So there I was, lying on the operating table, waiting to go under the general anesthetic.
At this stage I was paying very, very close attention to what was happening. I wanted to register, in as much detail as possible, exactly what it was like to go under an anesthetic. The experience would be interesting to write about. And maybe, when I came round after the operation, I would have some interesting morphine hallucinations. (Nobody had suggested to me that I might have hallucinations, but, nevertheless, I speculated that I might.)
"Are you feeling anything yet?"
But I didn't. Instead, a woman was asking me, "Mr. Cook?" And, though no time had passed, I knew that the operation was over and that I had been moved from theater to a ward. I had been warned that I would quite possibly wake confused, and would be, probably, groggy from the aftermath of the general anesthetic. But I felt relaxed and clear. I was sure the operation had gone perfectly.
"What day is it?" said the nurse.
"It's Monday 17th January 2005."
"And where are you?"
"I'm on the eighth floor of Auckland Hospital."
"And what's happened to you?"
"I've just had an operation. A brain biopsy. Question: did the operation go perfectly?"
"Let me see ... yes, it went perfectly. Your blood pressure was stable throughout, and there are very few notes."
I did not have a tube going into a vein in my chest. I had been warned that the insertion of such a tube was a possibility, but apparently in this case it had not been necessary. Also, I did not have a urinary catheter.
"Did they put in a urinary catheter?"
So that, then, was how I came round after my general anesthetic. The transition between lying in the operating theater and coming round afterwards occupied zero time. If you wake after sleeping, you probably have a sense of having been out for a while, but the transition from theater to recovery bed was like flipping a card. Or, more exactly, like one card transforming itself into a completely different card, effortlessly, in zero time.
As I mentioned earlier, I wouldn't want to oversell the "maybe you're dying of cancer" experience, but my medical adventure did have a couple of supremely happy moments. One was the period of free-floating happiness that I experienced immediately after the successful conclusion of the biopsy of my left eye. The other was the period of elation that I began experiencing immediately upon coming round after my general anesthetic.
My only disappointment (and it was a small disappointment) was that the intravenous morphine which I had received was not having any appreciable effect on me, unless it was the morphine which was making me feel supremely relaxed.
When I came to, I was in a special ward called the high dependency unit. I think that immediately after leaving the operating theater I was taken to some kind of recovery room and it was from there that I was taken to the high dependency unit, which had all the gear that would be needed to monitor my condition and take care of any problems that arose.
By the time I came to my bedside locker, which had earlier been in my private room, had been wheeled up to my bedside in the high dependency unit. I was reunited with my spectacles, though I don't remember exactly when how. Somehow, they were there as soon as I was ready for them.
The next step was to use a urine bottle. To do this, I knelt on the bed, which was screened off from the other beds by curtains. When I got up into a kneeling position, the blood pressure monitor went crazy. The nurse who came to investigate told me that this was "because of the position of your arm". That statement made no sense whatsoever. There was no blood pressure cuff on either arm, so how could the position of my arm possibly be influencing the blood pressure monitor?
The nurse seemed unhappy with the fact that I was kneeling, and I got the impression that kneeling was aberrant. I realized that my kneeling was, sort of, a modified version of the now-familiar squat toilet style of doing things.
There are plenty of Western-style toilets in Japan, but, during my seven years in Japan, I had used a squat toilet on plenty of occasions, and, when I confronted the urine bottle, it was my squat toilet training that came into play. The nurse seemed to think that, when using the urine bottle, I should be sitting down on my bed with my legs straight out in front of me, but I'd never relieved myself in any such manner in my entire life, and I didn't feel up to the task of learning a new method of passing urine.
After I'd used the urine bottle, it was time for me to have dinner. I'd recovered consciousness at perhaps 1830 or thereabouts, and dinner had already been delivered and was waiting at the side of my bed. Dinner was chicken, spinach and carrots. It was a bland meal and I did not feel that I needed to eat anything. However, I ate.
My parents visited between 1900 and 2000, but I have only the slightest blurred memory of this initial visit. I'm in bed and my parents are sitting there. Beyond that, nothing. Despite having woken up after the operation feeling crystal clear, in retrospect I don't think that I was in fact crystal clear.
And, now, a note on perfume.
