Thursday, February 4, 2010

Why Me? Why Not Me? Part Three

This is part three of Alison's ongoing story about diagnosis and treatment of her bladder cancer.

by Alison

“… And the blind shall see.” (Luke 4:18)

About a week after the cystoscopy where I saw my tumor(s) floating dreamily in the water, I had surgery and the tumor was removed. It was day surgery, and went like most day surgery does: you arrive, strip down, get put on a bed with wheels, are wheeled about hither and yon, and wait a lot between places. You’re in this assembly line and you end up in an operating room.
Everyone was very nice to me. I’ve noticed this before. I guess when patients appear before hospital staffers briefly on an assembly line, it is easier for the staff to be pleasant, attentive, and reassuring – compared, say, to a patient’s office visit or ER visit or a stay on a hospital floor. There, the patients are around long enough to make their own feelings and wishes known, and workers are expected to respond. They do not, under these circumstances, always respond helpfully. Geezer-Chick herself was waiting a long time in an ER for something to be accomplished and she said to a doctor that she didn’t exactly enjoy being there. You would have thought she had criticized his child or something. He actually said, “You are talking bad about my workplace!” He berated her for this. To her, it seemed obvious that no one wants to be in an ER – right?
I was horrified when she told me about that. I have worked in health care for about thirty years, and the first rule, actually right up there with Do No Harm because it is a way of Not Doing Harm, is Be Nice to the Patient. That includes not berating, not yelling at, not being sarcastic, not being rude, not putting down, not rolling your eyes, and just – stifling it when a patient is being a pain. (Note: Geezer-Chick was not being a pain at all.) The patient is the one seeking help; you, a nurse or doctor or whatever, are the one giving help, and indeed are being paid to provide help. For this period of time, these are your roles. Period.
I had to take this little test at the hospital where I work and one of the questions was about a hypothetical patient in the ER who is drunk and lewdly harassing a nurse. Among the multiple choice options about how to handle it was, “Go to the patient and explain that this is against hospital policy and he must stop.” I would never check that one, though it turned out it is the one the testers thought correct. No! Patients are not

supposed to know hospital policy. No! A drunken patient is not going to sober up when you talk earnestly to him. The nurse is supposed to either suck it up and deal, or get another nurse to tend to the patient who can. (I have strong feelings about this!)
Anyway. I ended up in an operating room with a lot of nice people bustling around in blue scrubs and paper hats. My doctor was there, greeted me warmly.
He chose spinal anesthesia for me. I was surprised, but he said it was safer. So the needle went in my back—not totally painlessly, by the way—and after a while I became totally numb from about the sternum down.
This lasted for hours. It is very very odd to touch your own thigh and not “feel” that touch, or to move your foot and realize it never moved. No matter how hard you try.
He also gave me something to sedate me mentally, but I never felt like I was asleep, the way I have in other day surgeries. I felt like I was more or less alert the whole time—though maybe I was not. I do remember clearly hearing my doctor say to the resident who was actually doing the work under his supervision, “See that? That is all CIS.” I knew what that was but my words took awhile coming out. Finally I said, “I know what you said. Carcinoma-in-situ!” They said yes, yes, that is right. Carcinoma in situ just means “cancer in place.” It is also good news, because it tends to refer to cancer that has not moved away from its original place, that is, it has not spread.
What seems most extraordinary to me is that the doctors worked with a camera and a light again the same way they did with my cystoscopy. They could easily see everything they were doing. My doctor said to the resident things like, “over to the left there…” I could not see the TV screen this time. But imagine! The doctors could! I suspect cleaning a bladder of tumor is roughly similar to a D & C – where a uterus is cleaned of its removable lining. I have heard a D & C described as somewhat like scraping out melon seeds with a tiny spoon, through a very small opening. It is (or was?) done by feel, not by eye. As such, there is some skill to it, and it can be learned. But my doctors could see exactly what they were doing. They knew the extent of the tumor and were able to take it all out. There have been untold generations of healers and doctors who could not see what they were doing and tried anyway; inside the mysterious human body. Now it is different. Now the blind can see.

Next up: Treatment Plan!

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