Friday, February 26, 2016

Memories from a Prostectomy: The Spirometer, the leak and the wasps

I've debated over and over about documenting my recent and brutal prostate biopsy (the brutality comes in the bloody evidence after the biopsy), the subsequent cancer diagnosis by a very aggressive form of cancer, the recent hospitalization for radical prostrate surgery, and the current harsh recovery. 

And I'm still not really sure why I started to do it here, because this is an art blog, not Lenny's diary or whine-blog, but here it goes.

Why? There are some excellent lessons learned in the process which maybe can help someone; who knows. If I had read this ahead of my own surgery, it would have made some things a lot easier. I also plan to print this and mail it to the hospital, as there is some good feedback in here for them.

It has been over a week since the surgery, which was done on Tuesday, February 16, and things are not all 100% good, but we're moving forwards (I hope).

As noted in an earlier post, I arrived at Suburban Hospital last Tuesday around 5:30AM for a scheduled robotic assisted prostate surgery. The road that led there was accented by multiple pokes, biopsies, meetings with doctors, nurses, and deciding between chemo or the knife.

I decided to get rid of the little fucker outright and quickly, rather than cook it to death. The end results are the same: your prostate is history, but with surgery at least it is out of your body, unable to spread, and they can also biopsy the surrounding areas so that they can verify that it hasn't spread. Surgery, especially the robot assisted surgery which eliminates surgeon's tremors, also has a decent chance that after recovery you'll be able to still get your crank up.

That's one giant-assed issue, know what I mean.

So, after arrival at the hospital, I was prepared for the surgery, which is done by a team of doctors and nurses and a robot. 

I'm imagining this guy from Star Wars, but I know that it must be something quite simpler looking; later on I discovered that I was pretty close! At least the top half.

To the left is what the DaVinci Robot looks like (note the artistic name).

My surgery was to be directed and done by a genial Mexican-born doctor who has loads of experience in this area.

The staff at Suburban is like Whole Foods, there are people from all over the planet, and the accents reveals Americans who were once Russians, Ethiopians, Filipinas, Jamaicans, Asians, Indians, Central Americans, Nigerians, and the Gulf States.

A smiling tech wearing a hijab puts the intravenous needle kit into my left arm, while a nurse reviews the pre-operative protocol for the 100th time at different stages.

At some point the anesthesiologist comes in and walks me through his part of the operation. Soon after, my doctor comes in and we converse in Spanish. He tells me that all will be OK.

As I am rolled to the operation room, all that is in my head is the fact that I will have to wear a catheter for 10 to 14 days. The thought makes me shudder, but the mind (and the gurney) rattles on. But at least I have been told by most people that I should be heading home the next day, if everything goes well.

At the operation room a smiling nurse puts a hair net on my hair and that's the last that I remember.

I wake up to a smiling and efficient Asian nurse who checks me out. I'm not feeling any pain or discomfort, but have a very sore throat. She explains that I had a tube going down my throat into my lungs. I am also very thirsty and start drinking lots of water.  I'm also beginning to cough, the familiar feeling of phlegm in my lungs ticking my throat.

Each cough feels like someone is stabbing my guts in five different places, the result of the multiple robotic probes and the macabre tube coming out of my stomach. I also know that it's there, but don't want to think about the catheter tube up my crank and reaching into my bladder.

My wife looks under the sheets and grimaces. "What?," I ask alarmed. She describes the multiple angry incisions in my belly, the stomach tube, etc. She also notes that I have been "manscaped down there."

Much later, when I've had a chance to get a mirror, I inspect the manscaping, which goes all the way from below my nipples to my testicles. Curiously, whoever did all the shaving stopped halfway through my balls, so the top of them are shaved, but the bottoms are still covered in pubic hair, somewhat making them look like balls with beards, or one of those Japanese haircuts where they shave your forehead all the way up to half of the top of your head.
Eventually I'm released from the recuperation ward and I'm taken to my room; and I'm pleased to see that I'm the only person there. When I was a teen and got whacked by a car running a red light in Brooklyn, I spent months in a giant ward at Kings County Hospital; not pretty.

My wife is there by my side with a bag of essentials, such as my iPad. I use it to snap this photo and Facebook the image. She notices that my eyes are watery, and I tell her that they feel very odd.

With the exception of my colleagues that were at Context Art Miami with me in December, my wife's immediate family, and my two daughters, no one knew that I had been diagnosed with cancer, much less that I was to undergo major surgery.

And thus, after the Facebook posting makes the rounds, the Cuban side of my family is surprised that I kept them in the dark. My reasoning for that is clear, as I explain it to them.

