Atypically Recovering

Image – online search for ‘first aid kit’ image; not my photo

I’m glad today is over, and at the same time am amazed at how well it all went. I had 7 scalp cysts removed, and this is by far the least painful of the three major surgeries I’ve done for these recurring little beasts. One was 5 cm in diameter; the others were more in the 1.2-1.7 cm range, arranged like a bizarre ski moguls course on my head. It’d gotten to the point with the biggest one that getting into the car required me to ‘duck’ so I didn’t whack it on the car frame. I also had to drain it weekly for 2 months, to keep it from exploding, as it got tight with the build up of fluid inside. They go back to 1985 (three removed in an office procedure), with the two prior multiple-cyst (12-13 each) surgeries in 1998 and 2001, and other ‘one offs’ in MD offices, emergency rooms, and urgent care situations. There must be some new techniques that in the last 25 years and/or having a surgeon who specializes in them made a huge difference, though my surgeon with the two biggest surgeries was one I worked with and respected at the rural Texas hospital where we met.

The surgical team at the hospital I was at were very good– and SO attentive to everything. I’ve generally had good outpatient experiences at this facility, and this was no different. The first person I saw today was a certified nursing assistant. Not all hospitals employ these amazing folks, who are the backbone of any nursing home, with incredible patient care and time management skills; the ones I worked with loved ‘their’ people; one turned down a promotion so she could keep looking after the folks she’d taken care of for many, many years. CNAs are often seen as the ‘lesser’ healthcare workers, but I’d argue that they make many facilities able to run at all. With them, there is no better personal patient care.

‘My’ CNA was very sweet, and said she’d like to kidnap me to take home and spoil. She was all smiles in a genuine way, and knew her job very well. The next person I saw was a phlebotomist, who got my sketchy veins to produce blood with one stick. That’s rough to do on someone who has had prior IVs (two) in boob veins. My primary pre-op nurse was also great, and knowing she had to get an IV in, got a warm pack on my hand quickly to dilate the veins in my hand to improve the odds of getting an IV line in. It worked well. While she was toasting my veins, she also went over a bunch of medication and medical history info, and told me about asking for pain meds sooner rather than later (more on that in a bit). The nurse manager also came in and talked to me and my friend about letting her know if I needed anything, giving out her business card.

The anesthesiologist came in to tell me about the nurse anesthetist I’d have keeping me alive. She got a good history, and paid attention to the ‘no midazolam’ message (makes me a bucket hugger for many hours from severe nausea), and passed that along to the guy who was to be my ‘gas man’. My surgeon popped in, and let me know that they were cleaning up the room from the last case, and I’d be in there within a half hour. I then met the two OR (operating room) nurses I’d have, who moved me to the OR when it was ready. The gas man got me knocked out very comfortably, with lidocaine to make the propofol (“milk of amnesia”) burn less. Then a good couple of minutes of getting my oxygen levels up to allow time for intubating me for the ventilator. My oxygen levels weren’t low that I know of, but more of a ‘loading dose’ of oxygen for the period of time that my respiratory muscles were paralyzed to allow for intubation (used to do the same kind of thing with an AmbuBag before suctioning tracheostomy and ventilator patients). I was off to sleep. I was ‘under’ for 2 hours and 20 minutes.

I don’t remember the first recovery area where the tube came out (post-anesthesia recovery unit, or PACU), but do remember the next level ‘down’ where I was still closely monitored, and got some nausea meds. Those worked well, and I munched on a graham cracker and ginger ale while looking at the other sorry looking folks who were in various stages of stupor and coherence. Once it was deemed that all was well, I was taken to the discharge instruction area (most of the verbal instructions were given to my friend and driver for the day, thank goodness, because it took me forever to find the written version when I got home; I had the bag of instructions and antibiotic ointment, but no clue where I put it; found it after sleeping for a few hours). It was a short stay in the discharge area after peeing, and not returning the graham cracker or ginger ale. I was sent along with a couple of barf bags to be safe, as well as a towel and disposable pad to collect any blood/drainage on the ride home.

While I did have local anesthetics, in-surgery pain and nausea meds, and some other ancillary meds (to improve outcomes and comfort), this was very different than the surgeries I’ve had before, decades ago. I was a little surprised when I wasn’t given a pain med prescription, but so far the acetaminophen/paracetamol has been adequate. I’m a little sore, but about 1/4 of my scalp is still numb, likely from the incision to get to the sort of linear cluster of cysts on one area of my head. It will take some time for the nerve endings to find each other again. In the past, I was on routine injectable narcotics after scalp surgery, either a shot in the butt (lasted longer) or with a patient-controlled anesthesia machine (PCA) during my overnight stay (surgeon didn’t want one of the few RNs who worked there circling the drain at home alone). I never liked IV pain meds- just get comfortable enough to get a good snooze on, and then the stuff wears off and it’s back to Pain-opolis, but that was the trend at the time. Then I’d be sent home with hydrocodone for a few days, which made me a bit loopy with residual anesthesia effects, and not entirely safe unsupervised at home alone, ultimately needing a weaker prescription.

The only things I’m dealing with now are a couple of small areas that are continuing to ‘drip’ onto my clothes, the inside lenses of my eyeglasses, and anywhere else gravity dictates (so maybe it’s my posture?). I didn’t have a bandage when I left, and agree with leaving things open to air for healing, but with the CPAP (sleep apnea machine) headgear straps, and the oozing, I went rogue and put on my own dressing sandwich of a non-stick gauzy film thing (Adaptic) to prevent stuff getting gummed up in regular gauze, some regular gauze over that to absorb anything running amok, and a roll of light gauze to hold it all together. I look like a very large used and busted up Q-tip/cotton swab. But it works, and I got about 4 hours of sleep after getting home. Then there’s the post-intubation cough and hoarseness, but I’m doing my deep breathing and coughing (old school now?), and am finally getting up some gunk that is helping with not coughing as much. I kind of squeak when I cough, so with the white gauzy bandage job and squeaking, maybe I’m more of a wonky looking stubbornly independent sheep with a tight-ish throat and awkward ‘baaa’ bark. Overall, they’re all very routine and expected post-op situations, with absolutely NO red flags in my case (everyone/each situation is different- if you have any concerning symptoms after any medical procedure or illness, please contact your healthcare provider immediately).

Another note- ex-therapist and I exchanged some pleasant emails wishing me well. I’m not looking for regular contact, but it definitely helped with easing some of the pain of feeling so discarded last year.

Many thanks to my friend for getting out of bed before dawn and staying at the hospital for longer than anticipated, lugging my junk around for 10 hours out of her day, and then getting me home safely.