A little outpatient surgery, Scarecrow?
I had my biopsy and ear tube insertion on Wednesday, September 8. The day before, I was told to arrive at outpatient surgery a little before my 7 a.m. appointment, so I took a cab and signed in at 6:40 a.m. And waited.
8 a.m. Waited.
9 a.m. Waited some more.
9:45 a.m. I asked if there’s any estimate of remaining wait time. It turned out that my ENT had had an emergency or two, but I was fourth on the list, and three had been called (if I understood this right).
At 11:10 a.m. or so (I was so overjoyed and relieved that I didn’t look at the time), I was called. I had moved closer to the desk because I was having a difficult time hearing. It didn’t help that a few other people had “Sch” names. I probably jumped up a half-dozen times, especially as time continued to pass. Because I couldn’t hear and didn’t want to miss my name, I found it difficult to concentrate on Thomas Hardy’s The Return of the Native, and I ran out of spam e-mail to read on my cell phone.
The nurse introduced herself and took me to a small room to undress. Everyone introduced him- or herself. “Hello, I’m Trina, and I’m going to take your temperature and blood pressure and give you a pregnancy test.” “Hello, I’m Dr. So-and-So, and I’m your anesthesiologist.” This was all said in the same tone you would hear a server say, “Hello, I’m Bradley. Tonight’s special is a delicate orange roughy, baked to perfection by Chef Jacques.”
The first thing I notice is a sign printed on green paper in a plastic sleeve on the wall that says something to this effect:
SURGEONS: You must mark the site of surgery on your patient. We “can not” accept patients in the operating room who have not been marked.
There was a binder on the table, so I looked at it. The top sheet had “mild systemic disease” checked. I thought to myself, “Do I have a mild systemic disease that everyone forgot to tell me about?” At 43, I saw my life falling apart. Not only do I have sensorineural hearing loss usually associated with aging, but now apparently I have a mild systemic disease. I became a bit sadder than I already was.
Then I noticed that the health coverage is “Medicare.”
Then I saw that the name is . . . a man’s.
I checked the binder to see if it’s a collection of other patients’ records, but my name was on the front, and that’s the only section in there that wasn’t mine. I wondered if I should tell anyone, and I worried that I’m going to embarrass someone if I do, or get them into trouble. I wasn’t thinking straight, because I didn’t really consider the consequences of not speaking up.
I don’t know how many different RNs I saw — at least a half dozen. The RN who’d called me brought me a larger gown (her idea) and also administered the “lactated” IV solution. First, she tried a vein in my right hand, but was muttering something about it moving (who knew that my cardiovascular system was so elusive?), although I may not have heard correctly. At that point, she jabbed a nerve. Imagine hitting your elbow squarely on a corner and that painful, radiating, vibrating pain. Now imagine someone stabbing a nerve directly . . .
I made a face but did not cry out (although tempted), and she said, “Did I hit a nerve?” “Yes,” I said hoarsely.
She moved over an inch and found a vein. Our VP of resident care, a RN and MSN, looked at it today and said she did a very good job; there’s very little swelling or bruising. The only real bruise is in my mind, the memory of the sensation of a nerve being stabbed.
A different nurse took my blood pressure (120/80) and temperature, and gave me a pregnancy test (required, apparently). The result was predictable.
At some point, a young man came in and introduced himself as the anesthesiologist. He told me that the ENT had warned him that I might have difficult air passageways (I thought, oh, sure, just because I couldn’t breathe through my nose for four months last year, give me a reputation). He asked me how I sleep (on my side, never on my back), but his real concern was whether I can breathe while lying on my back. He kept looking at my chin after having had me open wide and say “Ahhh,” saying it was on the short side, but he could work with it. “It’s not ideal,” he said, “but it could be worse.” Yes, I know; I’ve said that for years, but I mean aesthetically. He also asked me if I have any loose or damaged teeth. “No, just braces.” He said, “But no loose or damaged teeth?” I didn’t know how to explain to him that braces make all my teeth feel like they’re on the verge of falling out or breaking.
I did tell him I’d been under general anesthesia in the 1970s for an emergency appendectomy. He said, “That was a long time ago.” It occurred to me that he might not have been born yet . . .
He described in glorious detail the approaches he could take to putting me under, including a tube down the throat, and adding that if none of them worked or if I came around, anesthetizing the area would be a last resort. He had me sign a consent, which included wording about common side effects such as sore throat and nausea and then went on to mention liver damage, heart failure, and even death, I think. I pointed this out to him, and he assured me that these were highly unlikely to occur. It also mentioned the possibility of damage to the teeth. At that, I said, “Look, I really don’t care if you kill me, but for pity’s sake, do NOT damage the teeth that I paid $5,000 [slight exaggeration] for.” He looked a little taken aback and said he’d do his best. I was reminded of Jean-Luc Picard: “Not good enough, damn it; not good enough!”
Every time I was left alone for a few minutes between these astral visits, I would feel tears running down the sides of my cheeks and into my ears. “I’m not crying,” I practiced saying. “I’m tired, and my eyes are watering.”
At some point before this, I think, the ENT had come in and dutifully marked my right ear as the area we’d agreed on. (Like corporate America, even medicine has become a team effort, with physician and patient having to agree on the obvious.) As he was looking through the binder, he found the chart of the Medicare patient and said, “This isn’t you.” I played stupid and deaf (the latter part particularly well). He said, “This is someone else’s information. They’ve been looking for it. No wonder they couldn’t find it.” Then he took off with it to pass it on to its rightful owner. At that point, I realised I should have spoken up.
He then filled out some paperwork and at one point said, “Ooops!”
I had to stop myself from saying, “‘Ooops!’ is not something you want to hear from a surgeon.”
