Another Chapter in the Book of Pain

BP: Before Pain

A certain tentative joy comes with rising early—and I do mean early—on the morn of an elective surgery. As when one meets any day of reckoning, there is a dawning relief that before too long, the worst will be over. But unique to this kind of event is the carnal knowledge that the cawing emptiness in your stomach will soon be replaced by sustenance you never knew could taste so good. However, trepidation remains; they are, after all, using sharp knives on you while you’re prone and helpless. And if anything had diminished the fear, all those forms you have to sign acknowledging the risks would give it right back to you.

I rose at 4:00 am because that’s when my eyelids flew open as though they knew what they were in for. It was easy to wake; I never really slept. Going to bed the night before had been a hollow tradition, and I knew it when I lay down. No makeup, no jewelry, no perfume. This was an easy preparation for a day out. They said to dress comfortably (the usual advice) and not to wear anything that needed to be pulled over my head (involuntary shudder).

It was still dark when we departed the house, arriving at the scene so early that we were the first patient-victims to arrive. I wondered by how much the receptionist could have beaten us there, but she didn’t seem to mind the early hour. Her smile was reassuring, her manner businesslike as she had me sign all those aforementioned forms. I sat down to await my fate.

When the nurse appeared at the door to call me in, I stood and turned back to grab the sweater from the chair. “You won’t need that,” she said looking at me meaningfully, “And you can remove the wedding bands” (anxiety begins rising). I did as she recommended, though I had to work at my rings with soap and water in the bathroom. I’m pretty much wedded to my wedding bands. I delivered them to my husband who accepted them, smiling at me wanly. I smiled wanly back at him and passed over into the Next Room.

Preparing the Victim

As I entered the surgery area, the players greeted me cordially and introduced themselves: nurse anesthetist and surgery assistant. They were so young I wanted to ask where and when they graduated and, while I was at it, what grades they made. But a great deal is always taken for granted in these situations, so I refrained. The nurse anesthetist reviewed my medicines and allergies, asked when I’d last eaten, who would be able to drive me home, etc. They knew all the right questions to ask, I thought. They told me the surgery would be about two hours; I had left the waiting room a little before 8:00 AM.

Then came the ritual undressing, “Everything except panties,” the nurse instructed. Then came the re-dressing in the stunning little faded gowns that are standard issue for surgery patients. I lay down on my back on the table as directed and the nurse proceeded to wrap my hair back out of the way and position my carcass like a butcher laying out a side of beef for carving, except in this case the side of beef helps. My skull fit neatly into a head-shaped divot at the top of the table, the better to keep it from moving about. Surprisingly, this arrangement was more comfortable than it sounds, and I settled myself into it. They placed a pillow under my knees to reduce strain on my aging lumbar area and asked after my comfort level. “Just great,” I said.

The other nurse took my right arm and began prodding the inside of it at the elbow like a vampire looking for the juiciest place to puncture. She got it right with one stick. Obviously, she must have gotten good grades in that. About this time, a third nurse appeared, apparently to kibbitz, as she had no role in this particular play.

Talking with the Surgeon: An Eye-opening Incident

The nurse anesthetist explained that this surgery required me to be awake for at least part of the time so that any needed adjustments could be made in the size of the eyelid-tuck. She said it was normal to hear them talking during the surgery, but I should make it known if I was feeling any pain or anxiety and they would address it. I assured her I would not hesitate. She also informed me I might have retrograde amnesia, meaning that I might not remember anything during the surgery or even that I had it. She assured me that this, too, was normal. Though it sounded anything but normal to me, I smiled and nodded to confirm I understood.

After I was hooked up to fluids, Dr. Isurge* appeared. Unlike many doctors I’ve encountered during my extensive medical history, he inspires confidence. He seeks to be neither a comedian or your best friend. I would characterize him as quietly professional. Plus, everyone I knew who had had eyelid lift surgery (a.k.a., blepharoplasty) went to him, and they’d both been very happy with the result; neither had that unnatural, perpetually surprised look.

