My Gallbladder Surgery by Rachel

One of my biggest frustrations leading up to surgery is that I could not find anyone to tell me what the surgery would be like or how my recovery would go. Me being me, I needed this information. While my surgeon described the procedure to me, that was just a few short days before undergoing it myself, and I still had no real grasp of what I could expect while recovering.

*** WARNING: I am going to discuss my surgery, my recovery, and gross stuff. This post is intended to be helpful, not funny or insightful or pithy. As a pregnant lady who was facing surgery, I wanted this information, and I was unable to find it. If you do not want this information in your head, DO NOT READ THIS POST.***

Here's (my recollection of) how the Robotic Assisted Laparoscopic Cholecystectomy was described to me (*my surgery was performed through ONE incision in my navel - some are done with more incisions*):

- you will be anesthetized
- an incision will be made in your navel
- your abdomen will be inflated with carbon dioxide
- the table you are lying on will be tilted until you are almost upright - this is done so that the majority of your organs press downward and are 'out of the way'
- instruments are inserted into the incision, and guided up to the gallbladder
- the gallbladder is removed, and surrounding ducts are checked for additional stones / blockages
- navel incision is glued closed
- et voila! surgery is complete
- 1 week out from surgery, most patients still have some pain, but are reporting improvement
- 2 weeks out from surgery, most patients have returned to a normal level of activity

This is a relatively short procedure. Barring complications, my surgeon estimates between 30 - 45 minutes for this surgery, but reserves the operating suite 2.5 hours just in case.

I was required to fast - no food, NO liquids, no fooling - for 12 hours prior to my procedure, so I woke up at 3 a.m. and had some soup and a TON of water. In the future, I will schedule all procedures requiring fasting for the MORNING so that I do not have to spend the day hungry and cranky.

I was asked to shower using Hibiclens (a hospital grade antibacterial wash) twice in preparation. After the second time, I couldn't use moisturizers, lotions, deodorants or perfumes... that was hard. I cheated and moisturized my face...

I arrived at the hospital at 1:30 for my 3:30 procedure. Admitting was quick, easy and friendly (THANK YOU, staff at St. Luke's Baptist!). As soon as the paperwork was done, admissions called surgery, and were told that they were waiting for me :-)

The hospital provided an incredible woman in an expensive looking sheath dress and low heels as the Family Liaison. She escorts all patients into the surgical holding area and personally settles them in. Then she keeps track of each patient and all of their family members for the entire time that the patient is in the care of the Surgical Unit. She escorts all family members in and out of the holding area (where pre-op & recovery take place) so that family spends as much time with the patient as possible. She was incredible. Organized, authoritative, knowledgeable and compassionate. She is worth her weight in gold.

I handed over my dignity in exchange for a hospital gown and some gray socks... o.k., fine. I got to keep my dignity, just not my underwear... Then the nurse took my vitals and asked aaaaaaaaaaaall of the usual questions. Since I am 17 weeks pregnant, a hand-held doppler was brought in to check Baby Bean's heart rate. It was (as expected) perfect.

Next was my I.V. Now people, I have a vasovagal response to needles. This means that I am probably going to pass out - it's just how my body reacts. I can be as calm as I want, but my body reacts poorly to the introduction of needles, and that's that. It's also worse when my blood sugar is low, so... I expected this to be hard. It was, in fact, the part I dreaded the most out of the whole day. Crazy, right? I almost panicked when she was looking at placing it so high - it went in my left arm right at my wrist, just below my thumb. I was positive that I would be able to feel it the whole time and would throw up then pass out. Well, a surgical catheter is a completely different animal than a regular I.V. First, the area is numbed with Lidocane prior to insertion, so that's awesome. Second, an 18 gauge flexible catheter is soooooo much more comfortable than any I.V. that I've ever experienced.

The next step is meeting with each member of your surgical team. In my case, this was my surgical nurse, my anesthesiologist, and my surgeon. Each explains (or re-explains even if you've heard it all before) their role in the procedure; including any risks involved.

