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Monday, December 18, 2017

The Day I Knew Things Were Going to Suck For a Long Time

(continued from The Night My Face Was Ruined)

I've been dragging my feet on this last part, and I'm not sure why. Clearly there's something which happened that I don't want to think about, but I'm not sure what that could be; all of the painful memories have already been discussed.

I don't know. The brain is weird. Anyway, here is the conclusion to my three part tale.

I've often said that hospital emergency rooms are where time goes to die, and I mean that. There is something oppressively eternal about those windowless rooms and sterile halls and flourescent lights, the kind of eternity where it feels like you've been there for hours instead of minutes. It's a pretty good vision of purgatory, especially if you're in pain or scared, because without windows to look out or televisions to look at to judge the passing of time (and there's usually crappy cell reception, too) there is a profound feeling of isolation and being left to one's fate.

This is essentially how I felt for the three hours it took for the ambulance to arrive and take me up to Jacksonville. About the best thing I can say about it is that the Ativan really took the edge off my impatience as well as my worry; I was essentially just "in the moment" for those three hours with my brain idling. Which, to be honest, is much better than it could have been, because me being worried and impatient and bored for three hours is not a pleasant thing.

So I chilled for three hours, and eventually the EMTs came to get me. I said goodbye to mom, they loaded me up into the 'bolance, and away we went... doing the speed limit. I remember being distinctly miffed that they weren't using the lights and siren, because Daytona to Jax is a long-ass drive that can take up to two hours depending on traffic and which side of J'ville your destination is. I thought, "Don't these guys want to get this done so they can get back to doing more important things, like saving lives or going off-shift?"

I may have asked for more Ativan, I'm not certain. I remember being bored enough for it to register that I was bored, and uncomfortable enough to feel uncomfortable, but not enough of either for me to really want to do anything about it. I may have dozed off at this point, because I was lying down and it was past my bedtime, and the motions of a moving vehicle tend to put me to sleep anyway, but if I slept I didn't dream and I didn't sleep for long because I was awake and aware when we pulled up to the hospital and I was wheeled into the ER.

I recall being disappointed that they wanted me to butt-scootch over to the ER bed rather than doing the thing I see on TV where the staff lifts the patient over, but maybe that's because I wasn't on a backboard. One thing they did do, though, was to cut my t-shirt off me. I was quite upset at this, because 1) I hadn't gotten any blood on it, 2) it was a damn comfortable shirt, and 3) I didn't see the need for it. I still had the EKG leads on from when I arrived at the first ER, and I figured they would cover everything except my face with a sterile sheet, so I couldn't understand why they did that. In fact, they had me take off my pants as well, so I figure "it's just policy" is probably the answer.

I didn't put up too much of a fight because I decided they wouldn't allow me to keep it on and I didn't want to go to the trouble of trying to get it over my head while holding my lips in place.

Then the plastic surgeon came to take a look at the damage and expressed a sentiment that can best be described as "Yes, this is adequate for disturbing my rest, but is not a challenge. I shall vanquish this easily." Then he pulled out his smart phone and asked if he could take a picture. I said, "Only if I get a copy" and gave him my email address. He took the picture but I still haven't gotten a copy of it. Jerk.

Then the nurse came in to prep me for surgery, and confirmed that I wasn't being wheeled up to an OR but would instead be treated there in the ER under local anesthesia. (So again, I felt like they cut my shirt off for nothing. I would have understood if they needed to put me under.) She asked me if I thought I would need anything, like more dilaudid, for the procedure. I explained that I didn't like how the dilaudid made me feel and that I was pretty good other than hurting in the places that were going to get localed, so as long as I could lie back and have something over my eyes I would probably be okay. Although could I get more ativan just to make sure I didn't get all antsy during the procedure?

I realize I sound like I'm suddenly an ativan addict but I promise, once I left the hospital I never had any cravings. I just really really liked having a chill pill that calmed me down and made me less impatient and squirmy.

The actual procedure is fuzzy, because I got the ativan IV and I put a towel over my eyes (because those surgical lights were fucking bright and right in my face) and so time just sort of... passed... in a twilight of not really sleep but not really awake either. I felt each injection of local anasthetic (and they really hurt, too -- the needles felt like they were barbed and the juice burned as it went in) and I was aware of each puncture of the suture needle, but it didn't really hurt -- or maybe it hurt but I didn't care? -- and it wasn't quite a dissociative "I am not in my body as this happens" state but I wasn't fully present for it, either.

