My Three Surgeries

It's not uncommon that a person who reaches anything we'd call "old age" would, at least onece, be wheeled into an operating room and have an invasive procedure in which the antiseptic seal we call our skin is sundered and instruments are applied to our flesh and organs. At age 70, I've had three surgeries thus far, not counting wisdom teeth extraction and a colonoscopy. None would qualify as major. I have no sweeping tracks across my chest or back, and each surgery was successful by some standard, though only one could be called normal.

Tonsillectomy, Concord Hospital, Concord, N.H., Summer, 1968. Or was is '67, I can't recall. My doctor was the family "quack". He'd been my pediatrician throughout my childhood and I stayed with him out of loyalty well into my 20's. On one routine visit he looked in my throat and said "your tonsils are infected, they must come out." I was 27 years old, never much bothered by sore throats, but I took his word for plain fact. He said that when he pushed on them puss came oozing out. He said the local nose and throat surgeon could remove them, or he could remove them himself, though he was a general practitioner, not a surgeon. In those days it was not uncommon for GP's to deliver babies and yank tonsils.

Dr. Q (I'll call him that to avoid embarrassment, though he's long since dead) was a great admirer of Teddy Roosevelt. A portrait of TR hung in his examination room. He saw himself in the tradition of great individuals, men of bold action. He practiced medicine in that spirit and his readiness to do minor surgery in spite of his lack of surgical training was in character. TR had led the Rough Riders in the charge up San Juan Hill, and Dr. Q would vanquish my tonsils. I thought I should stick with the doctor who had treated my family, and saved my father's life once, according to family lore, and so I chose him to perform the surgery. This proved to be a mistake.

I learned later that Dr. Q had had his operating room privileges at the local hospital suspended twice before. I also learned that no qualified surgeon would extract infected tonsils. First cure the infection, then remove the tonsils.

Of the operation itself I remember only my reciting the Lewis Carol lines as I began to slip under the anesthetic: "The time has come/The walrus said/To talk of many things/Of shoes and ships and sealing wax/Of cabbages and kings." I don't remember how many of these lines I actually spoke before going under. I had planned to say this in order to have some clever outro. It was supposed to reflect my insouciance at the prospect of surrendering my consciousness and permitting others to cut me up without harming me. This was unwarranted.

My next memory is of being held down by nurses in the recovery room where I was desperately trying to raise my head to vomit. This struggle lasted a long time because I had a lot to give up and I rebelled against vomiting with my head mashed down on the mattress. I just wanted a little elevation, but the nurses believed I was trying to run away. My next clear recollection is of being wheeled into a hospital room about 8 hours later. The next 18 hours were the only time when I thought I could actually be dying, so violent was my vomiting, which lasted through most of the night. I was experiencing toxic shock, caused by the release of toxins as Dr. Q tried to extract my disintegrating tonsils. "I had to scrape them off," he told me later, as if to demonstrate his valor, not his incompetence.

On the morning after the surgery they brought me breakfast on a tray. I took a sip of apple juice and swallowed. The juice came out my nose and a blinding pain ripped my throat. I pushed the tray away and took no food or drink the rest of the day. I was placed on an IV drip and given morphine injections, which dulled the pain to tolerable levels but gave me a feeling like I was watching my life on closed circuit television. After three days I was released. Except for one followup visit to Dr. Q I stopped using him as my personal physician. I would call this a close-call, with no complications beyond an overly long hospital stay for a tonsillectomy which is often an out-patient procedure. I had no lasting adverse effects. In fact, I think there may even be some vestigial tonsils left in my throat.

Lymph Biopsy, Mary Hitchcock Hospital, July, 1971. On my 30th birthday I noticed a sore spot near my angle and a soreness in my heal. These complaints got worse. The spot on my ankle grew in size and became angry; it was so painful to touch that I couldn't walk normally. I went to my new primary care physician, who ordered a chest x-ray, an odd choice, I thought, for soreness in my feet.

