prelude: random mental sprawl
I had a minor surgical procedure yesterday, one which was probably needless but which brought some fresh anxiety into my days. Being fully put under is weird. I’m not making a big deal out of it, but being “put under” is not something I go through every day, so I wanted to record my memory of it as best I can for whatever posterity awaits me when I am gone and completely put under.
Sedation is a fuzzy beast. I found myself trusting the actions of strangers surrounding me, some of whom may or may not have full backgrounds in medicine. Some of these guys might have had backgrounds in publishing or engineering before making a late-life career change.
These guys seemed more trustworthy than the last, she who munged the insertion of the needle and made weirdly formulaic chit-chat afterward, covering her possible lawsuit with textbook questions like “What’s your favorite movie?” as I lay there with a needle jutting 60-degrees out of my arm. As much as I hate needles I could only chuckle at the woman’s way. I ignored her questions.
It reminded me of a sports blooper. A novice reporter covering Olympic swimming asked her esteemed elder colleague Jim McKay how she should approach these world-renowned athletes. McKay advised her to butter them up with non-sports-related questions, like what their hobbies are or where they grew up.
The cub reporter was there when Mark Spitz won a gold medal with a world-record-breaking time. Spitz lept from the water in unbridled joy, tears streaming down his face when the reporter ran up to him and yelled “WHAT’S YOUR HOBBY?”
I was told not to eat or drink anything for 8 hours before the procedure, which was scheduled for 2pm. On account of the ban on any intake (including juice, water or tea) I slept as late as I could so as to avoid as much hunger as possible. People in this world suffer through considerably greater hunger and dehydration than this, and on that account I was almost happy to take a half day off of my American gluttonousness. But world hunger is another matter for other discussions and other agendas.
It pained me to sleep so long, but I forced my eyes to stay shut until 12:30pm, when I got up to shit and shower. The remaining time I passed in the way I pass so many days: Playing piano. Practicing piano, playing piano, this is the surest way for me to make time disappear, and Schubert is my composer of the moment for when I need to consume as much time as possible. The middle movements of Schubert’s gigormous G-Major Sonata are my current explorations, and I made a quick study of the B-Major trio passage before taking a crack at Schubert’s “Beethoven” Sonata — that’s what I call the late C-Minor Sonata of Schubert, for its first movement seems to be an attempt at Beethoveniana. I also hear echoes of Beethoven’s “Waldstein” Sonata in some passages from the first movement of the great D-Major Sonata of Schubert.
I started playing at 1:00pm, and when I stood up to check the time it was 1:18. 10 more minutes, I thought, and I’ll walk over. More Schubert, flipping pages to what I call the “Hunting Song” passage from the 2nd Movement of the D-Major Sonata.
My mind rambles not so far and not so wide when I play at the piano. Some memories return like clockwork any time I play certain passages. Every pianist I’ve ever known has discussed their earliest piano lessons at 6 years of age as if they just happened, as if they were as vital a part of their work today as decades earlier. The musician’s art (as the writer’s and the researcher’s but never the surgeon’s) always builds on their earliest lessons and disciplines.
While rummaging through passing memories of grade school nuns teaching me 5-finger patterns and conservatory professors expounding on the depths of their pianistic heritage I remembered that I had to stop at an ATM to get cash for the $55 co-pay. I contacted my ex-girlfriend to give what I thought would be approximate timings for my arrival and departure from the office. She had offered to escort me home after the procedure. This “escort” was recommended in the paperwork from the doctor’s office, since the sedation after-effects could make normal travels (even walking) hazardous.
I got there a few minutes before 2pm. I signed 3 sheets of paper authorizing the sedation, the endoscopy, and something else I didn’t read. We did this exact procedure 5 years ago. At that time a camera-headed tubular -oscopic thingy was sent down my sedated throat, deep into my innards, almost down to my asshole, to see what damage acid-reflux might have wrought and causing me sudden, nearly permanent heartburn.
