Hello again, my buddies! I can now confidently inform you that I have survived the operation. This should be evident from the posting of this blog entry itself, but I dunno, just in case anyone thought I might be dictating this to my voice recognition software from Some Realm Beyond, I assure you I'm not. It's now a week — in fact, a week down to nearly the minute — since I opened my eyes in the recovery room. Spoiler alert: it hurts, but I'm doing okay. But let's take it from the top.
I didn't sleep much the night before (nerves); I did assume that I'd be sleeping much of the next day but it actually turned out that last night was the first semi-decent night's sleep I've had since last week Saturday (two days before the surgery). Thanks to a number of elements in my background and history, for the trip out, by myself, on the train, I kept calm. Sure, I was scared out of my mind although obviously also highly confident about what I was about to do (or I wouldn't have done it), but I'm long-practiced at keeping my heart rate down, my breathing steady, my thoughts in a row. I did have a weird, irrational urge to tell everyone around me that I was about to have major surgery, and this did get out into the world as I left the train and the conductor told me to have a nice day: I answered, mostly involuntarily, with, "I sure will try, but I'm on my way to get an operation." He replied, "Well, good luck, it's nice weather for it!" And indeed it was. Lovely day.
Upon arrival at the clinic, there was no one at the front desk because I'd been instructed not to go to the floor where main reception was and the nursing floor's desk isn't always humanned, so I followed the sign telling people who were there to check in to make their way to the lounge at the back. Said lounge proved to be a narrow, well-lit room with comfy sofas I was far too keyed up to sit on, and large windows overlooking the roofs of an adjacent building upon which were two families of Greater Black-Backed Gulls: two sets of parents and in total seven little bundles of grey fluff about the size of tennis balls with big seagull feet and beaks wandering around on tarpaper. Unfortunately, for obvious reasons, I didn't have my camera with me and I do not have any photos for you, but damn they were cute.
I was considerably early, because relying as I do on public transport and its inconsistencies I prefer to always aim for the conveyance in the timeslot before the one I actually need. After a while of admiring the fuzzy little clowns, I heard someone get out of the elevator at the other end of the long hallway. After a while, apparently he was noticed, because I heard someone ask, "Are you here to check in?" It transpired that he was not, and had missed the sign directing people to the new location of the receptionist's desk, so he got back into the elevator but I popped up before the attendant could disappear and said, "I am here to check in, but I'm early." From there it went like clockwork: the schedule was consulted and I was escorted to my room which was halfway between where we were speaking and the lounge I had been in. It was a nice room, with two beds; at that point I didn't know yet whether or not I would be getting a roommate. I stowed my stuff as instructed and was told that it would probably be about an hour and a half before I would be summoned for the operation. Obviously, due to anxiety, I would've preferred to get it over with immediately, but scheduling is scheduling and I fully understand: I've always worked behind the scenes myself. Clearly, because some operations were going to finish early and others were going to run over, there was a lot of wiggle room planned in. I sat around on the bed provided, made sure my book and phone were where I could get at them later, and tried not to fret (no small task). Only about half an hour later however, the nurse reappeared, handed me two paracetamol, and said it was actually time to go.
I did not walk: they take you straight from your room in your own hospital bed, so I went for a ride. The prep room is also the recovery room; I got there early, one of the first people of the day, so it wasn't very crowded yet at the time. I was informed that when I came back to the recovery room I would need to be there for three or four hours — what I didn't know was that most people stay in there a much shorter time, so I wasn't particularly shocked by this news. Later I learned that open spinal surgery requires considerable extra observation at first. The anesthesiologist came over and recognized me: he was the one who gave me the nerve root block some weeks back. Absolutely love him. He said, "Oh, it's you!" I replied, "Yeah, the crazy photographer." He said, "You painted that jacket." I was delighted he remembered. He moved on, we got my IV installed, and away we went. It was a short hop to the operating theater, where of course the anesthesiologist awaited me, and the neurosurgeon, and three assistants/nurses. To say that I was absolutely terrified (although, again, certain I was doing the right thing) would be an understatement. The neurosurgeon, as per protocol, asked me what he was going to do to me, and I told him that he was going to remove the disc between my C6 and C5 vertebrae, replace it with a titanium implant, and fuse the vertebrae. He chuckled, shook a finger in my face lightly, and said, "Oh no, YOU do the fusion part youreself over the next few months and years." I like him.
I've never been under general anesthesia before and although my husband has, he's only been able to report back about dental anesthesia, which I understand is considerably different from a proper hospital experience. It was kind of strange: one minute the nurse was leaning over me saying, "This is just oxygen, breathe deeply, he's injecting anesthesia into your IV now; think of something nice." I found myself thinking that it wasn't working, that I was fully alert and not starting to experience any form of drifting or sleepiness or dissociation or what have you… and then I woke from a vague dream about grazing horses with three people hovering over me saying, "Mrs. Cooper, Mrs. Cooper, it went well, you're in the recovery room."
