The Surgery - 003

In my experience, after you’re initially diagnosed with cancer, there is a “settling in” period. The time of denial is over. Sadness and anger arise. In the first few weeks, I also experienced what I call the Groundhog Day effect, based on the movie Groundhog Day. You go to sleep each night, and in your dream time, you forget that you have cancer, and then you wake up each morning only to remember you have cancer and be traumatized all over again. Eventually, this effect seems to wear off as the daily remembrance fades into fact without the same traumatic emotional response.

During the first few weeks after my biopsy, I had to tell my family, friends, and colleagues. I hated doing that because I didn’t want to upset them, and I really didn’t want to keep retelling the story. It seemed each time I told the story, it became more of a reality. There were days I call emotional meltdown days, where I’d cry my eyes out, but thankfully, these occurred less frequently as time passed. Emotional lability is a normal response to a cancer diagnosis.

My beloved sister Dianne, a registered nurse, asked if she could accompany Mike and me to the hospital for my surgery. She told me she would stay with us for two weeks afterward to care for and cook for us. I’m so glad she did because I honestly don’t know how Mike and I would have done it without her. We picked her up at the airport and left for Celebration, Florida, the next day. I had to do a liquid fast the day before my surgery, along with a bowel prep.

They want your bowel cleaned out just in case they accidentally cut your bowel during the surgery. In addition, during the robotic prostatectomy, they fill your abdominal cavity with carbon dioxide gas to give them room to work. If your bowels weren’t clean, everything would come out because of all the pressure from the gas.

While in my hotel room doing the bowel prep, I received a video on my cell phone. My medical team back at the office sent me a video of them grouped in my office, saying, “We love you, Dr. Holden.” I burst into tears. That was such a sweet thing for them to do.

The next day, we show up at the hospital and are brought to the anesthesia area. I undress except for a hospital gown, and a nurse comes to put an intravenous (IV) line in me. I tell her I’m a physician, my sister is a nurse, and her face turns bright red. I guess that information distracted her because I felt a very painful jab.

She gets the IV needle in, but not without some trauma to my vein. I subsequently developed painful superficial phlebitis in that vein that lasted for two weeks after the surgery. Lesson learned - don’t make the nurse who starts your IV line nervous:)

The anesthesiologist, who looked fresh out of residency, made his rounds, as did the urology fellow who would be performing the surgical opening and closing for the urologic surgeon. They were nice, and I felt like I was in good hands.

Then, another nurse came by and said it was time for my medication to initiate anesthesia. I was grateful because I was starting to get very nervous thinking about what was about to happen.

If you ever have to undergo a radical prostatectomy, don’t make the same mistake I did, and watch the procedure on YouTube. It’s an extremely brutal procedure. The surgeon tears and burns tissues while cutting away omentum, fascia, and lymph nodes. The worst part is watching when they cut the urethra on both sides of the prostate and then reconnect the distal urethra to your bladder.

In that process, they have removed two of three safeguards that prevent urinary incontinence. So, it’s a given you’ll be incontinent of urine for at least a few weeks to months after your procedure. Also, the surgeon cuts away nerves that give your penis the ability to initiate and maintain an erection. So, it’s also a given that you will be impotent for at least a few months after your surgery, and for some men like me, it’s permanent.

The nurse injected a syringe full of medication, and I kissed both Mike and Dianne goodbye. I’m taken away, and the last thing I remember was being wheeled into the operating room and thinking how incredibly bright the room was. Then I was out. It’s a good thing I don’t remember anything else. I’m glad I didn’t see the multi-armed robot sitting over my surgical bed.

During a robotic prostatectomy, the surgeon sits at a computer console in the corner of the room and directs the robot’s arms like a computer game. It’s high-tech but the stuff of nightmares if you were to see that as a patient.

The next thing I remember is waking up in the recovery room with Mike holding my hand, telling me to breathe and to remember my meditations on how to relax. He says I was moaning and groaning and lying very stiff in the bed.

My sister said the recovery nurse told her that she had given me all she could for pain and couldn’t give me any more medication. Really? Then she rushed them out of the recovery room.

This was one of two experiences on this journey related to not providing adequate pain control. In this instance, part of it is the recovery room nurse wanting to keep me awake so he or she can open the recovery room bed for another patient. Regardless, it is inappropriate when healthcare providers don’t provide adequate pain control for their patients.  

The next thing I remember is lying in my private room in a hospital bed with Mike and Dianne standing next to the bed, holding my hands. I lifted my hospital gown to look at my bloated stomach and saw five small blood-encrusted incisions and one fairly large midline incision above my belly button.

There was also a drain inserted in the left lower part of my abdomen, filled with watery blood. Each incision was stinging, and my entire abdomen hurt. The contents of my abdomen were so traumatized and stunned that I wouldn’t even pass gas for another three days, much less have a bowel movement.