When my parents came to visit me, they were instructed not to bring flowers, because the perfume of flowers can have a deleterious effect on the recovering patient. In retrospect, this ban on flowers was the strangest aspect of my brain surgery, something I could not have imagined for myself.
After my parents' visit, there then followed a very long and uncomfortable night. Uncomfortable, because I kept getting interrupted. I'd been given intravenous fluids while under a general anesthetic and I had no idea how often I should expect to urinate. I ended up experiencing a nervous need to urinate when there was just a little urine in my bladder. A little felt like a lot, so I would press the buzzer to ask for yet another bottle, and then would have to press the buzzer again to have an embarrassingly small quantity of urine taken away.
I was still wearing my surgical gown and the associated nappy (that is, diaper) which could be dragged to one side so I could do what I had to do.
One nurse, early that night, walked in on me while I was urinating. She parted the curtains and walked in to find me in a kneeling position on the bed, busy trying (with very little in the way of success) to fill up the urine bottle. She got flustered and confused, and backed out of there with an apology.
You can knock on a door, but, obviously, you can't knock on a curtain. Not effectively, at any rate.
Later in the night, another nurse walked in under similar circumstances and started asking me some kind of question. I was confused. I'm kneeling on the bed with my penis stuck in the neck of a translucent plastic bottle and a young woman who is a complete stranger to me is standing right in front of me asking her question. What is the protocol in this situation? I didn't know, so I decided, the hell with it, and kept on doing what I was doing. The second nurse, for her part, seemed totally at ease with the situation.
Evidently, however, it is aberrant to keep urinating repeatedly in small quantities after an operation, and the second nurse started interrogating me, evidently trying to find out if I had prostate trouble or some similar problem. I felt tired and irritated and just wished I could vaporize the interrogator. I was quite sure there was nothing wrong with my prostate. Apart from anything else, in the 2003-2004 period I'd had not just one but two prostate examinations in Japan (pretty much anything that could be checked had been checked).
One other thing that struck one of my caregivers as being unusual was my habit of wearing my spectacles while sleeping.
"Do you always wear your spectacles while you're sleeping?"
"Sometimes. On aeroplanes and so forth."
Way back when, while doing military training, I started wearing my spectacles when asleep while on exercises which involved camping out. That meant that if, for example, I had to wake up suddenly at four in the morning, rather than start by fumbling around for my spectacles case, all I had to do to be ready was open my eyes and pull on my boots (assuming that I was lying in my sleeping bag fully dressed, which was the norm).
Admittedly, if you sleep wearing your spectacles, then you really have to train yourself to sleep lying on your back. However, this is doable. In fact, I once read about a German military academy (a Prussian academy, I think) where the regulations required that the cadets sleep not just lying on their backs but lying to attention.
Later, it became natural to wear my spectacles while sleeping on a plane, because I might be disturbed from time to time by the arrival of meals and so forth, and, when I ended up in hospital, it became natural to keep my spectacles on my nose rather than have to scrabble around for them every time I wanted to pull my blurred surroundings into focus.
I suppose that the success which the staff had in identifying my various weird deviations and their willingness to inquire into those quirks indicates a high degree of professionalism. But, on the night, every inquiry just irritated me, though I disguised my irritation (I think I was successful in this) by maintaining an expression of bland inscrutability.
In addition to all my other bits of strangeness, another thing that was aberrant was my pulse, which at one stage set off an automated alarm because it dropped right down to about forty-five beats a minute. This didn't worry me because, ever since I've been a teenager, there have been occasions on which my pulse rate would drop right down to forty-five. However, abnormal is abnormal, and my aberrant pulse rate prompted another visit from the interrogative second nurse, who decided, after some questions, that, given my age (not all that old) and given my level of fitness (I was accustomed to walking a lot) my pulse rate was acceptable.
In the course of subsequent hospital admissions, my pulse rate (typically resting at somewhere round about fifty or sixty beats a minute) would, on occasion, prompt another round of questioning, and, occasionally, when my pulse was being taken by some kind of monitoring equipment, it would drop low enough to set off an alarm.
While lying in my bed in the high dependency unit I was trying, in the interests of self-preservation, to keep track of what was being done to me, and to analyze the gear that was hooked up to me, but I didn't do very well at this task. I completely failed to think about the mystery of how my blood pressure was being monitored.
