December 22, 2010

Pre-surgery

I’d be honest to admit. I couldn’t sleep the night before the surgery. Not because I was worried about the surgery, but I was starting to run a slight fever. Took my temperature every hour and it hasn’t changed. 37.2 degrees. Not a good sign. I don’t know if the surgery will be postponed again but I need to do whatever it takes to ensure I go through with the surgery. My mum also could not sleep the night before, she stayed up late watching TVB drama so when my alarm went off at 520am, I was surprised she was still sleeping. She had planned to make breakfast for Dad so looks like she overslept. Woke her up, got dressed and we were out in a jiffy.

The ride to SGH was smooth, at 6am, there is hardly any traffic. We arranged for Dad to drop us off, there is no need for him to accompany us this time round. Too stressful. The last thing I want is to have to deal with his nagging now. We were too early so we waited outside the Admissions office.

This time round, we are more familiar with the processes. The docs were not in yet so nurses are conducting the basic checks first before docs do a more detailed examination after we have changed into “surgery uniform”. My blood pressure was 136/90, I looked at it…DIE…isn’t it pre-hypertension levels???? The nurse told me to calm down and she made me take in deep breaths. At one stage she used one of her hand and raise it up and down and ask me to follow her hand and breathe in…and breathe out….according to nurse, such readings is considered normal at pre-admission checks as many patients are nervous. Very interesting.

Then I was shown to a room where I had to change out all my clothes into the surgery gown. No underwear allowed, only paper underwear and nothing above. But the surgery gown is quite well designed, we have to wear a light blue gown that is fastened behind with strings and another long coat over so you can’t check out the person’s chest. hehehe. Then I had to pass my shoes and clothes over to mum and wore ugly oversized slippers which the nurse passed to me.

I was then directed back to one of the rooms where the medical officer took my temperature. 37.9 degrees. WTF…AGAIN!!!!!! I swear I will not be sent home again. I told the doc that all the changing and walking around makes me hot. I was sent out to the waiting area for 10mins. I took out a booklet and started fanning myself. I was attracting attention, cos I was probably the only idiot fanning herself while in full surgery uniform with ugly slippers sitting in the waiting area filled with people and their relatives in normal clothes waiting for their turn to be called.

10mins later, I was called in again. Temp checked. 37 degrees. PHEW. Doc gave me the go ahead and mum and I were ushered to the waiting area inside. We now have to wait for an ENT doc to go through the surgery risks with me and get me to sign a form before I can be brought to the operating theatre. And so, we waited. One by one, people dressed in surgical uniforms are being called up and led away into a lift at the side. Their loved ones would hug them, wish them well and then exit by another door.

The ENT doc then highlighted the risks again, this time, in front of mum. My vocal cords may be affected, and I may need temporary calcium replacement or if the parathyroid glands are removed, then I’ll be on calcium replacement for life. Not very nice to keep reminding you, but I guess they didn’t want to be blamed if things go wrong. Its surgery afterall. So, after acknowledging the risks, I signed the form.

A nurse then brought me to the lift and as the cold hard steel door closes, I waved my mum goodbye. One of the most painful goodbye in my life.

I was brought to 2nd level where the “trolley bed” awaits me. At this point, I have to say, I have been asked to say my name and my I/C number like for the 1 millionth time!!!! From nurses to doctors, they keep checking that you are the right person. They were so scared of sending the wrong person for the wrong surgery.

The surgery

Once I am on the trolley bed, I have no control anymore. I can’t even run if I decide to change my mind. So I laid on the bed and waited for the attendant to push me to the operating theatre. Exactly like in those medical dramas, I am being wheeled around and I can only look up towards the ceiling lights. Only lacking at that point was some cute guy holding my hand and running along with the trolley while I am being pushed into the theatre. hahaahaa.

I was pushed into Operating theatre 6, there were 2 nurses and 1 assisting anesthesiologist at the area just before the operating theatre. Its where they insert the plug into my hand so the drugs can be fed intravenously and once again check my medical history. The assisting anesthesiologist then asked my I/C number one last time and she exclaimed ” sorry ah, I always tell my patients that they will be asked to verify their name and I/C many times so you just have to bear with it.” I asked her “hey doc, what happens if the patient has alzheimer’s /dementia???..how do you guys verify then?” she laughed. hahahaa. Then I joked about how this is something the doctor shows like House never showed you. She laughed again. Then, I was pushed into the theatre. The last time I saw those bright operating theatre lights was when I was 4. According to my mum, I needed to remove my teeth..but I was screaming so badly that the dentists gassed me and I passed out and they went on to remove the teeth. In my memory, till this day, I still remember seeing those bright lights and the mask coming towards me. I looked around the theatre while lying down, there are 3 sets of lights in various directions.

