Category: Health

Part Two: Surgery

It’s too bright in here.

No.  No, no, no, no, no. I don’t want this.

WHAT is that? They didn’t tell me about that.

I don’t want it, I don’t want it. I want to get up.

No. NO.

I’m going to be sick. I AM GOING TO BE SICK. Can’t you hear me?

I don’t have to calm down, this is wrong, I don’t want to be here.

No. No I don’t need this, I don’t want this.

Let me up. LET ME UP.

I’m going to be sick, again. AGAIN.

Morphine?

I don’t want to be here.

It’s too bright.

I’m told I didn’t wake up in the Post-Anesthesia Care Unit (PACU) with grace. I think perhaps luckily, I don’t remember the majority of the experience. What I remember most about waking up following 12 hours of brain surgery to remove an acoustic neuroma (more than 14 hours away from my family) is being angry that I was hooked to so many devices. I had three IV needles (though only one was in action), a catheter, a plastic bulb connected to an incision in my belly button collecting fluid, a heart monitor with five attachment points, and I couldn’t move my head because I had a heavy bandage wrapped around my brain like a donut. I woke up angry, and I woke up confused, and I woke up feeling, as I apparently slurred at my family, “aaawwfullllll.”

IVs in my right arm. Photo by John Podolak

IVs in my right arm. Photo by John Podolak

I was angry and confused. Either it was not explained to me, or I never processed the fact that I would have a catheter. Why this horrified me to the level that it did, I’m not sure. The sense of helplessness I guess. How suddenly and unexpectedly I had been transformed from an able-bodied 26-year-old, to unable to exert any control over even the most basic functions of my body made me confused. I wasn’t prepared to wake up in this new reality. I think, “will you put a catheter in me while I’m under anesthesia,” is something I should have asked when the doctors repeatedly beseeched me, “do you have any questions.” But, I didn’t think to ask. Even though it is obvious that I would need one, I hadn’t considered it. I hadn’t considered it because it didn’t even register as something to consider. I didn’t know that I didn’t know.

When I woke up connected to bags and tubes and needles late Thursday night I flipped out. My lack of grace included struggling to sit up, arguing that I didn’t need a catheter, and poking at the bulb collecting fluid, while repeatedly vomiting (into my oxygen mask at one point) before an increased cocktail of sedatives and painkillers finally took the fight out of me.  At that point, though I don’t remember my Mom being there, she assures me I vomited on her too. Less than 48 hours before, I thought I would have surgery perhaps in a month. I thought I would go back to work for a while. I thought I had time to get ready for this.

Progressing too quickly

Only a week before I channeled Linda Blair from The Exorcist in the PACU, I was diagnosed with an acoustic neuroma. My diagnosis followed months of symptoms like headaches, dizziness, vertigo, hearing loss, ringing in my ear and numbness in my tongue. It was a long process to get an accurate diagnosis, and I had been assured that my type of tumor was slow growing. My doctors told me to take time to plan for my life to be disrupted by the surgery and recovery. These same doctors warned me to pay attention to the feeling in my face. The numbness I was experiencing in my tongue may just have been a starting point, so, if any other numbness occurred, my medical team needed to know. It could be a sign that the tumor was growing faster than anticipated, a sign that it wasn’t benign after all. If my doctors were going to save my ability to control and feel my face, it was important that there be as little preexisting nerve damage as possible. A week after being diagnosed, I woke up unable to feel half of my face. I was numb from cheek to chin on my right side. Not wanting to be alone, I did what made sense to me, and I went into the office.

I called the doctor too of course, and left a message with the patient coordinator about my new symptom. While I waited to hear from my phsicians, I worked. I tried to answer emails, and tie up some loose ends to square things away. My doctor asked me to come in to see her that afternoon, so in the spirit of “just in case,” I set my out of office message. A friend picked me up and drove me to my appointment. My doctor explained that she felt we needed to get the tumor out as soon as possible, that we really couldn’t wait because my symptoms were worsening at a worrying rate. “Tomorrow,” she said. Tomorrow? I should probably call my parents, huh?

