Wave Fronts

Under the Knife Again

Warning: parts of this entry might be highly unpleasant for squeamish people.

I'm getting a hernia repaired in about a week. The surgeon has promised me a lifetime guarantee and the ability to exercise as hard as I want to without any concern about recurrence and minimal risk of chronic pain. And no more lower back pain for four days after trying to right my motorcycle without seriously hurting myself in such a way that I have to drop everything and rush straight to the hospital (but I know the "lift it behind you" trick now). But this high quality repair requires open surgery under general anesthesia and I haven't required that for a long time. I just recalled that first time and a surprising "without any anesthetic" memory that I'd left buried until this morning.

When I was five I lived in Ypsilanti Michigan. I was a very happy kid and full of self confidence. I clearly remember beating the snot out of another kid for bothering my younger brother, sitting on his stomach and having a great time pounding that mean kid's face. But all my life I've been subject to moments of "excess enthusiasm", and one day I suffered a consequence from that. I was chasing after a neighbor girl, racing through her house as we laughed and played tag. I was "it" and was running as fast as I could through their living room, but Inga was maybe 10 steps ahead of me. She shot out their front door and as I reached it a strong spring was causing the door to slam shut. I straight-armed the door to push it back open again but misjudged the acceleration that would be involved. The heel of my right hand hit the storm door with my arm in column (thus very stiff) and I was amazed to notice that I was passing right through the door. Then I was standing on the concrete slab in front of the door, noticing that the concrete was very rapidly becoming covered in red. I looked down at my right arm and there was a fountain of blood coming from where my right biceps and triceps used to be. Except they weren't where they should be. My arm didn't look right at all. I just stood there, perplexed about what was happening, but knowing that this was about as serious a situation as there ever could be.

Meanwhile there must have been a hell of a commotion. I have no memory of any sound, but guess Inga yelled for her mother, a registered nurse. I was told that Inga's mother grabbed a large bath towel on her way to rescue me and I remember that towel and the vice-like grip she used with it on my arm. I guess she saw me through the broken glass storm door and doubled back to the bathroom. I remember her picking me up like I was a doll and running. She had no car, but a neighbor was backing out of his driveway. She opened the back door and got in with me. We only lived a mile from the hospital and were there in moments.

I remember a lot of poking and a lot of sharp pains and a lot of very gentle, reassuring, smiling faces and voices looking down at me, explaining what they were doing. What they were doing was repairing my bicep and triceps muscles, and I was conscious. It didn't hurt too much, but I remember scissors cutting into me as the doctor explained that it might hurt a bit, I guess because whatever anesthetic they had used had not taken hold before they'd started the repair work. They couldn't save all the muscle, and I lost a "half my biceps and a third of my triceps", according to my mother who talked to the doctors. The rest of me was OK, with just a few lacerations of my forearm, hand, and scalp. Oh, I guess a lot of blood came from my head, as I recall a lot of stiches in my scalp.

But they also gave me a general anesthetic later to remove my tonsils. I remember the mask coming down and the obnoxious smell and weird feel of that gas in my lungs. But I trusted the doctors and wasn't afraid. For me, going under was exactly like flying into the front of a TV screen when the TV was between channels and the screen was just filled with a visual representation of thermal noise. The "wind rushing noise" of "TV static" coupled with the rapidly moving jangle of the visual noise was what I experienced, and then I remember more gentle voices talking to me as I woke up.

That "wind rushing noise" was very deeply frightening to me years later when I experimented with psychoactive drugs. I was in a car being driven along with the window down and within the noise of the wind, which was somehow amplified tremendously, were the constantly repeating words "Whooo arrrre you?", which was of course the hookah-smoking caterpiller's line in the Disney version of "Alice in Wonderland." But I didn't remember that connection or see it as an amusing line. The repeated question simply scared me to the very core of my being and made me wonder what flavor of masochist I might be to smoke something that would make me question myself so deeply, because I had no good answer to the question of who I was back then.

But back in those old days before tempered glass for storm doors I was treated to ice cream, ostensibly to celebrate the tonsillectemy they'd performed, and the next several weeks were spent with bandages and various forms of therapy that I have no memory of.

