10 days later
It’s hard to believe it’s been only 10 days since my surgery. To anyone reading this post who offered a prayer for me, thank you so much. I firmly believe that your prayers enabled me to experience a blessing of healing in the last week and a half. If you want to skip the over sharing, you can jump down to “Heading Home”.
Ten days ago I was in the PACU, prepping for surgery. Beyond the typical questions and prep, I was also given a smorgasbord of random pills whose collective intent was to coat the lining my small intestine in order to dampen the pain and promote post-op healing. These meds collectively were part of an ERAS (Enhanced Recovery After Surgery) protocol; I’m sure most procedures now have this protocol, but I was amazed at the effectiveness of the seemingly random conglomeration of meds used for GI surgery. Celebrex? Really?
Anyway, because I’m me, and I cannot move my neck, I need to get intubated before they knock me unconscious. The idea being that if they apply the general sedation and then cannot move my head to secure the airway, game over. They need to secure the airway while I’m conscious. If that sounds bad, the reality is much worse. In preparation for getting intubated, the nurse anesthetist (CRNA) stopped by to start numbing my throat. First, she gave me a shot to dry out my mouth (I can’t even imagine the rationale for developing such a med) and then hooked me up to an inhaler with lidocaine in the bowl. Folks, it’s 2019; you’d think that they could develop a vapor med that tastes less like licking a compost pile but, alas, no.
Fortunately, after answering all-the-questions and getting an IV started, Larisa was permitted to join me. We had over an hour to kibitz, worship, and listen to a recording of breathing techniques intended to help us relax and help me heal better. All too soon, the transport service was there and I said goodbye. If you’ve never been through surgery, this is a really poignant moment. Your brain is grappling with the realization that you may only have 30 minutes of human consciousness left; this may be the last time you ever feel your wife’s hand, or look at her lovely face. Faith is real. To fear the unknown is human. Through my multiple surgeries and procedures, Larisa has learned not to say goodbye. Instead, she says, “See you soon,” because no matter what happens, it’s true. Hopefully in just a few hours, but if not, just a few short years until Heaven.
They wheeled me outside of OR 47 at 8:26AM and parked me beside a bunch of empty boxes. Literally lying beside the trash to be taken out. Cleveland Clinic needs to work on this metaphor a bit. The CRNA came out and added more compost to my inhaler. Thanks. Then my perky nurse came out, introduced herself and asked what surgery I was having. After I explained my redo, she piped up with “and you know you’re getting stents placed, right?”. Stents? What stents? To grossly paraphrase Acts 19:2 - I had not even heard that there was a stent… this is not what you want to hear immediately before surgery. When your mouth tastes like compost.
At 8:33 I was wheeled into the OR and shimmied over to the operating table. It’s bizarre because the table is so tiny they have put arm boards on the side so your arms don’t hang to the ground. There was only about an inch on either side of my hips. I’m not sure what they do when they one of the Cleveland Browns shows up for knee surgery… presumably two arm boards?
Over the next little while, my CRNA alternated between spraying lidocaine down my throat and and keeping me on the inhaler. Good times. Also, my surgeon arrived; this was cool because, during any of my prior surgeries, I don’t ever remember seeing my surgeon before the procedure. While discussing possible outcomes, my surgeon opined that I would almost certainly need a temporary ileostomy. While he was confident in his skills, he didn’t intend to let everything pass through the newly connected site unless all the conditions of the surgery were perfect. This isn’t really what I wanted to hear, or what we had discussed previously, but there isn’t really any turning back when you’re on the operating table and know that both permanent and temporary ileostomies are possible outcomes. I was also able to ask about the stents and got an answer that didn’t help much at the time. Later, I came to understand that the stents were inserted into my ureters to provide rigidity so that when the surgical team was poking around with small bowel they could feel where the other plumbing was located.
It turns out, we were waiting for the Anesthesiologist to show up. The doc was covering two cases and because of the complication of my intubation, she wanted to get the other case started first. I could tell that my surgeon was not amused by this, but he passed his time fiddling with a new machine off to my right. Somewhere in this timeframe, the CRNA administered two doses of Versed. This is a sedative that blocks short term memories from being formed. I remember asking her “So, I’m talking to you fine now, but won’t remember it later, right?” Right. Except I do. I’m guessing the adrenaline of the impending intubation negated the effect of the drug.
The Anesthesiologist finally arrived and the team huddled one last time. I asked if I could pray with them, which they graciously allowed. I hadn’t factored in the super dry mouth (that med worked!) or my now thoroughly numb tongue and throat. I’m not sure the team understood what I prayed; hopefully they got the gist. Regardless of whether they understood a word, God understood it all.
