Five weeks after the stroke, the neurosurgeon says it’s time to put Mom’s head back together. He tells us that he will re-attach her skull using 4 millimeter screws and some metal plates.
“Will you be using a power drill on my head?” Mom jokes to the neurosurgeon, her voice soft and raspy. “I’m not entering any beauty pageants anytime soon so it should be fine.”
She alternates between humor and bouts of deep sadness that escalate as she becomes more aware of her physical limitations. At first, she could not even open her eyes or speak, so we held her eyes open while she used markers and a dry erase board to communicate. But with occupational, speech, and physical therapy, she went from bedridden to walking with a four-footed hemi-cane in a matter of weeks.
After her first brain surgery, Mom began taking blood thinner medication, which helps prevent blood clots, but also increases the risk of bleeding. As a result, her blood thinner medication is reversed before her second brain surgery, restoring her blood’s natural ability to clot. As a pre-caution, a radiologist places a small umbrella-like device called an inferior vena cava (IVC) filter in her abdomen to catch blood clots until she heals from surgery and resumes her blood thinner medication.
“The filter is in her abdomen, in the major highway known as the vena cava,” the radiologist explains. “We come up through the femoral veins, the major veins in the legs, which make a fork in the road and bifurcate from the vena cava, the main vein that empties up to the heart.”
Leaving only a minuscule incision, the radiologist positions the filter via tiny cameras and small catheters, all so Mom won’t pass another clot while they are screwing her skull back on. Doctors can now thread tiny catheters and devices through veins and arteries, transforming open heart surgery into minimally invasive procedures like angiograms, angioplasty, and stent placement, yet cerebral edema can only be treated by cracking open Mom’s skull and cutting out part of her brain. Modern medicine contains surprising juxtapositions of old and new, invasive and non-invasive.
After the surgery, she is awake, but groggy. Iodine is lightly smeared on her right cheek, mixed with blood. She wears a turban of gauze. She says she can’t find her thinking brain.
“This brain says bad things,” she tells us.
“Like what?” I ask.
“That maybe it should be like ‘Million Dollar Baby.’”
I think for a moment and then explain the allusion to Dad. “It’s a movie about a boxer who asks her coach to euthanize her after she becomes paralyzed.”
We are quiet.
Despite tremendous physical healing, I can’t help but think that another type of healing—much more elusive, hard to treat, and slow to heal—has hardly begun. With physical rehabilitation has come a devastating awareness of her physical limitations. We have been well trained in the use of wheelchairs, hemi-canes, and leg braces, but we are unable to deal with our own grief. I fear random, unpredictable things, like the brain not having enough room to swell, or a clot smaller than the tip of a pencil causing a stroke. When it comes to mortality, we have a natural suspension of disbelief, and mine had been forever shattered.
As we try to chase her bad brain away, on the other side of the curtain dividing Mom’s room, an oncologist is telling Mom’s elderly roommate, the primary caregiver for her diabetic daughter with kidney failure, that she has terminal liver cancer.
Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts
Thursday, October 21, 2010
Tuesday, October 12, 2010
Five Years Later: Part 3
“Can you wiggle your toes?” a nurse asks. Mom moves the right side of her body on command, but there is no movement on her left side.
The nurses in the critical care unit check Mom’s neurological status every hour, shining a small flashlight in her pupils, pressing on her fingers and toes, and asking her to follow commands. But as the morning advances, Mom no longer responds.
At noon, when the nurse shines the flashlight in Mom’s eyes, she leaves immediately.
“We’re losing her, aren’t we?” Dad questions the nurse in the hallway.
“Her pupils are uneven. I’m calling the doctor.”
Within minutes, the neurologist arrives with a neurosurgeon. The neurosurgeon is tall, with a boyish face—big brown eyes and dark hair. He wears a knee-length white coat that has “Brain & Spine Institute” stitched on the left breast pocket.
“You have to decide,” the neurosurgeon says. “You don’t have time to call anyone. You’ve got to tell us now. If we don’t operate immediately, she’s going to be brain dead in a few hours.”
