One for the Books

I'm swimming up into consciousness. The air around me seems to go from black, to dark blue, to pale blue, and suddenly I blink as the brightness of dozens of fluorescent lights shines into my eyes... my first thought is that I survived the surgery (it's always the first thought that comes to your mind when you come out of general anaesthetic) and that I am in the quiet, concentrated bustle of the Recovery Room. As I focus I see a familiar figure standing at the foot of the stretcher. It's Dr. B., the head surgeon. Gathering my strength, I croak through an aching throat, "Did we get good placement?" I can see that he laughs out loud, then gives me an enthusiastic thumbs-up. I stiffly give him one in return, then, contented, pass out again.

I didn't even remember this encounter until Dr. B. reminded me of it when he came to visit me later in my hospital room. He thought it was hilarious. But I'm getting ahead of myself.

We drove to Halifax Tuesday morning and were lucky to head off a bad spring storm which hit that afternoon - driving rain and hurricane-force winds. We went to the hospital for our pre-op registration. We met with a nurse who gave a very basic interview consisting of name, address, review of what I was there for, asked which side the implant would be on (that's one); then we were passed on to an RN who interviewed us in much more detail about my medical history (allergies? seizures? heart conditions? etc. etc.), and who asked me which side the implant would be on (that's two). Then they drew blood for testing and matching in case transfusions were needed. I then met with an anaesthesiologist, who interviewed me about pretty much everything the RN had asked me, including confirming the side the implant was to go in (that's three times).

After that we went back to the hotel, where Husband had gotten a room which overlooks Citadel Hill. (I read a survey last year of Halifax tourist-industry workers that asked the most commonly-asked tourist questions. "Why is there a ship buried in a hill in the middle of the city?" ranked near #1, as I recall.) It was a nice room and I had a wonderful dinner of poppyseed-encrusted filet of salmon with pesto sauce (hey, it could be your last meal!) but it was a sleepless night.

At the hospital at 7:15 a.m. we began immediate pre-op processing. That included another detailed interview with an RN, with the same questions, including asking me to confirm which side was to be implanted (that's four). Then deeper into the bowels of the hospital to a pre-op waiting area. After a minute, I was called into an office where, yep, another nurse did another interview about medical history and asked me to confirm which side was going to be implanted (that's five). After that, I got to exchange my clothes for a johnny gown and a little green dressing gown and was parted from my luggage (bye-bye to Bunny, who I'd been clutching so far.) Then I was weighed, temp and blood pressure taken, and given another brief interview to confirm who I was, what I was here for - and which side was to be implanted (that's six).

Then it was 8:30. In the world of the OR department where surgery time is 8:45, this is apparently the equivalent of "places, everyone!" All us ladies and gents in the green dressing gowns were to follow an orderly to an elevator which would take us to the OR floor. I was lucky - at this point, everyone else was separated from the family and friends who'd accompanied them this far. Because Husband was interpreting for me, he was allowed to come with me right to the operating room doors.

So like little green ducklings we went in a line behind this big linebacker of an orderly and onto an elevator. (I noticed an older women behind me was crying a little and wiping her eyes. I wanted to say something comforting to her but in the absence of being able to hear her reply it seemed impossibly awkward.) Then we were ushered into an efficient little room with eight gurneys in eight little niches, all labeled - "OR 1" "OR 2" "OR 3" and so on. I was to be in OR 4, and lay waiting for what was next as Husband sat next to me in a chair the orderly thoughtfully produced and rubbed my arm.

Then they unleashed the Residents.

O! Lord! the Residents. Each patient got one. The ones that aren't trying desperately to look confident look terrified. They can't help it... they're too young, in their mid-twenties, to know what we see at 40. The lady next to me got a man who looked about twelve and terrified. I got a woman who looked 21 and was overcompensating. I suspected this when she walked confidently up to the bed, looked at Husband and me, and said, "I am The Doctor".

Oh well, it was too late for her to do any harm now, at any rate. But she asked a few questions and then asked me to confirm which side the implant would go on. That's a lucky seven times, folks. Malpractice suits have put an end to the bad old days, I guess. And since she was The Doctor, at least for this five minutes, she literally signed off on me, initialing my left cheek to confirm "PUT TAB A INTO SLOT B HERE".

