Ed And Me

This next anecdote deals with a moment in a series of medical events. The decision to proceed with heart surgery had actually been made a few years earlier but before they could get down to it I was diagnosed with cancer. On that hangs another tale but this one is pretty good on its own.

Ed and Me

This next anecdote deals with a moment in a series  of medical events. The decision to proceed with  heart surgery had actually been made a few years  earlier but before they could get down to it, I was  diagnosed with cancer. On that hangs another tale  but this one is pretty good on its own. 

When Donna and I first met with the heart  surgeon, he said with neither wink nor nudge:  “Having surgery at this point may seem strange  to you since you have no symptoms. However, it  is not uncommon in cases such as yours that the  first symptom with which the patient presents  is sudden death, and we would like to avoid this  complication if we can.” So, on October 5, 1993,  I entered the Toronto General Hospital for heart  surgery that was scheduled to take place the  morning of the next day. 

I had opted for the still somewhat experimental  Ross procedure. It involved switching one of my  pulmonary valves for my aortic valve, and (in my case) replacing the missing valve with a donor  valve. It was a procedure that they hoped might delay, if not totally avoid, another go-round. This  promise was offset by its being a surgery that  was both experimental and more difficult than  the standard version. Being a more complicated  procedure implied being on the heart-lung  machine for longer, being under anaesthetic  longer, more of all kinds of nasty stuff . The  operation took more than 5 hours, which was  a couple of hours longer than anticipated. The  surgeon later said this was because the damage to  my heart was much more advanced than had been  anticipated. In any case, the operation was deemed  successful, and the recovery has, so far, from a  medical standpoint been relatively uneventful,  though it has been accompanied by some curious  events.

Projection of the Double

In the weeks before the surgery, besides  developing a few mild symptoms, shortness of  breath and fatigue (that may have just as likely  been psychogenic), I also started to imagine what  might happen during the surgery. I don’t mean  all the horrible slip-ups that might occur. That  was not the issue. What held me in thrall were the great stories that one hears about people who,  during surgery, claim to hear the doctors talking;  claim to see the surgery underway; claim to see  themselves from outside. They explain how, during  some surgical procedure, and with the assistance  of a general anaesthetic, they found themselves  looking down from the ceiling of the operating  theatre at the action unfolding around their  recumbent form. They tell us in great detail, and  with wonderful precision what they saw, what they  heard. What could be more exciting than that? 

Facing the cruel certainty of the surgeon’s blade,  who could resist the promise of a life not limited  to the, apparently, too weak flesh? Imagine if your  mind could reach out beyond the confines of your  body, if life wasn’t dependent on the vagaries  of neurochemistry. Anyway, the idea of “tearing  around outside of my body” was very appealing  and I thought quite a bit about how I might pull  this off . After all, I knew something about flying  about. 

As I mulled it over, it seemed to me that the major  problem with my plan of temporary liberation  from the suffocating confines of this mortal coil was the likelihood of being overwhelmed  by the anaesthetic; I would almost certainly be  unconscious before I managed to figure a way to slip the mortal coil. My only chance lay in the  possibility of preparing myself—of rehearsing  the image and intention in such a way that at the  crucial moment before losing consciousness I  might, perhaps, with luck, slip away.... 

And come back… of course.

A Method
I spent the day before the surgery asking the  doctors, nurses, and attendants about what I  should expect. If they thought this was just normal  apprehension from someone who was about to  have their chest split open, pried apart, their heart  stopped and…. If that’s what they thought, they  must have soon begun to suspect there was more  afoot. I grilled them for every detail: What does it  look like? What happens then? Where? Who does it  and what does it smell like? I would construct the  most precise picture possible and then imagine  the process, rehearsing it over and over so that I  might produce a new kind of reflex that would, paradoxically, be set in motion by my loss of  consciousness. 

Once visitors’ hours had ended and the friendly  distraction of concerned faces dispatched, I was  able to turn my attention to the task at hand. Lying  in my narrow hospital bed, I stared at the walls,  which were appropriately painted a slightly queasy  hospital green. I reviewed the images, letting them  play out in my imagination, searching for when  and how I might find my way out of the constraints  of my own body. 

Tomorrow very early, they would wash me twice;  I couldn’t quite imagine the smell of the special  antiseptic soap, but I could almost feel the razor,  hear it as they shaved my arms and chest. I  knew that they would wash me for a third time  before the anaesthetist came around to insert  the IVs in each arm and then administer some  delicious narcotic. Then I would be wheeled down  to the surgery. They told Donna that she could  accompany me as far as the surgery doors, but  then she would have to wait in the designated  area.

