Monday, March 31, 2014

My Hospital Adventures, Part I

A lot has happened since I last checked in. At the time of my last post, on March 8th, my surgery was still nine days away and the real dread hadn’t yet set in. But when it came, it came gradually and then rapidly, kind of like this:

The hours just before surgery were the worst.

The procedure, even in its abbreviated form—RPLND—sounds awful. All those letters. The full name is worse, of course. Retroperitoneal Lymph Node Dissection. “High risk,” according to my surgeon and everything I had been reading on the internet. Six hours on the table, an incision running from my sternum to below my belly button, scalpels (and whatever else they use) slicing around organs, nerves, and two major blood pipelines—the aorta and vena cava.

I checked in at 5:30 on the morning of the seventeenth. Outside the hospital it was dark and quiet; inside the hospital, the only activity was from the few of us scheduled for surgery. Me and Shannon, an older couple, and two women. It was easy to identify which person in each group was headed for the table; told to wear “comfortable clothes,” we all opted for sweats and slippers. After we handed over our insurance cards and got tagged with wristbands, we shuffled over to the elevator and headed up to pre-op.

Prepping for surgery entails getting naked, being hooked up to machines, and waiting.

When you’re waiting to do something unpleasant, time does funny things. It’s both longer and shorter than usual. At one point I lay there for what seemed like an hour to see that only ten minutes had passed; another time, the clock had jumped from 6:30 to 7 seemingly in the blink of an eye. During all of this, I was visited by various people—all kinds of nurses, members of my surgical team, anesthesiologists.

At a certain point, you just have to give in and see yourself as a piece of meat to be poked, prodded, moved around, cut open, and put back together.

Close to 7:20, they wheeled me into the OR, put an epidural into my back, and not long after that I was asleep.

I blinked myself back into awareness in the recovery room. People were calling my name. I made no attempt to move, and nobody asked me to. I couldn’t have even if I wanted because of a few new tethers—two more IV lines (though they weren’t attached to anything), cables on my chest, an oxygen line under my nose, leg massagers, and a catheter.

They didn’t have a room ready for me, so I lay in recovery for a few hours, over which time I became vaguely aware of a dull ache down my middle. I had two triggers for pain—one upped the epidural and the other Dialaudid, a painkiller. While I was there, they continued to wheel people in from the operating room. The only one who made an impression on me must have had some serious sedation based on her anesthesiologist’s half of their conversation, the only half I could hear:



“MICHELLE! Can you raise your right hand?

“MICHELLE! Raise your right hand!


The first day was all about immobility, and only partly because of my huge incision. The drugs from the epidural had not quite distributed themselves evenly, so my right side was way more numb than my left. I couldn’t, in fact, really move my right leg at all.

I was in the first bed of a semi-private room. My roommate was a gravelly voice on the other side of the curtain. I asked him how long he’d been there, and he just said, “Long time.” Other than that, I only heard him say “No” (in response to the nurse asking if he wanted to get out of bed), “Pain meds” (in response to the nurse on the other end of his call button), and “Nausea meds” (in response to the same).

When lunch came that first day, the voice croaked out, apropos of nothing, “You should get the baked fish. I get it every day.”

“They’re not giving me anything yet,” I said. “Not even ice chips.”

“The baked fish is good. I get it every day.”

“They said I might get some liquids tomorrow.”

“Y’oughta try that baked fish.”

Okay, I thought. Please stop saying “baked fish.”

Shannon brought the boys to visit on Tuesday afternoon. I wanted to at least be on my feet for that, but nothing doing. Instead, a nurse’s aid helped me into a wheelchair and rolled me out to a lounge area, where I had the energy to visit for about a half hour.

On the ride home, Shannon told me later, Tony said that he didn’t like how everyone could see my butt. I didn’t have the heart to tell him that my catheterized wingwang had also been on pretty prominent display.

The next day they removed the main dressing and I got the first good look at my scar.

The days unfolded in long stretches of nothing punctuated by short bursts of intense activity—a nurse appearing to check my vitals and give me a shot, a resident stopping by to look at my incision, my phone ringing. This would go on through night, too. I’d be lucky enough to slip into some pocket of deep sleep, only to wake up as a nurse velcroed a blood pressure cuff on my arm.

