Can you shove fries down a feeding tube?

On Tuesday, we saw the medical oncologist for the first time. While going through the standard questioning about my symptoms and surgery, the doctor asks, “So, you don’t smoke, never have, don’t use tobacco products, and don’t live in a house where others are smoking. How’d you get cancer?”

Beats me, doc, I thought that’s what the guys and gals in the white lab coats were supposed to figure out.

Nice guy, though, and we talked about this clinical study the radiation oncologist said I would qualify for. The medical oncologist is pretty sure this new drug will be approved for head and neck cancer very soon, just as it is approved now for advanced colorectal cancer. The bonus is that of course the manufacturer would pay for the new drug, and depending on which group I land in (that is, which of the chemo drugs I’d get in conjunction with it), they would pay for one of those drugs as well. In his estimate, the cost for the experimental drug itself would run just shy of $100K for a year’s worth of treatment. So, from both a medical and an economic standpoint, he said if he were in my shoes, he’d go ahead with the study. It’s not going to do any harm, and the efficacy is good either way, so there you go.

He also recommended that I go ahead and get fitted with a feeding tube before the treatments start. There are quite a few side effects associated with receiving radiation to the mouth and throat, and having chemo at the same time can make those side effects a bit worse: sores in the mouth, trouble swallowing, painful swallowing, loss of appetite (which would be complicated by the pain in the mouth), etc. Getting the tube in before treatment starts would be much better than getting the tube when things start getting too painful, of course. What they do is run a tube down your throat, make a small incision in the abdomen, and pull the tube out. Then you just uncap it, pour in whatever it is you’re drinking, and put it away. So we decided to go ahead and do that. I’ll eat regularly as long as possible, and then if I need it, it will be there. Now we have to wait for the referral to the gastroenterologist, who will do the procedure.

On Wednesday, we saw the ENT once more. He removed the dressing, scrubbed out the open incision with some gauze and peroxide, and pronounced the wound as “looking very good”. And so it is: on my right side, under my chin, the incision has closed up again entirely, and the big hole on my left where the two incisions meet is down to between 1/4 and 1/2 inch deep. It’s a little weepy, of course, but that’s healing for you, and it’s not the same smelly, nasty weeping that was the reason he ripped it open again in the first place. The best part is that it no longer needs to be dressed. The remainder of the heaing can be done in the open air, although I still have to be very careful not to get anything into the wound.

One funny exchange: my mom took my to this appointment, as she has to all the others. When the doctor indicated the dressing would not have to be replaced (great news for me, since the constant gauze and tape were highly annoying and irritating on my neck), she asked if I could shower now (rather than taking a bath, which is what I had been doing). His reply, with a sort of fake relief:

“Oh, yes, please do.”

Funny guy. We like him quite a bit.

And I have to tell you, I love showers. I’ll take a shower over a bath any day, and particularly now, since showering takes a lot less energy than bathing. It also means I will no longer need to kneel on my hand and knees and stick my head under the faucet in order to (carefully) wash my hair while trying to keep the dressing around my neck as dry as possible. No way, baby: now it’s a sort of contortionist bend backward to let the water run over my head. I’m still unable to raise my left arm all the way over my head, so I have to tilt my head down and to the left if I want to use my left hand to wash the old mop. Still, it beats the alternative.

The numbness continues to recede down the left side of my face. I can actually feel most of my cheek now, except from directly below my left cheekbone down to my jaw and across my jaw to my chin. My ear is still numb, but strangely enough, I can now feel the inside of my ear, in the ear canal. Behind my ear, down my neck, and into my left chest is still numb, alas, and the left side of my face is still significantly swollen. I look a bit lopsided, to tell the truth. One really annoying thing is that my left neck and chest are just hard to the touch – I can’t feel anything but the pressure, of course, but I can feel with my fingers that the area is much like pressing on the surface of a table: fairly unyielding. To get an idea of what it’s like, press gently on the front of your neck somewhere, on either side of your windpipe. Feel that give? Now, using the same gentleness, press down on your countertop or your table. The latter is what my neck feels like. The doctor assures me that will get better and is a result of the stuff they removed. I’ve also found that I’m starting to get itches in my neck, shoulder, and chest where the numbness is. The problem? They’re on the inside. I can’t feel myelf scratching my skin in those areas, and pressing too hard hurts, so I’m stuck with these nerves waking up, apparently, and no way to do anything about it. It’s difficult to put ice or heat on it, since too much pressure hurts, and there’s also a bit of danger there, since I can’t actually feel anything, and something too hot or too cold could damage the skin or tissue and I’d have no idea it was happening. I just squirm a bit until it goes away for now.

This week, we’re back to the radiation oncologist, where we’ll probably be setting a date to begin treatment. My guess? After Labor Day. The wound should be healed by then. Then we get to deal with what they’re going to do with me, and I am not looking forward to that at all. The thought of the mask is giving me nightmares…

Paging Dr. Ben Dover

Kidding!

