Monday, January 29, 2007

Blood

The Operation
Thursday was my day to have two skin cancers removed, with MOHR surgery (which has a success rate between 90 and 95%). The operation was to be at the Elk Grove Kaiser facility at 1 pm, so Larry volunteered to drive me; we didn’t know if I’d be in shape to drive home after the surgery was done. I hated to impose on him, but It was a comfort to have him there.

There was one cancer on each side of my nose. To operate, they numbed the area like a dentist does, sticking a needle into my nose. Ouch! That is a very tender area for having needles stuck. But truth to tell, that was the worst part of the surgery. The numbing worked very well; I couldn’t even feel it when Dr. Jack Stebbens was cutting. The surgery itself took only about 15 minutes. Then they sent me out to the waiting room with a temporary bandage while the lab checked the cancers to make sure they got it all. They did. So half an hour later they brought me back in, and stitched me up on the right side, cauterized me on the left side, gave me a new bandage that was so tight it totally cut off breathing through my nose, and gave me care instructions and a prescription for Vicodin. We picked up the prescription and Larry drove me back to Lodi. I was home before 5.

The doctor had told me to expect a little seepage, and there was seepage, especially on the right side of my nose. So I kept daubing my face with tissue, so that blood didn’t dribble down into my mouth. That night I took a Vicodin, which not only made my face feel a little better, but also took away my chronic back pain and bone ache. So I spread a towel over my pillow to absorb dripping blood, and slept like a log.

Wound Care
The doctor told me, “In the morning when you shower, let the bandage soak through with water, so that it will be easy to remove. Then take off the bandage, clean the area with a Q-tip, put on some ointment, and rebandage the area.” But the written instructions said to wait 24 hours before cleaning. I compromised, and took my shower about 1:30 pm. After the shower I dried (unfortunately I got some blood on the towel), and decided to deal with the bandage and cleansing before I dressed, so I wouldn’t have to worry about blood on my clothes.

So I stood there in front of my bathroom mirror, and removed the bandage from my face. It came off the right side easily, but a wad of gauze stuck to the left side. So I got my Q-tips, and my Hydrogen Peroxide solution, and cleaned the right side first, clearing the dried blood from around the stitches as instructed. That went well. So it was with a feeling of new confidence that I decided to tackle the left side.

Since that one wad of gauze was sticking, the first order of business was to pour water on it, to soften it up. Bloody water dripped off the gauze and into the sink. When the gauze was thoroughly wet, I pulled it off the wound - and started to bleed in earnest.

Blood
Blood poured from my nose. I grabbed the gauze bandage I’d prepared, and used it to apply pressure. It soaked through in and instant! I used the bandage I’d prepared for the other side. In an instant it too was sopping with blood. I grabbed what was left of the gauze roll, and pressed it to my face. It too soaked through in no time. I was out of gauze, and gauze wasn’t going to stem the flow anyhow. I grabbed a washcloth.

As I felt that washcloth growing warm and wet beneath my fingers, I realized that this might be more than I could handle by myself. I was going to need help. I could call Larry. In 20 to 30 minutes he could come to my house, bringing more gauze, and he could drive me to Kaiser. But that 20 or 30 minutes was more than I wanted to spend bleeding uncontollably - especially since there would be another 10 to 15 minutes driving to Kaiser. I could call the neighbors, and ask for female help - since I was stark naked. But I no longer know their number by heart, and by the time I looked it up in the phone book I’d need a new towel. Besides, I don’t even know the woman there by name! It is a lot to ask a virtual stranger into my house when I’m naked and bleeding and don’t know their name. I decided the best thing was to get some clothes on.

Dressing
Getting dressed one handed is not easy. I managed to pull on underpants and a pair of slacks. By then my washcloth was full of blood and dripping. I tossed it into the sink, and grabbed a fresh washcloth. I skipped socks - that is a two handed job. Instead I just stuck my bare feet into my New Zealand boots. Mostly I wiggled the feet inside, and just used one hand to pull the boot full on. Good. Next was bra.

To fasten my bra, I leaned my head against the door frame, to apply pressure to the washcloth that way, and used both hands to hook the bra. (There is still a bloody spot on the door frame that I need to clean up.) I tossed the sopping wet washcloth into the sink and grabbed another fresh one.

