Journey to the Operating Room and Beyond

[This blog was originally posted in the fall of 2007.]

I had knee surgery yesterday. The night before taking the bus to the hospital, I reread my courtesy letter explaining when I had to stop eating and drinking. I reread the notification that the hospital was required by law to ask about whether I had any advance health care directives. So I pulled an extra copy from my files, tossed it into my bag and walked to the bus carrying my crutches.

Soon I was in the pre-surgery waiting area, a small windowless room, stripping naked, putting on my surgery gown and staring at an enchantingly beautiful impressionist painting on the wall. Immediately I recognized the scene as a place I had visited in my childhood – Monhegan Island on the coast of Maine. In the background, Manana Island was silhouetted in the shimmering late afternoon sun, a black disc like a back of a whale, or a magical portal through time and space. In the foreground, a lady sat in an thatched wooden chair just up from the pier on Monhegan island, facing west towards the dark portal.

It seemed an auspicious sign, a reminder of the beautiful islands, both literal and metaphorical, along the shores of my passage through life. Everything is going to go well today I mused. I waited for the nurse to return, watched my breath slowly, and studied the painting further. I then noticed the three empty chairs next to the woman. Could the artist have included these as a reminder of death, of friends departed? A chill went down my spine, assailing my confidence of a moment ago. The more I gazed into the glimmer of the ocean beyond the island, I became aware that past and future life is little more than a dream, and the present moment life can end in any instant. Am I ready for whatever comes next?

When I was ten years old, I met an old hermit on Manana Island. In my late twenties, I found the mirror image of Manana Island on the remote west coast of British Columbia and played out my own version of Henry David Thoreau for several years before returning to the pavement of Seattle. My thirties passed in a blur – self indulgence, idealistic wanderings and exploration of inner and outer reality. My forties are now almost gone. The swift current of life is moving on.

Inside the borders of the painting, my eyes were drawn deeper into the dark island of mystery, death, and rebirth, continuing to glimmer as my breaths grew long and deep. I was in a trance. It was delicious. Then, I remembered the imminent surgery. Am I ready?

I began thinking about the possibility of discomfort and suffering coming my way in the next hour. I, like everyone else I know, do not like pain. But I also have come to realize that by facing pain and not running away from it, one can gain powerful insight into the nature of reality. I’m comfortable with the tiny needles of acupuncture, but the big hollow needles of western medicine still push my fear meter to the red line. So this is my Everest, my Mount Kailash today, to breathe into the jabs, pokes, and cuts and disentangle my consciousness from its deluded fixation on being the owner of this body, as if it were a permanent thing.

I asked for no sedation, just spinal anesthesia. One of my teacher’s had reminded me that this is a personal choice, not a Buddhist precept, and that it is good to accept that people’s comfort zone and circumstances are often different. The surgeon, with whom I felt good rapport with from the outset, told me, “not a problem.” But I had held a mistaken impression that she would act as grand communicator of my wishes to everyone on her team. In hindsight, I realized she probably doesn’t know who is going to be on her team on any given day.

The anesthesia nurse finally came back and after taking my blood pressure, she said, “now I am going to give you your sedation.” I suppose they are used to most people saying, “great, dope me up.” Despite my sudden surprise, given that I had made clear my wish not to receive sedation, I was alert enough to immediately say, “I prefer not to have sedatives please.”

From a Buddhist perspective, having a clear state of mind in each moment is the key to inner peace and spiritual enlightenment. This is true in life, but becomes especially critical during the dying process. And though the surgery was clearly routine, death is also routine. It will happen one day. Unless one prepares for that moment, emotional turmoil may prevail rather than a confident and calm clear headedness.

My IV drip of antibiotics was started and I was wheeled into the OR. In all the times previous in my life that I had been wheeled into an OR (five), I had always been under general anesthesia. It felt strange, like a dream, to be lying on the gurney, looking around at the banks of machinery and computers, hanging from poles everywhere, as if I had been initiated into a secret fraternity but someone had forgotten to tie the blindfold on me. I watched, wide awake, as the nurses and docs did their pre-op ritual dance. I felt relaxed, but was also bracing myself for the big poke, silently working on my wall of fear.

