SIGNS AND SYMPTOMS

Saw Dr. Abu-Rustum at my first post-op visit yesterday. I made the appointment at their satellite facility in Commack. It had a similar setup as the Manhattan Outpatient Center, large, comfortable waiting areas, with wings of exam rooms and treatment areas. I understand they do surgical consultations and follow up appointments, as well as chemotherapy and radiation treatments at that facility. Sitting in their spacious waiting area, I grew once again very grateful for the relatively early stage during which my cancer was found as well as the rather straightforward nature of its treatment.

Dr. A smiled when he saw me, and apologized for the delay. It was over an hour since my scheduled appointment time before I got in to see him. His face grew more and more concerned as I told him of the fever of last week, the symptoms I had, many of which, chills, sweats, pelvic pressure, were now gone. He nodded at the bloody drainage that I am still experiencing, and mentioned that the pulling sensation at my wound when I urinate was very common, described most often by women having hysterectomies in the face of endometriosis where the ovaries are preserved. In a panic I asked, “Is this going to happen every month?” He assured me no, that once the post operative inflammatory response of the endometriosis calms down, when everything heals, I should not be having these symptoms again.

I confessed to him that I had tried to go back to work last weekend, but that my associate was uncomfortable with such a short recovery period. He laughed and said, “Good, I like that guy…I like his thinking…smart guy.” He was not as entertained one bit by my experience with his own office, and found it particularly vexing that he had not gotten the message that I had called with concerns. It was evident that he was not keeping up with my blog! He grew anxious to examine me.

I will spare you the details of the examination. Suffice it to say that he remains concerned about the fever, the drainage, and the healing of the vaginal cuff (the upper part of the vagina which was sewn closed after amputating the uterus). He believes that there was a collection of blood, lymph, and fluid building up inside (fevers, sweats, pressure), that has now “broken through” to decompress via the vagina (bloody drainage). He now has me on two antibiotics, three times a day, and an antifungal chaser to take on day 10 to guard against any yeast infection.

He limited my activity to walking and going up and down stairs, but no lifting, no situps, no swimming or riding a bike, stay off my feet when possible. Absolutely no sex, no douching, no tampons, nothing per vagina…really, it is very fragile, it will rupture, he warned. (Yeah, as if…!)

No, I can’t go back to work just yet, he said, because I know what you’ll do…and I don’t want you standing hunched over an OR table for 3-4 hours, or spending a morning doing 3 or 4 or 5 or 7 colonoscopies, not yet, you’re still healing. Finish these antibiotics and if everything gets better, you can go back to work. He scribbled a sentence on his prescription pad… “Dr. B—may return to full work on June 5, 2006.” Is that OK with you? I didn’t answer.

He tried to cheer me up. “Well, it’s OK with me, in fact longer than that would be OK with me, but any less than that…not OK. And if your fever comes back, I need to know.” I smiled a smile reserved for such occasions. “I’m not kidding, “ he scolded. “Please don’t go through the regular channels to try to reach me. You call the page operator at Memorial and tell them ‘This is Dr. B—and I need to speak with Dr. Abu-Rustum.’” I kept smiling, maybe even a little nervous laugh. “Seriously, M, you are my colleague. You are a surgeon. And if you think something is wrong, I need to know.”

I stopped smiling. Now I was getting upset. He sensed this. “Listen, M, you’re going to be all right. You're not septic, OK? Just a localized infection, draining, which is good. This will get better. You just have to be patient, give it some time. You are still healing. I can still see the (absorbable) stitches we used. You have to let things heal.”

I thanked him, waited for his nurse to fill out my disability forms, then went to my office to break the news to my office manager.