the surgical holding area, the strength of old ladies, I make my incision swell, my father's stubbornness

Rain all day, as usual. Last Sunday—the day before my surgery—we had five inches of snow—a phenomenal amount for the valley floor—and I spent the day clearing it from the patio roof.

After I checked into the hospital, I was taken to a room that held six patients. Curtains offered visual privacy, but there was no verbal privacy. My surgeon was running two and a half hours late, so I saw other patients come and go. One was 88, and had suffered for nine years from infection following a knee replacement. He was there to have the joint removed and the space packed with antibiotics for three months. Then would come another replacement and, if that didn’t work, a fusion. He was sharp of mind and did his own talking. We were taken to the surgical holding area together, and, as he was wheeled into the O.R., I kept thinking, “You are screwed, dude; you are not going to survive this at your age.” Then I realized that he was probably screwed anyway.

Every day, I watch Mrs. Fredericks walk by. She is 90, lives three houses down, and lost her husband to diabetes last year. A few months later, her daughter and a couple of her grandkids were killed in a plane crash. She stays in her house until she “can’t stand the loneliness anymore,” and then she walks. I ponder the pain she suffers with every faltering step, and I wonder how much longer she can holdout. We denigrate men by comparing them to old ladies (“an old lady could run faster…lift more, etc…than you”), but old ladies usually live to see their once strong men dropped into holes.

I feel sicker now than I did the day after surgery, and I finally figured out why. It’s because I am forced to sleep on my back, and my sleep apnea is worse that way. Last night, I had dream after dream in which I was trapped in dark, dank, putrid rooms without enough oxygen. The constipation came back with a vengeance too. I lay awake most of the night reading Silas Marner.

This morning, I decided I was babying myself too much, and that I might feel better if I did some light housework. I unthinkingly lifted two empty backpacks from the top of a closet, and the area around my incision swelled alarmingly, forcing me back to bed. Peggy was in tears for worry.

Walt stayed with us at the hospital all day Monday, Shirley brings us food every morning, and others have reached out too, but I feel too vulnerable to open my heart. Instead, I am more annoyed by their faults than usual, and can hardly be civil. I am surely a difficult person to befriend, much less to be married to. But then aren’t we all, more or less? Maybe the human race is perpetually at war because we are too obnoxious to tolerate ourselves.

Peggy, I can tolerate better than usual, partly because I see how hard she is trying to help me, partly because I am in no shape to be argumentative, and partly because I see how hard things are for her. I don’t know how people who live alone are able to survive life’s travails, but, come to think of it, if Peggy were alone, she would be free to go to France.

I want Peggy to go to France no matter what, but Peggy wouldn’t be able to enjoy France no matter what. This makes me even more regretful of my foolishness this morning. I wanted so very much to not feel helpless that I made myself more helpless. Every year finds me longing for my comparatively strong body of the previous year. I apprehend further deterioration, and will have to grow stronger of mind if I am to survive.

The surgeon’s nurse said he might want to do further testing for cancer despite the biopsy coming back normal. Why didn’t he think to do “further testing” when he had me cut open on Monday? I seldom go to a doctor but what I leave less enchanted. As a group, they know so little, and most of them know even less than that. Besides, their services are so half-assedly rendered that I can but conclude that money is the main motivator. A five-minute visit costs $200.

Peggy and I tried to hide the cost of my father’s pills from him, but when the day came that he found out, he argued that if enough people chose death over “highway robbery” that medical costs would come down. This is probably true, but how few are willing to volunteer.

Everyone dismissed my father as a stubborn fool. I knew his faults better than most, but I have also observed that normal people don’t achieve sainthood. You’ve got to be a hardcore hard-ass to be a saint and, for better or worse, my father was that.

fun times with Vicodin

The lymph node biopsy came back negative, but now the surgeon wants to biopsy the other side.

I had an iodine-contrast CAT scan yesterday to look for a reason for my partially collapsed lung. Preliminary blood tests were ordered for the day before, and I was in a lot of pain when Peggy drove me to the internist’s office. I had called twice to verify that these tests hadn’t been run as a part of my pre-surgical blood-work, but Peggy asked a third time when we got there, and was told that they had. The nurse had an “Oh, well, shit happens” attitude, about it, so Peggy complained to the practice manager.

Another nurse promised me that we wouldn’t be charged for coming, but I stopped at the front desk to verify it. She appeared while I was there and, looking hurt, reminded me of her promise. I couldn’t very well tell her that I no longer trust anyone in the medical community to get anything right.

