Post-Op – Part One

The day before any travel plays out much the same for me, driven by multi-column lists. Things to buy, things to pack, media to load, devices to charge, email to send and colleagues to prepare for my absence. If it is air travel, there is the added dynamic of an off-typical mandatory wake up time that takes my body into some kind of high-alert mode that prevents anything but the shallowest of sleep.

And so it was on January 5 as I prepared for my 5-7 day trip, a mere 20 minutes away to Foothills Medical Center. I had been told to expect a 7:30 a.m. arrival time, so when the promised confirmation call requested I check in at 5:15 a.m., I couldn’t help but think of many airport-opening flights I’d taken to places I didn’t want to go to do things I didn’t want to do. My impending cancer surgery was on par with a logistics meeting in Michigan.

My parents came to town to assist me through the process. We made great time and found plenty of parking, as one can do at 5 a.m. I felt naked leaving home without keys, wallet, glasses, laptop or phone, but soon enough they had me literally so… swimming in a “gown” that I knew would be tossed aside the second I wasn’t able to object.

The nurse who settled me in expressed her pleasure that some of the 7:30 surgery patients had been called in early so that they could stagger our processing. Um, 7:30? I had been summoned two hours early to accommodate paperwork. Lost sleep so that I might sit in a row of beds and stew for hours about what my body was about to endure. They allowed only one visitor to this point, so my father knowingly distracted my tension with points of interest about the assassination of Abraham Lincoln. I attempted to align this with Lincoln’s role in The Hateful Eight, a historical drama I had seen just a few days prior.

After visits from my oncologist (who marked my cancer-filled hand with a Sharpie), plastic surgeon, reconstruction surgeon, and anesthesiologist, I was walked in to the operating room. It seemed massive to my eyes, maybe 1000 square feet fully adorned in stainless steal. In the center was a metal-slab bed, illuminated with a rock-show of spotlights. If this were a spaceship, it would definitely be the probing room. At least a dozen people were working feverishly, and a few were introduced to me for reasons I couldn’t understand — like having the restaurant patrons chat with their steak-providing cow before dinner in Restaurant at the End of the Universe.

The minutes staring at the sun-like bright light above me (undoubtedly designed to facilitate near-death experiences) seemed endless as I listened to buzz and chatter, a mix of the mundane and medically relevant. But that was a mere instant compared to the eternity the oxygen mask was held forcefully over my face while I was to remain calm. It took everything I had to not wrestle it away and…

I woke. My eyes darted right. My arm was there. My hand was there, though I could not see it through straps and dressing. My mind sent the instruction to strum. 1, 2, 3, 4, 5 fingers… at least phantom ones. Tears of relief. I wanted water.

I woke. “Mr. Ens, can you slide over to that bed?” I saw a bed to the right and understood what was being asked. I attempted to put my weight on my right arm. “He can’t slide over!” another voice scolded. “It’s ok,” I assured the bodiless voices, “I can do this.” I slid over.

I woke. Pain. Holy %#$@ &#@%@ %#@%. What is this pain? “Mr. Ens, we have you on morphine. On a scale of 1 to 10, what number is your pain?” I started to say ten, but then the voice of comedian Brian Regan played in my otherwise empty consciousness. “I had heard that the worst pain a human can endure is getting the femur cracked in half. I don’t know if that’s true, but if it is, they have exclusive rights to ten.” Nine, I corrected. “Then I thought no… childbirth. Can’t compete with that.” Eight, I settled.

I woke. My parents were there. They explained that they had been called half-way through my surgery with the news that they were confident that all of the cancer had been cut out of my armpit site and hand site. Tests were run while I was open to ensure that the outer edges of the removed portions were cancer-free. The tendon to my longest finger had to be removed, but I was fortunate enough to have an extra tendon going to my index finger, so the vestigial one was moved over and stitched in. Plan B had been to transplant an extra from my right leg. (I would notice the next day that they had shaved my leg and marked my foot.) The total surgery time had been longer than expected… six hours.

I was aware that my brain was not formulating coherent thoughts, but I was clear on the time and the morphine schedule. I could get a new bag for my IV every three hours, if I asked for it. Between my noisy roommate (Hank, who I believe may have introduced himself to me earlier) and the staff parade, I had reason to check the time pretty often and morphine math came easily.

