The Battle Begins

OPENING SHOTS FIRED - MAJOR DEFENSIVE OPERATIONS UNDERWAY

As requested, Mom and I arrived at UPMC Presbyterian at 5:30 AM and after registration, they took us directly to surgery prep. I only had a few things with me, knowing that Mom could bring anything else I might need from the House whenever I needed it.

I undressed got into a gown and my nurse promptly came in to perform all of her tasks, which were many. All of my nurses and all of my doctors were my army and we were all interlocked and focused upon one task; to find the cancer, cut it out and kill it. HIPEC would be used after the cutting as a total cleansing of the battlefield (which was in my abdomen) - the final procedure sort analogous to a nuclear bomb. Scorched Earth was our battle plan.

After starting an IV (one of many more to come) I think the pre-op nurse gave me a mild sedative because I began to slowly loose my ability to remember the sequence of events. I remember being moved from one bed to another, being moved around in the facility and I remember there being virtually no time lag - no waiting for the next step. Eventually, somewhere along the way, I lost totally consciences.

Some unknown time (to me) later, I woke up in a small room filled with many people. I had no idea how much time had passed, but it seemed as it the nurse had just put in my IV just moments before. In reality, nearly 10 hours had passed.

Dr. Bartlett was standing there in front of my mother and my dad and Beany (my step dad). Obviously, I was just barely conscience, but I can remember my mother saying to me that there had been a lot more cancer than had shown on he May CT Scan. She went on to say through a smiling face that they had gotten it all out, and that the HIPEC procedure had gone well. She seemed happy about the results, but I was concerned regarding the amount of cancer they had found. It had really been on the move.

Since they had to remove a portion of my colon and my rectum, they had to install an ostomy bag on my side (a colon bypass), which is to be reversed in a few months.

Mother recounted they had to remove the top portion of my liver, 25% of my diaphragm, and another portion of my colon. They removed many perennial seeds from throughout my abdomen and they also had to remove a portion of the peritoneal lining itself. They found cancer in my pelvic area and had to remove part of my rectum. They had cut me from the bottom of my rib cage all the way to my pelvic bone. Lying there in front of all of my family, I could not move at all. I didn't know it, but I had tube in my neck, tubes down my throat, down my nose and many other places as well. I had IV's all over and I was in pain that can only be described as indescribable.

I don't recall my family leaving, but they did, probably when I slipped back into sleep. The next thing I remember is pleading with my ICU nurse to put me to sleep, that the pain was too horrendous. He was a matter-of-fact kind of fellow, and he calmly said no. I keep moving my left hand I think because of some kind of pain, and the nurse firmly told me that if I didn't lay still and stop moving my hand, he'd have to tie me down. THE PAIN I WAS IN WAS UNSPEAKABLE, INDESCRIBABL AND BROUGHT FORTH THE IDEA, I'D RATHER BE ASLEEP OR EVEN DEAD.

Of course I was in Intensive Care and there was one nurse for every two patients. The doors and walls of he room were fully glass, and I laid there in full view of anybody who might walk by. There was a TV but I didn't have the heart to turn it on. I just lay there in pain that was going to change my life. I felt a sense of depression that could kill, but I've dealt with severe depresses all my life and I had "tools" for that. Mainly, I kept the room as quiet as possible. No TV, radio, music - no stimulation at all. For some reason, this has always allowed me to sort-of "hibernate" through my depression, and it worked now too. So now all of my friends know why I can be so hard to reach… because the best medicine for my depression is a "sterile" environment - no stimulation, which always makes my depression worse and sometimes even intolerable.

I noticed a clock on the wall. I'd doze a little bit thinking that I had slept several hours, when in fact only 10 minutes had passed. Oh my Gosh, I thought, I may be here four weeks, and with time passing this slowing, I was sure to go nuts. (Which I eventually did - discussed latter). Ever so often, one of the IV bags would empty, crimp or otherwise need attention from the nurse and it sent off this horribly loud alarm. Nurses came in, sometimes quickly, sometimes very slowly to restart the IV. And sometimes, more than one would go off at a time. I did not sleep for more than a few minutes for a couple of weeks, and combine that with the morphine I was taking and then all of he alarms, I was sure to loose my mind. In fact, one of the ICU nurses said that it was quite common for patients to have psychotic breakdowns due to all of these circumstances.

