Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

Archive for the tag “Operating theater”

Going Home…I Think?

Hospital

Hospitals are absolutely no place to get a good night’s sleep. Even with the door to my room closed, the noise in the hallway at 4:00 AM was deafening. It seems that the patient in the room next to mine had a crisis to which the entire hospital seemed to respond. I was awakened by the shrill scream of one of the nurses, “Help me, I need help. I can’t do this alone.” She repeated this cry with some minor variations for about three minutes. It was enough to wake the dead.

I am scheduled to go home this morning. I am now waiting for the urology docs to arrive to release me. Up until today, my urine was clear but this morning it was a bloody red color. This morning, however, the catheter bag is filled with a bright red colored urine. I don’t quite know what this means, other than the simple fact that I am bleeding and the blood is finding its way into my bladder. I hope this doesn’t mean that I cannot go home until they figure out what is going on. On the bright side, the pains caused by the infusion of CO2 is much better. After the vampire came to draw some blood, I took a walk around the hallway and had absolutely no pain. These are the facts, the raw data. Now it is up to the chief resident and my urologist to determine if the bleeding is significant or not. I will project no further.

Here I Am, waiting in proximate space for the urology team to arrive. I decided to do something productive with this waiting period so I write my first coherent blog post in two days. I think that I want to comment on the bureaucracy that is in the hospital and how crazy some of the rules are. I start with the dispensing of medications. Yesterday, the day nurse came into my room at 7:00 AM with one pill I take on a daily basis. The problem is that I have a regimen of seven pills I take every morning and four that I take in the evening. I asked her why she didn’t have my full morning regimen. She told me that she would be back at 8:00 and again at 9:00 to complete the entire cycle. I asked her why this is scheduled so as to provide extra work for her and anxiety (not really but I thought it was important to mention it) for me. She just shrugged her shoulders and smiled. I would like to meet the genius who decided on this practice.

I could provide more examples but I’d rather concentrate on the effect of the modern bureaucratic design and just how that bureaucracy effects the patient/staff relationships. Bureaucratic organization reduces each task in the hospital to a specialty to be performed only by people with the proper credentials. It is the job and not the person performing the job that is important. As an example, I have now had blood drawn early in the morning by three different phlebotomists and one nurse. Is there any chance that, as a patient, I can develop any kind of relationship with the person drawing my blood? Down the line, after the blood is drawn, it is sent to a lab where a lab tech runs the blood through a machine which, in turn, spits out a set of numbers. These numbers are then sent to the medical team who, I believe, are not acquainted with either the phlebotomist drawing the blood or the lab techs running the tests on that blood.

This one example goes to the core of the bureaucratic organization that is designed to create a distance between patient and hospital staff. This scientific detachment is, I believe, creates a space in which errors are bound to occur. Doctors write general orders even when patients have specific medical issues that my be contrary to these orders. Nurses, while working with these standard orders on a daily basis, cannot be fully aware of the special needs of individual patients because they are trained to be scientifically objective rather than be an empathetic care provider. The very organization of the hospital is designed to reduce the individual patient into the same so that the interchangeable providers of care don’t have to think a lot about individuals. Hospitals, in this sense, are clearly bastions of modernity designed for efficiency and economy.

This is, of course, the very reason I anticipate going home, where my recovery from surgery will be provided on a human level.

FLASH: The urology team just left my room. I am going home. I expect to leave the hospital around 9:30 AM and be home around 11:00. YEA!

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The Day of Surgery Finally Arrives

As with all things, the passage of time brings new experiences. After waiting for about one month since I was diagnosed with prostate cancer the day of surgery finally arrives. I am making final preparations getting ready to leave for the hospital, about an hours drive from my house. Yesterday afternoon I was instructed to arrive at the hospital at 6:00 AM for a 7:30 AM procedure. In all the operation should take about 2 hours so I should arrive in my hospital room no later than Noon Chicago time.

I have just a few things to do before I go but I thought that one more post is in order. I am bringing my laptop to the hospital and expect to post from there (assuming that wi-fi is available). For now, I am wrapping up that which must be done and off I go.