I won’t even begin to speculate what this entire process has been like for my parents. I know calling my Dad to tell him that I needed brain surgery the next day was not easy, so I can’t imagine what it was like on the other end. Luckily, we had already decided what type of surgery I would have, and had been able to meet the surgeons. So, while my parents and my brother rushed from New Jersey to Boston, I was admitted to the hospital.  My friend and I walked right from my doctor’s office into the emergency department and explained that I needed to be admitted. My boyfriend joined us, and the three of us switched from the emergency department to a room across the street by ambulance, then back across the street again by ambulance to a different room. I kept offering to walk, but rules are rules and I wasn’t allowed. Of course, I was rewarded for following the rules by losing my shoes during the room switching.

By now Wednesday afternoon had faded into Wednesday night. Things had moved so quickly I hadn’t had time to think about the reality of what was about to happen to me, to my brain, or to my life.

The Procedure

I left my friend and boyfriend sitting in my hospital room so I could get a pre-op MRI. I don’t have a problem with closed spaces, or noise, and I’d been fine during an MRI the week before to diagnose the tumor. So, when my nurse asked me if I needed anything to help me stay calm, I told her no. This was a mistake.

I didn’t really anticipate how LONG I needed to be in the MRI, because the one I’d had a week earlier lasted only 45 minutes. I also overestimated the strength of my emotional state. This time, the technicians needed to take pictures of the tumor to make sure it hadn’t grown. Then they also needed to image my entire spine to make sure there were no additional tumors. I was in the MRI for two hours. Alone. With my brain. My broken brain.

They tell you to hold as still as you can, but I sobbed for the entire last half hour. After the tumor was out, during a follow-up scan, one of the technicians told me that I was “a legend down here” for what had apparently been an out-of-the-ordinary, marathon, late night session.

Adding insult to injury, when I finished the MRI, the technicians placed garish glow-in-the-dark stickers, ringed in dark marker on my face. These stickers would serve as a map for the machines the next day, but that night I looked like someone stuck Lifesavers to my forehead.

Modeling a face full of stickers the night before the surgery. Photo by Nicholas Podolak.

Modeling a face full of stickers the morning of the surgery. Photo by Nicholas Podolak

When they wheeled me back to my room, I was still crying nonsensically and apologizing to absolutely everyone for losing my shit. This is how I entered into the first meeting between my family who had arrived from New Jersey and my new boyfriend, because, on top of brain surgery imploding any sense of normalcy in our lives, dating is still one of life’s most awkward rituals.

I eventually calmed down and tried to sleep, which anyone who has ever spent time in the hospital knows is not easy. It was morning and surgery time in the blink of an eye. They transferred me to the pre-op clinic, where both of my surgeons (one an ear, nose, and throat specialist and one a neuro specialist) came and talked to me. They ran through the procedure. They initialed the parts of my body they intended to cut. They explained the risks, all the things that could go wrong. I spoke to two anesthesiologists. I spoke to my nurse.  I signed the consent forms. Everyone asked if I had questions – I did, I just didn’t know it, so I asked nothing. I gave my family a goodbye hug, and was wheeled away.

The last thing I remember is seeing one of my surgeons, and being asked questions – Who am I? Where am I? What day is it? Why am I there? Then there is nothing until I came to in the PACU,  confused, upset, and angry.

I’ve been actively not thinking about the reality of the surgical procedure itself, because it is overwhelming to think that multiple people have literally seen my brain. My surgeons cut through the bone behind my right ear, and, because their approach cut a nerve completely, they destroyed my ability to hear on this side. This means I’m now deaf in my right ear.  Part of the surgery involved packing the hole in my skull with fat taken from my belly button. This is what made the bulb at my abdomen to collect fluid necessary.

