It feels like a lifetime since I shifted myself onto the operating table, and lay there shaking and bawling my eyes out, terrified as I was about to have a craniotomy. My first time in hospital, and I was having brain surgery. Frankly, it brings tears to my eyes even now.

It has changed my life profoundly, I am different. In May, with nothing else lined up, I quit my job that was making me miserable. It was one of the best decisions I have ever made. And so began Sarah’s ‘Summer of Love’. I decided to take time off from work, and do only the things I loved. As a designer, I worked on my creative passions – whiled away hours in front of my sewing machine, and took regular trips out with my camera. Every now and again I went out and networked with others in the industry, or picked up small design jobs to keep things ticking over.

I ran, went spinning, and generally sweated until I was soaked through. I also joined a gym and fulfilled a longterm dream of working with a personal trainer. He did my general fitness assessment, and jokingly asked if I wanted to get started the next morning (a Saturday) at 6am. I don’t think he expected “ok then!”. Three months later and he’s still stuck with me.

Through all this I found my passion for design again. Now I do all the things I love AND am busy as a freelance designer. Life is balanced and I am happier, healthier and fitter than I have ever been before.

People sometimes comment that I am hardcore, impetuous, or that I ‘bounce off the walls’. Of course I bloody do! You think that’s a bad thing? I work out five times a week because I love it, I have more energy than I know what to do with. I pick up projects, and work with people that inspire me. I make better money than I ever did in my miserable job (just a nice side effect). But really, you don’t know what hardcore means… hardcore is having a head full of staples, throwing on a hat, and taking the dog out in the snow.

prophecy

Today I was reviewing all the photos I have been taking during recovery. It’s amazing to see the progression from “normal” person (with a brain tumour), to post-op pictures, right through to today.

I looked so happy with staples crossing my head, and am even happier now to be able to show off my dent, I pretty much force people to feel the metal pins on my forehead. Hey, if you have war wounds you should flaunt them!

So, if you are facing the same journey as I did try and take photos throughout. On a day you are feeling sorry for yourself you can look back and remind yourself how freakin’ tough your are, and how far you’ve come.

I found this prophetic photo today, it must have been taken about a year ago not long before I got married. If you haven’t worked it out I am looking directly at the site of my craniotomy.

Before surgery Meningioma, bilateral frontal edema.

ct1

Day after surgery Pneumocephalus (air in the cranial cavity), hemorrhage, bilateral frontal edema stable. *Slightly different slice.

ct2

Day after surgery Lots of staples, and 3 plates/screws.

jan29th_side

Today 3 plates/screws

april1_side2

Craniotomy’s are things of horror movies, or TV shows like Grey’s Anatomy. It never crosses our mind that these things happen in real life, but they do. Many times a day in the city that you live in, whether planned like mine, or unexpectedly due to an accident for example… they are happening.

This is a series of clear diagrams and annotations from the Mayfield Clinic that shows how a craniotomy is performed (I take no credit for the information below, it belongs to The Mayfield Clinic). My neurosurgeon explained this to my husband and I verbally, but this is exactly the picture that formed in my head. It is good to be aware of all the layers of your head that need to heal afterwards so that you can truly respect the recovery time needed… and it’s a while considering you can look perfectly normal on the outside.

 

Figure 1. Craniotomies are often named for the bone being removed. Some common craniotomies include frontotemporal, parietal, temporal, and suboccipital.

 

Figure 2. The patient’s head is placed in a three-pin Mayfield skull clamp. The clamp attaches to the operative table and holds the head absolutely still during delicate brain surgery. The skin incision is usually made behind the hairline (dashed line).

 

Figure 3. A craniotomy is cut with a special saw called a craniotome. The bone flap is removed to reveal the protective covering of the brain called the dura.

 

Figure 4. The dura is opened and folded back to expose the brain.

 

Figure 5. The bone flap is replaced and secured to the skull with tiny plates and screws.

Hospital: Part 2

March 13, 2009

I woke up after my craniotomy in neuro ICU. My husband was there, and at the ready. I have no idea how long he’d been waiting, but he went and got me ice chips thank god… I was thirstier than I had ever experienced before. 

Taking stock, I was surrounded by bleeping machines. I had a clump of wires coming over my shoulder, each one sticking to a sticky pad monitoring my heart rate. There was a blood pressure cuff, that took my blood pressure at the most inopportune moments. Then there was the tubes… I had an IV in the top of my left hand, one in my left wrist, one in my right wrist, and a central line stitched into my jugular in my neck. They were all attached to one kind of drug or another, Decadron, Dilantin, Morphine…

Next there was the plethora of things around my head. Most noticeably, there was a serious bandage around it. Not just any kind of bandage, but a compression bandage that came right down to my eyebrows and that covered my ears. It was so tight that it was pushing my eyebrows down so I could barely open my eyes! Luckily for me, a nurse came and chopped a bit off so I could see properly again.

