Where I've Been for Two Weeks

All the stories I tell here on the Bruise Chronicles are true, but I have refrained from telling personal stories... until now. Although I have many many acquaintances, I share the details of my life with few people. Telling a story of this depth in a public place is something of a stretch for me, but some stories are meant to be told, in the hope that they encourage others, and more than anything else, keep us all connected.

Warning: In this episode of the Bruise Chronicles, I get up-close and personal with my pregnancy difficulties and discuss medical issues and female parts. My goal is not to make anyone uncomfortable, but to relate to you my experience and hope you find encouragement. Similar to Lance's story of conquering cancer, the details are central enough to the story to be unavoidable.

First, a big thank you to all of you who have been praying for me, who have sent me messages, and generally let me know you were concerned about me; it goes a long way. We often don't know what to say when someone is suddenly ill or distressed or in misfortune, but just a quick, "Hey, I was thinking about you the other day and thought I'd give you a call to see how you are," is often all it takes to sooth or cheer someone. Thank you to all of you who followed that impulse.

The Background: Wanting Children
Many of you know that Steve and I are planning to adopt a newborn. In fact, she's due in late October. We discussed adoption even before we were married, both of us recognizing that there are plenty of children out there who need good homes and dedicated parents. We've never felt that anything was "missing" from our lives, and never felt pressured to "produce" offspring simply because that's what people do. But as the years passed, and my statistical chances for giving birth started on the downward slope, we began making a conscious effort to have a child.

I have been dealing with endometrioma for a number of years. I don't know how long it's been there, but in the past year it has grown to the size of a 8-oz water bottle. Endometrioma is a strange condition that they don't fully understand, but briefly, it's a growth that occurs where it should not, usually near the female organs. It's non-cancerous. Sometimes it presents itself as a fluid-filled sac that adheres to healthy tissue. This is what I have. It has adhered itself to my right ovary and somewhat diminished its capacity for production. That's OK, though, because my left ovary produces eggs very well.

My doctor removed the growth laproscopically last year after it had grown to 9cm x 5cm, scraping as much of it from the right ovary as possible. And while its removal greatly relieved my pain and discomfort, the endometrial tissue which tends to regenerate had unfortunately adhered itself like a spiderweb to that right ovary, and the growth began to reappear early this year. It is now again a little larger than it was last year.

The Trip to the ER: How to get Moved to the Head of the Line
Sunday evening before Labor Day I begin having acute pains in the lower left quadrant of my back and abdomen, as if I have been pierced with a spear from back to front. I try to get the pain under control by stretching and breathing deeply. Nothing works. Every attempt to swallow pain medication results in it coming right back up again, and I am violently ill just trying to drink water. When I realize that it's been two hours, I've vomited four times, can't drink water, and am soon to dehydrate, I awake Steve and we head to Balboa Naval Medical Center ER. Just an FYI, if you ever need to get admitted immediately to an ER, but there's about twenty people already waiting there, collapsing at the registration desk, writhing in pain and then showing very visible signs of nausea are your ticket in.

The med techs peg me for kidney stones, and order the appropriate tests. After several hours, a CT scan and a sonogram, we have the word: everyone is fascinated by the largest endometrioma they've ever seen hovering over my right ovary, my kidneys are clear and look great, and my left ovary is an alarming size.

Smiling in the face of pain. Attitude is everything.
Besides, I never had a CT scan before, and it was kinda exciting.

Most likely (according to my doctor) my left ovary has become enlarged, has fallen over on itself and can't get up. If it got twisted, cutting off its blood supply, that would be the source of the acute pain. But by 6am, the sonogram reveals healthy sounds of bloodflow, and my pain is now more centrally located, not on the left. The doctors conclude that if the left ovary did experience a torsion, it has self-corrected. I am given meds for the pain and discharged from the ER late Monday afternoon.

Tuesday afternoon I see my doctor (Dr L.) for a follow-up at NTC, and I tell him little has changed. I have constant pain, and my whole belly has swollen such that it hurts to wear anything but a mumu, and I'm afraid to eat. The hours of distress have thrown my body into a reactive state of tension and created ah, complications, and I fear my GI tract is slowly starting to shut down. He tells me to keep doing what I'm doing, drink plenty of fluids, and come back the next morning for blood work. I go home to the couch, a heating pad, and pain meds.

Wednesday I return to NTC for bloodwork and another examination. Dr L. sits me down to talk to me, takes a deep breath and tells me I need to go immediately to Balboa to get a thorough sonogram. He tells me that he's very concerned that the left ovary is so enlarged, and he still fears that it has twisted over on itself and has no blood supply. I see by the look in his eyes what he is telling me.