When he put the x-ray film on the light box I got a start. My lungs looked covered with cobwebs. I braced myself for news of a dread disease. The cobwebs, it turned out, were not tumors, but rather lymph cells clogged with crystalline matter. The sore on my leg was identified as Erythema Nodosum , an inflammation of the fatty tissue under the skin. Tentative diagnosis of the underlying cause: Sarcoidosis a rare, non-infectious, benign disorder of the lymph system, whose cause remains unknown. To treat the lesion on my leg I was put on prednisone, a strong anti-inflammatory drug. Within hours the sore ebbed and I could walk normally again.

I was referred to an allergist I'd been seeing at Mary Hitchock Hospital in Hanover, N.H. I made an appointment and was instructed to stop the maintenance dosage of prednisone the day before. This was a mistake. Taken for more than 7 days, prednisone may cause the body to temporarily lose the ability to manufacture natural corticosteroids (especially cortisol). I arrived at Hitchcock a basket case from the crash induced by abrupt withdrawal. I was checked into a 4-bed ward and put under observation.

Lacking the suppression of symptoms provided by the prednisone, all the symptoms of the disease came full force on my body. Since the lymph system is pervasive this can have a broad range of afflictions. In my case it took the form of induced arthritis. Every joint in my body became swollen and painful. Turning over in bed became an agony.

A definitive diagnosis of sarcoid requires lymph tissues to examine under a microscope. That's where the biopsy enters the picture. Lymph nodes are not easily targeted with a needle, so an incision would be made in a place where lymph nodes are commonly found. I was scheduled for an operating room and two surgeons were assigned to make the incision and explore for nodes to extract.

I was sedated and draped so that only the patch on my neck was visible. I could see out the other side, but could not see the surgeon's faces or hands. The area was numbed with lydocane. When they began cutting it felt like they were tugging on my clothing. My arms were draped tight to keep me from moving. I was fully conscious. The two surgeons, hovered around the patch of skin on my neck began talking:

• • S1: What's that?

  • S2: Not sure.

  • S1: Take it anyway. [Snipping sounds]

They were not finding lymph nodes, so they expanded the incision, once, then twice. The second cut went outside the numbed area.

"Ouch," I said.

"Sorry," said on surgeon, in a loud voice as if I was across the room, not two feet from his face. "Nurse, lydocain."

I felt the jab of the needle and the numbness spreading. They continued poking and snipping. Then I heard this incredible conversation.

• • S1: Ah, there's the jugular.

  • S2: No, that's not the jugular.

  • S2: I know a jugular when I see one.

  • S1: Well, I'm sorry, you're wrong, its a [....] vein.

Looking back on it, I can think of many things I might have said, but, I chose not to interject myself in this argument over my anatomy. Perhaps it was the sedation, perhaps it was the fact that I had given up any semblance of control over my condition.

After about 40 minutes of this one surgeon spoke to me:

• • S1: Mr. Sawyer [again in a loud voice as if I were far away]

  • Me: I'm right here [just a few feet away from you idiots.]

  • S1: We're not finding what we are looking for but we hope to have enough microscopic tissue to the the diagnosis. We won't be much longer.

After 45 minutes they put a tube in the wound and closed it with 10 stitches. Attendants wheeled me back to my room.

The procedure must have been in the late afternoon because by the time the lydocane wore off and the pain from the incision reached intolerable levels it was evening. My requests for strong pain relief medication were declined on the grounds that the doctor had left no such order, the nurses were not authorized to make such an order, and there was no doctor available to give it. I spent the rest of the night in agony, lying still, trying not to move because when I did the tube in my neck made a belching sound.

The next day one of the surgeons came to my bed, removed the tube, and changed the dressing. He laid out a large assortment of bandages, tape, and scissors. Never once did he speak to me or even meet my eyes. Then he went away, leaving unopened bandages on my bed.

As sick as I felt, I was the least sick patient in the 4-bed ward. Next to me was an elderly man who had had a stone removed from his gall bladder. ["He was a deep orange color before the removed the golf-ball-sized stone," a nurse told me.] Across from me was a man in his 60's with bone cancer. Diagonally across was a man in his 20's with leukemia.