My mother is in her 90s and doing OK in her apartment of 40+ years in Florida; she doesn't need to worry about me, cancer, operations, etc.

My plan was to tell her after the operation (I did); had I told one of my relatives before the operation, I was afraid of the effects of Radio Bemba ahead of the operation

Radio Bemba is a Cuban expression that literally means Lip Radio. It's news, gossip, rumors, conjectures, etc. spread by word of mouth. In the Navy an equal expression is RUMORINT (Rumor Intelligence).

As soon as the Facebook news spread, I get emails from DMV artists Tim Tate and Elissa Farrow-Savos: "Avoid the Percocet!," they warn. "It will really mess up your bowels!".

The tone of their alarms gets to me and I insist to the nurses that I want to stay off that particular painkiller, even though they tell me that I'm on a stool softener. I also continue to drink a lot of water.

Considering the trauma of the event, the pain is mostly manageable. As recommended, I even get up a couple of times and do some walking zombie 15 minute strolls through the ward. A couple of other patients are already out there, and a nice nurse ties my hospital gown properly so that I can stop showing the crack of my ass.

We walk around in zombie patterns around the ward, rolling out the IV tower for support, and holding the urine and stomach fluids bags in the other hand.

I'm not hungry, but I know that I must eat, so I consume some clear liquids: chicken broth, lemonade, green tea and (as directed by the nurse) some most excellent lemon ice. The food delivery people from the hospital kitchens, both the tiny East Asian woman and the clean-cut, elegant, young African-American youngster, are friendly and vivacious. In fact, nearly everyone that I came across while at Suburban, starting with the Central American and the Dominican ladies at the check-in station, to the always-friendly, talkative and smiley (and pretty) African-American cleaning lady who cleaned my room everyday, were an unexpected joy at the kind of workplace that usually yields jaded, glum workers.

So far, the only thing that it really bothersome, and pain inducing when it happens, is the constant coughing to try to get rid of phlegm in my lungs. It is mostly futile and my throat is really sore. Each cough hurts my gut with multiple deep lances of pain, and a nice nurse brings me a HUG ME pillow.

"Hug it against your stomach when you cough," she advises.

I cough a lot; it hurts a lot. Otherwise, everything else is manageable.

My eyes have been feeling odd since I woke up, as if they were full of eyelashes inside your eyelids. After dinner I zombie-up to the bathroom to brush my teeth and look at my eyes.

What I see scares the crap out of me. A jell like substance, looking like the vitreous, jelly like substance that fills the center of the eye accumulates at the edges of my eye lids. As I tilt my head, it quickly slides around the eye ball to whatever direction gravity pulls it, but never spills out of the eyeball.

I am convinced that my eye vitreous has detached during surgery and is now floating around my eyeball. I bring my alarm to my nice Nigerian male nurse, a smiling, kind man always willing to help. He looks at my eyes and is also somewhat alarmed, although he tries to hide it.

"I will get the Physician's Assistant to look at it," he tells me.

A couple of hours pass, and I'm now obsessed with my eyes; even the coughing fits take second place to my concern about them. I get out of bed again, run into my nurse and ask about the PA. He assures me that she's on the floor and will soon see me.

Around midnight she shows up. She sits next to me and asks me if I get grossed out easy. From her friendly and smiley approach, I am somewhat relieved.

She describes the operating procedures that took place, including the fact that my eyes were filled with a thick lubricant, and taped up during the operation; that's what's in my eyes. She cleans them with a warm wash cloth, and tell me to do that gently over the next few days.

It sounds from her talk that she was actually part of the operating team that morning. She describes how my body is put into a 45 degree angle, with my head lowered, and how my pelvic and intestinal area is inflated with balloons to allow the robot arms access to the prostate, the seminal vessels, and the lymph nodes.

The main driver, in this case, my Mexican Doctor, sits at a console and does the cutting, re-attachment of the urethra to the bladder, and the stitching. I mention to her that the doctor had mentioned that the robot does "beautiful stitches."

She clarifies that it is the doctor, using the robot arms, who actually does the stitching. "Baseball stitches actually," she mentions. She adds that prior to the robotic advance, a surgeon could only do six stitches; now he or she gets to go all the way around and baseball-stitch that connection.

I'm curious as to how the prostate itself and other internal body parts are removed from the body, and I ask her. Her eyes light up. Apparently, that's her job at the operation; she "runs" the robot hand that contains a expansible bag that accepts the prostate as it is clipped off by another robotic arm. The bag is then closed and extracted from inside the body.

I go into a coughing fit and she looks alarmed at my pain. She asks me where my Incentive Spirometer is; my puzzled look is her answer, and she rushes out of the room and comes back with one of the devices.

