Friday, March 20, 2020

Life in lockdown - Day 10

For the greater San Francisco Bay Area, this is Day 4 of the Shelter in Place order.  For my partner and I, this is Day 10, as we got a bit of a head start from my own medical needs.  I’ve been quietly recovering from a surgery a week before the lockdown started.

Our days are spent quietly, playing around on social media, catching up on publications and articles, turning on the news to catch up on the outside world each evening.  I have books to catch up on, and I enjoy doing a bit of writing as well.

I’ve been digging out my old amateur radio equipment and getting it on the air, although due to my location, homeowners association restrictions, and the construction of this building, I have had very little luck with this hobby activity.  I do have some 50 year old equipment I have been restoring, and I have a couple of work tables set up in the guest bedroom that I use for tinkering about with this older equipment.  I don’t expect to have any house guests in the near future, so I can take over this space more for myself.

The view from the condo looks out over part of the huge Highway 680 and 24 interchange.  Roads that crept along in the morning and evening commute are almost empty, and “rush hour” looks like 3AM on a Sunday morning used to look.  I see a lot of trucks and utility vehicles going by, most intent on providing what I assume are necessary services, and a good number of private vehicles from the few commuters left on the road.

The downtown area looks like a ghost town.  The parking garages in the urban core are all shuttered, and street parking has been declared to be unmetered through the lockdown.  Many businesses are closed, and I honestly am not sure if some will re-open.  We’ve heard that unemployment claims are way up.

There’s a Kaiser Permanente hospital near here, as well as a CVS pharmacy and a Target store.  We’ve heard that these are all candidates for drive-up COVID-19 testing, assuming one meets all the pre-approval criteria, but have not yet seen signs of the expected tents in the parking lot for such a test setup.  Kaiser has already set up 19 drive-up testing sites in the region for its members.

Trying to maintain community contacts is a challenge.  Rainbow Community Center (RCC) and Mt. Diablo Unitarian Universalist Church (MDUUC), both groups that I am involved with, have been experimenting with teleconferencing software to handle team meetings and regular group gatherings.  MDUUC has been streaming its Sunday service for quite a while, and last weekend did its first “virtual only” Sunday service, with no audience and minimal staff, all practicing their safe social distancing skills, to provide a service that hundreds watched online.

Both my partner and I are quite active on the public side of Facebook, various private groups, and message boards, all of which feed virtual communities.  This can help a little, but I find that I am a social animal, and need some sort of human interaction.  Not being able to scratch that ‘social itch’ is frustrating, and has me feeling a bit irritable.

I’ve done some committee and board meetings for local organizations via the Zoom teleconference system, which has worked out very well.  I particularly like being able to see other actual human beings, and their facial responses to things I say.  It feels much more connected somehow than voice, and far better than textual exchanges such as message boards. Well, as long as folks turn on their cameras, anyway!  There are always the shy ones!

I have some books I am reading, and I really should get cracking on doing my tax returns, but I am so easily distracted, especially by my kitchen.  The past couple days I have made a Russian rye bread, a sourdough banana cinnamon raisin bread, and blueberry cobbler.  They all turned out very well.  I’ve been cooking full dinners, from corned beef and cabbage to a nice thick crust pizza, along with salads and sides.

I usually also do a hot breakfast, anything from simple steel-cut oats and berries, crumpets and coffee, to bacon and eggs with a hash or potatoes.  Some of that cinnamon raisin bread wound up as French toast yesterday.  The pantry is well stocked, and I have no problems improvising with what I have on hand.

Life in this odd enforced isolation is good so far, and my partner and I are getting along well and preserving each other’s sanity.  I have to confess that I do dread reaching the point where I have to brave the insanity of our grocery store again, a place that is dangerous for our health as senior citizens now, and apparently overrun by panicked shoppers.  Just why do you need two dozen onions and all of the beef jerky, anyway?

Sunday, March 15, 2020

Facial Surgery, Round 2

In mid-2017, I met with my surgeon at Kaiser, Dr. Andrew Kleinberger, as arranged by the Multi-Specialty Transitions Clinic.  We worked out what I needed for my facial appearance in the way of surgical changes.  A CT scan of my head was arranged to gather data the doctor would need in guiding his work.  

The doctor broke down the needed work, totaling some 14 hours of surgery, to be done in two parts.  The first stage, involving bone and cartilage work from forehead to jaw was about 8 hours worth, and the second portion, adjusting soft tissues to match the new bone structure and making some changes to alter the throat cartilage was estimated at about 6 hours of surgery time.  The two surgeries would be at least a year apart to allow adequate recovery and healing of the bone before shifting the soft tissue.

The first surgery was done in late August of 2018, and is documented here.

The second stage surgery was performed on March 9, 2020.