Over time my esophageal sphincter had loosened, letting acid from below rise up and cause really ugly heartburn. I thought this was a symptom of aging but I soon learned that it’s a pretty common problem. A friend of mine is 23 and she has had acid-reflux since she was 13, and since she had no “insurance” her parents have had to pay face value for exorbitantly over-priced Prilosec every day since her teenage years.
The consequence of the procedure performed upon my earthly vessel 5 years ago was a prescription to Omeprazole (a Proton Pump Inhibitor [PPI] that is a generic version of Prilosec) and that was about it. The prescription was renewed a number of times, and I felt just fine as long as I took the pill every day. The only signal that bothered me was that if I skipped a day or forgot to take the Omeprazole then the heartburn was way, way worse than it had ever been before. It was like I was on fire. A fistful of Pepcids couldn’t do squat to douse the flames.
5 years ago the conventional wisdom was that Omeprazole and similar PPIs could be prescribed indefinitely with no risk or side-effects. Now the thinking has changed a little as some patients have developed osteoporosis, magnesium deficiencies, esophagial cancer, spinal weirdness and other delights likely or definitely blamed on long-term use of Omeprazole. It seems that most of these instances (which are still very few in number) are among people with other pre-existing conditions and vulnerabilities, but I don’t know what to believe. There are 2 procedures I would consider for this problem, one endoscopic and the other minimally invasive. But as long as the pills are still generally considered safe I don’t have a problem with popping an Omeprazole every day.
After signing those 3 sheets of paper I took the one remaining seat in the waiting room. There was a problem with the waiting room. The room was crowded, but that was not the problem. No, the problem was that I felt like I was sitting in a homeless shelter. Someone among us had shit or pissed their pants. My eyes watered over with stains of tears induced by the foul stench of these crotchy fluids. I looked around, timidly, but did not see anyone who looked like a hobo vagrant. I could not figure out who might have wet themselves, and in the potentially incontinent anxieties of the moment I asked myself: Did I just shit my pants?
It was not I, but I remembered a comedy routine in which a woman described stepping into a conspicuously empty subway car to find that it was probably empty because someone had dropped a monster dump therein. The subway car smelled fouler than a landfill, and the subway car was empty because anyone who might have inhabited the space had certainly evacuated to adjacent, dumpless carriages.
The comedian said she had the same instinct (to evacuate) but she chose to stay just so she could mine for comedy in the reactions of future passengers who stepped in to the car and clenched their noses in sour remonstrance, quickly turning right back around to exit.
I entered the sedation chamber. I was told to put my jacket and other things on a metal cart. One of the anæsthesiologists was a short, ruddy man with a pretty impressive paunch. The other was a tall, bald Greek man who had told me to put my things on the metal cart. He asked me “Have you had anything to eat or drink for 8 hours?” I said “No.” He asked “No water, tea, or juice?” I said “No, water, no tea, no juice.” After I left my camera and jacket and hoodie on the metal cart he grinningly tapped his right temple, signaling for me to leave my eyeglasses on the metal cart. I did.
Lying down on a table to be sedated is a vulnerable way to be. I felt like nothing more than a fleshy bag of water and bones, resigned to trust the competence of strangers, strangers whose credentials and backgrounds were unknown to me. By my estimate these men seemed fully competent in their demeanor and actions, this differing from the previous encounter recounted above in the Mark Spitz anecdote.
A needle slid into my right arm. A plastic clip grasped the tip of my right index finger. A blood pressure device wrapped around my left arm and squeezed into action 3 or 4 times throughout the process. I faded to unconsciousness and mumbled to the anætheologist “How’s my blood pressure?” He chuckled and responded to my question, but I can’t remember what he said. These guys must hear a lot of amusing things as they inundate their patients’ minds with sedation.
My head filled with heat and nothing. My hands and feet grew cold but my head stayed hot. I felt a swath of sweat form on my scalp before my head, too, went cold. The sweat disappeared. This, I thought, must be what dying feels like. This deceptively cozy feeling of comfort must be how it feels when the charge of life evacuates its borrowed vessel.
