It’s Take Out My Gallbladder Friday!

The alarm went off, gently yelling at me to get up. It was 4:45 AM. I took a deep breath and gleefully sat up, ready to take on the big, beautiful day! What a day to be alive! Hurray! Today’s the day they take out my gallbladder!

Okay, the alarm part is all true. So is the gallbladder part. The rest is just silly nonsense.

I had been waiting for the call for weeks. When were they going to schedule my surgery? You know, the one where they suck out my gallbladder? For context if you haven’t been here before, or a refresher if you have, read this post.

Finally the call came. “We’ve scheduled you for your surgery.” Great! I had experienced a small attack a week before, and I was anxious to move on and be done with the pain. Surgery was scheduled for April 14, just two weeks away. They’ll call me the day before with the exact time. Now we hope for no cancellations…

The Attack Of The Gallbladder

The days went by and my impatience grew. I was truly looking forward to getting the surgery done. And then, two days before my surgery, I had another attack. This was a doozy.

I was at work, just going to the lunch room for a break. I started to feel the familiar pain in my upper belly and hoped in vain that it would go away. Less than five minutes later I was doubled over and trying to breathe, surrounded by my very concerned coworkers.

And. though it was intense, the attack only lasted about 15 minutes. The worst ones carry on for 45 minutes, so I was thankful. But it left me exhausted.

Heather came and picked me up and brought me home. I went to bed and slept for 3 hours. I couldn’t wait for Friday!

Thursday had me feeling a little anxious. So far there hadn’t been a call to postpone the surgery. I was glad of that, but my brain was starting to think a little too much about the impending procedure. Sometimes my brain can be such a party pooper!

Brain: Sometimes older people don’t wake up from surgery!

Me: Don’t be silly! I’m not 90!

Brain: I hope the surgeon doesn’t have too much coffee before the surgery.

Me: SHUT UP!!

The Big Day

And so Friday morning arrived. I got up and had my second shower in 10 hours, making sure I covered every inch of my body with the special surgical sponges from the pharmacy.

Brain: You missed a spot.

Me: Piss off!

As we drove up to the hospital, my nervousness increased. I realize this is a pretty normal procedure that’s performed everyday in hospitals all over the world. But my brain was making some decent points that I couldn’t easily refute.

“You haven’t been under general anesthesia since you were 5. What if you have a reaction?“

“What if he nicks an artery? He’s working in a pretty small space, you know!“

A few deep breaths, and Heather was with me, reassuring. She was feeling a little guilty leaving me there, but there was no point in her sitting around in a hospital waiting room. I told her it wasn’t emergency brain surgery. Just come back when I’m done.

Once checked in, things moved rather quickly. I was brought into an area that looked a little like a department store changing room and told to strip down and put on the iconic hospital gown. My clothes and other belongings went into a bag and secured in a locker. #14, the same as the date! A good omen? Sure, why not!

From there I was escorted back to a chair where I waited my turn to be measured and weighed. There were a couple of other folks there, having their own day surgeries. I suppressed the urge to ask, sotto voce: “What’re you in for?”

Waiting My Turn With The Uruk-Hai

The guy ahead of me was called over to be measured. He was a giant of a man, about six and a half feet tall and built like a large Uruk-hai. (Nerd!) The nurse had some difficulty reaching up to measure his height. The beast-man asked her if he was the tallest man she had measured that week. She replied, “You’re the tallest man I’ve ever measured!”

Then it was my turn. I stepped onto the scale and glanced at the nurse. I swear she smirked a little as she put the height gauge on my head. “Five foot five!” she announced, loud enough to be heard over in the perinatal ward. “It’s actually five foot six,” I muttered under my breath.

The nurse led me to a small office where she asked me about my general health, my eating and drinking habits, and medical history. She told me what to expect with general anesthesia, its possible side effects and how to manage my recovery.

