Lobectomy.

I expected to get nervous, scared even. A lobectomy sounds like such a big deal! I mean, a surgery that removes half your lung? How does one even breath after?! After my last surgery, the wedge resection of a tumor in my right lung, I remembered vaguely (as is the way with things after surgery) having so much pain that I didn’t want to breath. As I would take shallow, less painful breaths the machine that monitored my pulse oximetry (the amount of oxygen in my blood) alarmed so loudly it repeatedly woke me up. All I wanted to do was sleep without breathing but repeatedly nurses or family members told me I needed to take deeper breaths. It was irritating because clearly, no one understood how painful it was. During that surgery they also reversed my ostomy and had cut me open from my pubic bone to my sternum for the second time so that may have played a role in how much pain I was having. But I healed. Pain is no longer an issue I struggle with so I knew that I would also overcome any pain from this surgery since the incisions would be just as invasive as the ones on the right side but this time, I wouldn’t have my abdomen cut open. So I wasn’t nervous about pain. The last two surgeries, I grieved what I would lose in strength and capacity for my CrossFit training and that was the saddest and most troubling thing to me about them. As I had already had an almost full recovery from both those surgeries, I knew I could do it again. Lifting heavy is my favorite part and I know I can get back to that. My surgeons had told me functionally I wouldn’t notice much of a difference and would be able to get back to training in only six to eight weeks. That’s a blink of time! I’d be back before people would even notice I was gone! So I wasn’t nervous about my recovery. I had already lived through two other more invasive and dangerous surgeries so I wasn’t nervous about dying. I really wasn’t nervous at all. The worst part for me was having to watch the people I love have to watch me go through it. My closest friends and family, although very supportive and happy for me, were not excited to watch me go through another surgery and watch me be in pain. I think I was nervous about the post op narcotic withdrawals somewhere at the back of my mind. I could tell I was stressed even though I couldn’t pin point exactly what the source was. I’m pretty disconnected from my emotions overall, I don’t know how I feel at any given point in time. Generally speaking, a way for me to identify unacknowledged emotions or stress is by how busy I am. Let me tell you, the week before my surgery I was BUSY.

I had taken the weekend before my surgery to go down to San Diego and visit my brothers, my sister-in-law and my nieces. My aunt and cousin came down and we stayed in a nice hotel with my parents. It was a very pleasant weekend with my family, laying by pools, sipping Palomas, and laughing. I stayed till Monday and came home just in time to drive straight to the gym for a personal training client and to coach my evening classes. I had eight to ten hour days scheduled in the gym Tuesday through Thursday and surgery Friday. I didn’t realize I was stressed until late Thursday when after a full day coaching, my gym family threw me a surprise happy surgery party. I was overwhelmed by fifty-ish masked athletes, friends and family members, many I hadn’t seen in months since quarantine began. I cried. People were shocked that they had pulled off the surprise but I was so focused on coaching and training and every thought being occupied with not thinking about surgery that I had let things slide. Suspicious activities that caught my attention weren’t investigated or questioned because I had a full plate already. I think a lot happened that week that I was oblivious to because I was focused on staying busy and avoiding how I felt and what I thought. As things in life do, surgery came as planned whether I was ready or not, processed or not, emotionally engaged or not.

I didn’t sleep the night before. Not because I was nervous but because I was busy! To be fair, I needed to be up at three in the morning to leave by four, to get there by five to start the surgery at seven. I’m someone who would rather not sleep than wake up early so that’s exactly what I did. I had some friends and family stay over till one in the morning because they wouldn’t be able to visit at the hospital (Covid) and couldn’t bear the thought of saying good bye yet. But we finally said goodbye and I headed to my house to pack and clean and shower. I was on the gurney in my hospital gown in what felt like the blink of an eye. One minute I was laughing with my mom and the very next minute they were taking me to pre-anesthesia. This part is the hardest part of surgery for me. It’s the part where you say good bye to your family in a hurry and don’t really get a good good bye because there are people waiting for you and watching. It’s the part where the reality of surgery hits you and it’s hit you too late! Maybe it’s not that way for everyone but for each of my four surgeries that’s how it’s gone. And my heart breaks every time. It hits me that this might be the last time I squeeze my mom’s wrist and hear her voice and its too late to take all that in. I always try to be brave and smile so she doesn’t worry but I always do so through a stream of tears.

