I always wonder if I’m going to come back

From anaesthetics: I really do wonder, as I fade away into that fuzzy darkness, whether I’ll come back this time.

I’ve had a fair bit of practice, you see: I was counting them up prior to my last adventure in an operating theatre, and I got to fourteen times that I’ve had general anaesthetics, so far.

Fourteen times I’ve counted to ten, or as far as I’ve got before darkness claims me – again.

The first time I could only have been nine or so, in Lusaka General Hospital having my adenoids out, because “That will help your breathing”. Because I breathed loudly, and though my mouth – or so I was told. What I remember most about that time was that there was a delay in taking me through to theatre, and I got so thirsty I was going to sneak off and drink from a tap – and eat toothpaste, because I was seriously hungry too.

Waking up from that was interesting, because my top lip was swollen out like a duck’s beak: a clamp holding my mouth open had slipped, and cut right through the side of my lip, and my throat felt as though it was on fire. I also remember my younger brother lying, still deeply unconscious, with a gobbet of yellow-green mucus crawling out of his nose, after the tonsillectomy he had had just after me. I vividly remember the continuing pain from my throat, the ice cream did little to help, and no-one seemed to want to give me decent pain relief. I still have the scar that they gave me: I used to joke about it being from an attack by a guy with a knife.

The next time I was fourteen, and at boarding school in Zimbabwe. I had managed to break my nose against my own knee while practicing being a hooker in a scrum for the Under 14 B rugby side at St George’s College in Harare. It had been decided above my head that I needed my nose straightened, and “It will help with your breathing”. I walked myself the 5 km or so to hospital to check in – no lifts or taxis – and I was alert right up to the needle going in, and then heard my own voice fade away as the world softly went dark – and then I was awake and in serious pain, with both nostril stuffed full of gauze. A nurse would come and pull it out, half a metre at a time, which created the most exquisite agonies you can imagine. Two days of that, and then I had to walk back to school, nose swollen to three times its size, sinuses full of blood – to get a month off rugby, with no painkillers in sight. My nose is still slightly crooked, and it didn’t help my breathing.

I managed to stay away from anaesthetists for another fifteen years or so, until one day while at work at the University fo Cape Town, PhD newly in the bag, I noticed a little blood in my urine. I got a friend who had been a medical tech in the SA Army to look at it under a microscope, and he confirmed blood. I confidently self-diagnosed myself with bilharzia – I mean, I’d been swimming in every major river and dam in south-central Africa by that time, and had previously been treated for it – and went off to see a newly-minted urological specialist at Groote Schuur Hospital for a consult to confirm.

It took my new friend about forty minutes of the consult to realise I wasn’t medical, and then cautiously took command, and decreed that I should have a cystoscopy. I was not happy when I found out that this entailed having a stainless steel pipe pushed up my urethra; why couldn’t he just do a rectal snip like the last time, I asked? Because you’re bleeding into your bladder, he said, and I reluctantly checked myself in for what was supposed to be an in-and-out, one day stay. I recall being wheeled in to theatre dressed in one of those horrible gowns; it was cold and I was wide awake – because I was not a fan of sedation. Lots of joking around, then I was counting to ten as the lights faded…and I woke up in the semi-dark, in a corridor, freezing under a thin blanket. After what seemed like an age, my cheery surgeon loomed over me, and said: “You want the good news, or the bad news?”

He didn’t in fact let me choose, before he went on with “The bad news is, you had a tumour in your bladder. The good news is, we think we burned it all out!” He nodded cheerily, said “See you later, hey?!” and left me in the corridor – with what I realised dimly was a drip in my arm, and a catheter inserted up my urethra.

