Gastric Sleeve Surgery

Okay, in this post I'm in the talk about the surgery itself. It's going to cover the time from the pre-surgery assessment on the Tuesday before surgery until the release from the hospital on Wednesday two days after the surgery: a period of eight days.

I'm using Dragon Nuance software where I'm dictating this into my MacBook Pro. It's great software, especially for someone like me who's a very lousy typist. Unfortunately there can be some problems with spelling, capitalization, punctuation, and just wrong words. I've tried to correct as I've gone along but I would appreciate any feedback on where additional corrections should be made. Some of this material is kind of hard for me to read over again and especially hard for me to read over and catch mistakes in.  Dragon, for some reason, thinks I say "in" when I mean to say "and" and you will see that more than I would like and those are hard to catch. So bear with me.

When I had talked to the surgeon back in October, it was one of those brief doctor meetings. Everything seemed kind of rushed. It didn't seem like he wanted to really get to know me or anything.  Now, for a surgeon, he seemed actually very nice. Most surgeons I have met are arrogant pricks, and this guy was clearly not that. He was very handsome, very much in-shape. Most of his clients were very obese women. I imagined they were thrilled to get any kind of attention from him. Here I was, an obese gay man.  He didn't seem at all homophobic but you never know.

He immediately suggested the gastric sleeve.  He suggested this because first of all, I was not that overweight. And secondly, if I did gain weight following the gastric sleeve,  there was something else we could do, namely the Roux-en-Y. If we did the Roux-en-Y first, we were stuck. There was nothing beyond that. Since almost everything I have done has failed it seemed silly to do something that didn't have a failsafe option so I immediately agreed that the gastric sleeve was the way to go. And I certainly liked the idea he thought that there was something I wasn't fat enough for.

Getting back to the day of the preop assessment. On Tuesday morning at about 8 o'clock I got a call from Brittany, "that I did know that my appointment for the fourth class was at 9 AM didn't I?"  Well, no I didn't! I had gotten Robo-called by the hospital on Sunday night that I had a 1 o'clock appointment at the pre-op clinic on Tuesday afternoon, but I had no appointment for any kind of class on Tuesday morning. In fact, all my other classes had been at 3 o'clock on Tuesday afternoon. I had a patient scheduled for 9 AM on Tuesday morning but I wasn't going to let this get in my way. In the seconds before my 8:15 patient showed up, I texted my 9 AM patient saying an emergency  had come up and I could not see him at nine. After my 8:15 patient,  I bolted to the hospital and got there about 10 minutes late and had my fourth class. It's all kind of whirlwind, but they gave a lot of paper and it was a lot about the diet the first week after surgery -- I didn't know it, but there was a diet to follow the 10 days before surgery. Since we were now two days out from Thanksgiving this meant that I wasn't going to have the Thanksgiving I'd planned on it and I knew that my husband was going to be very disappointed as he had been planning this Thanksgiving for quite a long time.

In the class people were excited–nervous about their upcoming surgeries. I was right along with them. We met a woman who's going to visit us in the hospital, another dietitian type. I now learned that most of the bariatric surgeries go to the same place, the same floor after their surgeries so we patients might run into each other. I began wondering,  but never asked,  how many people were going to be in each  hospital room. When I was done with the class, I still had time until the pre-op assessment and  thought I might do some work for a psychopharmacology class I'm taking online.  I checked the syllabus to see what was due, and it turned out there was a midterm exam due the next day that was already posted online. So for the next couple of hours I sat in the hospital atrium and used the hospital's Internet to take my pathophysiology midterm exam. Guess what? I made an A!

After I finished the exam, I went to the Apple Store around the corner from the hospital for some one-on-one training I had previusly scheduled and then it was time for my pre-op assessment. They've really got everything mechanized now.  The last time I had surgery of any kind was to get my tonsils removed when I was six years old more than 45 years ago. Technology and medicine has changed since then. Today, Pre-op assessment is its own building with its own doctors and nurses. I spent the better part of three hours getting assessed. I had a cold about 10 days ago and still  had  a lingering cough and wheeze. I was really afraid this was  going to hold up the surgery but I also did  not want to go in for surgery and die from respiratory problems so I was torn. I ended up being pretty honest and straightforward about all the medications I take my medical history etc. etc. The doctor was really nice and answered all my questions,  even my questions that had more to do with my pathophysiology class than with my upcoming operation. After the exam, he sent me to the lab for blood work and then I was off  to see my own clients.

The next day, I got a call that my blood levels were abnormally low in vitamin D in that they would be sending a prescription to my local pharmacy that I should begin taking but not to worry, that many people in these northerly climes have low vitamin D and it's not life-threatening and won't stand in the way the operation. The next thing I should hear will be a phone call on Friday between 2 o'clock and 5 o'clock in the afternoon telling me when to show up at the hospital for the surgery itself.

