Thoughts On Surgery

Yesterday I had some surgery. Today, after (mostly) processing the drugs, it’s time to take stock of the experience.

Sometimes Scary/Painful Experiences Turn Out… Ok?

Sometimes medical treatment can be scary. But, also sometimes, the result turns out the opposite of scary.

A Previous Experience: The Joys of Dental Surgery (Really)

Case in point: about 20 years ago, I had some pretty extensive dental surgery. The dentist even warned me, “You won’t enjoy it.” Cutting open gums, reflecting up the tissue, quad-planing roots, stitches, all sorts of fun. But:

• Ok, the initial novocaine was “not much fun.”
• But after that, she went after the teeth & bones in my jaw with a belt sander. (Apparently dentists have orally insertable belt sanders; who knew?) But that was pretty much tolerable, and even enjoyable, because:
  • She and her assistant were carefully watching my muscle tension, breathing, and eye tracking. Every time I so much as twitched, she said something like, “Oh, I’m sorry. Did that hurt? Here, let me give you a little more painkiller right there.”
  • I felt like I was in the intense focus of attention of two highly competent women, absolutely determined to do well by me, and care for me. And by “care”, I mean attention not just to my teeth & jaw, but to my emotions in reaction to the experience.
  • At one point, I actually shed a few quiet tears of gratitude, in the middle of surgery. Hilariously, they misinterpreted that as a pain reaction, and gave more novocaine while gently holding my head.

I have to say, it was one of the more nurturing experiences of my life, to my huge surprise. I don’t generally recommend dental surgery as psychotherapy. But that’s how it worked out for me, at least this once.

You can find people practicing compassion at very high levels in the most unexpected places!

So How Was It This Time?

The details of what was being operated upon are both boring and personal, so I’ll spare you that. Just take it as read that I was an anxious, nervous old nerd. I wasn’t worried about the surgery itself (short of catastrophic failure, which was unlikely, but I did make sure our estate plan was up to date). I was worried about the recovery, which the surgeon warned me would be painful the first week, and quite tediously annoying for a month.

So how did the hospital folk react to an anxious, nervous old nerd who was keeping it together with sheer determination? They dealt masterfully, is what happened:

• The surgical prep nurse: While taking down my info and making sure I was the right person, wanted to know what I did for a living. After finding out I used to be a cancer drug researcher & statistician, she wanted to talk about evidence-based medicine. Why methylene blue is no longer used in certain tests, how hard it is to get people to change their minds, getting our most recent COVID-19 boosters, and so on.

  The net result: I felt I was among my own tribe, and it would be ok to surrender temporary control of my body to these sensible people.

• Surgeon: Gotta admit, I haven’t had good feelings about surgeons in general. They’ve tended to be a headstrong group, so sure of their personal knowledge that anything from me, a “mere PhD”, could be safely ignored. I have vivid memories of lots of such struggles during my research career.

  I’m happy to report that my surgeon was not of that ilk, but rather the opposite. Every single time I said a single word – and I mean every time – he put down what he was doing, made eye contact, listened, and demonstrated that he understood. He even joked how cute it would be to name the individual cysts being removed. (I noted that my spouse had already named them. Yes, it was cute the first time, but fractionally less cute each time thereafter.)

  The net result: I felt like I was entrusting my life with someone who wasn’t just skilled, but also not too full of himself and had a sense of humor. He know how to wield that humor in a way that calmed his patient, and I was grateful for that.

• OR nurse 1: He introduced himself by name, and noted “we’ll be together for the next couple hours”. Well, my body would be physically present, but my consciousness was about to take a long walk off a short pier. It was nice of him to offer a bit of humanity to take the edge off anticipating that. I learned that he follows minor league baseball teams in New England.

  The net result: Not much of a sportsball guy myself, but it was nice to know I would be in the care of a warm and friendly man.

• OR nurse 2: This was a short, cheerfully expressive black woman, with a mild tendency to dance. I absolutely love listening to people’s accents, and guessing their history. It turns out she’s from Haiti, and so the rest of our (short) conversation was in French. It quickly became apparent that my very weak grasp of French was not up to Haitian Creole, so she teased me about that a bit. And then the rest of the OR staff teased us both about switching languages. She put on the inflating boots over my calves to prevent blood clots; they were actually quite comfortable, almost like in a massage chair.

  The net result: Probably some drugs were starting to take effect, but she seemed like an absolutely lovely and playful person, to whom it would be a lot of fun to listen.

• Anaesthesiologist: I saw the milky fluid and recognized the drug as propofol. Given the other drugs in my system, I may have been a bit disinhibited, so it’s with a slight cringe I remember joking along the lines of “Ah, I see we’re using Michael Jackson’s favorite this morning.” He may have responded something along the lines of “Yes, he was a great anaesthesiologist”… but I kind of doubt it. At that point, my consciousness was fraying like a rotted flag in a strong wind. After all, they don’t call it “milk of amnesia” for nothing.

  The net result: The anaesthesiologist seemed to recognize the joke, or at least the last 2 functioning neurons in my brain told me so. That was some comfort.

