Surgery.

I finally went in to surgery this week, to remove the atypical, pre-melanoma cells from my body, which I was freaking out about a few entries ago.  This is mostly a diary entry, made for my own reference in case I wanted to look back on it.  But if someone has questions about the process, or what to expect, or anything like that….feel free to leave a comment and I’ll get back to you.  I may not have mentioned it here.  I’m no expert but I can tell you about my experience and what I know.  This is gonna be a VERY long entry.

Prep Work

A week before surgery, I met with both my doctors….the surgical oncologist, who would be cutting out the ‘bad skin’, and the plastic surgeon, who would reconstruct the area and close the wound.  They were both nice and explained to me what to expect and how things were going to happen.  I had to undress for them to check out what I look like before a scalpel makes a cut, so that the plastic surgeon knew what to make things look like.

They took some lab work too, meaning a nurse drew 3 vials of blood from me.  It’s just about the same kind of blood work you get done during a check up; they see your cholesterol, sugar, all that stuff….plus blood type, in case I would need a transfusion on the table.

I was then booked for surgery on May 1 (Wednesday), with the specific time unknown.  No eating or drinking after the midnight before surgery.  Not even water.  I got the call around Tuesday evening at work – my appointment was at 1pm, meaning I had to be at the hospital at 11am to finish all the paperwork and get ready for the operating table.

Day of Surgery: The Waiting Room

This was an extremely long day.  No eating or drinking wasn’t terrible, since I tend to “fast” in the morning until 1 or 2pm lunch on normal days…granted, that’s with a coffee at 10am.  I arrived at the hospital at 11am and met my mom and her brother there.  Mount Sinai, it turns out, is extremely modern, and it made the whole process of being there much more relaxed.  Every room has a modern computer in it (not one that’s 10 years old!) where the nurses, doctors, and various staffs can pull up digital patients’ records and see everything in their system related to them. There’s no hand writing, and that’s awesome.  Handwritten notes really slow down everything….you end up having to tell the same info to everyone you meet since they can’t just pull up the electronic record, or maybe they just ask you to repeat it since they can’t decipher the previous person’s handwriting.

For surgery, I went to the Guggenheim pavilion, 2nd floor, which was one gigantic waiting room.  Blue carpet radiated out from the reception desk, at the heart of the lines of cushy chairs.  I approached, and the staff there was extremely nice.  They handed me a packet of information – a rundown of what to expect today – to give to the person who’s supposed to pick me up after surgery.  Since I’m going under general anaesthesia, it’s policy that someone else takes me home.  Also included was a plastic beeper shaped like a remote control, the kind you get at a restaurant chain when you wait for a table.  People end up waiting hours and hours for their loved ones, so the beeper thing was really cool…I didn’t know this was a thing at hospitals.  Maybe it’s only Mount Sinai.  So if you are around the hospital building, the beeper will be within range to vibrate.  This is good since none of our cellphones worked inside the hospital.  I think they purposefully jam the signals, which I appreciate…there’s nothing more annoying than listening to someone gossip on their cellphone while you’re waiting to see if your daughter makes it out of the OR alright.  If no one responds to the beeper, the staff would switch to the mobile number on my form to call my mom.

Day of Surgery: Paying the Bill.

There was still some more prep work to be done, unfortunately.  I was called up to cubicle #4, where a very stern and bored woman presented me with several forms and a patients’ bill of rights packet.  I must have a dozen of those by now.  And every time it’s the same basic information I’m filling out or initialing.  No, I don’t have a health care proxy.  Yes, all these forms make me think I should have one, but the actual form for designating a proxy has never come up.  Staff always point to “No, option A” for me.  Now the sucky part is….a lot of hospitals, especially in New York City, have been losing tons of money and actually CLOSING.  Lower Manhattan has yet to fill the void that St. Vincents has left, for instance.  A lot of it is from bad administration, and a lot of it is from people who don’t pay their hospital bills.  The uninsured.  I know a bunch of people who have cut and run on their hospital bills.  Everyone probably knows at least five, the trick is getting them to admit it.  It isn’t a good thing though….and I don’t want to get in to the whole insurance debate.  I do think things need to change, because the current situation is not working out.  The high costs of the uninsured who use up services in the ER get passed on to people who go through the hospital the normal way.  I have insurance, but apparently it kind of sucks!  My deductible is high…for in-network stuff, which includes Mount Sinai, my deductible is $3500.

