(Humble Pie reference)

(The above is the name of a song by a 60s rock band called Humble Pie. I was singing the words to this song while being tended to by doctors and nurses and respiratory staff and whomever else had a claim on my body while inside by the 20th day of captivity.)

The briefest synopsis of my recent trip to the hospital goes something like this: They took a bug, they left a bug, they took awhile to take the bug they left.

Not so briefly, I went inside on January 31 for the wedge biopsy. It amazes me, but the operation was the easiest, the absolute easiest, part of my stay.

My troubles always begin with the gown and the argument over underwear allowance. I still have not really figured out why underwear are not allowed beneath the gown. If they need to cut them off, then they are free, of course to do so (somewhat carefully, I admit), but, in the meantime, and on the offhand chance that they will not need to do so, may I retain this last tiny morsel of dignity? Of course not. They, the nurses and the doctors, are slaves to hospital fashion when it comes to me, and so I must wear the ubiquitous butt-crack special, pardon my courseness. I WILL be seen, like it or not, in ways I normally reserve for my wife and closest friends and strangers of my OWN choosing:).

In the gown and on the gurney I am rumbled down the way to the Operating Room, where I face troubles two and three, insertion of an epidural (“Just like pregnant women!” they remind me over and over again, obviously to keep me from crying about it before, during, and after), and insertion of a tube in my trachea.

Although the epidural goes into my back, apparently into the meat between the vertebrae in my spine, its bark is worse than its bite surprisingly. Whatever do those pregnant women complain about? It turns out that mine must be inserted higher on the back than is the case for pregnant women. I am told that there is less to work with as they go higher up the back. I assume they mean there is less meat between discs or some such, which offers them an ideal excuse for requiring three or four attempts to get a good stick, all of which they use. The pain is rather minor, in any event, and as events would come to pass, I became very grateful for its existence. Both times :).

The trachea tube was a different matter altogether. I have a feeling that it is at least a minor issue for everybody that gets one, but in my case, with tissue swollen from
previous radiation (see references to head and neck cancer above), and with some deviation there due to the reconstructive surgery (perhaps … they feared it, anyway), this
became perhaps the second most painful experience I endured while inside. Both times :).

As I recall, the tube was about 12 inches long (it looked that long to me, I swear!) with a bend in it, so that it resembled a plumbing pipe in your home, and it was made of a really hard, diamond hard, plastic. I asked when they were going to invent a rubber version, but they had excuses for why that would never come to pass. The bottom line, though, is that I would not be getting the operation I was so looking forward to unless they managed to cram that tube down my throat. Fortunately (the first time) my anesthesiologist was another gentle soul with a degree of compassion. He was patient, for sure, and that helped as much as anything.

He used an anesthetic I am familiar with, from my trips to the ENT doctor for checkups, that they claim tastes like apple cider. He used it a lot and used it often. He didn’t, in other words, simply spray half a gallon of the junk down my throat and assume it would work. He was patient. He tried a little bit, tried inserting the tube; tried some more, tried the tube; and so on, until it went down. I was in tears, to be honest with you, before we were done. Gifted with a very fine gagging complex anyway, this was the kind of endeavor I was born to enjoy, let’s face it. The tears were, of course, a reflexive mechanism associated with gagging (sure, sure). I did stay with it, encouraged them to keep trying, and tried to say funny things between attempts. I am pretty sure I got funnier and funnier as I got number and number, until they could not understand me at all, after which point I was probably a veritable riot.

This anesthesiologist told my wife afterward that he had never before worked with a patient with a better attitude. Maybe he says that to all the girls, but I like to think he meant it. I can tell you that he dropped by my room just to chat for a short while, something those folks never do: once you are under, you are not apt to ever see your anesthesiologist again, are you? He also volunteered to handle my case the second time I needed to go under, but that, regrettably, did not happen.

Not bragging; just pointing out that once again humor, along with determination, made a positive impact.

He did eventually get it in, and we moved on.

You should know that throughout this process, a couple of nurses were holding my hands, as much to keep me from hitting somebody as to calm me, I imagine :). Later, I would be walking the halls and one of them would say hello, and I would say to my wife, “They expect me to know them, but they were all wearing masks at the time.” MUCH later, when I went into the OR for the second round and one of the nurses advised me she had been there the first time, I would reply, “I know, I remember your eyes.” Hey! You never know! 🙂

As far as I know, the operation went off with only a small hitch. When I was once again conscious, I was told that the biopsy had been successfully performed and that the small bit in my lung had proven to be malignant after all. No surprise there, really, although one can hope. It was of sufficient size that they were able to determine that it was squamous small cell cancer. This happens to be the same type of cancer that invaded my head and neck area a few years ago, meaning the cancer in my lung was metastisis from the earlier cancer (bummer). But not so fast! This same cancer happens to be one that finds its way into the lungs all by itself, as some of you know. It happened that the area surrounding the nodule was clear and lymph nodes were clean. So..a primary? (Hip! Hip! Hooray! And, again, amazing what we wish for when it comes to cancer, but I digress.)