"So best case scenario," I say, "is that I have really bad gas and some inflammation, but worst case scenario, my 'good' ovary is dying and I could lose it. I could be looking at the loss of both ovaries," I tell him. This is my GYN, and also my fertility doctor. We've been working with him for over a year trying to conceive. I'm essentially asking him if he thinks the battle might be lost. It's a really big question that addresses things he seems hesitant to say.

He straightens up. I don't think he's used to women reading the cards on the table without emotion. I read the cards and then sift through the deck to see what I've missed. I hate being broadsided by things.

"Well," he seems to back away from the dire diagnosis, "I'm just saying it could be the case."

"Right. We're planning for contingencies," I say.

"Yes. I like that word. It's contingency planning." He smiles a tight-lipped smile at me, and sends me off to Balboa.

I take a deep breath as I get in the car and put my earpiece in my ear and make my phone calls. I call my mother, and three different priests, and tell them the situation. I need their prayers. I just want to be healthy, and I want peace of mind. It's times like these that I remember the scriptural verse that "the prayers of the righteous avail much", and I lament that I haven't been more diligent in my own prayer life. So I call the people who inspire me to pray more. I briefly tell them the situation, and ask for their prayers.

The Wednesday 9/3/08 Sonogram: Grabbing Hope from the Jaws of Despair
By the time I'm taken into the sonogram room, I've been waiting in the lobby for half an hour, lying on the floor because it hurts too much to sit down, tears streaming down my face in pain and frustration. As the girl prepares the sono machine, I sigh and ask myself if I'm ready to know the outcome of this test. That's when the thoughts start swirling in my head, and quite unexpectedly begin to connect and take shape and actually make sense.

The Doubts and Fears
While Steve and I, over the past ten years have not tried NOT to get pregnant, we waited quite a while to pursue any fertility treatment options. I've never regretted that decision to wait, because I know in my heart that the time was not right when I was in my 20's and early 30s. I've been far too selfish for much of my life to pour my energy into children without resentment. But now that I'm ready... is it too late?

Finding Hope
We all have a purpose. I know this.

In a letter my mom recently wrote, she said:

[Despair's] goal is to steal our joy, drag us down, and see us trampled by our own hopelessness, never to rise to the purpose God has for our lives. And make no mistake, God has a purpose for your life… all our lives have purpose. Our job it to discover that purpose… and fulfill it.

Lying on the table in the sonogram room, her words come to me, spinning around in my head with many many other thoughts. I'm adopting a baby girl at the end of October. God has somehow chosen me to be the mother of this little girl. What if... what if He's chosen more? I mean, if Steve and I have decided that we can economically and logistically raise four children, well, who am I to demand that they be my biological offspring? If God has chosen children, who, in His wisdom, would thrive under our care, who might not otherwise have a two-parent, loving home, well, who am I to close that door?

In other words, if my purpose at this point in my life is to be a mom, then there is no diagnosis, no condition, and no test result that is going to stand in the way of that purpose. Things might not always go according to the original plan, but things seldom ever do. This pain that I'm having, whatever it may be, is just a bump in the road, not necessarily a brick wall. We can work with it. It wasn't part of the plan, but we can work with it.

I laugh out loud, let the tears run down the sides of my face, and smile. It's going to be OK. No matter what the outcome, it's going to be OK. I find Peace.

I am in the sonogram room for over an hour when the tech turns up the sound, and we heard the splashing sounds of heartbeat. It seems my left ovary is being fueled after all, which is good news, but we still do not know the cause of the pain, which is the bad news. They determine my sonogram to be "inconclusive," as one can never be absolutely sure where bloodflow sounds are coming from.

Regardless, I go home encouraged, knowing that those thoughts that came to me about purpose are not thoughts you generate on your own when you're lying on your back in pain. Those thoughts are given to you as a grace from God when you are being lifted up in prayer.

Time Passes, Not Much Changes
Friday morning I return to NTC to see my doctor, who sees improvement, and tells me that since I'm improving, he will schedule surgery for Oct 1, to remove the endometrioma and with it the diminished-capacity right ovary. However, should my pain increase, I am to page him immediately.

Saturday morning I sing in a wedding, take a nap, then return to church to sing again. I'm managing the pain well and have something of an appetite. However, Sunday finds me laid low and in pain. Sunday afternoon we page my doctor, who instructs me to come in on Monday so that we can prepare for a Wednesday surgery.

