Tuesday, August 12, 2008
Surrender in the OR (My experiences and Perspectives)
I am going back in the OR Thursday and so OR surgery and procedures are on my mind. I will be having this stent removed and he will do a procedure to evaluate the status of my ureter to see of it remaining open, etc. I am expecting it to be uneventful with good results. I am actually more concerned with post-op because I get sick from anesthesia, sometimes chills in post-op, but not always and I am anticipating significant (because big stent) kidney spasms after the stent removal. It always happens.. I guess because the kidney is being disturbed and so it spasms? NOT fun. And you know...I never asked why. ???
I began to think about the differences in my various surgical experiences. And how I feel knowing I have to surrender myself to my doctor and all other OR staff, in the OR and in post-op. I have strong feelings about it and will come back to it at the end of this post.
It's a weird feeling heading off to the OR on a stretcher. And I feel a little embarrassed too. That's silly... I know, but I just don't like not being in control and not able to do for myself.
I also feel shy while being wheeled through the halls, but I am a friendly person and so smile or say hi when really what I want to do...is slink right down and under the sheets with my face totally covered. It is my doctor and other staff that make it bearable.
The worst was the day I was crying the entire ride down to the OR from the 2nd floor and was crying in the pre-op area too. I was so embarrassed but was feeling so bad about the day before, that I may have backed up my doctor's and his partners day and messed up my family's day and hospital staff in various departments... the whole trickle down theory in progress. It was my urodoc who comforted me in pre-op. I never did that before and never will again. But I digress.
When a baby is involved...it is filled with excitement and eager anticipation, although with our 1st son there was fear that he would be alright and even though disappointed at not being awake for his birth..I was welcoming the relief from pain. My first born son was my first surgery. I was afraid, I prayed silently and believed for the best.
I only remember 4 things. "Her ketones are high" The anesthesiologist saw me wincing in pain and asks the OBGYN if he could hurry up to which the Dr retorted "Do you want to do it?" Then I was told to count backwards...I remember the ceiling to 96 and then I woke up getting wheeled to my room.
With our second son...it was very different. I wasn't afraid like the 1st time because it was planned. I felt more in control because I was awake... even though anything could've gone wrong. I still prayed. I was more nervous about the spinal and felt weird when I couldn't feel myself breathing..but am so glad I was awake for his birth. I will never forget Dr R coming over to me with Christopher crying, flailing his little arms and legs, holding him u, and saying, "Pat, Pat...LOOK!" and smiling. :)
They had a hard time with the spinal (not fun) and I guess my OB doc was afraid I was going to roll off the table because the next thing I know he ran forward, sterile hands in the air and guarded me with his body at my back. And it's funny the things you remember...he was talking about how he had a picture of the NY skyline in his office (it was nice) and every so often how he just has to go in to the city because he enjoys it so much. He died way too young. :(
And I was comfortable with my husband and doctors there and happy that a pediatrician I knew from work was in there too. He was funny because when I first got up to OB and the nurse started asking questions, she asked who my husband was (he was still downstairs signing me in) or something like that but before I could get a word out... B., the gowned peds doc stepped forward front and center and with a big smile said "I am!" Too funny! :)
The 2nd C-Section was my most fun and relaxed surgery. I felt in control because I was awake and it was fun and for a happy reason. My one regret is that they gave me versed after the delivery and I don't remember the rest. The following is an excerpt from a post I did in my 2nd month of blogging in which I discussed my concerns about being to breezy in the OR and other related concerns. It was after this surgery that my OBGYN enlightened me as to the effects of Versed. I was not a happy girl and have been squirrelly about it ever since. Here is the excerpt: "I was expecting to experience the immediate post delivery events along with chatting with the Doc and staff. When I saw him the next day, I asked him why he put me out as I was hoping to talk afterward. My doctor said "You talked the whole time, but we gave you Versed and so you don't remember anything." I am sure my expression was priceless, that of OMG - WHAT did I say? I didn't say that, but he looked somewhat amused, which unnerved me all the more. That was 18 years ago and it STILL bothers me now that I am remembering it again! At the time, and through certain resources I had within the hospital, I was able to find out what happened after the delivery. According to someone in there with me, I kept saying the pressure hurt, etc. and they didn't say that I said anything else. However, knowing me - I probably did say it hurt and I probably DID talk the WHOLE time...sigh."
Then going off for the knee surgeries (two) I prayed..I was nervous but not bad and I expected a good outcome. I honestly don't remember anything about them other then my terrific ortho doc joking and making light talk with me and the transport person on the way into the OR :)
Then the urology issues began with my first kidney stone in May 2004.
I have felt so powerless during ALL the urology treatments. And I have experienced intermittent fear like I never did with any other surgeries. I was afraid for my 1st born son but also trusted everything would be alright. But after working in a hospital for so long...I've heard stories and know that even simple things can go wrong when they shouldn't. Ignorance IS bliss!
It was emergent and extremely painful and I had to go to the OR. I was scared, but couldn't get there fast enough. I apologized for not shaving my legs and I thanked them all for helping me and I was out and woke up feeling much better. Then the same thing happened 2 weeks later. I thought I was done.
