The Side Effects of Elective Surgery

Part 1: The Diagnosis can be read here

By the time I was in junior high it was apparent I was developing a receding chin. It was really not a big deal, a lot of people are built this way (think Carol Burnett before her surgery), but my orthodontist dad had tried everything in his arsenal to fix the problem in his own office and told me someday surgery would be an option. My mom was especially eager about this idea, probably because she had a weak chin of her own, though not nearly as pronounced, and likely felt responsible for passing that feature on to me.

They had a full plan in place, that I should wait until after high school when I would be 18. I would be old enough to reasonably undergo surgery then and it would be less weird showing up at college where no one knew what I looked like. At the time I thought there was no way in hell was I voluntarily going under the knife for something cosmetic. The parents didn't press the matter and more or less dropped it.

Midway through the miserable mess that was my senior year of high school I had the brilliant idea all on my own that I should just go ahead and have the surgery. I'd been poked and prodded so much by then I was no longer fearful of needles, hospitals, or anesthesia. Also I kinda wanted to do something nice for myself, and what better way to do that than to be able to show up to college as my best me?

Step one was to clear it with Dr. Wenzl. Would this be a safe procedure for me to undergo? He had never had any other patients go through elective surgery with kidney disease (they were children after all) but he didn't see any reason to not do it.

Step two was to meet with my dad's "oral surgery guy" conveniently across the street from Children's Hospital in Oklahoma City. The surgeon was excited about my case, knew exactly how he wanted to proceed, and showed me before and after photos of similar patients. Not only would he be rotating my lower jaw forward, he would be removing a small portion of my upper jaw so I wouldn't have such a gummy smile. He also baited me with the possibility that if I didn't make a change I could suffer headaches in the future. I was sold.

About a month before the surgery and right before my high school graduation my dad once again put me in braces, though this time they were the nifty clear kind. The braces would be essential in securing my jaw post-surgery. Not to be wired shut, but for stabilization.

As a graduation gift and partially a "sorry you had a sucky year" present my parents sent me to Disney World for a week with two of my good friends, Catherine and Elizabeth. We had a great time and it was the perfect distraction for the looming trip to the hospital. Though the previous year had given me the courage to agree to surgery, I still felt butterflies slowly multiplying in my stomach.

June 10 my parents and I got up way before the crack of dawn to trek north. We arrived at Presbyterian Hospital, got checked in, and were pushed through to pre-op. I remember very little after that as they like to relax you with a little drug cocktail. Then after wheeling you into the operating room, you go night-night. This would be my first rodeo with general anesthesia. 

My first awareness coming out of unconsciousness was overwhelming nausea. This is not uncommon with general anesthesia, in fact these days they usually give everyone something ahead of time to ward this off. The anesthetist will even meet with you pre-op to see if you have a history of problems with anesthesia and give you a little something extra to help with the nausea if that is the case. Back then, however, that was not a thing.

I was throwing up pretty regularly for the rest of the day, continuing into when they moved me into a real room. Unfortunately, the only thing in my stomach at that point was the blood that had drained there from my head surgery. I have vivid memories of my dad recognizing the unmistakable signs of impending barfdom and rushing basins in front of me. My dad had taken a few days off of work to be there for the surgery and recovery. This was major surgery after all, and also this was kind of his area.

As one day of throwing up blood turned into two, the doctors became alarmed. Sometime in day two my heart-rate started speeding up. By evening I had full on tachycardia. I was surprised at 10:00 that night by a visit from Dr. Wenzl, clearly called in straight from home in casual wear.

After checking my labs and vitals, he wanted me moved nextdoor to Children's Hospital where he could better monitor my treatment. I was loaded in an ambulance and relocated to the ICU unit at Children's.

What Dr. Wenzl had determined was that my kidneys had decided to peace out after this surgery nonsense. Creatinine clearance is a blood test that measures the amount of creatinine in your blood, which is usually filtered out by the kidneys to be expelled in the urine. Too much built up in your blood can kill you. My creatinine had risen to an alarming level. If it didn't come down in the next few days I would have to have at least one dialysis treatment.

The ICU is a horrible place if you are at all lucid. Just by virtue of being there you feel like 10 miles of crap, and I was recovering from jaw surgery on top of that. My visitors were limited to one at a time for short durations and not allowed to stay in my room overnight. I would wake up in the middle of the night, too weak to do anything but lie there and contemplate my situation.

I started thinking about all of the children who had been in this unit. Here I was, an eighteen year old, scared out of my mind and incredibly lonely. How many truly little kiddos had been locked in these rooms with no comfort?