Those surgical lights..pic taken from keckler medical co. inc website

Then my doc entered the operating theatre. I was very glad to see him. He said ” Just wanted to let you know, we have cancelled our leave (he and his partnering anesthesiologist) and rescheduled your surgery so that we can do it today and you can get treated, so don’t worry” FWAH. I never felt more grateful to 2 men who placed me in a higher priority than their own personal commitments.

While my doc prepared for the surgery, his partnering anesthesiologist, came over and spoke to me. Anesthesiologist said ” hey, really glad we are going ahead with this today, blar blar blar” He told me he is currently doing a study on using a new method and tubing for the anesthetic which will reduce the pain effects of a patient. Traditionally, general anesthetic involves pushing a tube into the patient’s mouth, down the throat and into the trachea to facilitate breathing. However, its also this tube that causes a lot of pain after the surgery for people. I asked him how long has he been studying this method, he said he has been trying it out for 12 years. I said “go ahead, cos its hard getting people on a study, pain is pain afterall” He laughed and said “no, of course not, we will try to minimize it” Anyway, lying on the operating table, I signed myself away to be part of a new method/tubing anesthetic study. I guess to me, it doesn’t matter anymore, if I can be of help, why not? Considering it was such a pain in the ass when I was trying to get people to participate in my own study during the Masters course.

The next thing I knew, they placed the oxygen mask over me and then I saw the assisting anesthesiologist inject some liquid into the plug attached to my left hand. I was told to take in deep breaths……I only have one wish, I do not wish to wake up during the surgery.

And I had probably gone off the edge soon after that.

Post-surgery

I heard the nurse calling my name and they were gently waking me up. I was told to say “one, two, three” probably to test the vocal cords. I whispered with a raspy voice. I also overheard them saying something like “total thyroidectomy”.. ah, so everything did get removed afterall. Then, 30 secs later, the pain hit me with a wham. I felt like I have just been hit by a train across the neck. The nurses then asked me to state my pain level from a scale of 0-10. I told them 7. But they said they had already given me 2 doses of morphine so they will give me panadol. Hokay…anything to reduce the wham feeling. And they left me on the trolley bed. I don’t know how much time passed but I knew I need to do something about the pain. I started to take deep breaths in, the Yoga way. Amazingly, the pain reduced slightly. And then, I decided to tune out of the pain. I closed my eyes and allowed the memories of Sydney to flood my brain. Started with memories of packing for the trip, the plane ride to Sydney, mardi gras, cooking, gatherings, every memory came flooding back. These are happy memories, so maybe I released endorphins..but it worked. The pain level reduced further. By the time I popped 2 panadols down, the pain was manageable.

Getting to the ward

Before I know it, they were pushing the trolley bed and I was hit with the humid air. I was sweating profusely. By the time they transferred me to the bed, I was very glad I had chosen the B1 ward which is fully air-conditioned. The nurses then proceeded to strip me and change me into the ugly peachy looking pajamas with draw-string pants. I’ve always wondered if people wear underwear beneath those hospital PJs. I got my answer. My dear friends, we all go commando below and we are free above. Very “free”. The nurses then attached the drip to keep me hydrated. And I was handed a paper bag. About 30mins later, a nurse came to me and started briefing me on the facilities of the ward and how to call for help. I was pretty irritated but I guess they needed to do their job.They even switched on the TV and tuned the channel to HBO. But my eyes couldn’t even focus, moreover watch HBO.

De-anesthesizing

As I lay on the bed, with a neck that felt like it had been whammed by a train, I realized I had 2 drainage tubes attached to both sides of the neck which drains blood and fluid down to 2 bottles. Felt like some monster from Japanese Anime. I was also instructed not to get off bed so I laid on bed, sweating profusely even though room was air-conditioned and attempted to vomit. I tried and tried. I could only try to vomit but there was nothing. Only air. Not even liquid. Plus with a train-wrecked throat, vomiting is an art. I don’t know how much time passed but I was still pukey, then a nurse came over and showed me a menu. She wanted me to decide what type of meals do I want to order for my brekkie, lunch and dinner tomorrow. I was close to slapping her because I was in such a terrible state.

I controlled myself and simply told the nurse soft diet. And I was left to puke my heart out.

