color schemes
   rss feed:
16 Jul 2013

Under the knife – Some of my readers already know this, but last week I had a laparoscopic cholecystectomy. Those are two big words that I honestly did not know before last week, so let me rephrase that in simple English: doctors poked a few holes in my abdomen, inflated the abdominal cavity with carbon dioxide, stuck a camera in there, and then yanked my gallbladder out through my belly button. That is the most graphic description you will get of the procedure, because I wasn’t actually awake for it. But if you must know more, you can go to Wikipedia and look up “laparascopic surgery.” The photos at the very top of the page (not for the squeamish, by the way) are of a cholecystectomy, so apparently this is a fairly common procedure. Rather than talking about the procedure, though, I’m just going to write today about the experience as a whole, mostly as a way of processing it, but also on the off chance that people might find it interesting.

“I wondered if everyone who gets wheeled into surgery feels the same terror that I felt.”

It all began a week ago, on Tuesday evening. No, wait, scratch that. It all really began thirty-something years ago, at least. I’m going to have to work this in at some point, so I might as well get it out of the way at the beginning. Think of it as an opening sequence in a film that shows the protagonist as a child and then transitions to that character as an adult (for some reason I’m thinking of Indiana Jones and the Last Crusade—go with whatever works for you).

Since my youth, my digestive system has always kind of sucked. If the various bodily systems (respiratory, circulatory, digestive, etc.) were kids in a gym class, my digestive system would have been the fat kid who always got picked last for dodgeball. I don’t know exactly when this all started, but I can’t really ever remember a time when I didn’t have a crappy digestive system. There was one malady in particular that plagued me: I would get severe stomach cramps after eating and be incapacitated by the pain. I went to the hospital on a number of occasions for this, but the doctors never could figure out what it was. The leading theory was always appendicitis, but it never turned out to be that (think lupus on “House”). Another theory I heard was that my lymph nodes were becoming inflamed, but this didn’t turn out to be the answer, either. Over the years, though, I did discover certain remedies myself. One thing that seemed to work was taking a hot bath (based on the logic that this would relax my stomach muscles). But there were times when the pain was especially severe and none of my usual tricks would work. It felt like my stomach was going to explode, and I can remember lying there all night, moaning in pain until I passed out, because nobody knew what to do about it. If it hadn’t been so painful I think I would have felt special.

The first piece of the puzzle fell into place when I came to Korea. I was on a date with my girlfriend (now my wife) when I felt the onset of the stomach cramps. I just sighed and said, “Here we go again.” When my girlfriend asked me what was wrong, I said: “Oh, it’s this thing I’ve had since when I was very young, and no one knows what it is.” So she said, “Well, describe it to me.” So I did, showing where exactly I was feeling the pain, and she very casually said, “Oh, that’s just indigestion.” She used a Korean word that I didn’t know at the time (chehada), but I was shocked at how nonchalantly—and confidently—she had diagnosed my problem. I then learned that this was a very common problem in Korea and everyone knew what it was. It’s not like we don’t have terms like “upset stomach” or “indigestion” (which is how the word is translated in dictionaries) in English, but apparently dyspepsia (the medical term) is defined more broadly in the West; in Korea it’s very specific. I’m not sure why this never occurred to any of the doctors I saw as a child, but I was glad to have finally been diagnosed and—more importantly—to be able to do something about my problem.

So for many years I was able to treat my problem myself, and it was not as much of an issue anymore. It still happened on and off, of course, especially when I wasn’t in the best physiological condition, but most of the time I was able to treat it. On rare occasions, though, it would develop into that stomach-exploding pain that did not respond to any of the usual treatments. On a few occasions I went to the hospital, but, perhaps because of the prevalence of dyspepsia, I was simply given painkillers and muscle relaxants until the fit passed. This always worked, so I never questioned it. I just assumed that it was a very acute form of dyspepsia.

This brings us back to last Tuesday. I was feeling a little dyspeptic in the afternoon, but after some home remedies I started to feel better. Then I made the mistake of having lamb chops for dinner, and shortly thereafter the pain kicked in again. I thought I would be able to beat it with the home remedies, so we went home and I had some ginger and cinnamon tea with honey. Instead of getting better, though, the pain intensified to the point where I realized there was no choice but to go to the hospital—it was either that or suffer in debilitating pain the entire night.