I'm now mostly on a liquid diet, and have little appetite. I've lost about five pounds, that I don't really have to lose. I force myself to drink soup and eat some gluten-free cornbread. In sheer desperation for any relief from the abdominal pain, at the suggestion of my physical therapist Michelle, I go for a colonic at Living Water Rejuvenation Center. I enter the room where I see a table for me to lie down, and doing so, I see on the wall a framed image - detail from the Creation of Adam by Michaelangelo.

I stare at the picture as tears stream down my cheeks. I so need the touch of God right now! The girl who is to perform the colonic comes in and I explain my tears. She smiles and responds that she had hoped when she bought the picture that people would take courage from it, and be reminded that we all need a touch from God. Big shout out to Ciara, who was so loving and gentle throughout a somewhat delicate and disconcerting procedure.

The colonic goes a long way toward giving me some relief from my abdominal pain, which I am still convinced is caused by the enlarged tissues in my abdomen pressing on my colon, causing acute GI distress. No one suspects that there is anything more going on, partly because I'm so good at pain management, and partly because I know my body well enough to nuance what I'm doing in order to gain optimum performance from it.

The day before surgery I run errands and visit friends, then collapse on the couch at the end of the day, exhausted. Surgery is scheduled for Wednesday afternoon.


Wednesday 9/10/08 Surgery: The Best Team I Could Hope For
I'm in good spirits. I pack my overnight bag, half-convinced that I won't even need it. The last time I had laparoscopic surgery, I was back on the bike for a 30-mile ride within six days... of course, I hadn't been reduced to a liquid diet for the two weeks prior to surgery that time.

Pre-Op. Talking to the anesthesiologists.

I dress in the little peek-a-boo smock that they give you and am led to the OR prep room where my surgical team starts to show up. I see Dr W., who is my secondary physician at the clinic. He was not scheduled to scrub in on this surgery, but he was available, and came down on his own time to be here. Wow. For a moment I simply have no words.

Through the glass of the room, I happen to see Dr P., my orthopedic surgeon who fixed my wrist a year and a half ago. I rush to the hallway and call his name. He greets me with a huge smile and a fist bump, then inspects his handiwork. I show him that I am at 100% mobility and still going strong. Pretty good for a plate and eleven screws in one tiny wrist. I'm encouraged by seeing him, and by remembering what a great team I had for my orthopedic surgery.

Back in the prep room, I speak with the anesthesiologist and tell him my concerns:
1. I tend to blow through anesthesia like it was never there
2. I always wake up nauseated
3. I always wake up with vital signs in the tank and therefore no way to relieve the pain without compromising the respiratory system (opiates depress the respiratory system)

Without hesitation he says, "Well you sound like you're an ultra-rapid metabolizer..."

"What do you mean?" I ask. I've never heard this.

"Well, there's about 10% of the population who metabolize opiates much faster than normal. Where most people would be given a dosage that would last 45 minutes or an hour, it might last you at most 15 minutes. We can work with that."

Putting in the main line.

As it happens, I see one of the anesthesiologists on my team the day after my surgery. I excitedly tell him that I felt no pain and no nausea and how it was such a beautiful thing. He tells me that indeed, I am an ultra-rapid metabolizer, and that when they went to put me under normally, within ten minutes I was coming out of it. They knew then to put me under "really deep," and I did just fine.

The waiter takes my cocktail order...

Just before they administer the "cocktails", I see Dr L., my GYN who will perform the surgery. I ask him if he would mind if I pray for him. He smiles in mild surprise, and agrees. I take his right hand, pause for a moment to gather my thoughts, and say:

May God give you clarity of thought. May he guide your hand. May He give you wisdom, and bless your decisions. Amen.

It's a powerful prayer that I have thought about for several days. With that, they administer the meds through my veins that will put me out for the next few hours.

Already groggy with the drugs, I revert to my nerdy side. My last words before I drift off into oblivion are, "Live Long and Prosper."

Post-Op: Not the surgery I was expecting
I awake from surgery in good spirits, with an overwhelming sense that everything was good. Then I overhear the nurse talking to someone about "removal of the left ovary..." and I rouse from my sleep, shaking off the fog in my brain. That's the wrong one. She must be referring to someone else.

"Um, left ovary? Who are you talking about?" I ask her.

"Oh, I was discussing your surgery with--" she begins.

I interrupt her. "But I didn't have my left ovary removed. It was the right one. It had an endometrioma..." I explain.

"No, they had to remove the left..." She continues explaining, but I stop listening. It makes no sense. I want to talk to someone else. Where's my doctor? Is my husband around?