The next hour was terrible. I was both still somewhat dissociated (they used ketamine) but in increasing pain. I'd been told that there would be a "dreamy" kind of out-of-it state for a while after I woke up and that I should try to enjoy it, but anesthetics in general don't always work the way they're supposed to on me, and I woke right up compared to their expectations. The specialist nurses in that room were phenomenal. During that hour, a woman reappeared at my side frequently, giving me sips of water, looking at the level of tightness in my face, and offering me more painkillers. We finally hit a level that achieved some kind of equilibrium and I was able to relax a little bit. Meanwhile, the room was filling up. About once a month, this clinic turns itself over entirely to operations instead of consultations for a few days, so while I lay there flat on my back, not allowed to move, I could hear and see many other people, mostly as heaps of blankets glimpsed through curtains, and all of them left again before I did, except the one wheeled in at the last moment before I left; the doors opened, someone yelled, "Spinal!" and I realized that someone else was also in for a long stay. There were knee replacements, hip replacements, trans surgeries, what have you. I will report, although without any details because it's their business not yours, that all of those trans surgery people were very, very happy, grinning ear to ear through the pain. One turned out to be a hallmate of mine later, super nice guy on his third or fourth surgery who knew everybody there already and wandered into my room for a chat later that night, which was nice. I began to understand why they had warned me about how long I would be there, given how many people came in and left again during my stay. After an hour or so, they asked me if I would like a popsicle. I would! I enjoyed it very much, what with the super dry throat and all. People came and went, even the knee replacements and hip replacement only being there around an hour, while I had to remain absolutely flat on my back, very uncomfortably, but I understood. I'd had something pretty fucking major done to me, after all. After a time they brought me my phone, let me be very slightly propped up on pillows but still on my back, and I took this picture to show my friends and family that I was okay.
They gave me another popsicle. Sometime later, anytime anyone would complain or moan or even look frustrated, the awesome nurse would point over at me and say, "Poor Mrs. Cooper's been here so long she's had TWO popsicles!" and they were chastened. Pleased to be of service. I did want to pee, but they told me that would have to be with a bedpan if it were to happen in the recovery room. They did a nifty little ultrasound to tell me that it wasn't actually urgent, and I agreed with them that I would rather wait to get back to my room where, I had been assured, I would be able to walk to the toilet by myself (well, with a nurse the first time). The recovery room nurse kept joking that I was probably sick of her face and of her in general, but I made a point of saying loudly, using her name, that she was fantastic.
Finally it was time to go. Off we went, bed and all, back to my room. Before I do the other half of this, let's go over in more detail what they actually did to me. If you're squeamish, you might want to skip this part. Among my papers upon discharge was a very detailed letter about everything they've done. So, referring to that letter, in order, here it is: first, they used imaging to establish the exact location of my C5/C6 junction and my platysma (a sheet of tissue extending from the clavicle to the mandible). They flooded the area by needle with adrenalin and xylocaine. Then they made an incision at the C5/C6 level, moved my musculature and carotid artery toward the center of my body to keep them out of the way, and my trachea and esophagus toward the outside. Then they employed the spreader. They sliced their way on down all the way through my neck to the vertebrae in question, peeled off a section of the longitudinal ligament, and used curettes, grasping forceps, and a bone punch to remove the intervertebral disc, and then proceeded to use the punch to trim away all of the extra bone growth in this photo:
Once that was done, they inserted a 3D custom-printed titanium cage, which is not like it sounds: it's not some sort of enclosure made of wire or something, it's a block of 3D-printed titanium in the correct shape filled with holes like a sponge and stuffed with bone-growth-promoting materials. This was plated and screwed into place and they proceeded to back out, closing things up on the way, finishing with an interesting rolled-in-on-itself closure suturing described in the letter as "subcutaneous", and expected to leave far less of an interesting scar than might otherwise be expected (for the record, I am absolutely not bothered about honorably-acquired scars, they are a record of experience). The incision was then covered with steristrips and a large hypoallergenic bandage (I have a topical reaction to some types of bandaging adhesives). Obviously, given the depth of the wound itself, a drain was left in. Here's a picture of how I spent the next 22 hours.
Back in my room, the first thing I noticed was that the other nightstand had the telltale used pack of two paracetamol on it, indicating clearly that I was going to have a roommate. At this point I still expected that I was likely to sleep for a lot of the day, but I did hope it was going to be someone nice. And it was! We're going to be friends! She had the same procedure, but I think a lighter version: she could already move her head more than I could, her bandage was much smaller, she seemed to be in less pain than I was, that kind of thing. We talked briefly, and at some point I mentioned being a photographer. So is she! Further discussion revealed that she lives on a working dairy farm in an area of the country chock-full of amazing birds and other wildlife, and works as a vet tech. I have also worked as a vet tech. We got on like a house on fire. We'll be seeing each other again; it turns out that our follow-up appointments are on the same day, 10 minutes apart, and she's offered me a ride (I don't have a car and haven't driven one since 1993). We exchanged photography-related business cards. It was a little unfair that she slept like a baby, is incredibly pretty, has some of the most magnificent hair I've ever seen in my life, and so on, but we can't all have it all. For my part, every time I started to nod off I would wake up before achieving even the top layers of true sleep. I think maybe my nervous system was reacting to being confused: after all, earlier that day, my body went to sleep in a nice comfortable way and woke up horribly injured. This is perplexing to a biological system. Furthermore I was in too much pain to sleep, despite the paracetamol and oxycodone they gave me (I can't take NSAIDs), and additionally I was terrified that if I did fall asleep firmly I would end up yanking on the IV or the drain. Thus it was that every time the night nurse came in, once an hour, to make sure our drips were still dripping and all was still well, I waved at her and she waved back.