We jumped in the car and my wife drove us over to the Kyung Hee Medical Center, the teaching hospital attached to Kyung Hee University (which is thankfully only a few minutes away). I went down to the emergency room and checked in. When I was safely on my gurney with my wife at my side, a doctor came over for an initial examination. I explained my symptoms as I always did: dyspepsia gone wild. They hooked me up to an IV and started pumping in painkillers along with other solutions. It would be a mild understatement to say that I was distressed when the pain increased rather than subsided. After three injections of painkillers there was no improvement, and my stomach felt like it was going to burst. I lost feeling in three of my four limbs (I could only feel my left leg), and I heard HJ telling the doctors that my body felt cold all over.

To be honest, the exact order of events at this point is a little fuzzy. I do know that I was in a tremendous amount of pain. It’s impossible to describe what it feels like, but I honestly thought I was going to die. I don’t mean that I was sitting there thinking, “Man, this hurts so bad I could die!” I mean that I told my wife that I loved her and I couldn’t have asked for a better wife, I prayed to God to forgive me of all the things I had done wrong, and then I started crying because I really didn’t want to die just yet. In retrospect it all sounds so melodramatic and not a little embarrassing, but that’s how bad the pain was. You think that you would get used to something like that—that the sensory stimulus would eventually fade—but you don’t, and it doesn’t. It just wears on until you are exhausted from the pain and eventually start wishing that Death would hurry up and get it over with. Looking back on it now, I don’t really care too much about the embarrassment or what other people thought of me, but I do regret what I put my wife through. At the time, though, I was just thinking that I had to say everything before it was too late.

On more than one occasion, doctors came over and examined me. They used palpation (pressing down on certain areas) and asked me if it hurt more when they pressed down or when they suddenly released pressure. From all the appendicitis examinations I had as a child, I knew that this was a test for appendicitis, and I also knew exactly where doctors palpate when they do this test. There was no pain in that area when the doctors released pressure, but there was one area much higher up in my abdomen where it did hurt a little—but nowhere near how much it hurt when they pressed down on that area. They also asked me if I felt nauseous, which is another sign of appendicitis. I answered truthfully: no.

Eventually they took x-rays, which had happened on prior visits to hospitals, but then they told me they were going to do a CT (computed tomography) scan, which is something that had never happened before. Having to lie still during the scan while in debilitating pain was very difficult, and they had to restart a few times because I moved. Eventually I controlled my breathing and willed myself to stay still, allowing them to complete the scan.

After all these tests and scans, I received a fourth painkiller injection, and the pain finally started to subside a little. My stomach was still distended, but I had passed the point where I felt like I was going to die. And then the doctors came out and gave me the diagnosis: I had cholecystitis, or inflammation of the gallbladder. To tell you the truth, I did not really know what the gallbladder was or what it did. Fortunately, the doctors explained it to me. The gallbladder is attached to the liver and stores gall (or bile). Bile production is one of the liver’s many functions, and bile aids in the digestion of fats. What the gallbladder does is store up this bile to save it for when fats come into the digestive system, and then it releases however much is needed.

The doctors recommended surgery to remove the gallbladder, but I wasn’t very keen on the idea at first. Actually, since we’re being honest, I was terrified. I asked what my options were, and the doctors explained that I could go without surgery, but even if the inflammation went down this time, it would invariably happen again in the future. I didn’t doubt it. They also said that the CT scan seemed to show gallstones, which would be another recurring problem. By that point I was lucid enough to weigh the options. Having the gallbladder removed would mean I wouldn’t have to worry about the severe pain anymore, but it also meant that I wouldn’t have the option of extra bile when needed, so I would have to watch my diet. I don’t remember how long it took me to come to the decision, but I did think about a lot of things. I thought back to all the pain I suffered as a child, and the pain I still suffered on occasion, and I realized that it had been my gallbladder all along. It never started out as an inflamed gallbladder, but it did start with the gallbladder: namely, it started with the fact that my gallbladder never really worked properly most of the time, which led to the dyspepsia. If the dyspepsia continued for too long, this led to a negative feedback loop that result in my gallbladder freaking out. No, taking out my gallbladder wouldn’t solve my difficulties with digestion—it’s there for a reason, after all—but if it never really worked properly, the risks of leaving it in outweighed any advantages there might be (which I guess would mainly be “not having surgery”). So I said yes and I was checked into a hospital room.

