A few hours...
In a few hours I will go to the hospital.
I've been up for a few hours now, doing the second half of my bowel prep prior to surgery. It's not a really unpleasant task, but honestly doing anything to intentionally cause diarrhea is a little strange. Setting an alarm to do so just seems wrong. And of course I couldn't go back to sleep because I have to go to the toilet every 15 minutes or so to evacuate my bowels for what could be the last time in months. It's not the plan right now, but I do have a little blue dot on my abdomen that the ET (enterostomy therapy) nurse I've worked with for five years put there, marking where my surgeon can divert my small intestine to give my rectum and bowel a chance to heal. One of the first things I will do when I awake from surgery is feel that spot to see if I have an ileostomy. But before that, in a few hours, I will go to the hospital.
There will be almost no traffic at that time of morning. If I were going to the hospital at the same time as everyone was trying to get to to work it might take an hour or even more to get there. Instead it will probably take twenty minutes. We won't have any problem finding parking, and I will probably be the first person checking in at the registration desk. I will go up to the pre-operative area where I will change out of my street clothes and into one of the hospital gowns that so many comedians have made jokes about. The jokes and the gowns are funny, even if what is going to happen to me isn't. I will lie on a stretcher and a very helpful caring nurse will cover me with a warm blanket. That nurse will start an IV and my anesthesiologist and surgeon will both come to see me to talk about the plan for my surgery. I will kiss my wife goodbye, and that will be the last thing I really remember of the first few hours I was at the hospital.
A few hours after I get to the hospital I will count backwards from 100 as the anesthesiologist injects a strong sedative like propofol into my IV. I might make it to 95, or maybe as far as 93. The smart money is on 96, although even that will be slurred. My eyelids will flutter and my world will go black. I will not dream or feel anything as an army of green-clad medical personnel cover me and clean me, shave the hair from my skin and poke holes in my belly, monitor my vitals and remove a piece of my rectum that for no good reason decided to go haywire and keep on growing. If I left it inside me it could potentially kill me so out if comes. The anesthesiologist will slide a tube down my throat and hook me up to a machine that will breathe for me. This will be necessary because they will have to give me paralyzing drugs so that I don't have muscle spasms or movements that make my surgeon's job harder if not impossible. Nurses will hand my surgeon instruments and write things down on my chart and assistants will bring in new sterilized trays of instruments or equipment if my surgeon decides that his original plan won't work. My surgery will last a few hours, and for those few hours I will have given up all autonomy over my body to the surgical team looking after me.
If things are more complicated than all of the diagnostics I have had suggest, I might be in surgery for a few hours longer than is expected. Those few hours will be hard on my wife because she won't really know why it's taking a few hours longer, just that it is. Someone will call her to tell her, but it probably won't be my surgeon because he will be too busy dealing with whatever he sees on the operating table. It won't matter to me because my world will be a void while I am under anesthesia. A few hours, a few more hours - hell, a few days won't seem any different to me in the state I will be in. But for those few hours, the fragile state of confidence that my wife and I both currently have in my future will be tested. She will exemplify the negative side of our vows for better or for worse, in sickness and in health. When we were young and bold and healthy, those words were easy to say. They may not be as easy to live if a few hours get added to my surgery time. But just like I know I will get through this surgery and recovery, I know that she will find the strength to be the amazing partner she has been for me for over three decades.
I will come through surgery well. I have a better chance of being involved in a fatal car accident than I do of succumbing during surgery. I will be taken to the post-anesthetic care unit (PACU) where another nurse/angel will watch over me for a few hours. They will monitor my vitals and watch over me with their trained yet empathetic eyes, looking for signs of pain and of me coming out of the anesthetic. That will take a while; I will be groggy and incoherent, I will slip back into my dreamless sleep and rouse several times before I finally wake up completely, and any inhibitions that I carry with me in a world where I am not anesthetized will be blunted or completely destroyed. I will probably say some pretty crazy things. My nurse will probably have heard it all before, but I may say something that is memorable enough for them to talk about with their colleagues over coffee a few hours later. I may be nauseated and I may even vomit as a reaction to the anesthetic. I won't be able to swallow properly or protect my airway reliably until I am fully recovered from the anesthetic so the risk of aspirating anything I vomit into my lungs is high. If I do vomit, my nurse will make sure I am safe from aspiration, then they will give me some strong medication to keep me from vomiting again before cleaning me up. And the whole time they are doing this, they will smile and treat me with care and concern instead of being grossed out that they have to wipe up someone else's puke. After a few hours of this odd relationship, I will say goodbye to this angel of a nurse as a porter wheels me from PACU up to my new temporary home, the surgical ward.