Finally she took me back to where I started, sitting in the waiting room with the other patients. But I didn’t have to wait long before another friendly nurse came for me. She walked me back through the doors to the inner sanctum and led me down a hallway. She explained we were entering “the racetrack”, where I would await my entrance to the OR. My brain started picturing nurses and doctors running and pushing patients on stretchers, bumping and careening off the walls in an effort to get to the operating room. Weird…

Hurry Up And Wait

I laid on a stretcher outside OR#7, covered in a warm blanket. It was very quiet. There was no one about and I could hear no voices. After about 10 minutes a nurse walked by with another patient on a stretcher. We didn’t race.

Soon enough, various doctors and nurses began to appear. I could hear voices behind the door to OR#7, laughing and joking. A nurse came out from the OR and asked me some questions, mostly what I had been asked by every nurse since I had arrived. But then she mentioned she wanted to be sure I was in the correct place, for the correct surgery. Yes, thanks for checking!

Another nurse appeared. She explained they would be out for me in a few minutes, and that I would get up and walk into the OR with her. I was intrigued. I had never walked into an operating room on my own before…

My anesthesiologist came out and introduced himself. A very cheerful fellow, he put me right at ease. He told me that, because I was such a healthy guy, I would have no problems today. As he distracted me, the nurse stuck an IV needle into my left hand and taped it in place with about half a roll of tape.

Time To Take Out My Gallbladder

Finally the surgeon came out and went over the procedure with me. I asked him a few questions about my recovery and after care. He mentioned some of the after effects and discomfort I would experience from the surgery. Something he said that I thought was odd; I might have some shoulder pain. Shoulder pain…?

They were ready for me, and I was led into the OR. Lots of fancy looking machinery lay around. There were 5 or 6 people milling about, dressed in blue scrubs and masks. In the middle of the room, under a great round light, was my table. It was a skinny thing, not much bigger than a camp cot. I took off my robe and lay down on the table, being careful not to roll off the other side.

A nurse worked down at my feet, tying me to the table. I was thankful, as my stupid brain presented me with a picture of me rolling off the table with doctors and nurses trying to catch me, internal parts hanging out of my abdomen.

The friendly anesthesiologist appeared as a nurse put an oxygen mask over my face. He was giving me something to relax me, before he put me under. He made a joke that I don’t remember, but I chuckled gamely. The nurse encouraged me to take deep breaths.

Then Dr. Sleepytime told me it was time to put me under, and he said I was in good hands and everything would be going smoothly. I think I said “Thank you”. And I lay there, looking up, wondering why it was taking me so long to go unconscious…

The Long, Slow Climb From Sleep

“Are you with me, Michael?” My eyes blinked open. The world was fuzzy, out of focus. “How are you doing”, the same voice asked. I couldn’t see anyone. I couldn’t see anything but blurry shapes.

Since I couldn’t see anyone, I just closed my eyes. That felt so good! My body was completely relaxed, and I just wanted to get back to sleep. Gradually I was aware of conversations going on around me. There was some movement by my head. My eyes fluttered open, but I couldn’t see anybody.

It was a very strange sensation, opening my eyes. Every time I opened them, it was like clicking the shutter on an old View-Master stereoscope. Remember those? My eyes just seemed to keep turning up in my head. So I just closed my eyes. It was easier.

But I couldn’t go back to sleep. There was too much activity going on around me. And then the disembodied voice spoke again. “I don’t think you can hold your liquor”, she joked. Now I saw her; a nurse sat in a chair to my left, looking at a small screen. I tried my best to focus on her, but the View-Master shutter kept clicking away. I answered her joke with an articulate “Gnarghhh.”

Waiting For The Drugs To Wear Off

Time passed as I lay there, doing my best to climb out of the fog. I looked at the clock. 10:30. I wondered how long I had been out of surgery. “How long”, I managed to mutter. “You’ve been here since about 9:30.” I’m pretty sure I went into the OR at about 8 o’clock. So an hour and a half to take out my gallbladder. My brain tried to imagine what was involved in the process, but I started to picture myself again hanging off the table as the doctors and nurses tried to keep me together. Humpty Dumpty! My brain is weird sometimes…

Heather was waiting for me as the nice nurse wheeled me out of post-op. I was still very groggy. All I wanted was sleep. The drive home felt like hours, but I just closed my eyes and listened to the road noises. I couldn’t wait to get home and into bed!