I don’t know how it is at other hospitals but the Operating Rooms at Loma Linda are through a labrynth of hallways. I always get distracted from my sadness by imagining that I am on some strange ride at Disney Land and make a joke about it to the guy pushing my gurney. We always laugh. Then I say something about how I’m glad they know where they’re going because I would be sure to get lost. Then we laugh some more. Literally, we turn right and left and roll past these double doors and those double doors, left then right, and pass people fully masked, capped and gowned, down a long hallway, the fluorescent lights whiz overhead, some of people we pass say hello, others don’t even see us, left then right, some of them walk past us casually, others dart out of the way, then we pause in front of some automatic double doors. These slowly open and I’m wheeled to a curtained area and a friendly nurse asks me my name and birthdate. If you’re going to have a surgery just be ready to tell people your name and birthdate a million times.

Pre-anesthesia waiting room is where the real waiting happens. The nurse hooks you up to an EKG so they can get a good baseline for what your heart rate is doing, it starts casually beeping along with your heart. They attach the pulse oximeter to your finger, it’s very annoying (you can’t bend your finger well). Then they put in the IV. It’s very important they chose a good vein because this is what is going to deliver the anesthesia that will knock you out and keep you out. I have said it before, I’ll say it again, I have excellent veins. All the nurses say so. This day was no different. The needle they use is huge so they numb you up first with tiny lidocaine injections. I hate them. I’d almost prefer just the jab with the huge needle because the residual numbness that lingers is just as irritating as the pain would be. Then you wait. This room is where you meet the anesthesia team and they discuss their plan. Then you wait for the surgery team to come through to confirm their plan. Then you wait more for the anesthesia team to follows through with their plan. Which in this case includes a thoracic nerve block. They lay me on my side and using an ultrasound basically inject, I can’t remember what, between the sheaths of muscle between my ribs. It was very fun to watch the ultrasound screen as the needle went in and then ballooned the tissue with the fluid then go in deeper and create another balloon. All the while my ribs and armpit are getting progressively numb. Then the OR nurses come and introduce themselves, and confirm your name and birthdate.

Between all of this I had the most amazing experience of my life. You might believe it, you might not. It’s my experience and my blog. If you don’t believe in supernatural things or a God that loves you and works actively on your behalf you might want to skip this paragraph all together. Weirdo. I feel like I have words for it thanks to C.S. Lewis. I had been reading Out of the Silent Planet, with friends just before surgery. Lewis has a way with words that just broadens my understanding of experiences in the most unique way. But anyway, in this book he describes eldil (we might commonly call them angels, heavenly hosts, messengers/servants of God, what-have-you) and the chief eldil, Oyarsa, as shades of light.

“… Oyarsa was coming up between the long lines of sculptured stones. Partly he [Ransom] knew it from the faces of the Malacandrians [Marsians] as their lord passed them; partly he saw– he could not deny that he saw– Oyarsa himself. He never could say what it was like. The merest whisper of light– no, less than that, the smallest diminution of shadow– was traveling along the uneven surfaces of the ground weed; or rather some difference in the look of the ground, too slight to be named in the language of the five senses, moved slowly towards him. Like a silence spreading over a room full of people, like an infinitesimal coolness on a sultry day, like a passing memory of some long forgotten sound or scent, like all that is stillest and smallest and most hard to seize in nature, Oyarsa passed between his subjects and drew near and came to rest, not ten yards away from Ransom in the centre of Meldilorn. Ransom felt a tingling of his blood and a pricking on his fingers as if lightning were near him; and his heart and body seemed to him to be made of water.”

As I lay on my gurney waiting. I had the sudden sense, not identifiable by any of the five senses, mind you, but none the less, I had the sense that I was surrounded by such beings as Lewis described. But not just surrounded like I was guarded but as though the surgery had already begun. These beings were generously and fervently working on me. I felt it so strongly, in fact, I kept squinting my eyes and peering on either side of the gurney hoping to catch a “whisper of light” or “diminution of shadow” where it shouldn’t be. I felt it so strongly that my eyes kept welling with tears. I felt immeasurably grateful and unworthy and humbled, but knew it had nothing to do with me and everything to do with an army of prayers and a God who loves to prove He is everything He says He is. So yes, I sat there waiting, but it was so much more than that. This unseen work was undeterred or interrupted by the many doctors and nurses who went about their duties around me. But every minute of silence I felt the unseen presence battling at the cellular level on my behalf. This surgery was a bigger deal than I could have ever prepared for, apparently!