The elderly man beside me never spoke, but, then, I wasn't up for conversation. He was an agricultural worker, the nurses said, a vegetable picker, I understood. His teeth lay on his bed stand. One morning a nurse came and shaved him, using shaving cream and a safety razor. When she finished she dried his face gently and wished him a good day. An hour or so later came a new, male nurse who greeted him in that overly cheerful, sing-songy way nurses sometimes put on.

"Oh, Mr. So-And-So," I never did catch his name, "I'm going to give you such a marvelous shave, you will look so young." He had a mug and shaving brush. At this declaration the old man began waving his finger and stroking his clean shaven cheek, but to no avail.

The nurse began working up a lather in the mug, all the while prattling about how wonderful he would look. Still the old man said not a word, just kept gesturing no-no with his finger. No matter. The lather went on, the razor went to work, and the imaginary whiskers went away.

The final clean up was done with great flourish.

"You look fabulous, Mr. So-And-So. You have a wonderful day now."

That's when the old man turned to me and spoke his first words, slightly muffled by his lack of teeth.

"Drive me up the fucking wall."

Later that day a group of medical students came in to witness a case presentation at the old man's bed. One doctor presented the details of the case, describing the surgery that was performed and the outcome. Standing at the back of the cluster of white-coated proto-doctors I noticed the surgeon, the one who had left his left-overs on my bed the previous day. His attention to the proceedings wandered and he gazed around the ward. Then his eyes came to rest on my bandage and a look of intense focus appeared on his face; he headed toward my bed.

He hit my bedside in a flash, eyes locked on my bandage, leaned over my lunch tray, lunged for my dressing, and yanked it off in one mighty jerk. Then he looked at my face and said one word: "Sorry". He stuffed my dressing into his coat pocket and rejoined the others around the old man's bed.

The examination of the tissues culled from my neck produced a positive diagnosis of sarcoidosis. I left the hospital in August after a three-week stay. My symptoms receded gradually under treatment of colchisine, a venerable anti-gout medication, originally distilled from chrocus blossoms; colchisine was the long-term alternative to steroidal drugs . Within 6 months I was completely free of the disease. I have had no relapsed. The only lasting remnant of this experience is a lovely scar, about 5 inches long with little railroad ties from the stitches. And good tale to tell.

Cardiac Catheter, a.k.a. Cardiogram, Beverley Hospital, April 12, 2012. A cardiogram is a procedure to observe the heart and its arteries in real time. Radio opaque dye is injected into the arteries and an x-ray fluoroscope visualizes the action of the heart and its arteries. This may reveal occlusion of the arteries, which is treated with angioplasty and, sometimes, insertion of a stent to insure that the narrowing doesn't return. It is recommended when patients exhibit symptoms of chest pain and shortness of breath.

The staging area for the cardio operating room had about 10 beds, all of them empty when I arrived there around 7:00AM with my wife, Cherie. The nurse pulled the curtain closed around us, offered me a plastic bag and told me, "Take everything off and put it in this bag." She handed me that infamous garment of humiliation, the hospital johnny. [How it came by the name "johnny" is a mystery.] Plus some pathetic cloth slippers. As I pulled off my clothes I realized that in shedding my external appearance and rendering myself more or less naked, I was losing a good part of my identity. I lay down on the bed and became a patient, a subject, an object of control by others.

The nurse took my wrist and read my paper bracelet. "To be sure you are not an imposter, tell my your name and date of birth, please." Just imagine posing as someone else in order to be subjected to a surgical procedure. I smiled and answered "Dward D. Farquard, February 22, 1998". [Don't bother to Google that name, there are no direct hits.] She smiled back. I relented and gave my correct name.

"What brings you here?" was the next question. 70 years of reckless eating, I thought to myself. "A cardio stress test," I answered.

