POD Zero

Today is the first day of the rest of my life.

I know - I already used that line on you. But it seems more true for me on the day of my surgery - post-operative day 0, or POD 0 in the vernacular of the surgical world - than it was on any day before I went for surgery. It is the first day I know that I am cancer-free.

I was surprised at how relaxed I was as I got ready for my surgery. I reported to the hospital at the time I had been told - 06:00H (or 6AM to most people) - and waited behind a group of about ten people who also had to register for their surgeries. The registration clerks were efficient and everyone got checked in, their wristbands applied, their paperwork handed over, and instructions given to make our way up to the presurgical admission area. Some of the people were having short procedures and were to be sent home later in the day, while myself and a few others were to be admitted for longer stays. We were called into the waiting area one at a time based on acuity; I was the third person called in so I kissed my wife goodbye and changed out of my normal everyday clothes and into a hospital gown and robe. I lay down on a stretcher as a helpful, efficient nurse took my vitals and charted them and gave me my preop acetaminophen. Each patient had a slightly different intake process, yet all of us had the same air of the mundane - as if getting prepared for surgery was a routine part of our lives.

My anesthesiologist - let's call him Rich - came to introduce himself. He had discovered that I was a pharmacist and he really respects pharmacists. He explained a lot about the approach he was going to take and asked if I would mind if he put in an arterial line and tried a different type of nerve block to reduce my postoperative opiate needs. "You have sort of low blood pressure and I'd prefer to have a real-time monitor on it," he explained about the arterial line. "And while the block isn't standard procedure I've used it before with great effect in abdominal surgery."

"Sure. Sounds reasonable," I told him. He gave me one of the warmest, most sincere smiles I've seen in a while before he left to prepare his area of the operating room. 

My surgeon was the next to see me. "Morning John. How are you feeling?" 

He looked calm, relaxed, and well-rested - all qualities I want in a surgeon.

"Pretty good Mark. Ready to get this over with."

"Good. Let me explain what's going to happen when you go into the OR then..."

Mark explained that he would hold a briefing when I got into the operating room. He would have everyone stop what they were doing and focus on me. He would ask me to say my full name and in my own words my reason for surgery. Each member of his team would independently verify that information before he would continue with  my surgery. I agreed to the briefing - it sounded like an excellent way of ensuring that everyone was on the same page - and then he went to check on his operating room.

I looked around the waiting area. Ten other patients were all laying on their stretchers, all calm, all relaxed. The nurses were quietly and efficiently doing their jobs. A lab technologist came in to draw blood on someone who needed it and an ECG tech came in to do a 12-lead ECG on someone else. It was all very orderly, very civilized.

Peaceful, really.

A few minutes later an aide came to take me into the OR, wheeling me through the OR core to the specific room where Mark and Rich and the rest of the surgical team were waiting. Mark introduced a few members of his team - nurses mostly - and then Rich got me on the operating table and started an IV in the back of my left hand as he explained about the high-tech beanbag I would be lying on to prevent pressure sores during my procedure. 

"All right. Everyone focus on the patient please," Mark said. Eight people in the room, Mark and Rich included, all turned to look at me. "Please tell us your name and why you're here."

"My name is John Francis Goring and I am here to have a lower anterior resection for rectal adenocarcinoma," I said. It was a mouthful, but the words were important.

"Good. Great. Thanks," Mark said. "All right everyone - let's get to work!"

Rich looked down on me, his smile evident in his eyes despite the surgical mask he wore. "I'm going to start the induction with some fentanyl, then give you a little gas before putting you under with propofol," he explained. I gave him the thumbs up as he pushed the fentanyl into my veins. The world got fuzzy, my eyes wouldn't focus right. He made some joke about the man who held a mask over my nose and mouth and told me to breathe deeply. I chuckled; I didn't know what he said but somehow I knew it was funny. "Okay - here comes the propofol."

I watched as the milk-white liquid was squeezed out of the syringe in Rich's hand and into my IV. I started to count backwards from 100 in my head. When I got to 97 the world just went black.

And that was it. I had entered a void.

I awoke what seemed like one second later in a world of chaos and confusion. A new nurse introduced herself as she was taking my vitals, explaining that I was in PACU (post-anesthetic care unit) and asking me what I would rate my pain as "on a scale of one to ten, with ten being the worst pain imaginable." She had clearly done this particular dance many, many times before, yet she still looked at me like I mattered in that moment.

