Heart to Heart January 29, 2018

10: Hey there Dilaudid

Surgery was scheduled for September 3, 2017. I was stressed about arranging my work schedule to accommodate the time off I needed. Without question or hesitation my incredible boss arranged time off for my procedure. I have been more than blessed to have such a supportive work family.

As the count down began, I felt nervous. I have had a few surgeries in the past but this one was the scariest for me. As I have written about before, I was afraid of so many things. This was the first abdominal surgery I have had. I have taken care of many patients after abdominal surgery. I see way too many complications and mistakes. What if my bowel is perforated and I need a colostomy? What if. . . STOP. Not helping. Laparoscopic procedures are certainly less invasive than open abdominal cases. But still, surgery is surgery. Despite my medical background, emotions tend to get in the way of logical thinking. After all, it’s my own body.

September 3 came around all to quickly. Mom came to Memphis to help take care of me after the surgery. Before entering the outpatient surgery center, Matthew, mom, and myself lingered in the car and prayed over the surgery, the doctor, and staff.

I checked in and we took a seat in the waiting room. I looked around the room. Again, I was the youngest. I wondered what people were thinking. What were they having done? Were they scared too?

They called me back. As is standard pre-operative protocol for any woman of child-bearing age they took a pregnancy test. Maybe we would find out that I was pregnant and all of this could be canceled! I should not continue to let myself think these thoughts. It’s not productive. But maybe the day that I don’t reflexively hope any longer is the day I should really be worried. The test was negative. So much for canceling the procedure. I changed into a gown, an IV was started, and a thorough health interview was conducted by the anesthesiologist. I didn’t say I was a nurse, but the anesthesiologist caught on. He happened to have worked on some cases with Matthew. We all waited in what felt like a cold sterile little cubby for Dr. B to arrive.

Once Dr. B arrived he reviewed everything again to make sure we all felt comfortable with proceeding. Just because I was scared and nervous did not mean that I had changed my mind. Matthew and I, along with our doctor truly felt that this was the appropriate next step in our treatment plan. What good would it do for us to pursue any further intervention to become pregnant, to follow expensive protocols, if there was some anatomical lesion lurking in my body like a dilated fallopian tube, just waiting to prevent or extinguish any chance of conception or implantation?

I made sure Dr. B and the anesthesia team had eaten lunch and slept well the night before. Yes, I really did. We had a few minutes prior to me being rolled back. I began to tear up, feeling scared once again. My mom began to tear up as well. Poor Matthew surrounded by women and hormones. Mom pulled out her phone and played a video of the sort that never fails to make me laugh: my father’s antics. We all laughed and felt better. The nurse anesthetist came in and administered a happy calming drug. I shouted “I love you” and held up the peace sign with my hand as they rolled me back to the OR. I remember transferring from the gurney to the operating table, a heart monitor being placed on my chest, and Dr. B calmly saying, “You’re going to do just fine, Elisabeth”. A mask was placed over my nose and mouth and I was told to count backwards from 10. I think I got to 9.

And just like that I awoke to a nurse saying, “Elisabeth, Elisabeth…. you’re in recovery now, take some deep breaths.” THE PAIN. I was crying, moaning, writhing. Then it stopped. Then I heard the voices of my mom, of my husband. I’m alive, I didn’t die! I began to pull off the covers and lift my gown trying to feel my belly. No colostomy. Thank you Jesus! Matthew came over to the bed and held my hand.

“What happened? Am I ok? What did they find??” I began to ask.

Matthew replied, “You did well, everything was ok for the most part”.

“FOR THE MOST PART?!?”, I shouted as my heart rate went up to on the monitor.

“It’s ok honey, we’ll talk about it when you are more awake”.

I lifted my gown up again to look at my belly. Just two incisions. It’s ok, it’s ok. As I became more coherent I asked the nurse what she gave me for the pain. “Dilaudid”. How much? “1mg”. I smiled. That stuff was nice. Now I understand why my patients ask for this stuff so much.

Mom helped me dress. They wheeled me out to the car. I arrived home and rested a bit in the bed, but made sure to get my post-op walking in that night. Walk, walk, walk is what I tell my patients. So I figured I better take my own advice. A yummy dinner was brought over by a friend and an influx of check up phone calls and texts from friends, family, and coworkers flooded in. My husband made sure to tell everyone how much I enjoyed my dilaudid. Thanks babe.

Towards the evening as my mental status approached normal, Matthew finally told me what the doctor found. Perhaps most importantly, there was no hydrosalpinx (dilated, fluid-filled tube) and none of my fallopian tubes had to be removed. My surgeon did find some inflammatory changes on my bowel, liver and uterus. My abdominal cavity seemed to be covered in a chronic low grade inflammation. Dr. B was able to remove some of the inflammatory tissue. We later found out a biopsy of the tissue showed non-specific inflammation. No endometriosis, which was one the possible differential diagnoses. As time has gone on, the etiology and meaning of the inflammatory tissue remains unclear. It appears more and more like ovulatory dysfunction may ultimately be playing the greatest role in our difficulty becoming pregnant, though the inflammation may be playing some role. With infertility, perhaps more so than other areas of medicine, you have to be ok with ambiguity.

I recovered like a champ and enjoyed some weeks off to physically, emotionally, and mentally regroup. I spent a good bit of time in Chattanooga with family and old friends while my precious mother drove me back and forth to Memphis for follow up appointments.

Dr. B told us to try to make a baby on our own (ya know, like normal people do) for the next month since he had been able to de-bulk some inflammation during surgery. Perhaps our chances of natural conception would be temporarily increased. We would meet with him in October to discuss the next steps.

The things one does to have a baby. You just wait.