Here we go again........

April 26, 2010.
I was to return to Beth Israel for a 1:30 OR slot for surgery #2. Erica was helping me shower that morning with that very special (and smelly!) antibacterial soap - once again. Rinse and soap up. Shut water off and wait 3 minutes. Rinse and soap up again. Shut water off and wait 3 minutes. Rinse and soap up - final rinse. Hallelujah! Just as I was wiping off, my cell phone rang. Erica reluctantly handed it to me after telling me it was from Beth Israel. I answered and heard Dr. Glazer's receptionist, Linda's familiar voice. She said that they were wondering if I could come in any earlier because Dr. Glazer's first surgery of the day had been cancelled. I leaped with joy to just get in and get this over with! She asked if we could be there for 11:00AM and I said I would try and would be there as soon as we could. We immediately called Ursula and my friend Dee, who was also accompanying us that day. They were both ready, so it worked out great. I was already packed naturally (I mean, what did I really need?) so I quickly dressed and I was ready to go. More than ready.

So we all embarked on yet another trip to Beth Israel. Gosh, I could drive there with my eyes closed. I have been to that hospital more times than anyone should have too. Ursula drove my car up with the idea that Erica and Dee would drive it home that evening, as Ursula wouldn't be needing a car as she would be staying with me for a week. I don't remember arriving and I must confess, I don't really remember any of what I have typed already. Erica has had to feed me all of this information. I just have no recall of it. In fact, I am not going to be able to tell you very much about the following four weeks without information from others. I don't remember any of it, but  for tiny blips and with any luck, I sometimes have some recall when someone reminds me of something. It is very frightening.

I DO remember walking into the OR prep area. Erica just told me that I went in with Dee while she and Ursula went and parked the car. I could have sworn it was Erica that came in with me, but she assures me that it wasn't, and that it was in fact Dee who came with me. I remember them being all ready for me because people were bustling about and everything was moving very, very quickly. We barely got in and I was given my johnny and socks. I hadn't even completely undressed when suddenly some man came in and started explaining that he was the anesthesiologist. I verified that he was an attending and he confirmed (as I was looking at his name tag  for the info too!) that he was definitely an attending and NOT a resident. So here I was, half-naked, having a very serious conversation with the anesthesiologist. I also recall him explaining that because Dr. Glazer had ran into some difficulty with my previous surgery, they were all concerned about what would happen in this one AND because I was a "bleeder", there was always the chance that Dr. Glazer would have to close quickly and therefore I may awake while still intubated!! Gulp! WHAT?? I asked, "What are the chances?" and he said, "There is no way of telling. WHAT?? He continued, "If he runs into complications, we would want to keep you intubated in case we would have to get you back in very quickly overnight or something. You do realize that this is MAJOR, MAJOR surgery - very, very invasive?". Are you kidding me? I've been researching this for almost 7 freakin' years, I know more about Flatback Syndrome than he does, that I can assure you!! And I know very well just how invasive this was. But now, I admit - I was scared shitless. I DO NOT want to wake up with tubes down my throat!!! I signed up for spine surgery, not for tubes down my throat?? God, where are you?? Mom?!?!?!? Is anyone up there helping me?? Dear God. Wake up intubated???? The next thing I know, Dr. Glazer is letting himself in through the drawn curtain and now here I stood half- naked with two doctors! He didn't even close the curtain tightly, so now I am standing there for all the world to witness practically. Naturally, they act like it is nothing. Good thing I am not an overly modest person. He wanted to examine the abdomen incision and proceeded to explain what he would be doing (again) and his concerns about whether my dural membrane was going to create problems again and because "you sure do like to bleed". He promised me that he would do his very best to get this all done in one shot and then he turned and was gone. I finished getting into the johnny and laid on the gurney when Erica and Ursula apparently arrived and then POOF! Here was the anesthesiologist again with my cocktail! They asked Ursula, Erica and Dee to leave momentarily as it was getting crowded in that little area. Ok, now this was going a little TOO quickly (I DO remember this!), good thing they were giving me drugs now. It was just like bam, bam, bam.....one thing after another with not even a half a minute in between. In a split second they were telling me that this was it and.................I don't remember anything else. With help from Erica this morning, this is all I remember of that morning. And I wouldn't have remembered 3/4 of it without her help. Isn't this just pathetic? Why do I have no memory of this chunk of time in my life? I have approximately 8 weeks of time between March 22 and May 15 that I remember very, very little of and the memories that I do have are blurred! Some say it was the anesthesia, or maybe it was the Oxycontin, perhaps it was the Neurontin, or could it have been the horrendous pain?? Perhaps a combination of all? Or maybe it was self-protecting, a subconscious way of forgetting a horrible period of time? I guess I'll never really know why but the fact remains - I have completely lost 8 weeks of my mind and I can never get them back. I need to go cry. I'll be back...........

Ok, I'm back. I think I went into the OR about 11 AM on the dot. Dr. Glazer would be going in through the back now, attempting to remove my old Harrington rods and to finish the osteotomy at L4 and L5 that he had started on March 15 and to complete the laminectomies and thoracolumbar fusion, with instrumentation at L4-S1. Here we go.........