Unlike my friends, I had elected to have an additional procedure called a brow lift. During my office visits prior to the day of surgery, Dr. Isurge had observed that I had what he termed “heavy brows” (not to be confused with furrowed brows, which as a Democrat I also frequently suffer from), and he advised having them lifted along with the lids. He told me that these brows were part of the reason I had droopy eyelids and if I didn’t address that, the brows can put sufficient pressure on my eyelids over time to bring them right back down again. Dr. Isurge had also outlined how my particular brow lift would be done. It would involve an incision at the hairline on each side of the face, then pulling up the skin to raise the brow position.

After pondering on it, I was inclined to spring for the extra step, even though Dr. Isurge had explained insurance would not cover it. My husband was doubtful about all this, worrying not about the extra cost, he said, but how it would change my appearance, with which he opined he’d always been happy. When I had asked Dr. Isurge about just how it would change me, he looked quizzical and replied, “Well, it’ll make you look younger.” I said I’d take two.

As I lay on my back with my head in the divot, Dr. Isurge looked at his sheet listing my procedures for that day as blepharoplasty and a brow procedure. He began drawing dots just below my eyebrow, explaining at the same time an entirely different brow procedure than the one he’d described in our office visit. I said, “Uh, Dr. Isurge, this is different from what you said before. You said there would be hairline incisions for the brow lift, not brow incisions.”

Dr. Isurge again looked quizzical. He retreated to review his notes. When he came back, he offered no explanation, but began surveying the terrain of my forehead below the hairline. I asked if what we discussed in his office was, indeed, what would transpire that day, and he murmured “Mmmm,” which I took to be assent. I decided that it was not the right time to think more on what had just happened. But I am confident now that if I hadn’t objected, I would have undergone a completely wrong procedure, which I’m sure would have ruined both my day and his. This hurdle behind us, Dr. Isurge gave the nurse anesthetist the green light to proceed.

Eyelid Music

Fluids began to flow, and I closed my eyes so Dr. Isurge could begin his tasks. Throughout the surgery, entertainment was provided that was so much better than any music. Instead, the three nurses chatted and gabbled like a coffee klatch about everything from diets to daycare. Some of their conversation was hilarious and yielded a couple toddler-talk classics. They agreed that dropping off their kids to daycare was heartburn-inducing for both parent and child. One nurse quoted her son’s plea on one such trip. As they arrived at daycare, he said “Mama, if you love your little boy, we’ll go back home now!” They agreed that trying to get the little ones to eat a nutritious diet was another vexing challenge. Mother to child, “No dinner, no cookie.” Kid sighs, resigned. “Okay, you can keep the cookie.” I wanted to laugh out loud but had to wait until later.

During the whole time, except for an occasional direction to a nurse, the surgeon said not a word. He went about what I perceived as a very meticulous approach to delicate surgery. It seemed to me he was using their nearly-nonstop chirping to each other as background music, calming him and helping him concentrate. He worked first on the brow lift.

They had told me the surgery would take about two hours, and even with the nurses’ amusing conversation to divert me, it seemed like forever until Dr. Isurge said, “Margaret, open your eyes.” My eyes flew open as if pulled up by strings. Dr. Isurge said, “Okay, too much,” meaning, I believe, that he had taken too much of a tuck in my forehead skin. I closed my eyes once more as he made the required adjustment and proceeded to the blepharoplasty.

Finally, both procedures completed, the nurses began cleaning me up to be presentable enough to go home. They spent what seemed like a long time sponging vigorously around my hairline and the back of my neck. Finally, I asked, “Is that the betadine?” “No,” a nurse said matter-of-factly as she continued sponging, “It’s the blood.” Though impatient to get up, I thought it was probably a good idea not to send me out bloody; Bill might freak. They continued the clean-up process until I they felt I was ready to see the result.