Here’s a tip for everyone: get health insurance.

Really.

I mean it.

I should have had insurance at the end of 2004. Between an agent who was impossible to get hold of and a company who couldn’t seem to get my records from my doctor’s office in a timely manner (they claimed they never got them, the doctor’s office says their records show they were in fact sent), the policy that I had signed up for was vacated. Naturally, while we were trying to figure out what was going on and trying to find alternate coverage, so as not to deal with the Agent From Hell (AFH), I was diagnosed with cancer.

Ha, ha, say the corporate overlords who run the insurance companies. No insurance for you! Pre-existing condition! Neener, neener.

No one actually said that, of course, because as soon as the biopsies came back, I knew I was going to foot the bills and I didn’t have the patience to listen to anything like that.

I’ve not yet received a bill from the hospital, but apparently while I was completely out of it the first day, a very nice lady from the financial office stopped in and had a chat with my mom. She also brought along the printout from the first day’s festivities: about $15,000. That would be for the surgical stuff, staff, room, whatever drugs they pumped into me, and so on. I’m sure the following days weren’t billed at that particular rate, but we’re still waiting for their accounting to catch up.

My ENT’s office called me, and then sent a nice letter with his total: just shy of $8,000.

And some of the others:
PET scan: $4,000.
CAT scan: $2,000.
Radiation oncologist: $5,000.
Medical oncologist: $5,193.
Radiologists: $600.
Pathologists: $300 .

There’s more, but you get the idea. I have to say, though, that everyone we’ve dealt with has just been great. The first medical oncologist the radiation folks tried to get me into wouldn’t even take self-pay patients. The second one did, and as an added bonus, the doctor agreed to shave 50% off the total bill, which is why that’s such an exact number up there. They also wanted half up front, either by credit card or cashier’s check, because as the nice woman in his office said (and not in an offensive way, of course), they’d been burned by people not paying or bouncing checks or what have you. I told her I understood perfectly, since I run a business too, and I would happily give them what they asked for in return for their generosity. This is not to say that it’s possible for me to do this for all of these fine people, but hey, I’m alive, and they’re all very understanding that it’s going to take some time to get them what they have due.

If you have the opportunity, do yourself a favor and get health insurance coverage, even if it’s catastrophic insurance at a minimum. If you never need it, more power to you. That’s the best possible scenario you could get. If you do need it, you’ll be happy you had it.

Healing…slowly

The horizontal incision the doctor ripped open to drain some fluid is healing. Very slowy. This is what happens when you have a large gash in your neck that descends into the neck about 1.5 inches deep on one side and tapers to about .25 inch at the other end. The deepest part throbs continuously with my heartbeat, and the entire thing burns. Parts of the left side of my head and face are still numb and at the same time, I can feel itching as well. That’s a rather strange sensation, as attempting to scratch the itch is an effort in futility since I can’t feel anything other than pressure.

In other news, we visited with the radiation oncologist, as the doctor suggested. From him, we received a recommendation of a round of radiation plus chemotherapy since the lymph nodes were involved. He gave us a thick stack of papers and said I’d be a good candidate for a Phase II study of a new drug call erbitux. It’s supposed to do something to bind to the receptors where cancer tumors would ordinarily, basically. This would be given in conjunction with one of two drugs used in usual chemotherapy rounds, and that would be done once per week. Radiation would be done every day, Monday through Friday, for six to seven weeks.

Both have their own set of side effects, naturally. Since I would get radiation to both sides of my neck and tongue, my largest concern is the ability to eat. Mouth sores, sore throat, difficulty swallowing, and severely decreased saliva production are all possible side effects, among others, of the treatment. This is why they recommend a feeding tube, but quite honestly, I’d like to leave that until I absolutely have to have it – like if I lose too much weight, for instance, in which case I probably wouldn’t have a choice in the matter.

That’s my one large concern. My one huge fear is the damn mask. I mentioned before that they created a mesh mask of my head and neck. That was bad enough, considering that I can’t stand to have anything pressed on my face. I can’t even stand to wear one of those ski masks so popular with bank robbers and movie bad guys. It makes me feel like I’m suffocating, and the worse part about the mesh mask is that they do lock it down to the table at the shoulders. I managed to wear it for ten minutes during the PET scan, although it took four tries to get it on and locked because I kept getting panicky. They took it off for the remaining 20 minutes or so of the scan. But I just can’t stand the thought of having to wear it every day, five days a week, for six or seven weeks, for 20-30 minutes each day. The mere thought sends me into an anxiety attack. What if I throw up? What if my mouth fills up with spit? What if I can’t breathe? All of these things kee running through my head nonstop when I think about it. I know, intellectually, that they monitor you pretty closely, and that you’re never alone. But somewhere deep down in the primitive brain, that voice just will not shut up. The doctor says they can give me medication before putting on the mask, but I’m not sure that will get rid of the voices playing the what-if game.