I asked the surgical nurse to set my gallbladder aside before sending it to pathology so that I could see it. He wrote that down.

The anesthesiologist explained that the baby would not be monitored during the procedure. He wasn't being ugly, it was just some hard, simple truth. Fetal monitoring in this procedure is difficult at best due mostly to patient positioning. Also, at 17 weeks gestation, since the baby is not yet viable outside the womb, there is not anything that could be done for the baby should things go badly. His promise to me was that he would keep my blood pressure as even as possible with no wild spikes or dips that would put additional stress on the baby. He also explained that I would not receive a dose of Versed (ver-SAID). Usually, patients are given a dose before being wheeled into the operating theater. It makes you slightly drowsy. The nurses call it the Margarita Mix. It's given to reduce anxiety leading into a procedure. It is not given to pregnant ladies. Dammit.

My surgeon again outlined the risks (general anesthesia always carries a risk. Surgery during pregnancy always carries a risk of miscarriage), and gave a general outline of the procedure. My mother got very quiet and still. She gathered her thoughts and started by asking if things would be removed in pieces. I jumped in to explain that it all has to come out in one piece because the possibility of loose stones in a duct was baaaaad. Then she stared at him for a moment and said 'Her bellybutton is smaller than her gallbladder.' Um, I had not given that any thought... dang. 'Yep' replied the surgeon. Yikes.

I said 'see ya soon' to my family and my surgical nurse wheeled me into the operating theater. I moved myself onto the table since I wasn't looped up on Versed. Then he bustled around getting things set up. I had to take my gown out from under myself, and I began to wonder exactly what would be covered and what would be exposed... to late to start caring now! Cardiac monitoring leads were placed. Anxiety started to set in, and 'Perfect Day' by the Fresh Beat Band started to play on a loop in my head. That just pissed me off. I wanted the Beatles, and I got the Fresh Beat Band.

The anesthesiologist came in and made easy, light conversation about parenting as he set up. I held up my end of the conversation, but was starting to really freak out in my head. As he put the oxygen mask over my face, I hit 'I REALLY DO NOT WANT TO DO THIS!' I started to formulate sentences about how I had changed my mind as the oxygen started. He asked me to slow my breathing down to deep, even in and outs. He let me know that as the medicine was introduced, it would burn a bit. I had time to say 'there it is' as I felt it start, and then I was out. I know that I was dreaming when they started to bring me around, but I don't remember any of it.

As I came to and was wheeled into recovery, my nurse showed me my gallbladder. I wanted to hold the vial and get a good look at it, but he told me it was gross and whisked it away :-/ As soon as the bed was locked into place, I started asking to hear the baby. 'Just a minute, Mrs. Doyle. We have to get you settled.' It took her less than thirty seconds to find Bean, but it was just enough time for me to feel anxious. Bean was (of course) just fine. My throat hurt from the intubation, and pain was starting to set in. I tried to wave away meds, but my nurse just frowned at me and told me that I was going to receive a small amount of morphine (to help keep in front of the pain instead of getting behind it) and a small amount of zofran (for nausea). I sighed and gave her a grudging 'fine.' Then I took a short nap (5-10 minutes) and snapped at her when I woke up. Luz is a saint. She let me gripe and gave as good as she got.

My family was brought back, and I was allowed to have some water. I drank more than I should have. My nurse explained that I had to urinate before I would be allowed to leave, so I should start thinking about that. I said 'DEAL. Let's do this' and started trying to stand up. Luz helped me up, hugged me, then told my mother that I was 'very stubborn'. Nobody was surprised. I peed and we all puttered around for a short while. Then Luz removed my catheter (yuck) and let me get dressed. She went over my discharge orders with my husband. Told me not to sign any legal documents for 24 hours, and sent me home. The ride home sucked. I was so sad that I'd had 4 ounces of water. I kept cursing and feeling nauseated.

