As I began to write this recap, I realized that I had several problems in doing so.
First, now that the dreaded surgery has been successfully completed, all the details seem so much less important and interesting. Survival was the big prize.
Second, some of the my anesthesia must have effected my memory of events before and after the surgery. I have no memory of even leaving the pre-op area to be moved to the OR. According to others, I was fully awake and talking when I left for the OR. Now, I remember little or nothing up until the nurse ordered a “clear diet” dinner several hours after arriving in my room. I had also been in Recovery for over two hours.
Monday, May 12, Day of the Surgery
I arrived to sign-in at Same Day Surgery Registration, NMH, a little after 7AM and signed a new release form for the surgery and had another C&T blood test. As Dr. Kozlowski, my urologist, has instructed I asked that he be notified that I was registering for surgery.
Dr. Lucy Godley, friend and neighbor had offered to sit with Jana during the surgery. She was scheduled to arrive around 9:30 and stay until 12:00 when she had to leave to arrive for 1:00PM clinic at U. of Chicago Hospital where she is an oncologist.
About 8:00AM, we asked what was causing the delay, and were told that the first surgery was being delayed. Jana snd I went to the cafeteria so she could have a cup of coffee with the hard-boiled egg that she had brought for breakfast. After Lucy arrived we went back to the waiting area.
At 9:30AM, the original scheduled start of surgery, we were all still sitting in the waiting area and were told that my surgery would be starting around 12:00 noon. I took that opportunity to impress on the nursing staff that I needed a special catheter because of BPH, and received assurance that it had been take care of.
At 11:30AM we were called for the trip down to pre-op. We went down the “service” side to my cubicle and gurney. By now, I knew the drill and what to expect. After undressing and donning the hospital gown, lying down on the gurney pulling the blankets over me, my “vitals” were checked, two IV’s inserted (one in my left hand and one in the left forearm), consulted with the anesthesiologist, signed the anesthesia release.
Since the exploratory surgery 10 days earlier, I had been wondering how they demobilize the left lung and still keep the right lung working during surgery. I was expecting a very sophisticated, anesthesia with very specific, controlled effects. Instead I learned that the anesthesiologist just puts a tube down my throat and inflates a small balloon at the primary bronchial tube leading to the left lung - effectively shutting the lung down. As soon as the lung is incised, it deflates.
Jana and Lucy came in to visit for a few minutes, we all chatted with Dr. deHoyos, the time for the surgery came (12:00 noon), Jana and Lucy left, and there my memory of events ends.
Two hours after surgery was completed, I was moved by gurney to my hospital room. Until I discussed it with Jana, I had no memory of how I got from the gurney into my bed. I remember they had a board, perhaps made of plastic, that they slipped half-way under me. Then using a sheet or blanket under me pulled me the rest of the way onto it, 3 or 4 people grabbed the board and lifted it to the bed and then slid me off the board, like using a spatula to remove a pancake from a grill. It seemed very clever a the time, because I realized there was no way that i could help in the transfer.
The first clear memory I have after the surgery is the nurse asking me if I would like something to eat. I was given a “clear” diet meal which in my condition was great: clear tasty broth, jello, tea, apple juice. Next since I had no nausea, I was offered a sandwich (turkey, of course). It never arrived, the nurse the next day found the sandwich delivered to the wrong room.
The First Night After Surgery
Jana stayed in the room with me, the hospital has a built in sofa bed in each patient room. We did not even try to go to sleep after 11. We were exhausted but were high on left over adrenalin.
They say sleeping is always a problem as a patient in the hospital. For me, “vitals were taken” at regular (4 hr) intervals. Pain medication taken by mouth was delivered on a different 4 hour schedule and by IV on a six hour schedule. I was assured of being awakened every two hours.
Two hours of uninterrupted sleep is o.k. However, since I could not sleep on my left side I would try to sleep on my back only to wake up in half an hour snoring and with a dry mouth and sore throat. The next hour I would try the right side and wake up in less than an hour with a sore hip. We figure that we got about 3 hours of sleep during this night.
But think about it, instead of complaining about incessant terrible pain for which I had been prepared, I’m complaining about a minor and quickly passing nuisance.
Day 1 Post-Surgery
I was awakened for a trip to radiology at 4. But then, Transport did not arrive until around 6, so I missed the early rounds with Dr. deHoyos.
After a pancake breakfast, I was visited by Dr. deHoyos and the residents.
He reassured me that everything had gone well. Of course, we had to wait for the pathologist’s report to know for sure. He reported that my upper left lobe was the size of most people’s entire left lung. This was a result of my height and long body trunk, and the reason the surgery had taken as long as it did.
When I mentioned this blog to Dr. deHoyos, he told me that he had the entire operation on DVD and could make it available. Now I don’t know too many people who would watch three hours of lung surgery from a distance of 1/2 to 3 inches, but I plan to extract a few minutes and provide a link to the short version from the blog.
Before leaving, he told me that he did not want to see me lying in bed. I should be in the chair or walking around the floor (at least 4 times a day). Also, I should use the deep breathing exerciser 10 times every waking hour. And well, yes, I could take a short nap from time to time.
The patient care team continues to enlarge. First, there is the floor nursing staff. Each patient has an RN and a PCT (patient care technician) assigned to him. Then there are the Residents whom the patient meets in the pre-op area. And finally the Thoracic Surgery group has a Nurse Practitioner and a Physician Assistant for the pool of patients. Everyone I dealt with was professional and as far as I can tell, highly competent.
Of course, when the nurse drew six boxes on the white board in the room and checked off my first two circuits of the floor I decided I could do at least eight. By the end of the day, I had done ten. Recovery was actually visible.
Jana asked if there was not some choice in the menu and was told that all you have to do is ask. Within an hour someone from dietary came by with a menu of choices. If you don’t ask, you just take your chances and get whatever is available. Subsequent meals were more t0 my liking.
One evaluates ones improvement according to small steps. For that chest xray, I made the technician make the images without my leaving the gurney. That afternoon, I had a follow-up xray (they were checking for an air leak), by then I had walked around the floor several times and was able to get out of bed and make transfers back and forth to the gurney. I had no problem leaving the gurney and standing for the chest xrays. I interpreted this as a major improvement.
Tuesday night both Jana and I got more sleep. We probably got 5 or 6 hours of sleep.
Day 2 - Post-Surgery
Another trip to radiology for two more chest xrays. During the morning rounds, the Residents told us the xrays looked good and that I would probably be discharged at the end of the day. In a later visit, Dr. deHoyos confirmed this. He explained that the pneumonia that I could catch at home would be less virulent than what I could catch in a hospital. There was little reason to stay in the hospital.
Discharge instructions and orders were prepared by CNP Sue Collazo, who has had extensive experience in thoracic and cardiac surgery. My case was tailor-made for this approach and illustrates salient features. It yielded early detection, limited risk, quick recovery and offered surgical treatment without follow-up chemotherapy. She is planning to present the case at a conference this summer.
We had a final visit with the PA and were discharged from the hospital by 5:00 PM on day 2 (about 48 hours after leaving the OR).