Suddenly it was time to go, and I said goodbye to Husband and I was in the OR... an overwhelming sense of deja-vu from past surgeries and past ORs, from the sight of the great, huge, menacing lights over the operating table to feeling the contrast between the icy air of the room (ORs are kept very cold for some reason) and the warmed blankets they put over you to compensate... in the corner I could see Dr. B. and Dr. H. and some others looking at my MRI and making final battle plans... then, after the much-dreaded fight between the IV needle and my busted-up veins (the anaesthesiologist kept asking the OR Nurse to write "SORRY" on a notepad and I kept gasping that it wasn't him, it was me, it was always like this), I was sound asleep until Dr. B. gently shook me awake so that I could groggily ask him the only question that seemed to matter after "Am I breathing?".

"Did we get good placement?"

The next thing I remember was being wheeled into my room, where Husband was of course waiting. ("Private room," Husband noted. "You are either very popular here or you sure catch the breaks.") He told me the surgery went extremely well and that Dr. B. had told him he'd gotten excellent placement of the electrodes.

It's important to remember that inserting a CI is like gently pushing a string into a snail's shell. You must work the "string" - the tail end of the implant - around and around the curls of the cochlea. Ideally, the end of it reaches the very center of the spiral, and if that happens, the electrodes are placed as perfectly as possible along the cochlea, waiting to stimulate the nerve hairs there. Partial insertion - if the surgeon can only get some of the electrodes in, and those only at the outer curve of the cochlea - is a huge handicap to positive results. Good placement is the first step to buying a chance to hear again.

I wobbled to the bathroom on Husband's arm. I looked like hell. Half of my head and face was swollen and sore and my whole head was wrapped in a tight white bandage with a huge dressing over my left ear. It reminded me of nothing so much as those silent films of wounded soldiers from WWI. It hurt more than I expected... I'd expected pain at the incision site but hadn't realized the whole left side of my head and face would swell and ache and be exquisitely tender to the touch.

Thanks to the pain medication I dozed on and off for awhile, then came 'round long enough to send Husband back to the hotel for some sleep.

Around four in the afternoon, Dr. B. and Dr. H. came into the room looking extraordinarily pleased with themselves - like two little boys who had done something terribly, terribly clever. The operation was "exceptional", they said. They'd even brought a copy of my X-ray to show me. Goddamn. There is was, and he had gotten full insertion, too. Dr. B. reminded me of our post-op conversation, which I'd completely forgotten until he reminded me. He still thought it was hilarious that I was focused like a laser beam on that placement even as I woke up. Dr. H. said he'd be back to see me the next day (Thursday), and they left, the two of them still grinning like two cats that just got the canary.

Well, if they were that pleased, damn it, so was I.

Husband came back later in the evening. He said that there might be a change of plans - initially, the local ENT, Dr. Henderson, who'd first treated me, was supposed to do my first post-surgery examination and remove the staples (eek). But now Dr. B. wanted to see me himself in ten days. That meant yet another 8-hour round trip to Halifax and possibly another hotel stay. (Public medicine pays for the treatment, thank God; but not for the travel or for the accommodations.) Husband shrugged; we'd ask again tomorrow but for some reason Dr. B. wanted, for the moment, to see me himself.

The next morning The Resident Who Introduces Herself as The Doctor and a couple of other Residents? Interns? Who knows? came by and took off the dressing. They were pleased by what they saw but not as much as was Dr. H., who was practically beaming when he inspected the incision later. ("Are these people this delighted with every surgery they do?" I was beginning to wonder.) "Beautiful," he pronounced.

Later, unexpectedly, Dr. B. showed up again. "I wanted to see the incision [now that the bandages were off]," he wrote. He was delighted. He would see me in ten days, he said. Have Husband make an appointment with his secretary. I ventured to ask, "So... you wouldn't rather that Dr. Henderson, back in Fredericton, do the initial exam and take the staples out?" (Maybe, I thought, he'd forgotten we are so far away.) No, he wrote in my notebook. "I just like to make sure myself the first time. Want to make sure there's no sign of infection. I would prefer to see you myself." Of course, I replied. If that's what he wanted.

But it was Dr. H. in his earlier visit, who revealed the real reason why Dr. B. wants to see me himself. We had roughly the same conversation, with me asking if it was really necessary to come all the way back to Halifax in ten days when the initial plan was to have the staples removed in Fredericton.

"He wants to see you himself," Dr. H. said. "He wants to track this. This surgery is text-book."

So, an inconvenience and more time off work.

But for a hell of a reason!

(This is your doing, you know. All that prayer and chanting and meditation and white energy had to go somewhere.)

ronnie