Saturday, November 26, 2016

Surgery

"Papa, do you want to play hospital?" Beren asked Jared today as I lay on the couch with an earache. The stuffed animals were listed on paper, each with their unique ailments. Bent feather, cracked shell, 3 different monkeys with glass in the stomach, earache, hurt tail, broken bone. The loon with the bent feather was an easy fix. The rest were admitted. Together, they healed each animal.

When Jared suggested they needed hospital medicine for one animal not herbal medicine, Beren said, "And herbs, too." 

Beren gravely added that their hospital did not have a laser knife. Instead, they used a snake to remove the glass from the monkeys' bellies. "What hospital has a laser knife? One nearby?" I inquired later, curious to discover where he'd learned about laser knives. He didn't know, he admitted slowly and uncertainly.

One animal received an injection to help them sleep prior to surgery. Jared and Beren agreed that they would need to tell the animal of what might happen when the animal woke up. "Tell them that they might wake up with a leg that feels bad and does not work right," Beren said.

***

About a year ago, our little guy had surgery. Jared and I had put it off for several reasons and finally several factors aligned making the surgery a possibility and making avoiding the surgery more and more of an impossibility. Better said, surgery seemed an inevitability, though Jared and I still found room to debate mixed in a swirl of unknowns and fears. Our reasons (hope and fear) to delay mixed. The hope that things would resolve faded, and fears needed to be faced.

We scheduled a doctor's appointment to for a referral to a specialist as required by insurance. In the midst of this, his health insurance switched unbeknownst to me, requiring obsessive phone calls to the insurance companies and doctors. When we arrived at an appointment with the surgeon and were told our paperwork was not in line, not in the folder, though I had called to confirm we were set twice.  

We waited for the surgeon's office and the general practitioner's office to sort things out and were seen after waiting what felt like hours. The grey waiting room lacked toys I assumed they might have. 

Our agitated child was barely interested in the stickers and coloring supplies we brought. Sullen kids went through the doors to be seen. Squalling kids came out. My resolve cracked when another patient came a out from being seen - a thirty-ish woman was pushed out the door in a wheel chair. She held her head up with one hand as tears of grief rolled down her checks. She'd just gotten bad news.

Beren was displeased. Jared was grim. And I was grim, too, my teeth set, guiding the family along. In our conversations about our appointments, I mixed alarm with empathetic listening and calculated responses with high-pitched cheerfulness and steely determination, in response to everyone's complaints. Beren told us he would never come back to this place, but he would a couple months later.

***

After I scheduled the surgery, I called the hospital and the insurance company to confirm that the appropriate paperwork had been generated on our behalf. Yes, they assured me.

In the meantime, Beren's surgeon changed office locations. I called again a couple weeks before the date and some paperwork was lost, confused, or misplaced. I spoke with the surgeon's receptionist, "I'll have a nurse call you back."

I kept my phone in my pocket, waiting for the call. The nurse called and asked for my information. She opened our file, "Ok, Mommy, I don't see the referral." I carefully listened to the nurse's words, noting her insurance lingo. Referral. A referral was needed. Referral not on file.

I called the insurance company. I begged for clarification. I'm a dummy. I don't understand the lingo, I told her, hoping for sympathy. Please help. "What do I need?" I asked. A very friendly, forgiving, and jovial woman with a Southern accent told me nothing. Nothing, it seemed. I needed nothing. Sometimes the doctors office get confused, too. I carefully noted that.

I opted to need something over nothing. If I had a referral, we wouldn't be turned away on the day of the surgery. This was my Greatest Fear Number 2. I  called our general practitioner's office again. I was apologetic. I had called them numerous times during the insurance switch. I was certain they had a photograph of my face on a dartboard. Or, perhaps they had a picture of my guts on the wall. My guts felt like they were filled with darts.

I repeated what the surgeon's nurse had requested. A referral. The irritable receptionist at the general practitioner's office bristled. It seemed that she'd set everyone straight. As it turns out, we needed a 'script' not a referral.

I called several numbers at the hospital again days before the surgery. I went deep into the belly of the hospital - the accounting department, the surgeon's office, and then some deeper layer. I felt as thought I was talking to a woman far inside some castle-like tower. Being close to Christmas, the people on the other line seemed kinder.

All seemed well. Then, as scheduled, a nurse called from the hospital the day before the surgery with instructions. "You'll need to be at the hospital by 6:00 AM. No food or drink after 9:00 PM tonight." I balked slightly at the time. "It's ok. We're used to cranky kids," the nurse answered.

I knew Jared would blow his top. He did. "What time?! They want us to arrive at WHAT time?!" By this time, I felt like a pincushion, covered in darts.

"The surgery is likely to be early. They take the kids from youngest to oldest," I said. "They don't even know what time?!" Jared exclaimed. "No, but I'm thinking we're likely to be early," I said, being optimist, and possibly lying.