Over the next while, I relearned one of the best lessons I think I have ever learned. It was in response to my condition of helplessness and total incapacitation. I learned to view the interior of my room as my "world". This was it and this was all I had to deal with. My job was to lay still and recover - no matter how slowly and no matter how long it took. This was all I had to do. I used this in bicycle races as well. During time trials, I would look as far down the road as I could see, and I would say, that, and only that, is my current job. Nothing else mattered at this moment. Another thing that helped a lot had everything to do with the oxygen I was on. I was told, that when the pain got so bad, I could breath through my nose and exhale through my mouth. I would then relax my fingers, then hands, arms neck and head, back, abdomen, legs and it seems as if I entered a Zen world and the pain and circumstances became more tolerable.

At about 4 AM the next morning, I declared that it was time to wake up (even though I had ever really gone to sleep. The declaration seemed to give some structure to the infinitesimally slow nature at which time was passing. As would be the case for many days, I would simply lie in the hospital bed and fully accept my situation - extreme pain, and maddeningly slow movement of the clock.

In all of this time, I contemplated the human condition regarding pain. I struggled to understand why human beings had to suffer so much pain. Incidentally, I was told that there was only one or two procedures more painful than mine; lung transplant being one. I thought, how often do people have to endure this kind of pain? And what keeps them in a desire to continue living? I no longer hunt, but I thought about all of the animals I had killed in my lifetime. I even thought about all the fish I had hook in the mouth (ouch!). I decreed right there in my morphine influenced philosophizing that I would no longer fish (one of my favorite pass times).

Speaking of the morphine, I eventually warmed up to the use of it. They had given me a plunger type device and I was to push the button when I felt too much pain. I could push the button indefinitely every eight minutes. Interestingly, it was illegal for anybody else to push the button for me; the idea being that I would pass out before I would overdose, making overdose impossible, so long as nobody was pushing the button while I was passed out I could not overdose. At first, I was hesitant to push the button because I truly didn't like the way it made me feel. But with the pain I had, the button and me became friends. If I pushed it 3 to 4 times every eight minutes (24 to 32 minutes of morphine) I became at least comfortable. Falling asleep was the worst - not able to push the button, if I slept more than 30 minutes I would wake in excruciating pain. And it would take 3 or 4 hits one every eight minutes for the pain to ease.

Since UPMC was a teaching hospital at about 6:30 AM the second morning, an army of about 6 interns filed into my room an took position all the way around my bed. The leader seamed to be this young Chinese lady who was very nice. She would look at my wound, and redress it and check it for infection. The other young doctors mainly watched, but many of them also jumped in to answer any one of my many questions. The intern squad came every day at 6:30 AM, and I began to look quite forward to their visit. One young woman helped change the dressing on my wound, and she was so gentle, I barely felt her work. It's funny, and the young doctors laughed when I accused them of it, but as any one of them was working on my wound, several of the others would talk to me - ask question or what not. Of course this was designed to distract me. No, it is easy to say that my visits from the interns was the highlight of my day. And they also came late at night also- about 10:30 PM.

The interns had a lot of power over my care. I believe that the main physician staff wanted them to take charge of my care, but if anything got complicated, then Chaudhury or Bartlett would redirect them. I liked the arrangement.

Another pleasant and frequent visitor was Dr. Chaudhury; a seemingly young man with the kindest demeanor you could ask for in an attending physician. He was soft spoken, but when he spoke, you had a tendency to cling to his every word. Dr. Chaudhury was and assistantant surgeon to Dr. Bartlett, my main surgeon. Instead of Dr. Bartlett making daily rounds, Dr. Chaudhury did this duty. Dr. Bartlett explained this to us at the onset.

For the duration of my hospital stay, my room was a virtual buzz of activity. Along with the above described caregivers, others would come as well. Social workers, wound care specialists to teach me how to care for myself when I was discharged, ostomy bag experts who came to show me how to change and maintain things, nutritionists, physical therapists, repertory therapists, and of course people from the business offices.

My Mother and Father were in Pittsburgh and they were staying at the "House". They stayed with me virtually all the time, shifting out their efforts. It was nice having them there, and they could take a shuttle from the House to the hospital, which ran every thirty minutes. I loved seeing them united behind me. They've gotten along very well for years, but now they were sharing something only parents of a child can experience…. The same exact emotions and concerns.

The second day was actually the first day of recovery. I spend the day, lying flat on my back in ICU. There would be many many more days.