When the brain is injured, like any part of the body, it swells—a condition called cerebral edema. Injury to the brain results not only from the infarction itself, but also from the resulting cerebral edema, which peaks 2-5 days after the stroke. Because the brain has little room to swell, as cerebral edema increases, so does intercranial pressure (ICP). The optic nerve is located close to the brain stem, so pupillary changes can indicate that ICP is at a deadly level, compressing the brain stem, which controls all vital functions including heart rate, blood pressure, and breathing.
The doctors explain that Mom’s cerebral edema is causing the damaged right side of her brain to shift over and compress the healthy left side and the brain stem. The neurosurgeon wants to perform a craniotomy. He will remove a large portion of her skull and remove the infarcted brain, to make room for swelling and to relieve pressure. Her skull will be stored in a sterile bone bank until it can be reattached.
“We have to give her every chance,” Dad says, looking at me. “Don’t you think?”
I imagine the neurosurgeon drilling open her skull and cutting out her dead brain. I want to scream. With all of our medical advancements, it seems so invasive, even primitive, that life-threatening cerebral edema can only be treated by drilling open Mom’s skull and cutting out part of her brain.
I know what we need to do. I just hope it’s what she would do.
Dad signs the consent forms. They take her to surgery. In the waiting room, someone hands me a small plastic container containing Mom’s diamond earrings. Grandma tells me her friend has been dreaming that “Josie lost her jewelry.” We realize we don’t know where Mom’s wedding ring is. We panic. We wait. Trying to make sense of things. Someone tells me about a 26-year-old girl who stepped off a curb the wrong way and broke her ankle. Two weeks later she died of a pulmonary embolism—a blood clot in the lungs. I wish I had heard the story sooner.
The nurses in the critical care unit check Mom’s neurological status every hour, shining a small flashlight in her pupils, pressing on her fingers and toes, and asking her to follow commands. But as the morning advances, Mom no longer responds.
At noon, when the nurse shines the flashlight in Mom’s eyes, she leaves immediately.
“We’re losing her, aren’t we?” Dad questions the nurse in the hallway.
“Her pupils are uneven. I’m calling the doctor.”
Within minutes, the neurologist arrives with a neurosurgeon. The neurosurgeon is tall, with a boyish face—big brown eyes and dark hair. He wears a knee-length white coat that has “Brain & Spine Institute” stitched on the left breast pocket.
“You have to decide,” the neurosurgeon says. “You don’t have time to call anyone. You’ve got to tell us now. If we don’t operate immediately, she’s going to be brain dead in a few hours.”
When the brain is injured, like any part of the body, it swells—a condition called cerebral edema. Injury to the brain results not only from the infarction itself, but also from the resulting cerebral edema, which peaks 2-5 days after the stroke. Because the brain has little room to swell, as cerebral edema increases, so does intercranial pressure (ICP). The optic nerve is located close to the brain stem, so pupillary changes can indicate that ICP is at a deadly level, compressing the brain stem, which controls all vital functions including heart rate, blood pressure, and breathing.
The doctors explain that Mom’s cerebral edema is causing the damaged right side of her brain to shift over and compress the healthy left side and the brain stem. The neurosurgeon wants to perform a craniotomy. He will remove a large portion of her skull and remove the infarcted brain, to make room for swelling and to relieve pressure. Her skull will be stored in a sterile bone bank until it can be reattached.
“We have to give her every chance,” Dad says, looking at me. “Don’t you think?”
I imagine the neurosurgeon drilling open her skull and cutting out her dead brain. I want to scream. With all of our medical advancements, it seems so invasive, even primitive, that life-threatening cerebral edema can only be treated by drilling open Mom’s skull and cutting out part of her brain.
I know what we need to do. I just hope it’s what she would do.
Dad signs the consent forms. They take her to surgery. In the waiting room, someone hands me a small plastic container containing Mom’s diamond earrings. Grandma tells me her friend has been dreaming that “Josie lost her jewelry.” We realize we don’t know where Mom’s wedding ring is. We panic. We wait. Trying to make sense of things. Someone tells me about a 26-year-old girl who stepped off a curb the wrong way and broke her ankle. Two weeks later she died of a pulmonary embolism—a blood clot in the lungs. I wish I had heard the story sooner.