"And, he doesn't need to do anything to be discharged. Doesn't have to pee," I'd been afraid of everything, imagining things that I heard about in hospital dramas might come true. Mothers who just gave birth have to go pee before being discharged, right? Or was it anyone who had surgery? Anyway, our stubborn child had a steely will and bladder. He'd never pee on request and luckily he didn't have to.

Meanwhile, I just wanted Jared to help me steer the ship towards tomorrow morning. I was too tired to discuss medical protocol. "Not even water?!" he went on. "No, they don't want him to vomit and aspirate," I said quickly. I hardly wanted to mention anything going wrong, but I wanted Jared off my back. "I'm not making the rules. Let's just follow the rules," I said.

I had been steering the ship for some months, making appointments and calls. He listened when I stressed out about the logistics behind the surgery. The surgery itself - we sought other options but surgery was the only answer.

Our care provider was encouraging. He's young and healthy, she told us. The Mayo Clinic online pointed towards surgery. A friend studying herbal healthcare asked her teacher - surgery was the answer. All our inquiries pointed towards surgery.

Ultimately, I had convinced Jared to move ahead with the help of his mother. We double teamed him in the kitchen one afternoon while Beren played on the other side of the house. Dealing with the insurance was a nuisance compared to the moral responsibility I felt I had taken on. Though Jared and I agreed, I pushed. If our ship crashed, I was the one who pushed. If all went well, we could forget the whole thing.

On the morning of Beren's surgery, we set our alarm for 4:00 AM. Beren, normally a late riser, woke, too. I cuddled him and we cheerfully talked in the dark until I reminded him we would be leaving to go to the hospital. We had given him several days notice about something he had never experienced. 

"NO IT'S TOO LATE. NO. NO. IT IS DARK OUTSIDE." Beren clung to the bars of his loft bed with fury. His adrenaline surge made him stronger than me. I spoke in quiet, calming ways, though I am certain my nervousness was felt. "NO NO NO. BAD GUY. BAD GUY. NO NO NO." 

"BAD GUY! BAD GUY!" Beren's screams were guttural, possessed. Who was the bad guy? Me? I wondered.

Once in the car, he continued to scream. I couldn't buckle him. His body was like a feral wire. We began driving and finally he settled. The cold air and routine of buckling prior to driving pierced through his anger. I had been counting on an out of sorts kid. I had been counting on a hungry kid who wasn't permitted to eat until after his surgery, but this was harrowing. I splashed us with Rescue Remedy.

The sun came up as we drove towards the children's hospital. Once there, we passed through momentarily exciting revolving doors.

We were directed to a waiting room where we sat, bleary. Beren played with the toys. I filled out digital forms binding us to pay for his care no matter what, absolutely no matter what. 

We sat. After awhile, I inquired about what we were waiting for, and our presence reasserted, we were hustled along to another waiting room. We sat uncertainly. There was no one to receive us. I ventured through two double doors. "We've been waiting for you," someone said.

Beren refused to sit on the tiny hospital examination bed. We sat on the floor of the small triage type room instead. A kind nurse took his vitals and talked with him cheerfully.

A friendly social worker brought him a canvas bag with the children's hospital logo. Inside were a box of trucks, a coloring book, and crayons. The trucks were seconds with the shiny paint chipping a little. They were welcome distractions. She worker squatted beside him and explained briefly about hospitals and asked if he knew why he was in one. "Yes," he said slowly.

I grimaced as he played shoeless and shirtless on the examination room floor. The nurses asked me to dress Beren in a hospital gown and socks. He refused. 

The nice nurse returned, commenting on the toys. She would be the one person he remembered favorably. 

An assemblage of hospital workers--nurses, doctors, the pediatric anesthesiologist--stood in the doorway. The anesthesiologist explained possible side affects to Jared within earshot of Beren and me.

Another hospital employee came in with no introductions. "This medicine will help you to not remember any of what happened today," they explained. [I can't recall the person's gender, I was so startled at this point.] They held out the small disposable cup of red liquid. Beren refused. I cajoled him. He refused.

"He will need to be in the gown," one of them said. "No, I have already forced him to do too much today," I said weakly to the phalanx in scrubs. I put on my own paper gown, booties, cap, and finally the mask. I smiled and joked to Beren and Jared about my outfit. I had a knot in my throat.

The social worker deliberately and with purpose walked us down the hall. I held Beren's hand, submitting to the social worker's friendly talk. All I have to do is make Beren trust us right now, I thought. I imagined Jared's eyes on our backs as we walked through double doors to the operating theater. My eyes stung, thinking of him.

We continued down the long hall, the doors clicking closed behind us. I felt more relaxed than ever. Beren didn't respond to the social worker's gentle, child oriented questions. "What color do you like?" I asked her. She replied orange. Beren, disarmed, added that he liked orange, talking easily for the first time that morning. I had made him trust her and I hoped that was not betraying him.

The operating theater was bright, so bright as to be shadowless. Video screens were suspended from the high ceiling. Fish swam across the screens. "Look at those fish. I like fish," the social worker said. "Do you like fish?" I was surprised to hear Beren reply, "Yes." She did her job well.

