Monday, May 26, 2014

Cerclage, Epidurals and a Nurse’s Divine Intervention

            Mayo Clinic defines a cerclage as: a procedure in which sutures are used to close the cervix — the lower part of the uterus that opens to the vagina — during pregnancy to help prevent premature birth.
            The best way I can describe it: turning your cervix into something resembling a marble bag opening.
            And my cervix was about to be turned into a marble bag clone.
            They scheduled surgery for the afternoon, since a heart surgery patient took priority over me. Dr. Landry arrived in my room prior to scrubbing to say, “Hi,” and discuss the procedure with me again, now that the muscle relaxants had worn off. During the go-through, he mentioned that an epidural would be administered for anesthesia. May eyes widened in terror as he talked, and I chewed my lip.
            The epidural I received when delivering Parker had failed to anesthetize my lower parts properly. After I explained that to Dr. Landry, he promised me an “audience” with the anesthesiologist to discuss my concerns. An anesthesiologist, he pointed out, that he highly regarded, and with whom he appeared pleased to be working. Lucky me.
            Surgery time arrived, and they prepared me for transport to the operating room. After being carefully, gingerly re-positioned on a gurney, Dr. Landry leaned over and asked, “Are you ready?”
            “Are you?” I questioned a bit too sarcastically I guess, because the nurses sucked in their collective breaths when I said it. I could almost imagine the “impertinent patient” discussion they’d soon be having at the nurses’ station down the hall after they wheeled me away.
            But Dr. Landry merely smiled and nodded before he and Chris maneuvered me to the operating room check-in area. I watched the ceiling tiles zip by as I cruised along. Chris then smooched me goodbye and said he’d return after going home to see Parker and take a shower.
            In the hallway outside the operating room, Dr. Landry officially checked me in himself at the window, and the anesthesiologist maneuvered to my bedside. Following a preliminary introduction and brief diagnostic back-and-forth with Dr. Landry—who firmly emphasized that he’d like to do an epidural—I interrupted by blurting out my experience with the relatively unsuccessful epidural during Parker’s delivery. I had a sense of urgency about her knowing it. I couldn’t dispel the feeling that an epidural would lead to catastrophe.
            She shifted her attention to me and carefully explained why epidurals sometimes don’t work. Dr. Landry hung over the bed, listening intently before again interjecting that he’d prefer an epidural. But she gave me one last look, turned to Dr. Landry and unequivocally declared, “No. I will do a saddle block so we can ensure complete anesthetizing of the area.” 
            I’d won! I couldn’t help but break out in a victory smile. Four eyes turned to look at Dr. Landry.
            “I guess that is better,” he agreed with a nod. “I can’t afford to have you wiggling around on the table. I might end up puncturing the amniotic sac during the procedure.” I breathed a sigh of relief at his change of heart.
            It would be the first of many God moments that day.
            The anesthesiologist left, cheerfully saying that she’d see me in just a few minutes. “You’re in my hands, now,” Dr. Landry said, gently patting my leg.
            Not entirely, I thought. Your hands and God’s. “I wouldn’t have it any other way,” I said with a grin.
            “I’ll see you inside. I need to go scrub.”