Tuesday, May 4, 2010
Happy Mother's Day
I entered the following into a Mother's Day Contest at a local TV station...guidelines were to submit a 250 word essay on why your mom is the best...
“Do you know what the secret to life is?” my mom asked, squeezing my hand and towering above me as a large, strange dog rapidly approached. “Don’t ever let them know you’re afraid.”
Even in one of my earliest memories, my mother spoke courageously, giving me this secret weapon that I would always carry with me. My mother acted courageously even through the greatest challenge of her life. In November of 2005, just a few months after she turned 60, my mom suffered a massive stroke, enduring several brain surgeries, four months in the hospital, and extensive rehabilitation.
Learning to swallow, walk, talk, and live with the use of one arm were only a few of her challenges. This strong, independent woman, who was the first of five children in her family to earn a college degree, had to let my dad, two sisters, and I learn to take care of her, and much earlier in life than she ever expected. We all learned to reinvent ourselves, taking on new roles, especially my mom, and she did so with grace, courage, and strength.
My parents just celebrated their 40th wedding anniversary. They enjoy traveling, gardening, reading, and catching up with friends and family—especially their eight-year-old grandson. Their commitment to each other and to their family is my cornerstone.
My mom is the best because her life is a model of what it really means to be courageous. Because of her I know that I can do anything.
“Do you know what the secret to life is?” my mom asked, squeezing my hand and towering above me as a large, strange dog rapidly approached. “Don’t ever let them know you’re afraid.”
Even in one of my earliest memories, my mother spoke courageously, giving me this secret weapon that I would always carry with me. My mother acted courageously even through the greatest challenge of her life. In November of 2005, just a few months after she turned 60, my mom suffered a massive stroke, enduring several brain surgeries, four months in the hospital, and extensive rehabilitation.
Learning to swallow, walk, talk, and live with the use of one arm were only a few of her challenges. This strong, independent woman, who was the first of five children in her family to earn a college degree, had to let my dad, two sisters, and I learn to take care of her, and much earlier in life than she ever expected. We all learned to reinvent ourselves, taking on new roles, especially my mom, and she did so with grace, courage, and strength.
My parents just celebrated their 40th wedding anniversary. They enjoy traveling, gardening, reading, and catching up with friends and family—especially their eight-year-old grandson. Their commitment to each other and to their family is my cornerstone.
My mom is the best because her life is a model of what it really means to be courageous. Because of her I know that I can do anything.
Tuesday, June 2, 2009
Subcutaneous Mass Right Leg
There is a bump in my leg. About two inches above the knee on the outside of my right leg. It’s small but hard, about the size of the tip of my index finger, with well-defined, sharp edges, like the corner of a plastic box, or the pointy tip of a plastic pen cover. Around this same time, I also notice that a portion of my right leg, just above the knee, has decreased sensation. Like when your foot falls asleep—numb, minus the tingly feeling. Just numb.
The bump in my leg feels like a bee sting. Sometimes, I wake up at night and that little thing is burning, stinging, and throbbing. It’s a sharp pain, snatching me out of my dreams. I put my finger on it, and the object is pulsating, right on the surface of my skin, like it’s trying to tunnel its way out. Other times, it’s small and hard to locate, dwelling dormant somewhere deeper in the confines of my leg, resting perhaps.
I try to ignore it. I obsess that it’s a blood clot. My mom had a blood clot in her leg after she broke her foot, and two weeks later she had a stroke. A DVT – DEEP VEIN THROMBISIS – they called this blood clot. I don’t want to know what it is, this little bump in my leg. This little stinging bump in my leg has awakened my dormant fears, sending my mortality back to the forefront, with stinging reality. I am not getting any younger, and all things are unstable. I nurse my tender edges with things that help me forget.
But a year later, the little stinging thing is still there, and stinging a little more often…I try to keep track, but there is no pattern. Random stinging. While I’m walking. When I’m standing still. When I’m sitting in a chair. When I’m sleeping. Randomly, that little object starts stinging. Always, it is sharp enough to draw my complete attention.
