I Learn to Stay Alert in the Medical World

My experience this morning at a diagnostic laboratory, where I went after a twelve-hour fast (no food no fluids) for routine blood tests, reminded me to take nothing for granted when I’m in the medical world.

This morning’s experience was of small consequence: My health was not threatened. But I was puzzled when the technician took only one vial of blood. I had read the sheet from my doctor, which I didn’t understand at all, but which showed three checked areas: two for blood and one for urine. So I asked the technician if one vial was enough. Sure, she said, pulling out the needle. I pointed to the second group of checkmarks on the form. “Oh I didn’t see those!” she exclaimed, and had to poke me again.

That’s no big deal. At worst, I would have had to go back another day, after another 12-hour fast. The reason I caught that mistake, however, was more serious. I learned to stay alert more than two months ago, on the day of my surgical lumpectomy. Let me recount it here:

The Day of My Surgical Lumpectomy

11:00 a.m. at the Women’s Center Diagnostic Lab. I am scheduled, I’m told by my surgeon, for a mammogram before surgery. She felt the first mammogram wasn’t clear enough. The lab is on the other side of town from the hospital where my surgery is scheduled and where I have to be by 12:00 noon. I have had nothing to eat or drink since midnight. I ‘ve taken no one with me for this appointment because, heck, it’s just a mammogram, and I was assured I could easily drive the twenty minutes to the hospital to arrive on time. So in no way am I prepared for what is going to happen.

I arrive on time. First, a nurse takes me to a room where the stereoscoptic biopsies are done. This room contains an elevated table with a hole for the breast to hang through. It’s very odd. I’d investigated this procedure because very early on, right after my first mammogram, it had been prescribed by the radiologist, but my surgeon decided on a surgical biopsy instead. So this is not the right room

Soon recognizing this, the nurse takes me not to a mammogram room but ultrasound. Fine with me. Ultrasound is more comfortable than a mammogram. The technician runs a sort of computer mouse over my breast, takes a bunch of pictures, calls in the radiologist, who checks things over. I ask whether they can have the films ready for me to get to the hospital in half an hour. No problem, the tech tells me. She just has to print them.

Suddenly the radiologist tells me he is going to have to “insert a wire” , a 45-minute procedure. The nurse begins leading me into yet another room.

It’s too much. I burst into tears. Not only was I not told anything about a wire, but it is already 11:30, I’ll be late for surgery, and worse, it’s my impression that the radiologist is going to insert it in the wrong lump. I don’t know if this misunderstanding is due to my surgeon’s illegible handwriting or if he is just confused by the fact that I have two lumps–one that I found myself, which took me in to be checked in the first place, and the one found by the subsequent mammogram. My surgeon told me that she wasn’t concerned about the lump I found, but she’d put an X with a felt pen on the new one so the radiologist would know where to concentrate.

Things feel out of control. I don’t think I can handle a “45-minute procedure” and I also am late for surgery. The nurse is very sweet and very concerned. The radiologist can’t deal with me. He calls my surgeon, who says to just give me the films and I can take them to the hospital with me. The lump is palpable (she can feel it) and close to the surface, she says, so she won’t need a wire.

12:00 noon at the hospital amulatory surgery department. Before noon I am home and am quickly picked up by my friend Judy who has volunteered to be with me through this experience. Thank God I didn’t try to do this alone. Judy and I go up to Amulatory Surgery and I am checked in, asked if I’ve brought the films, and shortly shown into a room with two beds and a tv. I put the film envelope on the bedside table and change into my gown and get into bed.

It’s not even 12:30 and my surgery isn’t scheduled until 1:45. I pull up the flannel sheets and the nurse comes in to put in the IV. I ask her to put it in the vein inside my elbow, as all my others are small and very painful if IV-ed. But she insisted on the back of my hand. It bruises the entire back of my hand. For the next hour and a half, I feel as if I am getting a typhoid shot (I’ve had several of those) that won’t quit.

The anethesiologist comes in, a middle-aged man, who explains to me what will be used, asks if I’ve had anything to drink and I admit to a few small sips. He is not pleased and makes me drink some horrible-tasting fluid. My surgeon comes in to say that I am next. I’ve checked on her credentials and I also like her–she’s upfront, no nonsense, all energy. She only does breast surgery and has been doing it for years. I’m not worried about her.

I wait. I am feeling crazy. I need to go to the bathroom but there isn’t one. Judy goes exploring, then helps me get my gown decent as I wheel my IV pole across and down the hall, which apparently I shouldn’t need, as no one had mentioned one. I am cold, so Judy goes back into the hall, hails a nurse, who brings me a pile of warmed flannel sheets.

1:45: At last, a team comes in to get me. But wait! Judy and I hear voices out in the hall. “We’re taking them out of order!” a voice says. The team vanishes. I have more waiting to do. I try to watch tv but I’m beginning to feel crazy. I pace the smallroom with my IV pole. I think I can’t stand it, trussed up like this. Judy says she’s never seen anyone so hyperactive, and she’s sat with plenty of others in similar circumstances.

At last they come for me. “Where are your films?” asks a nurse. I don’t know. I’d brought the folder from the morning’s film-shoot, the one they gave me, and I’d put it on the bedside table. “It was there,” Judy said, “and then someone put it in the rack on the door.” But it isn’t in the rack. No one can find it. They look for, maybe ten minutes. My surgeon appears, says she doesn’t need the films, and she’ll operate without them. Yikes. If she doesn’t need them, why did I go through that awful morning?

But I am not in control here. I am wheeled out the door, Judy squeezes my hand, and off I go down a series of surprisingly cold hallways to a small operating room, where I shift myself on to a very narrow, padded table. Both my arms are stretched straight out and strapped down. I feel like a crucifix. People I’ve never seen before surround me. One, I’m told, is my anethesiologist–somebody younger than I remembered. He introduces himself, explaining that he is taking the place of the one I met earlier.

And then I’m out. Bam. No time to count backward, just gone.

Next thing I know, I’m struggling to wake up. I’m sitting up in a wheelchair, and my surgeon is trying to talk to me. Judy is standing next to me. “It doesn’t look good,” I hear my surgeon say. “But don’t worry. We can always do a mastectomy.”

Holy shit! A mastectomy? I thought that was for the worst cases! I thought they did lumpectomies unless you were in really bad shape! I burst into tears. My surgeon is not cruel. She’s trying to be reassuring. But she also tells it like it is, and later I find I am grateful for this. Now, however, I am not reassured.

The surgeon leaves and a nurse asks me how I feel. I ask if anyone has found my films. Yes, she says. And where were they? I ask. That’s not important, she says. Judy says to me, I’ll bet they were in the operating room on someone’s cart! (Judy was right. When I later ask my surgeon where they were found, she tells me they were on the cart of the person who was taken out of order before me.)

As soon as I can walk, Judy takes me home. Home feels like heaven.

Two weeks later…I get a call from the Diagnostic Department wondering where my film envelope is. They’ve just found the films taken the day of my surgery. It appears that not only was the film envelope misplaced in pre-op, but the ultrasound films taken that morning weren’t even in it. I still had the film envelope, checked and sure enough, the ultrasound films were missing. I returned the envelope to the diagnostic people.

Fortunately, my health was not affected by any of this, but so many errors in my care were hardly reassuring and made my experience in the hospital unnecessarily frighening. A dependable level of trust helps one maintain courage when one’s well-being and even life may be at stake. Stay tuned for my relumpectomy a month later in the same hospital…and how learning how to take care of myself in pre-op pays off.