Thursday, December 21, 2006

Surgery Post Script
The Second Time (Out of Three) I Came Startlingly Close to Death

Happy (belated) Solstice to all of you out there who pay attention to this sort of thing. And thanks to AOF, who I neglected to acknowledge for her happy solstice wishes in my last post. (Sorry!)

Since I dreamed last night that my late father and I were fugitives from extraterrestrial aliens, (admittedly one of the most fascinating nocturnal fantacy-adventures my mind has ever created), I thought I'd feature one of his photos on this post.

As is most often the case, is one's a long one. With me, you may not get frequency from me these days, but you do get a lot in one big bite. I'm still trying to get caught up on reading everyone else's blogs, which is a daunting proposition right now, as many of you have been quite prolific. So, I feel like I'm doing you all a great service by not posting too often.

This afternoon I go for my post-op visit and I expect that my surgeon will yank the surgical tape off of this incision. Surgical tape closures are apparently the new thing. The sutures (stitches) are on the inside and they'll eventually dissolve. I don't think that's happened yet because I can feel a hard line below the skin that feels like it could easily be a stitched wound closure. I'd have put up a picture of the taped incision, but it may have grossed some of you out. I was badly bruised and it was pretty ugly under the bandage, but if you really like seeing stuff like that or are just insatiably curious and inquisitive (as I am), let me know and I'll send you a link or a JPG. Anyway, I get the impression that this severe bruising thing is not the norm. I'll tell you why in a minute.

Rather than general anesthesia, I had a MAC surgery. (Perfect for me, huh?) From the linked article: "The purpose of a MAC is to provide the patient with anxiety relief, amnesia, pain relief, comfort, and safety during the procedure. Like general anesthesia, MAC uses sedatives and other agents, but the dosage is low enough that patients, remain responsive and breathe without assistance. " I like this idea much better than general anesthesia. But if I had any awareness or responsiveness, the amnesia thing took care of it. However, there is one thing I do remember, and that was hearing the surgeon telling the residents, "we have to achieve hemostasis," and something to the effect of "we still have bleeding here," and something about clamps and directions to "get that one right there." Then, zippo. No other memories.

When I woke up in the recovery room I was told that hey couldn't get me to stop bleeding during and after the surgery and that I may have a bleeding disorder. I was advised to have my primary care doctor check it out.

It's not the first time this kind of thing has come up. I frequently find bruises in weird places that would not have been subjected to some kind of trauma. They just pop up spontaneously. In fact, I've watched it happen in different spots over the period of an hour or so without any kind of concurrent injury. And then there was the more serious bleeding episode.

It happened two weeks after Rachel, my second child, was born. I had been on the sofa nursing her and when she was finished, I stood up and almost instantly found myself standing in an enormous pool of blood. I knew all too well that I was hemorrhaging because I had heard the story countless times of how my mother almost died from a post-partum hemorrhage after my sister, her second child, was born --two weeks after she was born, just like me. Turns out that my grandmother had the same experience after the birth of her second child.

According to a source cited in this article from Contemporary OB/GYN, "massive uncontrolled hemorrhage after childbirth is the leading cause of pregnancy-related death in the United States and one of the most common causes of maternal death."

This is one of three times I've come ridiculously close to dying, but the other two times, I'd narrowly dodged the bullet. This time was different. I was hit by the bullet. I just didn't die.

Since I knew the seriousness of what was happening, I called my mother, then 911, and was quickly delivered to the hospital ER via ambulance. My mother was a nervous wreck. I told her that this was not going to be a replay of what happened to her because we understood what was going on and didn't wait to get to a hospital, where I would get good care and they wouldn't let the worst happen.

