Do Not Go Gently Into That Good Surgery
By Allan Stern
Chicago, December, 2001
I'm convinced the worst part of having surgery is the week before. I'm not talking here about the dread of anticipation of what can go wrong, the fear of the unknown and terrible pain. I'm talking about housecleaning.
Friends have told me they want to visit me at home after my upcoming surgery but there's no way I can admit people to my private pigsty. It has taken me days to organize miscellaneous pieces of junk, categorize boxes of old photos, toss out two-year old J.C. Penney catalogs, find homes for shopping bags full of materials from conferences, refile left-over vacation pamphlets, vacuum the rugs, make sure towels in the guest bathroom are matching, and throw "Lemon Pledge" on the now naked dining room table. It's overwhelming and exhausting. I need to go to the hospital to get a rest from housecleaning.
The other thing that I dread is the post-surgical casserole. The thought of all those well-meaning friends bringing casseroles takes me back to my bachelor days, when a tuna-and-macaroni casserole was the height of my cooking skills. It would last three days - the first day I was kind of proud of it, the second day it was "Oh, no, not again" and by the third day even the cat wouldn't look at it.
Anyway, my doctor on a routine checkup two months ago felt some nodules in my neck, in the thyroid. Probably nothing, she said, but it's best to get them looked at. I went for a biopsy and the doctor doing it told me, "Most of the tumors I see like this are usually benign. I wouldn't worry about it."
Two weeks later my doctor called again. She had gotten the biopsy results and was really surprised that it revealed malignant cells, a small tumor growing. "Papillary carcinoma" was the diagnosis. "Here's a surgeon's number," she said. "Call him and get scheduled for a complete thyroidectomy."
My reaction to her phone call is one I had not expected -- complete calm. No panic. No rages. No "why me?" Aren't I supposed to be feeling terrified? I'm not. Part of the reason is that there are no symptoms of illness at all - it's totally unreal as I feel completely fine. Part of it's just the way I react to major news; it always takes a while to sink in.
I'm not accustomed to having the word "carcinoma" connected with my name; it's always happened to somebody else. This will take some getting used to. I just need more information, the sooner the better. In the meantime, maybe I better try to enjoy every little moment I can.
So even though it's November in Chicago, I ride my motorcycle to the consultation appointment with the surgeon two days later. He tells me that this is a very small, slow-growing tumor, that surgery is very effective in cases like mine, and that 97% of people with my disease live at least 10 more years. "This disease will not get you," he says. "You have more to worry about on your motorcycle dodging SUV drivers on cell phones." But I still worry if I'm in that other 3%.
I read up on thyroid cancer. Can I live without my thyroid? Yes. Will I have a scar? Yes, but it won't be real noticeable. Will I have to take medication? Yes, every day for the rest of my life. Will I need chemotherapy and radiation? No, just a one-shot radioactive iodine "uptake" in a few months. Other than that, the surgery doesn't appear to be as dire as most. But it's still major surgery, with general anesthesia requiring an overnight hospital stay, at least.
I schedule the surgery for December 13th, four weeks away. I check the calendar to make sure that's not a Friday.
It's a weird four weeks. My mind goes from completely normal to thoughts of arranging all my life insurance and other documents. Is this the last Thanksgiving I'll ever experience?
A few months ago, I had decided to make some minor changes to my will. In a weird sense of timing, my lawyer sends me the newest version two weeks before the surgery. Are events conspiring against me, I start to wonder?
Then five days before the surgery, I'm working on my laptop computer, decide to take a break and lean my elbow down on the front of the laptop, putting some weight on it. The computer instantly crashes and will not start up again; the hard drive is unrecoverable, I lose all my files and email correspondence from the past two months. I am not able to communicate electronically with any of my friends.
The timing of this loss is way too creepy. Seeking some guidance over this unraveling of an essential part of my life, I write to a college buddy in New Jersey, a former minister, and ask him if this is some kind of omen. Yes, he replies, it's an omen for "Don't lean on your friggin' laptop." Maybe it's a good thing he left the ministry.
After much anticipation, December 13th arrives. My oldest brother has come in from Tucson for a few days. It's great to have him here, as he's worked in hospital administration all his life and is not intimidated by everything. Plus, he's my brother.
I get dressed to go to the hospital. Gotta be clean underwear, I know. Uh oh, my white socks are mismatched -- different patterns at the toe. My college-age daughter, a charter member of the Fashion Police, would be appalled. I quickly remedy this problem.
My brother drives me to the hospital, about 15 minutes away. He offers
to ride me there on my motorcycle, for one last possible fling, but I
politely decline. I'm too nervous.
The form states something like "Please choose between 1) Take all extraordinary measures to prolong my life; 2) Take normal measures but not extraordinary ones; and 3) Pull the plug at the first sign of a problem."
After some shaky moments envisioning myself at death's door, I choose #2.