I am actually a lot more nervous than I have ever been before any other procedure. I don’t quite know what is causing this stress because I don’t expect to wake up with much pain, certainly not the pain of joint replacement surgery. Perhaps, because I am entering the hospital feeling quite good. At this stage, cancer is not painful, it is not making me sick, it is just there. Unlike when my hips or knee was replaced I am in no pain at all. In addition, perhaps this anxiety is caused by the overall gravity of this procedure. After all, left untreated, the cancer will be the proximate cause of my death. Treating it leaves no guarantee thus making the import of this surgery greater than any other I have ever experienced.

For now, I plan on sitting quietly, meditating whenever I can up to and until the point where the anesthesiologist does his magic and knocks me out. I will continue to do that which must be done in between.

Veteran’s Day 2012

My father served his country in WWII.  Serving as an officer in the Quartermaster Corps stationed in South Wales, he often spoke with great humility of his role as a supply officer just prior to the Normandy invasion.  As a citizen soldier, he played a part in ridding Europe and the world of the scourge of the Nazis; that was no small task.  Of course, in the final analysis, the Second World War, you know, the one that followed on the heels of the War to End All Wars, followed by Korea, Viet Nam, Grenada, Panama, Serbia, Iraq, Afghanistan, Iraq again, and I am sure I am forgetting something along the way, taught us nothing other than grown men seem not to be able to settle conflicts with reason. Toward the end of his life, my father eschewed violence of any sort as a solution to the problems we face.  I applaud him for that.

But closer to the overall theme of this blog, during his lifetime, my dad twice battled cancer and survived.  His first bout came in 1970 when he was a mere 59 years old.  Diagnosed with Squamous cell carcinoma of the lung.  After a long period of diagnosis topped off with an extensive resection of his lungs, he was given but 6 months to live.  25 years later, aged 84, he finally succumbed to pulmonary fibrosis, perhaps a long-term after effect of his radiation treatment.  The fact that he survived as long as he did is a testament to why one must be quite careful when looking at mortality statistics.

When he was a bit older than 70, he was diagnosed with adenocarcinoma of the prostate (they say this disease runs in families and that if one’s father had the disease then the son is likely to get it as well).  His prostate was successfully removed and he lived a full life for an additional 14 years.

This Veteran’s Day I somehow reflected back on my father’s experience with cancer.  Some people argued that he was just too damn angry to let a little thing like his two bouts with cancer defeat him.  Others said he was too nice a guy to be struck down by his genes.  I think it was neither.  When he was told to go home and put his affairs in order, he chose to do otherwise.  He faithfully showed up at his oncologist’s office each month, getting sick when he walked into the lobby of the building, for his experimental chemotherapy.  He did this for nearly two years until he was pronounced cured.  He continued to show up for his x-ray scans and other tests for recurrence as well.  The long and short of it is that he did what he was told, he surrendered to the expertise of his medical team.  He did the very same when it came to his prostate cancer, surrendering to the doctors.  He knew they knew more than he did about these things.

I learned a great deal about how to face serious disease from him.  My friends call me the bionic man, having had three joints replaced and a lumbar fusion all due to significant osteoarthritis.  I am no stranger to debilitating pain or the operating room for that matter.  After all but one of these orthopedic procedures I have followed my physical therapist’s exercise protocol both in his office and at home and, while complaining from time to time, I still followed the discipline because I was told to do so.  This is the way I approach my medical challenges; to follow the advice of the professionals.  As my own surgery approaches I see no reason to alter my approach.  I am focused on the moment and on doing what I am expected to do to contribute to my own recovery.  All this I learned from my father, the World War II veteran.

Four Weeks to Go

On Saturday a package arrived from my Urologist that contained so much information that I simply wanted to curl up into a ball and go to sleep.  Forms to fill out, orders for pre-operative testing, a medical history (which they already have) and page after page of what to expect before, during and after this procedure.  Since we were on our way to the symphony, I just put the package away and didn’t think about it until this very morning, Monday!

Now I am no stranger to operating theaters.  Arthritis tends to wear out joints, impact the spine and central nervous system and I have experienced both.  Two hips replaced, one knee replaced a short four months ago, a cervical fusion and a lumbar fusion among other things have brought me under the surgeon’s knife.  So the information I received was, to say the least, redundant.  But, this one seems a bit different.  My very existence, my life, is at stake here, not merely relief from pain and suffering.  While this is perhaps a bit of an overstatement, it clearly reflects the gravity of this surgery…and it is being performed by a robot.  Once I am put under I won’t even know if the surgeon will be in the room or out in the lounge with his console performing radical surgery like it is a video game.