They could not be sure, but they were obviously really leaning toward a primary, because they proceeded to remove the lowest lobe in my right lung, where the cancer had lived its gnarly little life. This was, of course, with my prior permission.

When they told me this, they advised, as they had before the operation as well, that I would not be able to run any marathons but that I would otherwise never notice the lobe missing. This is fine with me, since I have no ambition to run to or from anything, and certainly do not want to run for the fun of it.

The surgery was a success, I was happy, my wife was happy, my family was happy, my friends were happy, the medical staff was happy, and it was just a matter of waiting a few days before heading home. I even cut short my stay in the ICU from two days to one. Things were looking good. Things were looking great, and I was feeling great, a bit impatient to hit the road, but feeling great.

(I said ‘briefly’, didn’t I?)

Okay. So the night before they are going to take out the second of the two chest tubes (these consist of about a foot of hard plastic, with half of that foot inside of you, combined with a lengthy bit of rubber tube that ends in a box on the ground, used to collect fluid from your pleural area), the immediate precursor to going home, I start having the most unimaginable, indescribable pain, seemingly throughout my body. I am doubled over, in the bed, moaning and groaning and thrashing about (the latter which is hard to do while doubled over, but doable, eminently doable, as I proved). The nurses fear a pulmonary embolism and act accordingly. You willl need to talk to them or other experts regarding exactly what they did. All I know is that they turned the suction for my chest tube back on and then re-situated me on the bed so that I was – incredibly – more comfortable. It was as if they were mixing modern technology with ancient Oriental body placement art of some kind to make me right. That is my story and I am sticking to it. That is what it seemed like.

By the following morning, anything connected to my body had been removed with the exception of the chest tube. Subsequent lab work would confirm the existence of MSSA, a grand staff cocci infection and a very close cousin to the dreaded MRSA. At first, I was put on vancomicin, known for its effect on MRSA but also for its negative effects on the body. Later, this was changed to Cipro and nafercillin, when MSSA was confirmed. I was hurtin’ for certain, and it would be another 20 days before I escaped my confines. Bummer. But better than at least one of the alternatives.

On Valentine’s Day, I advised my wife that I had brought her to the most expensive hotel we’d ever stayed in (our room went for $2,600 per night, it turned out). The next day I was back in the OR, where they wanted to remove pockets of infection, if you will, from my lung via suction and what I refer to as spooning. My doctor estimated there were between 194 and 205 such pockets in there (why 194, I don’t know, unless he actually counted them, which would not surprise me, um, efficient chap that he is, and you did not hear anal OR obsessive/compulsive from me, okay?) and he wanted all of them. And so, using the same openings he created in round one, and adding at least one, we repeated round one, at least from my perspective.

A small difference was that the guy doing the epidural got it on the first try. A big difference was that the guy sticking the tube down my throat was a fan of the Marquis de Sade. He went with the ‘dose him once and dose him large’ method of numbing, which was a fairly poor experience in and of itself, and then tried to shove the tube down my throat. That didn’t work, try though he might. Ultimately, I was saved by my cardio doctor, who asked if he could try and then, magically, it seemed, simply touched it forward and it slid into place.

An even bigger difference was that they decided I needed not two chest tubes but three, so that another hole in my side/back was created, giving me a nice little set of those to go with the big smiley face they created beneath my armpit. Worst case, I figured, I could go into bars topless and tell the ladies I’d been in a fight with a great white shark. “You should see the other guy,” I would say, and that part, at least, would be true, hopefully, not about the shark, of course, but about the other ‘guy’.

Early on during the treatment for the infection they gave me insulin. I do not know why. I know that they became obsessed afterward with checking my blood sugar level with that little razor that isn’t supposed to hurt like the ones we got in the old days but does if they do it enough times, which they did to me. I ran out of fingers on several occasions, and they would not accept a thumb, so I went back to finger one and repeated the process on each hand. Multiple times. It got so this was the worst part of my day sometimes.

I received respiratory awareness training every four hours for the duration (that’s what I called it, anyway). This consisted of wearing a mask plugged into the wall with a device containing various chemicals designed to crack up all of the garbage inside of my lungs. Most of the time it was the same stuff you get in your prescription inhaler, but on one occasion consisting of three treatments over six hours, which I suspect was an error on someone’s part, I was dosed with what smelled and acted like mustard gas. This caused a severe negative reaction in yours truly including the inability to breathe at one point, which, in case you have not experienced it, is scarier than a little old lobectomy. They said I probably had a ‘mucous plug’ that clogged my trachea. Sure enough, I eventually brought forth a ‘plug’ that looked like it fell out of a Chinese pork dinner, it was so big (you aren’t eating, are you?). Those were the days, my friend.

