AFTER SERIOUS SURGERY

There is some e mail that I don’t get to open right away. Offers to redeem my Marriott Rewards points at exotic new resorts, to lower the rate on my mortgage…the ones about cheap Viagra from Canada I don’t open at all. Regrettably, if things get really busy, as they were on Friday, I don’t even get to read e mail that I want to open. Like my poetry email, for example. At least two of the major publishing houses, and many of the internet resources for poets published frequent, if not daily newsletters and/or started sending daily “Poem a Day” e mails in celebration of the 10th Annual National Poetry Month this April. I’ve been getting so much poetry e mail, I set up a separate screen name on AOL just to accommodate it all. And, with April, which was busy enough, coming to an end, I was keeping pretty up to date with it…even uploading some of the Podcasts to my daughter’s iPod for later reference and entertainment.

Until Friday. After two relatively straightforward anorectal cases, my boss and I hunkered down for a long, difficult case. A young (51 year old) man with a very low rectal cancer, now six weeks following preoperative chemo/radiation therapy needed surgical resection. The operation involved removing over a foot of his colon and rectum, mobilizing (freeing up) his splenic flexure, connecting (anastomosing) his colon to his anus, and forming a temporary ileostomy. Seven hours and a couple of pee-breaks later, the tour de force was complete. My back was killing me, my associate’s hand was cramping, and the fifth anesthesiologist of the case was asking us whether we prefer our massages before or after a huge case like this. We both just looked at him. I saw this patient today on rounds, he looks great, just extubated early this morning, all the puffiness from the massive fluids used during the surgery to keep him hydrated starting to resolve. I told him, “Don’t worry, I got the number of the truck that hit you.” He grabbed his sides as he started to laugh, ouch.

Only last night I opened an e mail from the Knopf Poetry Center, dated 4/28/06. It was part of their “Poem A Day,” program and it contained this poem, by June Jordan:


FIRST POEM AFTER SERIOUS SURGERY

The breath continues but the breathing
hurts
Is this the way death wins its way
against all longing
and redemptive thrust from grief?
Head falls
Hands crawl
and pain becomes the only keeper
of my time

I am not held
I do not hold
And touch degenerates into new
agony

I feel
the healing of cut muscle/
broken nerves
as I return to hot and cold
sensations
of a body tortured by the flight
of feeling/normal
registrations of repulsion
or delight

On this meridian of failure or recovery
I move
or stop respectful
of each day
but silent now
and slow


My question is, after serious surgery is this how the patient feels, or the surgeon?

For a download of this poem, and a Podcast of Toni Morrison reading it, click here.

PRE-SURGICAL TESTING and THE MODERN LIFE OF THE SOUL

Thank you to all those who have come to visit me at The Wounded Surgeon. I am overwhelmed by the response…and you know who you are. In the past week I’ve visited with an angel on ice skates, an orthodox Jew, a nurse whose husband is being treated for squamous cell carcinoma of the tongue. Neighbors and cousins, a classy lady who sells wine, a writer, a priest, and the surgeons…oh the surgeons, one, an inventor, another who offered me food (“It’s a Jewish tradition, in times of need we throw food at people,”) another who’s entertained me with pictures and stories of Holy Week in Peru, one I’ve lived with, and one who I’ll love forever.

Great news from Memorial Sloan Kettering Cancer Center. They just completed a gazillion dollar renovation of their operating suite, and apparently it’s just that – sweet. Twenty-something OR’s fitted with state of the art technology for minimally-invasive surgery, beautiful family waiting areas, and (all my pals in the OR will salivate like me) over 300 lockers in the staff locker rooms. And they do their first case in the new suites on Monday.

All this from the ebullient nurse practitioner who took my history and did a physical at MSKCC on Wednesday at my Pre-Surgical Testing appointment. Kudos again to everyone at Sloan, who made me feel wonderful and special and whole, even as they were taking my blood, doing and EKG, or shooting a chest xray. The NP actually knew my history before she took my history…soup to nuts, she even told me what my hemoglobin was the morning I had to return to the OR for bleeding! When I mentioned my surprise at her strangely complete fund of knowledge, she explained that she always reviewed records completely before interviewing a patient. She thought at first it would cut down on the amount of crying at these interviews, but now has accepted that people will cry no matter who told the story. She had joked with the patient before me that it was actually her job to get people to cry while she wrote their H & P. She cried anyway. I assured her in my most authoritative surgeon’s voice that she was NOT going to make me cry. No way. Instead we dished about how kind Dr. Abu-Rustum was with his patients and how penetratingly blue Dr. Weiser’s eyes are.

