Map of life expectancy at birth from Global Education Project.

Wednesday, August 11, 2010

Some crude exposition

There isn't necessarily any profound point to what I'm going to tell you, but we need to set the stage for the rest of the story. I now have a diagnosis of acute appendicitis. Mind you, I had no idea I had already rung up a bill for $450. I estimate (generously) that the three people who inserted objects in my rectum spent a total of ten minutes with me. When you do all the math, it turns out they make an average of $2,700 an hour -- this being 1991 mind you, so I suppose it would $5,400 today.

I had to lie on a gurney and be wheeled up to my room, even though I could walk just fine. The doctor handed me some paperwork to take upstairs with me.
I had the chance to read all about myself on the way up. There was a note headed "patient EP". "Pleasant gentleman," he had written. That made me feel good. But what is EP? Extrasensory perception? Effective persona? And don't obnoxious people get appendicitis? Or is it the policy to tag them for inferior service? Then there was a lot of gobbledykook and the diagnosis, "acute appendicitis". "Admit," it said. Then, "shave from the nipples to the thighs." I would have to stay out of locker rooms for months.

We came to my room, which looked to be up to code. My hostess was a very nice looking, friendly young nurse named Leah. I liked her. She didn't try to stick anything up my ass, which was just one sign of a generally more relaxed attitude.

I wasn't allowed to watch TV -- except for video of surgeons from A Major Teaching Hospital of The World's Greatest University performing ankle replacements -- until the next afternoon, when they would come around to collect the daily fee required for TV service. They also could offer me nothing to read. I sat there for four hours.

Finally some people came and rolled me into an elevator, then through some big swinging doors with bright red warning signs. There are lots of people around in blue pajamas and shower caps. The male anally obsessed doctor from the ER is there and he gives me a shower cap. "You can be just like us now," he says.
"Do I get a lollipop too?" I thought.

Then it was much later. My mouth was dry. I was in pain but the thirst was far worse. There were windows near the ceiling, as though I were in a basement, and there was daylight coming in the windows. That was wrong, it was the middle of the night. There was a beautiful woman looking down at me. Her face was gentle and her eyes shared my pain. The pain was nowhere in particular, it was a haze all around me or it floated in a ball somewhere above me or else it was in my throat thrust on down and through me like a rod of ice and I needed water.

It was a while before I was in any condition to understand what had happened but to jump ahead of my stream of experience, here it is. They had opened my abdomen and found a healthy pink appendix. But there was a mass on my colon "like a robin's egg." They thought it was cancer and that I was doomed. They performed a right colectomy. That means they removed half of my colon. Then they sewed the cut ends of my intestines back together. I had been in surgery for six and a half hours. Apparently the Chief Resident -- the same man who had sodomized me in the Emergency Room -- had found my innards to be not as advertised, so he called up his boss, the guy who teaches surgery to the residents. He left his card game or the barroom or whatever and rushed over to do the actual cutting and pasting.

While I was still in surgery, they had gotten the pathologist's report. I did not have cancer. I had a cecal diverticulum. The cecum is the place where the small intestine joins the colon; the appendix is near it, hence the mistaken diagnosis. A diverticulum is a little dead-end wrong turn in the wall of the colon. It had become obstructed, filled with putrefying material, and infected. That's it.

This is not a particularly enlightening post but we had to advance the plot. Meaningful stuff anon.


kathy a. said...

well, that sounds fun....

why did they remove so much tissue? or to put it better, such a huge piece of colon? i can understand taking a piece on either side of the bad piece, but not beyond that.

i'm sure this is hard to remember -- not in the sense of having problems with the details, but in the sense that retelling brings all that back.

robin andrea said...

Your story in absolutely chilling, cervantes.

In the early 1950s, my paternal grandmother was diagnosed with rectal cancer. When she was on the operating table, as the family folklore goes, the doctors determined that she needed to have a colostomy. A doctor came into the waiting room and asked my father, her closest relative in the room, for permission to do the colostomy. He gave them permission. She died two days after the surgery. I never met her, so in the Jewish tradition was named for her.

The reason I mention this story is this: Is it standard practice to ask permission from a relative for such surgery that you had. Did giving them permission to do an appendectomy extend to any surgery they deemed necessary while you were on the table?

Cervantes said...

They thought I had cancer. When they do cancer surgery they remove neighboring tissue in case there's been some spread. They basically removed my entire ascending colon. I presume in Roger's case they took some extra as well, not just the piece with the tumor.

Perhaps he will confirm.

Cervantes said...

I will get to the informed consent issue in due course. Thanks for bringing it up, it is indeed relevant.

roger said...

the path report says one piece, the non-malignant, was 9.5 cm, and the other cancer piece was 12.5 cm. if my math is close that is 3.75" and almost 5". so.... 8.75" total colon removed. also 16 lymph nodes. 4 of which were cancerous.

Cervantes said...

Right. They actually took 12" from me, 100% non-malignant.