The breakdown is like this, in case you don’t know how deductibles work.

Scenario 1. Say the hospital charges me $2000 for everything.

Since it doesn’t hit the limit of my deductible, I pay everything, 100% myself.  I pay $2000 because my deductible “hasn’t been met”.

Scenario 2: the hospital charges me $5000.

I pay $3500, which is my deductible, out of pocket.  There is now $1500 leftover, of which my insurance pays 70% of.  That means I need to take care of the remaining 30% ($450), totaling my out of pocket cost at $3950/5000.

Scenario 3: The hospital bills me $18,000+ ….  this is the point my insurance will actually pay 100%.

Anyway, getting back to my surgery day….I was at the cubicle, and the lady asked for a “method of payment”.  Because of all the hospital financial issues, they now want you to pay your deductible up front.  It SUCKS.  My deductible is too damn high.  So that’s $3500 gone…my credit card’s limit isn’t even that high, so now I owe my uncle.  I guess this is like a deposit, so that I don’t just run after I get to recovery, without paying the bill.  But they had an estimate for my surgery, which was something like $4750….so most likely they’re gonna keep that deductible.  And I have to pay even more when I get the proper bill later.  It’s only an estimate because they don’t know what my surgery will officially require….if I hit complications and they need a blood transfusion for me, those blood bags are going in to my bill.  My mom was a nurse some 20 years ago, a supervisor for the ICU, and she said the whole billing process was a new thing.  Hospitals didn’t used to nickel an dime you like this….you paid one, solid, “package” fee for the OR.

Once the lady swiped my uncle’s credit card, she smiled for the first time and strapped the hospital bracelet on to me.  The last time I had surgery was nearly 20 years ago, and then it was just a plastic name tag around my wrist.  At Mount Sinai, it was this thick band with not just my basic info on it, but this electronic thing with a barcode on it.  I didn’t know this was a thing either!  It seems like it’s supposed to cut down on mistakes, since you get like 10 different people working on you at various times.  When nurses and doctors meet me, they scan my wristband to confirm who I am.  I’m guessing it shows my records to them too, and hopefully that cuts down on the times patients get injected with the wrong medicines…because they mix up who gets what.  It happens.  Sometimes people die, sometimes they’re only uncomfortable.

Waiting for surgery....#surgery #imscared #waitingroom #hospital #bracelet

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Day of Surgery: Exam Room

After payment and a little more waiting, I was summoned to an examination room.  There was a computer desk, a huge, double-wide recliner for the patient, two chairs for family members, and your run-of-the-mill biohazard garbage bin mounted to the wall.  There was a sink and a gown storage unit here.  I changed in to the cloth, backwards opening gown and put on a blue, front-closing paper robe.  Everything was a humongous one-size fits all; their ends brushed my ankles.  My clothing all went in to plastic bags that had my nametag stickered on to it.  I curled up on the recliner and passed the time by chatting with my mom.

Eventually, a nurse entered the room.  Now the cool thing about having a mom from the Philippines is that she can make instant friends with all the Filipina nurses :)  No matter where you are in the world, if you find a Filipino and speak Tagalog to them, they become very warm and welcoming.  I wish I was good enough to speak it myself, but the best I can do is understand it, unfortunately.  They had a mutual friend, a surgeon who retired some years ago from Mount Sinai.  She asked me a bunch of questions about my history…things like, are you sexually active (of course I said no infront of my mom), are you taking any medication, allergic to anything, etc. etc.  Unfortunately, she told us that for some reason, every patient’s record was showing “NO SAMPLE” under bloodwork.  So they drew my blood all over again, this time with the crappy syringe version instead of the butterfly needle, and I had to wait extra long for the results to come in.