The blouse I’d planned to wear was clearly a no-go, as it was a pullover. There was no way I could pull anything over my head in that condition. Instead, I put on the blue jacket that Margo wore while she was here. It is a jacket, not a blouse, and it is a couple of sizes too big, but it covered my nakedness, buttons up the front, and is reasonably warm, so It was good enough. I hurried to the fridge, extracted my Neupogen, then found my purse and my keys. I tossed my third sopping wet washcloth into the sink and grabbed two fresh ones. One I held to my nose; the other was backup. I put on my glasses as best I could, and headed for the car.

Valet Parking
I drove one handed to Kaiser, the other holding the washcloth against the wound. By the time I arrived, the washcloth was soaked. I held my keys out to Valet Parking, as taking the key off to hand them a single key one-handed was out of the question.

“No,” the man said, “I can’t touch anything with blood.” This despite the fact that neither the hand I was extending nor the key had any blood on it; that was all on my face and in my left hand and the washcloth. “You’ll have to go park yourself somewhere else,” he told me.

“That’s ridiculous. I’m clearly in no condition right now to go cruise the parking lot trying to find a spot, so that I can walk a lot farther while I bleed to death! I’m leaving my car here.” Okay, so I exaggerated a little. But essentially I meant what I said.

So the guy threatened me. “Do that and we’ll have your car towed.” Good grief!

Another valet said, “Just leave your keys on the dashboard.”

I didn’t much like that idea either. “You keep your eyes on it! Don’t let someone steal my car!” I begged. And I left all my keys there, and one bloody washcloth there, and grabbed my last washcloth, applied pressure, and headed inside.

Medical Care
I was heading for Medicine 1. But the lady at the front desk stopped me, said “Wait here. Someone is coming to help you.”
“I just want to walk down to Medicine 1,” I told her.

“No! Wait! Your helper will take care of you.”

“Wouldn’t it be quicker if I just walked down to Medicine 1?”

But then the helper appeared. She asked me a few questions, including who had done my surgery, which I couldn’t remember. “I don’t remember. You should be able to look that up on your computer. Elk Grove, yesterday, MOHR surgery, 1 pm.” She took my Kaiser card, and walked with me to Medicine 1. She had me sit down in the waiting room, but she took my Kaiser card inside, and within about 3 minutes someone called me inside - amazing time for arriving without an appointment! Had I just stood in line they wouldn’t even have got to me yet.

The nurse led me inside to a treatment room, had me lie down on the table, and got me a fresh gauze pad to replace my bloody washcloth. “Gauze won’t do the trick,” I told her, but pressed the pad against the wound. Immediately it filled with blood. “I need a new pad already. This one is dripping.” She handed me another, thicker, pad, and asked me all the same questions the first nurse had, including who had done my surgery, which I still couldn’t remember. “Jack somebody? You should be able to look that up on your computer. Elk Grove, yesterday, MOHR surgery, 1 pm.” . The new gauze had filled with blood. “I’m bleeding too much for gauze; this requires cloth.”

She handed me another wad of gauze pads. “This should do it,” she told me. “I’ve got to go report to Dr. Winn.” She disappeared. I lay there applying pressure, and bleeding.

My gauze wad filled with blood, and began to drip. I looked around, and saw no more gauze. But I did spy my own last washcloth, which still had a small dry area. I grabbed that, and pressed it to my face instead of the soaked gauze.

Dr. Winn arrived, and asked to see the wound itself. “It is pulsing,” she said. “That means it is arterial.” Dr Winn tried to apply pressure by grabbing my whole nose. I yelped. Her pressure on the stitched side of my nose hurt like hell! She quickly stopped doing that.

My washcloth was dripping by then. The nurse handed me more gauze. “Gauze won’t do this,” I told her again. This requires cloth.” The new gauze filled with blood.

“Get her a towel,” Dr. Winn said.

Dr. Winn asked a few questions, including who had done my surgery, which I still couldn’t remember. “Jack somebody? You should be able to look that up on your computer. Elk Grove, yesterday, MOHR surgery, 1 pm.”

She tried to apply pressure again - the same way. I yelped again. She quickly removed her fingers again. Then she told me, “This is beyond my competence. I’m going to call a surgeon.” Dr. Winn left. The nurse took my bloody washcloth away again, but this time she handed me a towel. She left too. I lay there applying pressure, and bleeding.

