A Post-Surgical Update

 

Here is how Johns Hopkins describes the surgery I had on Thursday: “A transurethral resection of the prostate (TURP) is surgery to remove parts of the prostate gland through the penis.  The surgeon reaches the prostate by putting an instrument into the end of the penis and through the urethra. This instrument is…12 inches long and .5 inch in diameter. It contains a lighted camera and valves that control irrigating fluid. It also contains an electrical wire loop that cuts tissue and seals blood vessels. The wire loop is guided by the surgeon to remove the tissue blocking the urethra one piece at a time. The pieces of tissue are carried by the irrigating fluid into the bladder and flushed out at the end of the procedure.”*

Four days post-op, I’m seriously fatigued and bored out of my mind, but aside from the fact that it hurts to pee, my pain has been minor. I can slowly start working my way toward normal functioning in two weeks, at which time I’m supposed to let bleeding be my guide to what I can do.

 
I told the anesthesiologist (a delightful man named Albert Cho) that I wanted to stay awake for what was supposed to be a 90-minute surgery—but ended up taking two hours—and he readily agreed. There being a drape between us and the other five or so people in the room, we had an intimate conversation that I would enjoy sharing if I knew he would be okay with it. 

Surgical tables are hard, and the longer I lay there, the more my back hurt. When I asked for relief, he gave me Fentanyl. The pain didn’t go away until I hit 200 mcgs, an apparently large amount that I could only tolerate because I’ve taken narcotics every day for years. Fentanyl is awesome. I was wearing a Fentanyl patch when I crushed my thumb (after breaking my back) in 2014. When I realized that I had closed the bathroom door on my thumb, I said to myself, “That must hurt...” and then, “By god, it does hurt!” and I opened the door.

When the surgeon visited me in recovery, I asked if there had been a problem, and he said no. I knew this couldn’t be altogether true both because of how long the surgery took, and because there had come a point at which the people on the far side of the drape had switched from talking to whispering. When he left, I asked my nurse (who hadn’t heard my conversation with the surgeon) what had happened, and she said I had bled more than expected, and the surgeon had thought it prudent to keep me in surgery a while longer. 

Recovery rooms are dismal places, what with people moaning, puking, and talking out of their heads—and that’s just the nurses—but I couldn’t go to a room because they were all occupied. I worried that I might have to spend the night in recovery (which has sometimes happened at Peggy’s former hospital), but my nurse predicted that I would be out of recovery in an hour or two, and she was right. My room being ready, off I went to meet my nurse, 27-year old Kristina, with whom I felt an instant rapport. I was so happy to have the surgery behind me that I babbled like a chimp. Before our time together ended, I was in envy of the man whose luck it is to be her father.

I left surgery with a double lumen urinary catheter, which consists of one tube carrying sterile water in, and another tube draining blood, clots, and urine out. Before entering my urethra, these tubes were joined together in a larger tube, which was taped to my thigh at one end and secured to my bladder with something resembling a balloon at the other. The balloon’s pressure made me imagine that I had to urinate, but there was nothing I could do about it. Nearly all of my post-op pain is due to the fact that it hurts to pee. My penis is black and blue, and my urethra feels sunburned, yet all of my post-op pain combined is minor compared to the back pain I’m in daily.

Most hospital nurses work twelve-hour shifts (hospitals appearing to be okay with the fact that consecutive twelve-hour shifts result in medical errors, job burnout, and car wrecks involving nurses who fall asleep at the wheel), so at 7:00 that evening, Kristina was replaced by Yani, whom I also liked and trusted. Before Kristina left, she said she would see me the next day. An hour before shift change the next morning, Yani said the same, so imagine my dismay when a gruff man with a loud voice—and a student nurse in tow—was introduced as my new nurse. I seek to avoid loud people, so his volume combined with my unhappiness over what I regarded as his hypermasculine persona, led to an unhappy relationship. On the other hand, he seemed competent and showed pride in his work, so my only real objection was that I didn’t care for him, and I didn’t think he cared for me. 

I tried to find out why Kristina had been replaced, but no one knew, although they admitted being surprised by it (I also learned that Kristina had spoken highly of me). I hate having to put up with things that make no sense to me, especially when I’m paying for them.

Before being sent home, I had to pass a two-part test. In part one, I had to pee into a urinal and show the result to my nurse. Part two was identical to part one. Had I flunked, I would have been sent home with a catheter that drained into a small bag during the day and a large bag at night. I easily passed, but my urine continues to be bloody, and I’m told that it might remain that way for quite some time. When I’m not peeing blood, I’m dribbling blood, but the nursing student who prepared me to go home offered nothing with which to catch the dribble. When I asked what she proposed, she gave me a stack of abdominal dressings, but I found that blood passed right through them, so I switched to stuffing my underwear with old washcloths, which cost nothing and are adequate for the task. Some men spend the rest of their lives dribbling, so I can but hope for the best.

