One More Time
However, multiple painful cystoscopies and follow-up procedures turned me into a nervous wreck when it comes to hospitals, a condition that only worsened as Friday approached. My head knows litho is very different, but my body and my emotions scream in total panic. So I asked the urologist for a Valium scrip for me to take before-hand. That way they wouldn't have to drag me screaming into the room.
When I've gotten pre-op Valium before, the scrip was for a single tablet. This time when I filled the scrip, I had ten! I'm not sure how panicky they figured I'd be, but whatever.
On Litho Day, we had a half day of school and my procedure was scheduled for 2:00, with a noon arrival time. This meant I didn't have to take time off work, and that I'd have something to occupy my mind in the morning, which worked out well. When I got home, I decided to do my run right away, partly because I knew I wouldn't be able to run for a while after the litho and partly to keep me from panicking more. When I finished up, I took up the Valium bottle. The instructions said to take one or two tablets a day, so I took two.
Darwin drove me to the hospital, and by the time we arrived, the Valium was seriously kicking in, and I couldn't walk safely. They had to bring me in with a wheelchair. I was calm, though.
There was the changing of the clothes. I asked for two gowns--one to use as a sort of bathrobe--and the nurse refused me. "We have to have the gown open at the back so we can do the lithotripsy," she said.
I got mad, like I did last time. And then it hit me. One of the things that upsets me the most is that I have no idea what goes on when I'm under anesthesia. I'm completely reliant on what the doctor says afterward and on the operating room notes (which I have to get special from the records department--they don't include them in your discharge papers, for some reason). I know it's illogical. I know it makes little sense. But when you're a survivor of sexual assault undergoing procedures that hit you right where you were assaulted, you're allowed not to make sense.
Meanwhile, they plugged in an IV and did other prep work. This included Dr. H-- signing my right arm to ensure they remembered to do the correct side.
The gown had a pocket on the chest for a heart monitor. I asked the nurse if they were going to put me on one. "You never know," she said, which irritated me more. (Why not just say, "We don't plan to, but we might need to"?) They'd already hooked me up to an EKG, so I didn't see a reason for a monitor anyway, and I've become an unfortunate expert in this stuff.
And then I had an idea. When I had a moment alone, I called up the voice memo app on my phone, set it to record, and dropped it into the pocket on my chest. Then I pulled the blanket up. A couple of times, nurses fussed with this or that, and I was careful to keep the blanket pulled up as if I were cold or hugely modest or both. Despite being high on Valium, I pulled this off without even Darwin noticing.
At last, the time arrived. I said good-bye to Darwin and they wheeled me down to a tiny room with a lithotripsy machine on it. It's a table with a long white arm looming over the top. That's the fluoroscope, a weak x-ray that locates the stone. Wedged on the side of the table is a round, rubbery object which rests against your side and conducts the sound waves in a directed cone. Guided by the fluoroscope, the sound waves focus on the stone and shatter it so it can pass easily.
The tech's name was J--, a tall, dark-haired man I couldn't see very well because his work station was hidden behind a leaded window. The nurse came to administer anesthetic through the IV. They said they didn't need to intubate or use gas, which I appreciated.
They positioned me on the table, and the nurse hit me with anesthetic. It burned like fuck.
"What are you using?" I asked.
"A bunch of stuff. Some Valium, some propofol, and several different things, here." she said. "Are you starting to feel it at all?"
"No," I said. It always takes a while for anesthetic to start in on me. I don't know why this is. I remember when I got my wisdom teeth out at 19, the dentist gave me Versed and asked me to count back from 10. I did, then said, "Now what?" He was surprised I'd gotten that far and told me to try again. I got to six before I felt dizzy.
Here, the nurse also seemed surprised I didn't feel anything. She gave me another shot, and I asked what it was. "Just an antibiotic," she said.
"It's cold," I said. "What is it?"
"Ancef," she said.
Meanwhile, another nurse said, "Penicillin" from across the room.
Alarm bells rang, and I got panicky again. "Penicillin?" I wasn't feeling anything yet, but my speech was a little slurred from the Valium I'd taken earlier. "Did she say penicillin?"
"That's what you're allergic to," the second nurse said.
"Okay."
She gave me yet another shot, and this one hurt quite a lot. What the fuck, man? Finally, I started feeling dizzy, and said so. This was about three or four minutes after the first shot of anesthetic.
"Just relax," said the nurse. "Let yourself fall asleep. It's all good."
Around then, everything went dark for me. But the recording continued. According to the sound file, another four minutes went by, and then you can hear them pulling me around on the table to get the sound emitter positioned properly. Several more minutes passed, and J-- said, "24" several times, and the pounding started. It sounds like a plastic ruler hitting a vinyl seat cover in a regular rhythm.