• Recovery nurse: I thought general anaesthesia would just be a slice of time that didn’t exist for me. I didn’t expect to dream, but I did. It seemed very meaningful at the time, but now I mostly just remember feeling cold. And then, as I was waking, the clear thought: “Ok, I guess have to go back into the world now, but why does it have to be this world?” (I also recall a flip-book of different worlds, 1 page each. Quite fascinating.) Really not sure at whom that question could be directed, or what the answer might be.

  The recovery nurse was quite reassuring, stroking my hair and telling me everything was all right, in a warm and calm voice. She put a heated blanket on me, and said I could just take a rest if I felt like it. She was monitoring blood pressure, oxygenation, and heartbeat quite closely while doing this. I remember coughing quite a bit, though I usually cough a lot anyway.

  She kept asking about thirst or pain, and seemed almost disappointed I wasn’t thirsty and had only moderate pain. When she helped me stand, I remember her hands being warm and strong, and her voice being reassuring. It was perfect, for that moment.

  The net result: Ok, yes, apparently I do have to be back in this world. But at least for a moment, there was somebody kind who was there to help me return.

• The drugs: You’ve already seen my lame attempt at propofol humor, above. I can’t really say what else was used, since there was not much of me left in running condition to notice. But the recovery nurse had lots to say, most of which slipped past my addled brain at the time:

  • Fentanyl: She actually seemed disappointed that I didn’t have pain needing immediate relief. (Maybe she really likes alleviating pain, which in her position is A Good Thing.) But my lower back was kind of sore from having to lie on it in a funny position. When I mentioned this, she gave me a bit of fentanyl through the IV line. There followed a conversation about how it’s “not the dangerous street stuff” that makes cops so trigger-happy and afraid for their lives (pure cop-superstition). I admitted as how it was a perfectly reasonable drug in the right time & place, with the right supervision. Not sure why she smiled at that, but apparently it was either amusing or she was being exceptionally indulgent. (Or maybe, under the influence, I was being altogether silly.)

    The verdict: It made me woozy, with erratic eye tracking and doubtful balance. It didn’t seem to affect pain too much, just made me care about it a bit less. It may have less of an analgesic effect than people think, if it just makes people shut up about pain?

  • Vicodin (or Norco): They prescribed me some hydrocodone/acetaminophen mix for mild post-operative pain, and told me to use it sparingly until I could switch to acetaminophen.

    The verdict: Upon taking the first couple doses, it became apparent that Vicodin/Norco cheefully wanted to be my new best friend. All things considered, I would prefer an arm’s length relationship. A short relationship. I’ve spent too many years working on drugs to set even a single foot down the other path.

  • Cephalexin: Now this is potentially my new best friend, at least for the next few days. It’s an antibiotic, and I am adamantly opposed to post-operative infections. So we are allies in this regard.

    The verdict: No overt side effects observed. It smells a bit bad, but then so do I on occasion. This will do.

Upon returning home, the Assistant Weekend Publisher, shown here, had some opinions on my brief absence.

I was concerned he’d want to get into my lap, with the no doubt intriguing smells of a fresh surgical wound. (It’s a predator thing. Don’t judge him.)

But, as you can see, he generally disdains laps as inadequate. He prefers you make a space with your arms, so he can get up in your face. After some biscuit-making on my neck, he curled up for his beard-brushing nap. It’s his way of saying: “Hands off keys. Hands on cat.”

I bowed before the superior logical force of his argument.

Now… on to the recovery, which the surgeon predicted would not be pleasant. Well, at this point I can cope with that. Not my preference, but it’s reality. And reality is the only thing with which any of us can engage. Or, as it says on my quotes page:

“Optimists refuse to acknowledge reality. Idealists remind us that it isn’t fixed.” — Susan Neiman, “Change Germans Can’t Believe In”, New York Times, 2008-Jul-26.

Time to be an idealist, in that sense. Whether I like reality or not, it’s what’s there. And it can, to a degree, be molded.

The Weekend Conclusion

These were people doing good in the world (tikkun olam, pikuach nefesh, and imitatio dei), with good skill levels, with good empathy, and good emotional care for those entrusted to them. They are good people, and I’m glad to have encountered them. (Yes, this opinion may have been colored by the anxiolytic effect of some drugs on an anxious and depressed old nerd. If that disinhibition made me more likely to recognize the good in others, then I can live with that as a revealed preference.)

The circumstances of the encounter, though… well, that could have been better. On the whole, I prefer not having my body cut open. But when that must happen, it’s good to have kind people handle the matter.

And, as always, for the near-term future: Ceterum censeo, Trump incarcerandam esse.

Addendum 2024-Mar-20: Cephalexin smell

Yup, it seems the smell of the cephalexin is well known. As you can see from this molecular structure diagram from Wikipedia, the culprit is the sulfur atom (yellow in the ball-and-stick representation). That leads to the generation of hydrogen sulfide (H2S), which gives rotten eggs their smell. And… intestinal gas. So that’s why my spouse has been being so polite…

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Notes & References