In the meantime, we’re making more doctor visits: the ENT, the medical oncologist (who will be taking care of the chemo side), and waiting for the incision to heal. We’re trying to gather as much information about this study and whether it will be worth it to go into the study rather than just go through the standard treatment. I’m trying to put back a few pounds of what I lost so I won’t need a feeding tube right off the bat. This blog was supposed to have been about adventures with food – cooking, restaurants, commentary on food shows. It’s turned into a play by play of an illness that I never in a million years expected to have. Fortunately, though, we caught it early, we have a great group of people taking care of me, and no doubt one day I’ll be able to get back to all those things this blog was meant to be about in the first place.

De-Frankensteining

July 27, 2005

Time for the de-Frankensteining of my neck. We head to the doctor, who cheerfully starts plucking staples (32!) out of my neck. He says the incisions look good, takes a look at my tongue, bends my head this way and that. Overall, things have gone very well. They also have the pathology report back from the tissue removed during surgery: two positive lymph nodes, as we knew from the scans, and the margins were clear on the tongue and throat tissue, with a note that there was some perineural invasion. The second doctor (the resident) is quick to point out that this is from the tissue that was removed – there is no real way to know at this point if any further invasion is present. They recommend that we go back to our radiation oncologist with the report to see what he thinks as well, just to have our bases covered.

From just beneath my left eye all the way down the left side of my face to just below my left clavicle is numb, as is my left shoulder. At the same time, there’s a sort of tingling I can feel. The doctor says this is normal, as it’s a result of the trauma from surgery as well as due to the nerve and muscle portions they had to remove. He tells me I have to start doing some exercises to bring that side back up to strength. Easy for him to say, since I feel like someone has been taking batting practice at that side of my body. But I tell him I will, and I have been trying to lift my arm to shoulder level anyway, so it’s all good.

My only problem at this point is a huge knotted area in my neck, just to the right of my windpipe. I suspect this is due to a rather severe coughing fit I’d had two nights previously, where I foolishly tried to send some water down the wrong hole, and I feel like I’ve pulled something. He tells me not to worry, it will go away on its own. He tells me that he’s switching me from the Roxicet to Tylenol with Codeine, as the former makes people feel too dopey to do anything. This is true, at least for me: the only thing I want to do after getting dosed with it is sleep.

That night, I notice a rather putrid smell. At first, I think it’s the shirt I’m wearing. It’s one of The Boy’s that I’ve borrowed, as it’s a button down, short sleeved shirt, which is much easier to get in and out of than my standard uniform (t-shirts). I tell my mother that the shirt smells. She points out that it did come out of my brother’s room – we laugh at this, because, well, he’s 19, what do you expect? I tell her, though, that quite frankly, it smells like shit. She’s sitting in front of me, and tells me that one of my incisions is weeping and little, and I should be still while she catches it.

As she’s wiping it, moving up my neck, I realize the problem is not the shirt: it’s me, or rather the ooze from the incision, that smells so horrible. I’ve just oozed onto the shirt, which is making it smell just as bad. We keep wiping it as it comes out, and each time I get a fresh whiff of it. Finally, I have my sister bring me a mint teabag, which I hold under my nose to drown out the smell from my seeping wound. My mom tells me we’ll call the doctor in the morning before she heads off for her own checkup, to see what they have to say. With that, I settle into my recliner with a towel near my neck to catch ooze and a teabag under my cheek to catch a more aromatic aroma. Must have looked a sight.

July 28, 2005

I am still sleeping when the doctor’s office calls. My sister catches the call, and tells the office we can be there in 20 minutes. She packs me off into her car and off we go. When we are pulling into the parking area, my mom calls and we tell her what’s going on. Since my sister has to go to work very soon, my mom heads toward the office as well.

Into the office we go. The doctor comes in, accompanied by another doctor who is visiting this morning. We tell the doctor what’s been happening since the previous night after the staples come out, and he takes a look. After snapping on a pair of glove, he hooks one finger into the horizontal incision (the one that’s weeping) where it connects to the vertical incision (which is healing very well), and pulls it open. The entire incision. With some large gauze pads in one hand, he then pushes on my neck, squeezing out pad after pad of gunk. All the while, I was thinking that I should have taken some of that Roxicet before coming in after all.

During this time, my mom calls my sister, asking her where we are, as she’s walking in the door right no. My sister – who at one point wanted to be a doctor – tells her we are in the exam room and describes for her what the doctor has just done. This, of course, freaks my mother out. My sister tells her she can just stay in the waiting room, but naturally this is not acceptable to my mother, who pops in. Fortunately for her, most of the goriest stuff is over, because she certainly would have puked or passed out if she had seen what had happened. She’s perfectly fine at handling other peoples’ grossness. But her own kids’ nasty wounds? No way.

