Steven and the Biopsy
At a relatively recent appointment with my urologist, he voiced concern about my PSA levels. He ordered a couple of other tests, including an MRI, and said the chances of cancer are very low, but also decided I should have a prostate fusion biopsy "just in case."
In case you've never heard of this phenomenon, a prostate biopsy is a special procedure in which a probe the size of a drinking glass is inserted into the rectum and pressed against the prostate. The probe takes a sonic image of the prostate, which is overlaid with an MRI which has been marked with places of interest. A computer moves the probe, using the MRI and the sonic image as guides and it snaps a thin needle through the rectal wall into the prostate, then rotates itself and snaps another needle through--twelve times in all. Although the procedure is supposed to be "tolerable" to aware patients, it's much more common these days to use general anesthesia.
My own appointment was set for late July, then I had the chance to move it up to late June, and I took it. This way, the appointment wouldn't be hanging over my head most of the summer.
Regular readers of the this blog know what I went through with the great kidney stone horror a couple years ago that left me a near basket case of anxiety and PTSD. I've gone through a great deal of therapy since then, and I thought I would be pretty okay with this procedure. I was wrong. As the day got closer, I became more anxious, to the point where I was going into the closet to sit with my head between my knees multiple times per day. At bed time the night before, I was crippled with anxiety so bad, I couldn't do anything but curl up on the bed and shake.
If it were a liver biopsy, or a lung biopsy, or even a marrow biopsy, this wouldn't bother me in the slightest. It's the combination of being anesthetized and the unavoidably sexual nature of the procedure that set off the triggers. A ball of fear forms in my stomach and paralyzes me, and no amount of self-regulation seems to stop it. I know that to the medical team, this is a dull, routine procedure they do a dozen times a day, hundreds of times a week on an endless parade of faceless patients. I know that the moment I leave the room, they'll completely forget me, much like a grocery store clerk forgets customers the moment they walk out of the store. I know that the team is there because they want to help me, not hurt or mock or judge. Not one bit of that knowledge changes the way I feel.
On the day of the procedure, Darwin drove me to the hospital in Mt. Clemens, an hour away. It took me a long time to make myself get out of the car, and when we walked in through the sliding doors, I couldn't lift my head. I stared down at my shoes and followed Darwin inside.
Somehow, I got through the intake process and the nurse took me to a prep room while Darwin stayed in the waiting area. The nurse assured me Darwin could come back to see me once I was set up. I answered the same sets of the questions from multiple questioners. Then the urologist came in. He wasn't =my= urologist, who doesn't do biopsies, but was part of the same practice. After he went through the spiel, he asked if I had questions.
"This isn't a question," I said, in a canned speech I keep handy. "It's more of a statement. I'm a survivor of sexual assault, and this kind of operation sets off all kinds of alarms and triggers. I cope by demanding a lot of information and requiring everyone to tell me every single thing that happens. I need you and the rest of the team to keep that in mind for me."
He nodded sympathetically and said the team would be sensitive. He also rather awkwardly patted me on the shoulder. I felt a little better.
Darwin came into the room at that point, and we waited together for about an hour before my turn came up on the rotation.
The nurse injected me with Versed, which I don't like because it messes with my memory, and wheeled my bed down to the OR. I'd already done some recon about this procedure and, as I warned, asked a great many questions about the equipment and commented on how it worked, somewhat to the team's surprise. The procedure is performed with the patient on his side, but the last thing I remember is getting an oxygen hose affixed under my nose and how it got momentarily tangled in the EKG lines.
But I have clues.
Here's the other thing, the odd thing. I recorded the procedure.
I bought a finger splint and a small voice recorder, thin and flat and the length of a finger. Before we arrived at the hospital, I put the splint on and slid the recorder under it so it looked like part of the splint. The nurse who put my IV in noticed the splint, in fact, and asked about it.
"I hurt my finger," I said. "Need to wear it for a few days."
"Ouch," she said, and went on with her work. No one else noticed it or commented on it, though one team member pointed out that I'd forgotten to take off my wedding ring and had me give it to Darwin. Just before the procedure started, I flicked the recorder on with an unobtrusive gesture. Later at home, I downloaded the sound file it had created and listened.
The reason I did this wasn't to play Gotcha! with the medical team or hope to hear something I could use in a lawsuit. It's so that I =know=. It's a way to maintain control.
As I said, the last thing I remembered in the OR was the oxygen line tangling in the EKG wires. But later, when I listened to the recording, I heard myself say things, and I abruptly remembered saying them. I said at one point that I wasn't feeling the first shot of Versed, which is normal for me, and the nurse saying she'd give me a booster dose.
