Going under the knife

Finally the auspicious day was just around the corner. My surgery for reconstruction of the jaw was to be conducted on Sunday  11th August 2013 at 8:ooa.m. The length of the procedure was estimated to be about eight hours.

 Was I scared? Truthfully I was not. I felt that I had waited so long that mentally I was prepared for it. I was excited with anticipation. Not just because I felt I would look more like myself but also I knew it would mean that eating would be the next step. I longed to eat some real food.

 The week leading up to that day was hectic and brought with it a lot of frustration. The frustration was manifested in tantrums on my part. I lost my cool for the first time in a long time with my mother, who had been a keen support and source of strength. Under the circumstances, this was understandable. Understandable, but not excusable. Thank God for mothers’ love. They forgive and move on.

 The frustration arose mainly because of issues with the insurance company and because of administrative issues at the private hospital. There was a lot of uncertainty just days before the surgery as far as payment was concerned. The letter from the insurance company detailing that they would cover the cost and how much they would cover was prepared and was waiting on someone’s desk to be signed. Without that letter I would have to pay the full cost upfront. The fact that the Friday before the surgery was a public holiday for Eid complicated matters. The letter may have gotten out in time had it not been for that holiday.


It was not to be. I had to make a decision on the Thursday morning to have a manager’s cheque made out for the amount. Another complication was that my little brother wanted to use his credit card to make the payments in order to get “miles” – the bonus miles issued from the credit card company for travelers. I was in the awkward position of having to deposit the cash in his account to be transferred to his credit card account before it could be used. The problem again was the holiday. Ultimately it would turn out that even if I deposited the cheque to his account on Thursday, it was not guaranteed to be available in the credit card account. Talk about frustration.


The Saturday before the surgery date came and I was a bag of mixed emotions. I was anxious, could hardly wait for the surgery. I was a bit scared, unsure of what to expect. I was still worried about the payment plan. I was above all certain that the Lord was with me, as He has always been. I did my routine morning tasks: had breakfast, had a shower, double checked my bags against my list and played with the cat, Pretty. Before long it was time to head to St. Augustine to meet the plastic surgeon’s accountant and pay his fee, then off to the hospital.


At the hospital, there was disillusionment. Generally the thinking is that if you are paying for a service, the service would be superior to one that is free. I have to say categorically, this is not true – at least in this case. To begin, there were no records of the pre-registration which I had taken the time to do the previous Monday. On that day, the anaesthetist was scheduled to meet with me to assess my situation and any special requirements for surgery. As I had the time, I enquired about payment methods and insurance procedures. This was when I was told about and completed the pre-registration.


 Once that issue was resolved, by completing a registration form for the second time, I then had to contend with sorting out the payment. There was some hesitation and the clerk made some snide remarks about the insurance method complicating matters. This was annoying but what could I do? I paid the full amount as specified in the original estimate which I had received from the hospital. Then I had a little wait before being wheeled up to my room.


That night the anaesthetist visited me and prescribed a sleeping pill to ensure that I had a proper night’s rest. That was a really good move for my mind would have been overactive that night. By five o’clock the next morning I was up. I had a shower and put on my theatre gown and waited. My mum had spent the night with me and she also got up early. Her plan was to be with me until I went in for surgery, then she would go to a church in the vicinity. She would return later to see me, even though I most likely would have been asleep. Before eight o’clock, the plastic surgeon arrived. He came in with a most pleasant demeanor and made sure that all was well with me.


All too soon the time came for me to go in. As I entered the theatre area, the nurses were asking for a hammer, a saw and a drill. I thought they were joking. Boy was I wrong. Those implements were going to be used for my surgery. Could they have been more explicit just minutes before I was “put to sleep”? Well at least there was little time to think and before long I must have been anesthetized. The last noise I think I remember hearing was the sound of a drill. The next thing I remember was waking up in the high dependency unit.


 Unknown to me of course is that the surgery had taken a full eight hours.  The anaesthetist had brought in another doctor with an endoscope to assist in getting the tube for the anaesthsia through my nostrils into my throat. This was necessary as my passages were restricted as a result of the injuries and the wiring of the jaws.


  The oral maxillofacial surgeon had completed reconstruction of the jaw. He had put in titanium plates held in place by titanium screws. He had also done a hip graft which involved removing bone matter from the left hip and grafting it onto the jaw where the bone had been removed during the emergency surgery on the night of the incident.


 After his job was done, it was the plastic surgeon’s turn. He had to provide scaffolding for the reconstruction. There had been a deformity left in my chin where the bone had been cut. This had to be filled in for symmetry of my jaw line and to assist in minimizing the chances of infection in the bone graft. A shoulder graft was done for the scaffolding. A flap of skin from the left shoulder was rolled back and attached as a tube- like structure onto the chin. A portion of skin, about ten centimetres by fourteen centimeters, was removed from the left thigh to fill in the shoulder from where the flap was created. That flap was to remain for three weeks.


