Thrice under the Knife: A Tale of Three Operations
I have gone under the knife three times in my life. Back in 1988 or 1989, as an outpatient, I had cryosurgery on one of my eyes to prevent lattice deterioration of the sort that would likely lead to a retinal detachment like the one my father had and the one my sister very nearly had. It took about ten minutes. I was home before I knew it, and the only side effect worth mentioning was a temporary swelling of the eye and an awful itching, which passed in a couple of days.
The second time I went under the knife was back in December 2009 or 2010 – when, again as an outpatient, I had my gall bladder removed. I went in early in the morning and was home by noon. I was under general anesthesia for an hour or so, and the operation, done laproscopically by making three holes in my chest, took a half hour at most. This time, the side effects were slightly more serious. I was groggy that day. My chest was sore, and my intestinal system did not function normally for a day or two. But, three days after the operation, I proctored my own final examinations and graded the exams. It was a while before I lifted anything at all heavy. I did not drive for a week or so. But I was out and about more or less right away, walking moderate distances, reading, writing, and going about my business.
I have been fortunate. I have almost always been in good health. Until last Thursday, I had never been an inpatient in a hospital. The only periods I had ever spent in such an institution were those in which my wife gave birth to our four children. I have asthmatic bronchitis, which got in the way of my doing sports when I was young, but I had never had an “attack” that landed me in a hospital – even as an outpatient.
This last week, however, I made up for lost time. I have already described in some detail on Ricochet the tests I was put through last Thursday and Friday and the operation I was to undergo this past Monday. Some of those at the National Institutes of Health (NIH) here in Bethesda, Maryland who were involved with that process have told me that the account I gave was accurate. If you are a man of a certain age and would prefer to live on to a more advanced age, you might want to glance at it. Knowledge in these matters is sometimes power.
Here I want to describe my post-operative experience, which, I am told, closely tracks what the textbooks predict. If you are at all squeamish, I suggest that you read something less graphic. I do not intend to pull my punches. It is good to know ahead of time what major surgery is like – from the perspective of the patient. Or so I suppose.
Let me begin by saying that the surgery seems to have gone well. We will know the full story in a couple of weeks when the laboratory work is done and we know for sure whether the cancer had spread from the prostate to the associated lymph nodes and perhaps beyond, but my surgeon is pretty confident that it was confined to the prostate. The point of the operation is to catch it before it has spread and to remove it from the system. It is for this reason that Dr. Peter Pinto at NIH and his team have developed the targeted biopsy. With a transrectal MRI, they can identify the lesions on the prostate; with a targeted biopsy, they can sample the places that look likely to be cancerous. I am told that their success rate is extremely high – that what they see with the MRI nearly always turns out to be what they suspect it is. This may save patients in the future from having to have a biopsy. But more to the point it is likely to save lives. Indeed, it is likely to have saved my life. That we will know in six to eight weeks – if I am then cancer-free.
As I mentioned in my earlier post, I did the usual “bowl prep” followed by an enema – an experience necessary to my safety but unpleasant and, frankly, a humiliating reminder of human fragility and of the degree to which our minds are dependent on our bodies. At our best, our minds roam the universe and explore that which is unchanging and true. At our worst, we cannot think past our wretchedness.
They came for me at 7:30 a.m. on Monday and put me under at about 8:15 – after I had made one last visit to the toilet. What followed was a delicious sleep filled with wondrous dreams. The operation reportedly went like clockwork. By 10 a.m., I had been “positioned” for the operation – more or less upside down with my feet in the air and my head down – five to seven incisions had been made (I can identify five but I believe that there are seven), and the robot had been hooked up. By 1:30 p.m., I was back in the recovery room. It went more quickly than usual, and it went smoothly – in part, I suspect, because the problem had been identified early and because I am in good health. I have the pulse of an eighteen-year-old, a low cholesterol level (thanks, in part, to Lovostatin), am not diabetic, and am not obese. Apart from my pulmonary function, where the asthma has taken a toll, there was nothing to worry about.
Waking up was pleasant enough. When I had the gall bladder out, I had had terrible chills. This time, not. I had been warned that I might experience shoulder pain due to excess oxygen trapped in my diaphragm. I had no such problem. Within an hour or so, I was back in a hospital room on an IV, and a nurse was taking me on a walk. This I had learned from my gall bladder operation was crucial to recovery. When you take general anesthesia, many of the body’s systems shut down. They need revival, and moderate physical exercise like walking does the trick like nothing else. It was, then, as the anesthesia slowly wore off, that I noticed that I was really, really sore – much more so than when I had my gall bladder out. The number of incisions, their size, their location in the lower abdomen where one’s stomach muscles operate – these aspects of my situation produced considerable discomfort. Coughing was an agony. It was painful to sit up and painful to sit down. It was also hard to be comfortable when lying down. I had an IV; I had a J-bag to siphon blood from deep in my abdomen; on my lower legs, there were cuffs that expanded and contracted to an established rhythm designed to squeeze blood into and out of my lower extremities and to keep me from getting blood clots. I was being asked to give blood and to have my temperature, pulse, and so forth taken virtually every hour and to suck air from a spirometer ten times an hour.
