Last Week
We got a lot of comments on last week’s State Of The Bill Pictures. Some people liked them, some people even loved them. Some people were harder to figure out. Katherine Chamberlain said, “Nice photos, Bill, too bad you couldn’t find smaller pants.” And some weren’t difficult to figure out at all. Stuart Ellison said the pictures were keeping him awake nights. Others just kept quiet, perhaps fearful of punishment in print.
Since we print these sorts of photographs every year on Bill’s birthday, we decided to take our cue from Sports Illustrated. Each year, they have an annual Swimsuit Edition and some of the suits in there are smaller than Bill’s. So they give warning shortly before that issue comes out each year, so that all the granny-ladies and evangelicals and others of like ilk can abstain from receiving the dreaded Swimsuit Edition. We can do that, too. We’ll let you know a week ahead next year and you can advise us accordingly. We aims to please.
Pre Op Hijinks
Before you can have your cancer surgery, the doctors want to make sure you don’t have cancer anywhere but in the area they’re planning to work on. Or any other little unforeseen problems. So they send you to a radiologist (just can’t seem to get rid of these guys), who scans you head to toe to make sure that you’re otherwise well. I have never had a colonoscopy so I thought this might be an opportune time to get some extra information.
“See any polyps in there,” I asked the guy.
“We’re not allowed to say,” the radiologist told me. “But no, looks pretty good. Although this isn’t the ideal medium for looking for them.”
“I thought you could see everything with a CAT scan.”
“Pretty much.”
That was good enough for me. Put that colonoscopy on the back burner for another five years. I get enough abuse as it is.
Checking In
About a week before surgery, the hospital gives you a little schedule of meetings they’d like you to attend. It’s sort of like starting in the quarterfinals of a basketball tournament—if you work your way through the various meetings, you get to play in the finals.
First, I visited Dr. Su. He wanted to make sure I had no last-minute questions or reservations. Just before he spoke with me, he had been advising another patient to go home and lose 50 pounds before he could receive the same surgery. I think Dr. Su doesn’t like to compromise his impressive stats by operating on fat guys or prospects unlikely to prosper. You have to get in shape for your operation. Who knew? Thank God I didn’t look like Chubby Checker.
After a brief resume of what to expect during and after my surgery, Dr. Su dismissed me for my meeting with the anesthesiologist. This guy is also concerned with your general health, whatever allergies you may be afflicted with, etc. Anesthesiologists are always worried about missing some little item, gassing a patient to death and being sued for kazillions of dollars. Anesthesiologists believe in being careful. I’m one of those few people who is not allergic to anything, so no problems here. On to the next meeting.
If you have had any heart-related episodes, you must receive cardiac clearance to have your prostate surgery. Most of the paperwork for this had been attended to by the hospital, Shands at UF, and my heart guys, Interventional Cardiologists, so cardiac clearance went smoothly, leaving only the question of the bill, which would be mighty. This is, perhaps, the best time to be old because Medicare takes care of the brunt of the expenses. A lot of younger people can’t afford the surgery and eventually suffer the vile consequences, another argument for National Health Insurance, but we’ll dispense with editorials for the nonce. I had made it through the quarter-finals and the semis. I would get to participate in the Tournament Championship Finals. Oh boy, this should be fun! Shouldn’t it?
The Big Game
I got up very early the morning of August 14, 2008. My operation was scheduled for 8 a.m. but they wanted you at the hospital by 5 a.m. Naturally, there would be no breakfast, no dropping in to Dunkin Donuts to put a little sparkle into my day. Arriving at Shands, I was impressed to discover a large number of co-operatees filling the ample waiting rooms. The most surprising thing was the number of children and young people assembling for their assorted surgeries, some of which would be minor but others—judging from the appearances of some of the candidates—obviously dire. I had been kind of aloof about my operation but this little experience provided more weight to the event upcoming.