Two days after the surgery I was still feeling nauseous from the anaesthetic. I could not keep any food or drink down. Yet I had to take antibiotics and morphine. I was a total mess. I could not move very much, could not turn, could not walk nor talk. During the course of the second day, I refused to take any medication until I ate or drank something. I forced myself to sip some Ensure. I did this throughout the day and still only finished about one quarter of the bottle. By the end of the second day, I kept praying that this ordeal would be over. I had never felt so ill.


One amazing thing happened sometime that day. I was feeling awful and at my lowest, when I suddenly smelt my father (deceased about four years). Simultaneously there was a message alert on my cell phone. A message from my mentor and friend had come, wishing me all the best. This may not sound significant but when my father died, this lecturer, to whom I refer as my mentor, began sending inspirational texts to me every single day. He filled in the gap left by my father’s death and as it turns out, they were born on the same day. We had communicated maybe once or twice for this year and he was unaware that I was undergoing surgery. Coincidence, I think not.


By the third day my stomach settled somewhat. I still could not consume a lot but it was sufficient to allow me to be medicated. I remember at some time I stopped taking the pain medication and the doctor and nurses could not believe it. The doctor remarked that my pain threshold must be very high. He, the oral maxillofacial surgeon, urged me to start moving around. He had recommended a walker for a couple of weeks.


All this time, my darling son stayed with me. He fawned over me. He slept restlessly, listening for me to call out for help. He slept on a tiny cot. Any movement on my part had him alert and vigilant. His sacrifice, his strength, his love and devotion during that time, have far surpassed any expectations a parent could have. My mother also spent some time, relieving my son by the third day.


I began to move about a bit. It took every ounce of determination for me to get up and off the bed. I did it slowly, with deliberation. I could not slip for to do so would result in an undoing of all that I had just been through. I held on to the walker and made those first few unsteady steps. The walk to the washroom seemed to last forever. I recovered for a while on the throne. Then, again with all my effort, I made it back to the bed.


There was no comfort on the bed either. Sleep came out of sheer exhaustion. I moved around several times during the day and by the fourth day the doctor was in for a big surprise. On the fourth day I walked out of the washroom, while he was in the room. I walked out sans walker! Can you imagine how shocked he was? Here I was walking after only four days when they had told me it would take weeks.


The secret to all of these recoveries is to know your body. Knowing my physical limitations, given the weakened state I was in, and being aware of the type of surgery done, as long as I had been given the go-ahead by the doctor, I was able to move. The movements were slow and painstakingly done, but they were done. This was one of the conditions for me to be discharged… and I really wanted to get out of that place.


Part of the reason for wanting to get out so urgently was the odours. Apparently after the surgery, my sense of smell became so acute that I smelt everything. Every nurse had a distinctive smell from their soap or perfume or deodorant. The room itself had a distinctly unpleasant smell. Any citrus aroma induced nausea. Even when my son tried to eat in the room, much as it hurt, I had to ask him to leave the room. I could not wait to get out of there.


My voice was also affected for a while. It became higher pitched and quite child-like. It was difficult to understand me at first. I remember when the doctor called me four days after I was discharged. He asked to speak with me when I had answered my phone. When I identified myself, he could not believe it. He had thought it was my niece or daughter.


Out of all of this my body grew weaker but my mind continued to function at an admirable level. I really feel sorry for persons who depend on the doctors and nurses to care completely for them. The truth is that one has to be able to take responsibility for oneself, even in a reduced state. It could be as simple as deflecting an unnecessary CAT scan (which I was nearly accidentally sent for, immediately upon coming out of the high dependency unit) to ensuring that medication is taken in the proper way.


 Of course, given certain circumstances, trust has to be placed in others for a brief time, but the desired course of action is to be able to analyse and think for oneself. This cannot happen in a vacuum. There must be some background knowledge, some common sense on which to base judgments and decisions. According to Voltaire, “no problem can withstand the assault of sustained thinking” and I would like to amend that to  “sustained, informed thinking.”


So out of all this I leave you to ponder on the following:

     1.     Learn as much as you possibly can about any medical procedure you may have to undergo.

     2.     Plan carefully for all aspects of the procedure – financial, emotional, physical.

     3.     Pray for guidance, for protection and to give thanks.

     4.     Consider the situation at hand from all angles, carefully thinking each step through.

     5.     Be alert for any diversions from what is correct. Do not assume that those assigned to do tasks are knowledgable or informed.

     6.     Seek help when you need it.

     7.     Think, think, think.





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