Sickness Unto Death
I had been rehearsing my images of the surgery for  some weeks already, adding details as I discovered  more about the procedures but concentrating on  forming a clear intention to “fly” as the anaesthetic  kicked in. And if it worked? What would it mean  if afterwards I remembered leaving my body and  gently drifting upward? Would it just be a dream  that I had managed to pre-program? Would it  mean I had actually been outside of myself? How  would I ever know what to believe? 

The days preceding my surgery brought with them  other occurrences that came to pressure me more  than the upcoming event. My friend Ed had just  been informed that he had an untreatable and  terminal cancer. At the same time, his wife was  told she had a possibly cancerous uterine growth.  Happily, her tumour ended up being benign, but  you can imagine how, in that moment, all this  added to the general climate of strangeness and  the sense of improbability. 

These and other unlikely and unfortunate  situations weighed heavily on our circle of friends. It felt like one more link in a chain of deaths  and illnesses in which we’d somehow become  entangled. Besides that circle of mutual friends  who formed part of this stochas-tic improbability,  there were a few more cases that I brought to  my personal version of ‘the list’. 

There was the  suicide of a childhood friend, a death made more  poignant since I was perhaps the last person he  spoke to before he killed himself; a young woman  dead from breast cancer, another dying. 

Around  the time I began chemotherapy an old friend and  mentor died in the hospital after receiving minor  surgery to his hand. Then my oldest friend (we  had grown up together) died unexpectedly of a  massive heart attack. The deaths and near misses  included my own bout with cancer only a couple of  years earlier. 

Now there was this situation with Ed, an old  comrade, and recently promoted to the status  of my oldest living friend; the likelihood of his  imminent death weighed on me. Was there  something I could do to help him live? Was there  something I should do to help him prepare to  die? 

When I entered the hospital in Toronto for  heart surgery, he entered a hospital in the city of London, Ontario, some 200 km to the west. I  would be undergoing heart surgery and he would  be having the sack around one lung drained of  fluid. Then, through a process of induced irritation,  the pleura would be forced to bind to the lung so  no more liquid could accumulate there. This was  not meant to affect the course of his disease in  any way—it was only to make him a little more  comfortable as he waited for death.

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, only sometime later, and after talking with  people who were there, did I “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 anaesthetist 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 anaesthetic; I don’t remember events that  took place before I was “medicated.” 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.

Post-op

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 various  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 and  wires 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 wanted out and 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 repeatedly 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 soon visitors appeared. I didn’t  sleep much but I could focus a bit, I could converse,  and the second night after the operation, I filled  the long hours devouring an entire (short) novel.  But none of this corresponded exactly to my  internal situation, which seemed to orbit solely  around questions of identity and location. As  soon as I started to wake from the anaesthesia, I  found myself laying restlessly in intensive care. I  kept wondering whether I was finished with the  surgery, or waiting for it to begin? My chest hurt,  I could feel the incision and the bandages, and on  one hand knew that meant the operation was over,  but I didn’t really believe it; I couldn’t remember  it and so was sure I must be waiting to go into the  operating theatre. The only certainty I had in all of this was the certainty that it would not be a good  idea to ask the doctors or nurses about any of this  because they would think I was confused and keep  me in the hospital longer. None of that was quickly  resolved. 

This was not my only preoccupation however,  not even the major one. I frequently found myself  thinking about Ed and the situation he was in just  down the hall. Then, suddenly I would realize that  we were not even in the same hospital. It would  dawn on me that I was in Toronto and he was  hundreds of kilometres to the west in a different  hospital, in a different city. At other moments, I  would be shocked to realize that I wasn’t in London  (where indeed Ed was) but instead would fi nd  myself either in a hospital to the northwest of  where I actually was (a non-existent hospital), or  in another (non-existent) city altogether. 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 clear 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. I understood that 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 more than once 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 had a moment ago been “me”  was now Ed. It wasn’t that I thought I was Ed, no  more 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 at the same time as I waited to  see my doctor, 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 had 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  at the moment—I didn’t doubt that I was me (whoever 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, they might have been  dismissed as a consequence of the anaesthetics.  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, 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. 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. 

His report maintained that these experiences were  in fact simply a reaction to stress and nothing to  worry about.