Monday
May212012

15. Surgery

Let me save you some time. Good news: I was asleep from 8 a.m. on Monday until 4 p.m. Tuesday, totally obvious to events in the meantime. Bad news: when I did wake up, I had to deal with the after effects of said events. They were not pleasant. Skip to the next blog post.

Now, for those who want to know the gory details -- and who are we kidding? you wouldn't be reading this blog unless you wanted to know the details -- my unpleasantness began the day before. Since the surgery involved my bowels, I had to make sure they were empty going into the hospital. Basically the same prep as if you were about to have a colonoscopy. A drink that is totally disgusting. Tablets you place in areas where you don't normally place tablets. And then the emptying began.

I could handle all that pretty well, actually. But what got me were the antibiotics I had to take at the same time. The logic being that I would be at risk for infections coming out of surgery, so prime the body beforehand. Okay, I get that. But these were really powerful antibiotics. And since I couldn't eat or drink, there was nothing in my body to absorb them. The result? Intense nausea. So much so I found myself laying on the bathroom floor much of the time, just waiting for the inevitable to happen.

At this point, fear set in. What am I about to do? How can I put my body through another severe trauma? God, tell me I don't have to do this. "You have no other choice," Kate said in a quivering then assertive voice. "You've got to do this surgery." Somehow, I made it to bed, shaking, clammy, frightened. Sleep. God, help me sleep.

Kate and I arrived at the hospital at sunrise the following morning, September 19, 2011. I felt just awful. Nausea and anxiety make for a nasty combination. To cope, I laid down on a couple chairs in the waiting room. A comfortable position, it was not. After a while, I saw my parents, who had travelled 25 miles from their home to see me off to the operating room. What amazing dedication they had.

Once in the pre-surgical carrel, the nurses prepped me for surgery. I was bummed that they couldn't use my mediport and, instead, had to open new veins to get the drugs flowing. Anesthesiologist arrived. As did the OR nurse and her cold hands. Finally, my man Schenk. "Are you ready?" he asked. Hell, no! But I wasn't here to go shoppng! I said my goodbyes to my parents. Kate gave me a big hug and kiss. Our eyes welled up with tears. And I was off. I don't remember anything after that.

But here's what happened. My body was put at a sharp angle, with my head closest to the ground. Gravity would make it easier to remove and insert all that needed to be removed and inserted. Dr. Schenk then spent a fair amount of time aligning the robots to my body. He would use robots to do the removing, and he would manually do the inserting. Why robots? Besides making the surgery less physically taxing on Dr. Schenk, his associate and nurses -- and it's a taxing surgery, to be sure -- robots cut more precisely and thus result in less nerve damage than manually cutting. Sounds good to me. All this took several hours.

On the coming out list: my bladder, prostate and a dozen or so surrounding lymph nodes. Also on the cutting list: my small intestine, which lost a couple sections. On the going in list: one small intestine part, now formulated as a new bladder connected to parts below, and another piece of intestine formulated as a chute above the new bladder to receive fluid from kidneys, all of which would kinda, sorta function as the bladder system it replaced. All pretty straightforward, yet dramatic, stuff. But a problem complicated the entire surgery. Dr. Schenk noticed atypical cells on one of my ureters, the tubes that connect kidneys to the bladder chute. Atypical cells are generally pre-cancerous. So Schenk whittled away at the ureter in question until he was confident that all the bad cells were cut out.

That was great, obviously. But it left him with another problem. One of my ureters was now much shorter than the other. And that made connecting my neobladder difficult. To make the neobladder function, it has to be connected to the ureter coming from each kidney and then to the urethra coming from below. The problem? Nothing fit. Argh. Schenk told me afterwards that mine was one of the most difficult surgeries he had performed on a neobladder candidate. "I was trying every trick in the book."

Finally, by moving my neobladder closest to the short ureter, Schenk was able to stretch the long one just enough to connect the top of the neobladder chute. But it was on a more horizontal plane, rather than an angled one, so the neobladder couldn't connect to the urethra below. His solution? Pull up the urethra and its connecting parts (ouch!) until contact was made with the neobladder. And the whole thing fit, just barely. Whew! All this took several additional hours to perform.

A neobladder typically hangs tension free from the kidneys. Mine doesn't. A neobladder is supposed to be centered in the body. Mine is off to the side. As long as it works, I'm okay with that. From here, the surgical team inserted four catheters and drains into my pelvic area. They were designed to redirect urine away from the neobladder and connecting parts until they could heal from the surgery. The entire surgery took about 12 hours. Off to the intensive care unit.

All this waiting made Kate a nervous wreck. Twelve hours is a long, long time. My parents kept her company. My sisters Cathy and Chris sat with her for a while. As did Kerri, her sister. As did Michael, our son. Other family members texted her to see how the surgery was going. From time to time, Schenk would come out to the waiting area to stretch and update her on the surgery. But the hours felt like days. She went back and forth between wanting company and wanting to be alone. Unfortunately, there would be no escape from the fear and anxiety she felt. Even having dinner with our boys provided little respite.

As a cancer patient, it's easy to dwell on your own problems. But the impact on loved ones is incredibly severe. There were times during my treatments when Kate would break down in tears, overwhelmed by the impossible tasks of caring for me, dealing with work, managing our household, and being a mom for the boys. I tried to lessen the impact by urging her to go out for drinks with the girls. While those outings helped, their effect was short-lived. They were a bandaid on a deep, deep wound. Cancer became an endurance contest for both of us.

Back at the hospital, Dr. Schenk emerged and announced that the surgery was complete. It was a difficult one. But he was able to install the neobladder. He would put the material he removed through pathology tests to see if cancer was present in any of these areas. The lymph nodes, in particular, would be a focus on his. If cancer was still present in them, more chemotherapy treatments and surgery were quite possible. With that news, the nurses were ready to take Kate to see me. But just a moment. They warned her in advance. I would look nothing like I did before surgery.

When she arrived at the ICU, Kate saw that my head had swollen to the size, color and dimensions of a basketball. This was due to the pressure of my body being put at an angle for so long, My head was wrapped in bandages. My eyes covered. A breathing tube still inserted. Several additional tubes emanating from my pelvic area. Seeing this, she broke down. "The night before, I told you that you had to go through with the surgery; after seeing you I felt so, so guilty."

The doctors tried to wake me up. But I gasped for air. Again. Another gasp. Again. Gasp. No oxygen. The doctors determined that I could not breath on my own. So back went in the breathing tube, and I was rendered unconscious again. Which made Kate feel only worse.

I finally woke up. I asked the nurse what time it was. She said four o'clock. Okay, I thought, not a long surgery. That's good. Then she added, "Four o'clock, Tuesday afternoon." Oh. I had missed 32 hours in time. "After surgery, you couldn't breath on your own..." Oh, Lord. This sounds bad.

For the next few hours, I'm told that doctors and family members talked with me. But I don't remember any of that. What I do remember: seeing Kate's eyes, tears streaming down her face, but with that pretty smile of hers. She kissed my cheek. We held hands. She said the surgery was a success. I smiled. Exhausted, I soon drifted off to sleep.

Another set of adventures awaited me.

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Reader Comments (1)

Thank you Sir very much for your blogs! It brought my tears when I read it. I wish you well! My husband just diagnosed with bladder cancer last May and we have 2 boys (12 and 5 years old). Things has been very rough but we will beat it just like you and your family.

October 6, 2014 | Unregistered CommenterBaotram

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