I was in the ICU for roughly five days, but it felt like an eternity. Children's Hospital was a teaching hospital, so I would get medical students coming into my room asking me the most inane questions.

"Have you been out of the country in the last six months?"

"Have you recently come in contact with any exotic birds?"

Really, med students? It's not rocket science. I had a surgery my body couldn't handle and my kidneys decided to take a hike. I always tried to be polite, but I also was not feeling great and my tolerance for stupid questions was sinking quickly.

Finally on day five my kidneys returned from their vacation. My lab-work was looking better, so dialysis came off the table. I was going to be moved out of the ICU. 

I was never so happy to see a regular old hospital room. It was easily twice the size of the ICU cocoon and had real chairs and recliners for real people. Surely now I could continue healing and be sprung from the hospital soon.

"Ha-ha-ha, not so fast!" said my body. It was time for the nosebleed situation. I don't remember precisely when the nosebleeds started, but they were intense. As Ryan often says when we are randomly discussing head injuries (as you do), "I don't think people realize how much blood is actually in the human head." They had to basically pack my nose and then come change out the gauze a few times a day. It was seriously disgusting and painfully uncomfortable.

At some point they just started giving me morphine, which...I'm not gonna lie was the best part of my hospital stay. Morphine just makes the pain magically disappear and also makes the time magically disappear. I genuinely think there were about 5 days where I didn't know what was going on.

The ENT specialists were called in. It was determined the source of the bleeding was an aneurysm about an inch below my right eye. The bleeding was not going to stop on its own. An experimental procedure was suggested, and at this point we really had no other choice. I couldn't keep losing blood. 

Similar to a cardiac catheterization, a small tube would be inserted into my groin and threaded through my body except instead of going to the heart, it would be going all the way up to my head. They would use x-rays to be able to locate the aneurysm and then clamp the bleed with aluminum coils. In theory. The whole thing sounded like some crazy made-up Star Trek nonsense, but what the hell?

It worked. It absolutely worked. The entire procedure took five hours and I was conscious for all of it (they needed me awake to give me instructions like holding my breath, turning, etc.) but was so hopped up on morphine I couldn't feel a thing. To me it seemed like a half hour. Those surgeons at Children's Hospital of Oklahoma were talented geniuses and heroes.

From there I could finally focus on healing from my jaw surgery. I was well enough to have visitors and one day my best friend Rebecca drove up with Catherine and Elizabeth to say hi and to bring me a card. My bulletin board was already littered with get well cards from friends and family. Doug drove up for a few days all the way from Houston where he was spending the summer before his last year at Rice. I have a vivid memory of him spending the afternoon with me playing cards while my parents took a well-deserved break.

My kidneys back online and my bleeding resolved, I felt like I was back where I should have been two weeks earlier. The oral surgeon's office had given us a "cookbook" for a liquid diet back before the surgery that made my mom and me laugh. It had recipes like "hotdog" that was basically "put a hotdog and some ketchup and mustard in a blender." Delicious! 

We weren't going to do any of that. I remember a lot of Carnation instant breakfast in the hospital once I actually felt like "eating" again. That got supplemented with cans of Ensure closer to the end of my stay. By the end of the three weeks I was in the hospital I had lost an alarming amount of weight and I was pretty slender to begin with. 

My release date finally arrived. It was determined I was stable enough to go home and continue recovery there. A few months into my senior year, my parents and I had moved to a temporary rental home on the east side of town. They had purchased property elsewhere and were working on the designs to have their next house built. The rental house was just about the ugliest thing I'd ever seen. The exterior was nothing to write home about, but the interior was next level. Orange shag carpeting. Fuzzy wallpaper. Bobby Berk would have just set the place on fire and started over.

Nevertheless, walking back through that door felt like heaven. Being able to sleep in my own bed and not be bothered all day long was such a relief. I was still incredibly weak and the lower half of my face was numb, but I was so thankful to have survived that experience and to be out of the hospital.

I would need the rest of the summer to recover fully, but we were hopeful I would be ready in time for college in the fall. Dr. Wenzl told me I had to gain 10 pounds before he would let me go off to Trinity. I went on walks with my mom, drank way too much Ensure for a normal human, and slowly learned how to eat again as my mouth regained feeling. 

So. Would I do it all over again knowing what I do now about the consequences? The not completely insane answer is of course not, but I hate that question. What's done is done and honestly I'm thrilled with the results. I know it was jarring for those who knew me pre-surgery to see me after, but I was happy with it and my college friends didn't know the difference. Ryan often says when looking at pictures of the before times that it's like when a sitcom switches out actors between seasons. If any good came out of this misery at all, it was that I was finally comfortable with my appearance. And it was almost time to go to college.

Next up: college life