Wednesday, January 4, 2012

Surgery.

A little before 5am the morning of December 6th my parents and I made our way from Arlington, Virginia to Baltimore, Maryland and to Hopkins. I had a MRI scheduled for 5:45 am. This MRI was called a "wand" MRI. Before the test the tech put green foam stickers on my head. These stickers are able to be used to create a GPS like map of my brain and tumor and were also able to be used during in-surgery CT scans to help the surgeon remove the most tumor tissue possible and do the least damage to healthy brain tissue. Pretty cool technology and amazing I think. Unfortunately I didn't take a picture of the green foam look but I found one online to give you an example of how I spent the rest of the morning walking around the hospital since I wasn't able to take them off.
I didn't have quite that many, but enough.

The next part of the day was the most frustrating I think. If I had to say one bad thing about my experience at Hopkins (besides from the food) it would be the pre-op preparation I got...or didn't get. While I had that "just do it" attitude it still would have been nice to know not only what the surgery would entail and what to expect, but WHERE TO GO! I was never told what to do after the MRI and Hopkins is a BIG place. So we went to the most logical place to us...the inpatient admissions office. There we were told that I needed to go to outpatient admissions...seems weird but apparently that's where people are admitted preop even if staying the night. So that was a 20 minute walk from where we were so we headed off. Guess what? NOT where I was supposed to be. They directed us to the neurosurgery clinic, which was in the same building...but they didn't say it was the clinic, just where we should go. It still wasn't right but at least I was within the right department and someone there was able to make a few phone calls and figure out where I needed to go. Of course this was back in the first building, another twenty minute walk, we got there around 7:30. Luckily we definitely weren't late for anything because we were told I was scheduled for "sometime" that afternoon, but because there was a possibility of one surgery getting canceled they would "prep" me right away. 

"Prepping" consists of being stripped of personal belongings, being given that dreaded blue gown to wear and sitting on a stretcher in the corner of a curtained "room". Oh yes, I did the routine admission questions with the nurse, had an IV put in, labs drawn and fluids started, but then we sat there for the rest of the morning and into the afternoon without a word on my surgery. Three people came and went from the room next to me and I was still there, entertaining myself with DVD's and texts to/from friends and family. My dad on the other hand may have caused some minor trouble pushing buttons just to see what they would do...

At 2 (six and a half hours later), my surgeon showed up to talk with us. This was the longest time I spent talking with him before the surgery. He went over risks/benefits etc., explained to us the use of the intra-operative CT scanner, special neuro-monitoring I would receive in which acupuncture like needles would be inserted at different areas of my body and attached to a computer for specialized monitoring and how he was planning on using a larger incision so that the majority of the scar would eventually be completely hidden under my hair. He apologized for the bad haircut in advance, which I have forgiven him for :-). Then he went over the consent forms and I finally signed myself completely over to him. Now here's the funny part...I signed three forms for consent for surgery, I then had no less than TWELVE forms to sign giving consent for them to use my tumor and blood samples in research. Twelve. That's kind of crazy, I mean, of course you can use it for research...I certainly didn't need it. If it weren't for hundred's of people who had gone before me these treatments wouldn't be available to me now, but I thought there should have been more concern over the surgical consent than the research one. Then he asked me where he was doing surgery...uhh the RIGHT side of my head please (I forgot they do this as a safety check before surgery) and he put his signature in big purple marker right across my right forehead. (I was actually his 5th case for the day but I wondered how many people were marked by that same purple marker every day).

Once he made his appearance things started moving. My OR nurse came in and introduced himself, made sure I was free of anything "extra" (clothes, jewelry, etc) and to see if I had any last minute questions, which for him I didn't. He told me anesthesia (good, the ones I wanted to talk to) would come by and then they would bring me to the OR. So anesthesia came in shortly after, an attending and a fellow. The attending was the first person to tell me she had looked over my history, knew I worked in an ICU and therefore was going to tell me exactly everything they were going to use and I could ask questions if I didn't understand anything. I appreciated that, and it's nice to know that someone had read up on me beforehand. She told me which drugs they would use for induction and throughout the surgery, she also told me it would take about an hour for them to do their thing, since they put patients with increased ICP under very slowly to not cause drastic pressure changes. I really only had one question though. Did I need an a-line?

For my non-nursing friends, the "a" stands for arterial. It is basically an IV that goes into an artery, typically the radial artery in the wrist. It can continually monitor a patients blood pressure and labs can be drawn off it without having to stick the patient. Since I have started working in the ICU, and seen many of these lines placed into patients, I have always said that is one of the things they would have to seriously knock me out for before trying. The reason is because the artery is much deeper than the vein, I have seen way to many doctors "fish" around to get this line in, sometimes for hours. They must extend the wrist back and insert the needle at almost a 45 degree angle...though sometimes it looks like almost 90! It is very painful looking, leaves major bruising and, while less common in adults, can cause serious injury if done improperly (like loss of fingers/hands/arms). I didn't want one.

The anesthesiologist seemed pretty surprised by my question (I guess it's not one she gets asked often). She responded by taking my pulse, and then saying yes, I would need an a-line. Of course I asked why...I wasn't having cardiac surgery and I was expected to be extubated (taken off the breathing machine) right after surgery. She explained they could better monitor my intracranial pressure by having an continuous blood pressure reading. Oh. Ok, I guess that makes sense...so long as she promised to knock me out first! She promised. (Though, thanks to the four insertion points and massive bruising I had I suspect her fellow got to practice his a-line skills on me, but at least I was knocked out).

Then, just like that we were off to the OR. I wasn't given any sedatives before going (my aunt, an OR nurse was shocked). Maybe because I seemed so calm? I don't know what their reason was, I wasn't offered any sedation so I didn't realize it was unusual. My parents took my things and were instructed on which waiting room to go to, and then, at about 100 miles per hour, we were off. Why we had to get there in such a hurry I don't know. The OR was in a more of a dungeon looking area of the hospital. The halls were small, crowded with OR equipment not being used and dim. On our way the fellow started asking me about working at Children's and how he had done a residency there and never saw me...umm, really, small talk now? All I could think was that I hope he never goes back to Children's now that he's getting the chance to see me and all my glory, including the inside of my skull.

When I was wheeled into the OR room I was first surprised about how small it was in there, granted there was a lot of equipment. I didn't have time to take it all in but there was the cat scanner, ventilator (anesthesia vents are also MUCH larger than ICU vents), the table I would be on, many many monitors, computer screens and video screens. Besides my nurse there were also at least 6 other people in the room, who barely even looked up as I was wheeled in, hunched over different computers and pieces of equipment. All I could think was wow, there was a lot going on in here for little old me.

The last things I remember are getting onto the OR table. My arms were strapped down out to the sides and my legs together at the bottom. One anesthesiologist gave me a dose of versed, the other put a mask over my face. My last thoughts were that I didn't like the mask, it made it hard to breathe. Then I was out. My life in these strangers hands.

2 comments:

  1. Thanks for sharing your surgery story. I am going to be having my brain surgery in June. It's good to get an idea of what I'll be in for when it happens.

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  2. Good luck! If you have any questions please feel free to ask!

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