"Mommy, you can put him on the table."

I helped Beren up onto the operating table. The anesthesiologist explained to Beren that he was going to put a mask on Beren. "Ok? Mommy will hold it." No refusal. I cradled him, and the social worker continued to talk about fish. Beren blinked.

"Mommy, he may shudder when he becomes unconscious," someone said to me. "That is normal." Moments later, he shuddered and I felt like his light went out. 

"Ok, Mommy." My cue to exit the theater. I froze.

"Ok, Mommy." Time for business. I laid Beren down. The social worker was at my side to escort me. I looked back at Beren from the doorway because I thought I should. 

Back in the waiting room, Jared and I hugged. We choked out a couple sobs. We watched the gritty city from our colorful seats on an upper floor in the children's hospital.

A groggy kid in a hospital bed was wheeled past and loaded into the elevator. His parents stared at their phones as an orderly pushed the bed. "Get off the phone," I thought. And then again, a children's hospital is the last place I'll pass judgment against a parent. I shifted in my seat.

I glanced quickly at a couple to our right. I wondered why they were here. I wondered if they wondered about us.

Hours later, the surgeon arrived with her team. "The surgery went well," I heard. I missed the rest and asked Jared about the other details later. Did they do this and did they do that? Did they do what they said they would (as if they might have forgotten)? I asked him. Yes, yes, he assured me.

The night before the surgery, I dreamed that the surgeon was driving a bus and we were waiting for her along a gravelly sand road. I told her the dream. I later hoped I hadn't offended her.

A nurse led us to the recovery area and to Beren's side. He'd wake in a hour or so. Don't try to wake him she told us. Curtains separated beds with knocked out kids. He looked so small under the white cotton blanket. I checked his breathing. I felt his chest. I felt something but felt under his nose, too. "He's breathing, right?" Jared asked. We sat by his side, relieved, slightly giddy at times, watery at others.

The nurse showed us his incision. It was more red, ragged and larger than I thought it would be. I hoped Beren's fury would not reignite at its sight.

We talked about gardening with the nurse. Beren blinked, rolled his eyes, and closed them again for some time. When he finally woke, he was groggy and sluggish but wanted to sit up immediately. He was still shirtless. He sucked down three blue ice pops.

He wanted to walk not long after but couldn't. The nurse was not surprised at his is feeble legs. Jared and I were startled. After several hours in recovery, he was ready to go, and the doctors agreed.

Back at home, he insisted on walking but still couldn't. His legs crumpled under him. Jared caught my eye. I called the hospital. The nurse reassured me, and said to call back in one or two hours. When he still has stumbling after a couple hours, I called again. The nurse explained that it was not likely to be affects of general anesthesia but of local anesthesia to prevent muscle movement during surgery.

He never took a painkiller, not that I was proud of that. I was relieved that his body handled it well. Within a day, he was walking and sooner than we wanted, he was running.

Nevertheless, Beren angrily complained that the doctors had broken his leg. For months he bitterly decried the hospital. Why would someone go into a place perfectly fine and come out unable to walk? he wanted to know.

I tried to explain. It wasn't easy. Our conversations often happened after Jared finished reading bedtime stories. I'd pad upstairs to kiss him goodnight. Suddenly, he tell me he'd knock the hospital down with dozers and rescue the children. He'd destroy the city. I listened to his fury. I stood by his bed holding his hand as he cried.

Some nights, I laid next to him, listening. I once added that we could build a wall around the hospital. Yes, and keep all the doctors inside, he agreed.

Sometimes, I quietly re-explained why he had surgery. Other times, I explained why doctors are helpful. I agreed that going into a hospital with working legs and coming out with non-functioning legs made no sense. Many times, I simply held the space, listening, reassuring him that we'd not return to the hospital.

I sometimes told him that Jared and I had listened to the doctors and carefully decided that going to the hospital was important. I talked too long and no matter what I said, I made no sense to Beren. He always blamed the doctors, never me, never Jared.

After Beren drifted to sleep yet another night, I stumbled downstairs in the dark, reeling emotionally. I had hoped for and expected a successful surgery. Unexpectedly, I had a furious and insulted five year old. Jared and I talked it over, again and again, reassuring each other that we made the right choice and that our child was well and feisty, too.
Back at school, he brought in his souvenir first aid kit from the hospital. It was my suggestion to help him process the experience. The children hadn't really listened to his show and tell he later told me. They were distracted and noisy. He was disappointed and tearful.
I was shaken up for some time after the surgery. Though all went well, I was in a haze and socially isolated, unable to complete the process. I often used the canvas bag from the hospital, proud of our hard work. I sensed Jared would rather not see the bag so I told him why I used it so often.

A year later, Beren scar has faded to a dull brown. He looked at it once, maybe, when it was red and painful. We haven't had a sad night-time talk about the hospital in many months.

When Beren asked to play hospital with Jared today, I knew this story was ready to be written, t least my side of it. Beren owns the rest, always did.

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