Year's End and New Beginnings (again)

The Tricks Of Memory
I recall clearly how on the morning of my surgery the orderly showed me the way to the shower; he handed me a squeeze bottle of antibiotic soap and a towel. I remember the colour and smell of the soap, the rough texture of the towel. I can vividly recall the orderly's face and mannerisms but not as clearly as his sure and decisive movements, when, back in my room, he shaved my arms and chest. It is here that things get a bit strange. I know certain events took place after these minor indignities and before I received any drugs, but I can't recall any of it clearly; in fact was only sometime later, and after talking with people who were there that I started to 'remember' any of it.

I remembered being shaved; I didn't remember my wife coming in and chatting with me for the next hour or so. I didn't remember joking with her and the doctor as I was taken to the operating theatre. I didn't remember that a friend working at a hospital nearby dropped by to see me. I didn't remember the anesthetist coming in talking with me or starting my medication. In other words it’s not just that I don't remember 'flying' or anything else after the anesthetic I don't remember events that took place before I was 'medicated'. In fact over the next days the question of what I remembered and, even more troubling, who was remembering it, were to become pretty serious problems for me.

After the operation I was taken to intensive care where I spent the next day or so under the watchful eye of monitors both electronic and human. Intensive care meant one nurse per patient, it also meant being hooked up to a number of machines. Some of them monitored vital functions others substituted for those functions -- like the machine, which, through a tube down my throat, breathed for me. That tube came out some hours after the surgery, others like the tube in the side of my neck or those in my legs and chest came out later, some like the catheter for my bladder came out the next day. The thin silver wires that lay neatly in two small coils on my chest were left in for a few days. These bare metal wires ran directly into my heart and were there in case something needed zapping in a hurry. All these tubes came out on time -- no problem. My first post-operative memory has nothing to do with them but with something that may seem much less intrusive, the triangular oxygen mask that covered my mouth and nose. I felt as if I couldn't breathe and the sweat and irritation from this respirator only seemed to make things worse. The nurses were great, very kind, very compassionate, but with no pity, hard as nails… an interesting combo.

Besides moments of worshipful admiration for the nurses who took turns watching me, my major concerns were the twin problems of how to remove the mask that I felt was asphyxiating me and how to get out of bed. I kept pulling the respirator off and the nurse would gently but firmly insist I put it on. As for the bed I just kept trying to get up, not having much control of my body at this point that intention ended up with my body just tossing and turning or writhing about. The bed was somehow associated with the discomfort I felt and I just knew I should get away from it.

Only A Small Digression
Years ago I was in an accident where the truck I was driving spun out of control on a wet highway and ended up rolling over a number of times till ending up in a ditch. I remember a similar feeling as I stumbled away from the truck and collapsed on the side of the road, the only thing I could 'think' was that the truck had hurt me and I should therefore get as far as possible away from it. Same with the bed in intensive care I just wanted to get up. I remember feeling nauseous, I'm told I vomited. A few hours later they brought in a chair and let me sit there. Soon the mask was replaced with a smaller device that delivered oxygen to my nose and didn't cover my mouth. Things got a bit more comfortable and I was slightly less altered, but still in a twilight world far from daily life. From that point on I remember more things clearly, both external events and certain internal considerations or preoccupations.

Recuperation begins?
The external events were simple: the next day I was moved to a less intense observation room called a 'step down room' and a day or two later to a normal room for the rest of the week. I started to walk around and people came to visit me. I didn't sleep much but I could concentrate, I could converse, the second night after the operation I read an entire novel. But none of this corresponded exactly to my internal situation, which seemed to gravitate solely around questions of identity and location. As soon as I started to wake from the anesthesia as I lay in the intensive care ward I kept wondering whether I was finished with the surgery or waiting to go into surgery. My chest hurt, I could feel the cut and the bandages, on one hand I knew that meant the operation was over, but I didn't really believe it; I couldn't remember so I was sure I must be waiting to go into the operating theatre. The only certainty I had in all of this was the feeling that it would not be a good idea to ask the doctors or nurses because they would think I was confused and keep me in the hospital longer.

The question of whether I was waiting for the operation or recovering from it was one that kept reoccurring over the next few days -- as well as the feeling that it would be better not to let anyone know that I didn't know what was going on. This was not my only preoccupation however, not even the major one. Much of the time I thought about Ed and the situation he was in, suddenly I would realize that I was not in the same hospital that he was. It would dawn on me that I was in Toronto and he was hundreds of kilometers to the west in a different hospital, in a different city. At other moments I would realize I wasn't in London but I would find myself either in a hospital to the northwest of where I actually was (a non-existent hospital) or in another (non-existent) city. These places not only seemed real but familiar; it seemed perfectly normal to be there – wherever there was at that moment.

I suppose I must plead guilty to a certain paranoia, for example It seemed obvious to me that I shouldn't let anyone know that I didn't have a clue whether I was going in for an operation or recovering from one. If they knew they'd want to investigate my confusion and probably keep me there longer. In the same way it seemed obvious to me that I shouldn't tell a doctor that I didn't have any idea where I was or even who I was. In any case what would I say to the doctor, that at moments I thought I was at some hospital visiting my poor friend Ed? That a few times I thought I was in the hospital not for heart surgery but because I had incurable lung cancer. Or that sometimes I would vanish or perhaps I should say transform. I would be lying on my bed (or shuffling along the hallway, or sitting watching television) and then the ‘I’ that was a moment ago me was now Ed. It wasn’t that I thought I was Ed, anymore than you sit around thinking you are you. It was just that I was him. Trying to clarify ‘who’ was feeling all this would be difficult, but there it is – I would wake up, and as I waited to see my doctor at the same time I was Ed waiting in his hospital for the result of some test. Or perhaps I would just be sitting in bed and I would suddenly realize that I had, a moment ago, been Ed lying in his bed in his hospital room

And Recuperation Continues
Within a week after the operation these 'delusions' were pretty well gone. It was also around this time that I started almost inadvertently, in conversation with those who had been there, to 'reconstruct' some of the memories of what happened before the surgery: who had visited me, who I had spoken to, what we joked about etc. Still even now those delusions, those strange displacements of time, place and identity seem more real than those reconstructed memories of what I know must have happened.

These descriptions don't capture the strangeness or the ordinariness of these moments. They were strange after the fact, in that they revealed a great confusion. They were also strange because they kept occurring over the next days in a range of variations. All this however seemed very ordinary in the moment—it was obvious I was me (who ever that was) here (wherever that happened to be); in one hospital or another in Toronto, in London or in some other place, I was myself (?) recovering from surgery or waiting to go under the knife, dying of untreatable lung cancer or visiting a friend in the hospital. I, maybe I was not me at all, I was my friend Ed.

While I started to recover quickly they kept me in the hospital a few extra days, not because they’d discovered that I’d lost my mind but simply because of a mild infection. Had I mentioned my strange symptoms it might have been dismissed as a consequence of the anesthetics. A bright young medical student might have, however, scribbled ‘pump head’ on their notes. It’s a term that’s sometimes used for those whose brains are affected as a consequence of the heart-lung machine. The machine that’s used to keep the blood flowing, it can have some pretty serious –sometimes-permanent – neurological consequences.

Oh yeah, as for flying out of your body. You can imagine what a great relief it was for me when a researcher in Virginia recently offered scientific reassurance regarding those cases where patients reported finding themselves out of their bodies during surgery. His report maintained that these experiences were in fact nothing to worry about. According to this diligent scientist what we are dealing with here is not a symptom of mental disease and should not be treated as such. It is simply a reaction to stress.