My Dad and I taking a hospital selfie. I was rocking the taped on glasses, him the mask and, yes, that is a cigar.

My Dad and I taking a hospital selfie. I was rocking the taped on glasses, him the mask and, yes, that is a cigar.

My family had been told it would be an all day surgery, but it took far longer than anticipated. One of the things the doctors had warned me might go wrong – “stickiness” of the tumor – did. The tumor was clinging to my brain, refusing to let go so easily. So my surgeons took extra time, ultimately clocking in at 12 hours after teasing out every piece. But they got it all, and were able to save my seventh nerve and thus my ability to control and feel my face.  While there is no such thing as an ideal brain tumor surgery, my team got it all and avoided any damage to my facial nerves.

I think the decision to move quickly on the surgery was the right one, but it definitely didn’t give me time to process what was happening. I’m certain that contributed to my performance in the PACU. I woke up in a completely new reality that I wasn’t prepared to face. Toward the end of the day on Friday, my memories of the PACU become a little more solid. Apparently, I kicked off my hospital socks as part of my defiant outburst, and I remember being told I had the nicest feet there, which is amazingly awkward upon recollection. I remember my Mom and Dad being there. I remember feeling like the world was spinning. I remember hating the lights. I remember wanting to sleep, which I did a lot.

Recovery

Late Friday night they moved me from the PACU to the Neurosciences floor. Saturday is a bit of a blur too, but I was definitely more with it than I was in the PACU. There were visitors and flowers mixed in among the vitals checks, finger sticks, and medications. Even though I was still hooked to the IV, they took away the catheter, the bulb at my belly button and the heart monitor. That helped a lot. I started to focus more on the donut around my head.

A close up of my bandage while I napped. Photo by John Podolak

A close up of my bandage while I napped. Photo by John Podolak

My hair was up in a knot, Pebbles Flintstone style, with a bandage wrapping around my head. There was a hard plastic piece over my right ear wrapped in more bandages. It was heavy. I felt like a bobble head anytime I tried to move, a sensation definitely aided by the fact that my vertigo was intense. My doctors warned me that the vertigo wasn’t going to go away with the surgery and was likely to get worse before it got better: they were right. I also struggled with my vision for the first few days after surgery. I had a hard time focusing and found things to be more blurry with my contacts in than my glasses. Combine my need for glasses with the bandage around my head, and I had a problem, thus I spent my hospital stay with glasses taped to my face.

I spent a week in the hospital following the procedure, which was an interesting experience in its own right. I had a constant stream of visitors, and was never alone, which helped tremendously to keep my spirits up. I fully utilized my ability to request quiet time for everyone so I could drop off for a nap. Soon I itched to get out of bed and walk, and I was surprised at how difficult it had become. Since my sense of balance was damaged, I wobbled and lurched around like I had consumed a few too many beers. I put my visitors to work, helping keep me upright, while I leaned on my IV pole and walked up and down the hallway in my slipper socks.

Walking the hospital hallway with my friend Emma. Photo by John Podolak.

Walking the hospital hallway with my friend Emma. Photo by John Podolak.

Hospitals themselves are ironically not restful places, particularly the neuro floor. The beds are pressure sensitive, so the nurses can tell if patients are getting up on their own when they aren’t supposed to be.  Apparently this happens all the time, prompting a stream of running feet as nurses rush to make sure no one falls over. Getting woken up every four hours for a vitals check, and finger sticks to check my insulin levels wasn’t conducive to sleep either. With the bandage on my head I was unable to shower. After a week in the hospital, this was not exactly pretty, though I tried my best to clean up and feel normal (never really successful, but I tried.)

A week after the surgery, they removed the bandage and I was cleared to leave. The vertigo continued intensely, and traveling even the short distance between the hospital and my apartment was rough. I spent a week at my apartment in Boston with my Mom taking care of me. I was still having trouble walking around without tipping over, and I was unable to do things like wash my own hair. I napped a lot, but everyday spent more hours awake and more time on my feet.