Eventually, everyone was separated into groups heading for the various operating areas. My section was divided into about sixteen cubicles, each consisting of a bed and some basic medical equipment. A nurse appeared and gave me a bag containing a gown, a hairnet and some no-slip socks with sticky treads on the bottom. My anesthesiologist popped in to make sure I had not eaten. There was nothing more Siobhan could do so I sent her home to feed the horses. And then, as my surgery-mates were called one by one for their appointments, I waited in silence for my own moment of reckoning. I didn’t feel quite so aloof anymore.
The Da Vinci Machine
The da Vinci Surgical System is a robotic surgical system made by Intuitive Surgical and is designed to facilitate complex surgery using a minimally invasive approach. The system is controlled by a surgeon from a console. It is commonly used for prostatectomies and increasingly for cardiac valve repair and gynecological procedures.
The surgeon’s console is typically in the same room as the patient and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, act as a scalpel, scissors, bovie, or unipolar or dipolar electrocautery instruments. The fourth arm is for an endoscopic camera with two lenses that gives the surgeon full stereoscopic vision from the console. The surgeon sits at the console and looks through two eye holes at a 3-D image of the procedure, meanwhile maneuvering the arms with two foot pedals and two hand controllers. The da Vinci System scales, filters and translates the surgeon’s hand movements into more precise micro-movements of the instruments, which operate through several small incisions in the body.
According to the manufacturer, the machine got its name in part “because Leonardo da Vinci invented the first robot,” and also because he used anatomical accuracy and three-dimensional details to bring his works to life.
To perform a procedure, the surgeon uses the console’s master controls to maneuver the patient-side cart’s three or four robotic arms (depending on the model), which secures the instruments and a high-resolution endoscopic camera. The instruments’ jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon’s hand movements. The da Vinci System incorporates multiple, redundant safety features designed to minimize opportunities for human error when compared with traditional approaches. At no time is the surgical robot in control or autonomous; it operates on a “Master:Slave” relationship, the surgeon being the Master and the robot being the Slave. (Wickipedia)
After The Ball Is Over
You awake from your surgery to discover that you have many holes in your body from the playful cavorting of the da Vinci machine’s robotic arms. The prostate is removed via a slit just under the navel and the other holes are above, below and to the left and right of the navel. All heal well with time and the largest, the prostate removal area, scars nicely along the bottom of the navel and is not particularly noticeable a couple of years later. Nor are the other scars unless someone is looking closely. Of course, you’re a mess at the time.
I lay around for a few hours, groggy from the anesthesia. I told everybody not to visit but John Cinnie (a fellow gymgoer) was at the hospital for a minor procedure of his own so he dropped by with his wife, Sharon. I recognized them and muttered some kind of appreciation for their coming but I was pretty much out of it. Which was just as well, since my roommate was some rural goober who had almost cut his leg off with a mower and was bestowing his unique manner of romance on the various nurses who were forced to attend to him. As soon as I was barely conscious, he unloaded an unending stream-of-consciousness litany of his past disasters and grim predictions for the future, which fell far short of any expectations of his ever being selected Queen For A Day.
Dr. Su didn’t particularly care for wildly dispensing pain pills (they constipate you, among other wonderful attributes) so I was pretty uncomfortable in my little bed, not to mention feeling like I constantly had to take a piss. Which was ridiculous, it was explained to me, because I had a catheter which was taking all the pisses it wanted. Common sense means little to a painful drugged man, however, so I continued to complain, to no avail. “Sometimes constipation is better than pain!” I advised, but nobody seemed to care. The goober tossed a new Sports Illustrated on my bed and I couldn’t even read it.
Home Again, Home Again, Jiggity Jig
I had to stay in the hospital overnight but got to go home next day. No lifting, said the doctors, no driving while the catheter is in (for a week), no nothing. Well, there's a horse sale tomorrow, can I go to that? Grumble grumble….okay, but take it easy. I figured it was alright to lift the catalogue, so we went and even bought a horse. The most unpleasant part of the deal is that now you have a growing bag of urine strapped to your leg and you must take pains to empty if every so often. This creates odd noises in the restrooms, leading stall neighbors to occasionally ask, “you alright in there?” My usual reply was “You don’t even want to know.” And I was right. They didn’t. “A big 10-4 to that one,” one guy said.
