July 10, 2007 - Have BiPAP, Will Travel

Today, Claire and I drive over to Ocean Medical Center, for the needle biopsy of my superclavicular lymph node (medical jargon for "above the collarbone"). I've been through this procedure once before, for the January, 2006 needle biopsy of the bulky tumor in my abdomen, that confirmed the lymphoma diagnosis and helped chart my whole course of treatment. Once again, Dr. David Feng will conduct the procedure.

Dr. Feng is an "interventional radiologist." That, as I understand it, is a relatively new medical specialty. Basically, an interventional radiologist is a doctor who sticks something into your body, while gazing at images on a screen that are provided by some form of radiological scanner (like an ultrasound or CT scanner). Sometimes the procedure is done for diagnostic purposes (as with me, today). Other times, its purpose is to deliver some form of treatment (such as placing a stent, or performing the "radio frequency ablation" treatment that zaps lung or liver cancer, through a needle inserted directly into the tumor).

As we drive over there, I try not to think about the fact that I'm voluntarily walking into a place where somebody is waiting to stick a needle into my neck.

Ocean Medical Center's Interventional Radiology Suite opened a couple of years ago, to great fanfare. It's a specialized operating room, that contains not only an operating table, but also an array of radiological scanning equipment.

Anesthesia is mostly by sedation, rather than general anesthesia. When the nurse in the same-day surgery staging area asks me about prior difficulties with anesthesia, and I relate my tale of waking up on the operating table twice (during my previous needle biopsy, and during the surgery to implant my port), she explains that I won't be dealing with an anesthesiologist today. Dr. Feng, she says, is his own anesthesiologist – and, I won't see him until I actually go into the operating room.

O.K, I think to myself. I'll go with the flow on this one. Today, I've brought not only my BiPAP mask with me, but the whole BiPAP machine. (It's a lesson learned from experience.) When it comes time for them to roll my gurney down to the surgical suite, the shoulder bag with the BiPAP in it is sitting on top of my legs. I have to be vigilant in hanging onto it. At least one nurse mistakes it for my personal belongings, and tries to whisk it away into a storage locker.

When I get to the operating room, two nurses there introduce themselves, and immediately ask about the black shoulder bag sitting on top of my legs. I explain that it contains my BiPAP machine, that I use it every night for obstructive sleep apnea, and that I'd like to use it during the needle biopsy, if that's O.K. with Dr. Feng. Fortunately, they don't seem fazed by this, at all – although they do grumble a bit that no one from same-day surgery warned them I'd be bringing such a machine with me.

It turns out I'm going to undergo this procedure without even shifting onto the operating table. I'll stay right on the gurney. (Sort of like drive-thru surgery, I think to myself.) There's no convenient place to put the BiPAP machine, so I just shift my legs to one side of the gurney, and the nurse places it on the other side. I put the mask on, myself (I'm a lot more familiar with it than she is), and she hooks up the tubing and plugs the electrical cord into an extension cord she pulls down from the ceiling. I explain that, once the mask is on, I won't be able to talk without first taking it off (the positive airflow of the BiPAP into my nose creates a sort of vacuum effect that keeps my mouth closed: which is precisely why the thing is so effective in preventing apnea – the dropping-down of the soft palate and its side-effect, snoring).

So far, all my dealings have been with the two nurses. I haven't seen Dr. Feng at all, and – with me looking straight up at the ceiling with the BiPAP mask on – I realize the chances of my having any meaningful conversation with him, pre-surgery, are not good.

The nurses shave the area at the base of my neck (I've got body hair there), then apply antiseptic solution. They explain that I'll first get some novocaine injections around the target area, and that I'll feel some pain and burning from that. I do, but it's not severe. Around now, I become aware that Dr. Feng is in the room. Because of my flat-on-my-back perspective (and because the nurses have directed me to turn my head to the left, away from the right side where they'll be working), I never do see him. I hear his voice, though – as he squeezes some ultrasound goo on the base of my neck, explaining that he's first going to take a look at the enlarged lymph node.

The next thing I hear is the nurse, explaining that she's going to start the sedation. Patients generally respond one of three ways, she tells me: they sleep, they get "very mellow," or they get very chatty. She doesn't think I'm the sort that would fit into the third category, she says. (Brilliant deduction, Sherlock; I couldn't say anything with the BiPAP mask on, even if I wanted to.)

As it turns out, my response is somewhere between sleeping and "very mellow." I feel no pain throughout the procedure, although I am aware of a repeated clicking sound – which, I realize, at the time, is probably Dr. Feng, doing whatever snipping-out of tissue he does, using the hollow biopsy needle. It seems like no time at all before I hear Dr. Feng's voice saying, "We're all done." One of the nurses explains that a pathologist has been on hand, and has confirmed that the biopsy produced a large-enough sample for analysis.

I have no recollection of the trip back to the same-day surgery staging area – other than deciding to use the BiPAP there for a while as well, to take a little snooze. I awake a while later, with Claire sitting by my side, and it's not long before the someone feeds me some lunch, and the nurse tells me I can get dressed and head home.

I see Dr. Lerner on Friday, and should learn of the results then.