The only rooms available at that time were single-occupant rooms. Rooms are classified as single-occupant, double-occupant, and multi-occupant (with maybe five or six patients to a room in the last), and the single-occupant rooms are something like twenty times more expensive than the multi-occupant rooms. We didn’t have much of a choice, though, so we decided that we would spend the night there and then move to a multi-occupant room the next day if possible (which we never did because we found that our insurance would cover most of the cost and, let’s face it, it’s a lot nicer to not have to share a room). The nurse who brought me in explained that I would need to fill out a chart keeping track of my “deposits.” Essentially I had to piss into a measuring cup and then write down how many milliliters it was next to the time. I was not required to weigh my poop, thankfully, only record the frequency and type (solid/not solid), but this was never an issue as my bowels did not even budge during my entire stay. I was also told that I couldn’t eat or drink anything before the surgery. The eating wasn’t a big deal, as I wasn’t that hungry, but it was rough going with no water at all. I was getting a lot of fluids through the IV, of course (which is why I had to measure how much I was voiding through urine), so it was mostly a psychological thing.

The night was spent in reasonable comfort once the pain had gone down. Different nurses came in throughout the night to check on my IV, and I usually was awake or woke up when this happened. All of the nurses were pretty, but there was one nurse in particular who was very pretty, and I tried to look less pathetic when she came in. I am sure I failed, and I am sure she didn’t notice, but what can I say? I’m a guy; it’s what we do. Cute nurses aside, although I was not in physical pain for most of the night, I was in quite a bit of psychological anguish. I had never had surgery before, and the fear of the unknown was almost paralyzing. I did manage to get some sleep, though, probably because I was so exhausted from all the pain.

In the morning I was told that the surgery was scheduled for noon. The possibilities had been noon or five or six in the evening, and I was hoping for the earlier time just to get it over with. As noon approached, though, I began to grow terribly nervous. A doctor came in at one point to explain the procedure in detail, but all I really remember about that is him reading from lists of things that could go wrong at various stages, and these lists usually ended in “death.” This was, of course, unnerving, but I knew that he was legally required to inform me of every possible risk. The truth is that you run the risk of death every time you step out your front door—or even before that! What worried me more, though, was when he said that they might have to make a larger incision and actually open me up if the gallbladder was too large to pull out through the smaller incisions that are standard in laparascopic surgery. I was worried because I knew this would multiply recovery time, and I vaguely remember the doctor saying that my gallbladder was three times its normal size (although, honestly, I might have been delirious at that point). He also said that I might have shoulder pain because the nerves that connected to the shoulders were in the area where they would be operating. That sounded weird, but I didn’t think too much of it at the time. When he finished reading from his list of horrors he said, “I’m not trying to scare you, I’m just required to tell you all of this. But I can also tell you that we have performed this exact procedure here many, many times and have never had a single problem.” This would be great for someone able to absorb the information logically and dispassionately, but I was not completely reassured. Still, I signed the surgery consent form because everyone else seemed so calm and confident about it.

About an hour or so before the surgery, they wheeled me out of my room to get an ultrasound examination. I had had such an examination before (again for stomach issues) so I knew what to expect: a cold metal device being rubbed on my belly. Besides being cold, though, ultrasound exams are completely comfortable. The doctor who administered mine started with my bladder, then moved on to other organs before finally getting to the gallbladder. I wondered why he didn’t just go straight to the problem area—had they not told him why I was here?—but then I realized that if you were going to have an ultrasound done, you might as well check out everything. And I must admit that it was reassuring to hear that nothing was wrong with any of my other organs. The gallbladder, of course, was still puffed up like a balloon, although it was not nearly as inflamed as it had been the night before. The doctor did say that he saw a gallstone near the entrance.