The bandage hid a variety of sins. Of course there were the 35 odd staples riddled across my head. Then there was the wire that went into a hole in my scalp and plugged into a monitor that measured inter-cranial pressure, plus the tube that went into yet another hole and drained excess fluid. Couldn’t feel either of them, and when I found out they were there I really didn’t care, they had major jobs to do.

I know it is hard to believe, but my head never hurt! I had a dose or two of morphine because of pain in my neck. So it stays absolutely still, they put your head in a vice-like clamp, and in a totally unnatural position during surgery. My neck was SO stiff I could never have imagined it in my wildest dreams. It was all fine when my head lay on its left hand side, but try and straighten it? Holy crap! I had to support my neck with my hands while I moved my head with it’s heavy bandage.

Neuro ICU was a safe place to be, but not one where you get any sleep! Every hour, on the hour your dedicated nurse came by and did neurological tests. If you are lucky enough to be asleep, you are woken up and lights are flashed in your eyes. You are told to put your arms in the air, IV lines flailing all over the place, and the turn your palms to the ceiling. Next you have to move your legs and push your feet against the nurses hands. Did I mention, every hour on the hour? Then you hear other patients going through the same ritual. I heard a lot of “Lawrence, Lawrence, open your eyes for me please” that night. He didn’t seem to be doing so well. 

Everytime a nurse came by to do these checks I asked for yet more water, also asked their name, how long they’d worked in neuro ICU, what time it was, and generally got chatty much to their annoyance. Hey, if you are going to wake me up every hour I expect a conversation out of it!

In the morning my neurosurgeon and his interns came by. About 6 medical students in their neuro rotation stood in an arc around the foot of my bed. Dr Muller proceeded to tell them that “This is is the lady who presented with the olfactory grove meningioma and Foster Kennedy Syndrome. Forget the interns, I was the one asking the questions, “What syndrome? What’s that? You never said anything about that!” He responded, and I promptly forgot what he said. 

The time before 11am and visiting hours begins is BUSY for the patients! Next came my surgeon’s senior resident, and his interns. Shortly thereafter came another nurse who cut off my bandage with scissors. Ahhhhh, the relief, my head no long weighed a tonne!

Then came yet another neurosurgeon, with another medical looking person in tow. He removed the two tubes from my head. There was quite a lot of tube hidden in my head, and while it didn’t hurt when he pulled them out, it felt gross to feel it moving under my scalp! He had to really yank to get them out. Ewww. Then he proceeded to stitch up the remaining holes… no local anesthetic, just the needle and thread. I laughed and used the F word (not the food one for Gordon Ramsay fans) intermittently until he was done.

At some point someone brought breakfast, and someone else came by cleaning the floor… he tested my reactions by nearly pushing my table into my face with his mop. He got the evil eye from me, thats all I can say. 

Next came a social worker, then two physiotherapists. They wanted to get me out of bed. So, maneuvering with all my tubes I managed to stand up. Much to the physios chagrin however, a nurse arrived with a wheel chair to take me for a CT scan. Phew, I got to sit down again and was whisked away downstairs. Uuuuugh, but how is it possible to get motion sickness from a wheel chair?! Anesthetic and steroids thats how. That nurse got strict instructions from me to slow down, especially when cornering! 

Once back in neuro ICU, a nurse came by and announced I was moving to the ward. All the IVs were removed bar the one in my hand (plugged and left for emergencies), including the horse needle in my neck, and was wheeled off to the neuro and trauma ward. No monitoring machines anymore, I was all on my own less than 24 hours after surgery.

The physiotherapist found me again and I had to go for a walk down the hall and up some stairs. I felt thoroughly gross afterwards and didn’t eat for the rest of the day. Then I felt icky from not eating, then from having to get out of bed… the viscious circle continued. I think I lost 5lbs in those few days.

All this before 11am!

The next day my surgeons came by and announced they wanted to send me home. Yes, one day after surgery. I was still feeling like crap from the anesthetic so managed to get myself one more night in hospital. Never thought I would be asking for that!

Overall my stay in hospital was as good as it could have been, considering I had a craniotomy. Every single person I came into contact with at St. Michael’s Hospital was polite and friendly, and the whole place was so efficient.

For those of you who have a date with the surgeon like I did, I really didn’t feel anywhere near as bad as I expected afterwards. It was terrifying beforehand, and it wasn’t fun afterwards, but it really wasn’t that bad at all! Recovery on the other hand requires much time, patience, and a level of self awareness that allows you to recognise (and work on) the subtle differences your brain presents you with on a day to day basis.