That one-day visit turned into four days and nights in hospital, with me with a catheter in to allow bladder wall healing, in a backless gown because I’d brought nothing with me, until friends took pity on me a couple of days in when they’d found out where I was. I learned from my specialist that I had had a “Well-differentiated basal cell papillary carcinoma”, and that he had managed to “fulgurate it”, as well as take a biopsy. I learned that having a catheter in was nothing like as uncomfortable as having a catheter taken out, and that some screaming while urinating was quite normal for a couple of days afterwards. The prognosis was all good, however, and check-ups were scheduled for a year’s time – until I got a phone call three months later, just as aI was about to head off to Belgium for three months academic leave to learn how to do molecular biology. It was my now private practitioner surgeon friend, saying they’d made a mistake in the preliminary during-op diagnosis in the path lab, that it turned out from the written report that it was in fact a poorly differentiated basal cell carcinoma, and would I make an appointment ASAP for another cystoscopy? There I was again, then, in a silly gown, with a catheter to protect a newly-biopsied bladder, after swimming back through the darkness – at least in a private hospital this time.

That was the rhythm of my life, set for the next two years: three-monthly cystoscopies with accompanying general anaesthetic, with me refusing any pre-op sedatives because they gave me a horrible hangover, and scheduling everything else around my hospital visits. Then the three-monthlies became two six-monthlies, then one a year later, then…I was told I had been clear for two years, that there was no trace of recurrence, and I wouldn’t need another of those damned procedures. By this time I had met and got together with Anna-Lise – who had been warned by her family not to get close to me, because I was probably going to die sometime soon – and was slowly warming to the idea that I might not die in the near future, and could actually start planning to be around a while.

I was good for close to another twenty years without needing a general, it turned out – until that fateful day in 2006 that I went to an ENT specialist to get an opinion on what to do about my snoring. Which Anna-Lise, having got married to me in the mean time, was worried had developed into sleep apnoea, and was in any case ruining her nightly rest even if she slept in the lounge. I think “heroic” was the word for it: audible from the other side of the house and from down the stairs, and interrupted by ominously silent periods of no breathing at all.

The enthusiastic ENT man turned out to be an old acquaintance from my UCT Mountain & Ski Club days, and I was happy that he seemed to be very clued up on possible solutions. The best of which, it seemed, was a procedure called a uvulopalatopharyngoplasty, which involved cutting away the flappy bit at the back of my mouth, tightening up the tissues in my pharynx, oh, and “removing your tonsils, shaving your turbinates and correcting your deviated septum” to boot. Which, it would appear, would improve my breathing through my nose. You see a pattern here?

All this was scheduled for a Friday afternoon in February 2007, and all went well until I met the anaesthetist – who was not the person scheduled to do the op, but “I’ve worked with him before, and he’ll be fine”, I was told. Again we do the count; again, I watch the world fade away – and wake to a ferociously sore throat, and both nostrils packed with what looked like tampons, right down to the strings hanging out. I get told that I’m in the medical rather than the surgical ward, because they ran out of space, and “Doctor has scheduled some morphine; I’ll give you some now, and tell us when you need some more?” I get the first shot, and it’s instant relief. I eat some jelly, and I’m watching the Super 14 rugby at 7 or so that evening after a wifely visit, and the ward sister asks me if I want my morphine now? The pain is beginning to grind again, so I say, “Yes, sure, if he said so?” I get a shot, pain ebbs away, and I feel my eyes closing….

I like telling people that I woke up dead. In fact, what happened is that a passing ward sister noticed me lying at an angle in bed, with my face blue – and not breathing. It was pure luck she looked in, because I wasn’t in the surgical ward, and they don’t check to see if medical patients are breathing very often – and this is why I later hear that it’s a REALLY bad idea to go into hospital on a Friday afternoon – it’s also just after shift change, and weekend staff complement is lower than weekday. She calls for emergency resuscitation, and because my chart shows a 15mg hit of morphine a little earlier, they administer the antidote, and – nothing. They intubate me and rush me to Intensive Care, and – nothing. I was non-responsive, right down to that nasty reflex test they do on the sole of your foot with a sharp probe. So it comes to pass that Anna-Lise gets called at 1 am or so, and is told “There’s been a bit of problem with your husband, and he’s not where you left him…” – so she panics for a couple of hours, then eventually drives herself to the hospital and comes to Intensive Care, to find a couple of very grim-faced medics standing around me, and me there stuffed full of tubes and drips, and lying very, very still.

