the lobectomy papers: part 2

July 22 - Stepdown Unit

The deed is done, the lobe is gone, the sutures tied and the tubes in place. Seemingly only seconds after the general anasthetic knocks me out, I wake up in the Stepdown Unit. The internet said I'd wake up in the Intensive Care Unit (ICU), but there doesn't seem to be one here on the 12th floor Lung Dept. Turns out that a Stepdown Unit is like an ICU, but not quite so intensively caring. This is a good thing. If I don't need intensive care, then I can't be in intensively bad shape.

The Stepdown Unit is a ward of up to ten patients with their own stable of on-site nurses and a variety of frequently visiting doctors and other medical professionals dealing with their particular case.

Today I have six roomies in Stepdown, and they've all undergone some type of major lung surgery. In bed, they're wheeled in, groggy and barely conscious, after their surgery and, when they're improved enough to join the general population, they're wheeled back out the door, bed and all.

Each Stepdown Unit patient is connected to a computer via an assortment of equipment to monitor pulse, blood pressure, heart rate and oxygen saturation. The blood pressure cuff is a permanent fixture, strapped to one's bicep to inflate every hour on the hour for yet another reading. So much for the healing properties of uninterrupted sleep.

At 10:30 a.m. on my second day at the Stepdown Unit, I am bestowed a visit by the Pain Service Doctor. Really, a Pain Service Doctor. Is he going to evaluate my worthiness to be in Stepdown, my worthiness to be served more of that kickass pain medication? Or is he going to order up some new kind of pain for me?

Next, the Social Worker makes her rounds. I think it's interesting that she spends most of her time with patients who already have a solid support network of friends and family, and those of a "spiritual" bent. I suppose this makes it easier for her to apply the basic counselling technique of paraphrasing the patient's words in a positive slant, getting the patient to agree to the new way of looking at their situation.

Social Worker: "Do you have someone to help you with routine household tasks when you go home?"
Patient: "Um, maybe I could ask the neighbour to bring my garbage out to the curb on Thursdays, and my other neighbour might be able to go shopping for me sometimes."
Social Worker: "So I'm hearing you say that you have a reliable and competent support system in place when you go home?"
Patient, visibly perplexed: "Um, well... I guess, if you say so..."
Social Worker, happily checking off a box on her clipboard form: "Great! Now, would you like to talk to a sister from the church?"

Sometime during the flurry of visits from doctors, nurses and others in the helping professions, I find time to take inventory of my condition.

Last time I was here, I was horrified to discover a drainage tube coming from my lung and leading to some unknown recepticle below my field of vision at the edge of my bed. Well, it's baaa-aaack, and it's every bit as Stephen King as the first time. The transparent, half-inch diameter tube regularly gushes bright red blood and gore from somewhere inside my chest. This is something I do not want my visitors to see, and I appreciate that none of them mention it.

Even more disgusting than the drainage tube is the urine catheter tube. Yup, there goes my last shred of dignity, zoom, right out the window, and I didn't even know I had any left. This transparent tube leads to a collection bag that sits at the bottom of my five-footed "Christmas tree," which also holds a collection jar for the other drainage tube and, at top, whatever drugs happen to be dripping into my i.v. at any given time. The urine catheter tube is a frightening half inch in diameter but, on closer inspection and with great relief, I see that the size is greatly reduced before it's taped to my leg and headed into my bladder. Again, thanks to my visitors for not mentioning this.

The third tube is a happy tube. I have a vague idea that an epidural is a procedure specifically for pregnant women, maybe an injection of some kind. I'm in the ballpark but pretty far out in the field.

The epidural is a small catether tube leading into the layer of fatty tissue surrounding the spinal cord. It feeds a regular, pre-measured dose of high-octane narcotic directly into the sweet spot of the nervous system, effectively numbing a large area. Ahhhhhhhh. If I handed out Nobel prizes, the inventor of the epidural would be at the top of my list.

I soon come to realize the containers of red stuff from my lung and yellow stuff from my bladder must be periodically emptied. And measured; the volume of liquid leaving my body apparently indicates something important.

The red stuff is disposed of discreetly, but not so the urine. It's poured into a clear, graduated container for measuring, then carried boldly down to the far end of the ward, to the bathroom. I don't know why the nurses hold this beer-glass sized contained up so high (picture the Statue of Liberty with her torch), but they look for all the world like staff in a busy pub, carrying a glass of Canadian draft to a thirsty patron.

There are certain benefits involved with the nasty catheter. For example, one can drink limitless amounts of fluid without the inconvienience of having to get up to stumble to the bathroom for a pee at 2 a.m. This afternoon I drank several large glasses of ice water, a cup of tea and a container of apple juice with lunch, and finally, later in the afternoon, a large cup of Starbucks coffee. One-point-seven litres of urine is produced while I have not the slightest sensation of a full bladder.

Yesterday, before sending me into Lala Land at the OR, Dr. Evans asked if there was anyone I'd like him to call to report on the surgery. I gave him Gerald's phone number in Port Coquitalm, and I had already instructed Gerald to, at their request, call Jane, Judy, Pat, Billy and Steve.

Today, Dr. Evans tells me that he repeatedly tried the number but was unable to get through. No answer, no answering machine. This is concerning. Gerald does not have an answering machine, but he certainly would have waited for word on my surgery before heading our anywhere. In fact, I remember that he was going to take the day off work to wait for a call.

A nurse was kind enough to try the number for me, again and again, on the Stepdown cell phone, but to no avail. By  3 p.m. I arranged to have a phone by my bed. By 4 p.m. I was wondering who I might call to find out if something has gone wrong. Gerald, if nothing else, is reliable. If he says he'll wait for a call, he'll damn well wait for the call. Understandably, I'm worried.

Then, Gerald strolls into the ward and up to my bed with a cheerful hello, to which I replied, "Where the hell were you!'

"I just got off work."
"Where were you yesterday, when Dr. Evans was calling to let you know how my surgery went?"
In a patient voice, not quite with his eyes rolled up to the ceiling, but close, Gerald says, "You called me yesterday. You told me the surgery went fine. Remember?"

Times like this, I want someplace to hide, someplace dark, quiet and completely out of sight, until everyone forgets my latest faux pas. At least there was a reason for this one: the epidural.