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You are welcome to apply any part of this article to your own personal use. Please do NOT publish any part of the article or apply any part of it to any non-personal use without the express written concent of the author.
Namaste, dear readers.
A lot has happened since my last dispatch. I'll walk you through it as I remember it, more or less.
On the days leading up to the surgery I was feeling pretty good. I was getting stronger and stronger as each minute passed. By Tuesday morning, September 7, 2004, I was able to walk 2 1/2 miles in just under one hour. I was ready, but then I had a couple of days yet before going under the knife. I had set up a chiropractic appointment with massage and a session with a Healing Touch practitioner - all to support my body in anticipation of the violation it would soon receive.
On Wednesday afternoon we got the phone call: "Surgery is scheduled for 11:15am, show up at 9:15am to prepare." An immanently civilized time... But man, oh man! Did my nerves and adrenalin step into overdrive...
We arrived at the hospital about a half hour early. No anxiety here... The early arrival included time to shave. Shave? You betcha! By this time it had been about a month since my last chemo infusion and the hairs on my upper lip were beginning to grow again. The same could be said for the top of my head but not on other parts of my body.
Unfortunately things in the surgery center had already fallen about half an hour behind schedule for reasons unknown to us, compounding my apprehension. But finally I heard that fateful cry: "Downing?"
Back into the pre-op center, off with the clothes and on with those horrible hospital gowns. Damn, it was cold in there!
Then a pre-op nurse did an evaluation, asking me all kinds of questions... When was the last time you had something to eat or drink? Did you shower last night and again this morning with the special soap we had provided? Are you allergic to any medications? If so, what kind of reactions do you have? And more...
After being turned over to another pre-op nurse who did his own evaluation (including another cut at those same questions) an Intravenous (IV) line was set up using my Hickman Catheter. Good. No needles.
After a pre-op evaluation by one of my anesthesiologists where the same questions were asked again we discussed my options for pain control following surgery, and settled on an epidural catheter. That is a tube inserted between two vertebrates in the region of my shoulder blades. With that tube, pain medication can be applied directly to the affected nerves with "amazing control and rapidity." It is especially useful for a PCA (Patient-Controlled Anesthesia), a pump with a button in the patient's hand. Pressing the button causes the pump to put in the right amount of medication, and prevents accidental overmedication by enabling the button only periodically (say, every six minutes).
Following yet another pre-op evaluation with the requisite questions, this time by my second anesthesiologist, two more lines were set up. An IV line was set up into a vein in my left wrist. The last line was set up into an artery in my right wrist. Their need was explained to me very patiently before being set up. The arterial line was interesting to watch as I spurted very, very red blood all over the surgery gown of the anesthesiologist and some distance away onto the pre-op floor.
I talked then with both anesthesiologists. I would be put to sleep by the general anesthetic, yet I requested that they consider that I am fully conscious during the surgery. I wanted them to let my body know when things were about to happen ("We're ready to make the incision, so move your blood a bit out of the way.") and to give my body positive feedback on how I was doing ("You're doing great, keep it up.") I had read that although the body is unconscious, the subconscious mind is still fully functional and can affect the outcome of the surgery. I had no direct experience with this phenomenon but did believe in it. They had no problem with the request and, as I heard later, did as requested. As far as I can tell from here, I think it worked.
At this point my timeline gets a bit fuzzy as the "la-la" juice started flowing. So from this point until I left the hospital my report is more of a set of scattered recollections more or less in the order in which they occurred.
It was after noon before I entered the surgery suite, or so I found out later. I was already asleep. By the way, as the juice flowed in, my anxiety flowed out. So by the time I was asleep I was finally fully prepared for the surgery mentally.
I heard later that the procedure went very, very well. The surgeon found only those lesions that were on the CT Scan and removed them quite easily using a vee-resection (the tissue was isolated, including clear margins, into a wedge shape with staples; the isolated tissue then cut out). There was the possibility that some number of smaller masses, too small to be caught with a CT Scan, might be found; THEY FOUND NONE! The one on the middle lobe of my right lung was of most concern; IT WAS EASILY RESECTED WITHOUT REMOVING THE ENTIRE MIDDLE LOBE. This was the best of all possible scenarios, the best we could have hoped for.
The surgeon also found a small scar on the upper left lung that was also resected (removed). Most likely this was scar tissue left over from one of my bouts with chronic bronchitis.