After a while Dr. Winn came in again, this time with a surgeon. He looked me over. He stuck one finger up my nostril, and pinched the wound with his other finger. “Just apply pressure,” he told Dr. Winn smugly. He held the pressure a couple of minutes, while he asked me the same questions everyone else had, including who had done my surgery, which I still couldn’t remember.

“Jack somebody? You should be able to look that up on your computer. Elk Grove, yesterday, MOHR surgery, 1 pm.”

Then he released the pressure, and as I expected (since I’d been applying pressure for over an hour by then), but to his surprise, I went right on bleeding. He put my hand to the towel, pushed it against the wound, and told me, “Just apply pressure” as though I hadn’t been doing exactly that for the last hour. “I’m thinking we’d better get a cosmetic surgeon for this,” he said - and everyone walked out. I lay there applying pressure, and bleeding.

Surgery
After a while a couple of nurses came in with a wheelchair. They had me get into the wheelchair. They gathered up my stuff, and wheeled me across the corridor, to surgery. In the treatment room, they had me lie on the table. They took my blood pressure. They asked all the usual questions one more time, including who had done my surgery, which I still couldn’t remember. “Jack somebody? You should be able to look that up on your computer. Elk Grove, yesterday, MOHR surgery, 1 pm.” Everyone walked out. I lay there applying pressure, and bleeding.

Then Dr. Kim came in. He was young, oriental, and a cosmetic surgeon. He knew who had done my surgery, and casually mentioned Dr. Stebbens name! He looked me over, gave the nurses some instructions, and left. They had me remove my jacket and don a hospital gown. They took my blood pressure. They set up a tray. They put a grounding pad on my leg (which Dr. Stebbens had NOT done. Twice we’d been zapped by a spark as a consequence). When they finished there preparations they called the doctor back.

The doctor stuck that needle in my nose again. Ouch again. That hurts. As soon as the site was numb, he cauterized the offensive artery. I stopped bleeding. He told me, “This should fix the problem, but if it should recur, apply pressure by sticking your thumb up your nostril and pinching the artery with your finger. Hold it for 45 minutes or so, and the bleeding will stop.” The doctor left.

Recovery
The nurses wiped most of the blood off my face and neck. They put a new bandage on my nose. They took off the grounding pad. They gave me some ointment samples to use when I change the bandage at home. They took my blood pressure, which was rather low. They told me to lie there a while, and they left. I lay there, rejoicing in the fact that I was no longer bleeding.

Ten minutes later the nurse came back, and took my blood pressure again. It was still low. I said something about of course it was low, as I’d been lying down and relaxing; so she moved the head of the table up to a sitting position. She gave me a clean damp towel and a mirror, so I could work on cleaning myself up better. She had me sign the permission to operate paperwork, saying they’d had my verbal permission, but needed it in writing. I agreed - they’d had my enthusiastic verbal permission. She laughed, and left.

Ten minutes later she came back, and took my blood pressure yet again. It was still a little low. But she let me exchange the bloody hospital gown for my jacket. She had more paperwork - the doctor needed to fill in what he’d done, then I needed to sign it. She left.

A few minutes later she came back and took my blood pressure one last time. She told me that the doctor had said that although the pressure was low, that was to be expected after some blood loss, and the pressure was high enough that I should be okay. I could go out to the waiting room to wait for him to fill out the paperwork so that I could sign it and leave. She helped me off the table, and led me to the waiting room.

Ten minutes later she stuck her head out to tell me that the doctor was with another patient and would get to my paperwork after he finished with that.

Ten minutes later she stuck her head out again, to say she was sorry I was having to wait so long, but the doctor was still with a patient. Quckly, before she could disappear again, I suggested that she bring me the paperwork now, let me sign it, and then the doctor could fill in the details at his leisure. She liked that idea! A few minutes later she brought me the paperwork, I signed it, and I was free to go.


Aftermath
When I went out to my car, it was sitting where I had left it. Unguarded. With the keys inside, in plain sight. I was mighty lucky that no one climbed inside and drove it away! I was also lucky in that the bleeding did NOT recur. The wounds are beginning to heal. I’m due to have the stitches out this Friday. Meanwhile, I look ugly but don’t have to worry about cancer - or bleeding.