What I Did on My Summer Vacation

As I mentioned in passing, last summer was a summer of surgery. In June, I had hernia repair surgery that went as planned. The recovery took longer than I expected, given that it was ambulatory surgery, but actually took no longer than I should have expected, given that they cut a several inch slit in my abdominal wall. I was misled by the fact that I got up from the operating table and walked out of the hospital into a taxi (I exaggerate slightly–I did pause to get dressed along the way), but it was a week before I should have been up and around. During that week, I took enough Vicodin that I developed muscle spasms (just as I did the previous time I took Vicodin for several days, after an appendectomy) and foolishly tried to go to work for a couple of days. And I discovered why the stereotypical examination for a hernia involves turning your head: Every muscle in your body is connected, directly or indirectly, to that central point. Every movement was a painful reminder of that simple anatomy. But all went as it should have.

The second surgery, five weeks later and also ambulatory, was a tympanomastoidectomy. This meant making an incision all the way around the back of my ear (all but removing it), taking some tissue from the area, and using it to replace my ear drum and the skin lining my ear canal. This was to remove a three millimeter cholesteatoma from my ear drum–a very unusual place for such a thing to be, the first wonder that my ear would produce. The surgery wasn’t supposed to be quite so extensive, but when the doctor got in there, he found that the infection stemming from the irritation caused by the cholesteatoma (which was later identified as a staph infection) had spread more widely than expected, so he thought it best to replace the whole ear drum.

Then I got up, got in a taxi, and went home to sweat in the late July heat and a three-inch thick gauze helmet. But I had air conditioning and codeine (I had told the nurses this time that I had bad reactions to Vicodin, so they gave me a special purple bracelet that read, “Vicodin Twitchy,” and codeine), and I was comfortable for the first few days. The last couple of nights before I returned to have the bandages removed became quite uncomfortable, and while begging the doctor I got when I called my doctor’s answering service for some sort of relief, I considered offering him $10,000 in cash if he would take the bandages off or somehow make the itching stop. He suggested Benadryl, and it helped, or at least it, along with the codeine, got me to sleep. The Tuesday after the Thursday surgery, I went back to the hospital during the morning rush, with the bandages covered by a loose fitting baseball cap, to have them removed. A few minutes later, I was back in a taxi headed home through rush hour traffic with the baseball cap covering hair matted with dried blood and disinfectant. When I got home, I took my first real shower, probably more than forty-five minutes, in almost a week. And then everything seemed to be healing properly for the first few weeks.

Through almost all of this (except for the two nights when the itching under the gauze nearly drove me insane), I felt extremely fortunate, almost as though I were floating in a state of grace. I’ve never been one to be bothered by hospital visits–truth be told, I actually kind of enjoy them. They’re a break from my everyday efforts and responsibilities, the one time when I’m in the hands of professionals who really will take care of me, when everything is intended to make me as healthy and comfortable as possible. Yes, these things had gone wrong, and I would have to go through some discomfort to have them corrected, but the work was being done by apparently competent and committed professionals, and it didn’t hurt that both surgeries and all related work cost me less than $100 out of pocket. And though I had all of these justifications for feeling fortunate, my feeling that way wasn’t the result of any sort of reasoning. It was just my gut reaction, which is a fundamental shift for someone who usually views the world through the filters of anxiety and depression. For lack of a better explanation, I’m assuming that this illustrates a shift stemming from my having taken the Bodhisattva Vow. And as I approached these various medical situations positively and with the intention of being appreciative and, where possible, helpful, those around me, doctors, nurses, orderlies, etc., took better care of me.

I was also given a unique opportunity to explore the sense of hearing. Immediately after the surgery, with my left ear turned inside out and packed with jelly and gauze, every sound seemed to be coming from my right. My wife would call to me from the bedroom, and I would turn toward the front door looking for her. And this impulse was surprisingly strong–I would turn toward the front door even though I’d just watched her walk into the bedroom. But that effect subsided pretty quickly as, I suppose, my brain adjusted to the fact that it was receiving sound from only one ear. As my brain made that adjustment, it was as though the world changed from stereo with the balance all the way over to one side to monaural. Unless I could see the source of a sound, I had no idea what direction it was coming from, and this had unexpected implications. It turns out that I would separate concurrent sounds based on their location. But without the ability to locate sounds, I found I couldn’t separate them unless they were very different qualitatively or I was looking directly at the source of one of them. In meetings at work, if more than one person was talking, I couldn’t make anything out. Also, because the tissue in my ear was swollen, it was as if the ear was blocked, meaning that my own voice sounded disproportionately loud, causing me to speak much more softly than I intended. Communication in restaurants, bars, and parties was out of the question (though I prefer to avoid such situations anyway). All of this was interesting, but when I described it to others, they would only offer their sympathy. Yet I still didn’t feel as though I was suffering.

