Saturday, July 5, 2014

Awake During Major Surgery— Part 3

I lay on the operating table watching the screen off to my right that showed the procedure to remove a huge uterine fibroid and adenomyosis in progress.  Actually, my surgeon had speculated that I was suffering from adenomyosis.  If indeed it was present, he would see it and would also have the lab confirm it.

In the twelve centimeter opening on my lower abdomen, I saw some adipose tissue (fat) and was so pleased to see it taken away.  A minor tummy tuck.  That has to be a bonus, I thought, feeling comfortable and quite enjoying the show.  I felt a tug as an instrument held the entrance to my guts open wider, but it was not distressful.  Fascia, sheaths, and connective tissues were separated from my muscle and then the muscles were pulled to the sides.  Old blood from hemorrhaging was there and they squirted what I guessed was saline water into the wound.  Often in the past months I had been sure I had suffered blood loss by how I felt, yet there was no evidence at times.  The blood had just stayed inside me.

The surgeon put his gloved hand into the hole that presented itself.  All of a sudden, out of nowhere, I felt nauseous.  The rush up my front quickly turned to a panicky feeling.  I could not understand why I would feel panicked when just a second prior I had been thoroughly enjoying myself.  I thought, Well, I guess I can’t handle this.  In disgust, I looked to the anesthesiologist and was about to tell him I supposed I needed general anesthesia when he came close to me and told me what was happening.

“The epidural made your blood pressure drop.  I’ve already given you something to raise your blood pressure and to stop the nausea.  You should feel it take effect soon.” 

Before he had stopped speaking, I felt blissed-out again, happy to get back to watching the procedure.  I was distracted, though.  It was an amazing thing to experience drugs at work.  With the sudden blood loss and anemia of months prior, I had experienced my blood pressure drastically dropping and had taken herbs to help get things closer to right again.  This was my first time experiencing my blood pressure dropping due to a drug.  (For two days to come, I would experience my blood pressure dropping suddenly, causing me to vomit and postpone walking.)  The speed with which the nausea and panic left amazed me.  I also truly felt that this doctor by my side had my back.

I had missed some stitches sewn into my uterus, leaving threads.  The surgeon and his assistant were pulling it up by these threads.  It took up the entire hole as it flopped onto my abdomen.  They had placed a tourniquet on an end of my uterus and injected what I thought to be a stop bleeding drug.  Truly, I needed a program!

I saw some blood on the outside of the uterus and now my uterus rested on white cloths which had been placed on me, completely covering all of my skin.  A laser was used to cut the uterus in half vertically.  I knew the integrity of the uterus had been compromised since horizontal cuts were better.  I also knew that if the surgeon had chosen a vertical cut, the fibroid’s placement would have required it.  As it opened, I could see very dark blood clots and assumed adenomyosis was indeed present.  (Endometrial cells swell with blood and cause bleeding-thus, the clots.)  I could see the fibroid’s shape hidden within a layer of the uterus.  It was huge, like a softball.  A tool was used to make multiple punctures into the uterus or fibroid.  When the fibroid finally came out, I saw it in the surgeon’s hand.  He could not close his fingers around it.  (It was really the size of a baseball, but part of my uterus had come with it, making it seem larger to me.)  As with the blood clots and such, it went off to the side out of my view.  (The fibroid turned out to be housing thirteen fibroids.)

I saw debulking occurring.  During my visit to his office when contemplating this procedure, the surgeon had told me that if adenomyosis was present, the upper third of the endometrial layer would be removed.  I watched him shave away the top of both halves and watched a part of me thrown to the side with the fibroid.

I could smell flesh burning when a laser was used prior to the uterus being sewn up.  His technique of long threads making knots was cool to watch.  They both worked with amazing speed.  I marveled at how my uterus became the size of his palm, about a third of what it had been. 

At one time, the surgeon and anesthesiologist discussed the World Cup soccer matches that were presently going on.  At another point, the surgeon was trying to get the anesthesiologist to make me sleep, though he did not directly say so. 

I felt great love for the anesthesiologist when he said, “We’re cool here.  Everything’s fine.” 

Again, the surgeon tried in a secret speech kind of way that I recognized both as a parent and as a practitioner myself. 