            From the anesthesiologist to the operating-room assistants, the process was a picture of precise efficiency. Within minutes, someone arrived to wheel my gurney into the operating room to quickly prepare me for surgery. Together, they carefully transferred me to the table and quickly strapped my arm down for an IV and then draped my body with warm blankets to prevent my shivering in the cold, sterile room. Instructing me to roll onto my left side, the anesthesiologist deftly inserted the necessary equipment into my back to obstruct sensation in my abdomen, hips and legs. Then she promptly returned me to my face-up position. Dr. Landry suddenly appeared, spoke briefly with her, and then turned his attention to me.
            He repeated the expectation scenario again, along with the expected thirty-minute surgery time. Then he positioned himself in an optimal viewing position at the end of the table and prepared to weave surgical thread through my cervix to draw it closed. All I could see at the end of the table was the green surgical cap on his head. The assistants threaded my legs through little stirrups and gently cranked up my pelvis with a pulley to a more acceptable, and operable, viewing level. A butcher shop picture floated through my mind: pig and bovine carcasses hanging by meat hooks from a ceiling.
            The glare of the operating room lights illuminating the room assaulted my eyes, so I closed them and communicated by nodding or wiggling my fingers at Dr. Landry.
            It seemed as though the process had only just begun when he roused me to announce he was finished. “Everything went well,” he smiled. “What we have to worry about now is labor starting because I was irritating the cervix. The recovery room nurse will keep an eye on the fetal monitor and start magnesium sulfate if that should happen, and I will be into check on you after I change. I may release you tonight if everything goes well.
            Release me tonight! Is he nuts? I don’t want to go home! I want to stay right here, to be observed 24/7, precisely where intervention will be immediate should anything go wrong. I had no intention of leaving the hospital that night. 
            I was briskly wheeled into the recovery room area and parked in a stall along the wall where a nurse busied herself taking and recording my vitals, making me comfortable, and observing my recovery from the anesthetic. What she was not doing, however, was keeping a watchful eye on the fetal monitor, regurgitating a stream of paper indicating stronger and stronger and closer and closer contractions. All of which I couldn’t detect because I’d been temporarily paralyzed from the belly button down. As far as I knew, everything was going like clockwork. Just peachy.
            While I lay there, immovable, my overactive imagination kicked into high gear. I entertained morbid thoughts of what it would like if the anesthesia never wore off, and considered what it must be like for paraplegics. The more I thought about it, the more I convinced myself that I’d never walk out of the hospital on my own power. Worse, I’d never walk again!
            It didn’t help that every couple of minutes the nurse asked if I had any sensation or could wiggle my toes. Mustering great will and determination, I attempted to move the leaded weights extending from my trunk to the end of the table. I was unable to wave even a big toe in her direction. I’d just look at her apologetically and shake my head.          
            Then try to keep from hyperventilating in panic.
            How utterly frightening, to realize that you’d be spending the rest of your life in that condition—with dead limbs hanging limply, uncontrollably from your body. My mind raced backwards ten years to the University of Wisconsin Hospitals physical therapy department, where I’d been volunteering as a physical therapy aide. No wonder those paraplegic patients—grown men and women, in the acute stage of their rehabilitation—spent so much time in fits of anger and tears, consumed with frustration about the unfairness of life and the futility of their condition. The physical therapist would get them on the floor and make them stand up, or get back in their wheelchairs on their own, using only their crutches or their arms and upper bodies for support and leverage.
            After long, drawn out minutes, they’d usually slump into a quivering heap on the floor, unconcerned about the other patients watching their meltdowns. Day after day after day of repeating the same procedure, the same instructions, the same exercises, they’d eventually emerge victorious. And then they’d weep over their success.  
            In an instant, my appreciation for quad and paraplegics deepened.
            This would be horrific.
            While I was mentally entertaining myself, and attempting every fifteen seconds to feel my toes, the double doors were thrust open and in walked Vera, looking determined and projecting a huge smile. My morbid thoughts abruptly disintegrated as I smiled back.
            “I just felt like I needed to come and see how you were doing, “ she said in her authoritative, yet soothing voice as she walked toward me. “How are you?”
            Before I could answer, she stopped abruptly, quit looking at me and scrutinized the fetal monitor paper ream rolling from the machine beside me.
            “Fine,” I replied, instantly calmed by her warm, hopeful presence.
            “You’re not keeping an eye on this monitor at all, are you!?” Vera shot at the recovering room nurse. “She’s having spikes of contractions all over the place, every three minutes! You’ve got to give her magnesium sulfate, right now!” she finished hotly as the nurse snapped to attention and, without a word of response to Vera, rapidly prepared the injection for insertion into my IV line. With visible disgust, Vera reiterated the need for attention to the monitor.
            I swiveled my head right to look at the recovery nurse, who busied herself preparing the injection. She refused to raise her eyes to meet Vera’s lethal gaze. Then I swiveled my head left to look at Vera, whose blazing eyes indicated she wanted to reach across the bed to slap her. Instead, she shook her head and told me she’d see me later. Then she pivoted on her white nurse’s shoes and strode back across the floor and through the double doors.
            I blinked. What just happened? If it weren’t for Vera… Within seconds, the magnesium sulfate flooded my body, bringing with it the familiar, scorching sensations. At precisely the moment the nurse injected the mag sulfate into the line, I requested two cold washcloths for my chest and face and reminded her of the drug’s other unpleasant side effects: nausea and vomiting.  She smilingly reassured me that Dr. Langford had ordered an anti-nausea drug to combat the problem. My eyelids slid shut in thankfulness, and I relaxed enough to momentarily withstand the hot flashes roaring across my face, shoulders and chest. Within minutes, the burning receded, the labor contraction waves quieted to just occasional blips of baby wiggles, and blessed sensation crept into my lower extremities to awaken my feet. All ten toes gestured ecstatically at their liberation. And I breathed a gargantuan relief sigh.
            Dr. Landry also arrived for a quick check—I didn’t blab on the recovery room nurse—and reported that everything looked good, although he reiterated that the next twenty-four to seventy-two hours would be critical. Fortunately, he had decided to extend my stay overnight in order to keep a close eye on me. Smiling, I wordlessly nodded my head. Good decision, doctor! I concur completely.
            They wheeled me back to my room and re-positioned me into the head-tilted-south position. And, once again, I inspected the ceiling tiles as we cruised along. Chris, Parker and my mother arrived to check me out and offer encouragement. Then I was left alone to fill the silence with television and any sleep I managed to self-induce. Seventy-two hours sounded like such a turtle race, especially when every minute hung in the balance.
            And I had plenty of time to think about what might have happened if the anesthesiologist had sided with Dr. Landry, and Vera had not responded to the “felt need” to vacate her post and make a quick trip to the recovery room, just “to check on me.” 

            Maybe God wasn’t so silent, and He hadn’t yet uttered, “No.”


NEXT WEEK: I get to go home, and hope sparks my heart…

Until next week,

Thanks for joining me!