Thursday, December 23, 2010

In My Eye: The Light The Heat

“She’s breaking the record for anesthesia,” I hear one of the nurses say. Or at least I think that’s what I hear her say. The funny thing about anesthesia is you never really know for sure what they said. Or what you said. Or really what did happen in there. Actually, that’s more than funny-- it’s good, because honestly I did not want to know precisely how the doctor scraped (or popped or pulled or nudged) the cataract out of my eye. Hell, maybe he shouted it out. Nor do I want to know details about how he used something involving a diamond to correct my astigmatism, though I did point out to some friends that was the closest in my life I ever came to having a diamond on my person. I had no temptation to Google photos or even illustrations of the procedure. I just wanted it done. And I wanted out of there.

The three worst parts about the surgery were these:

  • The big argument I had with the pre-op nurse on the phone last week.
  • The anxiety the day before surgery.
  • The fucking massive splitting headache the morning of surgery, which revealed to me the caffeine addict that I am.

When I went for my pre-op appointment weeks ago, a totally rocking nurse (or PA or whatever she was) proved herself to be a good listener. She was cheerful and efficient and heard me when I said I’m uninsured and set me up with samples enough to hopefully avoid the need to pay for expensive post-op eye drops. I made it clear to her that I have anxiety issues.

I always explain my anxiety to medical personnel before a procedure, laying out the information calmly the same way I would explain, say, an allergy to certain medications. I believe it is important for them to know, in advance, that the notion of having sharp instruments near my body causes a very strong reaction that can make it hard on all of us. I like to make a pre-game plan which typically involves anti-anxiety medication in advance of the procedure.

So I told this nurse that it was really important to me that I be allowed one valium (or even a half-valium) before surgery. She said she’d check with the doctor. She called a few days later saying it wouldn’t be a problem. Ah, that was easy.

Not so fast.

Last week, another nurse, the pre-op nurse, called to go over details. I asked her to confirm I’d be getting valium. “We don’t do that,” she said.

See, this is why I double-check these things. Because if you don’t get it all worked out ahead of time, you might not get what you want—or in my case, what I need. Pre-op Nurse and I went around and around and in her tone I thought I read a cross between annoyance and suspicion that I was angling to get my hands on recreational pharmaceuticals. I emphasized to her I wanted a prescription for a single pill. I explained that before my hysterectomy the anesthesiologist had no trouble with the request. And even before my last wisdom tooth pull I got a blessing to take some painkillers in advance.

I think maybe people who don’t have anxiety as a part of their daily landscape think those of us who say we do must be exaggerating. Maybe they’ve never had an anxiety attack. Maybe they don’t understand the crippling effect.

Annoyed, I explained to her that the other nurse said valium would be no problem. I then got off the phone and started calling around. I called my doctor’s office and left his assistant a message. I called the anesthesiologist practice and was told they never know until the day of surgery who will be assigned, so I couldn’t be put in touch with that person. After a round of calls, I finally got a call back from the doc’s assistant who helped to clear up the matter. She explained that the first nurse, who said valium would be fine, failed to mention that that she meant liquid valium would be administered once my IV was in. It had been lost in translation that I wanted oral valium.

Sigh. So next I explained that my anxiety flares up around IVs.

You see, when I was in the hospital post-hysterectomy, my IV popped out of my vein—but not out of my hand—in the middle of the night. Despite the synthetic morphine coursing through me, I woke up in the middle of the night to a discomfort I discovered was an enormous skin balloon where my hand had once been. Two women in their early twenties—an LVN and someone with even less training than that—came in and assured me they could get a new IV going. Even in my stupor I knew they could not. I have rolling veins, I’ve been mis-stuck a million times. I asked for a doctor. They refused. And for the better part of an hour they literally took a stab (and another and another) at their task, chatting with me the whole time, telling me about their personal problems, the anti-depressants one was on, and so on until, at last, one said, “Well, you were right. I can’t get it.”