And everyone asked the same question—Have you passed any gas?

I slowly shed my tethers—first the EKG cables, then the oxygen, and then the epidural. I wanted to start walking, and my main inspiration was my roommate.

I never really found out what was wrong with him, but he never had any visitors, and I overheard his nurses talk about moving him to a care facility. I thought he was pretty old, but one night, there was an Emergency marathon on the retro channel that he never seemed to shut off, and he said that he watched that show as a kid.

Holy shit, I thought. I watched that show as a kid. He couldn’t have been more than fifty.

He was in a bad way, but it was also clear to me that he was playing a kind of game with his nurses. During a shift change, I heard his nurse tell her replacement that he could move all of his limbs but refused to get out of bed. And at least twice a day, when his nurse suggested that he get out of bed and sit in a chair, he’d respond, “Nice try.” Once, he even warned the nurse, “I’m going to spoil your day today.”

Near the end of the week I was free of everything but my IV (the catheter came out Wednesday, and it was not a pleasant experience). I worked hard to get out of bed and into a chair by myself. To do that, and to then get myself out of the chair, I had to focus on using just my arms and legs. This is harder than it sounds; we use our abs for nearly everything. But whenever I’d use mine, a lightning bolt of pain would rip down the front of my body.

Once I could get up and out, I would amble, turtle-like, around the halls outside—first one lap at a time, then three, then as many as I wanted. There was a magnetic board with little cars on it in the hallway where patients could keep track of their laps (twenty-six equaled a mile, apparently), so I commandeered a green pickup truck and started keeping count. 

Every time I walked past that board and the sign next to it—“Bed is the patient’s #1 enemy”—I thought of my roommate, and how the nurses were now working on a new problem with him. He’d been constipated for four days.

“Ya better bring the dynamite!” he told them at least five times, inexplicably cheerful.

I’d hear this and think, Oh, hey, here’s an idea, Mr. Beddy-Bye: get up off your ass and stop packing your gullet with baked fish.

I couldn’t hang around that room. I walked lap after lap in the hall, and then I’d venture outside the ward and into the hospital proper. I kept track of the NCAA tournament games on my phone, and when a close one was winding down, I’d slip quietly into my room to catch the end.

Discharge came a day early—Friday instead of Saturday. The charge nurse removed my IV, went over instructions with me, and asked if I wanted to be taken downstairs in a wheelchair.

I didn’t. I worked hard to get walking again, and I wasn’t about to be wheeled out. Before I left, I wished my roommate luck. I felt bad for him. Life in a bed is no life at all. I had no idea what led him there or what was keeping him there, and I didn’t want to know. I hope I never know.

Leaving that hospital, I was happy to be heading home, and I felt a lot better than I had on Tuesday.

What I didn’t know at the time was that things were going to change over the weekend, and that in a few short days I’d be readmitted.

Saturday, March 8, 2014

False Peaks

When I biked across the country, my single worst day came pretty late in the trip. I was crossing from Tennessee into North Carolina on Highway 165, which is known around those parts as the Cherohala Skyway. My new friend Lawson—whom I’d met about a week earlier in Clarksville, Tennessee—told me that it was beautiful country.

And it was. Or I guess it was. It was kind of hard to pay attention because soon after I started out on it, I was climbing.

Obviously, at that point of my journey, I had done my share of climbing with a loaded touring bike. I’d already made it through the Lagunas in southern California, the Rockies in Colorado, and the Ozarks in southern Missouri. But the Appalacians—the mountain range I was crossing here—presented a different problem. Even though they’re not nearly as high as the Rockies, the roads are cut into them much differently—steeper and more winding.

I also had no real idea where I was. My phone read NO SERVICE almost as soon as I started up, and on my map, the road was little more than a squiggle through a big green field. No markers, nothing.

And then there were the motorcycles. Hoards of them passed me in both directions all day long, their motors chopping the air in rising fits until they’d appear either in front or behind me. I came to hate that noise, those thick tires, all that shiny chrome. I came to hate their riders, too, with those ZZ Top beards, leather vests, and thick, hairy forearms.

Okay, I didn’t hate them all. The ones who threw me a peace sign or a thumbs-up or a few quick taps on the horn as they passed, they were all right. But the others had to go. And so did their engines, which did all the work for them.