Between the pain of the (now open) incision and the knot in my neck, which he was pushing on, and the smell of what was coming out, I thought I might pass out. I was sweating as if it were a hundred degrees inside the office rather than a balmy seventy or so, and managed to stutter out my impending fainting spell. They tilted the chair back and finished the neck press before waving some smelling salts in front of my nose.

The doctor then packed some kind of antibiotic dressing into the open incision. To me, it looked like a giant tapeworm, as it was a long, flat strip of fabric-type stuff. While he’s creating more supernovas of pain in the wound, he’s telling us that not only is it an antibiotic, it’s also an irritant, designed to force the body to try and reject it by pushing it out and healing up – sort of the same concept as an oyster and a grain of sand.

He tells us to come back the next day so he can check the wound and redress it, then sends us off.

July 29, 2005

Back we go to the doctor. He takes off the dressing, pulls out the packing, and takes a look at the wound. Another round of pain. He says the wound looks good, and that there is actually no infection there. Most likely, he says, we probably had a little pocket that had a bit of fluid built up. A little? To me, it looked like my chest drains when they had gotten full. But he’s the doctor. He repacks the wound with the tapeworm, then dresses it, and tells us he wants to see us on Wednesday. Today is Friday. What about changing the dressing? Well, someone will have to pull out the packing on Saturday and then just redress it with gauze alone, and then change the plain dressing each day after that, so it can continue healing from the inside out. Who will do that? We nominate my sister, the once-future doctor. She doesn’t know this yet, but she’ll be thrilled with the opportunity, considering she wanted to watch everything he was doing when he ripped open the incision in the first place.

He wraps me up, and we’re off once more. The wound is terribly painful, and throbs with every heartbeat. I count myself lucky that there’s no infection, however, which could have landed me right back in the hospital. Who wants that?

The Hospital: Day 5

July 23, 2005

I was finally sleeping when I heard someone calling my name very softly. I awoke to see a young Asian doctor standing beside my bed. I’d never seen him before this morning.

“Hi. Can you tell me if you’re completely off oxygen?”

I was never on oxygen, actually, unless it was during surgery. Post-op, I’d not had any that I could recall. I wished idly at that moment that I had some, though, as the doctor was wearing a bit too much cologne, and it was a bit stifling with him right next to me. I croaked out that not only was I off, I’d never been on.

“God bless you, thank you so much. I’m so sorry for waking you.”

I mumbled that it was all right, since it was almost time for more vital checks and breakfast. He stepped over to the window and made some notes.

“Thanks again. Have a blessed day.”

And he was off. A rather strange start to my morning. Someone from housekeeping also popped in, tidying up whatever needed to be tidied, refilling paper towels, giving me another cheery greeting. Then, breakfast – cream of wheat (yay), more Boost (boo), coffee (decaf, no doubt, and untouched by me), milk (not ice cold as I like it), and tapioca (no thanks). Before I could get myself in position and the right frame of mind to eat it, the doctor also appeared.

He removed the second drain from my chest and gave me some very good news: time to go home. He’d already told the discharge unit to start the paperwork, so I should eat up and then they would release me because I was doing well and hospitals are full of sick people. Hooray! Even though I wasn’t feeling tip-top, and even though every single person I had encountered on the staff there was just as nice as they could be, it would still be better to be home amongst the family rather than in the hospital. He rechecked my incision, pronounced it a work of art – as had my family members over the days – and said I was to come to the office on Wednesday. No problema.

I started eating, and my family members started appearing as well. They were quite happy about the news of my impending release, and I slogged my way through breakfast, then had some help getting dressed. By the time we were all done, I was tired again and ready to go back to sleep. But it wasn’t too much longer before the wheelchair arrived and we were headed to discharge for final paperwork. After signing off, we rolled down to the entrance of the hospital and I managed to get into the car without damaging myself or anyone else.

We went to my mom’s house, where I promptly went to bed while they did everything else, like bring in my belongings, get prescriptions filled, and stock up on soft foods. When I woke up, it was time for some vegetable beef soup, whirled in the blender. Then sleep. Then up again, and time for more soup, which I promptly threw up after a couple of bites. I think perhaps things had a bit too much sodium after my survival on hospital food, as I’m sure that food had virtually none. So we tried something else: real food, to control the contents, whirled in the blender so it had the consistency of baby food. That worked out quite a bit better, and fortunately, I had no more puking episodes. I was still having some intermittent issues with swallowing, which led to coughing, which led to as much pain as the puking, since it involved so much tensing of the neck muscles. With careful eating and practice, this also got better.

Mostly, though, I ate and slept – sort of like my cats, really. I wound up sleeping in the recliner in the living room, since this afforded me a nice 45 degree angle so as not to choke on my own saliva as I tried to swallow, and so I could turn on my right side, rest my left arm on a pillow, and finally get some much needed deep sleep.

I lost 12 pounds between the day I went into the hospital for surgery and the day I was released. However, I would not recommend the surgery diet to anyone. It’s pretty unpleasant.