Shortly before noon the intercom from the nurses station came on and told me to get ready to be wheeled in to the operating room. They moved me to a gurney, had me lie down flat, and then wheeled me out of the room. As we rolled down the hallway, I watched the white ceiling tiles and fluorescent lights pass by above me. I thought about all of those movies and television programs I had seen where patients are being wheeled into the operating room, and I wondered if everyone who gets wheeled into surgery feels the same terror that I felt. What if I woke up during the operation? What if I didn’t wake up at all? What if there were complications? A “simple” procedure can be performed a thousand times without mishap, but there are always those freak cases where something just goes terribly wrong. I knew it wasn’t rational or logical, but I couldn’t help myself.

As I was waiting outside the operating room, three different people came along with clipboards and asked me the same questions. While it is true that doing this three times allowed me to practice my answers and ace the last questioning, I’m not sure why they didn’t just share the information with each other. Were they testing for inconsistencies? I have no idea. I also don’t remember what any of the questions were, just that all three sets were the same.

Finally they wheeled me into the operating room and the ceiling changed from white to minty green. I wasn’t sure if I liked the color. At first I thought that it wasn’t a very comforting color, but then I realized that it wasn’t a disturbing color, either; it was just neutral. It did not make me think of mint chocolate chip ice cream or fresh breath—in fact, I’m pretty sure that if I ever see that color again all I will think about is being in the operating room, so it’s probably good that the color did not remind me of anything. Maybe that’s why they picked it. (Perhaps more scientifically, speculates that green helps doctors see better during procedures, and this might be why the ceiling (and presumably walls, even though I coudn’t really see them) are green in the OR—but it is still just speculation. Interesting, though.)

All of the doctors and nurses were wearing masks, but I recognized the doctor performing the operation by his voice. Everyone seemed very calm and relaxed, like it was just another day at the office. For them, of course, it was. And I suppose that realization did help calm my nerves a little bit. But I was still terrified. Everyone was nice enough to explain what they were doing as they prepped for the operation. The doctor brought a mask toward my face and told me that it was an oxygen mask, which surprised me a little because I had always thought that general anesthesia was delivered in gas form. As it turns out, the anesthesia is an injection; the nurse told me this as she was injecting it into my IV. I could feel the solution enter my veins and I said as much. Then I wished the doctors good luck (actually, I literally told them to “please do a good job,” which is a fairly common phrase in Korean) and I felt everything start to go fuzzy. And that’s all I remember from the operating room.

I didn’t even have time to wonder if I was going to wake up again. A moment later, it seemed, I opened my eyes to find myself in the recovery room, lying next to an old man who was screaming, “Kill me! Somebody please kill me!” So, probably not the best way to wake up, but on the positive side it did put the pain I was feeling into perspective. It hurt, but it was nowhere near as painful as having a gallbladder puffed up to three times its normal size. Once I had regained my senses, the first thing I did was quickly lift up my shirt and look down. I was relieved to see four small bandages on my abdomen: one over my belly button, one above that, and two more fanned out to the right. There was no larger incision, as I had feared there might be.

They wheeled me back into my room, where I inclined the bed so I could sit up; for some reason, it hurt a lot more when I was lying flat. I don’t remember exactly what time it was when I came back from the recovery room, but I do remember that not too long after that the professor in charge and the doctors who had worked on me came in and told me how the procedure had gone. Again, the details are a bit fuzzy at this point, but the long and short of it was that everything went as expected. The only thing that did not go as expected was the gallstone—when they removed the gallbladder the stone was not inside. It was the professor’s opinion that, since the stone had been stuck at the opening of the gallbladder, it had probably come lose and passed on down the line, so to speak.

He also told me that I should try to walk around as much as possible in order to speed my recovery, which didn’t really make much sense to me. I wasn’t in too much pain just sitting there (except for—surprise—intense shoulder pain that would kick in every now and then), but when I had to get up to relieve myself I found it very difficult to walk. I did try to take one walk that afternoon, but I think we got halfway to the nurses station (maybe four meters from the door of my room) before I said I couldn’t go any farther and turned around. I spent most of the rest of the day sitting in my hospital bed and reading my Kindle. At eight o’clock in the evening I was allowed my first sip of water, but I was told not to overdo it. So HJ gave me a cup of water and a coffee stirrer to drink it through. This, my friends, is an exercise in frustration. it’s like trying to drink water by licking the dew off blades of grass.

