size before. I guess the upside was she didn’t tell me I was pregnant because that would have been truly unexpected.
Unfortunately, that doctor’s diagnosis was wrong and it would be the basis for me to receive the wrong medical treatments and incorrect level of pain management for almost a year.
I feel as if my life is in hyperdrive since I got my surgery date. Yesterday while I was having lunch with a friend I hadn’t seen in eons, our conversation was interrupted by a call from my surgeon’s office telling me that my pre-admission appointment was scheduled for today at 11:00 AM. I know my surgery is just a few weeks away, but everything is moving so quickly I can barely catch my breath.
This morning I went into the Pre-Admission Department at the hospital at 10:45 AM and I didn’t leave until just before 3:00 PM. Seven different people handled my chart. The first was a dry, nondescript, administrative clerk who completed my intake making sure all of my information was current and correct, that I have an emergency contact, and confirming that I understand the reason I need surgery. I found that funny in an “I better know by now why I need surgery or I’m in big trouble” kind of way. She had me sign all the necessary consent forms then directed me to the waiting room from which I was eventually collected by a lovely, bubbly nurse named Jean.
The entire time I was with Jean was light and filled with laughter. She went over some of the same information the clerk had covered then realized that some necessary people in the pre-admission process had not been contacted to come speak to me. She disappeared from the exam room for about ten minutes and walked back in triumphant that she had been able to contact Jo and Joan who were both available to come speak to me about vital post-surgery information. Jean’s responsibility was to record all my medications, confirm any allergies, and cover everything I have to do the day before and the morning of surgery. On the day before surgery, I have to fast all day except for the clear fluids I must drink because I have to do a bowel preparation similar to what you do before a colonoscopy. I did it last year for a colonoscopy and it made me feel awful, so I’m not looking forward to doing it again. I also have to shower with a special antiseptic soap the night before and the morning of the surgery. I had to buy both the soap, which comes with special instructions for the order to wash your body parts, and the bowel preparation solution from the hospital pharmacy on my way home.
The next person I saw was Jo, the Ileostomy Nurse. It is her job to find the best spot on a person’s abdomen for the placement of a stoma. What she actually has to do is draw a mark on your abdomen using a kind of permanent ink pen. Unfortunately, the timing of my surgery falls outside of what she considers an ideal window of time for a mark to still be visible enough for my surgeon to see if I end up needing to have a stoma. I will have to call her the week before my surgery and go into the hospital so she can draw on me – I’m lucky the trip to my hospital is not a long one. Jo will also recommend – if I need one – which of the available types of stomas she believes will work best for my body type and she will teach me how to care for it. As lovely as she was to me, my hope is that the mark she makes on my abdomen will not have to be used.
Then I met with Joan. Joan’s job was to prepare me for what to expect after surgery. When will they make me sit up for the first time? When will I have to get out of bed and walk for the first time and for what distance? How will my deep breathing allow them to gauge my pain level? When will I be allowed to drink something? When I will have my first solid foods – which may not fall within the realm of what’s considered normal because my surgeon has very strict rules for his patients after bowel surgery. She also explained the proven science behind these benchmarks and a few things I had never heard of before. For instance, after surgery, chewing a stick of sugarless gum triggers a reaction in the digestive system that helps you pass gas, which is a sign that your bowels are working. So I have to take a pack of sugarless gum with me to the hospital that I will chew three times a day to get my digestive system working more quickly and easily. This will be interesting because I never chew gum, but I suppose I can make an exception this one time.
Joan was followed by a lab technician whose name I can’t remember, but who had a cheerfully coloured manicure. She had a pleasant demeanor and was sensitive to my need to have her use the butterfly needle usually reserved for children because my veins don’t behave as they should during blood collection, and the children’s needles minimize the pain and bruising. She took five vials of blood for a variety of tests, and although she told me what they were for, the only thing that stands out in my mind is a pregnancy test – HA! The lab technician with the cheerfully coloured manicure also did my ECG, which was finished in less time than it took her to place all the ECG pads and electrodes on my body. I hope the test showed that my heart is still in the fight.
My Anesthetic Clinic consultation was the last act of the day. An Anesthesiology resident came in to see me just as my friend J and I each finished inhaling our lunches of coffee shop sandwiches and warm donut holes. He had a form with mandatory sections that needed information. I had to jump back to two years ago when the ordeal that is my illness started at another hospital, talk about the reason for each of my current medications, detail past surgeries and invasive procedures, and tell him what I already know about the proposed pain management plan so he knew where to start. He started with the night before surgery, which will not go as most do with me fasting because I will be completing my bowel preparation. Then he talked about the general anesthetics I will receive and the epidural option, which I assured him I do not consider an option. Upon hearing that, he launched into the list of benefits and side effects associated with epidurals where the benefits far outweigh the risks for me. He then instructed me to take my current medications on the morning of the surgery. He ended by telling me about the Acute Pain Service. How they will monitor me daily and how transitioning me from the epidural to oral pain medications will depend on how well I am coping with pain. He then left the room to check my blood test results and confer with the lead anesthesiologist.
When the Anesthesiology resident returned, he had the lead anesthesiologist in tow. They had some bad news for me. My hemoglobin levels are low, even though I’m taking an iron supplement. The level is low enough that it could pose a problem for surgery. I will receive a call from the Blood Conservation Team next week to come up with a solution to raise my levels in time for surgery so they won’t have to consider transfusing me. In the meantime, they instructed me to eat as much red meat as possible, which is going to be hard because I hate beef and I eat a mainly vegetarian diet but I’ve come too far to let a little bit of meat stand in the way of recovering my health. Is anyone having a barbeque this weekend?
David Bowie – Space Oddity (Ground Control to Major Tom)
My Small Surrenders 