I shuffled around my bedroom briefly. I made myself a nest of pillows on Don's side of the bed. The dog was incredibly confused - she hates change. I tried to eat some soup, but only managed two spoonfuls before deciding that was a terrible idea. I had some sparkling water and a hydrocodone left from my initial gallbladder attack as the pharmacy was closed by the time I was discharged. I kept up the cursing. My mom called to check on me... you know... stuff...

Fairly soon, pain really started to set in right around the level of my shoulder blades. It wrapped around my whole rib cage, but hurt more in the back. My surgeon had filled me in on this ahead of time, but nothing can really prepare you. People usually attribute this pain to 'trapped gas' because it feels a lot like you need to let out a huge burp (from your back!?), but it has nothing to do with gas. According to my surgeon, if you were to take an MRI of the torso after this surgery, there is no trapped gas, There is no extra space. A very large majority of the gas is expelled as the procedure ends, and the remaining tiny percent is absorbed by the body VERY quickly. The pain is actually a diaphragmatic spasm. Your diaphragm doesn't like to be messed with. Your gallbladder is right under your diaphragm. Inflating the abdomen to get to the gallbladder really pisses of the diaphragm. It has a bit of a temper tantrum, and goes into spasm. That spasm HURTS. I had my husband 'beat' on my back, then tried to take a bath. Want to see a pissed off husband? Curse loudly and randomly for an hour or so, then ignore him when he tells you not to get into the bath tub.

After a heated argument about the bath and a few tears because I lost, Don left to buy me a heating pad. They were all out of heating pads that weren't $40, so he came back with the herbal packs that heat up when exposed to air. I am in love with those. They stayed warm for almost 24 hours.

I finally fell asleep.

Thus ended my day of gallbladder surgery.

I will end this post here because it is crazy long. I'll talk about my recovery in another post in case you want to hear about that as well...

Long Day

SO - we had a wonderful vacation with fantastic friends. More on that later...

My gallbladder did not respond to treatment with a low fat diet and medication. I have continued to have a moderate to high level of pain pretty much every day. In the 9 weeks since my diagnosis, I have had a few good days and even a good week, but let's face it - almost constant pain and developing a Pavlovian response to food (I am overcome by a physical wave of dread when it is time to eat) are not healthy. Nor is that an acceptable burden to put on this pregnancy.

I came home from our vacation resigned to the fact that I would probably have surgery between Thanksgiving and Christmas and with an appointment to talk it over with the surgeon two days later.

I felt just at ease with the surgeon as I had on my first visit. He listened and nodded and we talked and joked. Then he started checking his surgical schedule. At my suggestion, we started out by looking at the week after Thanksgiving... moments later, he was on the phone requesting a room for Monday - as in THIS Monday - as in 3 short days from where we were sitting. I swallowed a huge knot of panic. He said that if we were going to do this, we might as well stop putting it off... plus, this way I have less time to freak out. What I want to know is how he figured me out so quickly! The man has spent a total of 45 minutes with me, yet he knew that giving me a long lead time into surgery was a bad idea. *sigh*

That brings me to today. Monday. THE Monday. Lily Ruth is with her paternal grandparents in Houston. She's having such a great time that she is refusing to talk to me on the phone :-/ I have bathed twice with Hibiclens (the hospital-grade sterilizing wash), and had my last food & drink at 3 this morning. Now I just have to show up and do this...

I asked one of my on-line communities for meditations or mantras or prayers that they use to offer things up and let them go. I know for a fact that dragging fear and uncertainty into surgery with me is not helpful. I got a few responses - all very sweet and well intentioned - but none of them struck a chord with me. Then today, I jumped into the car to get gas and cash before we go to the hospital. In 15 short minutes, I heard 'Let it Be' by the Beatles TWICE. Not an everyday occurrence. I stopped the car and cried. Let it be. Let it go. Trust and breathe. I can do this.

Here's my list of reasons why today is so awesome:

1) After I recover, I can stop taking all of this damn pills!
2) I won't be in pain or afraid to eat anymore.
3) I can resume my love affair with cheese very soon.
4) ... that's enough for now...

Gotta run. They're expecting me.