I am not at all certain that I am comfortable with a remote control device poking and cutting inside my body.  It somehow feels like the Matrix or Tron or something that is somehow the property of film special effects departments, not the surgical suite.  Of course, I have little choice in the matter for this is now how a prostate is removed from one’s body these days.

Sure I use computers and I even play games on the computer, but I know that eventually I lose the game.  The game is stacked against winning.  Perhaps that has something to do with my apprehension about having a remotely controlled surgery.  At least the surgeon is not trying to rack up as many points as possible before the game finally ends.

All that being said, I am still approaching this surgery with a bit of awe.  I would like to have a video made (I assume that since the operation is guided by a camera that is shoved inside of me that a record of the surgery is made for later evaluation if needed) so it would be easily transferred to a DVD for later watching.  I think that might be interesting.  I have watched a YouTube video of a DiVinci resection of a prostate but watching my own resection would be interesting to say the least.

Science and Postmodern Ethical Response

I [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or GFDL (www.gnu.org/copyleft/fdl.html)], from Wikimedia CommonsScience depersonalizes the individual; it addresses the exterior as a statistical body without regard to the individual human being.  In this sense science is impersonal, detached and objectivist.  Medical science speaks in terms of cure rates, mortality statistics and efficacy of treatment options all based on access to controlled experimental data and other statistics gathered through data collection in the field.  The goal of medicine, it appears, is to reach optimal cure rates with the fewest side effects based on a large and robust data set.

This does not mean that there are not going to be side effects of any treatment option; in fact they occur in x patients per 100 treated.  If the statistics call for a 10% possibility of any given side effect of treatment then 10 out of 100 patients treated will absolutely obtain the side effect in question.  It is a matter of numbers and a random luck of the draw that determines whether or not a side effect will occur.

The human being, the patient, is objectified into a group of patients for which treatment is offered.  The patient is a statistic, one that will comply with a normal range of expected results.  It is a matter of simply waiting to see which place on the bell curve any individual falls as treatment is administered.  No matter that a doctor will say, “We treat patients, not statistics,” they cannot escape the fact that the options offered are based on the statistical efficacy of the selected treatment.

All this means is that medicine is a-ethical.  It does not reach the standard of postmodern ethical obligations because it fails the test of humanizing the patient being treated.  In around four weeks, for example, I will undergo a robotic resection and removal of my prostate.  I will lay on a table with a robotic machine at my feet and my surgeon sitting at a control console somewhere in the operating room where he will control the robot as it performs the surgery.  In fact, the surgeon needn’t be in the room at all; he could be in Amsterdam or Melbourne and still perform the surgery if his console was linked to the robotic machine at my feet.   This places the surgeon two steps removed from the patient.  The surgeon need not look at the patient, only at the camera view of the insides of the patient, in order to perform the necessary steps of the operation.  The patient is objectified, turned into a piece of meat, and in doing so, is no more than a statistical probability.

Postmodern ethical relationships require a face-to-face responsibility (being responsible for the other even to the extent of being responsible for the responsibility of the other) which, in turn, may or may not elicit an ethical response.  The responsibility of the self is one that is given without reservations or expectations and once given, once announced, creates a state of proximity or waiting that is only interrupted by the commanding voice of the other.  While, entering the operating room, I may present myself as an ethical human being, what I am met with is a cold, sterile (in every sense of the word) environment filled with masked men and women, beeping machines and bright lights.  The room itself is uninviting and the people around me are cogs in the surgical procedure, each one with a professional task to perform; each one following a pre-determined procedure designed to depersonalize the procedure itself.

The operating room is far removed from the postmodern ethical stance.  But, it must be that way because if it were to somehow become a subjective space where ethical commands can be acted upon by individuals involved, there most certainly would be chaos; the last thing one might want in a surgical stage.

In the final analysis, it is clear that some things are best seen from an objectivist stance while other things must follow a subjectivist approach.  They are not mutually exclusive.  Each has a place and each must work within the boundaries acceptable for the practice.  So I will be objectified as I enter the surgical suite, put to sleep and violently operated on.  The ethics begin when I wake from the procedure and present myself to the nurses that will care for me during my hospital stay.  I’m fine with that!

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