The on-call physician from my OB-GYN's practice was a snippy young woman with some kind of serious chip on her shoulder. She walked into the ER exam room as I was again nursing the cranky newborn Rachel. Upon taking in the scene, she said in a very snide and sarcastic tone, "I hate to break up your little mother-daughter bonding moment, but I'd like to have dinner with my family at least once this week." I bit my tongue but in my head told in just as snide a tone that perhaps, as an OB-GYN, she shouldn't expect to be able to do that when it was her turn to take call. So, I gave the baby to my mother and told Dr. Snippy* that I was bleeding a lot. She dismissed it as hyperbole. I told her to look at the blood-soaked clothes and towel in the bag and noted that the rather large pool of blood in my house that was cleaned up with a different towel. She told me that towels disperse the blood and make it look like it's more than it is. Her disregard of the seriousness of the hemorrhage worried me, but clearly, I had no influence on her opinion.

Dr. Snippy's solution to the problem was to have me admitted and to give me a shot of pitocin so the uterus would contract and stop the bleeding. I was also given an injection of an agent that promotes the production of red blood cells. This is a normal first-course of action. Dr. Snippy wrote her orders and left, but the pitocin didn't work. I continued to hemorrhage and the nurses who monitored me were becoming quite concerned. They called the doctor to update her and she ordered another drug. I was told that I would not be able to nurse Rachel for two hours after this second drug was administered and that I should pump some breast milk before I received it. Nursing causes the release of pitocin and maybe if my uterus contracted more, it would help stop the bleeding.

A nurse brought the breast pump and left me to do my thing, but just as I got started, I began to feel nauseous, lightheaded, clammy and began breathing rapidly --all the early signs of shock, a life-threatening condition that occurs when the body is not getting enough blood flow. I knew I was in trouble and hit the call button. Two nurses bolted in and began working to stabilize my condition. There was barely enough blood left for my vital organs so my body reacted by cutting off the blood flow to my limbs. This was incredibly painful as the oxygen-starved muscles in my hands and feet went into spasm and contracted into what felt like contorted lobster claws. My head felt like it was disappearing into the pillow and the nurses voices began to fade. The last thing I remember hearing was a nurse announcing that my blood pressure had fallen to 50/30.

My poor mother was in the room holding Rachel and watching this horror unfold. And when I say horror, you have to remember that she was lucky, very lucky to have survived the same ordeal by the skin of her teeth and was terrified that I would not be so lucky. Thanks to the nurses' quick administration of fluid resuscitation, I didn't end up like a lot of women who suffer post-partum hemorrhage -- a CDC mortality statistic. I was revived and stable, but still feeling loopy when they wheeled me into surgery. After a D&C, the bleeding was under control and Dr. Snippy transformed into a sickeningly sweet version of her former self. Gee whiz, I had given them quite a scare! (No kidding, lady. I tried to tell you that I was bleeding to death. So did the nurses.)

The next big question was what caused the hemorrhage in the first place. None of the placenta or amniotic sac had been retained and it appeared that my uterus was able to contract, which would normally stop any bleeding. This was the first time I heard mention of the possibility of a blood disorder. It was particularly notable that it had occurred in three generations, but strange that it occurred only after the birth of the second child. (Both my mother and grandmother fearfully went on to birth a third without incident.) I never gave the mysterious blood disorder idea another thought, since I never had a reason to. It's been more than 10 years and, other than the weird bruises, there's been no reason to be concerned. But now I'm told that I'd better look into it.

I mentioned the bruising thing to my primary care doctor a couple of years ago and he did some clotting factor tests which were normal. I'm not worried, but I think it might be good to know if I have to watch out for some oddball bleeding problems in some unforeseen situation in the future.

So there you have it: my most serious brush with death. One of the reasons for this blog was to document some of my life stories for posterity (=my children). The other two were situations where there was a margin of milliseconds between me and an event which would have, without question, annihilated me. I could tell both those stories pretty quickly, but this post is long enough already.

*Dr. Snippy still practices in New Orleans and though I chose not to publish her name here, I have no problem telling anyone who asks via e-mail.


Anonymous Dr. A said...

What a scary scary thing!
If the surgeons had done a proper pre-op evaluation on you, they should've caught your "bleeding tendency" before hand. Sorry you had to hear what was being said -that would have scared me!
When you go to primary care dr., ask him or her to be tested for Von Willebrand's disease.
Many molecular causes of disease(particularly diseases of bleeding and clotting) have only been found within the past 10 years.
The body has many redundant mechanisms for handling problems and if one fails, another takes over, but after some dramatic physiologic/biochemical event-childbirth, surgery, serious illness- some or all of the mechanisms stop working and the equilibrium is thrown off and the bleeding problem is revealed.
Well, I don't want to give a lecture on hemostasis, so I'll just end by saying I'm glad you are better and you and Adrastos will have to compare scars!
Happy holidays!