Finally the moment had come. I was asked to lean forward and hunch my back. The sting of a local anesthesia wasn’t so bad, it was the deep pressure of something being forced into my spinal cord. Very strange. But it was over in a moment, and I was allowed to lie back and watch the tingling in my lower body grow. Finally, a shot of morphine into my knee, and I was all prepped.

I could feel my knee getting yanked into different positions that I know would have caused me pain without the anesthesia, and yet there was none. Then came odd sensations, as if someone were popping rivets off inside my knee, then the sound of a cutting tool, shaving my meniscus cartilage. I began to differentiate between the physical sensation itself and my mental response to the sensation. When the mind tightens, the body tightens. I watched my body tighten again and again, relaxing each time through my breath.

My anxiety was running a little high, but I had chosen this passage and even then, knew it was exactly where I wanted to be, on the edge of my mental comfort zone, with a tenuous hand hold on the sheer cliff of the present moment. I was learning to disengage from the intense ego-attachment that the mind feels for this body. This learning to let go is the basis for peace in life and death. Surgery, from this perspective, is an opportunity to practice a dress-rehearsal for death, and, to be more centered in life.

Then it was over. The curtain came down and I could see my knee being wrapped in gauze. The surgeon was pleased and said I would also pleased once I recovered from the procedure. My knee was good for another twenty years or so, she said. I was wheeled into the post-op recovery room for further observation where I overhead a nurse say that my venous system was “shut down” and that I was very anxious. Probably not aware that I was relatively alert and not all doped up and could fully understand their conversation.

Hours later, my perineum was still numb and my bladder had a liter of IV fluids in it. Unable to pee on my own, I was catheterized and helped into a wheelchair around 630pm six hours after the surgery. As she wheeled my towards the elevator to meet my wife, I told the nurse, “I feel very calm.” She said, “that’s because of all the drugs you have in you honey.” She told me that they had indeed given me anti-anxiety drugs. Not a word of this was mentioned to me as these were being slipped into my IV.

Was the administration of these drugs considered a medical necessity overriding any personal preference I would have had? I certainly would have refused if I had the option preferring to deal with my anxiety consciously. I suspect they were given in an effort to speed up my recovery, to relax my veins and thereby increase the reoxygenation process in my blood. I trust that my body would have recovered just fine in its own time.

How else can people learn to work with their mind if they aren’t given the opportunity to refuse mind altering drugs instead of having them constantly pushed on them (and delivered without their consent) by the system?

My desire to allow my body to recover on its own, without drugs, was in conflict with someone’s desire to go home before supper and not have to hang around for a “pesky spinal” to wear off, as one nurse put it. I wonder if it’s also a lot easier to boss around patients when they are all doped up.

And of course, there are the undeniable economic incentives built into the American medical system ensuring that pharmaceutical medications are liberally dispensed. Doctors, pharmaceutical companies, hospitals, corporate lobbyists, and Congressional lawmakers – the money goes round and round.

I could waste a lot of time ranting and pointing fingers, but little good would come of it. I am very fortunate: I had a good doctor who genuinely cared about people and I wrote her a thank you letter, politely outlining my experience, offering her my reflections for her consideration – or not.

I was able to pay for the surgery with the help of my bare bones insurance plan without going into debt and I lived to tell this story. Lessons learned: Always smile at people, give them the very best of my mind and attention. Help them avoid trips to the hospital with preventive acupuncture and wellness coaching. And when they need heroic hospital medicine, help them recover with more acupuncture. Teach them how to breathe into emotional and physical pain.

May all beings be healthy and happy, live in virtue, die peacefully, and awaken to supreme enlightenment.

Epilogue: A nurse later called me from the hospital and informed me that the nurse who told me I had received sedatives (she did mention specific medications) was merely assuming that I had received them, as 99.9% of surgery patients do receive them. While I was relieved to know that my wishes had been honored, the fact that I received misinformation on such a sensitive subject is unfortunate. Perhaps my efforts to clarify the situation with the hospital will save future patients from such confusion.


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