The Diary of a “Procedure”


This posting is going to take an odd before and after form. I’m scheduled for a hernia repair tomorrow, March 5th, so I’m going to report on my state of mind today – and possibly tomorrow morning – then reflect on the experience itself as soon as the anesthetic fog lifts.

The first thing to note is the carefully crafted language regarding the procedure, which is referred to as repair, not surgery. It reminds me of a dentist I visited once whose drills and x-ray machines were carefully hidden away in what looked like kitchen cabinets in order, so they explained, not to arouse the patient’s anxieties. I suppose I should be grateful for that consideration since this is – can you believe it – my first surgical procedure since I had my tonsils removed at age 4. I’ve been blessed with what you might call surgical virginity, while friends and family have been through incisions, excisions, replacements of body parts, insertion of mechanical devices, etc.

Given the novelty of the upcoming experience, my anxiety level is manageable. I’m aware that on the grand scale of seriousness, hernia repair is pretty routine stuff. Every time I mention what’s ahead to someone, they’re likely to report that they’ve been through it one, two, even three times, but no medical procedure is trivial for an 84-year-old geezer. The chances of “complications” are ever present. Most of the reports my informants have provided are about a time before laparoscopic (and robotic) procedures were the norm, so I’m hoping the troubling reports about painful recoveries will not apply to my situation in quite the same way.

In fact, the concerns I have are mainly about pain relief, both during and after the surgery. Even after 80 years, the scary moment when the ether mask was attached before my tonsillectomy is still with me. I worry about brain fog and other potential cognitive damage, which is why I lobbied for a local, rather than a general anesthetic. Before the numbing procedures dentists use were refined, I pleaded to have the drilling done without any medications because I preferred the transient pain to the long period of facial disorientation before the Novocain wore off. Similarly, I preferred being lightly sedated during colonoscopies, so I could enjoy the show of the doctor’s device worming its way through my pink and squeaky-clean innards. It was as good as a Discovery Channel special on “The Body.”

Unfortunately, my surgical team decided that my hernia was large enough so that a local anesthesia would not be sufficient. That leaves me with my concerns about post-operative pain mitigation. It may surprise some readers to know fentanyl is the pain killer of choice. The name itself is enough to conjure up images of the bodies of hundreds of thousands of ODed victims. Fentanyl turns out to be a really effective post-operative tool, but I’ve vowed to get off it and on to Tylenol as quickly as possible to avoid any chance of sliding into addiction.

One final concern – THE BILL! Our friend Dan Weismann hosts a wonderful podcast called, appropriately, An Arm and a Leg, which focuses on the cost of health care. His most recent episode about the differences between Medicare and Medicare Advantage is one that everyone anywhere near the age of 65 needs to tune into. We have Medicare Advantage which has the disadvantage of requiring prior approval for many forms of treatment. After listening to his show last night, I called the billing office at the hospital to make sure I was covered for tomorrow’s work, which I am. That’s one source of anxiety I can cross off the list.

So now all that’s left is preparing for the No Eating after midnight routine so familiar from my colonoscopies and the body cleansing to limit any potential infect-causing critters from the scene – they also add that I should sleep on clean sheets tonight and wear newly-washed clothes — and I’ll see you from the other side. That sure doesn’t sound right.

The Morning After.

It’s Wednesday morning, March 6th. The fact that I’m at my computer pecking this out should be sufficient to tell you how things worked out but let me tell the story the way I like it – chronologically. Things didn’t start well. I was feeling a bit off, wondering whether I should cancel, which would have created a lot of hassle because rescheduling ain’t easy. I reported, like a good soldier just before 11, the appointed time.

And then I sat and sat and sat for over three hours. Rarely do I travel without reading material, but I figured that my phone would carry me through what I assumed would be a short wait. In the third hour I was running out of power, so I began using it sparingly to assure continued communication with Rosellen. This situation was activating one of my pet peeves – the medical profession’s disrespect for patients’ time. Even the airlines, not known for stellar customer service, try to share information about the cause of delays and their potential length. The radio silence forced me to harass the poor blameless souls behind the counter, who resorted to appeasing me by offering a $5 coupon toward the indifferent food in the hospital cafeteria, which I refused. I

was not going to be bought so cheaply!

Just as I was threatening to walk out, a nurse arrived to escort me into the inner sanctum – no apologies, no explanations. Almost immediately, my surgeon arrived with information about my procedure which forced me to make an unanticipated decision. Apparently, they had taken my concerns about general anesthesia seriously, so they were going to do a local anesthetic, which only works if they abandoned the laparoscopic approach and did an incision instead. I decided to swallow my fears about being put to sleep, assuming the incision was going to increase the recovery time.

That decision slowed the process because they had to round up an anesthesiologist, who, under the proposed plan, was not needed. Then came the usual ritual of stuffing all your belongings into a garment bag, achieving the near impossible removal of the wedding ring and the battle to tie the strings on the back side of the hospital gown. The IV was inserted and my vital signs measured which showed a 50 point increase in blood pressure from the day before, no surprise after my infuriating 3 hour wait, and off I went to the operating room.

It’s amazing how large a team was assembled to carry out this routine procedure. If you’ve ever been on a movie set, or even just watched that dizzying list of crew members it takes to make even the simplest, most unadorned film you can relate to what I saw. I regaled the team with my memories of the ether mask that accompanied my childhood tonsillectomy and before I knew it I was no longer there.

The next thing I knew Rosellen was sitting bedside, holding my hand – the anesthesiologist had told me that they try to have someone close to the patient present at the awakening to reduce the disorientation. I was druggy for a few moments, but the fog cleared quickly, immediately eliminating my worst fears about cognitive loss. I was not very mobile, so they loaded me onto a wheelchair for the uncomfortable drive home.

It’s the next morning now. The anesthetic that remained in my system made for an odd kind of sleep, but still it was sleep. It’s been kind of miraculous the rest of the way. I’m getting around normally, and the pain is manageable enough so that I’m anticipating abandoning the stronger stuff and going with just the Tylenol the rest of the way. The fact that I’ve been at this computer, enjoying my rehashing the story of the last 24 hours, indicates how quickly the recovery has progressed.

My story tells us a lot that we already know. The quality of medical care in this country is impressive. The back-office stuff of billing and pricing and insuring, none of which I’ve had to deal with around this surgery, is a mess, as is, on occasion, the respectful treatment of patients. Overall, I’m brimming with gratitude that the care I received enabled this 84-year-old geezer to avoid the many pitfalls I might have had to navigate. In a way, I’m more whole than I was going in. Thank you, Team.

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Marv Hoffman

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