The breathless episode happened to occur as I was leaving the facilities, if you know what I mean and I think you do, and so a couple of the nurses who were junior psychologists played with the idea that I had some sort of phobia about bathrooms, and it took a considerable number of minutes to dissuade them from that line of questioning. I should add that one of them payed me back somewhat for my usual sort of humor by commenting, once I was more or less back to normal, “Must have been really straining in there, huh?” If I were not married I might have married her on the spot. A sense of humor is an important thing. She made me laugh right then, when I was in a moment of despair, to be honest, a moment of fear, with no idea why I had lost my breath nor whether it was to be an integral part of my future life. She made me laugh. She gave me a dose of my own medicine and it felt good, made me feel better. And that breathlessness has not been experienced since. It may be a coincidence that the mustard gas was cut off then. It is not a coincidence that we asked the cleaning folks to stop putting the toilet paper in that confounded anti-theft box where I could only get one page per pull. Our theory is that bending over for so long to get those pages adversely impacted my breathing ability. Again, that is my story and I’m sticking to it.

Ultimately, a nurse practioner associated with my cardio doctor came in and took a look at the box connected to my last chest tube (my doctor played them like they were the pipes of an organ, moving them out slowly, one at a time, and then removing first one, then another, until there was just this last one, and each time he moved them he had to remove sutures and then reapply them to firm things up). I had a strong feeling it was packing day, that she was going to remove the last tube and tell me I would be leaving in the morning. I had a VERY strong feeling, one I did not want denied. And she said, you know, I think this tube should stay in one more day, and you are anemic and would probably crash if we sent you home now, and you really need to get that endoscopy so we can confirm or deny the existence of that tiny leak in your GI tract, but I promise you’ll be home by the end of the week. It was Monday.

She was the needle. I was the balloon. Talk about your deflation! I had been counting ceiling tiles for far too long. I had been dragging boxes and poles around like Igor for far too long. Too many finger pokes, too many blood pressure checks, too many applied masks, too many nurses, too many doctors, too little of home. I had been suffering the slings of outrageous fortune, to borrow from the Bard, for way too long. And my expectations were expanded to the heavens. Only to be popped by this pregnant lady who meant well. Kill! Kill! Kill!!! (If you have not listened to Arlo Guthrie’s Alice’s Restaurant, I recommend it highly. When the song gets to the part where the narrator is saying “Kill! Kill! Kill!”, you will get an idea of my mental state at this time.)

To be perfectly honest, my eyes may have misted up. Such were my hopes. It was not that I could not have lasted another day or another week, even another month, for that matter; rather, it was that I had built up expectations that I would not have to do so. And she had burst them in a matter of minutes, adding only the warden’s type of last minute hope for reprieve that the governor might call: “But I am not the doctor and he makes the call.”

Right.

As if.

It proved providential. The doctor came in some 20 minutes later and rebuilt my hopes, albeit they were now constructed of bailing wire and used tape. He took out the tube, agreed that I could do the endoscopy (for a suspected microscopic GI bleed), if needed, on an out-patient basis, and said that if I would agree to a second blood transfusion he would let me go home.

If I handled the lack of tubes overnight, and if a bedside xray didn’t reveal anything untoward, I could leave the next day! And the nurse practioner returned and promised I would be out by 11 AM Tuesday. She was true to her word, as it turned out.

And so I am here, at home, documenting this brief (????) version of my latest adventures in Cancerland. I have a portable IV, which consists of a small computer and a bag of anitbiotic in a ‘man bag’ as my wife calls it, which has a line running to the picc line in my right arm, running 24 hours a day, seven days a week, with the solution changed every two days and a nurse coming in on Mondays to change the picc line dressing and take blood from me. I can carry the man bag over my shoulder. I was concerned that I would trip over the contraption, certainly when I woke in the night, but that has almost not been the case at all (one time, and one time only, I forgot it, because I was absorbed with something I was reading).

I have a couple of toys to use for breathing exercises and they are small and accessible so that I can use them whenever I get a whim, and I do. I have an inhaler, which is not a problem. All is good. I expect to lose the man bag and the picc line on or before March 30. This will happen if everything goes as planned re the infection. My assumption now is that it is gone and that everything between now and the end of the month is precautionary.

I DO see OncoMan tomorrow, and he may decide that another precaution is to go on chemotherapy for some period of time. I am almost certain, in fact, that he will make this recommendation. And I see the GI doctors on Thursday. They are to advise re an endoscopy. My current assumption is that this will be a no-go, unless I am interested in the opportunity to get my esophagus dilated. That interests me, of course, so we will see.

I need to go back to my ENT after the first of the month, so that he can see what damage, if any, they did to my head and neck and esophageal areas, the latter in particular, in my opinion, as related to that second guy attempting to insert his tracheal tube in a rather violent manner (the first guy DID stick the tube into the esophagus by mistake and only by switching to a larger light confirmed this error :)).

I will see the infectious disease doctor near the end of the month and he more than anyone will decide the fate of the picc line and the IV bag. He is an old, odd fellow, but also a gentle soul and a highly respected doctor in these parts. That is my way of saying that I respect him and fear him at the same time :). Let’s hope I get him on a good day :). And let’s hope he doesn’t read this, more importantly :).

All is good. At least for today, for tonight.

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