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BIOPSY ODYSSEY “Pinch and Burn”
I woke up this morning feeling great. Don’t ask me why. The biopsy site was still tender, but I felt well rested and glad the whole thing was over. I felt rejuvenated and ready to tackle the world (i.e. clean my office). Yesterday morning at 8 a.m., I arrived at the hospital and was shown to the room that would be my home for the next 6.5 hours, minus the 15 minutes it took to perform the biopsy. I had to strip down to my underwear and put on the infamous hospital gown. An IV was installed on my hand, and blood drawn for platelet counts and clotting factor tests. Since the IV went into my left hand, it was difficult to write notes in the margin of the book I brought to read (The Battle for Christmas: A Cultural History Of America’s Most Cherished Holiday by Stephen Nissenbaum). Every so often my brain would remind me that I was there to have my abdomen stabbed with a hollow tube. The butterflies were reminiscent of how it felt waiting to go onstage back in my nightclub days. At 10 a.m. I was told, “They're ready for you.” My bed was wheeled into the hallway where I awaited someone to take me to radiology, where ultrasound is used to perform the biopsy. The man that came to transport me to the 5th floor was a tattoo-covered, pony-tailed guy with a scruffy beard. He didn't say a word. He just looked at my chart, unlocked the brakes and started pushing me down the hall. I decided to make chit-chat—because that’s what I do. Me: Big place, isn't it? Tattoo Guy: What, sir? Me: I said it‘s a big place, isn’t it? Tattoo Guy: Yeah, you might say that. Me: Tattoo Guy: Me: Tattoo Guy: Me: So, how does this thing handle in the snow? Tattoo Guy: What, sir? Me: These beds—are they easy to drive? Tattoo Guy: They're not too bad. Me: Tattoo Guy: Me: Tattoo Guy: When we reached the radiology department, Tattoo Guy parked me in a corner of the hallway and left. Tattoo Guy: “Good luck, sir.” Me: “Thanks.” Soon, I'm fetched by two of the radiologists and wheeled to the room where the biopsy will be done. The room was surprisingly dark. There was an ultrasound monitor and several people milling around. It didn't look like the kind of room where an invasive procedure like a biopsy would be performed. I couldn't tell if it was the room, or maybe a preliminary step where they would only do the ultrasound. I realized soon enough that it was indeed the room, and the butterflies were unbelievable. Head radiologist: Mr. Hilston, let me describe to you what is going to happen. First we'll use the ultrasound to locate your liver and find a good place to get a sample. Usually we'll go in near and just below the sternum. Once we find a good spot, we'll clean you off with some soap and then we'll inject the site with lidocaine. When we go in for the liver specimen, you'll feel some pressure and then you'll hear a click. Do you have any questions? Me: Once you inject the lidocaine, how long before the numbness kicks in? Head radiologist: Seconds. Me: Wow. Head radiologist: Any other questions? Me: (Thinking) Head radiologist: Me: No. Head radiologist: Sign here. The radiologist then dipped the ultasound scanner in some goopy stuff and proceeded to push it, rather hard, against my upper abdomen, just under the breast bone. He moved it slightly left, then right. He adjusted the angle up, then down. Every so often, he would ask me to take a breath and hold it. He would hit the return on the keyboard and I would hear a somewhat familiar sound. Me: You've got mail! Head radiologist: No, it's just telling me that it the image was processed. Me: Oh. Lying flat on my back, I turned my head toward the monitor to see my organs and stuff. Of course, I didn't recognize anything I was looking at. Me: Can you tell if it's a boy or a girl? Head radiologist: I haven't heard that one in weeks. Me: Is that a “no”? One of the assistants approached from my left with some cleaning swabs. I kept flinching and apologizing because I'm extremely, insanely ticklish. She then walked away and returned four times, and brought with each trip sterile towels to frame the biopsy site on my abdomen. The head radiologist sheathed the ultrasound scanner with a plastic sleeve as the assistant appeared at my left with the syringe. Lying flat on my back, I couldn't really see what was going on, so I happily resigned to not being able to watch the procedure. The ultrasound scanner was again being pressed under my sternum when the radiologist said, “OK, first we're going to give you the topical anesthetic.” I could see him nod to the assistant, who then says, “OK, Mr. Hilston. Pinch