Next came the IV in my right arm, put there by the other nurse, a middle-aged man with facial hair. As he prepared the pieces and began swabbing my arm I noticed he was wearing a rubber glove on his right hand, but none on his left. Hmmmm, why would you wear just one glove when using both hands to set up the site? Are there no germs on his left hand? Oh, wait, he's not protecting me from his germs, he's protecting himself from blood-born germs and viruses, like HIV.

My two nurses conferred over the orders in a notebook at the foot of the bed. This conversation followed:

• • N1: That's not right.

  • N2: No, it's not. He couldn't have meant what's written there. He was thinking one thing and wrote another.

  • N1: We'd better check with him. I'll page him now.

One nurse went to the telephone and rang the surgeon, reaching an answering service. He left the message that the pre-operative sedation order seemed incorrect.

A short time passed and one nurse brought me a paper cup with two pills and a cup of water. "This is Valium and Benadryl to calm you," she said. "Take them please." "Did he call back?" I asked. "Yes," she answered, "this is what he meant for you to take."

Reflecting on this I see some important points about the way doctors and hospital staff practice medicine:

• • A mistake was made, probably a harmless one, but a mistake, nonetheless.

  • It was caught and confirmed by two nurses.

  • They made no attempt to hide this from their patient.

  • They checked with the surgeon, who was en route to the hospital.

  • They did not proceed until they got either confirmation that the order was what he had intended, or a correction, which was the case here.

  • Only then did they proceed.

One last step completed my preparation for the operating room. The dye is delivered into the heart by a catheter which is introduced into a vein in the groin and threaded up into the heart. The only incision needed is a very small puncture in the groin. Any incision, even a small one like this, requires great protection against infection. That means shaving the hair near the site of the incision and painting the area with iodine disinfectant.

The male nurse explained that he would shave both sides of my groin in case the surgeon decided to use the other side for some reason. He was wielding an electric shaver. "Shaver" gives the wrong idea of what this thing did in action. "Paint remover" might be more accurate. This was no shaver. It felt like a scraper. While he was about his dreadful work, Cherie, sitting to the side made a gesture as if to take a picture with her camera. It was only a joke.

One last indignity before rolling off, a walk across the ward to the toilet to empty my bladder. A little parade in my johnny and slippers.

This complete surrender of my autonomy and the application of a tranquilizer served me well to enter the operating room without giving in to panic. Someone was going to stick something directly into my heart while I lay there, and I was to take this calmly. Imagine, you drive your car into Midas for a new muffler, and imagine you don't go to the waiting room to drink coffee and read Sports Illustrated. Instead, imagine you sit in the car while it goes up on the lift. And while you sit there the mechanic goes to work below, and if he makes a wrong move, applies his torch to the wrong spot, turns the wrong nut with his wrench, the car blows up and you go to kingdom come with it.

I received a second sedative through the IV in my arm. Soon I was a happy camper, ready to sing "Kumbaya" while the surgeon wormed his little wire up into my heart. I remember few details there beyond the impression that I was in a high-tech shop amid massive electronic pods on long, flexible arms that moved along tracks in the ceiling. One clear memory is the site of my arteries dancing and twitching on the screen when they showed me after concluding the examination.

Once back at the staging area I didn't have to wait long for the surgeon to come to my bed. "You did great," he told me, shaking my hands. If anyone did great, it was he, not me, lying compliantly. He held up print outs of three views of my cardiac arteries. "Your arteries are basically clear," he told me. We would not be going on blow up blockages and implant any stents. I could go home after a respectable interval to remove my IV and dress my puncture wound, plus give me instructions on care and behavior for the next few days: no alcohol for 24 hours, no tub baths for 5 days, etc.

At noon my clothes were returned to me, and the IV site was removed. I took the mandatory wheelchair ride to the curb where Chere was waiting to pick me up.

At home I slept for 3 hours. In the evening Cherie went to the theater, leaving me alone to fix myself something to eat. My supper: buttered toast and fried eggs. W.T.F.

Cost (Paid to Beverly Hospital): $7,278.56