Detour from Normal (5 page)

"Ah, I see," he said as he noticed my naked belly. My intestines were so racked with infection that my belly had swollen to the point of looking nine months pregnant. It was shaven as clean as a baby's behind, and a glaze of Betadine coated it and dripped down my shivering sides onto the cold stainless steel table on which I lay. He walked toward me, eyeing the stainless steel cart that was set up next to me. On it was a rolled white cloth. He approached and within plain sight unrolled the cloth. There was an unmistakable clanking of steel against steel as it opened to reveal several knives.

There was a butcher's knife with deep, asymmetrical gouges on the sides and a rough, uneven cutting edge where it had evidently hacked into bone. There was a bread knife on which all the teeth were rounded
from years of sawing through flesh. There was a thin boning knife that had been sharpened so many times, all that remained was the sharpest sliver of a knife I'd ever seen. Lastly, there was a carving knife.

Dr. Mandela picked up each knife and examined it carefully until finally he picked up the carving knife. Its blade glimmered like a mirror. Unlike the other knives, its edge was razor-sharp. It was both a spectacular and frightening instrument. Turning it over, he admired it and said, "Ah, this should be perfect for the job." Then he turned to everyone in the OR, and they bowed their heads. They spoke in such low voices that I couldn't make out what they were saying.

Eventually, Dr. Mandela turned back to me and continued speaking. As he did so, I recognized the final words of the poem "Invictus" that had empowered him with its message of self-mastery so many times while he was imprisoned at Robben Island Prison.

... It matters not how strait the gate,

How charged with punishments the scroll,

I am the master of my fate:

I am the captain of my soul.

Then he turned to me and asked, "Are you ready, son?" I didn't reply. Instead I held my breath and blinked at him like an animal at slaughter. The knife in his hand suddenly flashed in the glare of the operating table lights. "Well then, let's see what we've got." With that, he raised the knife.

"Dr. Mandela, no...don't do it!" I yelled. He looked at me one last time with a gleam in his eyes, then plunged the blade below my ribs and ripped me open down to my groin.

I gasped and opened my eyes. I was cold, shivering despite several blankets laid across me. I looked around, wondering where I was.

"Hi, hon." I turned my head to the side, and there sat Beth in a chair by my bed. My throat hurt from the airway that had recently been removed from it. I cleared it and tried to speak, but my voice was weak.

"Where am I?" I croaked.

"You're in your room. You woke up about four hours ago in recovery. Don't you remember?"

"No, the last thing I remember was being in prep." It was dark in the room except for a fluorescent light above my bed. The sun had clearly gone down. "How did I get up here?"

"After you first came around and they determined you were OK, they decided to get you out of recovery. You went back to sleep after that. Everything went well. You didn't have to have a colostomy." I reached down and felt a long, thin pad on my belly, thankful that there was no plastic bag there.

"Thank God for small favors," I said.

"Hey, what were you just saying about Dr. Mandela?"

"Oh, that." I didn't want to tell her the truth—she'd think I'd lost my mind. "It was just something from the movie
Invictus.
I started to watch it last night before surgery but fell asleep partway through. It was pretty inspiring."

But to me, there was meaning to the dream. It was telling me that there were bad times ahead. If I persevered, everything would be all right—I would be the master of my fate and captain of my soul, but if I did not persevere? There seemed to be no answer to that question. I'd often had such vivid dreams but could never be certain of interpretations
until after the fact, so I wasn't about to tell Beth that things were going to get worse before they got better; it already seemed bad enough. Despite my prophetic dream, I couldn't have begun to know at that time how bad it was really going to get.

Chapter 4

ON THE MEND

I took stock of my changed surroundings. There were a few new bags hanging on my IV racks. There was also now a tube releasing oxygen into my nostrils held in place by a plastic shield that partially covered my mouth. A rubber band around my head kept the shield in place. It was part of a monitoring system used to measure C02 in my breath, tied into what I called the "Michael Jackson Pump" or "MJP" for short. The MJP was a morphine delivery system that allowed me to dose myself as needed, no more than once every six minutes. On the bed lay a push button assembly, which I could press to inject morphine into my IV. The shield monitored the CO
₂
in my breath as I exhaled to make sure I didn't overdose. I called it the "Michael Jackson Pump," because I could envision that he might not have died had he been connected to a system like that: it made a real racket if you stopped breathing or if the CO
₂
got too high.

I noticed something surprising after my surgery: I didn't have any pain. I had a twelve-inch incision, my innards had all been shifted around or cut up and sewn together, and I had thirty-six staples and several feet of sutures holding me together—but no pain. I knew that morphine was a respiratory system depressant, and I was very concerned
about weakening my respiratory system and getting a respiratory bug. Hospitals are notorious for fostering superbugs; the last thing I wanted was to depress my respiratory system. With no pain I really didn't want any morphine, which might lead to other complications. I brought up my point to the nurses and doctors and asked if it could be removed. They were all adamant that I keep the morphine pump in case I needed it.