Zachary was home, so he came out and gave Heather a hand to get me up the stairs and into the house. Why do we have to have so many stairs!? Whose idea was that?

But then I was getting into bed and putting my head back on the pillows. It felt so good! I was happy, with absolutely no idea what was in store for me a few hours from now…

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It was just after 3:30 in the afternoon when I awoke. I felt a bit groggy, though considerably better than I had felt in post-op.

Silly Nerd Reference Ahead

Taking it slowly, I carefully eased myself out of bed and gingerly walked out to the living room. I gently lowered myself into my favourite chair, but immediately found it was too painful to sit upright. Heather helped me up and I moved to the rocker. Much better!

I took a deep breath and instantly regretted it. Naturally I was feeling some pain and discomfort in my abdomen. You know, given that I had four holes arrayed around my belly button. But it was nothing compared to the pain I suddenly felt in my shoulder. What the hell??! I would take a breath and my body would seize up with an intense, stabbing pain to the top of my shoulder blade. I tried to relax my body, only to feel that phantom menace stab me again with his evil Morgul blade! How I sympathized with Frodo! (More Nerd!)

I couldn’t understand the pain I was feeling, but my brain accessed a file from earlier in the day, when I spoke with my surgeon.

(Through a fog, from afar…)

“You might experience some shoulder pain…”

Damn right I was experiencing some shoulder pain! Tears welling up, I tried to find a position that would make the pain stop. The evil blade dug deeper and gave a little twist. SUNOVABITCH!!

I took small shallow breaths through my gritted teeth and got out of the chair. I think I went back to lay down on the bed, while Heather got me a hot pad. It’s all a little fuzzy at this point. Pain has a way of making your brain fuzzy…

Shoulder Pain, Explained

Applying a hot compress to my shoulder brought almost instant relief. I still had the stabbing pain when I exhaled. But by keeping my breathing fairly shallow, I could reduce the jabs considerably. After a short time, my body relaxed and the pain abated. I drifted off to sleep.

So what was going on here? And how does my abdominal surgery result in such a nasty shoulder pain?

It turns out that laparoscopic surgery is the culprit. Most laparoscopic surgeries to the abdomen will cause this shoulder pain. It’s all a result of injecting CO₂ into the abdominal cavity.

WARNING: Nerdsplaining

You see, CO₂ is used to separate the diaphragm from the organs, creating a space for the surgeon to do his work. Otherwise the doc would need to make a large incision to remove the gallbladder, and that creates so many other possible problems for the patient. So these surgeries are done laparoscopically.

Four very small incisions are made in the abdomen. In one, a tube is inserted and CO₂ is pumped in. This creates the space for the doctor to work. Then a camera is inserted, and the other tools needed to clamp, cut, and move organs around are put in the other cuts.

The gallbladder gets separated from next to the liver, and removed through the incision by the belly button. The tools are removed, and the gas is expelled from the cavity. I should say, “most” of the gas is removed. It’s the stuff left inside that creates the problem.

That residual gas puts pressure on the abdomen. Turns out that the diaphragm and the shoulder share some of the same nerves. Including one called the “phrenic nerve”. So specifically,

when the CO2 gas irritates the diaphragmatic nerves, that pain is referred upwards through nerve connections, eventually landing in – and aggravating – the shoulder.

centerforendo.com/post-surgical-shoulder-pain

Congratulations! You are now smarter for having read this far…

The End Is Near

And now it’s Monday, and I’m well on the road to recovery. The shoulder pain is greatly reduced, though still a bit of an irritation. I was taking some Tramadol for pain, but I’ve cut that out to just the occasional extra strength Advil. The hot pad is the best treatment for my shoulder pain, and I can eat most foods. All in all, I feel pretty good!

My workout regimen is pretty strenuous. I don’t think most people could do what I put my body through. Let me break it down for you… Saturday I walked very slowly around the block, with Heather guiding me. I upped that to a couple of blocks on Sunday. And today I plan on getting in 3 blocks! At this rate I’ll be back to my regular self in no time.

Can’t stop-won’t stop!