At which point an anesthesiologist was at long last called and he popped that needle right in on the first try.

Back to my latest pre-surgery annoyance. Having cleared up the misunderstanding (liquid vs. solid valium) I called up the pre-op nurse who seemed to think I was nothing but a pain in her ass. She was argumentative. So was I. I suppose we both felt defensive. She actually said to me, “You don’t know what we know.” Well, duh. To her I explained that what is her daily routine—she’s around eye surgery all the time—is a big fat fucking deal to me and that any surgery is, to me, major surgery. And I told her that I wanted to feel listened to. At long last, to shut me up, she mumbled something about hearing me and said something like, “Well they can probably give you some liquid valium orally but it will taste terrible.” She did not say what I wanted to hear, which was that she would get to the bottom of this and hook me up.

The day before surgery, the doctor’s assistant called to say there would be no valium, that this was the anesthesiologist’s department. Hold on, what? At some point I’d been told by the pre-op nurse it was the doctor’s department. And so, in the end I felt like the only thing my phone calls had perhaps achieved was to red flag me as a nutcase, a high maintenance patient. I shut up then, gave up the fight, and decided I would soldier through, no matter what, because I really wanted to be able to see again.

The day before surgery I was an absolute wreck. I recognized this and took careful steps to put myself at ease, calling friends, talking it through, having dinner with my knitting group, distracting myself.

Morning of, I woke up and the no-caffeine headache kicked in almost immediately. My doctor operates midday so I knew it would be about eight hours til I could caffeinate. Now I felt like the junkie the pre-op nurse seemed to believe me to be. I might as well have been on an episode of Mod Squad, curled up on a dirty sheetless mattress under a dangling bare bulb sweating and shaking. A cleaver halved my skull. I tried not to watch the clock. I tried to bang out one last work deadline before Warren came to ferry me to the surgery center.

Once we arrived, it was time to pay. As an aside here—to all of you who bought my books and t-shirts, or made flat out donations, or paid me in advance for future services, or hired me to perform your weddings, or in any other fashion supplied me with cash—THANK YOU. After three months of working triple time, I walked into that office uninsured but ready to pay. The downside? They broke it into three separate payments: doctor, surgical suite, anesthesiologist. After they ran the first charge on my debit card ($1800) the second charge wouldn’t go through. And why was that? I can only guess my bank assumed someone had stolen my card and decided to go on a spending spree at an eye surgery center. They declined the second transaction. (I was able, fortunately, to rectify things by whipping out my checkbook.)

And now, back to pre-op. The nurse—thankfully not the one I argued with—said she understood I’d requested that the anesthesiologist put in my IV but she asked if she could please try it, that she was quite good. I was so worn out by then, from the anxiety, the lack of caffeine, the lack of sleep the night before, and the knowledge that patients are so rarely heard, that I thought what the hell. I agreed she could try. And then she informed me, after we talked about my anxiety, that she did have something oral she could give me—not valium, but something. Really? Why hadn’t anyone told me this before? Had I known this in advance it would have saved me many hours of fretting.

As the nurse prepped my hand for the IV, the anesthesiologist—trim, looking like he’d just come back from a long run, sporting a leopard print scrub cap—came over to tell me a few things. Looking at my chart, he said, “I see you had a valium this morning.”

“No,” I said. “I did not. Because nobody would give me one.”

“I gave her something though,” said the nurse.

“Well I’ll hook you up with something as soon as the IV is in,” he said.

I told him that was all well and good, but that my anxiety was mostly centered around getting the fucking IV in the first place. This gave him pause. Then a sting in my right hand as the nurse shot me up with something to numb me. I didn’t watch. I did feel the actual IV go in. And a few minutes later she admitted she’d hit something—what did she call it?— but that she didn’t want to tell me when it happened because she didn’t want to upset me. You know maybe she should have skipped telling me at all. Definitely TMI, but let me temper that by stressing that this nurse was extremely nice, extremely efficient, and truly did appear to have heard my thoughts on anxiety, which she did not dismiss. It was not her fault she encountered a problem—I have crappy veins—and it wasn’t like she poked me four hundred times.

