When the day for surgery number two dawns, one of my first thoughts is, “I can hardly wait for the juice and graham crackers in post-op.”
Then: “Why did I agree to an earlier date but a later surgery time? If surgery isn’t scheduled until 2:30, I bet I won’t be under until 3 p.m. That’s a lot of waking hours without food or coffee.”
Denial, so often destructive, can also be a powerful human tool. They’re going to cut open my left breast again to widen the “margin” dividing healthy tissue from where the cancer was cut away. The last time, it was only a 1 mm on one side. The docs say that’s not enough. In other words, they’re going to cut out a little more of my breast, just to be safe. And what do I obsess about on the day? Food.
That left breast had just begun to feel almost normal: The scar had stretched out; the pleat had become almost imperceptible. I no longer even thought of wincing if someone bumped my left side. Now, back to square one. Or, almost back to square one.
I wonder if I’ll ever get used to how quickly scary medical procedures take on the patina of routine. The first time I ever had anesthesia, for a minor operation in the late 90s, I thoroughly freaked myself out by researching “going under.” With phrases like “brink of death,” “always a risk,” and “no one’s sure how it works” swirling around in my head, the docs had to give me a tranquilizer before they could even start the IV.
For breast surgery number one, I was alert to every detail, though they didn’t need to give me tranquilizers. This time, it feels less momentous.
It’s still true that the exact mechanism of many drugs used in anesthesia still isn’t clear. Yet, a recent New York Times article profiles a Harvard professor trying to figure out exactly what happens when people take anesthetics. The professor, Dr. Emery Neal Brown, says it’s more accurate to describe anesthesia as a “reversible, drug-induced coma,” not as, “going to sleep.” I’m not sure why, but “reversible coma” seems somehow less threatening than other descriptions I’ve read.
This time, the procedures of surgery seem familiar: check in at nurses’ station and present two forms of ID; go into a room; take everything but everything off; put on lovely hospital gown; wait for medical tech to come take height, weight, blood pressure, body temperature; make small talk with husband; wait for nurse to come start IV; explain that top of right hand is still sore from the chemo IVs; grit teeth as nurse roots for a vein in my forearm; make more small talk with husband; wait for anesthesiologist to come in.
One thing that does get my attention this time is how many fail-safes have been built into the process. Checklists hang on the walls. Everyone who has anything to do with me also has a checklist. Everyone asks my name and date of birth. The anesthesiologist asks what surgery I’m to have, then marks my left shoulder with his initials. The nurse says that until every single check is done, the computer screen with my case will be red. Only when each stage of the process has been completed and recorded, will the screen go green, she explains. Good to go to the OR.
When I mention this to the anesthesiologist, he says that they also do this in operating room. Everyone takes a time out to repeat, again, why they’re all there. Then they go through the steps that will be required to complete this re-excision of my left breast. “Just so we’re all on the same page,” the anesthesiologist says.
Initially inspired by pilot’s checking procedures, medical professionals have taken to checklists in the past few years. Dr. Atul Gawande, another Harvard professor and a New Yorker staff writer, wrote a book all about checklists in 2009. While repeating one’s name and date of birth endlessly can be a bit of a bore, it’s comforting that my medical team tries so hard not to make mistakes. No doubt mistakes do get made, but I would imagine they happen less often than in a world without checklists.
The anesthesiology nurse comes in and, yes, asks my name and date of birth. Then, he injects something into my IV. “Here, we go with the ‘milk of amnesia’,” he says. I start to tell him something about another anesthesiology nurse who once asked me to list my favorite Brooklyn restaurants as he injected a similar reversible-coma-inducing cocktail. I think I got to number two or three. This time, I don’t think I even finish the story. I suppose anesthesiology nurses are used to missing punchlines.
Next thing I know, the coma has reversed and I’m waking up in post-op. The nurse brings over two packets of graham crackers. She mixes some ginger ale and cranberry juice for me. They are sublime.