Mayos and Surgery

I had two discussions on Tuesday afternoon and am still sifting through all of information.  One of those components was how potentially dangerous these fistulas can be, particularly the violent reopening possibly getting into the bloodstream involving then some systemic infection.  Unsurprisingly, the surgeon suggested surgery.  The doctor on the medical side of things has me doubling up on my main medication but also brought up surgery.  Both doctors put the ball for this firmly in my court, noting that if my symptoms are tolerable, there's no rush.  However, both doctors agree that this surgery in an inevitability, though neither can really say when. 

But I am so very tired of this hanging over my head.  Andy and I are of the opinion that if it's coming, why not get it over with?  We've not scheduled anything yet, but I think that within a year or a year and a half, unless the new treatment plan takes things on a significant turn. 

That's heavy. 

Particularly now as I'm recovering from an outpatient procedure and reminded once again of what that part of the process really means.  I remember what it's like to live with an ostomy.  I had blocked out what it was like to go back into surgery. 

For Mayos, I've got it pretty well down.  I make it a point to eat something the night before that sounds really good, aware that I won't have anything else until some crackers or pudding after the procedure itself.  And I like to go see a movie the night before, too.  This time, we watched The Count of Monte Cristo in the hotel room together.  After that, I shower with Hibiclens soap, that I refer to as "gas station soap" because it smells like cheap soap you'd use in a gas station bathroom.  This red goop is slathered on, left for two minutes as I avoid the warmth of the stream from the showerhead, then rinse.  The next morning, I sleep as long as I can, so I won't notice that I'm hungry for as long as possible.  One more shower with the gas station soap, in order to reduce the possibility of post-surgical infection. 

We then head down the shuttle to take us to the right Mayo building, usually Eisenberg (stemming several choruses of "We're taking Larissa to Eisenberg!" ala this tune).  I walk up to the front desk and find out what floor and station I need to head toward, walking around the corner to the left to the elevators.  We follow the directions on the wall and make our way to the nurse's station, me and whatever entourage I have with me. 

The nurse I greet sees that I'm sent to my assigned room, pulling out a gown and some grippy socks (so as not to slip on the floor).  I strip down everything and put the on the gown, clothes placed in the locker or in a plastic bag and then in the locker.  Trying not to flash anyone, I settle on the bed awkwardly.  I cross my legs unconsciously; even covered I feel vulnerable.  Warm blankets or warm air help make this at least a little better. 

My nurse for the day introduces herself and, after checking my name and birthday, goes through another few questions and takes vitals.  I am asked what procedure I am expecting today, to ensure that everyone is on the same page.  Another person comes in to start my IV.  Then, we wait until I'm called down to the next stage, the Pre-op.  I get on a different gurney, the warmed blanket tucked under my feet.  The warmth seems to evaporate off of the blanket almost immediately as the bed is pushed down the hallway, generating a breeze with that cool, sterile air.  My arms stay at my sides, careful not to bump the IV site, and my legs are still crossed at the ankles.  I greet and nod to people as we zip by until we eventually land in my own small room.  I have thoroughly lost my bearings on where we are. 

Another nurse comes in, introduces herself or himself, and confirms with me that I am who I'm supposed to be and I know what we're planning on doing today.  If they brought the antibiotic that they'll be giving me during surgery or even if they don't have it, I ask what it is to make sure that it is not the one that I explicitly asked them not to use.  Then, I stand my ground and explain that they will not be using that particular antibiotic and they have to contact the pharmacy to get it switched.  They cannot give me an explanation that I have not heard by this point, and I'm pretty sure they mention Gram Negative bacteria because they don't think I know what it means. 

This time, I had a view of one of the doors and did a lot of people watching while I waited for a little more than an hour doing so.  At some point in there, the anesthesiologist comes in and makes introductions.  I ask what cocktail they will be using today, because I make it a point to know.  They ask a lot of other questions and check my airway, particularly if I'm going to be intubated.  Time goes both fast and slow at the same time.  I am given a fashionable hat to stuff my hair into to keep it out of the way. 