The Hospital: Day 4

July 22, 2005

Today, one of the drains in my chest came out – well, not on its own, the doctor removed it. The tubes were stapled into my chest much like the incision in my neck was stapled closed. One snip, a little pulling, and presto! One tube removed. That left me with one to tote around each time I got up to toddle off to the bathroom.

They also removed my continuous hookup to the IV today as well. Since I was eating (or more accurately, drinking) my meals and getting some water down, I no longer needed the fluids they had been pumping into me. Instead, one of the nurses appeared every six hours to hook me up to a bag of antibiotics. Once that was emptied, I was once again unhooked so I could move around as the need struck me.

My roommate in the hospital – Mrs. Green – whom I had not actually seen once but had heard, was leaving this day. I wasn’t having a very good day, as my throat was hurting terribly, my head ached still, and I just could not find a comfortable position to lay in, but my family pulled back the curtain so I could see her and wish her well. Her family was also there, getting her things together and waiting on the wheelchair to take her down to the front door. I wondered idly if that would mean I would be by myself the entire day or until the end of my stay, but I was so miserable that I just fell asleep and missed Mrs. Green’s departure altogether when the wheelchair did arrive and they all left.

Story: the night before, the staff had given Mrs. Green some percocet. About 1 or 2 AM this morning, I had been awakened for a vitals check and meds, and shortly afterwards, as I was trying to get into the least uncomfortable position to try and go back to sleep, Mrs. Green woke up and starte talking about little things crawling on the walls. She asked out loud if I saw “those bugs” and I croaked out a negative, because of course the only thing I had seen was the evil smiley balloon. No bugs. I don’t think she heard me, because a few minutes later, she was snoring softly.

The doctor ordered up semisoft food for today onward. Cream of wheat, yummy. Also some pudding, but that was much too thick for me to get down, so I skipped it. More creamy soups, yay. And tea and coffee, although I didn’t touch those. I suspected they were decaffeinated, and who wants that?

Mostly, today was just sleeping, occasionally sucking back some food, visiting briefly with the fam, meds, a few trips to the bathroom, and trying to find something in the dozen channels to watch on television. In the evening, though, no one from the family stayed as they had before. This was a bit of a problem.

Around 10 PM, I had drifted off to sleep finally. I suppose just before 11 PM, I woke up, and had to go to the bathroom. The staff had warned me not to try and get up on my own – after all, who wants a lawsuit because a shaky patient fell and cracked their head open? My family wasn’t there. So, I did the natural thing and rang the bell for the nurse. Problem: when the attendant came over the intercom, I was not able to speak adequately, neither clearly enough nor loudly enough, for them to hear me. So the attendant closed the intercom and turned off the alert.

This frightened me a little. Not because I was in imminent danger of wetting the bed, but because it occurred to me that if I had been in real trouble – like trouble breathing, or something severe – that I could very easily die since I couldn’t make them hear me and none of my family was there to track someone down if I needed assistance. This was one of the reasons they had battled with the nursing supervisor so that someone could stay overnight with me the first few nights, as it happens. I thought while I lay there that if I were in deep trouble I could start throwing things I could reach from the bedside table toward the door and that might get someone’s attention.

As it turned out, that wasn’t necessary. About five minutes later, they wheeled someone in to take Mrs. Green’s place. Unlike Mrs. Green, this woman was not quiet. There was a reason for this, as I was to discover.

While they were positioning the bed, the woman – Vicky – started talking, quite loudly, about going back to her “old room”. I had no idea what that meant, but assumed that they’d moved her here from another floor. The staff told her that she couldn’t go back to her old room, that this was her new room, and this was where people went as they got better so they could eventually go home. That was not good enough for her, though. She rattled on about how her people knew where the old room was (note for those not from the south: “people” in this context refers to family) and she had to go back and get her “cup”. Another note for those not from the south: “cup” in this context means…well, you’ll see.

One of the nurses laughed and told her she couldn’t go back for anything, as all her belongings were right here. Vicky disputed this pretty vigorously, telling them again that she had to go back for her cup. The nurse responded, and I quote:

“There’s no alcohol allowed in the hospital, sweetie. That’s what landed you here in the first place.”

Vicky did not appreciate this at all. She repeated again that she wanted her things and that her people wouldn’t know where to find her. The nursse explained that they would direct her family here, and that she needed to try to calm down and get some sleep. The nurse also poked her head around the curtain and apologized quickly to me, then disappeared before I could raise a finger and point to the bathroom in the universal symbol of “Hey, I need to go, can you help me up”.

The nursing staff stepped out of the room for a moment, and the next thing I know, there’s a shrill alarm going off in the room. They had belted Vicky to the bed to try and keep her there, but she had tried to get out of the bed and triggered the alarm. All the while, she was muttering that she was going back to her old room to get her cup. That indicates some pretty serious issues to me. The staff came back, put her back in bed, and told her to stay there, as this was her new room and everything would be fine. She was not buying that, and asked one of the staff:

“Hey Boo. Run back to my room and get my cup, won’t you?”