After that they did hook me up with something strong and after that it was a blur. I’m up on a table and they’re draping my eye. I’m nodding in and out. I do hear one nurse yell at me—is she annoyed?—to OPEN YOUR EYE. OPEN YOUR EYE. I am too slurry to tell her what I am vaguely thinking which is that, as with foreigners and deaf people, yelling at me is not going to get me to hear better. I want to tell her—I think I try to tell her—that as when I was in labor and the midwife said push, “My brain hears you but my muscles won’t cooperate.”

I think she undrapes my eye, then redrapes it, then starts to cut a hole around my eye and her scissors poke my face, dangerously close to my eye, which I try to tell her. Only, again, I still have no idea if I said these things out loud. I do hear her talking to another nurse about holiday plans and I wonder if I’m annoying her because if only I would cooperate she could focus on her Christmas conversation.

Then the clockwork orange device is in place. And I’m out. More people. Weird shapes and colors. Do I ask who’s there? I think I do. The doctor says he’s here. I must still be mumbling. Someone says, “Give her some more…” And someone else says, “She’s already had two…” they talk in medical lingo, measurements and medicines I do not know. That’s when I think I hear someone say, “She’s breaking a record for anesthesia.”

What does this mean? Has my anxiety prompted my brain to fight surrender? Am I talking? Are they trying to shut me up?

And then before I know it, I’m slumped over in a wheelchair and a nurse is asking me if I want cranberry juice or apple juice and I’m thinking, “I want a goddamned quadruple espresso.” At which point the IV nurse pipes up, “She wants coffee.” Now, we’d discussed the coffee situation earlier and she said other patients—sloppy groggy people spilling hot liquids on themselves—had ruined it for the rest of us. No coffee in post-op. But because she’d listened and truly heard me, she honored my request. Someone handed me a styro of creamy, sticky sweet doctor’s office coffee and it was like nectar from the gods.

I slurped it down in the car, Warren laughing as he listened to me make the usual round of post-op phone calls—my mother, my son, his father— and attempt, unsuccessfully, to sound clearheaded. Even I, in my grogginess, understand that I am not accomplishing this task well. I hear my mother ask, “How are you?” And my mind is looking around for a sentence to reassure her.

Finally, I settle on a description. “I am FUCKED UP mom.”

Oops. Later, after ten more gallons of coffee, a hot lavender bath, a sleep-of-the-dead nap, and a plateful of sushi and a mince pie leftover from Knit Knight, I’ll start to feel a little more myself. I’ll text my mom, “Sorry about the F bomb.” And she’ll text back that it’s quite all right.

As Warren drives me through the streets of Austin later on, I’ll notice that halo effect they warned me about, where every single streetlight suddenly looks like a huge Ferris wheel of color, and even the tiniest dashboard light appears to be something twinkly and related to Christmas. Oh great, now with my new bionic eye, I will get a little bit of Christmas. Every single day. For the rest of my life.

Small price to pay for being able to see again.


Sue Reading said...

Spike, I hate to listen to people's medical experiences. They're icky and boring. I read every word of yours and loved it. Thanks!

Karla May said...

Dude, I am positively phobic about hospitals, so I can completely relate you your anxiety. Why does something that could be so damn simple--giving you a freaking Valium--have to be so fucking complicated?! I'm about to have an anger/anxiety attack just thinking about it!!

Glad it's over.

imjackhandy said...

I had to take Lexapro for anxiety a few years ago when my Meniere's disease was very bad. It is very hard to explain to people about anxiety if they've never experienced it. You would think more health care professionals would be sympathetic to anxiety and how easy it is to relieve it with Valium. But in their defense, pill abuse is such a problem in the US they have to be careful. Not stupid like a few of the people you had to deal with, just careful. Good story.

Ric Brooks