Surgery is a very coordinated effort with lots of moving parts, un-benounced to most, both seen and unseen. I’m still in awe of all of it. The nurses, anesthesiologists and surgeons all work together to bring about the desired result. When the different teams met up at my bedside they would joke with each other which put such a light hearted atmosphere on such a somber, serious affair. While we waited on the final finishing touches to be made in the OR, several teams had gathered around my bedside laughing about this and that. I liked it. I liked them. When they finally told me “Ok, everything is ready! Let’s head to the OR.” I said, “Oh! I’m so sorry I’ll be sleeping soon, I wish I could hang out longer.”

The rest is very fast. It’s a short road to the OR, only a couple of turns, the slow opening automatic doors and you’re there. Surrounded by everyone you’ve met over the last hour and a mass of machines and lights. “Ok Amy, we’re going to give you something to relax you a little bit then we’re going to administer the anesthesia and you’ll be asleep.” “Ok, bye, everyone!” I say as they plunge down the syringe into my IV. I hear gentle laughter as I fall asleep.

Then you wake up. Slowly, and groggily, you fight to stay awake, in and out of sleep, a nurse always just a whisper away. The pain is pretty intense but it’s all so blurry. I was fighting hard to stay awake because I knew the sooner I woke up the sooner they’d let my mom see me. I knew my mom needed to see me. She didn’t care what the doctors and nurses had to say she would want to see that I was alright and had come through it ok and wasn’t in too much pain.

Chest tubes hurt. Don’t let anyone tell you differently. It’s a half inch tube squeezing out between your ribs pressing on a nerve. Let’s not forget your ribs move with every breath which means the nerve the tube is pressing on gets irritated with every breath. Did I forget to mention I had four small one to two inch incisions besides the one with the chest tube coming out of it? Well I did. They felt exactly like what you’d imagine a stab wound would feel like. Like someone took a knife stabbed me, twisted it around, then pulled it out… five time. There’s no way that doesn’t hurt. Unfortunately, I’d already had three other major surgeries so my body tends to laugh at drugs and their attempts to control my pain. It’s amazing how your body remembers narcotics. It was as though my body said, “Only that much? That’s all you’re going to give me? I remember this stuff and I know you can do better!!” So I found the prescribed dose falling short to help control my pain and was in a constant six to nine out of ten pain for the first couple days. Yes, a nine meant I was moaning and crying and often couldn’t get more meds for another hour or two. Finally, a nurse cared enough to recommend to the doctor to increasing the frequency and staggering the narcotics with the anti-inflammatories. Pain management was a journey during this hospital stay, but we finally got it under control.

By the time I would have been able to go home my pain was controlled, four to six out of ten. But the kicker was the chest tube wasn’t ready to get pulled yet. If you pull a chest tube too early, you collapse the lung. So I was cleared to go home with my chest tube! Which is all good and fine but that means there needs to be a receptacle that needs to be emptied. But suction needs to be maintained so the only way to empty it is by sucking the drainage from the receptacle with a syringe. Putting torsion on the tube to attach the syringe then create enough suction to pull the fluid out is a very uncomfortable sensation I would rather never experience again. The next problem with going home was my bowels. Narcotics management doesn’t just relate to pain, unfortunately. It also relates to bowel performance, or lack there of. Narcotics and surgery both slow the muscle contraction of your intestines. Even though I was eating fine there was zero output reflecting it. You can’t go home until they can ensure that your bowels are moving and you aren’t developing an ileus or obstruction. The day of discharge I found myself with pain under control, a portable chest tube in place and stuck waiting on my bowels. The amount of laxatives, stool softeners, and even suppositories I had received to no avail would shock most of you so I wont go into it. Suffice it to say, the hour drive home after finally being discharged was one of the most painful and uncomfortable car rides I think I’ve ever had.

But it’s done now. All those pesky lung nodules are mere objects for scientific research. I’m still breathing. Still fighting. Focusing on recovery and trying to remember how to dream a big full life into existence. This is not a road well traveled, but I’ll keep narrating it as best I can.