I was, of course, blissfully unaware of any of this. There was never any circle of light to go towards, or away from; no heavenly voices – nothing, except the world having faded away while the Blue Bulls were staging a late come-back in their match with the Stormers. And then, suddenly, I come back: I seem to awake abruptly from anaesthetics; this time, it was zero to full awareness in a second or two, to find myself in the half-dark, with what looked like three of the Four Horsemen of the Hospital Apocalypse standing grimly at the foot of my bed. And me full of tubes, and things going beep around me, and a sister saying “Doctor, I think he’s awake??” Turns out the three horsemen were the ENT guy, the anaesthetist, and a neurologist – there to tell everyone whether I was brain-dead or not.

I recall beckoning for a notepad, and writing “What the FUCK happened to me??” Anna-Lise, who was hovering nervously near me, burst into tears, then there was general confusion – and the anaesthetist melted away, never to be seen again by me, or anyone close.

Oh, there was much ass-covering, and blaming morphine sensitivity, and delays in getting records, and – but basically, I got overdosed on morphine that I should not have received at all, given that it depresses breathing, and this is NOT what you want after an ENT op. I ended up with a raging throat infection thanks to being intubated on top of fresh wounds, and literally couldn’t function for a couple of weeks. This notwithstanding, my surgeon seemed eager to get me back to work, without any management whatsoever of me or any problems that may pitch up. I went back to work far too soon, in retrospect, because although my throat may have recovered, I had been hard hit by oxygen deprivation. Harder hit than I knew, although Anna-Lise noticed pretty much immediately: effectively no short-term memory, no sense of where I was, a really short temper…. And I repeat, with no management whatsoever, other than visits I organised to my GP and to a neurologist.

I could have sued, I suppose, once I finally got the medical records, and they showed how much morphine I’d had, in just a few hours. However, my ex-brother-in-law, himself an anaesthesiologist, said to me: “What would you want to get? They’ll drag it out as long as they can, you’d have to admit you’re damaged, and what would that do to your career?”

I agreed, reluctantly. I think I’ve got back to being fully functional in the last ten years – I’ve always forgotten people’s names and appointments, and that’s only slightly worse now, and my internal compass has returned, so I know where I am most of the time – and I’ve compensated for memory lapses by rigorously using a cellphone and an iPad as auxiliary memory. I’ve lost nothing in terms of scientific interpretation and memory of what I’ve read, although I do ask people to email me confirmation of anything I agree to in conversation – because if it’s not repeated in print, it’s often as if it never happened. I also find it hard to recognise people I’ve met since 2007 – so if I string out a conversation and act vague, it’s because I’m desperately searching for cues as to how I know you.

I really don’t trust anaesthetists any more – which accounts for why, during my latest encounter with someone wielding a knife, I flatly refused a general anaesthetic, or deep sedation. That adventure was a basal cell carcinoma removal from my nose, which knocked me way worse than I though it should, and still needs clean-up. Oh, I joke about it, saying “I could only afford half a nose job”, or “It was a big guy with a knife – I was helpless!” – but when it dawned on me that I hadn’t had the path result back yet, and people were asking me in a concerned way what the prognosis was, I was close to panic. It’s OK, though; it was all got out, and if you’re going to have BCC, mine was about as good as it can be. Although a little large – meaning my nose is probably ruined forever.

And you know what? I still snore. Possibly not as heroically as I did, but my breathing still isn’t what other people think it should be. And I think I’m going to be OK with that.


About Ed Rybicki

Ed is a 60-ish virologist and biotechnologist, formerly a Zambian and presently a South African. He is into family, virology, biotechnology, science in general, science fiction in particular, photography, red wine, wearing loud shirts, 70s rock, blues and smooth jazz...and telling stories. Sometimes, interesting ones. And writing for his own amusement.
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