Surgery Day!

My day begins at 4:30am with a solid 150 minutes of sleep under my belt. I am not pooping anymore, and I am seriously dehydrated so I drink water when I can. I have to take another shower with a second surgical scrub sponge soaked in chlorhexidine. I am even more orange when I am finished. I feel like I took a bath in Tang. Do they even have Tang anymore?

At 5:00am I take my morning medication which by now is reduced to my 50mg metoprolol succinate. I can’t have my 81mg aspirin, or any other drugs and supplements that could thin my blood and cause a dangerous complication. For some reason though, last night’s Crestor dose was perfectly safe. Ironic, because the statin is the most dangerous drug I take. Well, unless you count the melamine-laced 2000mg of generic back-alley metformin I had been taking for years that caused my right bottom rib to ache front and back for 24 hours a day, until they let me stop taking it in favor of Jardiance. And in the same day the pain miraculously stopped. Turns out all that melamine causes colon cancer. And the pain just happened to be almost exactly in the place where I had a 5cm cancer tumor. Who knew? Oh and the melamine-laced Losartan I took for 10 years before they figured out that was tainted and recalled it, too. A double dose of cancer-causing chemicals. But at least my heart seems to be working okay. I’m not bitter. Do I sound bitter?

No more clear liquids after 5:15am. I am still dehydrated and can feel my heartbeat is fast, with occasional pre-ventricular contractions. This seems to only happen when I am dehydrated, and it worries me a bit to go into surgery if my heart is beating erratically. At 5:30am I have to chug a ClearFast bottle. This is a special carbohydrate drink you drink within 15 minutes on the morning of the surgery. This drink helps in the recovery from surgery by making you less thirsty, controlling your blood sugar, and maintaining your muscle strength. It doesn’t taste terrible. It doesn’t taste good either, it is sort of like lemony wormwood tea. Very important: you have to bring the empty bottle to surgery with you to prove you drank it, or the surgery is cancelled. So I stick it in my pants where it will chafe and make me uncomfortable yet acutely aware of its presence.

I have to arrive at the hospital at 6:25am and I must get dropped off at the door. My wife isn’t allowed to enter the hospital at that time due to COVID restrictions. They will keep her up to date via text message and will call her on her cell phone so that she arrives at the hospital to talk to the surgeon the moment after the surgery is complete. After I spend some time in the recovery room and am moved to a proper room, she will be allowed to visit me.

So I creep through the dark, empty hospital at 6:10am and go to the surgical waiting room. A receptionist checks my name and I try to prove to her I’ve taken the ClearFast drink by showing her the bottle. She stares at it like I were holding up a slimy toad; she has no idea what this bottle is for and asks me to hang on to it. I get a wristband for this ride and I am pointed at the waiting area, where fully 5 people and their spouses are waiting together for their name to be called. That’s right, the spouses who had to drop them off and couldn’t enter the hospital or wait in the waiting room because of COVID.

I am feeling pretty encouraged because it’s clear I am far and away the healthiest person in this waiting room, ignorant spouses included.

The other day in the shower, I had a sort of geeky epiphany. I realized that my chances of surviving the surgery are like rolling a saving throw on a 1d20 — I have to roll a 2 or better to live. Those aren’t bad odds. And yet, there is nothing like the moments before a surgery to reflect on life and realize I have really had a great one — a wonderful marriage to a wonderful wife, a loving family that makes me proud, a life overflowing with love and joy, a great and interesting career and an amazing employer. I say a quick prayer of thanksgiving and in return I get a weird, warm feeling of peace. I am going to be okay. Be not afraid.

I am called into the surgery preparation area, asked my name and birthdate, and then they threw me a curveball by asking what I am here for today, and I briefly wonder if I shouldn’t have used a Sharpie to mark on my belly the parts of colon that should be removed, and the approximate location of the tumors. I have to confirm my list of prescriptions and tell which I have held for surgery and which I have not held, which takes a while. They confiscate my Freestyle Libre continuous glucose monitor, which sucks because I am on day 3 of 14 and that’s $37.50 cast to the wind. And little did I know, they would be pricking my fingers every couple hours for the next 3 days — even though I won’t be eating any carbs or sugar for a good while.

Finally I get asked for my ClearFast bottle and they also want my wallet and my belt. And my pants and shirt, shoes and socks. I need to cough up any piercings, contacts, or dentures, all of which don’t apply. Then I get a bright yellow pair of grippy socks and a gown.

My nurse worries me a bit. She looks about 19 years old, has zero confidence and is very unsure as she prepares to put a gigantic IV into my right forearm. I am still dehydrated so I know my veins will be pretty uncooperative. She inserts the needle and digs around quite a bit; blood is going everywhere. After what seemed like a full minute of torture she aborted the mission and pulled it out. She finds another IV kit and attempts to insert it into the back of my right hand. This round was even worse, she is determined this time to get it and I was getting really tired of the frustrated digging when she decided to stop, like 2 minutes later. She runs off to ask the head nurse for a phlebotomy specialist. The head nurse arrives and asks if she can try on my left forearm. I can tell immediately that she knows what she is doing. It takes her about 5 seconds to place the IV with perfect, practiced precision. I wanted to give her a hug but instead I complimented her profusely for her skills.

She follows up by pulling out a razor and dry-shaving the hair off my abdomen and unexpectedly, the top couple inches of my pubes. Now it reminds me of those super-thin French moustaches just above the lip, and I sorta hope that no one judges me while I’m under anesthesia.