Pre-stitch removal, a close up of my incision. Photo by John Podolak.

Pre-stitch removal, a close up of my incision two weeks after surgery. Photo by John Podolak.

Three weeks after the surgery, starting to heal. Photo by John Podolak

Four weeks after the surgery and starting to heal. Photo by John Podolak.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Friday April 11, my stitches came out. As I celebrated this milestone, I frustratingly also developed a seroma, a build-up of fluid around my belly button incision. I found out this is also a common complication from liposuction. The sudden onset of swelling was really unnerving, but my doctors answered my phone calls late on a Friday night to set my mind at ease. I can’t say enough good things about my doctors. What times we live in when you can text a surgeon a picture of your belly at 10:30pm on a Friday and get a helpful, calming response.

Even with this complication, my doctors have said they are happy with my progress. I know it will be a long time before I can say I feel like myself, but that is the goal I am working toward.

Part three: Aftermath

Part One: Diagnosis

 What follows in this three part series is a personal narrative. All of the decisions I’ve made about my health were chosen in close consultation with medical professionals. My choices are mine, and not necessarily right for anyone else even with the same diagnosis. If you have concerns about your health I encourage you to seek out a medical professional, which I’m not. 

“When you hear hoof beats, think of horses – not zebras,” is a widely known version of a quote attributed to Theodore Woodward, MD, late professor at the University of Maryland School of Medicine. He said this as a means of instructing medical interns to look for the most obvious, and likely, diagnoses first. The most obvious answer to a problem is usually the one that is correct, but not always.

I’ve been thinking about this quote a lot over the last year or so, like a mantra. Think horses. It’s just a headache, you sit at your desk too much. Think horses. It’s only a little dizziness, vertigo? You don’t get enough sleep. Think horses. Your right ear is ringing, an infection? Think horses. Think horses. Think horses.

Working as close to cancer research as I do can make you a little paranoid. I try hard to stay grounded, and remember that headaches are headaches for the same reason that hoof beats normally signal horses – it is simply unlikely for a headache and a little dizziness to be a harbinger of anything more.

My symptoms were easy to downplay, but when I started to pay attention to what my body was trying to tell me, it was much more than a headache and a little dizziness. It was a piercing headache radiating from the back of my skull and wrapping around the front of my head to above my right eye. It was the additional emergence of my normal migraines with a ferocious new frequency. It was vertigo that left me feeling unmoored multiple times a day, everyday. It was diminished hearing in my right ear that left me missing whole conversations, and constantly repositioning myself so people could speak on my left. It was ringing, incessant ringing, in my right ear. Eventually, it was fatigue. I typically walk 45 minutes each way to work, and I hit the point where I dreaded having to get myself to the office.

Of course, all this did not hit at once. It built up over the course of several months while I berated myself for worrying and reminded myself to think horses. I often joked with a colleague about the rare diseases I must have, things it’s absurd to think an otherwise completely healthy, 26-year-old would have. I kept expecting things to get better, like if I made it through the winter I’d magically start feeling like myself again (because that is clearly how the world works). I didn’t.

I’m really not making it up

The real drama started in February when my hearing loss had become a serious concern. I went for a hearing test that I passed, registering in the normal range. When the doctor who gave me the results told me I was fine, I stared at her in disbelief. I tried to explain that I couldn’t hear conversations that I couldn’t make out music and lyrics when my headphones were in my right ear. I tried to explain that identifying words was different from identifying tones like in the test, but the doctor just looked at me and said, “I trust my data.” As if I’m just making it all up.

Since I passed the hearing test, I wasn’t sure what to do next. So, I spent a few more weeks with the symptoms getting worse to the point that I was having migraines everyday, and actually didn’t go to the office because I was exhausted. Then, it was my tongue. I find it almost funny that my tongue was the conclusive sign something was wrong, but it was. It was numb, and I tasted metal. The migraines had sent me to my primary care doctor in mid-March, and at this appointment after I detailed all my symptoms, she asked me, “Are you feeling anything else?”