All resections were sent off to a pathology laboratory for a complete analysis and an official report.
I remember spending the first night in the Recovery Room following the surgery. This was not for medical reasons, but because there was no room Cardio-Thoracic ward of the hospital where they specialized in thoracic and cardiac care.
I remember waking up from the surgery in the Recovery Room with a lot of pain, mostly on the left side of my ribs. Much of the attention I got that first night was directed toward alleviating that pain. Whatever they did, it was never enough.
After being moved to the Cardio-thoracic ward more attempts were made at reducing the pain to a manageable level. By that night (Friday) I was still in unmanageable pain, even with the PCA Button pushing narcotics directly onto the affected nerves. In an attempt to get some sleep I asked for some medications that were given and drifted off to sleep. As it turned out, that was not a very good idea.
When I awoke I was in panic. I had this tube down my throat that kept me from talking or even making a soft groan. It felt like I was choking and would be asphyxiated any moment. I tried to reach the tube to remove it, but my arms and legs were tied to the bed so that I couldn't. I remember fighting and fighting and fighting... I HAD to get that tube out of my throat!
Eventually (maybe a minute or two after waking) I could hear a voice penetrating into my consciousness. The voice told me that I had stopped breathing on my own and that the tube was inserted in order do the breathing for me. They wouldn't put me back to sleep because they needed me awake to start breathing on my own. I needed to settle down and start breathing on my own. The voice recognized the extreme effort this called for because of the strength of the typical human gag reflex. It took a great effort, but I did get sufficient control to settle down.
Once I relaxed the person behind the voice left me alone. I presume I was being monitored, but still felt abandoned at that point. Periodically the gag reflex would regain the upper hand and the panic would be overwhelming. But each time I was able to regain control.
Once they were satisfied that I was again breathing on my own the nurses came in to remove the tube. Suffice to say, it was not one of the experiences in life I would care to repeat.
At one time I was visited in the ICU by one of my surgeons. It turned out that I had four drainage tubes in my chest, two for each lung. It was felt that the majority of the pain I was experiencing was due to the presence of the drainage tubes. As most of the pain was in my left side they'd pull those tubes out first. When she came back to pull the tubes it was the first time I was able to look at my exposed chest. Kind of weird looking down and seeing four tubes, each the diameter of my index finger, sticking out of my belly just below the rib cage...
Because the two tubes for each lung were joined into a single tube about a hand span away, both tubes had to come out at the same time. Surprisingly, the experience was not unpleasant... at least for the left lung. But when she returned for the right lung some time later the experience was distinctly unpleasant. The tubes were stitched in place. The stitches had to be cut before pulling the tubes with a hard flick of the wrist, and she missed one of the stitches. Ouch...
Medically the rest of the hospital stay was pretty much devoted to finding a combination of pain relieving drugs that I could take at home - which meant no PCA Button, no IV-delivered drugs, and hopefully no narcotics. The morning I was discharged was the morning we had arrived at that combination.
I also had an inordinate number of visitors. Some were my Angels from 6SE (my chemotherapy ward). Two were from my cancer patient support group. One was from my wife's support group whom I had never met before. And, of course, there were the plethora of family members plus a goodly number of in-laws and out-laws.
So where/how am I now? I'm staying in a condo ashore overlooking the marina for the time being, expecting to get back aboard Volant very soon (perhaps as fast as a day or so from now). I have some mild exercises to do with my arms to keep my shoulders from freezing up as my body recovers from the trauma of surgery. I must periodically cough to keep my lungs clear (very painful) to prevent pneumonia. I must walk every day, and extend the distance marginally every day. For the next two months I won't be able to drive a car or even sit in the front seat; nor am I allowed to lift/pull anything weighing more than about 10 pounds (4.56 kg.). Right now there are no medical plans other than to recover from the surgery. I have a follow-up appointment with the oncologist on September 22, 2004 (Wednesday, next week) to discuss my options and the surgeon on September 29, 2004 (Thursday, the following week).
Oh... the preliminary pathology results... Yes, the lesions were metastatic leiomyosarcoma as we suspected, confirming that we were engaged in an appropriate treatment protocol. Yes, all the margins were clear, giving me the very best chance at staying sarcoma-clear for the longest period. But we won't know until early next week what portion of the lesions were necrotic (dead) cells. But we will know in time for my meeting with my medical oncology team next week.
Namaste, dear readers, and fair winds.
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