The next day was Thanksgiving, and I tried as much as I could to stick to a high protein low carb diet. The ideas this I was told was to shrink my liver so that it would stay out of the way and they could better operate on my stomach. This makes sense to me. But damn, I like my dressing. I like my pumpkin pie. I did not have a single bit of pumpkin pie And just a tiny bit of cranberry sauce and just a little bit of dressing.  I only really lost my willpower on the dressing.  but Jesus, it  was Thanksgiving.

The next day I got the call from the hospital just as they said I would. Of course when the call came I was in the only spot in the hospital where I work on Fridays which is a dead zone for cell phone calls, but I didn't know it, so I had trouble getting the call. I ran outside to call the hospital back iand after just a little bit of confusion found out that I was to report to the hospital at 7:45. Of this couldn't be better! This must mean that my surgeries was at  eight!  I must be the first surgery of the day!  of the week! Nothing could possibly delay this!  I was really excited.

My parents had practically begged me to let them come up to "help out" during the surgery. I have never found my parents to be particularly helpful. Whenever they've tried to help me out, I end up taking care of them. At first I resented it when my mother, for example, insisted on helping my sister every time she moved from one apartment to the other during college but never helped me. One time finally I was talking to my mother just so happened a few days before move and she blithely said, "well if you want any help just let me know" I replied, "any help your willing to give I would love to have." Well, I have feeling that wasn't exactly what she meant. She meantt for her offer to be graciously dismissed.  and when she showed up to "help" she ended up being sick and spent the day mostly lying down and in the way all the while complaining about the way the rest of us were packing and moving.  So no, I didn't think I would ask them to help but I did want to keep them informed as what was going on I explained to them my excitement  of the early morning appointment and being the first surgery the day.  "well you're not the first surgery the day honey. They've asked me to be there as early as 530 in the morning before." Just a word of advice, when someone tells you they're excited about something, whatever it is it's okay to say, "that's great I'm happy for you. I'm happy you're excited."  They're not asking you to validate their excitement.  They are not looking to debate with you. They are sharing a feeling.  and if they want any validation, it's that it's okay to be excited and in my world it's almost always okay to be excited even if that excitement is based on something unrealistic. In fact, I think that's what people call hope. At any rate, I wasn't looking for counterfactual evidence of whether or not I was the first appointment in the morning I was looking for something to carry me through that weekend to give me more and more confidence.  The idea ofsomebody poking around in my body with a knife  after artificially putting me into a coma with chemicals  is a scary thought and for some reason clinging to that idea that I was the first appointment in the morning comforted me. My mother  saw fit to take that away for me. Idiot.

 Of course she was right.  and that weekend I thought about last directives powers of attorney I wanted to make clear them it was my husband and who would make all medical decisions for me if I was incapacitated as my next of kin but that I wanted the termination of all care to be a joint decision between the three my husband my father my mother in that any one of them had veto power. That they would be like the United Nations Security Council and that the do not  resuscitate order would come only when all three of them could agree on it. Otherwise I would be resuscitated.

For some reason, my sister Donna has become an amazing human being in the last 20 years. She's just an incredible person.  She is especially been a godsend during the surgery process. She had some difficult abdominal surgery of her own and so she knows about the pain and the other stuff more than almost anybody.  she's been amazingly helpful.

 Sunday night I went to bed and it seemed like Monday morning would never come.  every hour I'd wake-up, "Was it time yet?"  finally at about six I got out of bed got into the shower and scrubbed myself clean and started getting my things together for the hospital. My  husband and I drove down to the hospital  parked and checked in at the desk of the fifth floors as we'd been instructed.  for our privacy, they gave us a number: 58. This was what they would call instead of a name anytime they needed us for anything.  we had all our computer equipment with us we saw a corner with a plug and empty chairs we quickly to get over I tried to read a book on my iPad not sure what  my husband was doing,  and almost immediately I got a text message from my sister and started texting back and forth with her. I noticed there was a board kind of like you would see at an airport with arriving and departing flights it had a list of numbers and beside each number it said something like preop, operating room, recovery room  as where we were waiting was also the place where families would wait during surgeries and here they could keep track of where their loved one was in the surgical process. Beside my number 58 it was blank. I hadn't even started the process yet.

 After we'd been there about 45 minutes a guy came to the front desk and called two numbers including mine and took us back into the pre-op room.  We walked through several long, twisting hallways. I remember lots of people in medical equipment. I remember a large desk that looked like a reception type desk and behind it was a whiteboard with people's names which I assumed were the surgical patients.  just beyond this desk to the left it looked a lot like an emergency room with lots of little curtained off areas with like examining tables. My husband to wait here with me  I was instructed to take off all my clothes including my underwear  and to put on this gown which opened in the back. The next thing I knew the anesthesiologist poked her head in and suddenly I didn't want to hide the fact that I felt a little wheezy.

