Continuing in my self-absorbed mode while I recuperate, this is what happened during my last surgery. Not the last one I performed, but rather the last one that was performed on me.
Those of you who read the previous post, “My First Surgery”, will know that that surgery ended in failure. Failure to remove my kidney stones from their impacted position in my kidney. So there I was in a full and very real deja vu from signing in at the reception desk of the hospital, being escorted to the surgery center, getting dressed in the paper gown and smiling as the nurses went through their routine of information seeding and harvest all over again. This time around, the novelty had worn off, and I was approaching the whole event with more trepidation (knowing what was in store for me) and in a more analytical way since I had already lost my naivete.
As I walked into the holding area accompanied by my wife, I saw my surgeon standing in the middle of the hallway five feet away chatting with two residents (surgeons in training). He must not have seen me—the thought of his ignoring me, his patient and colleague, is just too horrid for my ego to bear. I always say hello to my patients from afar, even if it’s only a quick wave before I go into the cubicle to see them properly, explain the surgery again, tell them the instructions, draw on them and answer last minute questions—they are the reason I am there, after all. Why would I ignore them?
In contrast to my surgeon, the resident surgeon in training was polite, friendly, informative and kind.
LESSON: BE A HUMAN BEING TO YOUR PATIENTS
The anesthesia resident, a young girl, walked up while the nurse was talking to me and began to prepare to insert an IV while the blood pressure monitor was doing its thing—clearly annoying the nurse. No “Hello,” no “I am the resident,” just an introduction with a steel needle that she pushed in too far. A blood bath ensued, resulting in the sheets having to be changed. The last time, the nurse had done it, and the nurse was much better at it. The resident obviously needed the practice; I just wished it hadn’t been on me.
LESSON: INTRODUCE YOURSELF TO YOUR PATIENTS
The anesthesiologist was young, arrogant, curt and dismissive of my request for a type of breathing tube that is gentler on patient’s throats. The type I had only a few weeks ago. He gave me some rubbish about muscle relaxation being necessary. No room for discussion, just for his attitude. Some surgeries and some patients definitely do need intubation with an endotracheal tube for medical reasons. I had just had the same procedure attempted three weeks ago with a laryngeal mask tube by another anesthesiologist, and let me tell, you the difference is enormous. For three days after the second procedure I could not swallow without thinking ill of the anesthesiologist.
I moved from the stretcher to the bed, lay down, had a mask placed on my head and off I went. Unfortunately, no nice words to fall asleep to.
LESSON: LISTEN TO THE PATIENT, BE FLEXIBLE IN YOUR APPROACH AND LEAVE YOUR ATTITUDE ELSEWHERE
My wife noticed this, but I guess I have always known it. There are two types of nurses: the kind ones who hold your hand and are honey-sweet but ineffectual, and the no-nonsense, “I’m going to take care of you,” kind-but-serious types. I guess you need both, but in the operating room I was glad the no-nonsense type was taking care of me. Recovery room nurses are a different type all together and a combination of the two. Kind but with a job to do (getting you home), and efficient.
I woke up in that fog one wakes up in after a surgery; I drank the sweet apple juice, and after a while I tried to pee. No luck. Tried again, and again later, and then I was worried, because if you can’t pee you can’t go home, and I knew what the nurse would say after speaking to my doctor, and then he said it and… I went home with a Foley catheter in my bladder. A long tube up the urethra and into the bladder so the urine can come out. The most painful thing I have ever suffered. Yet the relief of having an over-stretched bladder relax is an equally extreme pleasure. That nurse was my hero!
During the early hours of recovery, your brain is in a time warp. A minute seems like an hour, and your next glance at the clock proves you right! You are chatting away with the nurse, making decisions about your healthcare, answering questions—do I want pain medication? am I thirsty? do I want to try to pee?—and you are full of rubbish. You cannot possibly be making real sense. I suppose the questions are not that life-threatening, but it’s the brain I have seen when dealing with patients who are under mental stress or have had head trauma of some sort. The ego takes over to protect the brain and the body. You are charming, verbal, manipulative, seemingly all there while being full of rubbish. It is delightful to experience it firsthand.
The way home
My darling wife suffered abuse on the way home. I constantly told her how and where to drive, got pissed off at sitting in the car while my prescriptions were filled and accused her of driving over potholes on purpose. I was in a bad mood. Those closest to you are the recipients of your worst venom just when you need them the most—I have never understood that part of our brain.
LESSON: ALWAYS GIVE PATIENTS THEIR PRESCRIPTIONS BEFORE SURGERY SO THEY CAN BE FILLED THE DAY PRIOR
LESSON: BE NICE TO CAREGIVERS
The recovery from surgery
The first night after any surgery is awful. Your family gathers around you with looks that are a mixture of pity and caring that somehow create in you only a sense of doom. Eventually they get it off their faces and make you comfy—as comfy as you can be—and a few pain meds allow you to drift into that place that is not quite sleep. The visitors late at night are anxiety and trepidation. My arm hurts—I’m having a heart attack. I can’t breath, I can’t move, I…
Narcotic pain medications, which I took for the first time in my life during these experiences, do not take the pain away! They take your brain away from the pain, leaving you warm, slightly dizzy and with a stupid grin that explains why they are the number one most abused drug in the US. I took Tylenol and Celebrex for the pain; remember, you cannot take anti-inflammatory drugs like Aspirin, Motrin or Advil because of the risk of bleeding after surgery.
For someone who takes at most one pill a day, the deluge of pills I was supposed to take was overwhelming. No wonder the elderly have such problems with our multi-pharmacopoeia-based medicine. Take two of these a day, three of those, four of the others, etc. It ends up with you taking some and forgetting others. Your brain is not equipped to keep it all straight during this phase of recovery—and an elderly brain is similar in many ways to one recovering from general anesthesia.
The day after surgery
I woke up, though I never really slept, and looked for the truck that must have run me over in the bedroom. Why does it hurt where I had no surgery? My arms, neck, shoulders and upper abdomen hurt more than my kidney or bladder tube! I am stiff all over. I know what happened this time that did not during the first surgery. In the first surgery, I had laid my arms on the boards and had them strapped down. In the second, Dr. Attitude must have stretched my arms and neck out beyond their norm after putting me to sleep. I should have known.
LESSON: PLACE YOURSELF IN A COMFY POSITION BEFORE FALLING ASLEEP UNDER ANESTHESIA
Slowly, normalcy returns. One pain is hierarchically replaced by another, one awareness of an ill by another, and with each passing you feel a little better. If you can take a shower as soon as you are allowed, it will catapult your recovery forward. The bad memories of the ordeal fade away with time, and hopefully you will be better. Still, I felt I had to write all this down so my cosmetic plastic surgery patients would know that I know how they feel.
Morad Tavallali, M.D., FACS
Cosmetic Plastic Surgeon