Wednesday, July 3, 2013

A short report about my further adventures in the world of uncontrolled growth...

Brummbaer July 2013


I packed until the last moment, everything had to be in boxes or anything might happen to it on the way to our new home. Sunday noon was my cut-off time – starting preop with the usual unpleasant drinks to clean my bowels and to be safe in case somebody slips with his scalpel.
Today's joke: Something you don't want to hear in an operating room:
Robin continued packing.
Monday morning 4:45AM we arrived at the Ronald Reagan hospital where I should be ready for surgery by 7:30. Most of the time I filled out forms. Over and over...
I assume they are still working on streamlining the process, because redundancy for safety reasons is unavoidable, but too much redundancy creates drag and slows down the process. – Anyway. Suddenly, it was 7:30, I was in my hospital garb and was being introduced to half a dozen people, everybody wearing the unique costume for the event, the nurses, the Md's, the anesthesiologist, etc...
It was impossible to remember all their names, but the name tags were a great help... ...and three more times the same question: Was I allergic? No?
Then I was out, but still in a sitting position, while I heard people hammering and drilling at my spine. It was painless and all I remember is that it was obviously really difficult to get the right spot for the epidural.
Next I was in stirrups, still not really conscious, but aware that now the tubes were being implanted, presumably by Dr. Kamrava the head of the team. A little later I was aware enough to answer questions and now a mistake occurred that is hard to avoid: The question, of course, was: Between 1 and 10, what number is your pain? Mine was between 6 and 7, and when they increased the dose I did not respond. So they increased the dose again. I myself was not clear enough to differentiate between a really bad back-pain coinciding with the pain from the surgery. The epidural did nothing for my back-pain. So I  received twice the necessary dose, without anybody's negligence.
Dr. Demanes head of the Brachy department at UCLA was present, and since I was already pretty much under, they added a sedative and Dr. Demanes worked on me, for what seemed another three hours, tweaking the locations of the plastic-pipes.
Finally everybody was happy with the template between my legs and I was transported from “radiation” to the hospital. I was tied to the gurney, where I would stay for the next three days. I arrived around 8 in the evening at the Ronald Reagan Hospital, which was adjacent to UCLA radiation, but it was a complicated odyssey to get there.. The room was pleasant, with a great view of Westwood and the ocean. Even though I felt like a truck had ran over me, I nevertheless was terribly hungry. I was ready to eat and spend the rest of my consciousness vedging in front of the TV.
Mind you, I came with instructions: “Strict bed-rest! Turn every 2 hours.”
To eat I needed to be turned and the two nurses available, were willing, but had not the slightest idea how to go about it. They just thought, I – for whatever reason -- had an epidural and they tried to roll me on my side – not aware of the sensible template between my legs. Somehow they manipulated me into a 45 degree angle, that felt really wrong, even with an epidural. Five minutes later I touched something like a tree-trunk next to me on the gurney, which turned out to be my leg that was completely paralyzed and without any sense of touch. The left leg was perfectly fine, without pain and a limited range of movement due to the epidural. But the right leg was gone!
I freaked!
The night nurse did not seem too alarmed.
I asked for a doctor. The nurse nodded and left the room.
Too late I realized that he left the call-button out of my reach and now I was truly stuck to the gurney – helpless -- my absolute nightmare!
A good thing that Robin had called a short time ago and was on her way, so I knew I wouldn't be helpless too long.
Five minutes later I saw the nurse walking by. I yelled: “Where is the doctor?”
He looked at me and nodded: “Oh, yes, I will call the doctor right away!”
I didn't believe my ears.
Now Robin arrived and shortly thereafter a black nurse, who really knew her business. She very quickly determined that my epidural was very high and she also had the authority to turn the dose down and indeed, after two hours, feeling and motion started to return to my leg. In the meantime I had a doctor at “Pain Management” on the phone, who told me that this happened before, was rare and it all would be fine by tomorrow.
Which it was!
Mind you, I never saw a doctor all night – and I was in a hospital!
God bless the nurse, who knows her stuff!
They asked Robin if she wanted to stay, but with her workload – moving our”stuff”she needed to go home and rest.
Sleep didn't come easy to me that night – even though I was dead-tired – the weirdness of my body posture, the noises of the little pumps, turning on and of, and the pumps that served the leg compressors to avoid thromboses, left, right, left, right...but with the help of an Ambien I finally drifted into unconsciousness.
Day two:
I woke up, a bit disoriented but relatively painless – my leg was still lacking sensitivity but obviously recovering.