"They were supposed to give you one of these when you came out of the operating room," she frowns as she teaches me how to use it. "It will re-start your lungs and help you get rid of the phlegm a lot easier."

I'm directed to exercise my lungs ten times an hour. As I do it, I wonder who fucked up the check list of what I'm supposed to do after a major operation. 

Within a couple of hours, my lungs are a lot better and a lot of gunk has been spit out. However, after ten hours of constant coughing, my throat has been abused and it is sore and the occasional cough from that issue still bugs me, but it's a million times better.

When my wife comes by the next morning, she's pretty upset that I had been Spirometer-less most of the day. Because she runs everyday, she actually runs from our home to the hospital (and back) everyday as part of her exercise routine; who knows how many miles this uberathlete logs on each round trip!

I'm expecting to be released later that day, but there's a problem.

It seems that something called a Jackson-Pratt (or JP drain); which is a soft, round plastic bulb that looks like a grenade and is attached to the end of my stomach tube, and "sucks" the fluid out of my body (from around the operated area), has been sucking too much fluid - there's a lot of fluid in that area.

Tests also indicate that there's elevated creatinine in that stomach tube liquid, higher than the creatinine levels in my blood. That essentially means that there's urine in the fluid. It doesn't take a medical degree to realize that the bladder (or something) is leaking piss inside my body.

I'm to be kept overnight and monitored; no one has mentioned the word "leak" yet - as in urine leaking from your bladder into your body. Later that night, the smiling female doctor from my doctor's practice assures me that things will be OK and that they just want to monitor the creatinine to see if it goes down.

Day two arrives, and the wasps make their first appearance... right after lunch.

DMV artist Tim Vermeulen has had a brutal couple of decades where his body has been wracked by pain due to side effects of some medical issues a couple of decades ago. He depicted this is pain in this chilling painting:

 The Seat of the Soul, Mixed media on panel by Tim Vermeulen
 The Seat of the SoulMixed media on panel by Tim Vermeulen

When I first saw it at Context Art Miami last December, it scared and chilled me to the bone. Little was I to know, that in a weird way, it would help me a tiny bit from Wednesday to Friday of last week. That's Tim at the bottom of the painting, hugging his stomach in quiet agony while the wasps go to town in his innards.

For me, it started as a little crampy sensation in my right pelvic area; suddenly one of my balls was in pain hell quickly and out of nowhere. It happened fast, so fast that it floored my senses, but soon the worst pain that I have ever felt was coursing through my pelvic region and my stomach. It was so unexpected, intense, fiery and full of living movement, that it surprised me and astounded me with the violence and level of the pain.

It felt like a million points of pain, each one a little needle poking into the meaty parts of your insides, drilling into your pelvic bone, and then moving quickly to a new spot to poke a hole inside your gut; it felt like a million wasps, and I remembered and recalled the Vermeulen painting.

The first time, after an agonizing 15 minutes, it was gone.

"Probably gas," said the nice nurse when I told her about it. "Call me if it comes back and I will give you some Percocet."

"Fuck that," I thought to myself, "I don't want to trade up to chunks of cement in my bowels."

The wasps came back three times or so that day. I cussed them out, begged them to leave, whined like an animal, and in my mind's eyes killed each little motherfucker one at a time inside my bowels. But there were so many! The clock became my friend, as I looked at the advance minute hand expecting the end of the agony. Within 12-15 minutes the wasps were usually gone and I was back to "normal."

That Wednesday night the JP Drain is out of control, filling up about once an hour. At one point it turns from the reddish, bloody discharge that it is supposed to be, to the same color as urine. I'm alarmed by that and mention it to the nurse. He tells me that it is not urine.

As Thursday arrives, the decision is made to keep me overnight once again, and my doctor comes in to visit. He explains that there's probably a leak, but that this is not uncommon. He also changes my stomach dressing and directs that the JP ball be changed to a gravity bag to hold the body fluids coming out of the stomach tube. He mentions that since the JP ball works with suction, it's filling out so quickly because of that.

Nature abhors a vacuum.

By now everyone is telling me not to worry that urine is leaking inside my body, because "urine is sterile."

"People even drink it," someone says grossing me out. 

At lunch, for the first time I sit down to eat. When I get up I notice that I am leaking fluid on the floor. It is coming from the stomach hole where the tube goes into my body. The nurse comes in, put me to bed and changes the dressing; as soon as she leaves the wasps make an appearance. 

I fight them with my own mental violence as I imagine pulling them off my insides one at the time, their stingers stretching my stomach walls as it refuses to release its penetration, and then the meat slapping back as the insect, angrily buzzing in my hand, is crushed between my fingers. But there are so many...