De-liquidizing

Its my own vocabulary. See, they kept dripping me but surely the water needs to go somewhere. Before I know it, I needed to pee. But the question is, how does one pee in bed? I pressed the button and called for help. The device that saved me — the bed pan. But the bigger question is how to do it? I was told to raise the butt (which I still can) and they placed pan beneath which means you kinda sit on it. And I realized, I’m in the missionary position. Then, I was told to start releasing. Again, its an art. Its against gravity, the whole setting is so wrong and I was worried if it would accidently leak and wet the bed. But it was ok, due to the way I was positioned, whatever human liquids released will flow down the butt cheeks down onto the pan. Then came another enlightening moment. The very kind nurse said, ” can i get you to spread your legs while I wipe for you”. And so, she did. Cleaned down under very well and then got me to raise the butt and she cleaned the butt cheeks too. It has been an eye-opening experience. Imagine bedridden patients, imagine doing this day after day.

And I went back to feeling pukey.

Rest of the night:

They served dinner, it was pork porridge and apple cinnamon tart. By now the pukey effects were wearing off and I took a few spoonfuls of the porridge. I’ve spent the past 1 month avoiding pork and yet the first meal I took after surgery was pork porridge. I was thinking to myself, what a joke. But the apple cinnamon tart helped to ease the pukey effects, in fact, it was quite tasty. Then, mum and brother arrived. I must have looked like crap, cos I had the ugly wound, puffy face, 2 drainage tubes and 2 drainage bottles and the oxygen tube attached to my nose as my oxygen intake was low. But I guessed me eating a few spoonfuls of pork porridge set my mum at ease. I could speak with a raspy voice, so I talked. I forgot the details of the conversation.  But I realized one thing, though the throat hurt, it was at the base where the thyroid is, I did not suffer from any after effects of the anesthetic tubing. Even my dad was surprised cos during his time, it was wayyyy too painful. I guess I did sign myself towards a study that helped manage the pain.

Again, I had no concept of time, I only knew people left and I slept. Throughout the night, nurses popped by and took my blood. A lot of it. 2 tubes each time and I was donating blood every 6 hours.

First Day and I no longer have my thyroid but more importantly, I made it through alive.

December 17, 2010

I was all set for the surgery. I woke up earlier to bathe with the prospect that I may not be able to bathe for the next 12 hours or so. Made sure my hair is in order. Ride to hospital was smooth but I was in no mood to talk. I felt strange the moment I got out of the taxi. Because I actually felt cold when the wind blew. if you know me, you will know 15 degrees is my optimum temperature. Still I thought, maybe its the cold December wind and maybe I am nervous. My nose was a bit blocked but I think it should clear soon. I have no phlegm and I have no cough. I should be able to go through the surgery as I appear to be recovering from the flu.

My dad was pretty impressed with the system, I had an admission booklet which I brought along and it has a barcode sticker with my particulars. I scanned it and was given a queue number. I was briefed through one more time on my insurance coverage and my chosen ward class and then told to hand my confidential temporary medical file to another counter where I will be checked by a medical officer before I even proceed.

Halfway, I started observing people. I noticed only 1 person is allowed to accompany the patient and rest of the relatives or friends waiting are rendered useless.

I was called in for the routine medical examination shortly after that. The nurse took my temperature and I had the shock of my life. 37.9 degrees. They took it another time, its still the same. WTF. I am running a fever. Prospects doesn’t look good. I was sent out to wait while they speak with my anesthesiologist.

Mum wasn’t too happy. Think she wanted to get it over and done with. She kept thinking that its just fever, what’s the big deal. That’s the common Singaporean misconception that unless you are on heart and lung support, the occasional sniffle is not a big deal. I think for a moment she thought I wanted to back out, that’s why I am not keen on the surgery. I had to tell her that its not just the fever, but fever means my body is fighting an infection, and god knows what infection is that. I am still nursing a cold, the antihistamines taken over the past few days have masked the blocked nose very well till I stopped it last night. Nose is still stuffy and blocked. I have some mucus stuck in the throat so its pretty scary.

My anesthesiologist called me in again and checked my temperature again. 37.4, decreased but its still a fever. Then he checked my throat, appears a bit sore, checked the nose, he is worried about the blocked nose. So, he decided to consult his senior anesthesiologist.

More waiting, I was starting to plant into mum the idea that the surgery might be delayed. I asked mum if we should go ahead with the surgery. She was getting agitated. She said “let the doctors decide because you won’t know.” Hokay…but I roughly already knew at the bottom of my heart.