But then 16 months later all the urology stuff hit me hard and I was ...to quote one of my urodocs "one sick lady". I didn't understand much of anything. I felt powerless and afraid that entire week. And I was so sick and weak. I knew people were praying for me, but I hardly prayed. I had never been that sick in my entire life. Maybe the drugs I had all week subdued me. I do remember that I was afraid of getting sick from the anesthesia and was speaking to the anesthesiologist about it. I think I remember my urodoc (who was a stranger to me then) behind my head while going in. Powerless is the best description of my feelings going in to the OR that day. I didn't know anyone. I didn't have options. I was just resigned to my fate.
Then all the other urological surgeries/procedures after that were becoming increasingly more familiar. I was even getting to know the staff in the various areas and actually derived some comfort in that because they were so terrific. And of course... I was getting to know my urologist and my trust in and respect for him grew as time and procedures went on. I knew (still do) that I was in skilled hands.
Yet..even though there was a certain comfort in the familiarity of it all... there still comes that moment when you say good-bye to your loved ones or friends...your leaving them and all that is truly familiar behind... and hoping all goes well and you come back to them healthy and better than when going into the OR. And then you are wheeled into the pre-op area where they gather and verify info. It is always so cold...but I love it. And this is where you get the 1st phase of your happy cocktail.
For some reason though...they don't seem to know your left from your right and these med professionals with degrees and licenses have to ask you to tell them if it is your left or your right. ? ;) I'm KIDDING!
And then you go through the OR doors. That is the point where I feel this is it..and the anxiety starts to creep in. I joke - they joke..I think we're all pretty funny! But I know it is a matter of minutes at this point. It's cold in there too, but again..I do like it. I Know where to go on the table...I can skootch with the best of em. I am aware of everyone there and yet even with the laughs..I am keenly aware it's close. I imagine what it is like when I'm out but I really don't know. I am trying to get a quick prayer in yet again. They strap my arm to something. Sometimes I am told I will be intubated and others I will not be.
Everyone has there role to play. But the two people that stand out the most in the room to me are the anesthesiologist and my doctor. It is my doctor who eases my anxiety the most...and he is pretty quiet..but I don't care..his presence is the anchor..because he is the one that got me through all the other storms. Unfortunately he isn't always able to be there..and I admit I feel the void.. and then I am asleep. But he usually is and I feel more comfortable knowing he is there. I know all the staff takes care of me but he is the one that does all the work, knows me the best and who I trust the most. I have even asked him to limit OR traffic if possible after watching an OR video on the web. I do believe if it is possible he would.
I had mentioned to the staff that from the point that I am told that is it and they're giving that last push of the medication...I fight it and try to stay awake as long as possible...but they always win. ;) An x-ray tech told me that isn't good to do because the patient can then wake up restless.
I heard/read something somewhere recently that the mood you go under the anesthesia can affect surgical outcomes. Is that true? Or only in certain cases? I think that is an interesting demonstration of the power of the mind.
The PAT nurse recently told me I shouldn't because I could get an elevated heart rate post-op. I know I have had tachycardia post-op.
So... this Thursday... I am not going to play my little competitive game with the anesthesia, but rather I am going to envision the ocean surf and imagine the light sea mist gently falling on my face from the sea spray created as the waves crash against the shore. :) Maybe I will throw in a few seagulls, seashells and sunshine too. :) It will be interesting to see if I have a normal heart rate post-op. (If I remember to ask or hear them talking in post-op)
For me... in the OR.. the joking with staff and seeing my surgeon are what calm me and put me in a good frame of mind before going completely out. My urologist is the surgeon who has been with me through thick and thin with these urological concerns and so he is like the anchor in the storm to me. I just feel more secure with the visual of him being there. Kind of like you know you can contentedly close your eyes because you know you are in safe surroundings...as much as you can be anyway. And the humor...well that is ALWAYS appreciated. When you're scared...there is nothing like laughter to break the tension. :)
It is an odd, somewhat insecure feeling when it comes to the point where you know you have to totally surrender your free will and your body into the care of others.
I really appreciated Dr Schwab's post "Taking Trust" (still my favorite and I strongly urge you to read it) where he eloquently describes the profound feelings he experiences while performing surgery on his patients. And I think what he said here is very sweet: "Having held the patient's hand as she goes to sleep, having whispered "We'll take good care of you" as his eyes flutter to stillness, the personal remnant is still very much there as I begin, even as the person is covered in sterile green paper, exposing only the belly." They must go under feeling somewhat safer and more reassured that everything will be alright... because he is in control...looking after them and doing his best to facilitate healing in their bodies.
I have been in the OR for 2 C-sections, 2 meniscal repairs (knee surgery) and multiple urology stent procedures, sometimes involving additional work prior to my urdoc's placing the stent. Or it is to remove or replace certain stents and then sometimes for just a follow-up procedure.
In one of the intros to a Grey's Anatomy show..the prologue opened with "There are inherent risks with all surgeries." and I knew that every time I went into the OR.