The worst of it in my case was the catheter. The prostate is wrapped around the urethra at the top of the bladder. It regulates the operations of the bladder. When it is taken out, the urethra goes with it, and it must then be reconstructed by the surgeon. This is the most delicate part of the operation, and when it goes wrong the patient really suffers. I suspect but do not know that corrective surgery is sometimes necessary. Frankly, I shudder to think.
In any case, while the reconstructed urethra is healing, they run a line from the bladder through the penis to a bag outside one’s body where one’s urine – very bloody early on, less and less bloody in time – collects. It is – how shall I say it? – uncomfortable. One constantly has the sensation of the need to urinate. There is a drug that one can take – and I do take it – to prevent bladder spasms, and there is another drug, related, I am told, to Motrin, Ibuprofen, and the like, that reduces inflammation. I took that as well. I refused the narcotic pertussin, which is a pain reliever. I can tolerate low-level pain (the soreness produced by the incisions) pretty well, and I did not want it masked. If I did something wrong, I wanted my body to tell me to stop right then and there, and I dislike being drugged.
Nausea can be a problem. I vomited on Tuesday. I also began eating solid food, and I walked a half mile in the corridors of the hospital. That day I began belching like a trooper. I was bloated with air from the operation, and it had to find a way out. I became more and more aware of the bloating Tuesday night; my stomach began making loud noises that could be heard down the hall; and the pain was at times sharp. For the first time in my life I longed for flatulence.
On Wednesday, my prayers were answered, and to celebrate I walked a mile in the halls of the hospital. The IV went on Tuesday; the J-bag came off on Wednesday; and that day my body began shedding liquid. The body responds to trauma by hoarding liquid. This is no doubt a protective mechanism. When the trauma passes, it sheds the liquid. Mine shed eight liters by way of urine in twenty-four hours. On Wednesday, I also began coughing up phlegm – almost black with blood. As I mentioned, I have asthmatic bronchitis. I take Advaire and Singulaire to reduce inflammation, and I take a couple of anti-histamines to reduce allergic reactions. The latter ceased to work effectively a year or two ago. So I cough up sputum nearly every day. It is a painful experience when one has incisions like the ones I have, and it is alarming when the color of the phlegm is nearly black. But that is a consequence of having oxygen tubes down one’s throat during the operation.
On Wednesday, I was given a pass and walked about a quarter of a mile away to the Safra Lodge, an elegant hotel-like facility where I now share a room with my wife, who is reading to me novels by Eric Ambler. Hospitals are necessary evils. There sleep is nearly impossible. In the Lodge, I could finally relax. No one poked me; no one came to take my pulse. I did not have cuffs on my lower legs squeezing them at regular intervals. It was a liberation.
On Thursday, I felt considerably better, and I walked a mile and a half. Today, finally, the constipation came to an end. I still have pain – though considerably less – and the catheter is an annoyance. But everything else is more or less in order. I have begun receiving visitors, which is a great pleasure, and on Monday morning the catheter should come out – a consummation devoutly to be wished.
In the meantime, a package came today from Harry & David’s – with pears, apples, crackers, cheese, and the like. It was sent by my friends at Ricochet. To Diane Ellis, Peter Robinson, Rob Long, and the rest I am most grateful.
This has been, as you can guess, a bit of an ordeal, and I have not had a particularly bad time. In fact, my sense is that I have had it easy. Nothing went wrong, and I have progressed in the manner described in the textbooks. Apart from the catheter, I suspect that my experience is pretty much par for the course for people who have major surgery. If you have not had such an experience, count yourself lucky, and prepare yourself. Your day will no doubt come. It is, I think, helpful to be fully ready for the shock to one’s system that major surgery with extended general anesthesia involves. Understanding can nourish patience, and patience is required of patients.
Once again, though, my main impression is that of being pulled up short – of having my mind wrenched back from its distant wanderings to the body to which it is tethered and to which it in some measure belongs. When that body works well, it is a wonder beyond most wonders. When it does not work well, one learns to appreciate what one had and what one has lost – temporarily, if one is fortunate.
Think also of what soldiers wounded in combat go through and be grateful for their sacrifice. My ordeal was nothing in comparison to theirs.