It just kinda happened, and when it was done, it was hours later. Like at least two, maybe even three, even though it felt like 45 minutes and I'd barely moved. Then the surgeon took an "after" picture to go with his "before" one. I asked him how many stitches it was, and he said "Oh, somewhere between 50 and 60. I tend to lose count after a dozen or so."

Then he said that "The surgery went well. Your skin came together in a good approximation", and I started to freak out because I wanted something more than "approximately".  He explained it, but I'm going to quote my friend Wendi Bragg who has some experience with Doctor Speak:
We are used to thinking of "an approximation" as "close enough" or "something that resembles" or even "something half ass that's the best we can do".

Whereas the surgical definition of approximation is "bringing tissue edges into desired apposition for suturing." So approximation may be poor, adequate, or good.

What he was telling you was that he was able to put everything back where it was supposed to be, without getting "creative". And that's an excellent situation to be in.
So apparently, " a good approximation" meant I AM FUCKING AWESOME from this surgeon. And that's a good thing, because I understand that mouth injuries are really, really difficult to repair because not only do they have the eating and stretching thing going on, but the inside and outside of the mouth heal at different rates and if things aren't done properly there can be puckering and wrinkles along the scar line. This is why I didn't just get a plastic surgeon, I got an OMS (Oral Maxillofacial Surgeon) and these guys are rock stars, because in order to become an OMS you're looking at about 15 years of school:
  • 4 years pre-med
  • 4 years dental school
  • 4 to 6 years of surgical residency
I don't even want to think about how big his student loans are.

Then he hit me with a doozy. I don't recall his exact words, but they went something like "While the surgery went well and I have every confidence in my abilities, the damage was extensive and there's a small chance that the skin could be too traumatized to survive. So keep an eye on it in case it changes color, starts to smell funny, or oozes anything other than blood."

Because what I really needed to hear after a traumatic evening and a long surgery was that there was a chance it could all be for nothing and I could get gangrene of the face.

Yay. Believe you me, that worry kept me up at night, especially when it began to scab over.

After that was done, the nurse came to see again. She had me fill out the admission paperwork and gave me some disposable scrubs to wear home. I asked for some breakfast because it was now 6 am and I was starving. Then I asked to use the bathroom because I really needed to pee (and to be honest, I wanted to see my face).

I discovered a few things in those few minutes:
  1. It was really hard to talk. Why, you'd almost think someone had sewn my mouth shut. 
  2. In addition to being a bloody, stitched-up mess, I was swollen damn near  everywhere on my mouth as well as my right cheek. I looked like a monkey who had gone a few rounds with a professional boxer. 
  3. If your lips are swollen and your mouth is stitched tight, it is really difficult to open your mouth wide enough to get food in. Even though I had been given scrambled eggs, I ended up essentially shoving them between my lips with my fingers. I ended up wearing a lot of that food, as it smeared over my lips and fell onto my chest. 
It was a very effective "This is what your life is going to be for the indefinite future, so you'd better buckle up, buttercup" moment. 

After that, I dozed for a bit until a family friend drove my mom up to Jax to get me. The nurse handed me a washcloth on the way out -- a thin white one, and definitely NOT as good as the plus red one the other ER threw out -- because my sutures were oozing blood and it was running down my neck. There's something irritating about walking out of an ER while still bleeding, but I was ready to go home and go to sleep, because I'd been up for 24 hours.

They put me on a BUNCH of antibiotics (two different pills plus twice-daily doses of triple antibiotic ointment, and whatever injections they gave me in the various ERs). They also gave me a prescription painkiller which I never took, because after the surgery it didn't hurt that much and I could control it with Tylenol or Advil.

You know the rest of the story via blog posts and Facebook updates. The skin never became necrotic, the stitches came out 2 weeks later (a huge relief), and things slowly got better. I'm told I'm healing well, and will see the local plastic surgeon some time in January, because the swelling is still going down and he won't see me again until it's gone. I'm still worried about some nerve damage because of loss of sensation on parts of my face, but that just might be because they're swollen. I'm back to about 99% full function -- the only thing I can't easily do is open my mouth really wide, like at the dentist's office, and the surgeon told me in no uncertain terms that I was NOT to do that until he said I could.

That's about everything I can think of. If you have questions, ask. 

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