It was time to be intubated. I hate this part. They literally blindfold you and then put a bite guard in your mouth with a hole in the middle. At this point, you just hope it goes quick. It didn’t. I remember squeezing my nurse’s hand hard enough that it probably bruised. I remember three times being told to “take a deep breath” as I could feel the tube in my throat and my body fighting to stop it. This is so hard because your mind is trying to suppress every gag/fight/flight reflex while your body is, understandably, sure that it is being murdered. Finally, they must have secured the airway and, like a light switch being flipped, all memories ceased.
My next memory is in the PACU (aka recovery room). If you’ve never recovered from surgery, the only way to describe it is non-linear and random. There isn’t really a “first thought” or progression; all recollections are kind of held at the same time. My “first memory” is telling Larisa that I didn’t have an ileostomy (Yay!)... but I have memories of talking to my nurse before Larisa was called back, and also of discovering for myself that I didn’t have an ileostomy. What is first anyway?
Woven into these memories is the slow realization that you are, still, alive on Earth. This is a mixed bag; I’m so thankful to see Larisa again, and to know that she is not dealing with the crushing grief of loss. I’m grateful that my sons do not have to deal with yet another separation. But, truth be told, it is also a little disappointing. There’s a lot of Philippians 1:23-24 happening in this moment. I don't remember this, but Larisa tells me that I asked her to pray with me. She asked if there was anything specific that I wanted her to say, and I responded, "I'm just so thankful." Later, I told Larisa that I was pretty sure that if Paul had been married, his take on Philippians 1 may have been slightly different. Not that the good Apostle would ever have put a wife above Jesus, but waking up to Larisa was an awfully good option if I can't be in Heaven.
One of the amusing, or so I’m told, consequences of all the meds I was given during surgery is that I say a bunch of funny things. Larisa says that I don’t have any filters. This isn’t exactly true: I do have filters. It’s just that all thoughts and words are inspected and given the green light. They seem like really good ideas at the time. I’m pretty sure I chatted up all the medical staff and propositioned my wife multiple times. It seemed like a good idea. Pretty soon a kind man named Paul came to transport me from the PACU up to H51, which is a colorectal floor. I’m fairly certain I mentioned something about the trip being a missionary journey. Again, it seemed like a good idea.
When I was hospitalized in October and December, I was fortunate enough to have a room on the H51 colorectal floor both times; being admitted through the ER is pretty much luck-of-the-draw as to where they can find a bed, and I was thankful to land on the very floor where they were so acquainted with my kind of problems. As a result of these experiences, I got to know several of the nurses really well and in the PACU requested to be transitioned to H51. Thankfully, a bed was open and I was able to return to my home away from home. I adore these nurses! They know what they signed up for, and are gracious and kind through the most disgusting and humiliating moments of life.
In the grand scheme of things, I had very little pain. This is amazing since they couldn’t finish my surgery laparoscopically and had to do an open incision to wrap things up. However, they were able to do a “block” on the pain receptors in my abdomen. Between this block and the ERAS medications they had given me pre-op, I required virtually no narcotics to deal with the pain. It was all NSAIDs and Tylenol… and something for my nerves (sensory nerves, not anxiety nerves).
One of the major concerns with surgery, especially colorectal resections, is that the general anesthetic administered during surgery stops the peristalsis in your intestines (this is the muscle action that pushes things along). Restarting peristalsis is a complete unknown - in 2009 it took me about a week to get things working properly. However, this time around my peristalsis restarted immediately, and I was moving things along within hours of regaining consciousness.
Honestly, the worst part about the recovery was having my catheter removed. My nurse aid was training a new aid. I’m pretty sure the new aid had never removed a catheter before. She was almost, but not quite, able to walk the line between caution and torture..
Prior to surgery, I was told that typical recovery time for this type of surgery would be a minimum of 5 days in the hospital. I was discharged on day three. I was expecting a lot of pain and an ileostomy. I had neither. In fact, my surgeon told me afterward that ileo-rectal redos are extremely rare, because you need almost the entire rectum to accomplish them. In spite of 3 prior surgeries, I still have all of my rectum, which is almost unheard of in this type of situation. I was expecting to burn through a lot of PTO time, but was able to start working on Tuesday, less than six days post-op. On day nine post-op I ceased all pain meds, not even needing the occasional Tylenol.
I attribute this success to two factors: excellent care, and the power of prayer. It is true that the Cleveland Clinic is amazing: from my excellent surgeon to the the ERAS protocol and pain block, and on to the nurses on H51, everything went smoothly and was optimized for a rapid recovery.
However, this is true for all their patients, and few are blessed with the speedy recovery I’ve experienced. As far as I know, there is no way to prescriptively restart peristalsis. There is no way to insure that wounds heal or infection stays at bay. There is no guarantee against a leak at the surgical site, no matter how skilled the surgeon. All these factors are dependent upon the body responding and doing what it was designed to do: the miracle of our fearfully and wonderfully made bodies. I attribute my body’s response to all of you who prayed so diligently on my behalf. Thank you.