“We’re doing great.”                

I was so pleased that I got to remain awake, but was confused as to why he felt I should be asleep.

The sewing took a long time.  It was very detailed, thorough.  (Ninety-six sutures, I later learned.)  At times, my uterus resembled Audrey as a young plant in Little Shop of Horrors.  By the end, it looked like a fish.  I saw a fibroid about three centimeters cut off the outside of my uterus and a cyst taken from an ovary.  (Blood spurted out, so possibly a hemorrhagic cyst.)  Something was also taken from each fallopian tube.  The tourniquet was removed and a lot of what I thought to be saline solution was poured into my cavity.  Tools were used to aid in the lowering of my uterus back into my abdominal cavity.

I sighed.  It was almost over and nowhere near to a four hour surgery.  I had made it!  Unfortunately; though, my peace was about to be broken once again.

I saw three huge cloths enter the cavity and only noticed two bloody and wet clothes come out.  (When watching the DVD two days later, I saw three go in and three come out.)  When the surgeon asked, “Isn’t there one more?” I could not help but nod.  The nurse started counting everything immediately.  Over and over she recounted and recounted.  Always, it was yes that everything to come out, had.  Meanwhile, though, the surgeon roughly searched for the cloth, his hand and half his forearm disappearing inside me.  At one point, I saw my intestines in his hands and thought they looked pretty healthy, though I had never seen real healthy intestines before, so I am perhaps no judge.  I had only seen those in autopsies.

Out of nowhere, a dreadful pain rushed up my front.  It culminated with my temples pounding.  The anesthesiologist touched my forehead and whispered, "Everything's ok."  (Apparently, my heart rate had raced.  Perhaps he thought it an emotional response.  It could have been a physiological response.)  Later, I asked the anesthesiologist why I felt the rummaging through my tummy, and intestines when the surgeon held them.  He reminded me that the Vagus nerve communicates with the intestines, but also with breathing.  The epidural cannot shut out such a powerful, important nerve.  After all, usually, the surgeon would not be rummaging around like that.  I was pleased he searched—better safe than sorry, because I would have been the sorry party!

The unbelievable, suffocating sensation finally stopped.  He was satisfied.  All was well.  I was so relieved. 

Stitches were made here and there as I was being closed up.  The next solution made a foam as hydrogen peroxide does.  Then, what I thought to be saline solution was also used.

Soon I was looking at adipose tissue again through a small ellipse.  He sewed the two pieces of skin that had never been joined before together.

The anesthesiologist helped me to call the nurse over with the container holding the fibroid and other waste in it.  To the diseases, I said, “Thank-you.   You've taught me a lot.”  It went to the lab to be tested.

Soon, the screen was off and the blue sheet was coming down.  I knew a nurse had placed an abdominal binder on me, even though I did not see it or feel it.  As I was moved to my bed, I felt like a head floating in space.  I said, “Weeee!”

It took three hours in recovery for me to be able to move a toe sufficiently enough to be allowed to return to my room.
My road to recovery included suddenly dropping blood pressure and vomiting...always fun on a freshly cut up abdomen...fevers that came and went,  a cough for a weekend...another joy to the abdomen...and male stalkers when out walking the streets of my home town-stalkers from whom I could not run.  But, hey, the adenomyosis is long gone and within a month, my fingernails started to grow.  (My nails showed the poor state of my blood for many months.)

Note: When you are asleep during surgery, things may occur about which you may know nothing.  For example, the surgeon's report says nothing about the search for a cloth.  It had been traumatic for my organs, and yet, there was no mention of it.  My medical report was there to list how many sutures, etc., but I think it fair to the patient to document goings on as well.  The report also said that I awakened in the operating room, yet I never slept.  My mother, who had also viewed the surgery live from our room, did comment to the surgeon that the roughness with my insides, having his arm inside me like that, might have caused some bruising that may be sore to me.  He did not think it would be.  This talk happened while I was in the recovery room.

On September 9, 2014, Temple Community Hospital was closed down due to not being up to earthquake standards.  It is a shame.  The employees at that hospital were a wonderful team.  I am so grateful that this hospital allowed the surgery that saves the noncancerous uterus. 












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