Since I was stuck with it, I felt I should at least understand what it could do for me. I already knew that getting morphine through a needle worked wonders for pain, but had no idea what to expect from a pump. The first night post surgery, I decided to give the system a test drive. My intention was to evaluate the effects of dosage, hopefully culminating with a deep, restful sleep. I pressed the button once and waited: nothing. I waited six minutes and pressed it again. What happened then was completely unexpected: I began to hallucinate. At first there were bright colors and soft shapes twisting and floating peacefully, but then the colors grew dark and sickly, and the soft shapes evolved into angular machines of destruction peppered with sharp, steely barbs. Instead of floating peacefully without a care, they now seemed self-aware and purposeful, and I couldn't help but think that their purpose had something to do with me. I held my thumb over the button, tempted to press it a third time and get beyond the disturbing visions to my goal, but I couldn't do it. Instead of believing that things would improve, I felt that they would only get worse. I never did hit that button a third time; I just suffered through the hallucinations until they burned themselves out. I ended the experiment there.

During my hospital stay, I tried my best to be a good patient, partly to be respectful and partly because I wanted to get out of there as quickly as possible. Among other things, I was very dedicated about using my
spirometer before and after surgery to keep my lungs clear while I was spending so much time on my back in bed. A spirometer is a plastic device consisting of a hose and a graduated tube with a plastic disc that floats up during inhalation. The idea is to keep the disc as high as possible in the tube by inhaling hard for as long as possible, then holding all that air in for at least five seconds, after which you exhale and rest for a few seconds. I was supposed to do that seven times every twenty minutes. When I did that, it spread my lung tissues open and helped my lungs clear out mucous. It was very effective, and I could feel the difference after doing it.

With my CO
₂
monitor, I could only inhale twice before the MJP alarm went berserk. I tried all kinds of things to trick it unsuccessfully. Again I asked the nurses and doctors if they would remove the morphine pump, but they still refused. I hadn't used it at all since trying to put myself to sleep with it. I was genuinely concerned that all the days on my back were going to be my demise if I couldn't keep my lungs clear.

Sure enough, my respiratory concerns proved valid. The next day—April 22—I went down fast. My white blood cell count shot up to 17.3 again, and my temperature went up to 103. As the morning wore on, it became more and more difficult to breathe. I was literally drowning in my own mucous, and my vital signs were in a steady decline. The flow of nurses, then doctors, to my room increased. Like me, everyone was focused on my lungs. At their command, I'd wheeze air in, and wheeze it out. They listened intently at the four quadrants of my back with their stethoscopes. They tapped on my back and listened again. Each would enter with a smile and exit with a look of concern.

Eventually, the flow of staff stopped and I was left alone in my suffering. It was worse than when I was young and had my lungs seize up
from childhood asthma. At least that had ended. This only got worse. I'd never felt I was done for in my life, but that day I genuinely did for the first time. That hospital room was going to be my last stop.

Just then a nurse and an aide scrambled into the room and commenced popping off IV lines. In no time I was counting fluorescent lights on the ceiling again as they rushed me to get another CAT scan. After making the journey to the first level, I soon found myself outside the CAT scan room once again. Because of my fever and high white blood cell count, the doctors were concerned that my resectioned bowels were leaking, spreading infection throughout my body.

All the activity helped clear my lungs a bit, and it was a little easier to breathe for a change, but more bad experiences were just around the corner: I was to have a "contrast enema" so they could look at my surgical repair in more detail. Everyone was in a terrific rush, so there was little consideration of my comfort. I'm sure they explained everything they were about to do, but in my condition I was focused elsewhere. The technician had me roll over onto my side, then suddenly jammed a cold enema nozzle into my freshly stapled and sutured rectum, and filled me with equally cold contrast fluid. The pain was horrific. To make matters worse, once I was filled near to bursting, I was told I needed to hold the fluid in for several minutes while the CAT scan machine created the images they needed.

What I didn't realize until that moment was that during my surgery just over a day before, a "dilator" had been used to stretch my anus to extra-large proportions so an EEA (end-to-end anastomosis) stapler that was about as big around as a golf ball could be slid into it. The EEA stapler was used to pull my rectum and shortened colon together and then apply two neat rows of titanium staples to reconnect them. In the
process, things got pretty ripped up down there. I had no way of knowing that because I hadn't gone to the bathroom since my last round of Golytely before my surgery. That couple of minutes in the machine felt like a year. Finally, they were finished. They drained me like I was a big water balloon, wheeled me back to my room, and hooked me back up to all my machines to await results. After a while a new doctor I hadn't seen before arrived. He seemed very grave, like he was the last line of defense, which indeed he was.

"Mr. Dickson," he stated in a somber voice, "my name is Dr. Edwards. I'm an infectious disease specialist. I have some good news and some bad news. The good news is that your resection is sound. The bad news is that you've developed a nasty infection in your lungs. I'm not going to try and paint a pretty picture: you are seriously ill. I wouldn't be here otherwise. We're going to do our best to help you kick this thing though. So I'm going to start you on Diflucan, a powerful antifungal. It will have to be administered through a PICC line. I'll get you set up to have one put in. Do you have any questions?"

There were so many things spinning through my head that I was unsure what to ask. It was without a doubt a life-and-death situation—I could literally feel myself getting worse by the minute, but the questions that came to mind all involved my wife and children living without me and of things beyond death, for which no doctor could provide answers. "No," I finally managed to wheeze.