After a few weeks, my ear started to hurt, first just in the ear itself, and then down through the jaw. And the noise of chewing became horrendous, loud, wet, and queasy, punctuated by a variety of pops and cracks. When my otherwise unflappable MacGyver of a doctor peered into my ear at a follow-up visit and said, “Wow!” I suspected I was in trouble. My ear had produced its second wonder: It appeared that a case of TMJ disorder was pushing my jaw bone through the healing tissue in my ear. He had never seen anything like that. I went to see a still more special specialist (an extra-specialist?) who made me get into a very unusual position on his panoramic jaw x-raying machine, but he couldn’t really see anything wrong. He told me he wanted to do further tests, but he never called back (the lesson being, I guess, don’t get into strange positions on the first office visit). But he did discuss the matter with my ear doctor, and they came up with a plan to put expanding sponges in my ear to push back against the jaw bone. That worked, and except for the pain of yanking out the sponges around which the ear tissue had begun to heal, the TMJ disorder was overcome after a couple of months.

When it first became apparent that things were no longer progressing as expected, I got a little disheartened and vaguely frightened, mostly because I was away on my one vacation of the year, didn’t want to cut it short, and couldn’t get the doctor on the phone. But when I saw him next, after making it as clear as I could that things weren’t going the way they should, I kept reminding myself to be sympathetic and, if possible, helpful. That approach had served me well to that point, and I didn’t want to abandon it. Just deciding on that intention, I saw the doctor’s reactions differently. I could see how much he was struggling with this, how disappointing this was to him, and how much better than this he was used to things going. So I softened and was a little more patient, and in response, he was more forthcoming about the problems, and he was genuinely apologetic. Being, in a very different context, something of a technical expert, I’m familiar with the frustrations of lay people ignoring the fact and the value of your expertise. For doctors in the current climate, this must be especially annoying. I can only imagine the nonsense they hear from patients who’ve strung together random comments from the Today Show and a couple of misunderstood “facts” from a Web site and believe themselves prepared to take control of their own health care process. I tried to make it clear that I wanted to understand what was happening, that I wanted to help, and that I trusted him and valued his expertise.

But five months after the surgery, the ear still wasn’t healing properly. The issue at that point was that although the tissue had healed into place and everything was firmly attached as it should be, the grafted tissue had become mucosa (like the inside of the mouth). Normally, mucosa exposed to open air heals into dry skin. Yet in the wondrous realm of my ear (which was now producing its third biological anomaly), dry skin taken from behind the ear had, against all logic, become mucosa. The doctor’s first course of action was to leave it for a few weeks and see what happened. He expected the dry skin from the outer ear to migrate down the ear canal, turning it, and eventually my ear drum, into the dry skin it was supposed to be. That’s how this worked for everyone else. But that’s not what happened for me. He said he could see a stubborn ring around my ear canal past which dry skin wouldn’t migrate. He was at a loss and he was willing to admit that to me while he thought out loud for a few minutes. Normally if things didn’t heal properly, he might repeat the surgery, but in this case the surgery itself seemed to be completely successful. The problem seemed to be with the subsequent healing, and there was no reason to believe that starting that over again would make it go any differently. He decided to try a combination of eye drops (prednisolone and gentamicin), and after almost four weeks, they seem to have done the trick.

At this point, the ear still feels a little blocked, the hearing is still reduced, and there a soft ringing, but I hear well enough to locate sound in most cases. In loud places, I can still get overwhelmed, and I still talk more quietly than I mean to sometimes. But it doesn’t hurt, and most of the time, I forget about it all together. The only persistent annoyance is having to keep the ear canal dry, which means packing my ear with cotton and sealing it with Vaseline before every shower, and pulling the whole mess out afterward. I go back to the doctor in a few weeks, and I hope to find that the progress is continuing.