How would you rate your pain... I've heard that phrase many times in the past twenty-four hours.

"Four," I said, although I'm still not sure why I said four and not three or five or six. She looked dubious and asked me if I wanted a shot of Dilaudid (hydromorphone) for the pain.

I nodded. My belly did seem more tender than I thought it should. She returned a few moments later with a syringe and injected it into the subcutaneous (under the skin) tissue at the back of my arm. "That should work in a few minutes."

The world became a little more confusing then. My pain dulled but so did my senses. There were a bunch of patients in PACU and a bunch of nurses talking to them and I couldn't seem to filter out any of the conversations to focus only on my nurse and my care. My mouth was impossibly dry; I asked my nurse if I could have some water. She shook her head but got me a swab - a sponge on a stick - that she dipped in a small cup of water. She put it in my mouth and in that moment it felt like the greatest gift I had ever received.

New patients came into PACU and other patients left. My brain couldn't really make sense of most of what was happening. My nurse took my vitals again as the nurse for the patient next to me was told that her patient's preoperative swabs for MRSA - an antibiotic resistant organism - had come back positive. Somebody else said they had to keep two metres between that patient and any other; the patient was at least twice that far away from me but my nurse seemed concerned nonetheless.

"You're doing fine and they're ready for you on your ward," she said, looking down at me with a confident smile. "I'll call and give them report." Before I knew what was happening a porter was wheeling me through the halls from PACU, into an elevator, and up to my ward.

I still felt a little dizzy and confused. The ward was calmer, less chaotic than PACU, but somehow my eyes were still not working that well. They didn't seem to point where I wanted them to or focus like I expected. My nurse introduced herself and the student she was precepting, writing their names on the whiteboard in my room. 

I'm glad she did, because I forgot their names the moment they left the room.

I was given a lot of information in a short time. My surgery went well. It was about three and a half hours long. I did not have an ileostomy. I had an IV running and a second one started just in case. I had sequential compression devices or SCDs - air-filled stockings that are hooked up to a pump that squeezes them rhythmically to keep blood clots from forming - around my legs. It was time for my antibiotics. My surgeon had already spoken to my wife and she was on her way up.  How the fancy hospital bed I was lying in worked and how I could call my nurse if I needed anything. 

So much information. But nothing seemed as important as your surgery went well.

My wife came in to see me, and she sincerely looked more beautiful in that first moment she saw me than she has in thirty-three years of marriage. She hugged me and kissed me and told me everything was going to be fine.

My kids came to visit me. I tried to engage with them but kept falling asleep. Then I seemed to have a bad reaction to the anesthetic and started to vomit. I called my nurse and she gave me a medication for it, but I still kept vomiting. My mouth was still unbelievably dry but now I could at least sip water - when I wasn't falling asleep and vomiting, that is.

My family left at 18:00h - 6PM - because I kept falling asleep. It was so hard to believe that only twelve hours had passed since I calmly walked through the front doors of the hospital, but I was so tired! I was glad they left because if they were there all I wanted to do was talk to them.

I slept from 18:00h to 06:00h the next morning, but only in fifteen minute intervals. I would wake up, look at the clock on the wall in front of me, and fall back asleep for another fifteen minutes. I have no idea why I kept waking up; there was nothing that was on my mind, no reason for me to wake up. I just did.

"On a scale of one to ten..."

I had different nurses overnight, and every time they came to see me they asked the same question. I really didn't have much pain at all, but at 01:00 I did feel more discomfort so I asked for some hydromorphone. I was able to take a pill, swallowing it with some water and then falling asleep a few minutes later. I woke up fifteen minutes later, then fell asleep and woke up fifteen minutes later again. That time my discomfort had eased. 

At 02:00 my nurse took another set of vitals, gave me my last dose of antibiotics, and asked me about my pain. 

"Two," I said.

By 05:30 it was up to a five - whatever that means - so I took more hydromorphone. I haven't taken any since.

At 06:00 my nurses came in and took off my SCDs and removed my foley. They took more vitals and asked me about my pain again. 

"Two," I told them.

Twenty-four hours. Had it really been just twenty-four hours? So much had happened, so much had changed...

Most importantly, any remnant of my tumour was gone.

Time to start my life without cancer.