That night I slept with the bed inclined because I still couldn’t lie down, and I did not sleep heavily. Once again, I was either awake or woke up whenever the nurses came in, although I had given up on any pretense of trying not to look pathetic for the really cute nurse. By dawn I wasn’t feeling that much better, and I noticed that my stomach was starting to swell a bit. One of the nurses asked me if I had farted yet, and (after looking at her for a moment to make sure that I had heard her properly) I said no. She said, “That’s why you have to walk—to get your digestive system working again and get things moving.” Oh. I wish I had heard that the previous afternoon, although I suppose I should have just listened to the professor.

Anyway, we did take a number of walks in the hallway throughout the day. What sucks about walking around in hospitals is having to wheel the IV stand around wherever you go. It also sucked that I was still in a good deal of post-op pain and discomfort and could only shuffle along like a traditional zombie (not one of those new-fangled “fast zombies” all the kids have these days). But I did try to walk as much as possible. I also started eating again, starting with breakfast, although I couldn’t finish much of what they gave me (mainly rice porridge and soup, with a few side dishes).

HJ had been with me the whole time, but she had a class to teach in the afternoon, so her sister HD came to stay with me while she was gone. I tried to tell HJ that I could handle being on my own for a few hours, but the sisters insisted, so I was handed off to the younger sister. We get along fine, though, and I will admit that it was nice to have someone around. She was also diligent in making me get up and go for walks even though I didn’t want to. HJ came back later in the afternoon, and HD stayed around for a little while longer.

I still felt pretty weak that afternoon, but the doctors said it was fine for me to go home. They also said that I could stay another night if I felt I needed to, but again I weighed the options and decided it would be better to be at home. For one, I wouldn’t be chained to that blasted IV. And there’s also the plus of not being in a hospital, as I find hospitals to be fairly depressing places overall. So it was that I checked out of the hospital on Thursday evening and headed home.

My story, however, does not end here. Oh that it did. But it turns out that what makes surgery suck is not the surgery itself (at least in the case of general anesthetic surgery, which you don’t remember at all), it is the recovery. I continued to eat—still limiting myself mainly to rice porridge/gruel—but nothing was coming out the other end, either solid or gaseous. After eating half of my breakfast on Friday morning I had to stop. I looked down at my belly, which was horribly distended. My first thought was that I was going to tear the sutures in the surgical incisions. My second thought was that I was going to turn around to find Sally Struthers standing in front of a camera, telling viewers that I could be saved for the price of a cup of coffee a day. Fortunately, neither of these things actually happened.

That afternoon we called up the hospital to see what we should do. The first thing they told me to do was to stop taking the medicine they had given me—I should only take the medicine with meals. They also said I could try taking medicine to loosen up my bowels. At that point I was ready to try anything, because having an abdomen full of gas is very uncomfortable. So I got some bowel-loosening medicine and, even though it said to take the medicine at night, I took it around lunchtime. Drastic times call for drastic measures, as they say. And then I spent the afternoon alternating between resting and getting up to go for painfully slow walks. Finally, a few hours before bed that night, the trumpet sounded, and it did indeed feel as if I had been raised from the dead. The next morning my bowels moved (“moving” here is meant in the same sense as when one says earth “moves” in a landslide). For the first time I felt like things would be manageable. I was also able to determine exactly how much pain I was feeling from the incisions, and the answer was not too much.

We spent the entire day Saturday, from the moment we got up to the moment we went to bed, watching a Harry Potter marathon (or, more precisely, the last four films) on TV, going out for walks in between the films. The walking was still slow at that point, but the improvement from the previous day was noticeable. On Sunday I had improved even more, and HJ commented that my walking speed had returned to “normal.” I said, “This is not normal. This is still slow.” And she said, “Well it’s normal for me!” By yesterday it was even easier to walk around, although I decided not to overdo it and stayed at roughly the same pace. The same was true today. I think at this point I can walk more or less normally, but I won’t be in a rush to get anywhere.