According to the OR notes, they intubated me, put on those lovely compression stockings with the blow-up boots and I was "gently transferred" into a prone position (face down) with my arms kept at 90* (to prevent injury). He then proceeded with his incision, which was made from T3 to sacrum. Now that is a LONG incision if I say so myself! In fact, it is 41" long (they measured it at Rehab). He pulled the skin apart and started at L5-S1 and foraminotomies were performed along the exiting S1 root on the left side. A foraminotomy is a decompression surgery that is performed to enlarge the passageway where a spinal nerve root exits the spinal canal. He states that there was a great deal of scar tissue to deal with accompanied by severe stenosis, which we already knew existed from my earlier Myelogram last September. Meanwhile, he did everything he could to protect the dural sac during this portion of the decompression, but..........he encountered yet another dural tear when he attempted to remove a fairly large ostephyte (bone spur), which was adherent (once again!) to the dura exactly where the bottom of the lower Harrington rod hooks had been placed back in 1974! Those damn Harrington rods!! He managed to expose the whole Harrington rods with an osteotome (instrument used for cutting bone) and he removed the prior fusion mass over the rods and then the rods were cut in half and these were then divided and then the hooks were removed on both rods. When the previous fusion mass had been burred to success, he then performed the complete laminectomies sequentially from L5-S2 on the left side. At the L4 level is where he encountered the dural tear due to the severe thinning of the dura and due to it's adherence to the lamina. The notes state that his attempt at closure of the tear, was "fraught with difficulty" given the limited structural integrity of the dura at that level, but he managed to patch the tear. He also noted that when he exposed the L2 nerve root there was evidence that the previous tear from the March surgery was still leaking from the ventral aspect of the sac! Yikes! He proceeded to pack that now as well. The neurosurgeon, who was also co-surgeon on Dr. Glazer's new "team", placed a lumbar drain in the right side of my back. Then Dr. Glazer went ahead and inserted the new pedicle screw instrumentation from L4-S1 bilaterally and then a rod was hand contoured (interesting, huh?) into appropriate lumbar lordosis and then attached using set caps at each level and they were placed in, gaining the level of correction he was seeking. Two more small rods were also placed to the previously-placed pedicle screws and tightened down with a torque wrench. Hmmm..........wonder if he got them from some car mechanic! I mean, a torque wrench?? Like I'm a car or something!!

Now the real trouble began - AGAIN! I started bleeding extensively despite multiple units of FFP (fresh frozen plasma), blood platelets and Cell Savers (Intraoperative Cell Salvage Machine). At that point, Dr. Glazer made the decision to halt the surgery immediately. He was concerned for my well-being. Well, later he told me, he was more accurately, gravely concerned about my life. He closed me up as fast as he could but he had to first use bone graft (that he obtained from the previous fusion mass) and repack from T3-S1 bilaterally (He certainly couldn't leave the space where he had just removed the old fusion empty!) and then FloSea (bovine packed gelatin) was used for the epidural hemostasis (stopping the flow of blood). He then closed me up with sutures inside and then the skin was closed with staples and sterile dressing.

At this point, he was VERY worried. Very worried. The decision was made to keep me intubated in the event I should start bleeding massively regardless of his attempt to pack me as well as he could and I was brought to the ICU. He, at some point (I don't remember exactly when), told me that he didn't sleep that night because he was so worried about me.

Meanwhile, Ursula, Erica and Dee were waiting word. Eight hours later, at around 7pm, Ursula received word from Dr. Glazer that the surgery was over. He was very upset that he had to close me up again without completely finishing, but he told her that it would have been too dangerous and that he would have to do finish sometime the following week. I had lost so much blood that I would need additional transfusions and that I would need to regain some strength in order for him to continue. He told her that with what he was able to complete up to this point was successful, but that he couldn't believe how bad it was "in there" and even with the MRI's, CT Scans and the myelogram, he had not been prepared for what he saw and encountered and that I should have had the surgery much sooner. Words he has repeated to me several times since. I guess I waited too long! Big shock, huh? He also stated that the most difficult part still lay ahead, even though it would be the smallest area he had left to work on.

The group was finally allowed into the ICU to see me at around 9-9:30 Pm. As Erica recalls, it was a very long and stressful day for all of them. Erica states that she was slightly discombobulated by seeing me with the ventilator still intact. She tells me that I looked beat up and my face was swollen with slightly black and blue eyes (common when being in a prone position for that many hours). She claims that I was very pale, almost white and my skin was very, very cold. She tells me that when she held my hand it was as if I were dead, it was so cold and limp. My eyes were swollen shut and she feels I was would have been unable to open them if I even tried, but she is sure that I did hear them. She tells me that she asked if I was in pain and I nodded, so she told the nurse who came and gave me more pain med. I have no recall of this. She asked if I was cold and I nodded, so she had the nurse get me some heated blankets. I have no recall of this either. Evidently I was coherent enough to hear and respond to their questions, but I do not remember and for this I am actually happy. She says she was scared to death. Little did she know, when I did awake enough to realize I was still intubated - I was too.