Then, another SGH staff and her assistant came by. It was my tissue donation. She explained that one part of my tissue will be tested and the remaining of the tissue will be thrown away. From the list, I realized I have been identified for research. Cos its thyroid cancer, probably damn rare, so they want to do research. I wanted to tell her immediately, just take it lar, do as many things as you want with the tissue. Hopefully you can discover a miracle cure. I said yes before she finish explaining to me.I told the staff that I had read about tissue donation on the internet. Many countries do it, the hospitals especially research ones need it for research. There have been cases of people donating their entire thyroid for research as well. I wanted to give mine away but I was wondering how to go about doing it. There you have it, the opportunity presented itself. Signed the form and signed away my tissue. They were so delighted. I must have made their day. Come on, I knew how painful it is to get someone to participate in research, you need my damaged thyroid, take it manz.

Third round, senior anesthesiologist came. Went through my history and went through the situation and then did the checks on the block nose and throat and stuff. He wasn’t comfortable in letting me through. He explained with mum listening, that it would put my recovery at risk because I obviously have an infection and since mine is a throat area operation, it said its not pleasant if I am to develop a cough or pneumonia. Plus the immune system will be even weaker after the surgery so I am more prone to further infections. He is not for it. But he said he would discuss with my consultant.

I was given a new appointment on 3 January 2011 to see the specialist again. Its another wait. But what can I do? I can only blame me and my body for giving up on me at the most crucial moment. But still, I needed to get the flu and fever treated. To lighten the mood, I told mum at least I can celebrate xmas now and new year and we decided we will go order roast turkey.

Mum then brought me to Raffles medical (she said she doesn’t trust neighbourhood doctors) to see a GP. Halfway while waiting for our turn, I received a call from a doctor from ENT. She told me my surgery had been re-scheduled for Wednesday, next week. They advise me to get a stronger dose of antibiotics to fight the infection and be well next Wednesday.

The new date now:

22 December 2010, Wednesday. I might just be discharged on Xmas..how apt..like its my present to go home ….

In the meantime, I am using Dettol to clean all the surfaces in my entire home and I am doing nothing but nurse this cold with a stronger dosage of antibiotics.

I want to be thyroidless by Xmas.

December 15, 2010

How long would the operation be?

According to the admission letter, the op will last about 2 hours.

Will I be awake during the op?

This is a medium risk surgery so I will be under General Anesthetic.

What’s gonna happen during the surgery?

Within that 2 hours, the base of my throat will be slit open about 8cm or more and the surgeon will proceed to remove a part of my right thyroid particularly the part where the nodule is and then freeze it and send the frozen tissue for biopsy. In the meantime, maybe they’ll crack jokes about me while waiting in the operating theatre. if the pathologist calls back and confirms its cancer, they will proceed to remove everything. As much of the thyroid as possible. If its not (quite unlikely), they will remove the rest of the nodule and then sew me up.

Are there risks related to the surgery?

Yes, there is a possibility which the surgeon has to remove my lymph nodes as long, particularly along the throat. As the thyroid cancer tumour may have grown into the wind pipe, if he has to cut off more tissue, he may cut off the parathyroid glands. Parathyroid glands help the body to produce calcium or we will get pins and needles in the feet and hands, if that happens, I have to be on calcium pills for life. There is also risk of my vocal cords being affected. So, I may end up sounding like I have sore throat for life. I may not be able to reach high notes when singing as well.

What will happen after the surgery?

I don’t know how long it will be before I wake up but I have been warned that I will vomit when the effects of the anesthetic wears off. Given my past record of vomiting even when I am having a headache, I figure I will have a major vomit time.

Will I be in ICU right after the surgery?

The anesthesiologist has informed me that because its a throat related surgery, if I have difficulty breathing normally after the op, I will be placed in ICU until everything stabilizes.

Can I walk about and talk after the op?

My energy will be low and it will get lower as the days pass. See, other ops make a person feel better, my op will deprive me of thyroid hormones for life. So, expect me to be weaker and weaker till my body starts on the hormone replacement.

I will not be able to talk much after the op, my dad warned me my throat will hurt, like a perpetual sore throat and his was only to remove part of the thyroid. My entire thyroid will be gone so I figure the pain factor will be 10 times more. On top of that, the breathing tube will be stuffed down my throat so it will also make the throat more sore. In short, the entire throat will be attacked.

How long is my stay in the hospital?

Its estimated to be 3 days, I am hoping it stays that way.