My blood pressure was displayed on a bedside monitor (the display duplicated, I was told, at the nurses' station). However, there was no blood pressure cuff on either arm. It logically followed that I was not hooked up to any blood pressure monitor. And yet, my blood pressure was being displayed right there on the screen. How was that possible? It never occurred to me to wonder.
Although I was trying to be analytical about my situation and to work out exactly what was hooked up to what, I just accepted the blood pressure figures magically.
After some time, the drip which had been running into a vein in my left arm was disconnected. There were no more intravenous fluids going into my left arm. But there was still a length of plastic tubing connected to something that had been inserted into the back of my left hand. Why?
I asked, and was told that the bit of tubing which was connected up to the back of my left hand was an arterial line. It was not connected to a vein but to an artery. And that arterial line contained a tiny blood pressure monitoring device. That device, the existence of which I had not even suspected, was keeping track of my blood pressure from the pulse of arterial blood which came beating up the arterial line, and was feeding the results to the monitor on my right.
If I had looked more carefully then I would have realized that a tube ran all the way from my left wrist to the monitor on my right that was keeping track of my blood pressure, the tube passing somewhere behind my head en route. But I did not look because I did not think to look.
Up until that point, I had never heard of a bit of tubing being connected to an artery. The usual thing is to insert a cannula or similar into a vein rather than an artery, since the pressure in a vein is much lower. But, evidently, by going into an artery it is possible to monitor both pulse and blood pressure.
Through the night, I got various checks. From time to time a nurse would come by to see if I still remembered my name (if recollection serves, I always did) and I got given medication. I experienced no pain whatsoever, but, nevertheless, took the tablets I was offered. A couple of Panadeine tablets, I think. (A mix of paracetamol and codeine phosphate.) I didn't have any occasion to ask for the morphine which had been charted in case I needed it.
Eventually, the arterial line was taken out of the back of my left wrist, and the entry point was covered with a bandage.
And, finally, it was morning. And soon it was 8 a.m., meaning it was just about breakfast time. But breakfast failed to arrive, and I started to entertain the paranoid suspicion that perhaps the hospital had managed to forget about me. Perhaps nobody was going to bring me breakfast.
A little later, I got the impression that I could hear other people discussing breakfast. Not just that, but I thought I could hear them eating it (cutlery scraping against plates and so forth). Because my bed was still screened off by curtains, I couldn't see. So I pressed the call button. A nurse came.
"Is it possible that breakfast has arrived on the ward?"
She went to check, and shortly returned to tell me that, no, breakfast had not arrived.
All through the final months of 2004, I had been deliberately eating extra calories in a futile attempt to gain weight. I had internalized the perception that "Weight loss equals death". And that dictum was conditioning my emotional response to the fact that breakfast was (still) failing to show up. My paranoia intensified. I became increasingly convinced that, yes, they had forgotten about me.
Finally, I pressed the call buzzer again, and another nurse came to my bedside. She was surprised that I had not had breakfast. She went away to investigate and returned to apologize. Sorry: a mistake had been made, and my breakfast had gone astray. But not to worry. The situation would be remedied, and a breakfast would be delivered to me in due course.
Doctors dropped by briefly to say hi. Someone showed up and removed the blood drain which had been lying in a long shallow cut in my scalp. This drain had been secured by two stitches, one of which was long and caused a little pain when it was pulled out. That brief pull of pain was the one sharp moment of my brain operation. Later, I did an escorted toddle to the toilet (goodbye urine bottle).
And, later still, I pressed the call button yet one more time, and enquired after my breakfast. Surely it should have been delivered by now.
Well, yes, it turned out that my breakfast had indeed been delivered. It had been parked in the corridor outside the high dependency unit, and had been sitting there for quite some time.
While I do remember that my breakfast did eventually arrive, at this stage I do not remember what my breakfast was.
Beyond this point, the sequence and timing of events becomes blurred in memory and difficult to reconstruct from my notes, but I eventually had lunch.
And a second visit from my parents (at about 1500, I think).
And (finally, the delay being because of my slovenly reluctance to move) a shower.
("We're not bossy about showers," someone said at one point, after I declined an offer of an early shower.)
My operation was definitely behind me, and I had successfully joined a small and select group of people: neurosurgery survivors. The irritations of the night behind me, I was happy, and counted myself as the perfectly contented patient.