Completely as an afterthought I added, “My tongue feels weird.”

“Weird, how?”

“Numb? I guess? I’m acutely aware that I have a tongue. Does that make sense? I feel it, but only half of it. And everything tastes funny, but only funny on the right side.” (Obviously, at my most eloquent.)

To my doctor’s credit, she didn’t let her concerns show, and since she was calm I was calm. She told me later when I mentioned my tongue she knew something was seriously wrong. She recommended I go for a CT scan of my head the next day. I took that day off work, and went for the CT in the early afternoon. It was quick and painless; I left the hospital around 3pm and took a cab home.

I intended to go to work the next day since they weren’t going to find anything and all this was just to rule things out because, well, horses. I didn’t entertain the idea that my joking about rare diseases may have had merit. I called my older brother, and told him explicitly, the idea that the doctors would find something on the CT was silly, and I was going to be fine. Later that night my phone rang it was my doctor calling at 8:30pm with the CT results. It probably goes without saying that your doctor doesn’t call you personally at 8:30pm with good news.

There are four ventricles in the brain. These ventricles are hollow cavities filled with your cerebral spinal fluid (CSF) the fluid that surrounds your brain. My fourth ventricle, the one at the back of the head, was compressed, putting pressure on the flow of CSF – but the CT didn’t show what was causing the compression. My doctor told me to go to the ER immediately, because I needed an MRI. Even then, I was completely rooted in denial. My health has been my privilege, I have never had any other medical problems, and I have a clear family history. It felt silly and paranoid to think it was anything bad.

In the hospital

Yes, I took a selfie in the Emergency Department while waiting for an MRI.

Yes, I took a selfie in the Emergency Department while waiting for an MRI.

Since I needed to get myself to the ER, I called a friend. I don’t have any family in Boston, but my friends are incredibly supportive.  When I called and said I needed a ride to the ER, the response was, “I just have to put on pants.” Another friend met us there, and we were taken back quickly. After a brief bit of confusion about why we were there (my appendix is just fine where it is, thank you) I was told I needed a consult from neurology.

In the ER that night I saw two nurses, and three doctors (or four, around 1am I got kind of fuzzy, and I don’t remember any of their names). I did a lot of touching my finger to my nose and following the light with my eyes. I cracked jokes with my friends. We discussed the upcoming nuptials of another friend and the hotly debated issue of the wedding date. I wished I had sweatpants because those gowns leave a LOT to be desired. I wondered when I would get the MRI so I could get out of there and go home.

Around 2am, I was told I was being admitted. I felt silly about it, like, I’m fine, horses and stuff, we’re just ruling things out this is not necessary. I just wanted to go to sleep. I kept getting asked if I had questions. I should have questions, shouldn’t I? I was too tired for questions. So, I just let them push me through the hospital to the neuro floor (riding a bed with wheels is a weird thing, for the record). I was incredibly concerned about the fact that I didn’t have my mouth guard to keep me from clenching my jaws, and didn’t want to sleep without it. I was assigned a room, and a nurse, and a tech. Vitals were taken for what felt like the 10th time. My friends were allowed to leave, and come back to bring me my mouth guard and a pair of sweatpants. By the time they headed home for the night, it was 3am.

My nurse woke me at 6am to get me ready for the MRI. I’m not afraid of tight spaces, and I was sleepy, so I just let them do their thing. I was back in my room by 7:30am, ordering a bagel and coffee for breakfast. My friends returned and we spent the morning hanging out as if we were anywhere but the hospital. I was texting my parents, but didn’t want them to worry since it was all a lot of fuss for nothing, so I downplayed the situation.