My sister and I made a day of my trip to the city, visiting the Edvard Munch exhibit, The Modern Life of the Soul at the Museum of Modern Art. His work is haunting, deep, and sad. The figures in his work wander through a vibrant, boldly-colored landscape featuring orange skies, moonlit waters, or monstrous green shrubs. Their clothes are somber and dark. Their faces (the ones lucky enough to have faces) stare zombie-like, expressionless, except for the rare expression of sheer terror (The Scream, 1893) or angst (Jealousy, 1895). My sister thought she saw a smiley face hidden in the shadows of a rock, and insisted that it was intentionally the only smiling face in all of Munch’s work. I told her she was nuts and we’d better leave or I’d be late for my appointment. As we left, we had a plebian discussion over whether the word modern means contemporary or only work from the early 20th century, and what happens when modern art becomes centuries old? Can artists get kicked out of the MoMA for being too old fashioned or traditional?

During the train ride home I wondered how Munch would have painted today’s modern soul. Two guys in Rangers jerseys got in. Sad and dejected – check. More people in dark suits boarded – check, check. Not a smiley face in the bunch. Perhaps today we are just as zombie-like and faceless, still dealing with Munch’s century-old principal themes of (lost or frustrated) love, anxiety, and death, just now with iPods at our hips and cell phones to our ears.

My family picked me up at the Stony Brook train station. My son couldn’t wait to tell me about his baseball game. Before I tucked him in, he read me a bedtime story about a little house in the country that watches the country turn into the city around her, until she is finally rescued by the great-great granddaughter of her original builder and brought back out into the country on a flat-bed trailer. I kissed him goodnight. I tried to apologize for missing his game. I wanted to tell him how proud I am that he can read as well as he can pitch. I secretly thanked him for rescuing me, and bringing me back out to the country where I belong. He was already asleep.

I got into bed, and finally let myself cry.

WHERE I HAVE TO GO

Occasionally there are moments of clarity and purpose. Moments when I realize that I am exactly who and where I need to be. Prior to one such moment today a patient unraveled before me saying that she would gladly take my cancer as her own. At first I took this as a deep gesture of devotion from a doting patient. I felt like Sally Field at the Academy Awards, “You love me…You really love me!!!” Then came the moment. My patient’s red eyes welled with tears, and she rolled into a litany of her woes. A widow in her forties, she was now fifty-six. Her second husband is in his eighties and frail, but has been a good companion. She is in chronic pain, which none of her doctors can seem to cure. She is restless and tired, hoards Ambien like treasure, and takes pain medicine like candy. She is unhappy, desperately unhappy, and she is addicted to drugs. She does not love me, although I have no doubt she would like me to have a full and happy life, she does not love me. She wants to die.

In revealing all this, I can tell she feels better already. She describes her young granddaughter, for whom she would like to scrape through a few more years, just to watch her grow. We joke about the new bar-coded, state issued prescriptions mandated just this month that will eventually, hopefully, mean the demise of her secret stashes. I make her promise to see her gynecologist who she hasn’t visited since her hysterectomy, to make sure that she doesn’t have what I have. She feels better as she leaves, and promises also to badger my office staff during my upcoming medical leave, for progress reports.

My patients don’t love me. They can’t. But they need me. And I need them. My work, my patients… it is where I have to go.


Read The Waking, by Theodore Roethke.

AT ANY MOMENT A GREAT MOMENT

A nice, easy day, actually home in time to catch the Yankees home opener. And what a game! The Yanks took an early lead, then lost the lead, then fell behind, walked seven gazillion times then won it on a bottom of the eighth three run homer by Derek Jeter (sigh). The offense was strong, and Jeter, Bernie, and Mo had great games, Damon got a warm reception, a couple of hits and RBIs in his new home, Sheff hit a homer after almost taking off Larry Bowa’s head with a foul down the third base line. Very fun to watch. Unseasonably warm early spring afternoon. Feeling stronger, and resting well. And, as Michael Kaye paraphrased, “The great thing about watching Yankees baseball…at any moment, a great moment.” Happy spring.