Before bedtime, dinner was served — I was deeply grateful that I was at that time still able to swallow because they had something on the menu that I can never afford to get for myself: salmon. It was good, too. I suppose there's not a lot more detail about the hospital stay itself with which to forthcome; in the morning they took out the IVs and drains and told us to lie down for half an hour to make sure the drain sites didn't leak, and then they sent us home, me by taxi and her by husband.
That was Tuesday. Tuesday, Wednesday, and Thursday, what I did was Be In Pain. I'm sure many of you know how it is when you hit a certain level of pain: it's not passive anymore. It's not an environment, it's not experience, it's an activity. Like vigilance. These nights I did not sleep. Sure, half an hour here, 45 minutes there, but the pain was too bad and also I do not like sleeping on my back. It's uncomfortable for me but I can't lie in my right side yet (that's where the incision is) and I can't lie my left side because one of the reactions to the surgery has been the revelation of a long-impacted and now-freed nerve in my left shoulder which... woke up at me. Friday I was more able to do things like pay attention to television and have my eyes open for much of the day, but that shoulder just kept getting worse. Saturday, the same. More alert though, that's for sure. Even yesterday, Sunday, it was still bad; I've been alternating ice and heat on the damn shoulder the whole time and I was pretty pissed about it. Also there's a lot of cramping all over my upper back, that kind of thing. It's expected: the entire architecture of my upper spine is different now, the curve of my neck restored, muscles shortened by my slow crumpling over the years were suddenly ripped into new positions it would normally take months of physiotherapy to achieve. Of course everything's cramping up, overreacting, freaking out. Last night though, somewhere in the night, the hypertrophic knot of muscle over the nerve there let go and I think I topped six hours of sleep! Only took one oxycodone, too. I'm allowed six per day but never exceeded four even in the first couple of days; for two of the last three days I've only taken it at bedtime and in the middle of the night, and last night I never took that second one and still got back to sleep. I had some fun dreams, first time in a while, something about trickstering it up all around the riverlands in a place I dream about frequently; something about hanging out with some dogs and other animals after a barbecue on one of the houseboats, and then one of the boars came along back with me, just being companionable, and walked across a deck past some Yuppies' elite brunch setup which elicited a comedic pursuit… and I seem to have discovered a new way to fly in dreams. Fun!
I don't know when I'll be photographing again, I don't know when I'll be doing what again. I admit that my neck already feels better than I could possibly have expected at this point, all of the problems in my right arm and shoulder which were the reasons for the operation in the first place are completely absent (I was able to report that already in the recovery room), and this new left shoulder issue is easing. I'm under orders to "take it really, really easy", doing virtually nothing, for another two weeks; statistically, I can expect to feel mostly healed up 4 to 6 weeks after that, but have to be very careful for several months. In a year, bone should have grown all the way through the titanium and met itself in the middle, and in four years both vertebrae and the implant should be, in the neurosurgeon's own words, "one very expensive block" (I don't have to pay for it myself, I'm in the Netherlands where we have proper healthcare coverage, this is fully insured; in fact, if this were not the case I would never have been able to have this done at all). I'm an intelligent person, despite some appearances, and will not be returning to my old lifestyle. Sadly, a huge amount of who I identify myself as involves being the one who can pick up a bench, pop it on my shoulder, and walk several blocks home with it, carry 80 liters of dirt on each shoulder, sling flagstones and cinderblocks around with abandon, dig ditches, and relocate heavy furniture at will, but I accept that that's gone now. Likewise I need to find new ways to paint my tiny figures and do my other artwork without hunching over like some antediluvian watchmaker. I can do this; don't have to like it, but I can do it. My plans for the coming period of time are to work mostly on the novel, which I've been desperate to get back at anyway. Soon, when my hands are itching to work, I'll be whipping out the wood-burning set: one good thing about wood-burning is that to get a darker area, you don't need to press harder or go over it more times, all you need to do is let the tool rest there gently for longer.
I'm sure there's a bunch I've left out that I meant to say (like for example that I'm already back on solid food, somehow dodged the expected bullet of what they call eggplant-throat, never lost my voice, our roof is leaking, stuff like that), but this is getting long anyway, so I'll let you folks go this time but I'll keep you posted. Yesterday was the solstice and although I'm not up to much at all, obviously, I did take my phone out to the garden and grab this little "Happy Summer" photo for you to enjoy. Be well folks, and have a good time.
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i'm glad it was a nice day for it.