My primary doctor, who had ordered the CT and told me to go to the ER, came to see me that morning. It was reassuring to see a familiar face. She said they were waiting for the MRI results, and we’d know that day. Around mid-morning a group of doctors came in and asked me to go through the whole story and describe the events that had led up to me landing on their neuro ward. They said they would be back with the MRI results. My friends and I watched some mindless daytime talk shows. Then we watched the Jetsons, because daytime TV is the worst.

It was early afternoon when the doctors came back. There were five of them, ranging from medical student to the neuro attending. There was more medical history, and touching my finger to my nose. They pricked my tongue with a pin. After this, they told me the MRI results. Sitting in that hospital bed on March 19 with my friend and five doctors staring at me, I heard the words, “we found a mass.” The doctors told me that I did have a tumor, but it wasn’t a type of tumor they often see – the MRI hadn’t shown a horse, in fact, I had a zebra.

My zebra

A copy of my MRI taken with my cell phone showing a very obvious tumor.

A copy of my MRI taken with my cell phone showing a very obvious tumor.

One of the medical students (a nice guy, though perhaps a tad too gleeful about this) told me I have a type of tumor most medical students only get to see in textbooks. My tumor, in the inner ear, is called a vestibular schwannoma or an acoustic neuroma (the two are interchangeable). Your cerebral nerves pass through your brain and go out into your body to control all of your various functions. My tumor was growing on the eighth cerebral nerve (compromising my hearing) and putting pressure on the seventh (the numbness in my tongue because the seventh controls your face). It was between the cerebellum and the pons areas of my brain, and pressing on my brain stem.

Your inner ear is where your vestibular system, which controls your sense of balance, is located. Vertigo, the dizziness and spinning sensations I’d been feeling, is a common symptom of vestibular dysfunction. The location of the tumor meant that in addition to ruining my hearing on the right, my vestibular system was also seriously damaged.

According to the Acoustic Neuroma Association, these tumors affect one out of every 50,000 people and are typically diagnosed between ages 30-60. Any tumor is scary, let alone a tumor near your brain that is threatening your ability to move your face, but it also has a fantastic prognosis. I was told it is typically a slow growing tumor, so I’ve probably had it for years. These tumors are highly likely to be benign, meaning it won’t spread and become lethal. I write about neuro-oncology enough to know that operable is one of the sweetest words in the English language. I’ve had to talk to and tell the stories of family members who lost their loved ones to brain tumors that couldn’t be removed. I have never been so relieved by anything in my life as my zebra, because if it had been a more common type of brain tumor, I would face a very different outcome.

Instead, there are treatment options, all of which end with a full recovery albeit with scars. For someone like me who has had headaches and vertigo symptoms for years, I may leave all this better than I’ve ever been – this tumor needed years to grow to reach 2.4cm, and I’ve been unknowingly living with these symptoms the whole time. I decided that, for me, surgery was the best option. I felt that it would give me the best chance of never having a recurrence, and would preserve my ability to move and control my face. When I went to meet with my surgeons, they retested my hearing. The results showed that my ability to hear out of my right ear was at 56% meaning that functionally I was right all along; I couldn’t hear conversations or make out words. Since the nerve damage to my hearing would not recover, I chose a translabyrinthine approach to the surgery, which cuts the eighth nerve making me deaf in my right ear. This was a heavy decision, but when I considered all the choices my parents, surgeon, and I agreed this was most likely to give me the best outcome.

I was told that the timing of the surgery would be my choice, because this type of tumor was so likely to be slow growing, so I made plans to be away later in the month. My doctors asked me, while I processed things and made plans for my upcoming absence, to make sure to tell them if anything about my condition changed, particularly with regard to the feeling in my face. Since the tumor was seriously threatening the seventh cerebral nerve, the secondary goal for the surgery to remove it was to save that nerve. It could be the difference between having half my face paralyzed, I was told, and being completely normal. I kept being assured that I had time.

A week after I was diagnosed with an acoustic neuroma, on March 26, I woke up unable to feel half of my face. On my right side, from my cheek to my chin, everything was numb.

Part two: Surgery