"Don't you worry," she said cheerily. "The drug always wins!"
I only remembered that after I heard the recording. It was strange, like the memory had been pushed down but was able to emerge thanks to my own voice.
I must have fallen asleep before they could get me onto the table because one of the nurses said, "I need help lifting him," and I don't remember that at all.
The rest of the recording was . . . dull. The team talked very little, and when they did, it was often about stuff that wasn't related to the procedure, which reaffirmed for me that the procedure was routine and didn't require their full concentration. None of the conversation was about me directly, which I also was glad to learn.
One of the more unnerving aspects of the recording was that it clearly caught the SNAP of the needle every time it took a sample.
I also caught the doctor's phone call to Darwin when the procedure ended. Darwin, who also listened to the recording, said it was odd hearing the doctor's end of it.
My memory started up again in the recovery room. A nurse was on the phone talking to someone about how they didn't have any more beds in the area and the other people in the ORs would have to wait. That was on the recording, too, and listening to it helped center where and when I was.
Another nurse asked me if I was in pain. I was. Darwin had said he felt no pain whatsoever, but I was hurting, and the pain was increasing steadily.
"Do you want something for pain?" she asked.
Experience has taught me that when a nurse offers you pain meds, you take them, so I said, "Yes," and she gave me a pill that made me even loopier than I already was, though the pain ended.
I asked when my husband would be allowed to come in, and the nurse said it wouldn't be until I could sit up in a chair. This didn't make sense to me--what difference did it make to the hospital if I could sit in a chair or not? But I was still half-sedated and couldn't protest much. Eventually, Darwin was ushered in, and I felt quite a lot better. (Next time, if there is one, I'll insist up front that he be brought in the moment I'm awake.)
We waited together until I was more awake. "Do you want to wait here longer or go home?" a nurse asked. I said I wanted to go home. I couldn't get into the wheelchair or the car by myself, though by the time we got home, I was able to manage the stairs. I crashed on the bed for several hours.
I have a follow-up appointment in a couple weeks, though I'm sure the results will show up on the patient portal long before then.
Today? Today, I'm still anxious. The ball of fear keeps twisting my stomach. I'm having a hard time concentrating on anything. I can't eat due to nausea. Part of it is after-effects from the anesthesia. The larger part is the emotional side. I can't shake the feeling that I was violated, even though I have concrete proof to the contrary.
So I spent this afternoon looking for a counselor. I need someone to talk to.
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In case you've never heard of this phenomenon, a prostate biopsy is a special procedure in which a probe the size of a drinking glass is inserted into the rectum and pressed against the prostate. The probe takes a sonic image of the prostate, which is overlaid with an MRI which has been marked with places of interest. A computer moves the probe, using the MRI and the sonic image as guides and it snaps a thin needle through the rectal wall into the prostate, then rotates itself and snaps another needle through--twelve times in all. Although the procedure is supposed to be "tolerable" to aware patients, it's much more common these days to use general anesthesia.
My own appointment was set for late July, then I had the chance to move it up to late June, and I took it. This way, the appointment wouldn't be hanging over my head most of the summer.
Regular readers of the this blog know what I went through with the great kidney stone horror a couple years ago that left me a near basket case of anxiety and PTSD. I've gone through a great deal of therapy since then, and I thought I would be pretty okay with this procedure. I was wrong. As the day got closer, I became more anxious, to the point where I was going into the closet to sit with my head between my knees multiple times per day. At bed time the night before, I was crippled with anxiety so bad, I couldn't do anything but curl up on the bed and shake.
If it were a liver biopsy, or a lung biopsy, or even a marrow biopsy, this wouldn't bother me in the slightest. It's the combination of being anesthetized and the unavoidably sexual nature of the procedure that set off the triggers. A ball of fear forms in my stomach and paralyzes me, and no amount of self-regulation seems to stop it. I know that to the medical team, this is a dull, routine procedure they do a dozen times a day, hundreds of times a week on an endless parade of faceless patients. I know that the moment I leave the room, they'll completely forget me, much like a grocery store clerk forgets customers the moment they walk out of the store. I know that the team is there because they want to help me, not hurt or mock or judge. Not one bit of that knowledge changes the way I feel.
On the day of the procedure, Darwin drove me to the hospital in Mt. Clemens, an hour away. It took me a long time to make myself get out of the car, and when we walked in through the sliding doors, I couldn't lift my head. I stared down at my shoes and followed Darwin inside.