Whoever she was talking to didn’t answer, as they were walking out of the room again. I heard one of the nurses on the phone with a doctor, telling him they had one of his patients down here. I wondered if it was someone from the psych ward, because this woman’s focus was only on her drink, almost to the exclusion of her family, and perhaps she needed a little detox. She then tried to get out of bed again, once more setting off the alarm, which bored its way into my brain and I decided then that there was absolutely no way this was going to work.

The staff apparently decided the same thing, because after once more getting her into bed, not five minutes had passed before they were back and moving her out of the room. That had definitely been the weirdest hour I’d been aware of during my stay thus far.

Fortunately for me, not only was my noisy neighbor gone – although I heard her down the hall, as they had an empty room somewhere and I heard a nurse telling her “this is to help you sleep”, ha – it was also time for my meds, at which point I managed to get the nurse to understand that it was also time for something else, and could she please help me stand up so I could take care of the rest.

And then, it was once again time for the quest for a little sleep.

The Hospital: Day 3

July 21, 2005

Each day becomes a bit clearer than the last, opening up entirely new revelations. Mostly of pain, because I tell you what, it’s amazing just how involved the neck muscles are in even the tiniest bit of movement. It’s like when I used to do squats when working out because they involve so many different muscles. The next day, even though you might consider the quads to be the only muscles worked, it’s an overall ache that greets you.

The nursing staff was waking me up every four hours for vitals, and every six hours I was receiving an IV of antibitioics and fluids. The morphine self-administration was also still attached. I was grateful for all of it. One thing I did finally notice on the third day was pressure cuffs on both legs. These would pump and then deflate every 30 seconds or so. I hadn’t noticed them before, even when they had to be removed so I could shuffle to the bathroom and back. Their purpose, I was told, was to help ensure that I didn’t wind up with any nasty blood clots in my legs, since I was fairly motionless the first few days.

I had noticed a couple of tubes in my chest connected to plastic drainage bottles. Like the leg cuffs, these were designed to empty any gather blood and fluid from my left chest to avoid clots. The tubes were inserted near my left clavicle – that’s the collarbone, for those not up to speed on their anatomy. We had a bit of an issue with the drains, or at least the bottles: for some reason where they joined the tubes, the seal was not tight, and the bottles were sucking in air. This meant they would reach their capacity, mostly of air, long before they reached their capacity of fluids which the staff would measure before emptying. Solution? Whoever was hanging around in my room would release the air from the bottles, or the staff would do it during the evenings if no one stayed.

Sounds easy, right? It was easy – for them. For me, it was another ride on a weird pain express. As they released the air from the bottle, and reclosed it, it would suddenly start pulling from whichever tube it was attached to. This resulted in gurgling in my chest which was strange enough, but it also resulted in pain as the pressure evened out once more. Felt a bit like an alien was about to pop out where the drains were.

I spoke to one of the doctors this day. Well, to be honest, he spoke, I croaked, but we managed to communicate nicely. He told me what they’d done during surgery, now that I was coherent enough to understand. My family, of course, knew all about it. They had removed part of the tongue on the left side and sent it to the pathologist for a read while they opened up my neck. They did remove the lymph nodes on the left side, along with part of the nerve, part of the muscle, and part of the jugular. All of that was the reason my left ear felt so huge even though I couldn’t feel it save for pressure when it was touched. It also accounted for the horrendous weakness in my left shoulder, the numbness on the left side of my face, my inability to pull back and down the left side of my mouth (as for a wide smile), and the pain that circled around to the left rear of my neck and up into my head. The incision itself ran from just behind my left ear down to the left clavicle vertically, and then horizontally from slightly under my left jawbone and across my next to just past the right of my chin in sort of a half circle. My sister counted the staples for me: 32. And here I thought the answer to life was 42 all this time. While they were working on my neck, the results came back from the lab: missed. So they went back into my mouth and took more of the tongue further back and also some pieces from the back of my throat in the tonsil area. The second time was the charm, as the margins came back clear. So they sewed me back together, unhooked my chin from whatever they had holding it (I had three little punctures in my chin, as if I were a fish that had been hooked), and sent me off to recovery.

The food choices were still liquids. I’ll say right here that I didn’t care for lukewarm Boost in its can, but I managed to take down about half of it each time, mostly to please my mother. Jello was still dicey, but the soups were ok, if rather bland. It’s a hospital, what do you expect?

By late in the afternoon, we’d all agreed that I could get up out of bed and sit in the chair for a bit, and as long as I was moving around nicely that the leg cuffs could be taken off. That made it ever so much easier to move around nicely, so it was sort of a self-fulfilling thing.