Both he and the anesthesiologist had me sign consent forms while my right hand was immobile (and sore) from the IV. I asked if I had to sign my own name (I was seriously thinking “Oprah” might work). Of course, these signatures were so shaky and irregular that no one will ever be able to read them. They could say Oprah for all anyone would know.
Throughout the entire day, every person asked me how I was getting home, and I told them either public transportation or a cab. They all found this disturbing. “But you were told to bring someone with you who could drive you home. You can’t take a bus!” I told them I didn’t have anyone handy, and besides, I would be just fine on my own. They seemed skeptical. I promised to take a cab rather than a bus.
After waiting a bit more, an orderly came to wheel me off. Everyone should be wheeled through the labrynthine, brightly lit, fluorescent hallways of a hospital in a prone position at what seems like fairly good speed. It’s a more surreal, scifi experience than any amusement ride could offer.
In the operating room, I saw Dr. ENT again. He patted my arm twice reassuringly, which made me think of my appendectomy in 1975 or 6, when my dad had smiled and squeezed my hand just as I was losing consciousness — one of my oddly happy memories, because it was one of my dad’s rare moments of open warmth.
The anesthesiologist put a mask on me and told me to breathe regularly. I did and noticed no effects whatsoever.
Then I was suddenly awake in a different room, with no more full feeling in my ear but with a painful nose and a dry mouth. I heard a beeping behind me. A plastic mask was digging into the skin under my right eye. Suddenly, a blood pressure cuff startled me by inflating around my left arm. I was in recovery, on oxygen, attached to a heart monitor and to a blood pressure cuff on a timer. Dastardly clever! How different from my appendectomy, when all I had to keep me company was the IV solution, a painful thirst, and unbearable nausea.
This time it was okay, except the small of my back hurt, and I began feeling an urgent need to urinate. I figured the cuff was on a 10-minute timer (just a guess), so after a few inflations, I asked the nurse who kept wandering by how much longer. “Just a few minutes.” I am sure that is what all jailers tell hapless prisoners. I kept bending my knees and trying to sit up to take the pressure off my lower back, but it was difficult with everything attached to my arms and chest. I also noticed how much the inside of my nose hurt, although I thought it might be partly from dehydration.
I noticed I could hear better now that the right side was no longer filled with fluid, but the improvement did not seem as great as I would have liked.
I felt something tickling my cheek. I thought it was a hair, but couldn’t figure out how to brush it aside. The nurse checked on me and said, “Oh, let me tape that.” “I almost brushed it aside,” I said. “I’m glad you didn’t because you need to leave it in for a while.” She taped a monstrous length of black thread hanging out of my nose to my cheek. I thought she said it was a catheter, but I realise now I must have misheard.
The nurse came back over, not to release me, but to throw warm blankets over my chest, the top part of which was uncovered with all its attachments. “We are Borg. You will be assimilated.” She said after a bit, “I’m just waiting for transportation.”
Transportation arrived, and I got another free-wheeling ride through innumerable hospital-coloured hallways. Finally, I arrived at a different room, where a nurse (who introduced herself, of course) and the cart with my clothes awaited me. She asked me how I felt, which was fine. “I am very thirsty, though.” “Would you like some juice?” “Yes, that would be great.” She got me apple juice. Halfway through it, I said, “Oh, and I really, really have to pee.” I then proceeded to do so in a way that would make a racehorse proud — must have been the IV, because I hadn’t eaten or drunk anything since 10 o’clock the night before, and it was now 3 p.m. The nurse was amazed at how I leapt out of the chair, which reminded me of the same reaction the nurses had had when I sat up immediately after my appendectomy. I recover quickly.
I happened to look in the mirror, curious about the black thread taped to my face, and noticed that there was a cotton ball in my ear. “Oh, they were supposed to take that out,” she said. I did, and my hearing improved even more.
She removed all the IV tape, complaining that I was so dehydrated that it was stubbornly sticking to me. I pointed out that I’d dutifully had had nothing to drink since the night before, other than the apple juice she’d just given me, and she said, “Oh, yeah.”
She gave me the ENT’s instructions, which were for no medication and for no diet or activity restrictions. She did have a bottle of eye drops but figured out they must have been for someone else. “You don’t use eye drops, do you?” “No.”
At that point, I asked hopefully, “Can I swim then?” “Ummm, no, no swimming. Ask him about that at your appointment, which you’ll need to schedule.” “Oh, it’s already taken care of.” She told me that I was to remove the thing in my nose the next morning.
I found my way to the main entrance (not easy, given all the twisting and turning halls and corner), walked over to King Drive, and took a cab home uneventfully, except for people looking at me because I had a foot and a half of black string coming out of my nose and taped to my face. An elderly woman waiting in front of The Flamingo gave me a knowing look.
So naturally I removed the tape and cut off the string so it was shorter than my nose. I figured I could use tweezers to get it when the time came.
I made organic macaroni and cheese and coffee and brought them with me for a walk and meal by the lake. I felt okay, except my nose was runny and irritated, and I was afraid to blow out the mystery object, which I mistakenly thought was small. I sounded and felt like I had a cold.
By 3 a.m., the irritation had woken me up, and I decided that it was technically morning so it was okay to remove the thing in my nose, whatever it was. I tugged. It ached. I tugged harder. It ached more. It began to occur to me that it was perhaps larger than I’d thought. I resolved to remove it, never mind the discomfort. Out it came with dull aching rip of pain. It turns out it was a piece of foam (nasal packing) about 3 inches long, a 1/2 inch wide, and maybe an 1/8 inch deep.
I went back to sleep. That morning, I got rid of more irritants up my nose. It now feels so much better, as does my ear without fluid and with equal air pressure on either side of the drum.
Now about the biopsy . . . I’ll find out on September 16.
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