I ordered breakfast, but before it arrived I was whisked away to my first radiation treatment. Breakfast has to wait.
Two young men were responsible to deliver me at “Radiation” and gently warned me about every bump in the road. The gurney had no built-in suspension, but I had not much sensation in my pelvis anyway.
The radiation team consisted of two radiation technicians, who we shall call Tom and Al, and a young Asian nurse, with round glasses, a geometric haircut, and a pretty face.
Tom is an old hand at this and has years of Brachy behind him, a matter of fact attitude, like someone who knows what he's doing. Al was a little older and asked me if I had any musical preferences for the time in the radiation room. I didn't.
Meanwhile Tom had conducted a Ct-scan of my abdomen and a few things were not to his satisfaction. So suddenly my feet were raised by the stirrup, and between my legs I see three faces, lit from below -- blue like in a science fiction movie, looking at the area between my ass and my balls, poised and concentrated like they were expecting some great revelation any moment now. I understood how science can help us to love our not so attractive parts. It trumps revulsion!
A few Ct-scans later I was ready and Tom attached the tubes to the after-loader, the part of the construction that housed the radioactive pellets. Al had to double check, because mistakes are out of the question, regarding the damage that the high dose radiation could do, if the wrong tubes were connected. The room was well lit, not to fear, the heavy doors slid shut and Al chose “The Police” and more “Sting” to accompany me through the 45 minutes during which the radioactive pellets, mounted on elastic steel rods, would be guided into my bladder muscle with great speed to minimize the radiation of healthy tissue – you could see the tubes vibrating. Then the door on the opposing side opened and a little later I was back in the hospital in front of my breakfast, a plate of meanwhile cold scrambled eggs, that I wolfed down anyway, because I was starving after all these turbulent events.
I had another treatment late afternoon and felt pretty familiar with the procedure by now.
That night I had all my three sleeping aids lined up. A Lorazepam at nine, amitriptyline at ten, and between 11 and 12 an Ambien, By midnight I was out like a light, gurney or not, the little electric pumps that sounded like a defunct CD Rom drive, muffled laughter in the corridor, nothing came through – I was pleasantly gone.
I woke up early, ready to do my morning exercises – but only half of my body was under my jurisdiction. I started planning my escape...
This morning I had time to have breakfast before the radiation.
Then the usual procedure, double-check, all numbers matched – Al played the Rolling Stones for me. For my fourth and last treatment later in the day I suggested he should play “Last time” by the Stones.
...and so he did. It emphasized the emotion that everybody that said “Good bye” at a dentist office, or while being released from jail – carefully avoiding a “See you soon”, or “Later...” Because the extraordinary circumstances the hearts have opened up and you feel like your saying goodbye to friends.
Miss Lalaine, the physician's assistant, arrived to remove the tubes from my perineum and I have to admit that it was a strange situation to have a beautiful woman leaning on my thigh, bending over my abdomen, to pull 19 plastic tubes painlessly out of my ass.
She did great! – Now even the epidural was turned off, but my escape plans still had to wait 'til the next morning, when they would remove the epidural hardware from my spine.
Thursday morning “pain-management” sent somebody, who extracted the epidural in 20 seconds, and now my last attachment to the hospital was the bladder-catheter. – Which was permanently checked for it's blood content. They would only let me go, when there was very little, or no blood to be detected.
My urine – to my delight – was almost clear, the nurse called the doctor that I was ready to be released, when I made an unfortunate move, and a big red blob flooded the urine bag. The nurse was almost canceling my release, but the doctor calmed her down, it is expected to bleed for a while, as I also knew from other bladder surgeries.
Then the catheter was gone! I made my first steps, a little wobbly, a little weak, but I was moving all by myself, and all I needed now, was transport. Robin had problems picking me up – mind you – she had organized the whole move ( a couple of trucks) while I was in hospital, and was momentarily stuck in the new house with some plumbers and the cable company. Luckily my friend Matt was not busy, and jumped right away into his car to take me to Baldwin Hills.
Our new house – the power was on, there was my bed, close to the bathroom and the TV worked. I was in a elated manic state, could not find a robe and started running around naked – looking for light-switches – locating towels, etc...
I felt great – but after an hour the pain set in, and a night of torture started, oscillating between bath and bed – until I finally fell asleep around 3 or 4.
Since then I got better every day, with occasional slip ups.
The day after I came home I managed to attach my computer, but it took another week before I had the energy to read my email...
Now two weeks have passed and I finally wrote this chapter.