Hospital: Part 1

March 8, 2009

My memory of being in hospital is clouded by the drugs they were pumping into me. The memory fades even more as time progresses so I decided it is time to get it down.

I woke up that morning to find it had snowed all night, sparking the discussion “drive or TTC”. Bundled up against the elements, my husband, Dad, and I ended up walking down the sidewalk, single file towards the TTC station. The mood was heavy, and while standing on the train I could see the worry on their faces. 

I scanned the people around me, what were they doing that day? What were their hopes and fears, what challenges would they face? I felt isolated and different, while these people were eating lunch, I would be wheeled into an operating room for a craniotomy to have a meningioma removed.

St. Michaels ran like a well oiled machine. Within 5 minutes of arriving I had an ID bracelet on and was in a hospital gown. A nurse called Judy started an IV. She told me that they like to get my neurosurgeon’s patients admitted and on an IV as soon as possible, as he likes things to be done, and likes them to be done on time. Another nurse came in and took blood, and not long after an orderly came by and wheeled me downstairs for a CT scan.

As quickly as the orderly arrived to take me for my CT, they left. I lay on a bed in the corridor, my husband and Dad hanging around with me. Patients, technicians, and doctors came in and out of the CT rooms, but no-one came to get me. Eventually Dr. Muller emerged from the stairwell, exclaiming “There you are!” No one had brought the patient to him, so he came to find the patient himself. Apparently I didn’t need another CT, in fact he had just been studying my CT from December in preparation for surgery, and that was all he needed. 

The neurosurgeon wheeled me with enrourage in tow, up to the 9th floor and the final waiting area before you get wheeled into the operating room. When was the last time you ate or drank anything? Are you allergic to anything? Have you or anyone in your family had problems with anaesthesia? Do you have any loose teeth? The neurosurgeon, the neurosurgeon’s senior resident, the nurse, another nurse, the anaesthetist, and yet another anaesthetist all asked me the same questions. Very thorough! 

Not long after the nurse arrived to wheel me into the operating room. It was hard to say goodbye to my family, and I suddenly realised how frightened I was without them around me. Big double doors opened, and the bed glided through into a long, wide corridor. On the right were windows, it was still snowing and gloomy outside. On the left was one operating room after another. Some doors were open, some were closed, but all were quiet and were full of people shuffling around. Next thing I knew I was being wheeled into one. 

The first thing I saw was a shelving unit full of metal contraptions, and I am pretty sure my blood pressure went through the roof at that point! There must have been 8 people or more in there, quietly moving around readying things. Machines were everywhere, as were IVs, and trays of vials. Once on the operating table, my arms were pulled out into a cross position and placed on their own supports. A nurse on one side, an anaesthetist on the other, IVs were going in on both sides. They were calm and so incredibly kind, I was terrified and was pretty much bawling my eyes out. That is until they gave me a sedative and I immediately stopped and became Miss Chatterbox. I think thats when they knocked me out…

So my follow-up with my surgeon on April 2nd, over 2 months after my surgery. Hey, lets do a craniotomy, now shoo shoo off into the world! To be honest though, it has all been absolutely fine and I haven’t needed to see a doctor asides from having my staples removed. 

I can finally get all my questions answered, GPs really don’t see (m)any brain surgery patients so can’t really answer anything with certainty…

  • How is my brain, my cerebral edema, my skull, my incision?
  • Am I officially 100% tumour free, and was it definitely WHO Grade 1?
  • Is the gaping hole in the middle of my head filled with brain again? Lets see that CT!
  • Give me a time-line on this no-smell thing! Plus, the persistent chemical smell is getting really really boring. 
  • When will the large areas on my head that have no feeling, sort out the nerve damage? When my head gets itchy, I can’t feel anything when I scratch. Its driving me bonkers!
  • Do I still have to sleep on a 30 degree angle? Your nurses put the fear of god in me when it comes to head drainage! I’d really like to go back to a single pillow.
  • When can I exercise again? More than walking that is, I’m talking getting back to spinning and running here. 
  • When can I ride a bike, or more specifically when is it ‘safe’ for me to fall off a bike?Will it ever be safe?  I love my little Dahon, and hate the TTC.
  • When can I drink tea/caffeine again, and alcohol… when can I have a lovely glass of red again? Mmmmm Cabernet Sauvignon!
  • When can I fly? Life owes me that Parisian honeymoon that we had to cancel.
  • And I know neurosurgeons don’t care about vanity, but I’d like to know if  I will always have a dent in my head, and when I can have a hair cut, and use styling products. 
  • When will I be able to go back to work? Right now I can’t even concentrate through a 2hr lecture and be able to function afterwards.

There will be many more questions by April…

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