New years eve – and finally a win!

Pick a good dream.

The anesthesiologist tells me this is her only requirement. This task was not as easy as it sounds. I found myself getting slightly anxious about not having catalogued my dreams. What if I don’t wake up? What’s the last thing I want to be thinking about? How could I not have a ready playlist of good dreams? I had never really indexed them in any proper way!! fool! I ended up thinking about Michelle, the kids, wedding day, births, hikes in nature… then my mind drifted to something physical, kinesthetic, visceral – sailing on the Narragansett bay on a small craft (a sunfish). I could feel my bodyweight dance with the wind and water. My right hand clenches the cold, rough wet rope as my left hand holds steers the boat holding the wooden tiller. I was “hiking out” leaning back against the top of the boat to keep the forces of wind on sail in balance as the boat hummed along (when you do it right the hull literally does make a humming sound). I liked the contrast of physical/sensory embodiment and finger tip feeling (Fingerspitzengefühl) against my current state of immobility in bed. But I wasn’t yet ready for dreamland so I came back to reality.

I was still in the pre-op area. My brother Eli was with me having flown out from Boulder the day before. He brought a book by Jesse Itzler who goes to live with Christian monks. He was reading aloud to me to help calm

Eli keeps my spirits up!

my nerves. I couldn’t stop laughing at certain parts. For example his account of biting into a crispy apple in a room of quietly eating monks (as if they were in a silent movie). We were both howling in laughter when the guy next to me, behind a curtain, starts wailing in pain (couldn’t tell if it was mental or physical but it sounded like he was quite literally dying). I kept shooting glances over to the nurse like – you want to give this guy something? I felt simultaneously excited to be getting on with this (now that I we had a solid strategy after a week of stressful planning), as well as hyper anxious that I was going to be permanently injured in some surgical error. Anyway the decision was made and I always feel relief when shifting from strategy to execution mode. Now we can focus on the fight. So now it was a waiting game and all I could do was keep calm.

I jotted down some notes in my black notebook (that never leaves my side – I’m naked without it).

Live each day as the last (cheesy but true); light against the dark of nothingness. Let the day emerge as pure joy, you need only allow it to happen for it is existence. And while the arc of life may be suffering, the moment is joy. Polish the mirror and seize the gifts as they are abundant. Dwell less on earthly stressors (you do that too much). Safety/security is found in goodness & love, not the social contract. Continue your seriousness & purposeful conduct – it matters. But the key is to anneal purpose with lightness. Remember this feeling of impending nothingness, of the looming knife cut, as you conduct your affairs. No time to overthink – Act! You will emerge from this successfully. 

The Surgeon Dr. A came in dressed in civilian clothes. He looked like a regular guy that I would have met for a coffee. We spoke for a few minutes. His manner was soothing. I felt again comfortable with him, as I did on the call a few days prior in which we discussed attempting the procedure laproscopically. I asked if he would mind speaking with my friend to which he readily agreed. I called Charleen (my surgeon friend) and they spoke for a few minutes. He walked her through the concerns and details (very candidly, which was actually awesome as he wasn’t hiding anything). He handed me the phone after and she gave me her vote of confidence and wished me luck. I thanked them both. He then left and said he’d see me in a bit in the OR.

The nurse then placed an IV in my arm. I’d have skipped this piece of the account as routine except that after about 3 seconds it was obvious she did a poor job with the placement. She then struggled to push it in while I started heavy breathing to deal with the searing pain of her snaking that IV into my vein. 30 seconds later Eli tells her she should give it up and try again in a different spot. As readers by now know I have little patience for this kind of thing, so I said: “Listen, I’ve had 6 rounds of chemo and countless blood draws and not once has an IV hurt this much. Can we please get someone over that’s more skilled in this department?”. To her credit she calls over another guy, her manager. He places it in about 10 seconds with no pain – done. Thank you! Eli jumps right back into more reading and laughing – exactly what I needed.