For the first few hours after I get to the ward there will be a lot of activity. My bedside nurse will introduce themselves to me and ask me a lot of questions and will check on my IV and take my vital signs and check my dressings and my drains. They will have known that I was coming for a few hours by the time I get there and will have gotten report from the nurse in PACU and also collected a lot of information from my electronic chart. Still, they have to spend the first few hours of my tenure on the ward admitting me and getting me settled in, checking on my pain, and making sure that I am comfortable as I start the process of recovery after my surgery.
Depending on when I get to the ward, I may also meet other allied health professionals a few hours later. A registered dietician may come to see me if I have an ileostomy, more to introduce themselves and let me know what their role will be in my care. I already know that they will help me choose a diet that will help me heal, keep me strong, and will not clog my ileostomy - but they don't know that I know that. A physiotherapist may introduce themselves to me and may even help me to stand and take a few steps around my room. It's important that patients undergoing major abdominal surgery like mine get up and moving in the first few hours after surgery to help improve healing of the surgical sites as well as to prevent blood clots from forming that could break off and cause a pulmonary embolism. The ward pharmacist - a colleague that I have spoken to professionally about other patient's care in the past - will come to see me more as a courtesy than because I really need the benefit of their knowledge and training. But if I wasn't a pharmacist myself, if I didn't do the same work as them at a different hospital, they would talk to me about my medications and most importantly about the importance of the blood thinner I will have to inject for several weeks after surgery to help prevent those pesky blood clots. Even though I have only been conscious for a few hours after my surgery, I will have already started the process of rehabilitation.
And in those few hours, I will be reunited with my wife. It will seem like almost no time has passed for me and any memories I have of what I was alert for may be erased by the midazolam I was given. But for her it may seem like a lifetime of waiting for me to come out of surgery. I will look like crap, but she won't care. She will hold my hand and tell me she loves me and not even notice all the tubes sticking out of my body.
My day is going to be divided into chunks of a few hours at a time. Thinking about anything beyond the next few hours is pointless - too much will happen in the next few hours for me to even be able to contemplate the next few hours after that.
Remember the lily pads I wrote about earlier? Well, today the jump from one lily pad to the next is separated by a few hours.
Time to focus on the only few hours I can do anything about.
I've been up for a few hours now, doing the second half of my bowel prep prior to surgery. It's not a really unpleasant task, but honestly doing anything to intentionally cause diarrhea is a little strange. Setting an alarm to do so just seems wrong. And of course I couldn't go back to sleep because I have to go to the toilet every 15 minutes or so to evacuate my bowels for what could be the last time in months. It's not the plan right now, but I do have a little blue dot on my abdomen that the ET (enterostomy therapy) nurse I've worked with for five years put there, marking where my surgeon can divert my small intestine to give my rectum and bowel a chance to heal. One of the first things I will do when I awake from surgery is feel that spot to see if I have an ileostomy. But before that, in a few hours, I will go to the hospital.
There will be almost no traffic at that time of morning. If I were going to the hospital at the same time as everyone was trying to get to to work it might take an hour or even more to get there. Instead it will probably take twenty minutes. We won't have any problem finding parking, and I will probably be the first person checking in at the registration desk. I will go up to the pre-operative area where I will change out of my street clothes and into one of the hospital gowns that so many comedians have made jokes about. The jokes and the gowns are funny, even if what is going to happen to me isn't. I will lie on a stretcher and a very helpful caring nurse will cover me with a warm blanket. That nurse will start an IV and my anesthesiologist and surgeon will both come to see me to talk about the plan for my surgery. I will kiss my wife goodbye, and that will be the last thing I really remember of the first few hours I was at the hospital.
A few hours after I get to the hospital I will count backwards from 100 as the anesthesiologist injects a strong sedative like propofol into my IV. I might make it to 95, or maybe as far as 93. The smart money is on 96, although even that will be slurred. My eyelids will flutter and my world will go black. I will not dream or feel anything as an army of green-clad medical personnel cover me and clean me, shave the hair from my skin and poke holes in my belly, monitor my vitals and remove a piece of my rectum that for no good reason decided to go haywire and keep on growing. If I left it inside me it could potentially kill me so out if comes. The anesthesiologist will slide a tube down my throat and hook me up to a machine that will breathe for me. This will be necessary because they will have to give me paralyzing drugs so that I don't have muscle spasms or movements that make my surgeon's job harder if not impossible. Nurses will hand my surgeon instruments and write things down on my chart and assistants will bring in new sterilized trays of instruments or equipment if my surgeon decides that his original plan won't work. My surgery will last a few hours, and for those few hours I will have given up all autonomy over my body to the surgical team looking after me.