Day of Surgery: Patients-Only Waiting Room

Another nurse came and led me away.  Just me and my two gowns – no cellphone, no 3DS to play with, no nothing.  Not even shoes…I had navy-blue socks on instead, with these rubber dots on it so I don’t slip.  The nurse walked me and an elderly patient through the hospital.  I was surprised at how grand everything looked.  The ceilings were insanely high, maybe 3 or 4 stories high above our heads, with floor-to-ceiling glass windows instead of walls.  The floor was heated, clean, and shiny.  If you think of futuristic utopian movies, where characters walk through an alien, alabaster city of technology, this was it.

The nurse dropped us off at a small waiting room, your standard fare.  She left me with a warm blanket, fresh from the dryer.  And now began the most BORING waiting of the day. I saw patients come and go, I saw doctors greet everyone but me, I saw my surgery slot also come and go.  1PM was long gone, and no one had come to talk to me.  Maybe around 1:30pm, I did see my oncologist…she had come out of a previous surgery, and said I would be in soon.  In half an hour.  But half an hour passed….I devoured all the magazines, and the TV mounted on the wall was on CNN, reporting a lot of non-news and speculations.  It got REALLY boring, but most of all I got REALLY HUNGRY.  I hadn’t eaten since midnight, if you recall.  Actually, since dinner time at 8pm the previous day. The staff felt bad for me and let me use the phone to call my mom.  They beeped her for me and I told her I was still waiting, I hadn’t even gone to surgery yet.

Around 4pm, more nurses came to interview me, along with the Anaesthesiologist.  He was a nice guy; tall and with a huge, cheshire grin.  His hair cap had a pattern of speech bubbles with “ZZZ’s” on it – very cute.  They asked me again about my history, my allergies.  They pulled up my blood work on the computer.

The anaesthesiologist looked at my blood results and said, “You’re a perfectly healthy, 25 year old female.”

I laughed and said, “A healthy 25 year old female who’s going in to surgery.”

His smile almost faltered; eye contact broke.  The man shrugged and said, “These things happen.”

I’m a pessimistic jerk.

I explicitly mentioned I did have an inhaler, even though I don’t officially have asthma.  Albuterol.  Very important to mention if you’re going under general anaesthesia…

Oh, here’s an embarrassing thing that I don’t have to mention, but will.  After the interview with the anaesthesiologist, I went back in to the waiting room as they prepped the OR for me.  I been sitting around in that cloth gown and paper robe for HOURS at this point.  And I have an IUD….which is known to increase the amount of cervical fluid a woman has.  So…hm…yeah…eventually I soaked through all my clothes :(  This is why women have that double-layer of cloth in their panties!!!  But they took all my clothes and I had no underwear.  My two surgeons came and got me; the male plastic surgeon led the way, with my oncologist behind me.  I’m pretty sure she must have seen the huge wet spot in my robe.  I could feel it brushing against me, ick!  And if I were her, I’d probably joke about it in the OR, when I was under anaesthesia and couldn’t hear.

Surgery Time.

They led me in to the OR, and here I was getting very nervous.  When I was in surgery for appendicitis as a kid, it was literally just a flat, cushioned table.  This time, I had a table that looked like a crucifix….and if you ever watched shows like Nip/Tuck, you’ve definitely seen these.  It’s in the shape of a lower-case T, and they strap you down with your arms spread open.  I’m guessing it allows for surgeons and nurses to move around my body with more ease.  My legs and lower torso were tightly wrapped in another warm blanket.  This was not going to stay, because they had to get between my legs for the surgery, so it was probably just to make me feel relaxed.  A nurse pulled the top part of my gown off, so that my arms were not in sleeves anymore.  Circular stickers attached to wires were placed around various parts of my thorax.  They strapped down my arms and the anaesthesiologist stuck the IV needle in to my left, inner elbow.

He smiled at me again with his huge, toothy smile. “Before I put you under, I’m going to give you a ‘cocktail’ to help you relax first.  It’s sort of like a Tequila Sunrise.”

I remember saying “Huuuuh?” at him before passing out hard.