I took full advantage of Vicodin for the first two days. Even with it, I hurt too much to sit up for long, but time passed pleasantly enough in bed with an ice pack on my groin. I was determined to read a book on informal fallacies, but I dozed off so often that I re-read most of it twice.

I was just starting to understand how people get addicted to painkillers when the side effects hit. I hadn’t pooped in three days and was eating heartily, so my weight shot up an incredible ten pounds, and my abdomen became as rigid as it was bloated. (When you’ve had hernia surgery, the last thing you want to do is to strain to poop.) Then came the itching. No sooner would I scratch in one place than it would start in another, and I was soon itching in way more places than I had hands to scratch. Last—but not least—I was forgetting to breathe. I would be feeling all happy and mellow, when all of a sudden I would gasp for air, and realize I had missed a few breaths. It was like sleep apnea, but I was doing it while awake. I can’t say enough bad about how this feels.

The surgeon’s nurse advised that I cut the Vicodin in half, but I decided to simply endure the pain. I thought that, being two days post-op, it just couldn’t be that bad. It was. Now, four days post-op, the pain is so intense that I have trouble walking. It is worst in my privates, which are purple and swollen.

19 hours hernia post-op

Surgery went well, as far as I know. The doctor was running 2 1/2 hours late, and I spent the last hour, as usual, in a line of ten gurneys in the pre-op holding area. These gurneys face a bank of windows opposite which stands a two-story cross (the sole evidence of Sacred Heart’s Christian ideals is that cross and a crucifix in every room).

Just before I was rolled to pre-op, Peggy read on my chart that I am 6’10”, so I passed the wait pondering the implications. As a young man, I would have thought it great to be a foot taller, but now I can see the downsides, things like beds being too short, chairs being too low, airline seats being too close, and so forth.

The surgeon wanted me to stay awake during surgery so he could have me cough when he was done. He apparently decided against this, because while I was still on the table trying to ask questions, he was calling a friend to make dinner arrangements. It was by now 5:30 p.m., and he had put in a full day, so I naturally accepted the priority of his dinner plans over my health issues (in all fairness, the tranquilizing agent might have caused me to forget being told to cough).

He did say that the lymph note he removed didn’t look ominous. I went home shit-faced on Percocet, but optimistic that I had dodged the cancer bullet. Bright and early this morning—7:30 in fact—a nurse from my internist’s office called to say that I needed to come in for blood work and a full-chest CAT scan. This was more than a bit of a surprise since the surgeon had said nothing to me about my x-rays being abnormal. The nurse had no explanation, so I asked if she might please find out and call back (or, better yet, have the doctor call). She called (no surprise there) with a confirmed diagnosis of chronic atelectasis (a word she couldn’t pronounce, but that Peggy could upon hearing the first four letters). Chronic atelectasis is a lung blockage that can be caused by any number of ominous diseases, one of which is asbestosis (I used to work around asbestos, and have long worried about it).

Other than the kind of shabby treatment that I have learned to expect from doctors, and the fact that my anesthesiologist was pitifully sick with a cold, everyone else who was involved in my care were terrific. From the young man who shaved my groin to my many nurses, I have only praise. As for the doctors, I can but reflect on the irony of the fact that they make far and away the most money, yet act as if they are doing me a favor by treating me at all.

The surgeon said I would hurt and swell more than most people (I don’t remember why), and I suspect he was right, but the pain meds are keeping the hurt down to a dull roar, and ice applied thirty minutes every hour is keeping the swelling manageable. My bandage is bloody, so even as I write Peggy is out getting a new dressing.

With this, as with my last surgery, the post-surgical pain is minor compared to the aggravation of trying to get information from nurses who don’t know and doctors who won’t talk to me.

That’s where things stand at 11:00 a.m., nineteen hours post-op.

credo

We’re like the people in the Twin Towers just before the planes hit. We can do nice things for others; we can enjoy good food and good books; we can even create meaning in our lives, but the moment will come all of this is gone from us—or rather us from it. We will then exist in the same way we existed before we were born, which is to say as matter and energy. I ate sardines tonight. They used to be little fishes; now they are me. Soon they will be something else. Such is our existence. The personal is transitory. The eternal is indifferent.

The universe is incredibly dark, incredibly cold, and infinitely uncaring. This I worship because it is nobler than an anthropomorphic deity such as the petulant and vindictive god of the Bible. Yet, I could happily partake of mass or communion because they are like the word god in that they have so many different meanings that they lack meaning. It’s not the object of worship that matters but the impulse to worship. I refer to worship that comes from the inability to not worship. In this, I find purity.

