Chapter 5

Getting ready for surgery

In preparation for my surgery, I asked to speak to someone about the many questions running through my mind.  I do not recall who I spoke with or when I had the discussion, but I found out in the interim that Keith and Melissa were not present (remember this when you read the next chapter).

I was most concerned about two issues;

(Q) Was I going to be conscious after surgery?  (A) Yes. I needed to be awake in order for them to monitor me neurologically.

(Q) What could I expect post-surgery?  (A) They were clear - pain. So I asked for a guideline on how bad and for how long.  Basically, I wanted to be given a "finish line" I needed to cross.  I was told that the first 24 to 30 hours would be the worst and things would get a lot better after that.  So in my mind, I just needed to make it to Sunday.  That was my goal.

By Friday morning, the pressure in my head is so intense; I float in and out of reality.  My recall is scant and poor from here until approximately Saturday afternoon.  I am so out of it; I do not even comprehend what is happening.  Frankly, in retrospect, this was a good thing because I believe the events of the day would have freaked me out. 

Here is how the day played out on Friday;

6 AM:  The physician's assistant (PA) for neurosurgery comes to shave my hair and place markers for where they will position the frame to hold my head still during the craniotomy. Keith and Melissa chose to stay while the PA shaves my hair so they could hold my hand and provide support just in case I need it as she worked .  The PA did a terrific job preparing them by explaining ahead of time exactly what she would be doing.  I am sure it helped to minimize their anxiety.

The PA explained that she needed to shave small areas of my head to accommodate each marker (imagine a disk the size of a Fruit Loop). Due to the length of my hair, it would appear that she was shaving more than she actually was. In fact, most of the shaved spots would be hidden by all of my remaining hair.  The only exception would be the area in the front where the incision would be made to remove part of my skull to access the tumor.

9-10AM: Transport comes to take me down for another MRI.  This one is to check the alignment of the markers in relation to the cyst and tumor and to verify everything is in order for the craniotomy.

12:15-3:30PM: I am taken down to pre-op, one hour before my scheduled surgery time.  I feel extremely nauseous. I ask for a basin because I am positive I am going to vomit.  I am reminded that I have had nothing to eat or drink since dinner on Thursday evening (not even an ice chip), so it is unlikely I will do anything other than have the dry heaves.  When I insist (come on, humor me here), I am given a basin (thankfully) because up comes any remaining body fluids.  This actually makes me feel better but it stresses Keith and Melissa out since it they know it demonstrates how much pressure my brain is under.

My IV was really bothering me.  It had been placed on the inside of my right arm right in the bend at the elbow.  I had rolled onto my right side on Thursday night and had been sleeping on my arm with my elbow bent causing the IV to be jammed in.  The area is badly bruised and the IV is no longer laying well despite a mountain of tape (that is further irritating my skin).

The pre-op nurse offers to “fix” it.  When she is unable to improve the situation, she decides to remove the IV and start a new one in a better location.  Unfortunately, I am now so dehydrated that every IV they try to insert to administer my anesthesia fails because my veins are collapsing.  After two different nurses in pre-op make three failed attempts each into my lower right and left arms, a nurse from the ICU is called to try for a seventh time.  He determines that none of the veins in my arms will work any longer and decides to use the top of my hand.  Finally - success. 

Because I have had several bad experiences with anesthesia (it has made me violently ill in the past), I am anxious that the doctor be made aware of my history.  The thought of having to vomit several times post craniotomy fills me with dread.  Dr. Collier (the anesthesiologist) comes in to talk to all three of us.  Our discussion provides some much needed reassurance that the drug being administered will be completely different from the ones used previously by my oral surgeon to have my wisdom teeth removed and the other local which was given to remove my original melanoma back in 1994.  Thankfully, the anesthesiologist has a full arsenal of choices for me.  Plus, this time a full sedation drug will be utilized.

I can't wait for them to put me under.   We have now been in pre-op for several hours, far beyond my scheduled surgery time.  The neurosurgeon's first two surgeries have taken much longer than expected.  Understandably, the delay causes Keith and Melissa to fret.  At 3:30, I am finally taken into the OR.

Keith and Melissa are encouraged to go do something rather than sit in the surgical waiting room on the second floor: get something to eat, go outside, etc.  Since my surgery is expected to last for a few hours, they decide to grab some food from the first floor cafeteria.  The concierge outside the surgery waiting room on the second floor gives them a pager that will beep when I am out of surgery.  It reminds them of the kind of beeper you are given at a restaurant to alert you when your table is ready.   They return to the waiting room after eating and attempt to distract themselves by working on a list of people they feel should be contacted about this whole crazy situation.