Finally, I have to go see my primary physician anyway, so I tell her about the stinging bump.
“Yes, I feel it,” she says, poking at the stinging bump. “It could be a sebaceous cyst or something like that.”
She says she doesn’t have to tools to remove it, so she sends me to a surgeon.
At the surgeon’s office, I wait anxiously, anticipating the removal of my stinging bump. I fill out a health history, essentially the same form that I just updated at the office of my primary care physician. I anticipate the quick removal of my stinging bump. I wait in the lobby. I wait longer in the examination room. I keep my finger on that stinging bump, scared that I will not be able to locate it when I need to. That he won’t be able to feel it.
“It’s a lipoma,” he tells me. “Usually a type of benign fatty tumor. I don’t think I have the proper instruments here in my office,” he tells me. “I think I’ll have you come to the surgical hospital.”
I tell him about the numbness.
“That’s not related,” he says, matter-of-factly. “That’s a nerve issue. Have you hurt your back recently?”
“No,” I reply.
I am disappointed. My stinging bump has already turned into a much bigger deal than I imagined. And the surgeon has already moved the conversation on to my occupation and marital status, and within moments, his nurse has booked me an appointment for next week at the surgical hospital.
Two days prior to the procedure, a nurse calls me at home to go through yet another health history…another version of the same information that I’ve already completed for my primary care physician, again at the surgeon’s office, and now once again on the phone (why can’t these medical people have some sort of integrated database???)
I am told to arrive almost two hours prior to my actual appointment time. The surgical hospital seems more like a hotel than a hospital. A place you’d like to return to, not a place to be afraid of. A brand new building, the lobby decked out with a large flat screen TV, wireless internet, a computer station, coffee and complimentary beverages...complimentary meal vouchers for family members. I am directed to a private registration area to check in, where I sign numerous forms and receive a wristband on my right arm, and then return to the lobby.
Soon I’m called out of the lobby by a nurse who immediately introduces herself and shakes my hand. I’m shocked by this, as it is in direct opposition to most of the health care professionals I encountered during the four months my mom spent in a hospital after having a stroke, professionals who rarely introduced themselves or explained medical concepts in a way that an average person can understand.
The nurse takes me back to a staging area where she asks me what my name is, date of birth, and what I’m there for. She is the first of various nurses who, before that surgeon takes any instrument to my leg, asks me a series of questions to validate who I am and what I’m there for. She asks me if the doctor explained to me, in a way I could understand, about the procedure he was going to perform that day. She goes through some information with me on my chart, at the top of which says, “Subcutaneous mass right leg.”
After I change into a disposable gown, and put on a hat and booties, the nurse escorts me to a bed with a curtained off area and my own private flat screen TV. A new nurse now takes over, saying she will be with me throughout the surgery and recovery time, asking me several times if there’s anything I need, or if I have any questions. She explains that they will be using local anesthetic, which will be painful, but after that I will feel only some pulling or tugging in the area of the lipoma.
Finally the surgeon arrives. “That bump didn’t go away, did it?” he jokes, as he takes a black marker to the spot on my right leg where the lipoma resides. And quickly he is gone, the nurses then wheeling my bed from the staging area and into the operating room. On the way, we pass through a bustling nurse’s station and the recovery area.
In the operating room, there are now three nurses, each who has a different job. They wheel my bed up next to a narrow, elevated bed and ask me to move over. Again I’m asked who I am, my birth date, why I’m here. They put sheets over me and above me and arrange lights and do all sorts of things in preparation for the procedure.
But no matter how busy these nurses are, they never lose that personal touch. It is the job of one of these three nurses, to remain next to my head, and within my sight, at all times during the procedure. “Don’t worry,” she tells me. “Nothing will begin until you’re told, so you don’t have to worry about anything happening suddenly.”
Soon the surgeon is there, greeting me by my first name, although I cannot see him, due to the sheet that is elevated above my face.
“You’re about to feel a couple bee stings here,” he warns me.
