I’ve only ever really worn two bits of what might be considered jewelry: a watch of some sort, since middle school at least, and a wedding band, for most of the time since about the turn of the century. Neither, however, sports any actual jewels. I’ve recently added another piece to my daily parure:
Crafted of titanium, to match my watch and ring, the top bears my name and the eye-catching red Star of Life, along with eight syllables that have come to be more worrisome than anything so terse and explicable as mere “brain surgery.” Malignant Hyperthermia, sensibly abbreviated MH, is a rather logical nomenclature for the condition. It’s malignant, i.e., potentially deadly; a thermia, a condition concerning temperature; that temperature being hyper-, in this case meaning elevated. It’s plain to see, then, that with this condition, I could somehow get hot enough to endanger my life; to be specific, when anesthetized with certain gasses. Which I of course did, in the early afternoon of December 16.
I, of course, was unconscious, and as a result missed all the excitement that followed. I’m told my relatively incidental neurological procedure had just concluded with the addition of 28 stainless steel staples to my shorn pate when my temperature started to rise. It kept rising, to everyone’s horror, to the neighborhood of 105F, and my heart rate followed it, accelerating madly. The doctor managing my anesthesia recognized the symptoms and called the number that’s now etched on the underside of my new accessory, 1-800-644-9737, and reached an expert at the Malignant Hyperthermia Association of the United States (MHAUS). Subsequently, I was bathed in ice, and administered a drug called Dantrolene, a substance with which I developed a love/hate/hate relationship, and which sounds like a brand of motor oil.
I returned to the waking world some time later, my wife and parents having whiled away the afternoon and evening in fear for my life. About twelve hours after my last recorded memory of swoopy and bright operating room lights and technicians joking about the freezing temperatures, I woke groggily to the sensation of my limbs uncomfortably bound, and my breathing being haltingly interrupted. “Quelle heure est-il?” I asked in writing, for some reason in French. It was 10pm, a solid eight hours later than I had anticipated, an early indication that something was definitely wrong.
I had been indicating my displeasure at just about every annoyance in the room by liberally flipping it off, in particular the breathing tube that was trying to help me breathe, but was mostly just frustrating my own attempts to do so. Its continued presence was another clue that something seriously bad had transpired. With my family briefly out of the room, I was extubated, which was every bit as unpleasant as it looked on ER. Finally able to talk, I could answer important questions, like what my pain level was on a scale of 1 to 10. “Pi,” I croaked. Suspecting brain damage, the nurse asked if this was my usual personality, and my father apologized that yes, it is. Curious at to how things looked at the site of the original area of concern, I had Sean snap a shot of the scene upstairs.
I had no real idea of my location, other than that I was in ICU. For some reason, my mind filled in the unseen areas to either side of my bed and behind it not with walls or empty space, but with nigh-endless rows of dimly lit beds, similar to my own. The next day, I got to see the extent of my space.
Never having been under general anesthesia before also meant that I’d never experienced other wonders, like having a Foley catheter, or an anal temperature probe, or the astonishing disorientation that comes from spending almost 24 hours lying down. Nonetheless, the next day found me hobbling down the hall in doubled-up hospital gowns, pee-bag mounted on my walker, probe cleverly arranged so it didn’t trail behind me like a brontosaurus’ tail in some 1950s stop-motion SFX extravaganza.
It was also on the second day that I took stock of my situation, became more completely informed about my allergic reaction to the anesthetic gas, and learned about the downside of the lifesaving Dantrolene. The Evil Bastard Juice, as I came to think of it, was urine-yellow in color, and had to be formulated on-site, as it degraded too quickly for storage or transport. It arrived in a translucent brown IV bag, indicating to me that it was also photosensitive. For all its chemical fragility, it packs quite a punch once it enters the body.
When I was wheeled into surgery, I had one IV on the back of my left hand. Eventually, that was joined by another on my left arm, and five exhausted IVs on various spots on my right arm. After a few uses, a given vein became too damaged to administer the drug though. In fact, once I was past the fog of painkillers, I could feel the Dantrolene entering the vein in a very painful manner, as if a burning knitting needle was being forced into its minuscule diameter. Yeah, I cried. On the third day, though, that came to an end, as it was suggested that I get a PICC line.
A PICC line is essentially an IV writ large. Using ultrasound, the very pleasant nurse whose job it is to go about inserting these time and pain saving devices found a large, deep vein and inserted a surprisingly lengthy tube into it, ending with a trio easy-access screw-top ports through which drugs and saline could be administered, and from which blood could be drawn. Life was good. There was, however, the small matter of my temperature.
My bout of hyperthermia had mightily fouled up my temperature regulation. Dantrolene attacks the root cause of the symptoms, an imbalance in my calcium level, but in order to bring my temperature down to normal levels, other means were necessary. On the evening of Decemeber 18, I had the unique frustration of watching my family grow more and more anxious while they visited me and got to see my temperature gradually rise above 102F on a monitor behind my head, which I couldn’t see. Frightening though that was, it did bring about my introduction to yet another nifty bit of technology, the cooling blanket. With one on top and one below, I slept the night away in 55F comfort. I need such a device for my side of the bed this summer!