and burn.” Wha ...? Oooooooh. She was right. That familiar cold, intense bee-sting kind of sensation, followed immediately by a feeling of gradually spreading warmth. But that wasn't so bad, I thought to myself. “OK, now we're going to do the deep anesthetic at the liver cap. Take a breath and please hold it.” And again, he nodded to the assistant. At this point, with my breath held, my brain was trying to register what he just said. Milliseconds passed as the words "deep" and "anesthetic" were being looked up in the Hilston Dictionary of Layman Medical Knowledge in my mind. Using the mental thumb tabs, I opened the dictionary to the letter D. Under the word "deep" was the following definition: deep. adj. Not shallow. Of or pertaining to a depth deeper than the surface. When used in the context of liver cap during a liver biopsy procedure, the term denotes the depth of the surface of the liver, sissy boy. Ah.I see. I thought to myself. Deep. I get that. I then went to the A section of the dictionary and found the term “anesthetic.” But instead of reading the definition, I looked immediately at the picture. It was an engraving of a syringe the size of a horse's leg, with an especially long needle and cartoon lettering in all caps on the side of the syringe that said, “LIDOCAINE, HOLMES.” OK. I'm no moron. I can put two and two together. I see that the needle is going to go ... oh. my. "Keep holding your breath, Mr. Hilston. ... OK, you can breathe now.” My reaction at that point was more due to the idea of what just happened, than anything I actually felt, if I recall correctly. But it wasn't long before I was asked to hold my breath again. With nothing to really distract me, my mind was focused on every sensation. Knowing that the area was probably sufficiently numb, I actually wondered if they had gone inside to get the specimen yet. I couldn't distinguish between the pressure of the ultrasound gizmo and the pressure of the biopsy instrument. Suddenly, I felt a deep, more intense pressure, followed by a sharp, plastic-sounding click. At the sound of that click, I immediately felt something I had never experienced before. It was a dull, nauseating feeling, like a punch in the stomach, combined with a strange, misplaced pre-belch pressure. I actually had the urge to swallow air and to try to belch, but I was still busy holding my breath. “You can breathe now, Mr. Hilston.” I could feel my heart pounding. The assistant walked to the other side of the room with the liver specimen she just took from me. At that point I just felt crappy. Partly annoyed at the unfamiliar internal sensations I was experiencing, and partly elated that it was over. From across the room, I heard the assistant say, “It's not big enough. We need to get another one.” So, not only did I have the distinct pleasure of having my liver penetrated a second time so they could get a larger specimen, but I was privileged to enjoy yet another punch-in-the-stomach feeling on top of the previous one. “I need you to take another breath, Mr. Hilston. And hold it, please." Click! Crikey! As I lay there, I was quietly groaning to myself, making the same noise I made the last time I had the wind knocked out of me—the day I was flattened by a Antoine Davis during high school football practice trying to catch a pass over the middle. Again, my heart was pounding. This time, all I wanted to hear was, “It's a good specimen.” Apparently, the thumbs-up was given because they began to remove the sterile towels and put a bandage on the fresh holes in my abdomen. ”Everything went just fine. You did very well, Mr. Hilston.” I looked for the high-five prompt from the head radiologist. It never came. Things would definitely have to change in that regard if I were running that place. “You'll have to lie flat for an hour, Mr. Hilston. I don't want you to try lifting your head for a full hour. After that, you'll need bed rest for 3 hours and then you can go home.” I was then wheeled out of the room and put in the same spot in the hallway where I had been parked earlier. Soon, Tattoo Guy arrived, as talkative as ever. He pushed me to the service elevator and hit the button. Apparently, the elevator was being used because we had to wait a couple minutes before it arrived. While we were waiting for the elevator, Tattoo Guy attached the IV support pole and hooks to the frame of the the bed. All of a sudden, I felt something hit my bed, followed by a vibration, accompanied by a metallic rattling. A second passed, and I felt and heard it again. Whack! Rattle. A second passed, and I felt and heard it again. Whack! Rattle rattle. A second