Sunday, October 3, 2010

Thyroidectomy or Getting One's Throat Cut

As the day of surgery approached I kept expecting a high level of anxiety to kick in at any moment. I don't know why, but it never did. Admissions to hospitals the night before surgery, with interviews by the anaesthetist, are long gone so it's up to you to ensure that you don't eat or drink after midnight.

Surgery was scheduled for 8.30 am, with an incredibly early (for the retired folks) check-in at 6.30 am. The bleary eyed Old Scientist drove me there and handed me over to the awaiting staff who prepared me for my visit to the operating room. Lying on a gurney in the day care surgical area I received drop in visits from all kinds of people, including the surgeon.

Most basically just said Hi, introduced themselves, explained their role in the scheme of things, asked, are you ready for this and were gone. One young man, with whom I had spoken on the telephone, came by to get a signature on a consent form. I had agreed to take part in a study which required some tissue from the thyroid gland. Blindly, they are searching for a common gene which could be involved in thyroid cancer as it often runs in families.

Finally it was time to go to the OR (Operating Room) where the anaesthetist swiftly did her job and four hours later I awoke in PAR (Post Anaesthetic Recovery). For some reason my respiratory rate was low, so I was there for a long time before they sent me up to the ward.

My nurse in the PAR had had her thyroid removed too and showed me her scar. We then had this totally bizarre conversation, considering where I was. She was somewhere in her mid forties and said her thyroidectomy several years before had been as a result of radiation treatment she had received as a four year old child when she was treated for a brain tumour. Who was your doctor I asked, since I have a friend who was a radiation oncologist who treated such children for many years. Dr B, she said, who is of course my friend and we talked about her experience of the whole thing. Tell Dr B Debby says hi, she said as I was finally sent to the ward. Sometimes it's a very small world and it's proved to be so in the oddest places.

For my part this conversation was conducted with a tiny croaky voice, for that is a side effect of the surgery. Four months later, while my voice is stronger, I still sound like a cross between Donald Duck and Lauren Bacall, or a male who is a heavy smoker, depending on the moment. But my voice change deserves a post of its own.

The area where the thyroid lays is well supplied with blood vessels and lymphatic tissue and after a thyroidectomy a surgical drain is usually inserted to prevent blood and serum buildup under the skin. So there I was, hooked up to an IV on one side, the drain and its container on the other side and oxygen prongs stuck up my nose, sitting almost bolt upright in a hospital bed and feeling a bit sorry for myself. The OS arrived, established that I was still in this world and in good hands and beat a hasty retreat. Well I wasn't exactly up for conversation!

Dietary personnel came by and left a covered dinner tray at the bedside. I couldn't move an inch even to take off the lid. A nurse obliged but I had been ordered a regular diet! I could hardly swallow so eating that wasn't going to happen. Oh they don't have a soft diet anymore, she said I'll see if I can find you some jello. But I never saw her again and the tray was returned untouched. Fortunately I didn't exactly feel very hungry.

Nurses came regularly to take my blood pressure and blood was drawn every six hours to monitor the calcium levels since the parathyroid glands can be affected by this surgery causing hypocalcemia, since they are situated right behind the thyroid gland. The first disrupted night passed with me sitting almost upright, sleeping fitfully. While I was pretty uncomfortable strangely there was little pain considering the size of the incision, which was between four and five inches. Yes I had literally had my throat cut open. After the first two very small doses of morphine I tried without it and managed just fine. The body is truly an amazing thing.

The next morning I staggered to the bathroom with the help of a nurse, dragging my IV pole and my drain and I was able to see myself in the mirror for the first time. The very red looking incision had been closed using 13 nasty looking metal staples, rather than the dissolving stitches I had expected and the lower part of my face and my neck and chest was tinted red from the disinfectant they must have doused me with in the OR, and my gown was covered with it too. It was even in my hair and I still have pink patches of hair that haven't grown out yet.

They did change my gown from that first stained one but do you know in two days, no one offered to wash my face to remove that disinfectant? In fact I received no personal hygiene care whatsoever in my time at that hospital. No one even offered me hot water and soap to do it myself and I was too far out of it to really care. It seems nurses these days are very good at the technical skills while ignoring the more obvious basic needs of the patients, well at least this was my experience there.

And oh joy, oh bliss, it was the time when the student nurses were doing their practicum on the wards. Now from my experience working in a hospital I know how trying a time that can be for everyone. Yes they have to learn and they need to practise their book learning on real patients and it is a teaching hospital but sheesh!

First of all they are accompanied by their instructors from the nursing faculty, most of whom haven't actually done any real nursing in years. They don't know where anything is and everything takes two to three times longer to accomplish. The regular nurses hover in the background trying to do their jobs as best they can. The first day, I had a very good male nurse who simply got on with it while the sweet little student mostly observed. But the second day, I had two nurses who seemed to work as a team, so they said, and the student nurse was more involved, fussing around rather ineffectually. The team nurses were joined at the hip and it appeared to me it was most a most inefficient use of two qualified people's time.

I had plenty of opportunity to observe this in my hospital room that day. While I had asked for a private room and was willing to pay, none was available so I was in a four-bed room, three females and one male. Yes a male. Mixing the sexes in a hospital room never, ever happened in all the years I worked in a hospital but that rule too, along with personal hygiene care and soft diet, has disappeared.

The last day was one of confusion, as one moment they were telling me I could go home and the next I would have to stay for another night since my blood pressure was high. Well no bloody wonder!

The surgical resident asked for a medical consult but when the medical resident came by he didn't want to deal with it either. Eventually they decided to discharge me regardless, after they removed the drain and gave me wound care instructions. The OS was waiting at home for a telephone call to come get me and in due course he appeared and in no time at all I was home in my own bed, still elevated however by many pillows.

So step one of my treatment for thyroid cancer was completed. Surgical removal of the organ itself. But of course it was just the beginning of my journey with this cancer.

Part one, part two of the saga.


rlbates said...

Somehow JMB I missed your post regarding your diagnosis of thyroid cancer. So happy to know the surgery went well. Best to you!

jams o donnell said...

I hope the further treatment has been a success JMB

CherryPie said...

I feel for you with the indignity of your treatments and placements in the ward. It seems to be the way of times!

But the most important thing the competence of your specialists. And from what you say they are good :-)

jmb said...

Thanks to everyone for reading my personal journey with this disease.

It's still coming!

Rositta said...

Yes I know all about the indignities in hospitals having hip replacement four months ago. I also had a very recent experience in a Greek ER and no matter how bad it has become in Canada, Greece is worse, far far worse. You will be well..ciao