At some point that first night, I was alert enough to assess my situation. There was a tube coming out of my side with outgoing fluids. The receiving container was pinned down, limiting my shoulder movement. My right arm was wrapped abundantly from fingertip to elbow and was perched upon a tower of three blue hospital pillows. Any attempt to move that shot a sharp sting of pain to my back, like a whip. My left arm was slightly more free, but there was an IV line taped down to the back of my hand. This was connected with a short hose to my morphine machine. Lifting my head revealed that an oxygen tube was wrapped around my face and anchored in my nostrils. My left leg was wrapped in a tight brace that contracted and released at regular intervals — I would learn that this is to prevent clotting from immobility. Last, but not least, a bit of a hip wiggle was enough to confirm that I had another tube in me to handle outgoing fluids. I did not investigate further.

My reconstruction and plastic surgeon team showed up for rounds at 7 a.m. and I saw a bit of my hand for the first time. They cut a hole in the dressing, and puffing out like a Seinfeldian muffin top was a bit of flesh that I did not know as well as the back of my hand. Each doctor and resident took turns touching the exposed balloon of skin, and each nodded and made approving noises. I couldn’t feel any of it, but they were very pleased with the temperature. I tried touching the area and it felt cold to me. They assured me it was great.

They reviewed what had happened to me for the second half of my surgery. After migrating a tendon and hooking up my finger, they took a hand-size circle of flesh from my forearm — still attached, blood vessels and all — and moved it to cover the area of my hand that had been removed for cancer. A graft of skin from my thigh had been taken to cover my forearm site.

A few hours later, I had my first confinement freak-out. No one was around to see it and I got myself under control without tearing out any tubes, but the checklist of obstacles to freedom became my new mission. Over the course of the morning, I got my fluid collector pinned to me instead of my bed, got the oxygen requirement lifted and convinced a nurse to pull the catheter (easier out than in) with the sworn promise that I would take four walks before day’s end. Just 22 hours after surgery, I was standing on my own, peeing into a screw-on-lid collection vessel. (I’m told this was for measurement purposes, not posterity.)

It was at that time that my nurse freaked-out at the site of the empty venti Starbucks cup sitting beside me. During pre-surgery chemotherapy, my parents brought me Starbucks coffee each morning, and the tradition had continued. My vigilant caregiver was scrambling to notify a doctor. “You can’t do that!” she kept repeating, and finally, “Caffeine restricts the vessels and can cause transplant rejection.” I quietly told her it was decaf. Instantly she went from code-red to all-is-calm and let me be. I never ask for decaf, but I did that morning, hoping to spend as much of the next few days sleeping as possible. Good thing.

The rest of the day passed with visitors and morphine. As much as I wanted to be free of the rolling IV poll, the pain was still too much to leave it yet. But by 3 a.m., I figured out that the cause of the most intense pressure was the swelling in my hand. A call-out to my doctor team got me switched to an anti-inflammatory pain med mix and by morning, I was ready to ditch my IV.

I must have been quite out of it the first day, because several caregivers introduced themselves with, “We met yesterday, but you probably don’t remember.” Each of the four rounds of doctors seemed impressed with my status and started talking about sending me home. Having been warned that I would need to be in the hospital for 3 to 5 days for infection watch, this was an welcome possibility and I pursued it.

The only obstacle was my need for a custom splint that would immobilize my fingers and wrist while avoiding the graft site on my arm. This was early Friday morning and the heavily-booked occupational therapy team that performs this task doesn’t work weekends… it was today or wait until Monday. My team of doctors and nurses were excellent advocates and got the reluctant craftspeople (and their entourage of bulky equipment) squeezed into my tiny room within a few hours, and I gladly sacrificed time with visitors and the emptying of my bladder to get it done.

While my mind was on the complicated logistics and precision sequencing that would be needed to don clothing, my nurses were bombarding my parents and I with instructions on wound care, pain medication, drain management and follow-up bookings with various teams. A stack of papers and bags of home care supplies at the ready, I wove a shirt onto my body with contortions matching a catburgler dodging laser security. Pants were less an intellectual exercise and more one of balance and pain tolerance. And a father willing to do up that final button.

Ready or not, I was in a vehicle headed home.

(Without exception, every doctor, nurse and staff-member at Tom Baker Cancer Center and Foothills Medical were talented, articulate, caring, concerned, helpful and accommodating. I owe them much thanks. As I do to my mom and dad, but more on that next time.)