Sunday, August 9, 2009

Surrender in the OR ... a Patient's Perspective

The following post (revised) was written last August (2008) ... 2 days before I was scheduled to go into the OR to have my last ureteral stent removed. I had been through a lot with urology issues and I was hopeful for good news from my urologist post-op because I had been trying to avoid having to have a Psoas hitch (ureteral replacement) surgery. I was considered high risk for the surgery because of other co-morbid conditions and would have had to go out to another facility and to a different surgeon. I was beginning to feel the pressure of the possibility... but was hoping for the best. And because I was so afraid of *the big surgery* and thinking about what it would be like if I was going into the OR for that one... I began thinking about all the other trips to the OR and my feelings regarding my patient experiences in various parts of the hospital, emergency, inpatient, SDS, Pre-Op, the OR and Post-OP.

I especially pondered the final surrender.

I am going back in the OR Thursday and so OR surgery and procedures are on my mind. I will be having this ureteral stent removed and the urologist will do a procedure to evaluate the status of my ureter to see if it is 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 it was a big stent) kidney spasms after the stent removal. It almost always happens.. I guess because the kidney is being disturbed. Not fun!

I've been thinking about the differences in my various surgical experiences. And how I feel knowing I have to surrender myself to my doctor and all the other staff, in the OR and in post-op. I have strong feelings about what feels like the ultimate surrender and I'll 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 what I really want to 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 ride to the OR was the day I was crying during the entire ride down to the OR from the 2nd floor and I was crying in the post-op area too. I was so embarrassed and was feeling so bad about something that happened the day before and someone triggered (they didn't know it) those feelings just before it was time for me to go down there... and the tears began and they wouldn't stop. It was the longest transport to the OR ever. I felt like the entire world could see me crying. We had to stop at a nurse's station to get tissues. Everyone probably thought I was afraid of the procedure.. but that wasn't it. I should've just pulled the sheet over my head! It was my urodoc who comforted me in pre-op. I never did that before and never will again.
When a baby is involved... you're filled with excitement and eager anticipation, although with our 1st son there was concern that he would be alright and even though I was greatly 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 from when I was in the OR. "Her ketones are high" The anesthesiologist saw me wincing in pain (although it now occurs to me he may have seen something on the monitors he didn't like) and asked the OB doc 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 the next thing was that I woke up as I was getting wheeled to my room.

With our second 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 am glad another woman shared her spinal experience with me. She told me she had gotten panicky when she couldn't feel herself breathing. Having that knowledge ahead of time did help me because I did feel uneasy about not feeling myself breathe, even though I knew that I was. It was an uncomfortable sensation. I will never forget Dr R coming over to me with Christopher crying, flailing his little arms and legs, holding him up near my head, and saying, "SeaSpray, SeaSpray...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.

And I was glad my husband was in there this time ... although I was worried about him because someone asked him if he was alright. I am so glad we got to share the birth experience! And I appreciated the other docs and nurses in the OR too. I was happy that a pediatrician I knew from work was among them. 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... the gowned peds doc stepped forward front and center and with a big smile said "I am!" Too funny! :)

Surgical experiences would be awful if it wasn't for the terrific staff in all areas. The patient is under enough stress and they should feel positive attitudes (as much as possible) prior to going into the OR. The patients pick up on all words and actions ...even if not directed at them. It is also possible they misunderstand a negative being said when it has nothing to do with them. It is imperative that you are careful with conversations with co-workers when you are anywhere near patients because you set the tone for the patient and you want them going into the OR as upbeat as possible.

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 too breezy in the OR and other related concerns. It was after this surgery that my OB/GYN 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 orthopaedic 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 in a way 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!

The kidney stone was stuck in the ureter. It was extremely painful and I had to go to the OR. I was scared, but couldn't get there fast enough. It's amazing how the excruciating pain, along with being so ill on top of the pain seemed to put fear in the back seat. I prayed silently while still in the emergency room... but I was anxious to get into the OR. I apologized for not shaving my legs. Of all the things to be concerned about! I thanked them all for helping me and then I was out. I woke up feeling much better.