Ok – we’re ready. The nurse anesthetist then loosely placed the molded plastic mask over my face. It’s just oxygen. They wheel me from the pre-op area to the OR. Large automatic doors spring open as I move deeper into the operating theater. White light everywhere. Each room gets progressively colder. We get to the final room. I’m comfortably laying on the bed. They placed warm blankets over me to offset the cold temperature. I’m certain the temperature doesn’t fluctuate more than a degree or two and think for a moment how I’d design a study to optimize OR temperature for maximum performance. I quickly turn my attention to the surroundings and instruments in the room. Lots to take in; all this for me. Maybe it was the propofol (had they injected me?) but I was feeling quite relaxed. I fixated on the large light that looked like a circular array of nubbly crystal things. In my peripheral vision I take note of the personnel. The team goes around in a circle discussing their checklist items. In my last post I mentioned that I wanted to think of surgery more like a pilot flying a plane. And here they were implementing the best practices from flying (as referenced in the excellent book, the checklist manifesto)! Once they completed their round (basically the equivalent of a standup in the tech world) I removed my mask and told the team that witnessing this was very confidence inspiring. Then I wished them all good luck, placed the mask back over my face and inhaled deeply of the sevoflurane.

That was it.

There’s a moment when you wake up from surgery when your world is suspended between various possibilities. Was it successful? Did something go horribly wrong? Am I in one piece? ….

Me: Opening my eyes I see a faint outline of blond nurse. I soaked up that moment of uncertainty. No pain. Good. I knew I lagged behind reality. How did it go?

Nurse: Dr. A. was able to get the needed tissue sample. And he was able to do it all laproscopically! No residual damage – it was clean. You have 3 small cuts in your abdomen. It was a great success. We’ll keep you overnight. You’re very lucky.

I let the news sink in for a very long moment. I’m so used to getting horrible news these days that it took a few extra beats to process the magical feeling that something went well! I floated on a cloud of joy. I’m still floating as I write this days later. This was the second surgery I’ve had in my life but certainly the most involved (first was a hernia repair which is routine). And it was the scariest. The nurse and I then spoke for probably 15 minutes. I talked about how satisfying it was to have put together a quick model that suggested pushing for this direction; how amazed I was with Dr. A., and how now all I wanted was to see Michelle and the kids (they’ll be landing soon!).

That evening as I recovered in a private room I was totally high. Eli was exhausted and I kept talking and talking. He must have told me to shut up (nicely. But how are you not tired! what’s wrong with you?) about 8 times but no matter. On and on…I was so happy to be alive and functional. Had we gone with the open surgery approach I’d have been in the hospital 5 days to recover. Then It would be 3-4 weeks of further recovery at home (no lifting etc). Instead because this was done laproscopically it was just an overnight stay and ~10 days no lifting. And I would go home to celebrate Lua’s 2 year birthday! Meantime my friend Abe grabbed the car and went to the airport to pickup Michelle and the kids (thanks Abe!). What a team effort!

The next morning the surgeon came in and we de-briefed. He was very pleased about how it went. He paid me a complement for being diligent and pushing for laproscopic. He said that MOST of the time this kind of procedure ends up going open surgery (called laparotomy) but it worked out very well. I thanked him again for his incredible bedside manner, his flexibility in approach, his willingness to take a few extra moments to talk to my friend, and his skillfulness in getting the job done. I then asked him why the procedure took so long (>100 minutes vs. estimated 60) given that he didn’t have to cut me open. He said that most of the time was actually spent on the phone with both the oncologist and pathologist. He wanted to ensure he got exactly the right tissue from the right spot and that he got enough for them to do their jobs. I was blown away. This guy is a 10/10 and to me reflects what a professional doing a job right looks like. Sometimes my faith in people gets restored. This was just what I needed. Talk about good fortune!

So this is a terrific win and I will celebrate it for all it’s worth. I got home the next day and was already walking around (painfully, but still). We celebrated Lua’s birthday with cake – the big payoff!

This was just a step with many more to go. The tissue will now be interrogated with flow cytometry (to sort/assess various cell populations), and various cell staining techniques. I should get those results end of this week or a bit after.

Just before going in. Feeling anxious.
3 bullet holes. And it feels like it. But the alternative would have been WAY harder.
On the way back from Boston – wishing me well (they were in the air as I went into the operation)
Happy birthday Lua!