If things are more complicated than all of the diagnostics I have had suggest, I might be in surgery for a few hours longer than is expected. Those few hours will be hard on my wife because she won't really know why it's taking a few hours longer, just that it is. Someone will call her to tell her, but it probably won't be my surgeon because he will be too busy dealing with whatever he sees on the operating table. It won't matter to me because my world will be a void while I am under anesthesia. A few hours, a few more hours - hell, a few days won't seem any different to me in the state I will be in. But for those few hours, the fragile state of confidence that my wife and I both currently have in my future will be tested. She will exemplify the negative side of our vows for better or for worse, in sickness and in health. When we were young and bold and healthy, those words were easy to say. They may not be as easy to live if a few hours get added to my surgery time. But just like I know I will get through this surgery and recovery, I know that she will find the strength to be the amazing partner she has been for me for over three decades.
I will come through surgery well. I have a better chance of being involved in a fatal car accident than I do of succumbing during surgery. I will be taken to the post-anesthetic care unit (PACU) where another nurse/angel will watch over me for a few hours. They will monitor my vitals and watch over me with their trained yet empathetic eyes, looking for signs of pain and of me coming out of the anesthetic. That will take a while; I will be groggy and incoherent, I will slip back into my dreamless sleep and rouse several times before I finally wake up completely, and any inhibitions that I carry with me in a world where I am not anesthetized will be blunted or completely destroyed. I will probably say some pretty crazy things. My nurse will probably have heard it all before, but I may say something that is memorable enough for them to talk about with their colleagues over coffee a few hours later. I may be nauseated and I may even vomit as a reaction to the anesthetic. I won't be able to swallow properly or protect my airway reliably until I am fully recovered from the anesthetic so the risk of aspirating anything I vomit into my lungs is high. If I do vomit, my nurse will make sure I am safe from aspiration, then they will give me some strong medication to keep me from vomiting again before cleaning me up. And the whole time they are doing this, they will smile and treat me with care and concern instead of being grossed out that they have to wipe up someone else's puke. After a few hours of this odd relationship, I will say goodbye to this angel of a nurse as a porter wheels me from PACU up to my new temporary home, the surgical ward.
For the first few hours after I get to the ward there will be a lot of activity. My bedside nurse will introduce themselves to me and ask me a lot of questions and will check on my IV and take my vital signs and check my dressings and my drains. They will have known that I was coming for a few hours by the time I get there and will have gotten report from the nurse in PACU and also collected a lot of information from my electronic chart. Still, they have to spend the first few hours of my tenure on the ward admitting me and getting me settled in, checking on my pain, and making sure that I am comfortable as I start the process of recovery after my surgery.
Depending on when I get to the ward, I may also meet other allied health professionals a few hours later. A registered dietician may come to see me if I have an ileostomy, more to introduce themselves and let me know what their role will be in my care. I already know that they will help me choose a diet that will help me heal, keep me strong, and will not clog my ileostomy - but they don't know that I know that. A physiotherapist may introduce themselves to me and may even help me to stand and take a few steps around my room. It's important that patients undergoing major abdominal surgery like mine get up and moving in the first few hours after surgery to help improve healing of the surgical sites as well as to prevent blood clots from forming that could break off and cause a pulmonary embolism. The ward pharmacist - a colleague that I have spoken to professionally about other patient's care in the past - will come to see me more as a courtesy than because I really need the benefit of their knowledge and training. But if I wasn't a pharmacist myself, if I didn't do the same work as them at a different hospital, they would talk to me about my medications and most importantly about the importance of the blood thinner I will have to inject for several weeks after surgery to help prevent those pesky blood clots. Even though I have only been conscious for a few hours after my surgery, I will have already started the process of rehabilitation.
And in those few hours, I will be reunited with my wife. It will seem like almost no time has passed for me and any memories I have of what I was alert for may be erased by the midazolam I was given. But for her it may seem like a lifetime of waiting for me to come out of surgery. I will look like crap, but she won't care. She will hold my hand and tell me she loves me and not even notice all the tubes sticking out of my body.
My day is going to be divided into chunks of a few hours at a time. Thinking about anything beyond the next few hours is pointless - too much will happen in the next few hours for me to even be able to contemplate the next few hours after that.
Remember the lily pads I wrote about earlier? Well, today the jump from one lily pad to the next is separated by a few hours.
Time to focus on the only few hours I can do anything about.
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