J-- turned on some music to pass the time, and he and the nurse made idle conversation.
"I didn't think he was ever going to go to sleep," J-- said at one point.
The nurse laughed a little. "I didn't either! He was asking me every single thing I gave him, too."
"He seemed to know every one of them," J-- replied. "Just an observation."
About 40 minutes passed, with background conversation and the steady THUMP of the litho machine. A LOT of people wandered in and out of the room, talking. Finally, J-- said, "That's it?"
"That's it!" said the nurse.
"15:06," J-- said, calling the time, and the thumping ended.
"Steven!" shouted the nurse, but apparently I didn't respond.
"He'll wake up in recovery," J-- said.
Another nurse said, "I heard it was . . . "
"Interesting?" J-- supplied. His tone said "interesting" meant "problematic."
"Yeah."
"Well, that's . . . he just wants to stay appraised of the situation."
Here, we have an editorial aside. Have you ever noticed that whenever you read material about how to handle a doctor visit, the literature always, ALWAYS says, "Ask questions. If you don't understand something, ask questions." And, as both a teacher and a patient, I DO ask questions. I need to know not only WHAT is going on, but WHY it's happening. If I don't understand the why, I get angry and rebellious, exactly the kind of patient hospital staff hate the most. So I ask questions until I'm satisfied I know what's going on. Because I grew up in a medical family (I'm one of the few people in my family who doesn't work in a hospital or clinic), my knowledge of medical procedures, medications, and hospital regulations goes far beyond most laymen, so my questions get very specific and pointed. This helps my post-assault traumatized self cope.
But despite the admonition to "ask questions," the doctors and hospital staff I've encountered inevitably act surprised, or even annoyed, that I'm asking. I'm not sure why this is. I certainly have a right to know what procedures will be performed on me and exactly what medications will be administered, especially when I'll be unconscious for a chunk of it and can't object or change my mind, and it's part of the staff's job to answer patient questions. Not only that, either I or my insurance company is paying for these medications and procedures. When you get your oil changed, you get a comprehensive list of every single thing the mechanic did to your car and how much each costs, but when you go to the hospital and they do things to your body, they get weird when you want exact details.
More conversation between J-- and the nurses. J-- said the stone broke up easily, which was good. They slid me onto the gurney with J--'s help, and I made a weird groaning sound.
"You're all done!" called one of the nurses.
"All done!" another one repeated.
"Open your mouth!" the first one said. I don't remember this, and don't know if I obeyed or not. "Gonna take you to recovery."
"How you doing? Tuck your elbow in for me!" another nurse called at me. So I must have been waking up. I don't remember any of this, though.
Then you can hear the gurney rolling and nurses talking about charts and slots in the recovery room. Cloth rustled a lot. Another nurse read off my allergies and noted my heart rate.
"Fifties?" she said in surprise.
"That's where it's been the whole time," the other nurse said.
Several minutes passed. I was sleeping--you can hear me breathing. And then the recording finally overlapped with memory. My first memory is about someone in the background talking about the Eastern Market in Detroit, and that comes through on the recording. Finally, a nurse asked if I was awake and if I wanted my head up. I usually can't speak when I come out of anesthesia. My tongue feels too heavy and I can't summon words. She asked if anyone was with me, and I nodded.
More minutes passed, and they finally brought Darwin back to sit with me while I slid in and out of a doze. Darwin commented that my heart rate kept fluctuating--up to 50, then down to 42, then back into the 50s, and then down to 38. "Unpredictable," he said gently, "just like you."
The nurse went over discharge instructions with me and Darwin. This included a warning that I might have bruising, redness, or soreness at the site of the lithotripsy. This was indeed the case, but it was minor and way, way, way below cystoscopy. My current pain levels were nothing compared to that.
Unlike the other procedures, they didn't have me empty my bladder before I left the hospital, but I wasn't in real pain, either. They wanted me to bring a urine strainer home to collect the stone pieces when they passed, and I asked why. The nurse said it was so I could bring the pieces in for analysis. I refused the strainer on the grounds that, after two dozen kidney stones, we already know what they're made of.
"Did they give me any other medicines while I was under anesthesia?" I asked.
"Like what do you mean?" the nurse asked.
I repeated the question, not sure why she didn't just answer.
"You got anesthesia by injection," she said. "What else do you mean?"
"I don't know," I said. "That's why I'm asking."
See? This reluctance to answer questions baffles me.
"Well, we gave you some anti-nausea medication, and some pain medicine, and everything else was part of the sedation."
