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Ask Tog, January, 2000

Maximizing Cards and Flowers

In late 1999, I had two major surgeries. The first generated a steady and satisfying flow of visitors bearing cards and flowers. The second generated bupkis. The first was a relatively simple procedure with a pleasant, drug-induced sequella. The second damn near killed me. That was the one without the cards and flowers. Don’t let my fate happen to you. If you’re gonna check out, at least arrange to smell the roses.

The first operation had the stuff of a good TV Movie of the Week: I was unexpectedly diagnosed with a rare kidney cancer and was not expected to live for more than a few months unless a team of crack surgeons performed a (simple, routine) operation to extract said cancer. Since they had no other pressing appointments, they did.

Then I had my gall bladder out. “Gall bladder? Everybody’s had their gall bladder out. My Aunt Gertrude had hers out last Tuesday. Played Bridge that night.”

Now, how ya gonna get sympathy when people take that attitude! Simple operation! No sweat! Play Bridge that night! And, in truth, it works just that way, if you’re lucky. They just whip you in, shove a bunch of tools through holes in your abdomen, inflate your belly like a balloon, and light up your insides like a circus tent on disco night. In and out in an hour and fifteen and send you home in time for lunch—if all goes well. If it doesn’t, they generally “convert” to plan B: They put band-aids on all four of their cute little incisions, then open you up wide like an oyster and take the thing out the old-fashioned way, with garden gloves and a Boy Scout knife.

7:00 AM, Monday morning, I arrived at the hospital. (Well, 7:20 actually, but who’s in a hurry to get blown up to Cirque de Soleil proportions.) Laughing, smiling surgical nurses popped various tubes into my body while regaling me with stories of people dancing out of the hospital and onto a plane for Las Vegas. No time for folks to visit, not time for cards and flowers—none of that old fashioned stuff. I would be under by 8:00 AM, likely to be discharged from the hospital by 11:00 AM.

At 11:00 AM, I was not doing well. I couldn’t dance. I couldn’t stand. I couldn’t even sit up. In fact, I couldn’t move. About the only thing I could do was groan, and even that effort fell well short of my usual performance. All this after what had allegedly had been the simple operation.

It turns out I had sort of a hybrid operation. It looked simple, but it wasn’t. I had a surgeon who has one of the lowest conversion rates in the country: Down below 3%. (Some surgeons average as high as 30% of their patients ending up with a long smile carved into their stomachs.)

Because I had had three previous abdominal surgeries, the going was tough. With repeated exposure to the elements, everything in there just kind of grows together into one big lump, like that deep-fried Economy Entrails platter down at the Lickety-Split House of Guts and Rabbits. These “adhesions” have to be carefully sliced apart, one-by-one. The going got tough enough that the team stopped the operation and consulted on whether they should convert. The surgeon decided to give it one more try and, after hacking through several more layers of underbrush, the way was clear and the deed was done.

By 2:00 in the afternoon, I was doing no better, and the docs decided to keep me overnight on oxygen, with fluid levels maintained via the IV. I missed Ally McBeal, but, what with the morphine being pumped into me, I didn’t mind.

The following afternoon, they asked me if I was prepared to be cut free. While the switch-over from IV morphine to oral Vicodin would be somewhat jarring, the threat of hospital food left me no choice. I was soon whisked home by my personal physican/comely wife and tucked into bed. I had spent 32 hours in the hospital instead of the expected four. This 8:1 ratio of actual vs. expected hospital time represented a new personal record.

About the new “instant operations”: Hospitals have only recently rediscovered these “carve out his heart and send him home in 20 minutes” operations, originally perfected years ago by the Aztec priests. They find them a real boon, because they eliminate half the pain and suffering—the half the people in the hospital used to experience listening to all those patients moaning and groaning day and night.

Even the patient’s half of the pain is attenuated, since much of it comes from the muscles in the abdominal wall saying, “Hey, what’s going on? Hey! Hey! ARE YOU LISTENING! YOU THERE! THE ONE I’M ABOUT TO MAKE COUGH!” However, the parts inside are still talking (particularly when they have been “de-adhesed” with that cute little hi-tech machete), and all the other sequella are pretty much the same as they always were: Bloating, fever, night sweats, chills, and an inability to form full-length sentences—or, for that matter, form any thoughts at all that don’t center on popping pain pills and peeing.

Wednesday morning, two days after the operation, I struggled out of bed and eventually achieved oneness with my verticality. According to the color brochure, this was the day I would return to my golf game (only the front nine—no use pushing things). Instead, I was staggering around the room in a semi faint with my heart fairly pounding through my skin. Julie did an immediate pulse check on me, found I was hitting 130 beats a minute, and told me to get in the car. Now!

She later told me she fully expected me to die before we reached the emergency room, that she had never been so frightened in her life. The rapid pulse and my chalk-white color told her I was bleeding into my abdomen. When working the ER herself, she had had patients with my symptoms who bled out so fast there wasn’t even time to open them up.

As soon as we pulled up, they started attaching me to additional high technology. Over the course of the next several hours, I would be poked, prodded, have lots of fluids that are quite important to me taken out and lots more that are quite painful put back in (try a blood-oxygen-level test sometime). They were getting hourly blood counts, watching the ticker like a internet daytrader, and sent me to radiation no fewer than three times. Why? Because they had to ascertain whether I had sprung a sudden leak, which meant instant operating room, or whether I had reached this condition by bleeding over a longer period of time.

Julie had done a baseline blood count on me two days before the operation, just ‘cause that’s what she does. I had a “crit” (blood count) of 59. This is above normal, but I’m that kind of guy. However, by the time we got to the ER, my count was at 31, almost a 50% drop. An hour later it had fallen another point to 30. Still dropping, but not precipitously. The x-rays continued. I was spiral sliced so many times by the CAT scan I felt like a honey-baked ham, while surges of doctors took turns interpreting the results. In the end, they determined that, while I had lost a lot of blood, it had now slowed. I had enough fluid in there to open up a water park for Lilliputians, but there was no pressing need to open me up immediately. Instead, I spent the next two days with Julie running periodic blood counts to see what was what. By Friday, the tide had turned, so to speak, and my blood count was slowly creeping back up. The surgeon had made the right choices from the beginning.

On Saturday, the acute pain phase was behind me, but I was just barely entering the acute Gee-I-really- need-another-handful-of-Vicodin phase. It was time to turn off the good drugs which, reluctantly, I did. I spent the next 48 hours in significant narcotic withdrawal. I then entered phase three of said withdrawal: Feeling sorry for myself. Thinking it would be an ideal time to share, I sat down and wrote this column.

I have learned several things from this recent experience:

  1. There is no such thing as routine surgery, even if your Uncle Phil and Cousin Sally had the same operation and you felt no pain at all.

  2. There is no such thing as a simple operation, regardless of the pretty pictures in the brochure, particularly the ones showing them replacing your heart, liver, and spleen, then covering up the incision with Scotch Brand Cellophane Tape.

  3. Even if there were a simple, routine operation, never, ever admit it to a soul, at least before entering the hospital. I did such a good job of convincing myself that this little gall bladder thing was just a nice way to gain a few extra days off with drugs that I went on to keep all my friends in the dark. After all, we’d probably see each other at our favorite dining haunt that very night. Big mistake. Particularly when exacerbated by the next little lesson:

  4. Never have more than one operation in any 365-day period. Not only is the narcotic withdrawal much, much worse, but you won’t get a damn bit of sympathy. It takes at least a year for people to recharge their sympathy cells. I promise you you won’t see a single card or even a wilting poesy.

  5. Finally, today, more than ever, it is important to marry a doctor.

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