Dec 10, 2010

I was scheduled for 3 blood tests and 1 chest x-ray for my pre-admission procedures. My mum drove instead as parking is usually the biggest nightmare at Singapore General Hospital (SGH) so its easier if mum drives so I can just hop off the car while she go figure out how to park if its really a nightmare. It felt strange that for the past 2 years, I have always been the one driving my dad and mum to SGH for their respective health checks. I’ve been the one to pick Dad after he was discharged from hospital, I’ve been the one bringing my mum for her specialist appointment. I am glad I made all the trips with my parents. Its really not easy both emotionally and logistically to go to SGH for medical appointments. Its also another reminder that whatever overseas single girl dream I have, I won’t be able to carry it through. Its just me. I am those softies who cannot get over my own emotional barrier. I admire those who can and are chasing their dreams now. Softies like me have another path to take I guess. I dunno, I have no answers, just a thought.

Once again, the system was flawless or so it appears. Register and then wait for your number to be called, then I was directed to another room for my blood to be drawn. 3 samples, 2 ordered by my doc and 1 for the optional HIV test. When doc asked me if I am ok to test for HIV, I agreed cos its not a big deal. I don’t do drugs and dating life had been dry as Sahara desert for 8 yrs…I would be the last person on earth to have any form of sexually transmitted disease.

After the blood tests, I was sent for admission counselling. I chose B1 class because A1 is ridiculous. PLUS, I am seriously freaked out of being alone in the hospital. There is nothing better about staying alone in a room at the hospital. Did anyone watch The Eye? Things happen in the hospital ok, I am sure I would be much happier in a 4 bed ward.I had to pay a $2k+ deposit for my admission, when I swiped the credit card, DBS cards immediately sent me a message informing me that there had been a transaction of the exact amount a moment ago. Very impressed. ahahahaha.

Chest X-ray was next, changed into some funny costume and then did my x-ray and then its back to admission centre for the last part, meeting my anesthesiologist.

They took my blood pressure and checked my lung capacity. The senior nurse commented ” your heart beat seems a bit fast” I answered “its my first time and had never been hospitalized”. She was really nice and went on to give me a brochure and also went through the procedure. She assured me that everything will be fine, even asked me whether I want to have breakfast. I thought that’s pretty nice of her.

The meeting with my anesthesiologist was about 20mins, he was pretty thorough, asked me about my drug allergy history blar blar but the most amazing thing was he keyed in my details and whatever previous records I had with other hospitals, it was reflected. FWAH. There will be certain risks because its a throat related operation. A tube will be stuffed down my throat after I am knocked out. This is to allow for oxygen to enter the lungs. And throughout, my blood pressure and breathing as well as heartbeat will be monitored. I asked the doc..will I wake up? Last thing I want is for the surgeon to say hi to me during the op, the anesthesiologist said that they will know when a patient is about to wake up, apparantly the levels will increase.  Because its gonna be GA, general anesthetic, I will feel like puking or will be puking after waking up. Ok, something to learn about.My throat will also be sore so I won’t be able to eat. Ok, lose weight then.

The hospital staff would call me on thursday to inform when my surgery would be scheduled. So its more waiting game for the time being.

To take our mind off, I suggested to mum to go Daiso at IMM. Its a happy place without burning a hole in the pocket.

Yes, this waiting period is pretty stressful  but shopping at Daiso is extremely therapeutic.

Daiso, I love you.

Once diagnosed, I couldn’t remain in Sydney anymore.

Within 2 weeks, I packed up and returned back to Singapore to seek treatment. I guess if I am to die, it would make sense to be surrounded by my family members. The 2 weeks went by in a haze, there were farewell dinners, tonnes of items and clothes that I had accumulated during my time there and all the administrative details that I had to complete before returning home. The University and the lecturers were kind enough to allow me to complete my final 2 papers and submit them from Singapore. I was even given an extension for one of the papers so that I would have time to complete them once I am home.

I realized Cancer kick starts the fight mechanism in a person. It forced me to refocus on my priorities and decide what to let go off and what to hold on to so that I can win the fight. By November, I had already met my surgeon who told me that most likely it would be cancer, based on the FNA. However, they can only confirm during the surgery.

In other words, surgery would be the best way to confirm the cancer diagnosis. According to my surgeon, a tissue sample will be taken from the thyroid during the surgery. The tissue will be tested immediately for cancer. If it is confirmed cancer, the treatment would be to perform a total thyroidectomy, that is to remove the entire thyroid and possible infected tissues around it.

As this would be a life changing decision, the surgeon sought my consent for the go-ahead.

I felt like my life was in his hands, so naturally, I said yes to his suggestion.

I just wanted my thyroid out, as soon as possible.

Because deep down, I felt that this part of my body had betrayed me.

The operation was scheduled for 3 weeks later and in the meantime, I tried to distract myself with final submission of the papers because I still want that Masters Degree.