They put me in a private room where I immediately put my clothes, including the clean underwear and matching socks, in a plastic bag. I'm handed a hospital gown, the only garment I know that in 30 seconds can transform bank president and janitor to the exact same status. I wonder who was the last person to wear this gown and how they did in surgery. I search the garment for any sign that this was a lucky gown. Wait! Here's a message in the back -- "Wash lukewarm, tumble dry at medium setting."
A nurse also gives me some panty hose to help with circulation while lying in bed after surgery. I think back to the last time I wore panty hose; it was shortly after I finished college and I was playing saxophone in the orchestra in a community theater production of the show "Cabaret." This was not the usual anonymous orchestra in the pit, however. The script called for an all-girl orchestra, onstage the whole time. The director made us wear red dresses and pantyhose. Some of us didn't look too bad but for me the effect was slightly spoiled because I had a full beard at the time. I remember my parents coming to the last night of the show and my mom saying, "For this we sent him to college?"
This is the worst part, I think, waiting for the gurney to take me to "pre-op." All the thoughts I've been putting out of my mind come roaring back. What if the surgeon's knife slips and he cuts the nerve to my vocal cords? What if the anesthesiologist isn't paying attention and gives me an overdose of anesthesia, or not enough oxygen, and I'm stuck in a wheelchair for the rest of my life? Will either of my two children want to take care of me? If not, do nursing homes have Internet access?
Finally the gurney comes. The moment has arrived. I give my brother a hug and climb on. I get wheeled down several hallways and through several automatically swinging doors.
The whole weird thing about all of this is I feel perfectly fine. I keep wanting to shout, "You've all made a mistake! Get me out of here!" My mind goes into Monty Python mode and I envision taking control of the gurney and heading out the hospital front entrance on my own, being madly chased by nurses and doctors in their lab coats with their stethoscopes flying.
This mental escape doesn't last long, however. I'm soon wheeled into pre-op, a large room divided by curtains into six or eight sections for all the patients going into surgery.
I lie there, listening intently to all the other conversations going on. The woman next to me is having her gall bladder taken out. The guy across the way is having lung surgery. Where do all these body parts go to after surgery, I wonder?
I'm in analytical mode now. I wonder, can you tell what operation people are going to have by the way they look? Older out-of-weight guys are obviously going in for heart surgery. Middle-aged women, maybe a hysterectomy. Sounds like possible Ph.D. dissertation material to me.
An older woman gets wheeled in. We exchange commiserating looks and I half-wave to her. She half-waves back to me. It reminds me of 40 years ago when drivers in then-rare Volkswagen beetles used to wave at each other. Here there's a different common bond, the brotherhood of the soon-to-be-cut-open.
One of the pre-op nurses finally comes over and starts an I.V. in my left hand. I look at her name tag -- it's "Tracy." I'm thinking it's important to get names in case of possible malpractice suits.
Finally two of the attending surgeons come over. One of them has a beard and is wearing a black turban. As he will be part of the surgical team cutting me open, I decide this is not the time to make some Taliban/Osama-bin-Laden joke.
Then the head surgeon comes up. "How are you feeling?" he asks me.
"Scared shitless, but otherwise fine," I reply.
I have my questions ready for him. "Doc," I ask, "you feeling OK today?" He nods. "No arguments with the wife last night?" He shakes his head.
"Let me see your hands," I ask and he holds them out for me. They are not shaking at all. Obviously, I am not the first patient to ask him to do this.
"How many times did you say you've done this operation?"
"OK," I say. I feel a little better.
Then the anesthesiologists come by. For the fourth time this morning, I am asked, "Are you allergic to anything?" Figuring that by now they should know the answer to this obviously vital question, I say, "Yeah, country and western music."
Now it's time to wheel me into the Operating Room. Feeling a little more emboldened, and trying like mad to stay in control of the situation, I thought about the guys on the hijacked airplane that crashed in Pennsylvania and said, "OK, let's roll."
They roll me into the O.R. It's pretty intimidating with the huge lights overhead, all the surgical tools arrayed around, the gas cylinders for the anesthesiologists. I get pretty apprehensive again. I had thought I would be unconscious before I got in here and wouldn't have to look at all of this.
It's time to move from the gurney over to the operating table. I start to crawl over by myself but then they say "We'll do it for you." After watching a thousand episodes of "ER," I know the drill. I'm ready for..."On my count....one, two, three!"
Without saying one word, though, they just lift me over. I am deflated. It's the same feeling as when I discovered there was no Santa Claus.
Now comes the final attempt at retaining some control. Knowing that a surgeon with a knife can do anything he wants while I'm unconscious, I have decided to leave him a reminder of what not to touch.
I have prepared a yellow post-it note and taped it below my stomach. On the note I have drawn an arrow pointing down to my...uh...private parts.
Above the arrow I have written in clear black capital letters "NOT HERE!" Hopefully this will do the job.
The surgeons and anesthesiologists see the note and crack up.
That's all I remember.