Then a very friendly anesthesiologist arrives to chat and assess my surgical history and past reactions to drugs. He is pleased I’d had a cardiac catheterization in 2007 using versed and fentanyl, and tolerated it well. He was super nice and whiled away the time by asking me lots of sympathetic questions about my heart attack 7-hour wait time in the ER. He had a similar experience with his mother and learned to just go to the hospital in an ambulance from then on.
He asks if I have questions about the procedure or anesthesia, and I do have one concern: is it possible to place the foley catheter after I am “out”? I sure would like to live the rest of my days without ever having to experience a tube shoved up my urethra. He smiles and says yes, that is what they usually do anyway but warns that people are gentler about inserting it when you’re awake and reactive, there are usually less complications afterward. It gives me pause but I opt to be out anyway, and put my full faith in the skills of the person doing it.
He gives me a dose of versed in my IV and I don’t feel like it has done much of anything, but after a while I realize I am noticeably less anxious and probably a good deal more cooperative.

He explains that I will be getting an epidural for pain management since it is very targeted to resolve pain without large doses of opiates. Lots of opiates will depress the colon’s ability to restart, and besides I don’t seem to tolerate such drugs very well. I am allergic to Vicodin and had a nasty experience with morphine during my heart attack. I make them describe every tiny detail about what they are about to do, and they promise they will start with lidocaine which will be like a bee sting, and I won’t feel any of the rest. They have me sit sideways on the bed and put my chin down towards my chest and curl forward. They are happy with my performance and go in with the lidocaine. It is expertly done, more like a mosquito bite that didn’t bother me hardly at all. Then there is some fidgeting around and a little pressure, and we’re in. They curl up the tubing and cover the whole thing with a huge Tagaderm patch.

They lay me back down on the bed, check my comfort level, and it is time to head to surgery right on time: 8:45am. They wheel me into the surgical room and I think I get some small dose of Fentanyl because I feel a bit dizzy, not a LOT dizzy which is what happens when I get a full tank. I remember marveling at the complexity and brightness of the overhead lights, and I wonder aloud if I could get some for my workshop. The anesthesiologist remarks that they probably cost a hundred thousand dollars.

As people enter the room and begin a lighthearted banter, I am somehow participating in it and realize the drugs have put me in full chatty-Cathy mode. Soon, probably to relieve their suffering, they put an oxygen mask on me and pushed the propofol, and I drifted into sleep. I remember thinking how great it would be to get three more hours of sleep after the two-and-a-half I got the night before.

I wake up in unbelievable abdominal pain, and for a moment I think I woke during the middle of the surgery, but through tired slits of eyes that are a huge struggle for me to open, I could see I was in the recovery room and some concerned anesthesiologists are swarming over me. They ask me to put a number to my pain level and I quickly said “seven!” Seven seems like the worst pain imaginable to me at the moment, because 8 would be like having a baby and 9 would be getting shot while trying to pass a kidney stone, a 10 would be outright torture and I would totally reveal the location of the rebel base.

“Seven” probably wasn’t the best answer, because everyone notably relaxes and stops swarming, and so I have to underscore the fact that I was lying, by moan-screaming in pain very loudly. They quickly roll me onto one side, not without my pain level going up one or two notches in the process, and it turns out the epidural medicine is not flowing, so they rip off the Tagaderm, adjust some tubes until the drugs were flowing, and they cover it with a new Tagaderm panel. The drugs immediately begin to reduce the pain to a more tolerable level, but it is about fifteen minutes before I am really comfortable, with unbelievably ZERO-level pain, and I think I fall completely asleep. I remember asking the time but I conk out before I got an answer. It is silly to ask the time when you wake up from surgery, do I have somewhere else I needed to be?

My brain is in stream of consciousness mode and I am very, very fuzzy when I wake up again, I think I was being moved to my room and my wife arrived shortly after. I keep dropping in and out of sleep while nurses hook up EKG wires and attach tubes to my IV(s). I notice they installed a second backup IV in my right arm, and I also notice with a jolt of panic that a big humongous tube is coming out of my penis. I had no idea a catheter would be that big, but luckily unless it gets jiggled it wasn’t causing a lot of discomfort, which I am thankful for.

My wife is happy to see me alive, and I think I have been neglecting her questions in my weird mental state. I think the time is like 3 or 4 pm. A huge amount of time has gone by. I had survived the surgery, knock on wood, and I am growing more focused by the minute. Jen explains the surgeon left a lot more colon than anyone expected, as the 2nd transverse colon tumor was much farther to my right side than CTs and colonoscopy reports indicated. I am not surprised, as my esteem for CT scans is pretty much nonexistent after the one I had in April somehow missed two cancer tumors, one 5cm long and the other 3cm long. And the one I had a couple weeks ago couldn’t find them either. So not only are those bad boys malignant adenocarcinomas, but they can cloak like Klingon Birds of Prey whenever someone aims a scanner at them.

Then suddenly I realize the tumors are gone now. A wave of satisfaction washes over me, and I am pleased with this surgery. Hours later the colorectal surgeon shows up to chat, and I thank him profusely for a job well done. His residents in tow shoot me winks and thumbs-ups for showing gratitude. Do they not get that very much?

I lean my head back to catch some more sleep. I have more gratitude right now than I know what to do with.

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