Why are they always blue?

Eventually, my gurney then gets wheeled into the OR proper.  It's always cold in the OR, particularly when your warmed blanket is just a thin blanket by now.  I am asked to move to the operating table.  My IV port is then hooked up to the appropriate solution, and I am asked again what we are doing today, confirming my name and birthday one more time.  The electrodes for the EKG are attached to my chest.  The other persons in the room introduce themselves.  I try to keep from shivering.  I allow them to take my glasses and feel more naked than before.  I am secured to the table.  The large, circular lights above are all the I can see when I look up, apart from the face that hovers over me from time to time to ask another question or check on me in a different capacity. 

There are two or three of these above my head.

I am given a mask with 100% oxygen, and the first wave of pain killers hit, making me feel heavy, heavy, heavy as the world begins to slip away. 

I wake up somewhere else, still feeling extraordinarily heavy.  I am reminded to keep taking deep breaths, because I am forgetting to breathe.  I want very much to go back to sleep.  My throat hurts from the tube that they placed down it, likely to hurt for the next couple of days.  They give me a spoonful or two of ice chips as I'm waking up to help.  Fighting, fighting to stay awake when breathing is oppressive.  I give a test wiggle to see what hurts.  Finally, the heavy feeling starts getting better (though parts of it will linger over the next couple days), but I'm still antsy and uncomfortable. 

My bed is moved back up to my original room.  My entourage is coming if they're not already there.  At some point, either I or my family has been given some basics of how things went.  I have to go for a walk, eat something, void, and meet a couple of additional criteria before I am allowed to leave.  If this is a longer stay, a more complex surgery than something outpatient, then we settle into the room, under some of the same criteria with a few extra bells and whistles, like pain management.  Occupational therapy, physical therapy, wound ostomy care, whathaveyou will also stop by as necessary over subsequent days.  If it is overnight or more, there will be a parade of phlebotomists, the main residents under my surgeon, and then a posse of people learning under my surgeon (really, possibly twelve different people) to come in and discuss my case, all by the time I have breakfast decided and delivered.  Well, the last part there is more Mayo specific, but you get the idea.  Over the next few days, anywhere there was an adhesive on my body gets this shadow of residue, showing exactly where the piece of tape, electrode sticker, or whatever else was placed. 

This go around was a minor procedure, taking a closer look at the angry areas and feeding through some seton drains.  So, the two fistulas that have an exit, imagine some fishing line that goes from where the hole starts in the rectum and all the way through the fistula, exiting out and tied to itself.  The seton drains keep it from closing, meaning that it continues to drain.  So far, they're damned uncomfortable and bleeding a lot, because they're fresh.  This procedure, though, takes out some of the immediate danger, that it cannot explode if it cannot build up pressure.  It gives us time.  Meanwhile, I'm awfully scared of what the first poop is going to be like with these in. 

No matter how many times I've done this, I'll still admit that going into surgery makes me anxious--there was only once that I can think of where a different emotion predominated, that being relief when we were going in for the emergency surgery after my bowel resection had failed.  And I'm glad that I do still have that healthy dose of anxiety--I don't want this to ever feel normal.  Familiar is bad enough.  Once I wake up from this surgery, life and self as I knew them will be done in a few senses.  I'm looking forward to being past the anxiety of deciding, but not the recovery time, the adjustment time.  I am keeping my eyes on the goal and in the preparation details at the moment, like focusing on the marriage and not the wedding details.

That means that emotionally right now, I don't really know where I'm at.  I'm making plans, weighing my options, waiting on some additional calls.  I don't know whether it's better to ignore everything or sit in a pity puddle for a while.  That's going to take some different sifting. 

In the meanwhile, though, thank you all for your continued thoughts and prayers.  They have meant the world to Andy and me.  Thank you, too, especially to those who reached out to Andy this week.  If you missed out this time, unfortunately, there will be another place to be present, whenever we do dive into that surgery. 

More as it develops.