I think the nervousness I was feeling was exacerbating my asthma.  They found me a nebulizer  and the anesthesiologist listened closely to my lungs.  I was hoping and afraid at the same time that she would say that I couldn't have surgery. I loved the fact that she was a woman. For a woman to do anything like be an anesthesiologist means he has to be at least twice as good as a man. Another guy came in in said he needed to mark on my skin where the incision was good to take place. There was a marker in a sterile seal which he opened and promptly dropped on the floor. He picked it up from the floor I guess it was no longer sterile and marked an X on my belly  and left. I was hoping the sterility standards were higher in the operating room. I get judgmental when I'm nervous. The nurse put an IV in my arm and I remember a shot of heparin in my stomach and I remember one of the surgeons popping his head in to see if I'd had the shot of heparin already, I got the idea that they were getting impatient with the operating room and that the anesthesiologist held the reins at this point because she got to decide if I was good to have the surgery or not.

Soon it was time to go. They wheeled me a short way from the pre-op to the operating room I remember looking kind of old-fashioned with big round lights people bustling around all over me the anesthesiologist giving me a shot in my arm and I asked him what it was he said it was Versed.  I smiled and said I like Versed.

The next thing I remember there bunch of people over me I'm in a it seems like a large room with several beds each of them have curtains drawn around them does a nurse's desk right in front of me I can tell I ask if I'm all right, They say everything's fine.  I asked what time it was. I think they said it was about 11:30. In addition to the gastric sleeve,  they found that I needed a hiatal hernia corrected.  I feel like I've been punched in the stomach, I somehow knew that I have a catheter in me and that lots of wires connected to me.

After maybe half-hour so 45 minutes they wheeled me up to a room and I think  my husband was there   when I got there. I had a Dilaudid drip  that I could squeeze every 15 minutes for pain and that made me feel pretty good.  I certainly didn't feel at all hungry and with all the IVs that I was getting I did  not have to drink water. The big deal that first day was getting up and walking. That evening at about six a push by Caldwell the nurse came in and unplugged everything so that I could take a walk and my husband and I took a walk around the hallway. They have a nice little set up  in the building with distances marked in the little map in your room of if you take different routes how far you go so you can keep track of your progress and lots of little sitting areas along the way.

After that walk I felt exhausted my stomach hurt. I felt a little nauseated. I collapsed back into my hospital bed.   I could see the incisions were the surgery taken place. They were just tiny cuts covered over with tape larger cut above my navel couple of inches long was covered up by three pieces of tape there were some bruises in my stomach normally I harry area had been shaved. I had been meaning to do some manscaping.

 There was a whiteboard in my room. Where they would write today's date, the name of my nurse, in the name of my CMA. I don't remember any names from that first day, but they were also very nice to me. When my husband and I took a walk, everyone was so encouraging. And it felt so safe, that people have their eye on us in case I were to stumble or anything. But back to the whiteboard, it also had a goal on it, and the goal was to manage pain. I like that goal. It seemed that my job was to rest and to push the Dilaudid  button every 15 minutes.

 The Dilaudid  seemed to control the pain,  but I also noticed that I had a hard time thinking. It was very hard to focus on anything. And I would kind of drift in and out of consciousness. My husband and I watch a show on TV called Revolution and it was on that night and we watched it together but I could not pay attention to the plot and when I would hit the button for my Dilaudid  I would get a wave of nausea that was like nothing I'd felt before.  well, it felt kind of like the nausea I felt one time that I later figured out must have been gallstones. When I told the nurse this she said maybe I shouldn't use that the Dilauded as   much.  I started getting nervous and while previously I told my husband he should go home, I meekly asked if he wouldn't mind spending the night with me and of course he said he would.

 That first night was kind of rocky. I was actually in a lot of pain, but I didn't want to use that the pain button because of the  nausea. At about 1 o'clock I decided to go ahead and use the button and I got one of those emesis trays that fit under your chin and you can vomit into just in case. In the meantime my saline  IV was running out and that machine started beeping. For some reason my heart rate would get very slow and another machine would start beeping. There were things wrapped around my legs which would inflate and deflate all night long. It felt like everything was conspiring to keep me from getting any sleep. At about 4 AM, a resident physician came in she put a shot of something into the IV it was a different kind of painkiller and she said I could get this every 12 hours i and it would  not make me nauseated.  She was right!

I forget the name of the painkiller, but it seemed to kill the pain and allowed me to get some sleep. I decided that for the whole day, I would punch the Dilaudid button every 15 minutes, using my iPhone as a 15-minute timer. Today, I was going to get my catheter out!! I was a little spooked about the process, about having someone diddling with my privates and how much it was going to hurt. The nurse bent over me. pulled the covers down, put a pad under me to catch god-knows-what coming out of me (blood?pee?). She used a syringe to deflate the bulb up in my bladder and slid the tube out.  The sensation was definitely weird, like peeing seaweed for two seconds, but not all that unpleasant and not painful.

This second day I like to think of as the day of piss and pain.  it was all about producing pee on my own  and Michael and