Under the Knife with Thyroid Cancer (A.K.A. Saskatchewan Nurses Rule) / by alec vanderboom

On March 11, 2014, I had surgery to treat Papillary Thyroid Cancer at Royal University Hospital (RUH) in Saskatoon, Saskatchewan (Check out the backstory in my first post, “Mr. Chuck D & Me”). The procedure not only involved a thyroidectomy, but a right side lymph node dissection as well. I want to write about the hospital experience to: a) inform anyone who may go through a similar surgery (I didn’t really know what to expect, so maybe this information will help the process a little); b) Give a few insights into the process, specifically what I saw during my time in the hospital. I’ll admit that I can think of things I’d change, and the tone of this blog may come across as being negative at times, but I guarantee that I’ll end on a positive! After all, the care that I received was excellent, and my wife and I see this surgery as an opportunity for renewal—a chance to start fresh with a clean bill of health.

Pre-Op Visits
Before the surgery, I had to go to two pre-op appointments: one with my family doctor, and another at the hospital. Since I was lucky to get my surgery booked to take place 10 days after the diagnosis, I actually completed both appointments on the same day. My wife, Jenn, and I found that both of these appointments put our minds at ease about what to expect before, during, and after the surgery.
The hospital visit only took about two hours to complete, and most of that time was spent waiting. After registering at Admitting, I completed a blood test and had my vitals checked—something I would get extremely used to over the next week or so. I was told that because of my good health, I didn’t need to have x-rays or an ECG. We then met with a nurse who asked a lot of general questions about my health and outlined the procedures for the days leading up to the surgery, the day of the surgery, and a bit of information about what to expect after leaving the hospital. I was given two sponges to use in the shower on the two days prior to the surgery, and a general information booklet. A meeting with an anesthesiologist confirmed my clean health record and that everything on the day of the surgery would be relatively routine.
My family doctor admitted that our visit with him was a bit of “red tape.” I just needed to obtain my physical record, so he asked me a lot of questions that had already been covered at the hospital, checked vitals again, gave me the paper to take to the hospital on the day of the surgery, and then I was on my way.

Two-Days Prior
Getting ready for the surgery was simple, but there were a few things that I had to do:
·      Cut off solid food at midnight the night before the surgery
·      No alcohol for 48-hours prior
·      No Omega oils (this is a blood thinner)
·      Use the cleaning sponges twice
·      Pack an overnight bag
·      Leave jewelry and money with someone else

Day Of the Surgery
6:30 am: Check in at admitting
6:30-7am: Change, check vitals, sit in waiting room
Just after 7: moved to a pre-surgery room with a few other patients. Seeing these other people who were going to get opened up just like me was quite surreal. This was actually something that bothered me a bit about the process. Each patient met with a surgeon and anesthesiologist separately, but these meetings were all conducted in one big room. Hearing what everyone else was going through seemed too public considering the severity of some of the procedures being discussed.
8ish: A nurse walked me to Operating Room #4. I jumped up on the table, got the meds flowing, heard the surgeon say my name and the procedure (for a recording, I imagine), and then I drifted off.
1:45pm (I think): This is the first time I remember seeing the clock. I was awakened in the Recovery Room. I was asked about my pain level, and I was glad they did because I was definitely uncomfortable. I reported an “8,” got some morphine, and then drifted in and out for the next hour. My surgeon, Dr. Christian, came and talked to me to tell me that everything was a success and that he had met with my family. He was also happy to hear that I had my voice; this was one of the possible side effects of the surgery since the thyroidectomny was so close to my vocal chords. However, the risk was less than 1%.
2:45ish: I was moved to the Observation Room.  The nurses actually forgot to inform my family (haha), so I was left in the hallway for a bit so that everyone could come and see me.