“Ok,” the nurse next to my head says. “Now is when you get to abuse my hand,” she said, squeezing my hand hard.
And suddenly the stinging begins, in the side of my leg, moving deep and down, and I cry out, and squeeze hard...my heart beating hard and fast, like a rocket coming through my chest…my breathing heavy…my cheeks flushing red and hot.
“Can you feel that?” the surgeon asks.
“I don’t think so.” I feel some tugging, like the nurse predicted, but no pain.
“Ok, it’s out,” I hear the surgeon say, only moments later.
And it seems then, that it takes longer to patch it up than it did to remove it, as the surgeon asks me what kind of music I like and jokes with us about the musical preferences of his wife’s ex-boyfriend.
“Would you like to see it?” he asks me.
“Yes,” I reply.
It’s a small, white mass, floating in a container of clear fluid. A tiny little white thing, about the size of the tip of my index finger. Like those chunks of fake fat they show you in health class when you’re in high school.
“I don’t think it’s cancerous or anything, but I’ll send it in to the lab,” he tells me.
Moments later, they are telling me I did well, and wheeling me in to the recovery area, where yet another nurse offers me complimentary beverages and a complimentary meal from their on-site bistro restaurant. I’m already perusing the menu when the surgeon comes in to check on me, assuring me that the food here is excellent, and then he is gone…
It’s hard to believe something so small could create such a ruckus…but what a state of the art bunch of professionals they were. I’d like to go back to that hotel—I mean hospital—any time. My complimentary mandarin chicken salad was exquisite.
I can’t wait to see the bill…
The bump in my leg feels like a bee sting. Sometimes, I wake up at night and that little thing is burning, stinging, and throbbing. It’s a sharp pain, snatching me out of my dreams. I put my finger on it, and the object is pulsating, right on the surface of my skin, like it’s trying to tunnel its way out. Other times, it’s small and hard to locate, dwelling dormant somewhere deeper in the confines of my leg, resting perhaps.
I try to ignore it. I obsess that it’s a blood clot. My mom had a blood clot in her leg after she broke her foot, and two weeks later she had a stroke. A DVT – DEEP VEIN THROMBISIS – they called this blood clot. I don’t want to know what it is, this little bump in my leg. This little stinging bump in my leg has awakened my dormant fears, sending my mortality back to the forefront, with stinging reality. I am not getting any younger, and all things are unstable. I nurse my tender edges with things that help me forget.
But a year later, the little stinging thing is still there, and stinging a little more often…I try to keep track, but there is no pattern. Random stinging. While I’m walking. When I’m standing still. When I’m sitting in a chair. When I’m sleeping. Randomly, that little object starts stinging. Always, it is sharp enough to draw my complete attention.
Finally, I have to go see my primary physician anyway, so I tell her about the stinging bump.
“Yes, I feel it,” she says, poking at the stinging bump. “It could be a sebaceous cyst or something like that.”
She says she doesn’t have to tools to remove it, so she sends me to a surgeon.
At the surgeon’s office, I wait anxiously, anticipating the removal of my stinging bump. I fill out a health history, essentially the same form that I just updated at the office of my primary care physician. I anticipate the quick removal of my stinging bump. I wait in the lobby. I wait longer in the examination room. I keep my finger on that stinging bump, scared that I will not be able to locate it when I need to. That he won’t be able to feel it.
“It’s a lipoma,” he tells me. “Usually a type of benign fatty tumor. I don’t think I have the proper instruments here in my office,” he tells me. “I think I’ll have you come to the surgical hospital.”
I tell him about the numbness.
“That’s not related,” he says, matter-of-factly. “That’s a nerve issue. Have you hurt your back recently?”
“No,” I reply.
I am disappointed. My stinging bump has already turned into a much bigger deal than I imagined. And the surgeon has already moved the conversation on to my occupation and marital status, and within moments, his nurse has booked me an appointment for next week at the surgical hospital.
Two days prior to the procedure, a nurse calls me at home to go through yet another health history…another version of the same information that I’ve already completed for my primary care physician, again at the surgeon’s office, and now once again on the phone (why can’t these medical people have some sort of integrated database???)
