2 Weeks Out From Life Saving, Life Altering Surgery

by GregP_WN

I'm not sure what I expected going into surgery at Vanderbilt 2 weeks ago today. Leading up to it I was anxious and in a hurry to get it done and get it out of me. I was diagnosed with laryngeal cancer that required having a complete laryngectomy and bilateral neck dissection.

Me Pre Op

Sweetie waiting with me for the docs to come get me for surgery

That morning started like so many other mornings that we have been at Vanderbilt for me to have a procedure. Until this one, I have had several procedures that were quick outpatient surgeries that weren't much in the way of life changing or life saving, except for the last time I had a radical neck dissection, and a month before had a malignant tonsil removed. 

Most of the others were more of what I call maintenance procedures to check for colon polyps or spots inside my throat, several oral surgeries, and there was that time that I had a TIA and had to have a stent put in my interior carotid artery. This one was going to be a big one, I knew what was coming, Doctor Rohde had told me that it would be a bigger ordeal than anything I have been through so far. 

The usual routine is to sign in, wait to be called back to pre-op and get naked and put on the famous "paper gown". I call it the "I C You" gown because if anyone is behind you while you're walking they can say "I see you". 

After assigned a little cubicle that is sectioned off in a big room by curtains, you are told to strip down, completely and put on the gown, hair net, socks, and put all your belongings into a plastic bag. Part of this is humiliating to some, but after being through as much as I have it doesn't phase me. Then one of the kindest, calmest, and most caring nurses you will find in any facility anywhere in the US comes in to take your vitals. And, as has happened every time I've had blood pressure checked in the last year, my BP was running real high, somewhere around 200 over 100. 

After I am naked as a J-Bird and laying on the hospital bed, had my vitals taken, then comes the next nurse to give me the good news that she is here to get an IV started. After having extremely harsh chemo 32 years ago, I have really hard to stick veins. My record for number of sticks to get an IV started is 9. That was by 4 different nurses who all said they would have no problem getting an IV started on me despite my telling them I have hard veins from chemo. That day I was having a gall bladder removed that had decided to try to kill me. I wound up all the way into the OR with no IV. That anesthesiologist wasn't to happy that somebody couldn't do their job. He got it started with no problem. 

Vandy

A view of Vanderbilt Medical Center out of our ICU window

At Vanderbilt, every time I am going to have a stick I always tell them that I've had chemo and am a "hard stick". Most of the time they have no problem getting an IV started. This time wasn't any different. I always compliment them on doing a good job on a hard case after they are done. Everybody needs a little appreciation now and then, and nurses don't get enough. 

After the IV is rolling they say someone else will be in to see me shortly. You can tell that they have this stuff down to a science from doing it thousands of times. The next one in is the head nurse that will be with Dr. Rohde in the OR. She introduces herself, then does what is a redundant procedure the first time. She looks at my armband and asks who I am, date of birth, and why am I there today. After I answer those and she agrees that I passed the test, she then asks do I have any questions and tells me a little about what will be happening and a time schedule for it. 

Next in is the nurse anesthetist who is assisting, or "doing" the anesthesia. She goes through the whole routine again. Who am I, date of birth, and why am I there. She wants to look inside my mouth and asks be to open wide and stretch my neck in a few different directions to see how flexible I am to give them an idea how difficult it's going to be to have a tube in my throat. She also asks do I have any questions, tells me everything looks good and tells me someone else from the team will be in. 

Sweetie's Home

This was Sweetie's home for six days. Bless her short little heart.

I young lady who we have called Dr. Rohde's "mini-me" comes in next, one of Dr. Rohde's capable residents. She is a brilliant, young, talented doctor. She also is a doctor Sarah.  Same routine, who am I, D.O.B. and why am I there. After I pass the test for the 100th time, she lets me in on a little more of the details of the morning. She has a stack of paperwork that I have to sign stating that I have been told of all of the possible bad outcomes of the surgery, that I have agreed that I'm OK with it, and my next of kin, and a few other things that make you wonder about some of the "what ifs" of this surgery. 