It wasn’t like in the movies; I didn’t even get to count to ten.

Day of Surgery: Recovery.

The next thing I remember, my bed was moving through hallways.  It was a different bed, one without arms…or perhaps the arms were removable?  The tube had already been extracted from my throat, which was now sore.  My left arm was still connected to an IV bag, and gravity seemed heavier than normal.  I lifted my right hand, opened and closed it, stared at it.  They moved me again to a double-wide sized recliner chair in the recovery room.  Up above, on the drop ceiling, was a speaker….I stared at it, trying to concentrate my vision.  It was sort of like when you’re drunk, and it’s hard to focus on one, stationary object….except the world wasn’t moving like it does when you’re drunk.  Things were perfectly still, I just couldn’t focus.  My hand dropped to my side like a rock.  Off in the distance, I saw my mom in her green, Uniqlo vest that I got her, and one of her friends.  I waved to them with great effort, and the two approached me.  Two more nurses came by; one stayed at the computer, entering information in to it.  Another took care of me; gave me ginger ale to drink, removed the EKG stickies from my chest, helped me put my cloth gown back on so my breasts weren’t exposed.

I was happy to learn that the plastic surgeon stitched me up very cleanly and didn’t need a skin graft afterall :)  He otherwise had permission to take a square of paper-thin skin from my inner thigh.  I was a little nervous about that, because if I wear a swimsuit, what if people can see that scar?

My mom had arrived with one of her friends who was also a nurse, but at a different hospital.  This woman….egh.  My mom thinks she’s funny, and they seem to be good friends since before I was born. And she’s a nice person, but she’s PUSHY nice.  She’s kind of a bully, and very rough.  She was helping the Mount Sinai nurse get all the EKG stuff off me and everything, but I didn’t like how she was shoving me around, forcing me to do things while I was still out of it.  The regular nurse was even telling her to let me rest a bit first.  I mean, I just woke up.  Give me five minutes, yeah?  I can’t even stand without falling yet.  She even started pulling out my IV, which is when the Mount Sinai nurse scolded her.  Yay!  But everyone was pretty good natured about things.  It was really only me who was getting very annoyed.  My throat was too sore to voice my opinion.  I also found a strange, crusty white stuff on my forehead, above my left eye.  I didn’t know what it was…and yes, it made me think things.

Later I asked a good friend of mine about it, since she’s an anaesthesia tech and is always in the OR.  She said it’s residue from a gel they use; they put another thing on my head during surgery to monitor my brain activity.  If I am touched and my brain activity is above a certain magnitude, then they assume I’m feeling pain and adjust the anaesthesia accordingly.  So…it isn’t semen.  Yay!

My bag of clothing appeared around this time.  I took off the hair cap and dressed myself, with great difficulty.  My mom’s friend was trying to help me, but again she was being so pushy and annoying I really wanted her to just leave me alone.  Not to mention she was shoving my leggings on to me inside out.  And she put my socks on before the leggings.  I took everything off and redid it.  After I was dressed and was looking rather normal, a lot of the nurses came by and kept calling me “Barbie”.  Maybe it was a lie.  I probably looked like shit since I just woke up from surgery.  But it did make me feel a little better.  I’m glad I didn’t wear my skull dress to the hospital…that would’ve been kind of inappropriate.

I didn’t really feel okay yet.  Not even 40% okay.  Again, I still couldn’t stand by myself.  But my mom’s pushy friend said I was fine, despite the Mount Sinai nurses saying I could rest a few minutes more first, and they started the discharge process.  A male nurse helped me in to a – once again – double-wide wheel chair.  That’s the thing with hospitals now….everyone in the US is not just overweight but obese.  Some rooms have hydraulic cranes hanging from the ceilings, because even with 3 huge male nurses, it’s impossible to move a patient that weighs 400+ lb without a machine’s assistance.  It worries me about the US.  Imagine that, it takes 3 people and a machine to move one patient…imagine all 400lb bearing down on that patient’s knees, every day of his life.  It sounds awful, and I do hope we as a country can get healthier.  Nothing about that sounds comfortable.  And what if the crane isn’t there?  A patient could die, lungs crushed under his own weight, with nurses unable to help him because they physically can’t prop him up.  Anyway, I’m 103lb and short at 5’2″.  I felt like a child, a little doll sitting in a giant’s home.  The recliners were huge, the beds were huge.  They used pediatric equipment on me to test vitals at certain moments during my hospital visit.  Even with my arms down, I was no where near touching both sides of the wheelchair, so I couldn’t reach the arm rests on it.  Not comfortably anyway, so I didn’t bother.  I would’ve liked the wheelchair to be a bit more snug against my sides so I wouldn’t rattle around in it.  The nurse pushed me first to the original waiting room area, where we picked up my uncle, and then out to the street below. We hailed a cab and went to my mom’s place, where I still am right now.