"What was the pain med?" I asked.
"Fentanyl," she said. "They gave it to you right at the beginning." (She didn't mention the antibiotic the nurse in the litho room told me about, and the nurse in the litho room didn't tell me about the fentanyl or the antt-nausea med. This is why I ask multiple people the same question--the answers seem to change.)
Here, the nurse went to attend another patient. I pulled my phone out of the pocket and shut off the recording.
When I got home, I went to the bathroom. I have to say I'm very tired of watching for blood and blood clots. This time it was a nice surprise. There was blood at the beginning, but it cleared up and vanished after just a couple seconds. I had no blood after that. About the third time I went to the bathroom, I felt some fragments pass, but they didn't hurt at all.
I spent a groggy afternoon and evening. I slept most of Saturday, too. Darwin, the cats, and Max kept wandering into the room, waking me up, and got pissed at them after a while, and they finally left me alone. I'm awful when I get home from the hospital--cranky, miserable, and I snarl at everyone like a wounded animal. Afterward, I always feel bad about the way I treat everyone, but I can't seem to stop. I can't always talk right, either. Darwin will ask me a question, and I can't form an answer, even to something as simple as, "Do you want me to order Chinese for supper?" It makes me a difficult patient.
I kept waiting for the crying jag. Whenever I come out of anesthesia, I eventually cry like someone has just died. The previous time, I mentioned this to the anesthesiologist, who monkeyed with the medication, and I didn't cry when I woke up. That was great! But about an hour after I got home, a hurricane of bawling swept over me, and I couldn't stop. The anesthesiologist was able to delay the crying, but not stop it. I know it's a brain chemistry thing, but that doesn't make it any less miserable when it happens.
So I was waiting. And I waited. Finally, three or four hours after I got home, I figured, "Yay! I won't do it this time. Maybe it was the kind of anesthesia they used." I was taking a shower at the time and got out to dry off, and--WHAM! I was crying again. Jesus fuck. Darwin heard me, and came running in to see what was wrong. Same shit, different day. He got me into bed.
Later, I downloaded the recording to my computer and listened to it. It was "interesting," to use J--'s words. Parts of it relieved me--I knew pretty much everything that happened while I was unconscious. Parts of it ticked me off--I didn't much like some of the comments the staff made. (I didn't reproduce them here.) I understand why they made them, and I know they wouldn't have made them within my hearing if I were awake, but it's "interesting" having a recording of what people say about you in the same room when they think you're unconscious.
Would I do it again? Yes. I'm sure I'll have more of these procedures, and I'll probably have to have a full cystoscopy again at some point, and I want to know what happens when I'm out, even if it makes me angry. I want the unvarnished truth. One thing a recording like this does is arm me with more knowledge, so next time I can tell the staff, "I don't like ___, so please don't do it."
I talked to Lenny, my counselor, about the recording, and he shifted uneasily. "You're not happy about it," I observed.
"Well, no," he said. "It makes me wonder if you're recording us right now, for example."
"I don't have to record us now. I'm awake and I know what's going on."
"But you can understand why a medical team wouldn't like it," he said. "They'd be wondering if you were planning a lawsuit or something else."
"Don't care," I said. "This makes ME feel better, and it's not my job to stop them from worrying. It's their job to stop ME from worrying."
"If you were recorded in the classroom," he countered, "how would that make you feel?"
"I get recorded in the classroom all the time," I said. "My students record me during lectures, and god only knows how many cell phones record class that I don't notice. I used to record classes and post them on YouTube, but the new software the school bought makes that a technical nightmare, so I don't do that anymore. I =expect= to be recorded at my job. Besides, these recordings help me get answers to questions, and let me know what to ask later. The staff never answers completely, and that frightens me. I need to know everything, and I need to know why it's happening so I can cope."
I paused. "This I don't understand. The staff acts like I'm weird for asking all these questions. Don't other people want to know this stuff? I mean, it seems like there'd be a few who'd say, 'Just do it and get me out of here, I don't want to know the details,' but I don't understand why MOST people seem to act that way. It's MY body, and I want to know everything that's done to it, especially when I'm unconscious and under the total control of strangers who can--and do--perform any procedure they like without my knowledge."
"Here's what you can do for that," Lenny said. "It'll mean repeating a lot, but tell the staff that you're a trauma survivor, and you need complete, step-by-step details for everything that's going to happen, including a list of medications and the steps, even the little ones, the staff will be taking during the procedure. Then they'll understand why you're being unusually inquisitive and they won't take it the wrong way."
I agreed this was a good idea.
I'm still going to record the next procedure.
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