We arrived at Kaiser Oakland at 6 AM for checkin and preop stuff.  I was quickly tagged and after a few minutes was back in the pre-op area to be weighed, measured, plumbed and wired for surgery.  I was in the usual little hospital bed, the Gown of Embarassment donned and ready in just a few minutes.  They had that lovely warm air blanked already running and hot, which felt very good indeed.

Because of the time I would be on the OR table, special pads were placed on my rear and shins, something new to me.  The usual EKG wires were placed, and an IV run into my left hand.  Blood pressure was through the roof initially, so I spent a little time in breath meditation to bring this under control.

Laurie was brought back to help me relax a bit, and we chatted about nothing in particular, she trying mostly to reassure me all would be well.

Dr Kathy Brandstetter came by about 7:30, along with a newer doctor on the team, to place guide marks for surgery on my neck and face.  Both had excellent bedside manners, quite reassuring.   They explained that Dr. Kleinberger was a little late and I would see him in surgery.

My anesthesiologist came by, and we discussed what would be done, the broad sequence of events, IV + oxygen + gas, intubation once I was well sedated, and that the tube would be removed post-op, likely before I would be able to remember.  We discussed nausea control and whether or not the anti-nausea patch would be a good idea.  Oh, I got the patch, unlike the first round, and it worked very well!

At 8 AM I was rolled away, saying good bye to Laurie until I was done.  I had the easy job and would be asleep.  Laurie got to sit in the waiting area watching the status board for color changes next to my tracking number.

I was rolled into OR6, still wide awake.  “Good morning, Dr. Kleinberger!”  Three surgeons (one in training), anesthesiologist, scrub nurse, assisting nurses, all circulating around me!  I was shifted onto the surgery table, positioned, armrests attached and my arms lightly fastened down.   My head was on a foam doughnut and chux pad, giving me a great view of the upside-down anesthesiologist and some huge adjustable surgery lights.

The recorder started, all present checked in.  “Michelle, do you you understand what we are about to do?”  “Yes, sir.  Rhytidectomy and chondrolaryngioplasty.”  Basically, a lower facelift and trach shave, as we had discussed a few years ago.  The other stations gave their reports.

“We are ready to begin.”  The anesthesiologist placed the mask and started the oxygen feed.  The doctor mentioned that he would not intubate until after the chondrolaryngioplasty.  (They need to use probes to verify that the incision on the cartilage would not impact the attachment point of the vocal folds.)  Position would be shifted 180 degrees after the chondrolaryngioplasty.  

The smell of the gas suddenly changed.  The room gently spun and faded from view.

I woke in the recovery area about 4 PM.  I felt more than a little spacey, and was thoroughly bandaged up.

I was told that the surgery had gone well, and I would be shifted upstairs for an overnight stay shortly.  I gathered that a Foley catheter had been placed for the hours of surgery, and had been removed about half an hour before.   Laurie was able to join me in post-op, although I don’t remember too much.

At some point we were rolled upstairs to the 11th floor.  I was placed in my room, met the staff, told I would be on a liquid diet, and was asked to watch a couple of videos on fall safety and the hospital stay.

After a few hours they had me out of the bed, and with the aid of a walker made a lap of the floor.  I managed to demonstrate bladder function to their satisfaction, so I was not catheterized (Yay!), and drank my juice and water.

Laurie would be sleeping in my room with me,k a great comfort.  I drifted off after being given two Tylenol for pain control.  I woke just about midnight as the night nurse came in to start an antibiotic IV going.  Pain was ramping up, and I was given 5 mg oxycodone.  This got me to sleep more easily, although the BP checks at 2AM and 5AM woke me again.  

About 7:30 two other doctors on the ‘head and neck’ surgery team came by on their rounds and changed the dressings, showing me how to tend to this.   The dietician came by for my breakfast order... cream of rice or cream of wheat... Decisions, decisions...

The discharge orders were in by 8:30 and a Percocet prescription was ordered for me.  Laurie went down to pick this up.  By 10:30 I was getting dressed, and Laurie went to get the car while I waited for the nurse to take out the IV line and the escort to roll me out of the building in the usual transport chair.

It all went smoothly, and I was home by 11:30.  Oh, breakfast never showed, but Laurie and I had some steel cut oats once home.

The first two days I used a Percocet every 6 hours just to ensure I was comfortable.  The third morning  I switched to one 325 mg Tylenol and stayed with that a few days, just taking a Percocet at bedtime.  

I’ve adjusted my bed to raise the head a foot and have been using a few pillows to support myself.  The elevated position lowers pressure at the surgery site and promotes drainage.  Everything is healing nicely, and the stitches come out Monday, a week after surgery.

I’m back to eating solid food, and the soreness in the jawline and throat congestion from probes and intubation is almost gone.

I’m just waiting for a little bruising and swelling to fade away.

I think I’ll be happy with the result.