Then the same thing happened 2 weeks later, 3 more stones were stuck in my ureter and another trip to the OR to have them removed and another ureteral stent placed in me. I thought I was done. This time... I was emotionally and physically drained. I was upset that I was going to be experiencing the exquisitely painful sensation of having the ureteral stent removed in the office in a couple of weeks... just as it was removed the day before. I wasn't afraid of the procedure because all I could think of was that I didn't want to get sick from the anesthesia (I was horribly sick from anesthesia after I left SDS 2 weeks earlier) and I did not want to endure the stent removal. Fear of that pain trumped any fear of my going into the OR this time.

I thought I was done with urology, but then 16 months later all the urology stuff hit me hard because that kidney stone damaged the distal end of my ureter causing scar tissue to build up which caused the completely constricted ureter and subsequent , pyelonephritis, hydronephrosis and sepsis.... and I was quote one of my urodocs "one sick lady". This was all so new to me and 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 remember my new 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.*

It was a difficult case. Then all the other urological surgeries/procedures after that were becoming increasingly more familiar. I was 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 the 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 you're hoping all goes well and you will 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 side being worked on. ? 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. You really get with the program when you're a frequent flier to the OR. :)

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 other times I will not be.

Everyone has their 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 had mentioned to the staff that from the point that I am told this is it and they're giving that last push of the medication...I fight it and try to stay awake as long as possible (competitive spirit ...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 in can affect surgical outcomes. I think that is an interesting demonstration of the power of the mind.

The PAT nurse recently told me I shouldn't fight the drugs 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 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 experienced 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.

So...I have been in the OR for 2 C-sections, 2 knee surgeries ( meniscal repairs) 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 another.

I have almost 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.
I had been doing well, but had a relapse with the ureter this past June, I was very afraid of going into 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 told me how concerned he was and how serious it was.

And I know this may sound silly by comparison... but I was so thirsty because I had been NPO since going into the ED the night before and now here it was Saturday night..approximately 24 hours later. I didn't tell anyone until I saw the anesthesiologist in the OR... but I was also feeling afraid because I was beginning to feel like I was losing my ability to swallow because my throat was so dry it felt like it was sticking together with every swallow. And I was also afraid that if urodoc couldn't get the ureter open... I'd be even more thirsty post-op and during the transport and getting into the OR at the other facility. I honestly didn't know how I'd do it... continue swallowing with no saliva in my mouth. But I didn't express those concerns.

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 was on the table in the OR and everyone was ready to start.. but they graciously let me do that. 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.

Thank God... my urologist was successful in doing what he needed to do to facilitate healing in me and so I didn't have to be transported to the other facility. I was so relieved when I woke up and heard the good news. :)
In the 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... at that moment in time... 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 the 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 working on me on the OR table. That really is the weirdest thought to ponder... that these could be your last moments on earth... even though in all likely hood you will be just fine. And having to trust another person so much with your life...well that is weird too. And that you just have to resign yourself to what will be... will be.

I know that my experiences pale in comparison to people having the more dramatic surgeries ... the ones that will make the difference between life and death... but still... it hasn't been easy and there are always risks... and no matter what kind of surgery... *the patient always has to surrender their self control, free will and their body.... that is a profound surrender... from one human being to another.*

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! ;) 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! :)
*Update: It is now August, 2009 and I am doing well since the stent was removed last August 14, 2008. I had a good report with the lasix renal scan I had done this past March. I will be having that moment of surrender again in a follow-up procedure in October. I am feeling good and believe I will get a good report from my urologist.

It's in the hands of my physicians now... my urologist and the Great physician. :)


QuietusLeo said...
This comment has been removed by the author.
QuietusLeo said...

This post is a masterpiece and should be required reading for everyone (even non-medical staff) in the OR.
The loss of control is a very important issue. I usually try to put the patient at ease and give them some control back with light humor: I ask what movie they would like to watch during the "flight".

SeaSpray said...

Hi QuietusLeo - Thank you so much for your kind words.I think it's great you try to put the patient at ease and your flight joke is hilarious! That would send me under laughing. :)

loss of control is so very important and with all those words I used..I still feel like I can't articulate what it really feels like.

Thank you for reading the post and feel free to share or use it.

P.S. You made my day with your comment. :)

QuietusLeo said...

Glad to be of service and thank you for your comment over at my blog!

SeaSpray said...

Your welcome Sandman. I added you to my blogroll too. You have a great blog and enjoy your thoughtful writing. :)