Recovery At Home

The day of the surgery, I got home around 8PM and pigged out!  It had been 24 hours since I ate, and I was starving.  The anaesthesia was still working, so I didn’t feel any pain whatsoever, just heaviness and lethargy.  I ate probably a pound of very tasteless, bland spaghetti, mashed potatoes (not the good kind, just your typical cafeteria mash), cream of broccoli soup, a bite of spicy pork chop, vienna sausages, and some Ferrero Rochet chocolates my sister brought over. She also brought me a mini-rose bush, which I have a pic of at the start of this post.  It’s cute, I like it!  But I don’t know how to take care of it.  My sister stayed and talked with me for a while, and we stayed up to 1AM just looking at dog videos on youtube.  Time well spent!

The next day, I woke up at 6am from pain.  I squirmed around a bit, trying to sleep again.  Cautiously, I took one Percocet….then the 2nd tablet a half hour later.  The directions say I can take two every four hours.  And that stuff is pretty amazing…I’ve never had anything stronger than over-the-counter Tylenol.  The pain went away in about 30-40 minutes, and I was back asleep.  It was nice, and I think I can see why people would get addicted.  The Oxy in it leaves you with this nice, warm, fuzzy feeling.  Like a million hugs from people I actually like.

My skin at the excision site was still numb….I’d estimate it was numb for at least 24hrs since the surgery.  It scared me a bit – what if they nicked a nerve and I permanently lost feeling there forever??  Thankfully, it came back.  I wasn’t aware that anaesthetics could last that long.  But things seem okay now.

Mild Overdose…?

Later in the day, four hours had lapsed and the pain was returning.  Feeling braver than earlier, I took two tablets of Percocet (which contains oxycodone) as per the directions.  It made me drowsy, and as I was falling asleep….I realized I had stopped breathing!  My whole body was like lead…I had to consciously force myself to inhale, to exhale, and even doing that was very difficult.  My chest would move so slowly, and it took great effort.  I’m sure most people have heard of “Sleep Apnea”, where a person ceases to breathe while sleeping, and suffocates to death.  Well, I’m not used to opiates so all the bad side effects really hit me.  One of them is Apnea, where you have slow breathing or when one stops breathing….while awake.  I’m so glad I was awake.  If I drifted off to sleep, maybe I would’ve suffocated.  Some friends were telling me oh, your brain will make you breathe when you’re asleep.  But your body doesn’t work quite as intended when you’re on drugs…

Besides having to make myself inhale and exhale consciously, I was dizzy and could barely stand, extremely drowsy, light-headed, and felt like barfing.  I became itchy all over my body too.  All of these, according to the paper the pharmacy included with my painkillers, were signs of overdose….but it wasn’t so bad.  I rode it out, with my forehead against the wall for about an hour before things were a little more manageable.  It took a few more hours to really get out in the clear.

So….I just take one tablet now.  At 325mg, that’s good enough for me.  I’m also glad I took the day after surgery off from work. I almost didn’t.  With the painkillers, I was way too loopy to do anything worthwhile, and kept passing in and out of consciousness.  My laptop is with me here at my mom’s place, and I tried to watch some work-related tutorials…but it was pretty pointless.  Since I can’t concentrate very well, I had to keep rewinding things.  Nothing sunk in.

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3 thoughts on “Surgery.

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