Dr. Isurge told me I could open my eyes and said it had gone very well. After showing me what I looked like, he seemed about to leave, but one nurse motioned to him that he had a paperwork task. Apparently, the surgery had gone a good bit longer than scheduled, and he had to do a written explanation to the eye surgery center. I wondered if it had anything to do with the brow lift confusion. Maybe the one they thought he’d be doing was shorter? At any rate, he completed the explanation sheet and disappeared from the scene while the nurses showed me how to use a small plastic bag filled with frozen peas as an ice pack. Finally, they helped me get dressed and applied an antiseptic ointment to my eyelids.

I felt quite alert, considering what I had just been through, with a propofol-refreshed feeling. I had been instructed to dress comfortably, but this seemed a superfluous direction, as I hadn’t worn anything but panties during surgery. With the nurse’s help, I dressed quickly, my breakfast awaiting at home sounding better and better to me.

At that point, they brought Bill from the waiting room, gave us some instruction sheets and a Tramadol prescription, and sent us out a back door. I figured they didn’t want any of the waiting patient-victims to break for their cars at the sight of me. By then, the ointment had found its way to my eyeballs and made my vision blurry enough that Bill had to text Paige and our friends for me to let them know I had come through okay. It was right before noon when we left for home. Once there, I ate everything in sight.

The Aftermath: Side Effects I’m Glad I Didn’t Know About Beforehand

When I looked in the mirror at home, I looked like a rat that had first been beaten-up, then drowned. My hair, mousse-matted and wet, stuck up in sticky tufts; I was the Frankenstein version of Phyllis Diller. Though stapled, stitched, and bruised, as expected, and shiny with ointment, I realized that I had little pain, then or during the surgery. And if there was any retrograde amnesia, I didn’t remember it. Seriously! I’d recalled what seemed to me every part of the experience, all the eyelid music, Dr. Isurge’s error and “too much” comment, the works. Apparently, I had just enough anesthesia to take pain away but none of my memory.

I couldn’t take a shower until the next day, and my vision was too blurry to read, so the rest of the day was TV and frozen peas. I never did take the Tramadol.

The shower the next day felt so fabulous, it was like a celebration. I had survived! Phyllis Diller was gone at last, though Frankenstein remained. The stitches and staples came out a week later, again with no pain. Weird to have threads pulled from inside the skin of your eyelids. The real problems, however, were with sleeping, of which there was little for the next couple weeks.

I had been advised that, while lying down, my head had to be well elevated to keep swelling to a minimum. Also, it was imperative that I lie only on my back. Sleeping on my side or even worse, on my stomach, might pull out stitches or sutures or otherwise do damage to the surgical wounds. These were problems, Dr. Isurge said, I did not want to have. I averaged about four hours a night and, as a result, was not very companionable. After nearly two weeks, I said the hell with it. I flipped over on my side and got a full night’s sleep at last.

But yet another problem emerged as a direct result of two weeks of lying in such an awkward position and getting no pool exercise. The inexplicable pain in my legs that had taken me the past year to work out with water aerobics returned with a vengeance, and I had to increase pain medication and use ice for the first time in months. There was nothing to be done for it except take the meds, get back to the pool, and start the gradual strengthening process all over again. Bummer.

Three weeks later the bruises were still there but gradually faded away into the history of my past traumas. My eyes, free from the weight of drooping lids and brows, seem somewhat more open, though not drastically so. My upper forehead was still a little numb and tender to the touch for weeks, and I could still feel the bumpy sutures under the skin. Dr. Isurge had said they would take about a month to dissolve, but that was the same medical optimism I have heard from all surgeons of my acquaintance.

I’m back in the pool and still having about the same leg pain as before the surgery, but I’m hopeful I’ll recover completely before writing another chapter in the Book of Pain. Another unexpected side effect of this surgery? It’s given me a whole new respect for women who have facelifts. You go, girls! As for me, I’m enjoying my sleep.

*Dr. Isurge is a pseudonym.