Due to the continuous vomiting, we also decided to switch from morphine to another painkiller, which would allow me to better abe to keep down the fluids I was taking in. They detached the PCA and we went with Roxicet, which is oxycodone and acetaminophen (Tylenol). Every four hours, the staff started nudging me to swig back a dose. Administration was rather interesting: I couldn’t lean my head back in order to drink the entire thing from the dosage cup itself, so they loaded it into an oral syringe and I was able to take it about 1/4 teaspoon at a time, still swallowing quite a bit of air along with it. Cherry flavored belches. The new drug did take the edge off the pain, but nothing could touch the headache that was with me constantly. Solution: motrin. From another syringe. That dulled the headache a bit. There was still no comfortable position to sleep, but I slept a lot anyway.

I received flowers from several people, and I’ll thank them right here for that. They leant a bit of color to what otherwise was you standard beige hospital coloration (which includes the patients, mind you).

One last story for this day: on the first day, one of my aunts brought in a smiley face balloon. The standard yellow colored, big happy face type. It had a small weight on the bottom of the string to keep it in one place, or at least from floating off to join its other helium-filled buddies at some secret hideaway, and it was in front of the small closet that was across from the foot of my bed. During the evening on day three, I had awakened for some reason not related to the staff wrapping a blood pressure cuff around my arm or taking my temperature under my armpit. As I opened my eyes, trying to recall exactly where I was again, the balloon swayed in a slight draft. I swear the thing looked like one of those evil smiley faces, with the canted eyebrows, and in the dimmer light of the room at night, it looked like it was winking at me. At first, I couldn’t figure out what was going on, and it was a little upsetting. But as things cleared, I realized it was just the happy balloon, greeting me from its post as it kept watch over me. That allowed me to fidget around in a vain attempt to find a comfortable sleeping position and then drift back off to sleep until the next scheduled something or other.

The Hospital: Day 2

July 20, 2005

This day is a complete haze, except for one moment of clarity and one repeated activity. My family tells me I was mumbling about a lot of things and asking people how they were, but I don’t remember any of it. I’m just happy that they aren’t telling me I did something truly worthy of shame and/or embarassment, since those stories will never die until you do.

The doctor wanted me to eat, since I’d had no food for a day and half, and he ordered up liquids for me. Broths, Boost, Jello, tea, milk, and coffee of all things were on my tray for breakfast, lunch, and dinner. Swallowing was an adventure in not offing myself via choking. You never realize how much your tongue is involved in things until you lose about half of it. I swallowed enough air to pump into a blimp, which resulted in some interesting moments as my body expelled it one way or another (mostly through gigantic belches, after which I always excused myself, according to my observers). The Jello kept geting caught at the back of my mouth, and left me with two choices: either wait for it to melt, at which point I could get it down, or help it along by drinking a little warm broth (to help it melt) or something cold (at which point I could usually wash it down with another gulp of air).

One unpleasant activity I do remember is more puking, multiple times. Between my body getting rid of the blood I swallowed and the morphine, I barfed several times throughout the day. Each time, my neck fired itself up to remind me that it had some trauma the other day, and would I please stop this silliness.

The part I remember best about this day: the nursing staff telling me they wanted me to use the bathroom. I wasn’t particularly thrilled about the prospect of moving, as even with medications, the pain level was significant. I had a headache that would not disappear even when the other pain was dulled by morphine, and trying to find a comfortable position in the bed was both agonizing and annoying.

The nurses told me that if I didn’t go on my own, they’d put in a catheter. That spurred me into action. With my IV disconnected for the moment, I shuffled into the bathroom. In the hospital, they measure everything: the drugs they give you, your blood pressure, the amout of vomit you puke up, your temperature, your urine. Hanging on the edge of the toilet, in the bowl, was a cup that held up to 26 ounces. Once you’ve done your thing, the staff notes the amount, dumps it, and then flushes for you.

If you’ve seen the movie Apollo 13, you’re probably familiar with the part where Swigert (Kevin Bacon) is guiding the lunar module in a sort of docking maneuver. That’s about how it was with me. I managed to plant my ass on the toilet without incident, which boded well. I also managed to overflow their measuring cup – but this helped me avoid the specter of a catheter.

I was more awake on day two, but wished I weren’t. I was starting to notice the weakness in my left arm, my left shoulder and the left side of my face were almost completely numb, and my ear felt like it was about five times its actual size. They had also placed two drains in my chest to make sure we had no clots in that area, which made my chest alternate between numbness and a stinging, burning sensation that I couldn’t itch and that would only go away when the pendulum swung back to numb.

Overall, I’d rate the day 2/10. And I couldn’t even dance to it.

The Hospital: Day 1 (Part 2)

“Are you allergic to any medications? Ever have any surgeries? Major illnesses? Recent cuts or open wounds?”

Over and over, various people wandered back and forth past my gurney and asked thse questions again while checking my wristband to make sure an alien pod person had not somehow taken my place while I escaped.

During all this, I met the anesthetist who would be taking care of me during surgery and ensuring that I didn’t do something gauche during the procedure, like swallow my tongue or die. She was very pleasant, asked me the questions again, and then asked me one more: are you in any pain right now?