The Observation Room Experience:
I was in this room for about 20 hours or so. Honestly, this was the toughest time in the hospital. I mentioned how the pre-surgery meetings lacked the privacy that the patients deserve; well, I had no idea how much I would value my own privacy after the Observation Room.
·      There were six patients in this room, separated by curtains, with the eyes of nurses on us constantly (for good reason).
·      On a night that I really wanted to sleep, I couldn’t. Let’s just say that I got to know the other strangers in my room extremely well without saying a word to any of them. I heard things, saw things, smelled things that I never want to experience again. A very loud patient next to me was moved out after 1 am, and replaced by a patient that the staff kept saying “shouldn’t even be there.” He was in bad shape, and had to be awoken every 30 minutes or so. Needless to say, sleep was hard to come by.
·      I got to shower the next morning. Again, the walls of privacy came down quickly with this experience. Nevertheless, it’s amazing that no matter how difficult it was to actually complete the task, the shower was unbelievably refreshing. Discovering things like how I had been prepped in the operating room and finding a patch of dry blood on the back of my head were things that I didn’t expect. It was also very awkward, and slightly painful, to handle the two drains that I had at the base of my neck. All in all, this wasn’t a spa treatment, but it was refreshing!
·      Another aspect that was a bit shocking was the size of my scar. Since the lymph node dissection was required, the incision ran horizontally from the left side of my Adam’s apple to my right ear, and then vertically toward my ear lobe. The 45 or so staples caused discomfort, and the procedure caused numbness that I am still experiencing as I type this two weeks after the surgery. I was told that the numbness will eventually go away, and that it was caused by work being done around nerves in my neck. I’m still not used to barely being able to feel the right side of my jaw and the bottom half of my right ear.
·      I had some devices on my legs that pulsated regularly to help with circulation. These were removed after my first night.
·      I only experienced nausea after taking my first Calcium supplement. It wasn’t pretty. I’ll leave it at that.
·      Sidebar: patients and visitors should have limitations on cell phone use in these rooms. When I was fresh out of surgery and trying to sleep, hearing personalized ring tones and loud conversations didn’t help at all! Why aren’t there any rules in place for this?

Semi-Private Room
When I checked into the hospital, I requested a private room for a $120/day fee. Unfortunately, the facilities weren’t available so I was moved into a semi-private room. An older lady and I shared the room, and two other people also called the room home at separate times over the next two days. The fact that there were more than two people in a room only designed for two showed me how stretched our hospital facilities are. I hope the Children’s Hospital will alleviate some of this pressure.
Anyways, I was quite comfortable in this room, and the procedures were routine:
·      I ate regular meals. I should mention that the Chief Resident was disappointed to hear that I had only received Jell-O for my first meal. He wanted me on a regular diet right away. This was a pleasant surprise since my radical surgery was focused around my throat. Although, I had to change my eating habits because the staples made repeated chewing painful. Also, I found that I was only comfortable swallowing small bites of food or sips of a drink at once.
·      My vitals were checked regularly and my blood was taken a couple of times a day. Checking calcium levels was very important after this surgery.
·      I got up to shuffle around for some walks whenever I felt like it. It was a bit awkward to be carrying around my two drains and being a little hunched over, but the air in the 5th Floor Atrium was a nice change from what I was becoming accustomed to.
·      I stayed in this room for two nights. We were originally expecting one, but it was decided that my drains should be kept in for an extra day, and then some time was needed to monitor how I’d react after they were removed. I was nervous about the removal process, but it only took a maximum of ten-minutes, and it wasn’t very painful.
·      My pain was managed mostly with Tylenol. Measuring my pain on a 1-10 scale was a difficult process since the cluster headaches that I’ve had since grade 10 have built up an extremely high pain-tolerance. I’d say to the nurses, “I’m at a '5' right now, but that might be someone else’s '8'.” Does anyone know how these discrepancies from patient-to-patient are dealt with?

            When the Chief Resident came on his rounds on Friday morning, I found out that I could go home. Even though I knew it was coming, I was so relieved to get the news and to hear that everything was progressing as it should. When he left, I put on my headphones just as Curtis Mayfield’s “So In Love” started playing on my IPhone. It was one of the most joyous moments of my life. Maybe that sounds like hyperbole, but that song just seemed like the only song that should have been playing at that moment. The groove, the organ, the horns, the space, the honesty of the lyrics: “So in love. You do so many things with a smiling face.” That first line got to me when I considered all of the stress that my wife had put up with over the few days that we were there.

The Positive Ending that I Promised!
            I have a profound respect for nurses. Teachers and nurses always seem to share a mutual appreciation for each other’s professions—perhaps it’s the multitasking and the long hours, but the most significant common ground has to be in the personal touches that excellent professionals strive for. The RN’s, staff, and nursing students who cared for me made me feel secure and comfortable throughout the entire experience. Esther, Amber, Paul, Grant, and Ben are a few of the names that I can remember of people who went out of their way to make me feel like I was their only patient.
            Also, despite some of the uncomfortable moments, I can’t say enough about how grateful I am to be Canadian and to have access to our health care system. I am going to live a long and productive life because once I received my diagnosis I received efficient and personalized care for a grand total of $0 out of my pocket (with the exception of parking fees for my visitors). This is something that I will never take for granted.

Take a listen to Mr. Mayfield in order to solidify that positive vibe...