They wanted me to get up as soon as possible and walk, so, being a good patient, I asked to get up and walk. I made it about fifteen feet down the hall and had to stop because of severe nausea and sweating—too soon. I made another attempt about an hour later and did okay.

My only complaint about the hospital stay was that my pain was not well-controlled. They did not use pain pumps or any injectable narcotics. They did give me intermittent shots of Toradol, a non-steroidal anti-inflammatory, and a five-milligram hydrocodone tablet every four to six hours, which helped for about three hours, and then the pain returned. So, I was up most of the night due to pain.

This lack of adequate pain control is unacceptable, and I feel it is a part of the pendulum swinging back from the excessive prescribing of narcotics over the past few years. But we shouldn’t go to the other extreme and not provide adequate pain control for patients.  

Despite being a robotic prostatectomy, the physical trauma to my abdomen from the surgery was so intense that I wasn’t able to lie in any position other than flat on my back for one and half weeks after the surgery due to pain with any other position lying down.

The robotic surgery does reportedly cut down on blood loss and gives the surgeon better fine hand control, but it doesn’t reduce trauma. This is in part due to the robotic arms requiring six incisions in your abdomen.

Five of the incisions were about an inch long, and the sixth incision was about three inches long and located above my belly button. My prostate was removed from my body through the larger incision, and there must have been a lot of tugging and pulling because a huge bruise surrounded that larger incision.

I spent one night in the hospital, and the nurse woke me every four hours to check my vital signs. Then, bright and early the next morning, the door swings open, all the lights are turned on, and the surgeon, with his team of four, comes in.

He tells me he didn’t see anything unusual during the surgery - no surprises, in his words. In other words, he didn’t see anything to suggest that the tumor had spread out of the prostate. I was relieved.

Shortly after that, the nurse came in and pulled the drain that had been collecting blood from my lower abdomen. Pulling the drain felt like somebody putting a lit match on your abdomen.

I attended a mandatory class in the hospital the morning after my surgery that taught seven of us about the medicines we’d be on and how to clean and replace the bag connected to our urinary catheters. I was to come back in five days to have the catheter removed, and I’d have to spend the night nearby afterward just in case there was a complication. I was sent home on Tramadol for pain, along with a stool softener and another medication to keep the bladder from spasming.

I slept most of the drive home and began to eat a regular diet the following day. The more I ate, the bigger my abdomen got. I began to get concerned when I had not passed gas in three days. By the third day, my stomach was really uncomfortable.

Within a few hours, the pain in my abdomen became intense, and I began to dry heave. The contents of my stomach and intestines were trying to go somewhere, but nothing was moving. All of the surgical trauma to my abdomen had stunned my bowels. Each dry heave brought excruciating abdominal pain, feeling like my bowels were about to explode and my incisions were about to tear open.

I got scared and had my sister call the surgeon’s office. His fellow asked to speak with me, and in between dry heaves, I told him what was happening. He said that if I was still like this in a couple of hours, I was to go to my local hospital and be admitted for bowel rest.

Bowel rest means nothing by mouth, with a nasogastric tube inserted through your nose and into your stomach to decompress the air and contents that have built up. As soon as I hung up the phone, my body said no way to that, and my bowels began to move. Thank God because I was in terrible pain.

Slowly, my bowels resumed functioning, and I could eat again the next day. Because of the pain, I could only sleep on my back with my legs bent. So, I slept on the couch to lean my bent legs against the side of the couch while I was sleeping.

I became an expert at cleaning and changing the bag on my catheter. It’s a surreal experience to wear a catheter in your own home and try to go about your everyday activities.

You carry your catheter bag in a nylon bag, like the one you get when you go grocery shopping. This experience made me highly aware of how serious this was and how serious the surgery I’d just undergone was.

Despite my abdomen being decompressed after passing gas and having a bowel movement, it remained seriously bloated from all the swelling and fluid build-up. When your body is traumatized, it leaks fluids into the damaged area. Think of a sprained ankle and then multiply that by ten. I looked like a stabbing victim who was four months pregnant - not a pretty sight.

Despite how I felt, I was instructed to walk a mile daily. The first two days home, I walked about a half-mile, and then after that, I was compliant with the mile-long walk. Walking a mile a few days after my surgery wasn’t painful, but it did show me how much the surgery had impacted my stamina. I was exhausted after each walk and had to nap.

Before I knew it, it was time to head back to the surgeon’s office to get the catheter removed and get the pathology results of my surgery. I had this vague sense of dread but still hoped for the best. The best is that the surgeon had gotten all of the tumor, which could mean I was cured.

I would soon find out information that would change my life forever.