Somehow, I got through the intake process and the nurse took me to a prep room while Darwin stayed in the waiting area. The nurse assured me Darwin could come back to see me once I was set up. I answered the same sets of the questions from multiple questioners. Then the urologist came in. He wasn't =my= urologist, who doesn't do biopsies, but was part of the same practice. After he went through the spiel, he asked if I had questions.
"This isn't a question," I said, in a canned speech I keep handy. "It's more of a statement. I'm a survivor of sexual assault, and this kind of operation sets off all kinds of alarms and triggers. I cope by demanding a lot of information and requiring everyone to tell me every single thing that happens. I need you and the rest of the team to keep that in mind for me."
He nodded sympathetically and said the team would be sensitive. He also rather awkwardly patted me on the shoulder. I felt a little better.
Darwin came into the room at that point, and we waited together for about an hour before my turn came up on the rotation.
The nurse injected me with Versed, which I don't like because it messes with my memory, and wheeled my bed down to the OR. I'd already done some recon about this procedure and, as I warned, asked a great many questions about the equipment and commented on how it worked, somewhat to the team's surprise. The procedure is performed with the patient on his side, but the last thing I remember is getting an oxygen hose affixed under my nose and how it got momentarily tangled in the EKG lines.
But I have clues.
Here's the other thing, the odd thing. I recorded the procedure.
I bought a finger splint and a small voice recorder, thin and flat and the length of a finger. Before we arrived at the hospital, I put the splint on and slid the recorder under it so it looked like part of the splint. The nurse who put my IV in noticed the splint, in fact, and asked about it.
"I hurt my finger," I said. "Need to wear it for a few days."
"Ouch," she said, and went on with her work. No one else noticed it or commented on it, though one team member pointed out that I'd forgotten to take off my wedding ring and had me give it to Darwin. Just before the procedure started, I flicked the recorder on with an unobtrusive gesture. Later at home, I downloaded the sound file it had created and listened.
The reason I did this wasn't to play Gotcha! with the medical team or hope to hear something I could use in a lawsuit. It's so that I =know=. It's a way to maintain control.
As I said, the last thing I remembered in the OR was the oxygen line tangling in the EKG wires. But later, when I listened to the recording, I heard myself say things, and I abruptly remembered saying them. I said at one point that I wasn't feeling the first shot of Versed, which is normal for me, and the nurse saying she'd give me a booster dose.
"Don't you worry," she said cheerily. "The drug always wins!"
I only remembered that after I heard the recording. It was strange, like the memory had been pushed down but was able to emerge thanks to my own voice.
I must have fallen asleep before they could get me onto the table because one of the nurses said, "I need help lifting him," and I don't remember that at all.
The rest of the recording was . . . dull. The team talked very little, and when they did, it was often about stuff that wasn't related to the procedure, which reaffirmed for me that the procedure was routine and didn't require their full concentration. None of the conversation was about me directly, which I also was glad to learn.
One of the more unnerving aspects of the recording was that it clearly caught the SNAP of the needle every time it took a sample.
I also caught the doctor's phone call to Darwin when the procedure ended. Darwin, who also listened to the recording, said it was odd hearing the doctor's end of it.
My memory started up again in the recovery room. A nurse was on the phone talking to someone about how they didn't have any more beds in the area and the other people in the ORs would have to wait. That was on the recording, too, and listening to it helped center where and when I was.
Another nurse asked me if I was in pain. I was. Darwin had said he felt no pain whatsoever, but I was hurting, and the pain was increasing steadily.
"Do you want something for pain?" she asked.
Experience has taught me that when a nurse offers you pain meds, you take them, so I said, "Yes," and she gave me a pill that made me even loopier than I already was, though the pain ended.
I asked when my husband would be allowed to come in, and the nurse said it wouldn't be until I could sit up in a chair. This didn't make sense to me--what difference did it make to the hospital if I could sit in a chair or not? But I was still half-sedated and couldn't protest much. Eventually, Darwin was ushered in, and I felt quite a lot better. (Next time, if there is one, I'll insist up front that he be brought in the moment I'm awake.)
We waited together until I was more awake. "Do you want to wait here longer or go home?" a nurse asked. I said I wanted to go home. I couldn't get into the wheelchair or the car by myself, though by the time we got home, I was able to manage the stairs. I crashed on the bed for several hours.
I have a follow-up appointment in a couple weeks, though I'm sure the results will show up on the patient portal long before then.
Today? Today, I'm still anxious. The ball of fear keeps twisting my stomach. I'm having a hard time concentrating on anything. I can't eat due to nausea. Part of it is after-effects from the anesthesia. The larger part is the emotional side. I can't shake the feeling that I was violated, even though I have concrete proof to the contrary.
So I spent this afternoon looking for a counselor. I need someone to talk to.
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