The road ahead is going to be a gradual one, at least in the immediate future. As I write this, it is now almost a week to the day since things started getting seriously painful, and it still hasn’t been a week since the surgery. It’s a little hard to believe that, actually, because it feels like I’ve come such a long way, from barely being able to move to moving around without too much difficulty. That being said, I know I’m still a long way from full recovery. My digestive system is still not entirely back on track (although I feel like I ate the first “normal” meal for dinner tonight since the surgery, in that we just ate normal food without any special consideration for my innards), and I can feel that the surgical incisions haven’t fully healed. I wouldn’t want to try any sort of running right now, and strenuous activity (all types of strenuous activity, unfortunately) are out of the question. I mentioned before that I was doing Brazilian jiujitsu, and that was actually going pretty well—I had reached a point where I was finally starting to feel fit again, what with the addition of a stretching and light exercise regime every morning, and I could get through a session of BJJ without any injuries, either major or minor. So to say that I am disappointed that the exercising and BJJ have to go on hold would be a major understatement. To look on the bright side of things, though, the fact that I was so active and working on my fitness before the surgery should help speed along my recovery. But I suspect that plans for wakeboarding this summer are no long realistic, and that’s a bummer. Right now, this seems to me to be the biggest disadvantage of the surgery—not being able to get too active this summer. Considering the advantages of the surgery, though, I suppose it is a small price to pay.

Tomorrow I will be going back for an outpatient examination, during which they will check on the incisions to see how they are healing and make sure they are clean. I’m also hoping to get some more concrete advice on what sort of changes I should be making in my diet, although to be honest I already have a pretty good idea of what it is I am going to have to do. As I mentioned above, I have spent a good deal of my life without a properly functioning gallbladder. Even at its best, especially in recent years, it hasn’t really performed the job for which it was designed. After every fatty or greasy dinner, it was pretty much guaranteed that the next morning was not going to be fun. So nothing really has changed, except that now I don’t have to worry about having an inflamed gallbladder blow up in my stomach. Well, that’s actually a pretty huge thing, because knowing that I will never again have to deal with that particular source of excruciating pain is incredibly liberating, and because you can actually die from this if it leads to an infection. But I mean that nothing much has changed in terms of how my body will react to what I put into it.

So right now I’m thinking that I mainly want to avoid fatty or greasy foods, and going by what I know about my body that is going to be mainly fatty meats. For some reason I am better at processing dairy fat well; this may be because dairy products have less fat in general than fatty meats (this is HJ’s reasoning, and it sounds logical) or because it is a different type of fat... or both. Whatever the case, I’ve never had a problem with cheese or cream or that sort of thing, but fatty meats just don’t agree with me. I can handle them in small amounts, like if they are a smaller ingredient in a dish, but my days of all-you-can-eat lamb chops are probably over. Other fatty or greasy foods, like heavily fried foods (and by this I really mean “improperly fried foods,” as properly fried foods absorb very little of the fat they are fried in), will also be things to stay away from. Basically it comes down to being smart about what I eat if I don’t want to have an unpleasant morning the next day. It’s nothing life-threatening, of course, it’s just about being healthy and comfortable, and that’s never a bad thing.

I’m also thinking it will be a good idea to cut down on heavy alcohol consumption. It sounds a little silly to say it, since I don’t drink that much at all these days, and when I do drink I will have a pint or two, or maybe three if I’m feeling crazy. Up to three pints, as long as I drink enough water and manage my post-drinking time properly (i.e., don’t go to bed right away, take multivitamins, etc.), and I don’t have a problem the next day. But four pints or more and I feel pretty miserable the next day. I don’t like feeling miserable, but sometimes I get lazy when it comes to regulating my alcoholic intake. So I’m going to make an effort to stick to a maximum of three pints, even if I really want to have another pint or two (or three). This is especially true for microbrews and craft beers, which tend to have much more alcohol than, for example, most of the “real ales” that I had when we were in England (which didn’t affect me at all). I’m sure I will fail on occasion and pay the price the next day, but even though I’ve known that three is my no-hangover limit (and two is my comfortable limit) for some time now, I’ve never made a conscious decision to try to stick to that. So hopefully articulating this will help in that department.

And I suppose that’s it for now. This entry is going to top out at just over six thousand words long, which is incredibly long, but I wanted to get all of this down for friends and family who wanted the full experience, and also as a way of putting it behind me. In a way, this entry is part of my recovery process. Hopefully my next entry will do with something far more pleasant.

color schemes
   rss feed: