Monday, June 25, 2007

June 25, 2007 - The Operation That Wasn't

Today I go to Ocean Medical Center for my long-awaited surgical biopsy (removal of a swollen lymph node near my right collarbone). I get all the way to the operating table, but then the operation is abruptly called off. Here’s the story.

I arrive at 2:30 p.m. (My original time was 1:30, but the hospital same-day surgery department phoned me to push my appointment back an hour, due to operating-room delays). I’m ushered back into the pre-op area, then prepped for surgery (don a hospital gown, get an IV line inserted, answer lots of medical-history questions). I meet Dr. Jeffrey Winkler, the anesthesiologist du jour, and discover that this doctor – unlike the one who sedated me last week, for my colonoscopy – has no problem with my using a BiPAP machine in the operating room. He does explain that I’ll be under “conscious sedation” – which means I’ll probably be aware of some of what’s going on in the O.R. With this kind of surgery, he explains, most of the pain control is local anesthesia, administered by the surgeon. The sedation is just to keep me comfortable, while all this is going on.

Two and a half hours after we arrived at the hospital, an orderly shows up to wheel me into the surgical area. After 10 or 15 more minutes’ waiting outside the O.R., a nurse wheels me inside, lines up my gurney next to the operating table, and has me slide over. Dr. Winkler is busy behind me, preparing to administer anesthesia. Dr. Gornish, the surgeon, comes in and greets me. “Let’s find this thing,” he says – all business – and he begins feeling around the base of my neck with his fingers. He seems to be taking longer than I’d expect, and soon I learn the reason why. He can’t locate the swollen lymph node he’d distinctly felt nearly a month ago, when I saw him in his office.

Dr. Gornish consults the diagram he drew at the time, then comes back and palpates me some more. Still no sign of the swollen node. It wouldn’t be responsible to proceed with the surgery under these circumstances, he explains. He could end up cutting me in the wrong place, then have to enlarge the incision until he found the suspect node. I could end up with way too much muscle and nerve damage. The best thing to do, he thinks, is for me to go for an ultrasound-guided needle biopsy. It won’t produce as large a tissue sample for the pathologist to look at, but at least the procedure can be accurately targeted. First, though, he’ll write me a prescription for a simple ultrasound, for a quick look-see.

In moments, the O.R. team swiftly undoes all the pre-op preparations they’ve just taken me through. There’s some light-hearted kidding around, among these twentysomething nurses and technicians, about my having missed out on the drugs (not the first thing on my mind, to be sure). I never do receive any anesthesia – although Dr. Winkler does tell me that, just before the cease-and-desist order, he gave me an anti-nausea medication through the IV line. It should cause me no ill effects.

Someone wheels me back to the same-day surgery staging area. In the curtained-off cubicles around me are several other patients, the few stragglers remaining after a long day of surgery. The woman across from me is holding an ice pack to the side of her face. In the cubicle next to her is another woman with a vomit bucket on her lap. Both of them have that ashen, post-surgery pallor. The nurse calls Claire in, removes my IV, and tells me I can get dressed. I don’t know whether or not I should feel fortunate – especially considering the fact that I may have to go through this whole routine soon again. We’re home by 6 p.m.

What does all this mean? It’s anybody’s guess. Because the swollen lymph nodes have been visible on various scans since March, I don’t think they were merely the by-product of some transient infection – though I’m no medical expert. If they were cancerous, then did the cancer suddenly and inexplicably reverse itself? Or are they still hiding out, but too deep, now, to be detected by touch?

It’s too early to say. The only certainty is that more tests are in my immediate future. Tomorrow I’ll leave a message for Dr. Lerner at his office, and find out what he recommends.

One way or another, cancer is forcing me to live one day at a time.


Anonymous said...

Carl...I can't believe it! It's as if you need to keep going through all the endless possibilities so you can have the experience! Let's hope that the missing lump is a GOOD sign!

Pat Shoppell

Carlos ("Carl") said...

Well, I can think of a lot of other ways I'd rather gain life-experience...

Vicky said...


Reminds me of a biopsy I endured on a CT table that was supposed to take "10-15 minutes" and lasted almost 100 minutes. The Ortho Surgeon assigned his PA to get the sample from a bone and she just couldn't quite "reach" the area so kept probing, poking etc. I had no anesthesia - was told it was "no big deal" so I laid there breaking out in a sweat from the pain each time she stuck that needle in. After all of that, I was temporarily relieved as they told me "NO CANCER!!!". A follow up visit with the actual surgeon soon dashed that hope - the PA had not biopsied in the proper spot and they had to put me "under" and did an open biopsy which did confirm mets to the bone (from the original br cancer dx.)

And this was at a well-known respected cancer institute!

Anyway, sorry for the detour there, heartfelt thoughts and prayers are with you!

Carlos ("Carl") said...

What an awful experience, Vicky! Makes me cringe just to think about it.

At the hospital, people kept telling me I've got a good surgeon in Dr. Gornish. My respect for him has actually gone up, after this episode. A good surgeon has got to know when to hold 'em, but also when to fold 'em.

Anonymous said...

...It's all such a mix of art and science. I certainly look and hope for docs to be both very agressive (let's figure out what the heck this is) and very cautious (let's not cut when we don't have to.) A doc I once knew would say "this is why we call it practicing medicine."



Mary Beth said...

I have to agree with your assessment that a good doc knows when to say when. You might have really "lucked-out" here....maybe this was all a BIG NOTHING. In the mean-time keep up your good attitude!
Mary Beth