I am told to arrive almost two hours prior to my actual appointment time. The surgical hospital seems more like a hotel than a hospital. A place you’d like to return to, not a place to be afraid of. A brand new building, the lobby decked out with a large flat screen TV, wireless internet, a computer station, coffee and complimentary beverages...complimentary meal vouchers for family members. I am directed to a private registration area to check in, where I sign numerous forms and receive a wristband on my right arm, and then return to the lobby.
Soon I’m called out of the lobby by a nurse who immediately introduces herself and shakes my hand. I’m shocked by this, as it is in direct opposition to most of the health care professionals I encountered during the four months my mom spent in a hospital after having a stroke, professionals who rarely introduced themselves or explained medical concepts in a way that an average person can understand.
The nurse takes me back to a staging area where she asks me what my name is, date of birth, and what I’m there for. She is the first of various nurses who, before that surgeon takes any instrument to my leg, asks me a series of questions to validate who I am and what I’m there for. She asks me if the doctor explained to me, in a way I could understand, about the procedure he was going to perform that day. She goes through some information with me on my chart, at the top of which says, “Subcutaneous mass right leg.”
After I change into a disposable gown, and put on a hat and booties, the nurse escorts me to a bed with a curtained off area and my own private flat screen TV. A new nurse now takes over, saying she will be with me throughout the surgery and recovery time, asking me several times if there’s anything I need, or if I have any questions. She explains that they will be using local anesthetic, which will be painful, but after that I will feel only some pulling or tugging in the area of the lipoma.
Finally the surgeon arrives. “That bump didn’t go away, did it?” he jokes, as he takes a black marker to the spot on my right leg where the lipoma resides. And quickly he is gone, the nurses then wheeling my bed from the staging area and into the operating room. On the way, we pass through a bustling nurse’s station and the recovery area.
In the operating room, there are now three nurses, each who has a different job. They wheel my bed up next to a narrow, elevated bed and ask me to move over. Again I’m asked who I am, my birth date, why I’m here. They put sheets over me and above me and arrange lights and do all sorts of things in preparation for the procedure.
But no matter how busy these nurses are, they never lose that personal touch. It is the job of one of these three nurses, to remain next to my head, and within my sight, at all times during the procedure. “Don’t worry,” she tells me. “Nothing will begin until you’re told, so you don’t have to worry about anything happening suddenly.”
Soon the surgeon is there, greeting me by my first name, although I cannot see him, due to the sheet that is elevated above my face.
“You’re about to feel a couple bee stings here,” he warns me.
“Ok,” the nurse next to my head says. “Now is when you get to abuse my hand,” she said, squeezing my hand hard.
And suddenly the stinging begins, in the side of my leg, moving deep and down, and I cry out, and squeeze hard...my heart beating hard and fast, like a rocket coming through my chest…my breathing heavy…my cheeks flushing red and hot.
“Can you feel that?” the surgeon asks.
“I don’t think so.” I feel some tugging, like the nurse predicted, but no pain.
“Ok, it’s out,” I hear the surgeon say, only moments later.
And it seems then, that it takes longer to patch it up than it did to remove it, as the surgeon asks me what kind of music I like and jokes with us about the musical preferences of his wife’s ex-boyfriend.
“Would you like to see it?” he asks me.
“Yes,” I reply.
It’s a small, white mass, floating in a container of clear fluid. A tiny little white thing, about the size of the tip of my index finger. Like those chunks of fake fat they show you in health class when you’re in high school.
“I don’t think it’s cancerous or anything, but I’ll send it in to the lab,” he tells me.
Moments later, they are telling me I did well, and wheeling me in to the recovery area, where yet another nurse offers me complimentary beverages and a complimentary meal from their on-site bistro restaurant. I’m already perusing the menu when the surgeon comes in to check on me, assuring me that the food here is excellent, and then he is gone…
It’s hard to believe something so small could create such a ruckus…but what a state of the art bunch of professionals they were. I’d like to go back to that hotel—I mean hospital—any time. My complimentary mandarin chicken salad was exquisite.
I can’t wait to see the bill…
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