The tall bald Greek man told me to lie on my side and bend my knees like I was going to sleep. He put a round plastic thing in my mouth and told me to bite on it. As I did this the doctor entered the room. Apparently referring to a previous patient he addressed the anæstheologists, saying “That’s a first. I’ve never seen that before.” The others either mumbled or said nothing. I don’t know the “first” to which he referred but something about his statement assuaged any ambivalence I had about the person, giving me confidence that he was actively involved in his practice and not (like most doctors I’ve seen) going through the motions of his work on auto-pilot. I trusted him. I trusted the others. I trusted that my things would still be on that metal cart when I came back in 10 or 15 minutes.
(This gastrœnterologist got a 1-star rating on Yelp. I take Yelp less seriously than the raving drunk delivering her 4am sermon at the bar. The single Yelp reviewer who Yelped this gastrœnterologist with a 1-star rating appeared to be an asshole. To quote several people I know with experience in being Yelped: “Yelp is where all the assholes go.” Ironic, in a way, that a gastrœnterologist would attract assholes.)
I was probably gone for 10 minutes. When I came to the needle was still stuck in my right arm. I questioned that but my mouth couldn’t move to ask WTF. Faceless tall people, like the adults rarely seen in Charles Schulz’ “Peanuts”, surrounded me. All seemed well, as they looked anywhere but at me. The beats on the heartbeep machine stopped, not to signal my death but that monitoring was no longer necessary.
Waking up from a complete obliteration of consciousness is existentially disorienting. There are no dreams to forget, no grousing on the quality of sleep, no sense that anything at all had just happened. I lay on the table for many minutes, thinking how my schedule would have to adapt to waking up at 12:30pm, going right back to sleep 2 hours later, and consuming no organic matter all the while.
I remembered those nightmarish accounts of people whose anæsthesia had worn off in the middle of major surgery, allowing them to feel every detailed sensation of scalpels and knives screwing into their exposed guts but rendering them powerless to so much as grunt in protest.
This was far from major surgery but I wanted to know what feelings might inhabit my body as a result of it. I didn’t remember any particular after-effects after the procedure of 5 years earlier but the paperwork I signed this day said that I might experience a sore throat for a few days.
The most notable feeling I had this time was of having eaten a big meal. I was hungry going in to this procedure (having consumed no water, no tea, and no juice for over 8 hours before) but I came out feeling like I could wait a few hours before grabbing the sandwich I had planned to devour after the procedure. The endoscopic tube going down my throat and into the digestive tract must have created an illusion of having consumed foodstuff, expanding the corridors as might food itself.
This, I thought, is the diet fad of the next 10 minutes: Lose weight by shoving an endoscopic tube down your face!
The tall Greek man asked if I was dizzy. I said no, and we slowly stood me up. I stepped across the room to get my things off the metal cart. The cart was empty. My things were gone! I mockingly confronted the man, asking “Heeeeeyyyy, man, what’d you do with my stuff? I trusted you guys…” He chuckled, and gestured toward the next room. He said he moved my stuff to the next room when he thought he might have to move me to another bed. I don’t know what that was all about but my stuff — my “STUFF”, as George Carlin might say — was all present and accounted for in the next room.
After a few minutes I stepped into the gastrœnterologist’s office, where he was all smiles, telling me my innards were virtually identical to how they looked 5 years ago (confirming my instincts that this procedure was completely unnecessary). He changed the prescription from Omeprazole to something else (I think it starts with a P and ends with -zole, but I can’t read his handwriting). Then he told me “Don’t drive a truck for the next few hours,” and I stumbled away.
I called my ex-girlfriend. I unwittingly confused her about the timing of things (long, useless story that) but she came over as quickly as she could to help make sure I didn’t stumble into traffic (I almost did). We broke up rather abruptly around New Years. This day in April was the first time we’d seen each other since. Now, as then, I swear that I could read her mind. I knew everything she thought from the confused ambivalence to the lustful thoughts to the dismissiveness of my apparent lack of ambitions to the regrets (mutual) over how it all went down with us. But we made a civilized time of it all. She came in and we watched CBS 2 News on my gigormous 70″ TV. We made a summary tour of things that have changed in my apartment since the last time she was there in December.