 

*https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transurethral-resection-of-the-prostate-turp

On Last Week’s Surgery and this Week’s Surgery

Last Friday (April 8), I had a posterior capsulotomy. This is a laser procedure in which a hole is cut through a cloudy, post cataract surgery lens in order to allow the cloudiness to dissipate. So far, I’m not seeing any great improvement in vision, but the resultant floaters are driving me nuts. They are large and appear to move more rapidly than ordinary floaters. Depending upon where I am looking and how distant they appear, I mistake them for gnats near my face, roaches on countertops, and spiders on walls and floors. Yesterday, I sidestepped what I mistook for a mouse crossing my path. I am told that the floaters will “probably” get better.

Later this week, I’m to have a transurethral resection of the prostate, which is the name of a surgical procedure that’s performed through the penis in order to reduce the size of an enlarged prostate. Death is unlikely (one man in a thousand), but incontinence afflicts ten out of a hundred, five of them long-term or permanently.

I’m up to twenty-plus surgeries depending upon what one counts as a surgery (is a posterior capsulotomy a surgery?), but instead of growing accustomed to them, I dread them increasingly because: (1) the risks worry me more; (2) the care I receive is often impersonal and sometimes egregiously callous or glaringly incompetent; (3) Whether they’re minor or major, somewhere along the line of the many people and departments that are necessary to make a surgery possible, mistakes happen, always; (4) The older I get, the more slowly I heal; (5) I have to be at the hospital hours before I usually get out of bed, and surgery is a crummy way to start the day; (6) I chafe under the limits imposed upon me during convalescence (I’m not supposed to lift more than ten pounds for six weeks following this surgery, which is nothing compared to the limits imposed after rotator cuff repairs and major joint replacements).

I try to reconcile myself to the things I fear or dislike by remembering that, if things go well, my life will be better for having had the surgery, and that I should be grateful to have access to medical care that is denied to most of the world’s people. In the 1950s, I saw my impoverished grandmother go blind in both eyes for want of cataract surgery, and after five hernia repairs, I know something of how miserable and limiting hernias are (I try to put myself in the shoes of a poor laborer whose family will starve if he can’t perform heavy labor, but who is sure to die a horrible death from bowel strangulation if he continues to work). 

A hundred years ago, the average American man died at age 59; today it’s 76, and without modern medicine, I would already be dead. I remind myself of such things, but counting ones blessings can make a person feel bad about himself for complaining at all. By way of comparison, if you try to reconcile yourself to having a toothache by telling yourself that your problem is nothing compared to dodging missiles in Ukraine, not only will your tooth hurt as much, you will hate yourself for being a whiner and a wimp.

 

Update: My speech difficulty being worse in the morning, Peggy  called the hospital an hour ago to ask why we haven’t heard from the anesthesia department (they invariably schedule pre-op tests and a consultation a few days prior to surgery). She was told that the hospital doesn’t have me on its surgery schedule (perhaps the doctor’s office never contacted them). Upon learning this, Peggy immediately called the doctor’s office, but it’s nearly impossible to get them on the phone, and they take hours to call back. I have also called them, but I have no idea if the urgency in my voice will inspire them to act.

So it is that mistakes always, always, always happen, and the patient can never, ever sit-back and trust that what is supposed to be done will be done in the way that it should be done. Instead, the patient can but hope that the mistakes will be temporarily frustrating rather than life-altering or fatal. In this case, if there’s no operating room available, the surgery will have to be postponed, and because I was getting in early due to another patient’s cancellation, I could end up waiting months.

All about Peggy: Part 2: Dancing with Bears

Peggy’s first adventure with bears occurred while camped in the Arizona desert (the place was named the Coronado National Forest because of its ten-foot tall trees). Our camper consisted of a bear-defeating aluminum canopy mounted on the bed of a pristine white ’73 Datsun truck named Lolita. I so loved Lolita that I at least sponge-bathed her daily when we were away, including the engine compartment. Such compulsion is burdensome, but I couldn’t imagine driving down the road in a truck that wasn’t sufficiently clean for surgery. Peggy later complained that our photo album contained more pictures of Lolita than of her. This was true, but it was also true that I hadn’t followed-up on my plan to put a wedding ring on Lolita’s cute little distributor cable, and that the only presents I had given her were things like spark plugs and oil filters that Peggy didn’t care for anyway. To make a long story less long…

There we were, in the middle of the night, camped sixty miles from the Old West town of Tombstone, when my young bride suddenly and inexplicably announced that she had to “tinkle.” The park service had thoughtfully provided an outhouse for such troublemakers, but between us and it gamboled a large flock of feisty bears who were pursuing their hobby of emptying garbage cans and demolishing coolers. As Readers’ Digest regularly reminded its readers, what bears most enjoy doing is killing attractive young women—a description that still fits Peggy perfectly despite her advanced years—by hiding in outhouses and ripping-off their arms, legs, and heads before working-up to serious damage.