A couple of hours later, a nice PA comes in to check on me, and while he's checking me, the wasps make another appearance. He listens to my bowels as I'm whimpering in pain and talking to the little bastards. The nurse is called and she injects some pain killer into my IV; it is no of use, the pain is not affected by anything but time. Everyone has been telling me that the wasps are either gas or bladder spasms. I am told to be proactive, and that as soon as I feel the spasms begin to call for painkiller.

These wasps do not listen to painkillers.

There's a double nurse team on duty today. One nurse is young and pretty, the other is much older and wearing a formidable tool belt of medical supplies, sort of like a Medical Bat-belt for nurses. They are both efficient, friendly and concerned.

Bat Nurse is especially active. As I zombie around in my ward walks, I see her all over the place helping patients; she never seemed to rest.

Later the young nurse comes in with the PA to switch my stomach bag and there's some jury-rigging involved in switching the bags, and much tape is employed in the process. By now I've noticed that my stomach dressing is soaked because the hole in my belly, where the tube enters my body, is leaking again.

Bat Nurse switches my dressing efficiently; she's a nice lady on top of being a very dedicated nurse; she tells me that she's only been a nurse for six months.

Later that day, my doctor returns and quickly disassembles what the nurse and the PA had done and makes an efficient water-tight connection to the new bag. He also changes my belly dressing, as it is soaked again. He re-assures me that the leak will heal itself.

I sleep fitfully and then it's Friday; the wasps are not nocturnal.

On Friday I am to be discharged and sent home with the body bag. "Make an appointment for Monday to evaluate the situation and see if we can remove the stomach bag," my doctor advises.

I'm feeling fairly decent, and that day I walk around a lot. The wasps make an appearance after lunch, and then just a few minutes after they had left, as if they knew that I'm thinking of going home, while I'm standing in the room, they come back with the whole hive.

This time the pain is not only outside the pain scale, but the wasps have even conquered the clock! An hour passes and I'm still being attacked; these are extra-terrestial wasps from the planet Waspathron; this pain are a million Janices from 1959's The Wasp Woman; maybe I should not have insulted them earlier; for every one that I kill, a dozen more show up, their long stingers dripping with pain venom.

They are joined by hornets, not just any hornets but those giant Chinese motherfuckers called Vespa Mandarinia. "Is there a difference between hornets and wasps?," I ask them as I fight them.

My wife calls and detects the pain in my voice; she's alarmed. I try my best to sound OK, but she knows better and she heads to the hospital. This time she drives.

By now I'm nauseous with pain and lay down; it's no use, the pain won't leave me. I call the nurse and ask her to bring me the puke basin. She's alarmed at the level of my pain, but reacts to the nausea as well. She injects me with something and the nausea goes away, while I battle the wasps and the Mandarin hornets.

A new PA walks by and hears me talking to the wasps, begging them to leave me alone, and she comes in and listens to my belly. "The pain is because of bladder spasms," she notes, "It's very common when you have a catheter." This is the hundredth time that I've heard that diagnosis.

"I'll order some muscle relaxer to treat the spasms."

Wait, what?

This is the first time that anyone has mentioned something specific to treat the spasms; so far it has been painkillers to treat the pain. A fucking light goes on in my head and I warn the wasps that payback time is coming. I also wonder why nobody has suggested this treatment the entire three fucking days that the wasps have been attacking me.

She orders something called Oxybutynin which according to the Mayo Clinic: "Oxybutynin belongs to the group of medicines called antispasmodics. It helps decrease muscle spasms of the bladder." 

Memories of the Wasps Attacking at Suburban Hospital
2016 F. Lennox Campello
Ink and conte on paper 11x8 inches
I get it into my system and the wasps and hornets die. This is Raid to these fuckers; it's over... technology and modern medicine have won.

But, why on Friday? How come none of the other medical professionals realized that bladder spasms are very common when a catheter is first introduced? Why didn't anyone came to my aid to fight the wasps?

I'm discharged later that day and sent home with two tubes in my body. An awesome Filipina nurse trains my wife and I on the process of keeping track of the fluids coming out of my stomach and my penis, and also the process of switching the bags around as needed. She then walks us to the exit and hugs me, and wishes us good luck.

I read somewhere that over 97% of the men who go through this operation go home the next day and it's very rare when anyone has to go home with a stomach tube.

Welcome to rarity.

Next: This is what a Borg feels like at home.


tim tate said...

OH .......MY.......GOD

John said...

Lo siento por ti.

Anonymous said...

This made me shiver in fear.

Anonymous said...

What a horror story! Thank you for posting. My husband is scheduled for prostate surgery next month at Suburban and this has helped tremendously!