Next up is the anesthesiologist, he goes through the routine again and asks me to perform the open wide and stretch test again, tells me that we are close to game time and asks who all has been in to see me so far. I can't remember that many people. Luckily, Sweetie, who is responsible for half of my memory has been sitting nervously beside my bed. He also tells me that he will be giving me a "little juice" to calm me before we reach the OR and am I alright with that, yeah dude, hit me and don't be stingy with it. #PropofolIsMyFriend He tells me that Dr. Rohde will be in to see me and we are getting closer to time. 

Next up is Dr. Rohde, she is the only one that doesn't ask the routine, who are you, why are you here. She just wants to know how am I feeling, do I have any questions before we roll off, and tells me a little more about the surgery.  I have said it before and will repeat it, Dr. Rohde is the best doctor I have had in over 32 years of dealing with cancer, and I've had a bunch. She asked Donna if she had any questions then wants to know if the general surgeon who is going to put a feeding tube in my belly has been in. Surgery is set for 730 and everyone has been in except for the feeding tube dude. It's now 740, and still no feeding tube dude. 

We can see out into the hallway outside the holding area and Dr. Rohde, her mini-me, who's name is also Sarah, and most of her team are standing in the hallway obviously miffed that the schedule is being held up. I see mini-me on the phone calling the feeding tube dude, I'm sure, to find out what the hell dude, you knew game time was 730, what's up?

Less than 5 minutes later he shows and goes through the routine, and tells me about all of the possible side effects and risks involved with putting a tube in my belly. As I am signing off on paperwork, several of the team gathers around my bed and tells me it's time. I tell Sweetie " I love you" for the last time with the voice that I used to have. They start rolling me out of holding and down the hallway towards the OR, doctor night night must have been behind me somewhere because the last thing I remember was making it around 2 turns in the hallway before it was lights out. 

It was a 6 or 7 hour surgery that went better than they thought it would. The surgery was a total laryngectomy, a bilateral neck dissection, and a rebuilding of my esophagus that had to be taken out. Muscle was taken from my chest to use for the reconstruction. During the surgery Dr. Rohde said the thyroid didn't feel right. She was going to take part of it out anyway, but after cutting into it she was suspicious that it may be involved too. It was sent to pathology and confirmed that it was also malignant. At this point we still are waiting for confirmation from pathology if it was a metastasis from the current diagnosis or if it was a metastasis from my previous diagnosis 11 years ago. 

I woke up in my room, I think. I don't remember waking up in the usual curtained off recovery room, but I might have. That stuff gives you a really good nap. 

Me In Vandy

A couple days out of surgery

My first bit of reality hitting me in the face was when a nurse came in and asked how I was feeling. When I opened my mouth to say "fine", nothing came out. Then it hit me. I had no voice, couldn't speak, and might not ever again. 

I was put in surgical ICU for what was supposed to be 3 days or so depending on my rate of recovery, walking, healing, etc. The nurses in that section were fantastic as always. Every trip into the room started with "Mr. Pierce, how are you feeling, how is your pain, do you need anything, and I'm doing this, this and this, and giving you these meds. About every 2 hrs. this routing was repeated for the 6 days we were there. The only difference was every 12 hours there was a shift change, but not a routine change, or an attitude change. Not a single nurse or doctor had the attitude that they were thinking they would rather be somewhere else that day. That's how it's supposed to be. 

The nursing team consists of a charge nurse, the head nurse for my case, a nurse practitioner, and a CNA. All were always great. Even the guy who came in to clean up the room each day was as polite as the rest of the team and just thankful to be there. It's tough being in the hospital, especially for something as serious as this, and having a crew that appreciates their job, are over the top cheerful and caring makes the experience a little easier. 

During this 6 days the daily routine was to be watched, drugged, and rehabilitated. The speech pathology team came in a few times to show my how to use an electro-larynx device and encouraged me to try to get better at it. The physical therapy team came in to get me up and walking around the floor and to do stretching exercises on my neck. Every morning one of Dr. Rohde's teams would stop by to look at my stoma, incisions, and ask how I was feeling. They would give me their assessment of how I was doing recovery wise and tell me the plan for the day. Every member of her team is fantastic.  