passed, and I felt and heard it again.Whack! Rattle rattle rattle. A second passed, and I felt and heard it again.Whack! Rattle rattle rattle rat.A second passed, and I felt and heard it again. Whack! Rattle rattle rattle rattle. And again. And again. And again. Straining with my peripheral vision, I realized that Tattoo Guy had decided he would whack the IV support hooks with his hand as hard as he could, just to see how many times he could get them to spin around the pole. In my mind, I imagined the following conversation: Me: Hey, Tattoo. Whack! Rattle, rattle. Tattoo guy: Me: Hey TatTOO!. Whack! Rat ... Tattoo guy: What, sir? Me: Have you ever had a liver biopsy? Tattoo guy: No, sir. Me: I just had my first. Tattoo guy: Me: If you don't stop banging those hooks, I'm going to reach up and pluck out both of your eyeballs and roll them down this hallway. Tattoo guy: Really, sir? Well how about I just open these elevators doors and push you down the shaft—Sir? Me: Tattoo guy: Sir? Me: Since even that imaginary scenario didn't work out in my favor, I opted to abstain from complaining. Plus I was beginning to feel a bit euphoric that the hard part was over. So here's how the real conversation went: Whack! Rattle, rattle. Me: This place is so big, you probably get good exercise moving patients around. Whack! Rattle, rattle, rattle. Tattoo guy: What, sir? Whack! Rattle, rattle. Me: Do you get a lot of exercise working here? Whack! Rattle, rattle, rattle. Tattoo guy: You might say that, sir. Yeah, I might also pluck out your eyeballs and toss them down the hallway After being wheeled to the recovery area, my blood pressure was checked, and I was left alone to rest for a full hour before I could lift my head. Still euphoric about the procedure being over, I was a bit too wired to doze off, even though I was functioning on just two hours of sleep. After an hour passed, the nurse adjusted the bed’s position so I could sit up and eat some lunch. A nurse brought a ham sandwich, a container of apple sauce, a diet Pepsi and a package of those awesome Nabisco™ Snackwell’s® cookies.
Not having eaten since the previous evening, that ham sandwich was, at that moment, the best sandwich I ever had. In the recovery room with me was a man who was there for an ultrasound examination of his kidney. His name was—well, frankly, I don’t know what his name was because I never asked him. His wife was with him and the three of us began talking. He is on his third kidney transplant. His first kidney lasted him 10 years. His body rejected the second one and the complications led to quadruple bypass heart surgery. His third kidney was doing better than the previous one, but he was having problems with fluid accumulating around the kidney. He has had more biopsies than he can count on his fingers and toes, which makes my couple of pokes seem hardly significant. We talked for a couple hours until their physician finally allowed them to leave. They wished me luck and said goodbye. I marvel at this: I spent 2 hours talking to these people about things so personal and private and I didn't even get their names. Nor did they get mine. We talked mostly about his condition and history, the city of Johnstown, where they're from, the wife’s upcoming LPN tests, etc., so they know very little about me. But I really feel like I know them, and I'll probably never see them again. That amazes me. After my new unknown friends left, I decided to try to sleep. Anyone who knows me well is aware that I can sleep anytime, anywhere as long as (a) it is dark, or (b) I have something to cover my face, like my hat.
But I had neither darkness nor my hat handy at the time. So I decided I would cover my face with my white t-shirt. I could feel the familiar heaviness and grogginess of sleep begin to wash over me —the “Little Death” I like to call it, although I'm not sure who originated that phrase— and I contentedly succumbed to its gravity. As I felt the pull and enchantment of La-La-Land, it suddenly occurred to me: I’m in a hospital where people die. When people die in a hospital, they cover their faces with white sheets. What if ... z z z z z z ... z z z z z z ... z z z z z. I awoke at 2:15 p.m., elated that I wasn't in the morgue in a refrigerated drawer. My discharge time was 2:30, so the timing was perfect. I called the Spousal Unit to come and get me, then awaited my discharge instructions. The results are supposed to come in this week sometime, but given the fact that a holiday weekend approaches, perhaps I shouldn't expect anything before Monday. The end of ©2007 James Hilston
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