France when you might be dying!

Peggy asked if I thought she would still go to France if I have cancer. I said she should consider the prognosis. Her response was that there was no way she would go. I was so surprised that I didn’t think to ask if she would stay home to support me, or because she would be too bummed to enjoy France. I wouldn’t want her here unless the prognosis was grim. I would miss her, but no more than I would miss her anyway; and I would be awfully sorry about all those nonrefundable reservations.

Peggy and I differ in that I am much more likely to make decisions based upon money. I love watermelon, yet I didn’t buy a single melon last year because the prices were too high. Peggy was horrified. “You’re worth the money,” she argued with generous intent, but with logic that reminded me of a television commercial. “What does my worth have to do with overspending on a watermelon?” I countered. “You could just as easily argue that I am worth saving the money.”

When I spend big, it’s on non-consumables like tools or that $1,750 bike I bought last year. I’m not cheap; I’m frugal. I’ve been this way as long as I can remember, and I have no desire to change. Peggy is also frugal, but not as much. If she weren’t frugal, we wouldn’t be together. She would be out spending like the average American, and I would be home packing my bags and separating our finances. She does have her indulgences, but we’ve worked it out so that I can live with them. Her skiing—like her trip to France—comes out of common funds. Her buttons are another matter because the expense is ongoing. When she began spending what I considered a lot of money, we agreed that, for every dollar she spent, I got one dollar for myself. Her “dollars” are displayed in cases; my dollars are in mutual funds.

She argues that the stock market could crash tomorrow and I could lose everything, whereas she has already gotten enormous enjoyment from her buttons, and is unlikely to lose them. She might be right, but then again, a fire or a flood could take her buttons while my funds would go on doing their compound interest thing. Maybe I don’t enjoy greenbacks as much as enjoys buttons, but they still give me a warm feeling. Money alone can’t buy security, but I never heard anyone say he felt more secure without it.

Peggy is away (reluctantly, due to my health) on her annual “Girls’ Weekend Out,” and I’m cleaning house in preparation for surgery. Hernia surgery is low risk, yet I had a friend who died on the table, so I’m doing a more thorough job than usual. Things like cleaning out closets, rearranging cabinets, putting contact paper in drawers, backing up computer files, updating lists, and getting rid of unneeded items. Peggy literally doesn’t know how to operate the washer and dryer, and she is all but computer illiterate, so I know I would be missed.

Yet, she would survive, I suppose, which is more than I might do if she died. I can’t say for sure because I haven’t crossed that bridge. I just know that I always hold suicide as an option, and that she does not. This is another of our differences.

Medical errors

The following is a weeks worth of medical errors—or at least medical system errors—and I haven’t even been to surgery yet.

1) My internist sent me to the surgeon with a form stating that I had a hiatal hernia instead of an inguinal hernia.

2) The surgeon’s office sent paperwork for me to fill out before my appointment. It was mailed Tuesday; my appointment was at 8:00 a.m. Wednesday.

3) The surgeon was a half hour late for my appointment, so Peggy and I took the liberty of reading my chart. Before the nurse took it from us, we discovered that I had been wrongly diagnosed with acid reflux and a missing left ball.

4) When I went for my pre-surgical appointment with the anesthesiologist, he said he had no idea why I was there. His office called the surgeon’s office for an order, but the surgeon’s staff was not yet answering their phone. Peggy went and got the information.

5) When I went to Oregon Imaging for my chest x-ray, I learned that I was scheduled to have it done at the Sacred Heart. I denied this. Since it is unusual for an outpatient to go to the hospital for an x-ray, Oregon Imaging called the hospital and learned that I had been admitted through the ER and was in room 683. The hospital was sure of this, and the lady at Oregon Imaging was equally sure that I was standing in front of her. I got my x-ray at Oregon Imaging.

6) After Oregon Imaging straightened out where I was to be x-rayed, they informed me that the surgeon had neglected to say why I was to be x-rayed. This meant that my HMO wouldn’t pay for the x-ray. I refused to pay for it myself so, after much discussion, they assured me that they had arranged things so that my HMO would pay for it.

7) After returning home, I called my HMO to be sure the surgeon’s office had contacted them to okay my surgery. My HMO was surprised to learn that I had a hernia, and they suggested that I “build a fire under the staff at the surgeon’s office”.

8) I called my internist to ask if my surgeon had called him to ask if he wanted to see me before my surgery (the surgeon had said he would call as soon as I left the office). The internist didn’t know I had been to a surgeon.