4:00 PM  
Anonymous Dr. A said...

I'm also appalled at the attitude of the horrible OB/GYN! I'm wondering if I might've come in contact with her -sounds a lot like someone I had for about 2 visits -let me know! Good docs are always hard to find -and post K, even harder.
About testing for clotting factors -sometimes, other disease processes particularly anything involving inflammatory processes causes increases in factors, (these clotting factors and other protein molecules such as cytokines/chemokines are released physiologically during inflammatory processes) so you should be tested several months down the road to make sure that they haven't been falsely elevated! (Interestingly enough, pregnancy is also an immune event -clotting factors that are low will be elevated by pregnancy and so if tested, levels will appear normal.)
You should also tell your dentist about this bleeding tendency as any dental surgery can also be a problem.
Anyhow.....I obviously hadn't finished before!
Take care of yourself. I love the photo by your dad.....and your dream sounds really cool! I once dreamed that my mom was going to be executed (for being a smart ass) by park rangers using bows and arrows! Do you dream at night more or less or no change post K?

10:40 PM  
Blogger LisaPal said...

Thanks, Dr. A., for your insights into this thing. I've had PT, PTT and bleeding times tested, once about 2 years ago when I asked my PC about the weird bruising and again before this surgery --all normal both times. I did some reading and noted Von Willebrand's and also vitamin K deficiency and will follow up on it.

The pathology report came back on the tumor. It turns out it was a hibernoma, which, according to my Googling, is apparently very rare. Not surprising. When I take personality tests and some of those online tests (like "What kind of car are you?), I always end up with a result that represents 1%-2% of the population. Why should my tumor be any different? My brother has what appears to be a lipoma on his neck which he'll have removed next month. It will be interesting if his turns out to be a hibernoma, too.

Next subject: when I heard the hemostasis talk during the surgery, it was not in any way a scary thing. I guess the MAC drugs really do a good job of making you not care. I was only aware of hearing the operating room chatter for a minute or so and it was with a detached sort of interest, and then that state of consciousness seemed to go as suddenly as it came.

As for Dr. Snippy, it was hard not to be appalled. My mother still talks about that incident. The ER scene was the second time I had to deal with her and the first wasn't much better. It was during the same pregnancy while my OB was out of town. I had an inflamed gall bladder and she was just as nasty in dealing with that. I was so glad that it was my regular doctor's call night when I went into labor because the idea of her showing up filled me with dread. I hope she's improved her manner by now, but chances are she's still the same. I'll e-mail her name to you.

That dream you had about your mom just cracked me up! That's pretty hard to top! The dream about my dad was also pretty wacky and now when I think about it now I just want to laugh and scratch my head trying to figure out what made me dream it. It's some of the details that make it so amusing. I should recount it in another post, just so I don't forget it. I think I've always had lots of vivid dreams, both before and after the storm.

I'm glad you like Dad's photograph. It was once used in an advertising brochure for a photography magazine. He did beautiful work, but also did some hilarious stuff, without even realizing it, (which is what made it so funny.) I'll have to scan and post some more of it.

1:08 AM  
Blogger Loki said...

I'm just REALLY glad you're okay! Been out of the loop a bit since the wedding and was unaware of your health problems.

Get your ass well soon so I can cook for you and your man! Email me (humidcity at gmail dot com)

9:22 AM  
Anonymous Anonymous said...

Read your story last night and I must admit it made me a bit queasy....I can only imagine how stressful it was for you!
Anyway, wanted to come back and say I hope you're feeling better and have a wonderful holiday!

12:20 AM  
Blogger LisaPal said...

Thanks, y'all! I'm 100% back in the groove now.

Loki, expect a call between Christmas and the New Year...

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9:25 AM  

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