As it happened, I was. I had not taken any food or drink in after midnight, nor had I had taken the medication I was on to control the pain in my mouth and ear while we went through the medical hoops. It had been about twelve hours since my last dose, in fact, and the armies were marching in my mouth and head by this time. I mumbled something to her to this effect, and she promised to come back and give me something for pain once the nurse got my IV set.

Which, all things considered, could have been worse. It almost, but not quite, felt like someone jamming a 2×4 down the back of my hand. I know she was being as gentle as possible, but I don’t imagine that it’s ever a picnic trying to force something into a vein in an area where there isn’t much skin to start. But she got it in and I only gave one yelp as she was taping it down with stuff they should probably be using on the space shuttle to keep that foam on.

As promised, the anesthetist did come back to me. She was speaking to me while adding something to my IV. Unfortunately, I have no idea what she was saying, because about five seconds after that stuff hit my veins, I was out, and I have no memory of what happened past that point.

A story: when I was in high school, I played fast pitch softball. During one game, I slid hard into third base, and managed to tear up my right leg from the ankle to the knee. Not only was it a bloody mess, it had clay and pebbles and whatnot embedded in the wound. Every day, twice a day, we had to debride the wound with Betadine and a stiff bristled brush, scrubbing the dead skin and crap out of it.

That was nothing compared to this.

I woke up in the most agonizing pain I have even encountered in my entire life. Recovery. Surgery over. Someone telling me that I had to stop moaning because that meant I was probably holding my breath, which would make it worse. Telling me they were putting morphine into my drip. Telling me this was normal and it would pass, that I should try to think calming thoughts while the drugs did their work and take deep breaths. I imagine it’s a lot easier on that side of the gurney, but of course can’t blame him for doing what he knows needs to be done.

They hooked up a PCA for me, which is just medical talk for a button the patient pushes to administer pain medication. In my case, morphine, which could be administered every 6-8 minutes by clicking a button. It’s all rather foggy, as I was also getting drips of something, but I distinctly recall being a little angry because the IV in my right hand was painful to the point where it was hard to press the button with that hand, and they had taken a piece of nerve and muscle from the left side during surgery, so it was impossible for me to click with my left. Somehow, I managed to properly give a click every now and then when I was awake enough to realize just how badly everything hurt.

They wheeled me into my room, and my family came in, but honestly I don’t remember who was there, what they said, or what I managed to get past my newly redesigned tongue. I do remember puking up blood that had gone down my throat during surgery. Several times. Black, black liquid that was not only unpleasant to look at, but which was a horribly painful process to get out, since all the muscles around my throat and neck were involved in forcefully expelling it.

I drifted off, occasionally clicking away at the morphine, with my family watching over me.

The Hospital: Day 1 (Part 1)

July 19, 2005

Check in time. My mom, aunt, and sister came to get us early this morning, about 6 AM. We took a few pictures of my neck and tongue, as a sort of “before” record – plus, the gross out factor of the tongue is good, and my sister (who used to want to go into medicine) liked that very much.

The sunrise was very beautiful, and naturally, this being Florida and all, it was already 100 degrees outside and humid. I was prepared in my sweats and t-shirt, and carried nothing at all with me. My mom took care of my id and phone, my sister took my gym bag, which had clean clothes and a toothbrush.

Once at the hospital, we checked in at admitting and then went up to the pre-op area, where we waited with the other suckers – I mean, patients – who were also there for early appointments. The check-in nurse presented me with a pager like those you get at restaurants, about the size of a large coaster. Table for one? Every so often, it would generate a high pitched single beep. I suppose that’s so they can find the damn things if someone leaves it in a chair or under a newspaper or something as they ready themselves for what lies ahead. The waiting room was very, very quiet and not uncomfortably cold or warm. Anyone who has spent time in large facilities knows what a treat this is, since there always seems to be a pocket of air where you regret not bringing your parka and another nearby where you feel like you’re on the surface of the sun.

I did not get the joy of being buzzed for the gurney that awaited me, as the check-in nurse called the waiting room and had the assistant let me know it was time. We walked back to the surgical holding area. My mom gave me one last word. “Whenever they do something, ask them what it is and make sure they check your wristband so they know you are you.” Yes, ma’am.

The holding area looks like any standard emergency room you see on television, without the chaos that is usually associated with trauma emergencies. Like the waiting room, it was quiet, with the occasional beeping of monitors and the ringing of the phone the only noise other than the murmur of staff talking to patients and one another. The nurse took me back to the last screen on the right, where I was given a bag for my belongings and told to strip to the skin. On the gurney were little paper booties for my feet, a paper hair net to keep my flowing locks (ha) out of everything, and a cloth gown that I was told opens in the back – like this wouldn’t be common knowledge from all the jokes made about peoples’ butts hanging out of the things.

Once suitably attired for my waiting table, I crawled onto the gurney and the interrogations began.

Reflections on gardening, cooking, and life