CHANGE THE WORLD

Back in the OR today. The same OR where less than three weeks ago angels were tending to me and a young, confident gynecologist was facing a known but terrible consequence of trying to do the right thing. I wrapped some presents for the scrub angels, the circulating angels, the ER angel, and my anesthesiologist. I brought in three dozen Dunkin Donuts for the rest of the staff and shivered a little as I walked between the PACU and OR#2.

If I could change the world,
I would be the sunlight in your universe.
You would think my love is really something good.
Baby, if I could change the world.

I entered OR 4 where my partner was operating. Eric Clapton was crooning off someone’s iPod near anesthesia. I went out to the sinks to scrub, came back in, suited up, then stepped up to the table and called for a clamp, another one, then a retractor. Now Clapton was singing “Tears In Heaven.” Can a place feel new yet familiar, a motion be automatic and perfect?

I must be strong, and carry on,
‘Cause I know I don’t belong
Here in Heaven.

I once said out loud but to no one in particular that I would follow Eric Clapton anywhere. Little did I know that today I would follow his voice home.

POST OP VISIT

Did a few colonoscopies this morning. Feeling a little stronger each day. And it felt nice to see some of my hospital friends…nurses, techs. They all wanted me to know how worried they were while I was out, and how good it was to see me again. No patients to see in the hospital, so I went home and took a nap until it was time to head to the office.

After work I had an appointment with my GYN. She seemed warmer now, more relaxed. I told her about my second opinion visit at Memorial and how I was planning to have the surgery with them. She didn’t seem too offended, and said she understood that it was worth a try to go someplace where they would at least try to do it laparoscopically. She warned that I should try to get an early time, and explained to my husband how important it was to have a big operation like that early in the morning when the surgeon and staff are rested and fresh.

I asked her if she would still be my gynecologist afterwards. She said of course, although there wouldn’t be all that much to do until my ovaries are ready to check out. My husband asked the burning question, “Can we have sex?” and after he got over the embarrassment of making sure my doctor didn’t think he was including her in the equation he got the thumbs down sign. “ I don’t think she’s ready yet,” she said. “I still see a little bleeding.”

She gave me a hug and wished me luck. She revealed that she was going to be away the weekend of my surgery. At an all-inclusive singles club in Turks and Caincos, or somewhere warm. My husband thought of setting her up with my brother, the only other person he knew with the confidence to go on vacation alone.

We took the kids out to dinner—Chinese food. I stopped to pick up some thank you gifts for the nurses at the hospital on the way home.

OPENING DAY

Back to work today. Not easy. Tiring easily, and not concentrating so well, but good to be in circulation, talking to patients, joking with my staff, discussing cases with my colleagues.

The Yankees start their new season tonight. Another thing to add to my ever growing list of things to thank God for…baseball season.

GREEN EGGS AND SPAM

In the chill of an early spring Saturday morning, my son and I snuck out of the house to find a store that would sell us eggs and food coloring. It was April Fool’s Day, and rather than replace eggs with plastic ones with funny sayings on them (my daughter’s idea), G and I had a more colorful idea. We would emulate the great Dr. Seuss and make Green Eggs and Ham, or spam as the cupboard would allow.

By the time we got home, my daughter, C, was awake. She, an eight-year-old aspiring chef wanted in on it…any excuse to make Daddy breakfast, and to scramble eggs. She got out the whisk and the bowl and showed her brother G how to break an egg with one hand. He was too busy with the colors, and thought a pink pile of eggs would go nicely with the green ones. I manned the frying pan, cooking up their colorful scrambles, while C made some toast, and G softened a stick of butter in a ramekin, coloring it to match the eggs.

So this is what I’m missing on Saturday mornings when I commute to our satellite office in Nassau County. Perhaps it is time to reclaim some of my Saturday mornings to spend with my family. The kids went to wake up their Dad. I made a pot of coffee. Daddy smiled at his family’s efforts, complained that the eggs were just a little salty for his taste, then gasped as he poured sky blue Half and Half into his coffee. The children’s laughter was like music.