It was 20 years ago today...Part Two

Because the hospital wanted me there before dawn on the 3nd, I drove to Winston-Salem the night before and tried to sleep at a nearby motel. I appeared on time and signed multiple pieces of paper agreeing to.... whatever they said. After being thoroughly processed - including shaved in places where the thought had never occurred to me - it was explained that I was to have an angiogram. This was to give Doctor Brown a detailed roadmap of the inside of my skull before he went inside. Seemed reasonable. More papers to sign. I remember being wheeled into a large room, wall to wall with equipment and what seemed a dozen technicians. I remember counting backward from 100 to something in the high 90s. The next thing I knew I was in a hospital room with a bandaged and sore groin.

Later that afternoon my mother stopped by. She had come from Virginia so I would not be alone in the hospital. While we were chatting Dr. Brown appeared. In his usual stoic manner he said the angiogram did not show a “growth.” It showed an aneurysm. They would look about the same on an MRI. My relief at finding that I did not have a tumor was momentary. He explained I had a “giant” aneurysm, an artery had ballooned to about the size and shape of a grape; he did not have to explain what would happen if it burst. Worse, it was in a location he did not like. He described it as inoperable; he said he really did not want to have to go in and try to fix it. “Might lose you on the table.” No nonsense, that Dr. Brown.

He explained he wanted to try an old procedure, one that involved putting a clamp around the artery in my neck that feeds the aneurysm and slowly close off its supply of blood. Clamped shut, blood from the heart could not put pressure on the weakened artery walls. In addition was the possibility that the aneurysm would be filled with clotted blood and eventually become a stable, solid mass. With no blood pressure to cause a rupture, and the area of weakness plugged, the aneurysm would be no longer life threatening. He said closing off one of the four carotid arteries should not cause any long term problems, in effect, 3 out of 4 wasn’t bad. He said the operation itself was relatively simple.

He asked if that was OK with me. I said sure, go ahead. At that point one procedure seemed as good as another. I still was not sure what an aneurysm was, but from his tone I guessed he wished for my sake it had been a “growth.” I asked how I got this aneurysm. He said I was probably born with a weakness in the artery wall that, over time, ballooned out creating the probability of a blowout. He continued that most of the time they were found only after they began leaking. So far, we were ahead of the game. Mother looked horrified, but said little. After she left I thought about running up and down that basketball court New Years Day with such abandon with a weak, ballooned blood vessel ready to pop in my head. Damn.

Later Dr. Brown came by my room to show me what a Silverstone clamp looked like. Quite taken by what would be implanted in my neck I reached out, picked it up off the tray, and gave it a good once over. It was about the size of those little metal pencil sharpeners I carried in my school box in the 5th grade. There was silence; the doctor and nurse looked at each other. Finally, as I gave it back, Dr. Brown reminded the nurse to sterilize the clamp before next morning, more for my ears than hers.

I spent an uneventful night as hospital nights go and remember nothing of the operation the next morning. I do remember throwing up on two nurses in the recovery room after I asked them to raised the head of my bed. In fact I threw up on just about everything within range. They smiled, accepted my profuse apologies, and had me and the environs cleaned up in no time. I was impressed; they were good. “Happens all the time,” they said.

A Silverstone clamp has a detachable tube that sticks outside the body that allows a small screw driver to reach the screw in the clamp, making adjustment possible. So after the operation I had a metal tube attached to my left internal carotid artery sticking out the side of my neck. Think Frankenstein. It was during my time in the ICU I realized why they did not have handy mirrors. When I found one I discovered that I didn’t look so good. That was also when I decided that surgeons must get paid for incisions by the inch.

But before I was in any condition to consider my appearance I had to pee. During and after the operation I was hooked up to an IV just poring in fluids. Drip, drip, drip - about that fast. The anesthesia had so relaxed my muscles that I could not void the old bladder. Hours passed. My bladder filled; a bulge appeared below my navel. The nurses kept trying to get me to relax and to fill up a plastic liter-sized bottle. Darkness fell. Finally a nurse came in, and, reflecting upon the empty bottle, advised that they were soon going to have to use a catheter if I was unable to fill the bottle by conventional means. She also allowed that she was going off-duty and the next nurse was rough, I had better get on with it. By now I thought I was going to burst and the idea of that catheter had me sweating. I may not have known what an aneurysm was, but I had heard about catheters. I stared at that bottle; this was going to require my undivided attention.

Sure enough, about midnight the new nurse appeared, as described. She demanded to see my bottle. She had tubes and paraphernalia in one hand and a wild look in her eyes. Never in my life have I ever been as proud as the moment I pulled from underneath my sheets - where I had been hiding it - an almost overflowing bottle of urine. She seemed disappointed when I handed it to her. Had she had been ten minutes earlier...

The next day I settled down into the routine that passes for normal in an ICU. I had very little discomfort (medical jargon for pain); my biggest aggravations were changing the IV needle, all the equipment they kept me hooked up to, and boredom. Once a day, for three days the screw was turned in the clamp, thus gradually reducing the flow of blood to my head. Every few hours a nurse would come in and ask me questions and scratch the bottoms of my feet; they were checking for brain damage as the blood flow diminished. As long as I knew what day it was and could feel the bottoms of my feet, I was probably OK.

The ICU was generally quiet. Most patients could neither talk nor walk. I could do both. Always the oddity. Visitation was restricted. Thanks to my ex-wife driving her almost two hours each way, my eleven year-old daughter could brighten up my room, but only for a few minutes at a time. Besides, she could not come every day; she had school. For the most part I read from the pile of books I brought with me and adapted to my surroundings. I kept telling the nurses I was fine, they should concentrate on the sick people. They kept coming in anyway.

One day there were unusual sounds from the adjacent room. I heard alarm beeps and staff moving quickly in the hall. Code this or that sounded over the intercom, doctors were summoned, and family members called. Then quiet. A few minutes later the family left. I heard gentle crying as they walked down the hall. It did not take a genius to realize that the patient next door had died. About a half hour later, behind schedule, my nurse swung open my door, bounced into the room, and with a big smile asked how I was doing. I just stared at her. I asked how she just did that. She stopped short, and looked a bit surprised. I told her I knew that her patient next door had just died, and yet she was able a few minutes later to come into my room smiling, positive and professional, as if nothing had happened. The smile left her face. She said yes, the patient next door had died. She said it hurts every time and she had never been able to get used to it. She said not letting other patients see her distress was the hardest part of her job, the hardest thing she had to learn. I asked no more questions as she checked the monitors, scratched my feet, completed her paperwork, and closed the door.