I see a surgeon about my hernia

I saw the surgeon today about my hernia, but he seemed more concerned about my swollen lymph nodes (Peggy asked me months ago to see a doctor about them). He seemed as eager to get me into surgery as I was to go, and he made special arrangements to reserve an operating room for Monday.

He suggested an open incision (instead of a laparoscopy), because it will enable him to attach the mesh better on such a thin person as I, and because I will run have less risk of chronic pain (a common side effect of hernia surgery).

I should be well enough by Peggy’s departure for France on February 14th to take care of my own needs, but I will be unable to exercise the dogs or wash their feet when they’ve been in the mud. The timing is no less bad for Peggy. I would not want her to stay home—unless the prognosis was grim—but I could hardly insist that she leave. Ironically, I have been worried for months about the trip, because it is, after all, a long way to France, and in winter at that. I think of all the things that could go wrong—closed airports, car wrecks, the flu, and a hundred more—and I know I will not rest easy until she is home.

Tomorrow is another doctor day. I see the anesthesiologist at 8:30, then have blood drawn, and then top the excitement off with an EKG. The surgeon said that the blood work will rule out some forms of cancer. Since I had expressed no great concern about having cancer when he said this, I concluded that he must be concerned.

Thoughts on diet

I’m down to 144 pounds—fourteen pounds lighter than at Thanksgiving. I only planned to drop to 150, but with my new diet the pounds keep disappearing.

I’ve inexplicably developed a taste for hot peppers. (Take it from one who knows: never touch your eyes or use the bathroom after handling a habanera.) I actually like to feel the heat climbing across my face and up my scalp. There’s definitely a high that goes with peppers.

More of Lowell’s advice about food…

Build your food pyramid atop a base of whole grains and beans.
Eat foods that are nutritious and low calorie.
Prepare your own meals from simple ingredients.
Learn to love cooking by cooking that which you love eating.
Eat only cold-pressed canola and extra virgin olive oil—even for things like piecrusts for which you normally use Crisco.
Reduce or eliminate meat, cheese, sugar, and butter.
A few times a week, eat fish that are low in mercury and rich in Omega-3s. Avoid farm-raised fish.
Don’t keep desserts or junk foods at home.
Remember that a little “sin” can undo a lot of hard won progress.
Drink only skim milk.
Dilute juice with water. Uncut juice will soon come to taste like sugar syrup.
Don’t buy foods that contain: enriched flour, artificial ingredients, added sweeteners, hydrogenated oils, or oils that you wouldn’t use at home.
Drink a glass of red wine a few times a week.
Buy un-processed foods, and observe how beautiful they are. Reflect that this is how food looked until a few decades ago.
Make every meal sacred. Instead of eating in front of the TV, eat against a backdrop of inspiring music.
Regard food as sacred. It will help you avoid foods that have been debased.
Avoid between meal snacks.
Consider fasting one day each week. It can be spiritually uplifting.
Consider only eating two meals a day.

By doing these things, I have come to prefer foods that are good for me. For a long time, I ate good foods at home, but pigged-out on junk at lodge. I eventually noticed that my favorite treats—like doughnuts—no longer tasted so good, so I would eat different kinds with the thought that the next one would taste better. I finally had to admit that I no longer crave doughnuts. I also decided that, if I pigged-out at lodge, and my weight was up the following day, I wouldn’t eat that day. This has helped me to at least moderate my consumption of treats that I still enjoy—like homemade lemon meringue pie.

People tell me that it is good to treat myself at times, which seems to imply that a treat is something unwholesome. My goal is to believe that a treat should taste good and be good for me. Inasmuch as I have tried to have the former without the latter, I have failed.

“Our whole life is startlingly moral. There is never an instant's truce between virtue and vice.” H.D. Thoreau

Letter to Guard

I had the following published in the Register Guard Monday.

“While browsing the new book section at the Eugene library last week, I came across the following instructional manuals: Street scene: how to draw graffiti-style and Moonshine! Recipes.... Whence this belief on the part of some librarians that they have a first amendment duty to instruct people in criminality? And what adolescent will continue to regard a crime as serious if the public library taught him how to do it? When I asked a librarian why they would carry such books, and was told that they carry books on every subject, I asked where I might find manuals on pimping, meth-making, and dogfighting. Clearly the library has some standard of discrimination.

"In a country that values free speech, some evil must be tolerated, but it need not be supported at public expense and endorsed by publicly owned institutions.”