But the worst part about that day were all of the false peaks. I climbed for six hours, twisting and turning up and up, telling myself as I rounded a bend—panting, sweating, ready to fall over—that this had to be the last one, this had to be the top, the road had to level off here and start to drop.

But no. Each time I would curl around a wall of rock and trees only to find that I was still going up.

This day came back to me two weeks ago, when I met with a surgeon to go over my latest scans. After my fourth and final round of chemo, my doctor scheduled a PET/CT scan. The PET part of things checks for cancerous activity, while the CT would provide a picture of the tumor sites to see how they compared with the scan I had back in October, at the start of it all.

The PET was clear. No real surprise there; my blood had been free of tumor markers since the second round of chemo. The CT, however, was a different story. Not much change from before. The specialists involved—my oncologist, my urologist, and my surgeon—were in accord on two points. First, that the tumors were more than likely benign, and second, that they had to come out. Surgery. A big one, as it turns out.

The procedure is called a retroperitoneal lymph node dissection, or RPLND for short, and I’d been putting it far out of my mind since my initial forays onto the internet back in October. It’s an invasive, complicated, and, yes, risky procedure given the proximity of the tumors to a few important innards, like my aorta.

As my surgeon ran through the finer points—six hours on the table, maybe close to a week in the hospital, a couple of other details that didn’t make it through the blood pounding in my ears—I kept thinking about that road that climbed forever. I felt like I was on it again. Just when I think I’ve crested, just when I think I can start to cruise a little bit, I turn the corner to find another false peak, that there’s still some climbing to do.

It started to feel like too much for me.

And then I remembered how that day on the Cherohala Skyway finished up.

Things came to a head late in the day. I was on hour six of the climb when I saw a little grassy area with a picnic table off to the left. That was it for me. I’d had enough and pulled over to camp for the night.

I leaned my bike against the picnic table and changed out of my soaking jersey. Feeling a  little better, I unhitched the bag containing my tent and sleeping pad from the rear rack and let it drop to the concrete pad with what I thought would be a definitive thump, but it caught the edge of the table and rolled onto the soft grass with hardly a sound. The only place to pitch my tent was on a narrow gash of lawn that almost immediately became forest. A quick rummaging through my handlebar bag revealed the contents of my larder: a few almonds, dried blueberries, and a pouch of tuna.

It was overcast and cool as the day headed into dusk. A blanket of trees defined the contours of the rolling mountains, and pockets of mist were starting to form in some of the indentations. These were the same woods that lay just beyond the picnic table; I could walk into them and within ten feet the road, these tables, and my bike would all disappear. In a few hours the forest would come alive, its inhabitants looking for food.

I remembered reading that bears could smell food up to eleven miles away.

The road had been empty for a while. Did the police patrol it at all? Maybe a state trooper would rouse me from my tent in the middle of the night. Better that, I figured, than a bear looking for my nuts and berries and tuna.

My phone still read NO SERVICE. If something were to happen, I had no way to call for help. And under a thick blanket of night, even with my lights, escape might be more dangerous than staying put.

At that point in my trip, I should have been more immune to the indecision of the road than I was. I walked to the edge of the grass trying to make something materialize in the forest, some clue that would tell me if I’d be safe that night, but there was nothing.

I picked up my bag, not sure what to do.

I’ve got to get out of here.

I’ll be fine if I stay.

No, I’ll die if I stay.

It was six-thirty. With rows of mountains behind me, the sun was already invisible, and its remaining light was being swallowed by the long shadows spilling from the forest. In another forty-five minutes or so, those shadows would roll right over me.

I decided to go for it.

And what did I find? The summit of those Goddamn mountains that I’d been climbing all Goddamn day was slyly waiting for me barely a half mile up the road. As I crested the top, I took a deep breath before hurtling down—beating the bears, beating the dark, beating my own bonked out, noodle-like legs—to a little town called Robbinsville.

So I’m hoping that this surgery on the 17th isn’t another false peak, that there won’t be any complications, that I won’t have to go through another round of “insurance” chemo. I’m ready for this road that I’ve been on since last October to start to level off.

But if it doesn’t just yet, I know what I’m supposed to do. Keep pedaling.