Years later at Auburn University I was forced to accept a B in physical education because to get an A you had to do N pullups and I could only do N-k. I wish I had a movie of that and I still think it had to be a funny sight, as while my left arm was still pulling me up quite nicely my right arm ran out of strength and the result was that my body was turned at an angle to the left. I hadn't worked out well enough to do left-handed pullups, so I got a B. Other than that episode my right arm has never been a handicap. It just looks funny, as were most people have a biceps bulge I have a crater.

But next week will be trivial. I hear they offer to give you a "happy shot" or something, to reduce anxiety about the general anesthetic. I think I'll decline that. I'm very curious to see how my mind presents a forced loss of consciousness this time and want to be fully alert as it happens.

Update: 2nd Op trivial, post-op a different story

After writing all this I was told to forget about experiencing gas directly, as the standard procedure now is to knock you out with IV drugs first. And that's exactly what happened and my memories run from being wheeled in my bed to the OR and wondering what that would look like to noticing one of the nurses approaching and looking at me in recovery, with absolutely nothing in between. I didn't mind this "excision" of my consciousness (I think I was mentally perserverating from the happy-drug they'd put into the IV to relax me for the general anesthesia).

But it wasn't too long before the unhappiness wore off and I became aware that I'd been "hurt" severely as a side effect of the operation. Enter the pain management nurse, who was very nice and was trying to be helpful every step of the way, but also had a finite shift and an apparently urgent hospital policy hanging over her to "get to closure fast, no matter what the outcome." That is, I felt like a trained seal being put through a performance as I was made to estimate my pain level on a 1-10 scale ("6"), then repeat that estimate after the first dose of hydrocodone was put into my IV ("no change"). Then a second dose ("no change"), then a dose of morphine ("zip: nothing"), then a second dose of morphine ("that took the edge off: down to a 4"). I think the fact that I'd finally reported some pain reduction charged the nurse up with so much enthusiasm that she just bubbled over with it as she hustled me to and from a bathroom to "prove to her I can pee" as a prerequiste to being discharged. I could pee, but I could more easily have simultaneously thrown up while losing consciousness. The pain was a clear "9", and so severe that it was as if my body was reacting on its own in ways that amused my observation powers while I was also urgently, vigilantly fixed on the idea of getting back to the bed by any means possible while not retching (and thus stretching the stiches in my muscle and other layers in my abdomen and making me flirt with the dreaded "pain level 10"). All dignity was simply ignored and I didn't mind at all that I was in a bathroom with my wife and two female nurses, demonstrating basic bodily functions and talking through every move. At one point I thought I'd be better off sitting on the toilet to rest before gathering myself up for the walk back to the bed. But that put more stress on my incision and only motivated me to hurry the hell up and get back to a state of no more stress and strain of highly ennervated tissues.

We did get me back to the bed and this is the point at which things went badly wrong. I was dopey with pain, a state that I hadn't had much experience with up to then, but realize now is possible apart from the dopiness of some drug side effects. So my "science muscles" were out to lunch at the point the pain management nurse gave me an anti-inflammatory drug by IV and we waited until maybe on hour after the very bad bathroom visit. She again asked what the pain level was and I told her a "2." But I should have lied! I was befuddled and didn't realize I needed to have said "It's a 2 now, because notice I'm lying here and not flexing anything. Let me get out of this bed, walk three steps, then come back and get back into the bed and give you a number for that. That number won't be a 2, will it?" And it would not have been a "2", but rather around the original "6." But instead of uttering the words to try to get some science into the situation I found myself listening to the nurse explaining in a very matter of fact manner that she wasn't going to get my pain lower, I was just going to have to live with it. I convinced myself I could do that and a couple hours later I was in my own bed at home.

