Thursday, January 22, 2009

Cotton Candy and Donuts

Last week my son had surgery, an adenoidectomy.  The adenoids are lymphoid tissue, like tonsils, that are located in the nasopharynx.  John's were so swollen they were completely blocking the passage between his throat and his nose.  No wonder his speech is lagging, and he snores almost as loud as his dad.

I took the day off, and woke him up at 5:00 a.m. to get him to the hospital for the 5:30 check-in time.  Why they had us get there at 5:30 I have no idea, because we were quickly shuffled to pre-op, only to wait for 2.5 hours to get the show on the road.  If you have ever spent 2.5 hours entertaining a 3 year old who was NPO (nothing by mouth) past midnight, you would be impressed by the fact that he never had a breakdown.  This was not a children's hospital, as evidenced by the barren waiting room and indifferent staff members.  

"Are you doing all right Mrs. Schneider?  Just keep entertaining him, like you are."  

We told stories of far away lands with castles, lollipop grass, and cotton candy clouds.  I borrowed a lot of imagery from Roald Dahl's Charlie and the Chocolate Factory  (I remember the first time I read that book - buried under the covers with a flashlight on the top bunk, finger poised at the ready to turn the flashlight 'OFF' if I heard my parents coming to check on me and my sister).  The central characters in every story were John and his sister Sicily, riding multicolored horses and fending off monsters and purple bears.  John got into it, and soon he became the storyteller and I just nodded and interjected as unobtrusively as possible; his stories were infinitely more interesting and imaginative to me than my own.

Another form of entertainment was the upside down mousse alcohol hand cleanser.  Every time he would get weary of the stories, he would wander over and look at me questioningly.  

"Okay Jack, one more spray.  No, no, that's enough.  Rub it on your hands.  No, don't eat it."

"Tastes like sunscreen, mama!"

The poor kid was so hungry,  I could hardly blame him for trying.  It also made me a little wistful, of the days when sunscreen tasted like cocoa butter, not alcohol.  The advent of spray sunscreen has tarnished John in ways he will never know.  

While we were waiting, we got to watch other families filing in for surgery.  When entering pre-op, only one other family member is allowed.  Our next door neighbors were a man and his wife.  They reminded me of the Jack Sprat poem.  He was tall, skinny, and goofy-looking, and she was short and stout.  Her hair was thick, straight, and unkempt, about chin-length - his was tucked unsuccessfully into a camouflage ball cap.  They looked to be in their early to mid-fifties, but he was aging much more gracefully than she.  His resting face evoked surprise, hers was set in a permanent scowl.

They didn't talk until the anesthesiologist came in for a pre-op interview.  He walked into their room, and introduced himself.  Although there was a wall between us, it was easy to overhear because the front sliding glass doors were all parked open.  

"Hello, I'm Dr. Bale.  I have a few questions for you before you go to surgery.  So I see you are here for a D&C."

A D&C is a dilation and curettage.  Usually performed for prolonged uterine bleeding.  The OB goes in through the cervical os (dilation) and scrapes the inside of the uterus (curettage), the endometrial lining, and sends it to pathology for a diagnosis.  The uterus is like an upside-down pear-shaped hollow muscle, at the end of which lies the cervix.  The cervix always reminded me of a donut when I was looking for it in medical school, through the speculum, to perform a pap smear.  A small, round rubber donut, like a donut hole, but with a tiny slit in the middle.  Sometimes hard to find, if the patient is large or the uterus is retroverted.  Seeing the donut always brought a huge sense of relief - your uncomfortable quest was almost over.  The size of the os varies individually, as well as pre- and post-partum.

We get the endometrial curettage specimen in pathology frequently.  Tiny cores of blood, grossly.  Mostly pink on the slide, with blue glands and stroma.  Most of the time the specimen is normal, and we just name the phase of the cycle based on the appearance of the glands.  We look for hormone effect, signs of breakdown, blah, blah.  I could bore you for hours.  Most importantly, we rule out cancer.  The most dreaded etiology of dysfunctional or prolonged uterine bleeding.  

The anesthesiologist continued.  "So how long have you been bleeding, ma'am?"

"For fifty days."

My eyes widened in disbelief.  Dr. Bale was also impressed.  He briefly lost his previously professional demeanor, asking incredulously "And you are just now coming in for the procedure?"

The husband piped in.  "My wife's a tough lady."

I could believe that by the look of her.  I heard her agree gruffly, her voice both challenging and defensive.  "That's right, I'm a tough old bird.  I kept thinking every other day, that it would stop tomorrow, but it didn't.  So here I am."

"Well, I'm glad you're here, now.  Your doctor will help you figure out what is going on."  Dr. Bale finished his history, examined her airway, and started to step out of the room.  The husband called him back.  His voice was overly loud and quivering with the anxiety surrounding his confession.

"Doc, I think there is something else you should know.  My wife pees, every time she walks down the hallway."

I worked hard not to laugh audibly, more out of surprise at his sudden confession, than content. 

The wife referred to her husband formally.  She was irate.  "Now Mr. Taylor!  You did NOT need to tell him that!"

He replied meekly and defensively, "Honey, I was just trying to help out.  It's not like you would ever tell any of the doctors."

She shouted, "Mr. Taylor!  That is not the point!  He is not the doctor that needs to know that!  This is neither the time nor the place to be tellin' that information!"

She had a point.  That was a slice of medical history for her OB, not the anesthesiologist.  But I could tell the anesthesiologist had probably been on the wrong end of his wife's arguments many times with how quickly he rushed to the husband's defense.  He was halfway out the door, and I was impressed with his straight face.

"That is important information, Mrs. Taylor.  I will certainly pass it along to the proper individual.  The nurse will come get you and bring you to the OR soon.  See you in the OR, Mrs. Taylor."

John's surgery went fine.  He was eating goldfish and drinking chocolate milk on the couch by ten.  We had an indulgent two hour nap that afternoon.  I cannot remember napping with him like that since he was a baby.  

On Monday morning I was clearing out my junk surgicals: quickies like gallbladders, athersclerotic plaques, corneas, heart valves, and tonsils and adenoids.  I got John's specimen, and examined it under the slide.  It was massive, and extremely reactive.  No wonder he couldn't breathe through his nose!  The doctor said he would probably have to re-learn, since he likely had not had the option before.  I signed it out:  Adenoids, adenoidectomy: Reactive follicular and parafollicular hyperplasia."  It reminded me of when I was a fellow, and I got my husband's appendix.  And of the other specimens that have crossed my path, routine except for the fact that I recognized the name behind the glass slide.  

I didn't get Mrs. Taylor's (that is obviously not her real name) specimen on Monday, and certainly didn't bother to chase it down.  That would be a HIPPA violation.  But I sure hope she didn't have cancer. 


Anonymous said...

Love it!! So has John stopped snoring now?

Gizabeth Shyder said...

Snoring is much improved. Still talks like he's all blocked up. I'm gonna miss that when it's gone, though, it's awful cute. Tonight, he was telling me a story:
"Ad den, da prince scooped da dirt and put in da flowers."
"Ad den, Cecelia danced in da garden."
"Ad den, da monster came."
Etc., etc.