DBS Surgery: Stage 0

The One Where DBS Surgery FINALLY Gets Underway

Apologies… My mind, and muse, has been elsewhere for the past several days.

It felt more than a tad self-indulgent to focus on my little life with so much else going on in our country and world. I have to remind myself that I can control only what I can control, that my anguished cries into the social media abyss on behalf of the marginalized don’t translate well into the binary world of alternating ones, dashes, and zeros. So I’m going to stay in the micro if only for today.

It’s been a few days since the prelude surgery (implantation of the fiducial screws into my skull) to the Mac Daddy of the three procedures (the one that foils the idiom “I need ________ like I need another hole in my head.” ) Because I do… need another hole in my head… in fact, likely more than one.

But I’m getting ahead of myself…

Pre-OP

I am the first to admit that I curated an unusual way to get ready for surgery; it worked—I was absolutely at peace throughout the entirety of the process—so I am eager to share it for others to consider. Long story short, I had closure with my life and those most important to me in the event that any of the statistically insignificant causes of death somehow found their way into my story. If you are a long time reader of this blog, you may recall Be Prepared, in which I detailed my extensive preparation for my demise while I still have my wits about me. With all of that done in the past, the only thing to do in the present was to say my goodbyes as if they were my last. This was particularly hard to do with my boys, but I took the opportunity the last time that I saw them in person to let them know how much I love them and how proud I am of them; that is not something that should ever remain unsaid. I even called my ex-wife and we had a long conversation. We were high school sweethearts whose shared path did not turn out as planned; we got lost along the way and grew apart from one another. But the conversation was extraordinarily healing (for me at least) and afterwards I felt like I had the final puzzle piece in place. I could go now. There was absolutely no fear about any of it after that.

We checked into our hotel near the hospital at around 5 PM and then—at my insistence as a former Boy Scout—did a dry run of the route we would take in the morning to ensure that we knew where to go and what to do so that we were certain to be on time. A nice dinner at a favorite Mexican restaurant and then back to the hotel. The beds were soft; I was concerned that they were too soft, but managed to get comfortable and my partner and I both slept until the alarm the next morning; this is exceedingly rare for me given the raging insomnia that PD has brought with it. And this is how I know that I was at peace. I’m prone to worry, especially in the early hours of the day if I am unable to sleep. But I slept like, well… the dead… and was actually reasonably refreshed for a change.

We got to RADCU the next morning at 6:30 AM ahead of most of the employees. I was checked in for the surgery and then again for the anesthesiology. Missing teeth, oddly shaped mouths, and stiff necks are apparently common foils for anesthesiologists, so they have their own set of highly specific questions. Having “passed” both intakes, a nurse escorted me to the changing room and I donned the drafty johnny, then headed to the awaiting gurney (around 7:15 AM). There were a lot of people bustling around me, especially for first thing in the morning; as I was attempting to discern their various functions, I was cognizant of the confidence I felt with my team. Dr. Raghani—chillin’ like a villain—arrived and we chatted. He shared that a patient had recently said that the Stage 0 surgery was actually the most painful of the three. I compared this to giving blood—the finger prick necessary to check your hemoglobin hurts more than any other part of the process—to which Dr. Raghani visibly recoiled and admitted that he gets squeamish around blood. This was laugh out loud funny to me. I tell my high school kids who plan to pursue an MD that med schools want you to have a clinical placement in which you get blood on your hands before you get to med school; not a good look to faint at the sight of blood on your first day. And then this—my doc is squeebed out by the sight of blood. That he clarified that it was only in the process of starting IVs that gave him the heebie jeebies made it no less comical. But I guess if you’re a neurosurgeon there really isn’t that much blood relative to other specialities; the brain is not as vascular as other parts of the body. I told him that I had written a blog post about him and had mentioned how soft his hands are; he sheepishly admitted that I was not the first.

So the nurse got my IV started and put a spontaneous oxygen sensor on my finger. I noticed soon after that my pulse and oxygen levels were close—off by just a couple of points—and slowed my breathing to try and slow my pulse to get them to match. Someone noticed and asked what I was doing. After I told them, the medical team had an impromptu interdisciplinary conversation about different approaches to accomplish this feat, discussing the function of the vagal nerve, aorta, etc. and my doc suggested that the best way to do it was to hold my breath. Which I did. Which worked. Coincidentally, this is why holding your breath stops hiccups; it resets the diaphragm. Damn these people are smart. I knew I was in good hands.

So I got a good look at what was about to be implanted in my skull x4 and then it was time for night night.

I gave my partner a parting kiss and the nurse anesthetist put the mask over my mouth and directed me to breathe deeply… and I was off to La La Land (around 8AM).

While I was asleep, they did two MRIs and a Cat Scan and implanted the four fiducials. This took like an hour and 15 minutes. When I came to, I started singing Kenny Loggins’ “I’m Alright.” Because I was. Apparently my body temp was a little lower than they prefer and I was covered head to toe in warm blankets. Cozy. As you will see clearly in the next photo, I was still on the good drugs.

This is the first look with the fiducials implanted when Julie arrived at about 10.

As I was going off to La La Land, I noticed that my nurse anesthetist had a Starry Night print on her cap. Remembering this video…

after I woke up, I was intent on telling her that science and art came together in beautiful synchrony to pinpoint the date and time of day when Van Gogh painted his masterpiece.

I would see her bustling around assisting other patients and ask Julie to go get her so I could tell her. Each time (4 or 5 tries) Julie would remind me that she was doing her job and did not have time to talk with me.

As luck would have it, she was in my path as I was departing and—with the earnest excitement of a child sharing a treasured find in nature—I finally got to tell her the story.

And then, still clearly on the good drugs, it was time to go home (10:30 AM)

Then a full look once I got home (around 1 PM)

Easy peasey.

The sites were sore then and are still a bit sore a few days later. Nothing that overlapping Tylenol and Advil couldn’t handle. Sleeping has been a challenge; finding a way to place my face/head without pushing on the sites has been a delicate proposition, but I have managed.

I’m ready and eager for Stage 1 next week. Bring on the drill!

Meanwhile, back at the insurance company…

Less than a week to go and they are still playing this game.

Should I start the GoFundMe now?

UPDATE!

So, my neurosurgeon is a Grade A Certified Badass.

He just CALLED ME directly to allay any concern about insurance.

Gave me permission to use his name in my blog

Reminded me to pick good music for surgery

And said "Let's have some fun with it" when I asked about bringing sticks and a drum pad to make sure that I will be able to drum once all of this is done.

That is badassery of the highest order!

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