I never questioned much until the urology issues began...but that was because it seemed so serious by comparison. Fortunately...I had never been so ill, until the 1st kidney stone which then got the urology ball snowballing me into the OR with one procedure after the other.
I have always prayed before going into the OR. I knew things could go wrong but truly didn't dwell on that. I believed for a good outcome.
But things have been different for me with the urology surgery/procedures. And perhaps with the other cases ...ignorance was bliss.
On Saturday night, June 7th I was very afraid of going in to the OR... even though I trust my urologist implicitly. I understood how sick I really was...that I had a dangerous blood infection. I was concerned the old damaged constricted part of the ureter was blocking which would mean that I would have to have the major ureteral reconstructive surgery that I managed to avoid in 2006/2007. I would be high risk and so I just did not want to do it...and I didn't want to do it now.
My urologist told me that if he couldn't get it open that I would have to go down to a larger hospital that night to have a tube placed in my kidney. I didn't want that or all the things I was imagining would happen after that. Now in my heart...I really did believe he could do it but because he said that...it told me how concerned he was and how serious it was.
My urologist was most reassuring to me that night and it helped tremendously! But even so...for the first time ever in any of my OR experiences...I asked them if I could say a prayer out loud...and so I did. I prayed for my doctor and the other OR staff and I prayed for me. That was me in the OR laying my heart bare fore all to see. I was just that scared...even though I also believed it would be alright. I guess you could say that I was covering all my bases.
I do hope I didn't offend anyone or hold them up too much. I feel a little embarrassed and wonder what they all think of me now. But...I would do it again if I felt the need. And I am not sure why I felt the need to pray out loud this time. I always pray for my doctor, the other staff, people concerned about me and me. That is a given but I do it quietly. But that night...I guess I needed to pray out loud to make it more concrete in my Morphine foggy brain. And I secretly hoped that some people in there might be praying with me because I really do believe in the power of prayer.
In the end...as I am being wheeled into the OR, getting set up and aware that in just minutes my life and fate is in the hands of others...I don't really have words for it. I KNOW their are risks. I realize that I am powerless to effect the necessary healing for myself and must rely on the skilled expertise of the surgeon and staff. I am just resigned to the fact that it will be what it will be...and I am hoping I wake up on the other side of the surgery with good results.
I do believe it...but there is always that...last glance around the room or up to the ceiling, knowing that I am right then surrendering my mind and body to them. The happy cocktail reduces the anxiety to a point... but right up to the end I am keenly aware that while not likely, something could go wrong or not as important... I may say and do things that I would regret if I knew I got too breezy or cried out in pain or whatever we patients do.
And my PAT nurse I had this time said people do say things. AHA! I KNEW IT... DARN IT!!
I did leave one description out. I also feel hopeful... hopeful that I will be fixed. Admittedly the hopeful is buried under all the other emotions... but if it wasn't for hope... I wouldn't be rolling through the OR doors in the 1st place.
And truly... it is my wonderful doctors and medical staff, with their upbeat attitudes and compassion in all the areas along the way, pre, during and post-op... that make it all bearable. If any doctors, nurses or other medical staff happen to be reading this... I just want to say you are much needed and appreciated and thank God for people like you who have dedicated their lives to facilitating healing in this life or helping a patient transition to the next life. Thank you. :)
The weirdest thing of all about being an OR patient for me is being resigned to whatever outcome and that there is a possibility, even if ever so slight...that I could be looking down at all of them and me on the OR table.
And yet... while the serious thoughts are running through my brain I am simultaneously worried about whether or not my legs are shaved. What can I say? Priorities! ;)
And...by the way... with ALL of these thoughts going on under the surface... the OR staff just sees me laughing and joking with them. I've always been good at multitasking! ;)
You know what else is weird to me...not as weird as the final surrender to doctor and staff..but still weird. There are people who never darken the doorways of an OR with their presence their entire life. Most of my family and my in-laws have not. And yet I have been such a frequent flier that the staff and I are getting to know each other and I am so familiar with the routines that no one really has to tell me anything.
And with all these frequent flier visits, the medical bills keep piling up.Too bad I don't get paid for it... um like .. oh I don't know... for giving staff the opportunities to hone their skills. I'm just sayin. ;)
I am just grateful I haven't had to have big surgeries and God willing... I will be able to avoid the re-constructive urology surgery. Hope springs eternal!
P.S. I am so looking forward to my new found freedom being STENT FREE!!! I've caught myself smiling thinking about the things I plan on doing with my new FEELING GOOD freedom. It's less then 2 days away and I cant wait! :) :) :) :) :)
O.k. I've never experienced this... but when I was in the OR for an emergency procedure on June 7th, I went under thinking about McDreamy and Grey's Anatomy. A girl can Dream! My last remembered thought on that side of anesthesia is that I actually remember it as some OR person asking me if I watched Grey's Anatomy and I answered that I don't watch much TV, but that is my favorite show. Then my next thought/image was of McDreamy in his scrubs- his face and dark hair with his scrubs cap on... and I was out. I've wondered if there was some kind of conversation that I am remembering a part of. I think so because I never remember being under. DARN VERSED!!
So CUTE!! :)