These efforts were rewarded on Christina’s birthday, Friday the 19th, with my move from ICU to a normal recovery room. I had my Foley bag removed, in the process discovering that it was kept in place by a small balloon of sorts, leading me to be even further weirded out by the thought of a balloon in my nethers seconds before it was gently-as-possible slipped out from my urethra, causing my external organs to retreat to approximately my sternum. IVs removed and personal effects collected, I was wheeled up to my new room.
Now, all this time, I had gone without a shower, my last one being the morning of the surgery. The intervening time I had spent mostly laying down, but often running a fever, or being generally clammy. This had left me in a less-than-fresh state. To make matters worse, the damage the Dantrolene had visited upon my various superficial blood vessels had left me with a left hand that cold not grip and a right arm that could not bend. One arm’s worth of usefulness spread across two arms makes doing things like showering well-nigh impossible. Fortunately, I was told I could get help with this from the tech who did other such wonderful things like refreshing the sheets, taking vitals, and checking in hourly to ensure my comfort. They rocked. When the overnight tech popped in, I chickened out of actually asking her to help me wash up, but Christina had no such compunction.
The family evacuated to the waiting room, and the tech helped me undress. No sooner did she disentangle the modesty-preserving doubled-up gown than she took note of something unusual. “Sir, what,” she asked, “is that?”I looked down and to the side toward my right hip area, and rested my hand on the faint grey shape I could just make out there without my glasses on. Stuck to my behind with a small patch of tape was the lead to my still-firmly-in place anal temperature probe.
Note that in the events leading to my being wheeled up to the new room, I never mentioned “had the temperature probe removed from my ass.” That’s because that step never happened. In the rush to get me out of ICU, someone forgot that step, and it’s not like the thing loomed large in my mind, either; I hadn’t been awake when it went in, and for the most part, it just felt like a minor wedgie, a condition endemic to lying around in a loose fitting garment. Plus, I hadn’t had more than a few bites of solid food since the night before surgery, so there certainly wasn’t any urgency that might have sped its discovery.
This was all made so much worse somehow by the fact that a) the tech was black, which despite my being married to a black woman, and not being especially liberal, still managed to stir some White Liberal Guilt™ over her scrubbing my hairy pale ass; b) she was also young and quite attractive, an inexcusable condition in which to be subjected to my rapidly aging and decidedly not-as-attractive physique in its full ingloriousness, which was in turn exacerbated by c) my family (wife included!) being in the next room.
Much to the credit of the young lady (whose name is withheld here to save everyone a bit of mortification), she not only soldiered on in assisting my hot and refreshing shower, helped me into a fresh gown, and made my bed while cheerily chatting and complimenting both my mother and my wife (between answering her phone tersely with her full first name, a decidedly de-ethnified version of which appeared on the dry-erase board in my room), she also managed not to laugh about my grey “tail” until out of earshot. Shortly after she left, the nurse entered to inspect the situation. Dignity long lost at this point, I parted the back of my gown like stage curtains, revealing the source of the problem. She ducked out, made a call, and returned with a pack of warmed towelettes and closed the door before she instructed me to relax and take a deep breath. A firm tug and an awkward and prolonged wiping or three later, and I was tail-free and able to relate this story, in the first of many re-tellings, to my family, who seemed to take a great deal of pleasure in my humiliation.
In the night, after the last saline IV for the day was spent, and I was wholly untethered, I made my move to recapture a semblance of dignity. Having expected a much less exciting recovery, I had packed normal bedclothes for my stay. It was these real, live underwear and undershirts that I pursued as I struggled to lever myself out of bed, using my left arm to push down on the rail and my right hand to keep me from falling out of bed. I shed my gown and gingerly maneuvered the garments. Never has so much strategic thinking gone into putting on boxer-briefs. In a fit of hubris, I even slipped on my lounge pants. Now I was recoverin’ in style.
By Saturday, word had gotten around that I was back on my feet, and so I received a giant bouquet of flowers, the sort that a man never receives unless his life has been in danger; a potted, leafy tropical plant from my colleagues, the sort that makes you regret any slacking you’ve ever done; and a tome of brief biographical sketches of great philosophers, the sort that lets you know the giver doesn’t know you too terribly well, but thinks you’re pretty bright…or at least the sort of nerd to enjoy it (which I am).
I proved to the occupational therapist that walking was not a challenge, and that the actual brain surgery had not had any meaningful impact on me insofar as moving my limbs. With Christina’s help, I refocused all my caregivers’ attentions to the wreck that my arms had become. I became a big fan of chemical heating packs, and learned exercises to promote blood flow and fluid drainage in the affected areas. There were rumblings that I would be released the next day.
Sure enough, on Sunday, December 21, after a fascinating ultrasound of my right arm meant to check for potential blood clots causing the swelling and pain, I was cleared to head home. Christina retrieved real clothes for me to wear, far in excess of what was needed to get me the five yards from the door to the car, while mom and dad went ahead to prepare our house for my homecoming. While Christina brought the car around, I chatted with the lanky African lady who had wheeled me down to the door. “I was a little afraid I wouldn’t get home for Christmas,” I mentioned. “So this is like an early gift, then,” she replied. I nodded my agreement. “Who from, do you suppose? Santa Claus? God?” I felt myself become slightly annoyed by what I took to be an opportunistic grab at proselytizing. I was too happy to be too snarky, though. “Hard to say; Mom’s always said I was bad at checking gift tags.”
The air was cold, but fresh. The car rattled, but was familiar. The house wanted tidying, but it was, at last, home.