Aside from sunny and safe Sunday afternoon outings to the Jackson, Mississippi, zoo where the bears are tastefully locked behind stout iron bars so that courageous adolescent boys can impress wide-eyed adolescent girls by taunting them (the bears, I mean), Peggy and I had never laid eyes on an actual, in-the-flesh bear. Worse yet, these Arizona bears were nothing like the Jackson zoo bears in that these bears were looking high and low for innocent young camperettes. What’s more, they had us surrounded, and the moonless night was every bit as dark as a moonless night. 

Despite these unhappy statistics, Peggy remained grimly determined to pee. Such stubbornness represented a side to her that I hadn’t seen, and that troubled me greatly because, as I told myself, any woman who becomes this stubborn over a trivial matter like peeing would be capable of committing any manner of faux pas in the face of something important. 

Having nothing better to do at the moment, I decided to approach Peggy’s problem through the application of intelligent thought. Specifically, I thought about the following: (a) Our bed occupied the entire interior of the camper; (b) The canopy roof was too low for Peggy to squat over a jar; (c) Peggy might find it impossible to pee safely and effectively within the confines of a space that rendered safe and effective peeing impossible; (d) The solution to Peggy’s problem lay in solving for X when X=a+b÷3.14-7. Because I had no idea how to solve for X, or what solving for X would even accomplish, I regrettably concluded that intelligent thought is a waste of time except when boiling popcorn.

However (and it was BIG however), I saw in a flash that the cerebration of the stupidest man who ever lived is so superior to that of the most brilliant woman (Peggy), that I had no choice but to cancel my subscription to Ms Magazine. “What are you talking about?” you ask. I am talking about how a man, any man, could, in three easy steps, solve a problem that had short-circuited the brain of the female genius who lay squirming at my side with yellow liquid sloshing against her teeth. Here are those steps: (a) raise the camper door (this is extremely important); (b) lie on one’s side; (c) pee through the open door!

Irrefutable though my reasoning was, I knew it would be ill-advised to share it with a member of a gender that becomes overcome by feelings of feminine inferiority in the face of male rationality, so I settled for suggesting to Peggy that she tell her bladder to stop whining until the bears had gone to bed. I shed a tear when she promised to do her best because, inadequate though her best would be, not even a man could do more than that. Unfortunately…

As time passed, Peggy’s moaning and squirming achieved the desperation of a sugar cube in boiling water. Between moans, we could hear the bears snickering as they awaited her emergence, but we could tell that some of them had moved to another part of the campground. It was then that a plan presented itself. Peggy said it was time for extreme measures, so she would get out of bed and pee by the back bumper while I stood lookout. “That doesn’t sound like much of a plan to my male brain,” I said, “but if it’s what you want, I’ll lie in bed and protect you,” To my dismay, she made the power-hungry argument that I could best protect her by getting out of the camper for a less obstructed view, and to be on hand to eviscerate criminally-disposed bears. I told her that she sounded arrogant, masculine, and shrill, and it was then that the air became pregnant with tension. 

Peggy finally said that I could do as I pleased, but that if I stayed in bed, she too would stay in bed, and her side of the bed would most assuredly remain dry. Dry from what, I didn’t know, but her tone sounded ominous, so I offered to accompany her. We knew there were no bears behind the truck because there was no noise behind the truck, so I exited first—Peggy was insistent on this point—and chivalrously helped her to exit. Once on the ground, it was my job to stand beside her as I leaned from one side of the back of the truck to the other so that no bears could sneak-up on us.

As I was heroically occupied in doing my job, Peggy busied  herself by keeping a bone-crushing grip on my calf while tinkling as fast as she could go. Simple though these tasks were, she performed them admirably, although I later found it necessary to chide her for bruising my shin and calf. I also took issue with the fact that she had peed on my foot. “How could this have happened?” you ask. It happened because I had been so dedicated to doing my job properly that I took no notice of Peggy’s failure to do the same, the result being that when warm liquid ran across my foot and made mud pies inside my dusty flip-flop, I didn’t immediately divine its source. The situation could have been worse, of course, had the bears found the odor so maddening that they charged us like Crazy Horse charged Custer. 

What I learned about peeing that night was that, on the one hand, abject terror can make peeing impossibly unavoidable; on the other hand, it can make it unavoidably impossible. Such considerations notwithstanding, Peggy stuck to the task at hand. When she emerged victorious, I said that, in the interest of companionability, I too would pee, and that, in the interest of chivalry, she would guard me as I had guarded her. When she didn’t respond, I looked toward where she had been and found myself alone in a moonless wilderness.