Walking The Hall

Me and one of the nurses making laps around the ICU hallways

When the last day was there we had a visit from a social worker who was setting up the things I would need to go home with. Mainly feeding tube formula, and a portable suction machine to suck out this space age mucus material that I have been choking on since then. That stuff could be sold as tractor hydraulic fluid.  

On the 5th day Dr. Rohde's weekend team came in to tell us that unless I had a setback overnight, I would be going home the next day. That was Superbowl Sunday. I wanted to be out of there in time to get home in time to watch the game. It was close because of the typical thing that happens when you're trying to get out of a hospital, waiting for somebody or something. My go home prescriptions were to be delivered to the room and our take home feeding tube formula was supposed to be delivered to the room. 4.5 hours later, we had the drugs, but still no formula. Two calls to that office later we find that this or that had happened and it wouldn't be delivered for a couple more hours and we would have it sent by UPS to us. All we needed to hear to get out of there. 

Since getting back home, I have found time and time again how my life has changed. 

I can't yell at the dogs, I can't even call them to come in.

I can't whistle.

I can't blow on soup if it's too hot. 

Swallowing is more of a process since part of my esophagus had to be rebuilt. There is no longer any danger of me choking.

I can't answer Donna when she says something to me. 

I lost my world class singing voice, and I'm sure to lose my recording contract. Oh....wait.....I never had either of those. 

You know how when you're sipping on a hot cup of coffee and you sort of suck in a little to get just a bit of it and not a gulp? Yeah, I can't do that anymore. 

I can take a bath, as long as the water isn't too deep. Water is my enemy now. I even have to wear a protective piece to cover up my larytube to keep water from running down into my lungs while showering.

After Walking The Hall

Back from making laps

Swallowing so far, I just started liquids yesterday, has been OK. One bonus is that since my trach and esophagus has been separated, there is no chance of me choking any more. 

Even though I can do a mean "Domo Arigoto Mr. Roboto" on my electrolarynx, I am having trouble speaking clearly enough with it so she can understand me. 

My daily routine is going to have an hour added to it each morning. I have what's called a "Larytube", it's a plastic tube bent in a fashion to fit in the hole in my neck that other devices can be attached to. Breathing filters of different types to filter the air I'm breathing and a neckband to hold the tube in place, mainly. That tube has to be cleaned every morning, a new filter put in, the mucous has to be cleaned up and suctioned out of my trachea. I never thought I would ever have to stick a plastic tube down my trach and suck out what seems to be as thick as peanut butter and chokes me. I also never thought I would be spraying salt water directly down into my lungs. But, that's where we are. These things have to be done each morning as well as I "eat" my breakfast of 300 ML of formula, and a couple hundred ML of water, I crush my pills and push them into my feeding tube. After all that, I'm good for the morning. That takes an hour or so. 

Waiting To Leave Vandy

Waiting to be discharged. Note the bright yellow gripper socks that I was given when I checked in because we forgot to bring me some.

As of today, each day gets a little better. Each night gets a little easier. I can sleep now for about half the night before being woken up by the mucous building up in my throat to the point of choking me. I have to roll over and suction it out. I spent the first few nights sleeping in my chair because of this, now I've been able to move to the bed. That's a bonus.

Today, I walked the dog to the mailbox and spent a few hours in my shop. I've also tried some soup and was able to get a piece of a bowl down and drink a half of a glass of water. This is a step up. Two more days of liquids and I can start on soft foods. 

At this point it's baby steps and meeting daily goals.

Next week it's back to the doctor and see what the next step is. I am a long way from where I was last Tuesday, but I still have a long way to go. With Sweetie's help, and the support of our two dogchildren, I will get there one day. 

I must give a huge thank you to my Sweetie, my Wife, my love, and caregiver for hanging with me for the last week sleeping on a hard hospital chair. I love you! And thank you to our family and friends that were sitting in the waiting room all day. I know it's not easy to be sitting in one of those chairs all day. I love you all!

Pierce Strong Drawing

A drawing made for us by a family member

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