But the bathroom trips were bad and only got worse over the next two days. Starting the morning after the op the pain as I walked to/from the toilet got to the "red hot poker in the guts" level. I'd experienced something in that range, but a bit stronger, in the 70s after a car accident. A fully size Chevy brought the passenger side of my Mazda RX-2 about 18" in the direction of my side. Luckily I drive "from the back seat" and the passenger seat was set a half foot forward and that blocked my body from kissing the metal that the Chevy was pushing in my direction. I was too focused on getting back to my first contracting job to make some bucks for BAS to listen to the EMS folks and I switched to my spare car and proceeded to a neighboring town. I was awakened out of sleep at the motel by the sensation of my broken rib ends 'tickling' each other. But the sensation I pereived was as if a fire had broken out in the room and I was breathing superheated gasses with every breath. I had to stop breathing, for the sake of making that amazing burning pain stop, but I had to breath to live. Bummmer.

But back in my bathroom this past Saturday morning I was faced with the realization that things had not gone the way they needed to on Friday and I was taking a two pound medication for a five pound pain. But surely I was healing and in just a matter of hours the healing would cross over and my pain would go down. It went up some more instead. So I drank as little as possible to minimize bathroom trips and went into "time endurance mode", waiting to feel better. By Sunday morning my wife and I had extrapolated the hydrocodone and it would run out around 2am Monday morning. So they hadn't even given me enough of this stuff to make it to the surgeon's office hourse on Monday. I was desparate at this point and called the physcian on call at the surgical PA. It was matter of factly explained that "pharmacy rules" prevented that doctor from doing a thing for me: I had to go back to the hospital. I got a little bit mad about that, and the doctor didn't contest the fact that it was going to hurt a great deal to get to the hospital in order to get more pain relief. The doctor finally suggested I take the next two hydrocodone early. The next two were due at 10am but it was only 8:30am. I was very agreeable to anything that would get me to a state of reduced pain, but unfortunately hadn't read the pharmacy details for hydrocodone that included strictly worded instructions to avoid double dosage. But with four tablets on the job I counted the bumps in the pavement between our house and the hospital. But I was sweating terribly, and feeling very uptight. This came to a head with the triage nurse in ER who just wanted me to fill out her form, not tell her what was going on with me, and I became openly hostile. It takes a lot to make me nasty, but we now know that excess hydrocodone in my system on top of uncontrolled pain can accomplish the job. The ER physician and I finally realized that the best thing for me was to be left alone in a room to "chill out." This of course let the excess hydrocodone wear off and my sweats and anxiety attack went away and I could once again put on a civil face and stop talking about what I'd like to do to the system that had not given me effective medicine the previous Friday. I got a prescription for hydromorphone and that did the trick, with one tablet taking my "walking around" pain level from "9" to "3" and two tablets taking it to "1" or even "0." That was Sunday afternoon, and by Tuesday morning I was free of the red hot poker was gone forever. The celebration was short-lived, however, as after the first substantial meal (two slabs of healthy bread with a thick dollop of humus on each) I had terrible stomach cramps. But they were familiar cramps and I just got through them well enough to go to math class and confirm that I have a lot more work to do in that course, to put it mildly. The cramps have continued, though, and I think I need to visit my general practitioner and just go over the situation to see if it's just a matter of waiting those symptoms out or if I should mask them with the hydromorphone. I'm drinking lots of liquids in the meantime, though, and hope I'll be back to normal in another day and this is just my body getting sorted out after a few days with a serious narcotic.

However I'm starting to get a very joyful feeling about the prospects for doing whatever physical exersion I want to without fear of "internal damage." A friend has a decent exercise machine and perhaps we can discuss his analysis of Job while I get my strength matched up with my endurance. But we might be better off remembering the mathematics he would have used for his chemistry instruction for the sake of my math class

Final Postscript: I'm pain free and back on the stationary bicycle, practicing yoga, and looking for strength training equipment. I'll call my friend but don't want to impose on himm and will most likely join my wife's gym membership to start "pumping iron." I'm very glad I made this improvement!

Side note: For some reason the little audio clip of "simulated TV noise" with some background piano that I could imagine might play in one's mind while in the process of going under from an anesthetic simply doesn't play properly when linked to on this blog site. It plays for maybe 2-3 seconds and then stops. This was going to be linked from the above "TV noise" picture. No big deal, but puzzling. If can make this work I'll amend the text box that shows when focus passes over the image.

Posted at 09:37PM Sep 21, 2006 by microwaves in Self Improvement  |  Comments[3]