I naturally concluded that bears had martyred my beloved, so imagine my dismay when I happened to glance into the camper and found that she was cleaning her facial pores with witch hazel. When I, too, had returned to our snug fortress, I respectfully inquired, “Had I been massacred, Dear, would you have pulled my corpse to safety or left it for the rangers to stumble upon while you toured the Grand Canyon?” Snores prevented her from answering, so I broached the subject again over breakfast, adding that she should have informed me of her proclivity for snoring before we were married, so I could have decided upon the advisability of a shared future. I also asked if she had withheld other fatal flaws, but I regretted my cruel words a moment later when her pretty face reflected the anguish of a sensitive soul who was too remorseful to speak. I have no idea why, but everyone else on earth mistakes the expression for boredom.

Part Two

After moving to Oregon, Peggy and I camped every other week in pretty weather, staying out for 2-3 nights at a time in areas so remote that we seldom saw anyone (in Oregon, such places are easy to find). When sleeping in Lolita became uncomfortable for my beloved’s constantly aging joints, I magnanimously surprised her with a vintage 3/4 ton van with almost no dents and a high ground clearance for traversing rutted logging roads. On this occasion—as on many others—she was so overwhelmed by gratitude that she went through four stages of self-expression. 

Stage 1: Peggy is unable to make a sound. 

Stage 2: Peggy makes sounds resembling speech, but no one knows what they mean.

Stage 3: Peggy jokingly asks if I can get our money back.

Stage 4: Peggy jumps up and down in her characteristic happy dance; smiles her grimace-like smile; and pours out her gratitude with such playful teases as, “I hope you bought me a parachute so I won’t break a leg getting out of the _____ thing.” Many people claim that Peggy’s childlike humor is her most endearing quality, and that they hope to experience it someday. 

By happy coincidence, Oregon’s black bear population abounds alongside salal, currants, gooseberries, raspberries, blackberries, salmonberries, huckleberries, and hazelnuts. On the joyful day in question, we were biking down an abandoned coastal logging road when I spotted three bear cubs not twenty feet away. I threw on brakes and exclaimed, “Sweetheart, bride of my youth, look, oh look, at the darling little bears!” I naturally interpreted her silence as the product of unspeakable delight, so imagine my dismay when I turned toward where she had been, and found that I had been speaking to a tree. I naturally assumed that a bear had eaten her and was busy accustoming myself to widowerhood when I chanced to see a woman who resembled my late wife receding into the distance as fast as her pretty legs could pedal her sexy red bike. Because I knew that Peggy would want me to love again, I set out after the mysterious “woman on red,” but a race horse couldn’t have caught her.

Some might say that Peggy, unlike her husband, behaved rationally given that mother bears tend to annihilate anything that comes near their cubs, trees included. I would respond that there is not a single record of a single black bear killing or injuring a single person to protect a single cub (although their predilection for human flesh often inspires them to peel people like bananas). What black bears are on record for doing is running rapidly away from their little ones at the merest hint of danger. Therefore, if you should someday sneeze while walking through the woods, you should immediately recite whatever prayer you remember (“God is great; God is good; let us thank God for our food” became favored by many after a news report claimed that no one who used it reported being killed by a bear) because you are in grave danger of being flattened by one or more fleeing bears...The image of a female abandoning her loved ones brings my thoughts back to Peggy.

“Why,” I demanded, when I finally found her cowering in her bedroom closet two days later, “did you abandon me to certain death?” “I didn’t abandon you,” she mumbled while staring at the floor. “Like you, I wanted to get all drippy while schmoozing with Pattington Bear’s mother, but because I love you, I gave up what I wanted in order to get help for you in case she turned out to be half grizzly.”

The realization that my wife held my physical prowess in such low esteem that she didn’t trust me to protect her from a buttress of brutal bruins hurt my feelings twenty times worse than had she proclaimed me a bear-destroyer par eccellenza, but I was too scared to tell her that, so I rhetorically asked, “My gentlest darling, was that really why you rode away as fast as your wrinkled legs could pedal your sexy red bike?” “How could you have doubted it?” she cooed. “After all, Snowie darling, you know what grizzlies are like because we almost saw a whole gaggle of them on that trail in Canada. If those hikers we met hadn’t told us that there were bears ahead, and if we hadn’t run to the car and stampeded back to Montana without even stopping at the border station, you would have shown those Canucks what you were made of, and it wouldn’t have been pretty.” “You’re right, my brown-eyed nymphet. If I hadn’t gotten homesick for the Home of the Brave, I might have pixillated every bear in Canada because I’m so intimidating that there are days when I don’t dare look at myself in the mirror.” It was here that she kissed my cheek. Most people mistake Peggy for a total hard-ass, but she can be half nice when she puts her whole heart into it.

Next time All About Peggy: Part 3: Peggy Abandons Me to a Flurry of Hawaiian Wolverines