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Education  |   July 2012
Remodel
Author Affiliations & Notes
  • Mary Oak, M.F.A.
    *
  • *Seattle, Washington,
Article Information
Education / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Critical Care / Gastrointestinal and Hepatic Systems / Infectious Disease / Ophthalmologic Anesthesia / Pain Medicine / Pediatric Anesthesia / Respiratory System / Technology / Equipment / Monitoring
Education   |   July 2012
Remodel
Anesthesiology 7 2012, Vol.117, 206-208. doi:10.1097/ALN.0b013e31823dadf0
Anesthesiology 7 2012, Vol.117, 206-208. doi:10.1097/ALN.0b013e31823dadf0
IN the heavily overcast dawn, as I strip down for surgery, I recall Inanna. In an ancient Sumerian myth, when she prepares to leave “the great above for the great below,” Inanna arranges her hair across her forehead and dons her regalia: her crown, a small lapis necklace on her throat, a double strand of beads on her breast, and wraps her royal robe around her. She puts on her breastplate and gold ring, and takes her lapis measuring rod and line in her hand. Gate by gate in her descent, each of these is removed from her. At each gate, when something is stripped away, she cries out, “What is this?” and is told, “Quiet, Inanna, the ways of the underworld are perfect, they may not be questioned.” But she keeps asking at each of the seven gates, until naked and bowed low, she enters the throne room of her sister, Ereshkigal. There she is struck by the eye of death and hung on a meat hook for three days: an ancient crucifixion.
My fingers feel odd without the rings I have worn for so long, and even my silver star toe-ring needs to be removed. My fiancé, David has taken my coat to the car, and alone now in a curtained cubicle with a rolling bed, I undress. Naked, I fold my hands over my heart and bow slightly in surrender. I glance at my intact chest one last time before donning the light green gown with busy blue lines and red squiggles. Versions of this will become my uniform in the next week and I will get to know all its openings, snaps and ties to maneuver around tubes. A nurse asks, “Ready?” and when I assent, she opens the curtains and tells me to lie down. She places a heated blanket on me. I try not to think of how during the surgery they will lower my body temperature severely to induce hypothermia. I won't let myself dwell on the image of cold salt water being poured on my heart, in the same composition as tears.
David returns, holds my hand and reassures me with his loving gaze. The presurgery bustle begins with Dr. Ching, the anesthesiologist, introducing himself. He begins an IV of Versed (to forget) and my awareness dims accordingly. Another gate in my descent. The assistant Surgeon, Stan Stacy, joins us and makes small talk. Dr. Vivian arrives in his scrubs with a cheery “Good Morning” and tells me that in going over my echo again, it looks more likely that my mitral valve will have to be replaced. He doesn't say cut out. I am given more papers to sign and they harness me into the bed. David stoops over, his lips finding mine in a long, slow, time-stopping kiss, before he takes leave. His taste lingers. I know he'll be waiting nearby.
My glasses are taken. Everything is a blur. Sounds muffle and din.
My body strapped down, I rise up from earth's hold. I become the light princess in the story I loved in my childhood. Unencumbered, I float. Instead of being held by the ribbons of courtiers, I am corded with tubes and wires. My consciousness is erased while my body is chilled down and operated upon. There are more gates to pass through in my descent: breath circumvented, circulation rerouted.
As a kite is reeled in from the sky, that evening I come to. In the blear of sedation, I still can't see, although I sense David nearby. As soon as I open my eyes, he is ready to tell me that I am in the ICU, that the surgery was a success. The hand I love above all others strokes my forehead. My lungs are being squeezed—open, shut. There are other hoses draining from my body, and wires connecting me to a monitor. I am being breathed by a machine. I try to find my chest. How is it?—too far away to know.
Over the next few days, my awareness vacillates between semi and complete stupor. I have my glasses now, but what takes place in the ICU is just a veneer, beneath which, as soon as I close my eyes, another world is revealed. It begins with dense black punctured by pulsating points of light, as if I am peering into cellular structures, galactic and subatomic in one. Not just visual, but dizzying, this gravity of oblivion. As long as I keep my eyes open, perhaps I won't fall in?
I vomit and bleed. With effort, I press the button to raise or lower my bed. I can't sit myself. I drift between worlds. I can't stay awake while Betsy visits with a gift of orange mountain ash berries, of crimson oak leaves, to bring nature in to me. David hangs them nearby, a dash of color in the sterile room where flowers are forbidden. I learn the nurses' names. I forget them. Blood is drawn from me every four hours, IV's checked, replaced. David tells me things. I nod and they fade.
The respirator has been removed. My breath is shallow, but my own. There is a plastic mask of oxygen over my face. I could speak now, if only I could form the words. To string them together demands a rigor I do not yet possess. But I mumble: “Lethargic …” To find the word to describe my condition is a supreme accomplishment. I have drunk deeply of lethe, the spring of the underworld, of forgetfulness. My eyes shut despite my effort to keep them wide open. It is useless.
Behind my lids, I enter a different realm. I have lost track how many gates I have passed through. Surely this is subterranean. Beings melt one into another, grasping, jabbering, crying out in anguish. They are hurt. They are tormented, molten, distorted, entrapped, cruel. This toll of misery keeps moving—suffering, suffering, suffering, suffering. Later I will recognize it as hell. Hells dancing. The nine circles of Dante's inferno crisscrossed and jumbled. Meanwhile, I try hard to keep my eyes open. When I don't, I sink back into the swirls of ghoulish agony.
Later, I awake, alone with the glow of machines interrupting the dark.
I don't know when the oxygen mask was taken off; there are tubes in my nostrils now. My breathing is shallow. I am lying on my back, slightly propped up. I can feel a little steady jolting inside me, against my back. I veer away from going any further into the sensation, understanding that in order to be comfortable, I will need to ignore this. I carefully maneuver to lie on my right side, facing the tube of my IV and the line of the morphine drip that I can self-administer when I want, by squeezing. I hardly use it, preferring pain to the blankness.
Slowly I move my tethered hands to my chest. They rest on the bandaging between my breasts, thickly taped up to my collarbone, and ending somewhere else out of sight, indeterminable. In a rush of gentleness, my awareness reaches into the wound below the wad. Tears flow in gratitude mingling with the pain, not unlike the time after giving birth. I want to comfort this newborn, raw and fragile. I want to cheer her on, “You made it!” I want to soothe what has been cut away, to welcome my remade heart, made new within me.