Bladder Chatter
After a week of these fun shenanigans, you get to have your catheter removed, and not a moment too soon is the way you look at it. This is almost a celebratory event, avidly looked forward to. Unfortunately, for me, it led to a horror show of bladder spasms that found me crashing to the floor in pain after each urination. And you know how many urinations there are in a given day. Ultimately, I had to return to the hospital and have the catheter reinserted for another week. By then I was glad to have it. Dr. Su assured a dubious Bill that one more week would cure the problem and he was right, as usual. There have been no further incidences of bladder problems, and thank God, whoever he is, for that.
The Aftermath
All men who have prostate surgery have some degree of incontinence. Fortunately for them, some companies manufacture little pads which fit inside underwear and prevent embarrassing problems. If you really want to know, post-surgical incontinence—at least in my case—did not involve waterfalls of escaping urine vaulting through the canyons. It was more a problem of the drip-that-would-never-end. Don’t leave your toilet too soon, son, or you’ll be running back. Oh, and don’t even THINK of using a urinal with all the other guys. You don’t want to be standing there for long minutes on end with your penis hanging out while your neighbors begin to harbor suspicions of exhibitionism or worse.
Anyway, I was lucky. The incontinence problem disappeared in jig time, if you call a couple of months jig time, which Dr. Su did. “That’s much better than the average,” he told me like a proud poppa. I still wore underwear to bed, just in case.
Another happy result of prostate surgery, erectile disfunction, lasted longer. You aren’t thinking too much about sex for a while after your surgery, and a good thing, too, for those guys who have to keep that urine bag on their legs for a few months. But eventually, of course, you must return to the sea again, to the lonely sea and the sky, and you must have your weapon available. Alas, the poor fellow is severely compromised by all the cutting of nerves involved in your surgery and he will probably not be showing up for work.
Dr. Su’s assistant, the ever-helpful Lisa Meyer, pointed out the many measures that could be taken to attempt to rectify this situation, including some sort of device capable of, um, inflating one’s penis. Well, that’s what it sounded like. Anyway, there was this lady in the hospital who worked for the manufacturer and demonstrated the use of this fine home appliance. I could kick myself for not trying it out but how was I to know I’d be writing this blog back in 2008? I can assure you that if I had been aware of my journalistic future I would have subjected myself to this scary and dangerous device (What if it doesn’t shut off? What if it doesn’t work for YOU and the woman-demonstrator looks at you like you’re TOTALLY worthless?) just so that I could bring you this important information. Because that’s the kind of guy I am. But instead, I opted for the Viagra prescription.
Viagra changes your whole sexual program. When I started using it, the little information sheet advised that it was most effective an hour from ingestion so that’s what I planned for. Forget spontaneity. Now the sex gets scheduled like a trip to Wal-Mart or the feed store. On the other hand, you probably won’t get rejected too much, what with the pills costing $13 apiece. Most women have a solid appreciation of finances which usually overcomes any sexual reluctance so they won’t be wasting that $13 investment you’ve made.
Eventually, I discovered that the “opportunity period” for Cialis lasted an alleged 24 hours, although I would never be one to push my luck. I liked the Viagra a little better but there’s obviously room for both in the surgical recoveree’s repertoire. After a year, I cut the Viagras in half (no easy feat, you need a very sharp knife) and now I am practically back to normal, though I do hate to part with my little friends. For the men out there who will ever need this surgery and be bummed by the sex prognosis (as was I), it’s not as horrible as you may think. You adjust and time passes swiftly. And it’s a little better to be slightly compromised than slightly dead.
That’s all folks, and just as well, if you ask me….