I'm still convinced she's mistaken as she wheels my bed out of the recovery room and into the hallway headed for 4 East where I will spend the night. I see my husband and ask him to please set her straight. He speaks to me instead.

"Honey, they had to remove the left ovary. When they got in there, they found that there was nothing else they could do. It had become twisted and lost all blood supply. They said the tissue was black and necrotic. They had to remove it. In fact, they were really shocked by its condition said they don't know how you even walked in here. Dr L. said he'd never seen anything so bad in someone who was still functional."

He paused, then reassured me, "The right ovary is in good shape; the endometrioma is still there, but Dr L. said that the pathway from the ovary to the fallopian tube is clear, and you still have a chance of becoming pregnant. Your right ovary is still healthy."

I am silent, taking all this in. My husband adds, "I'm sorry it's not the news you expected."


Choosing Not to Despair
I'm a planner. I like to know what all the contingencies are and be prepared for them. I hate surprises, and get really thrown off my game when I'm caught off-guard. When I go on long mountain bike rides, I take a small set of pliers in case I get into cactus and need to pull splines, and a space blanket in case I get injured and need to ward off shock. I'm usually prepared for the worst, while hoping for the best. I don't deal well with unforeseen outcomes.

Going into this surgery, I never foresaw this outcome. I figured I was just constipated...

To my own surprise, I nod my head and say, "OK," in quiet acceptance of the reality in front of me that it is what it is. The peace that had comforted me on the sonogram table a week before is here again with me this afternoon. Thinking again of that moment when Peace surrounded me like a warm blanket and assured me that if my purpose at this time in my life is to be a mom, then nothing will stand in the way of that, and remembering the prayer that I said over my doctor before the surgery, in which I asked God to guide his hand and bless his decisions, once again I find Peace. With those two reassurances, how can I let myself despair?

Clinging to those two memories and moments in time, I rest my mind, knowing that, even though this might not be part of the original plan, that's OK. We can work with it. After all, nothing ever really goes according to plan. This is a bump in the road, not even a brick wall. Even if it were, brick walls are scalable.

I spend a sleepless Wednesday night in mild pain and great frustration, mostly at not being able to sleep. My body metabolizes things strangely, and even after taking an Ambien in desperation at 3am, I am still wide awake at 4am. After I am authorized morphine at about 6am, I am finally able to sleep, and awaken to a better day Thursday. I take a midday walk in the courtyard with my husband, albeit a slow one. Thursday night is much better, now that I've been authorized almost as much morphine as I want. I'm a much kinder, gentler patient when I'm on narcotics.

Just before my discharge from the hospital on Friday, I see Dr W. (who had not been scheduled to be there for my surgery, but came and scrubbed in anyway). He remarked that I looked good and was improving quickly, and wanted me to know that he and his family had been praying for me. Wow. Another wow moment. I'd never spoken to any of my doctors about faith or prayer, I'd only heard Dr L. comment from the hallway one day, "God is merciful to me..."

Thank you to all of you who have kept Steve and me in your prayers. They have truly lifted me up and sustained me.


Recovery
I spent two days in the hospital trying to get all my - ahem - air ducts and plumbing operational again. Big shout-out to the angels of mercy in 4 East of Balboa Naval Hospital. Thanks for your diligence and concern.

Surprisingly, my discharge papers tell me that I may resume normal activities "as tolerated." So on Monday, lured by the idea of a bike ride with my buddies after a two-week hiatus, I show up for a ride at Donny's Cafe. When my buddies realize that I am less than a week out of surgery and that a minor organ was removed, they are less than sanguine.

"Wait. What are you doing here? What if you over-exert yourself and start bleeding internally? It's not like we can apply pressure or something. Go home. I mean, we'd love to have you come ride, but... please rest today. Come ride Friday."

Yeah. I know they're right. When you have to wear bib shorts because regular cycling shorts chafe the fresh incision at your navel, you should probably go home and rest instead.

Moving Forward at the Speed of Light... Lite Ranch Dressing, that is
It's one week today that I had my surgery, and I'm feeling pretty good. I tire more quickly than I'm used to, but I know that's just my body healing. My neighbor across the street saw me on my bike on Monday and didn't know whether to rush over and hug me in excitement that I felt well enough to ride, or rush over and beat me with a rolled-up newspaper for putting myself at risk of strain and injury so soon after surgery. She settled for hugging me and threatening the newspaper beating if I didn't rest. I have a great neighbor.

I know the hospital staff in 4 East were probably concerned with the amount of morphine I was on, and wondered if I weren't some closet junkie, but I'm down to one pain tablet a day, and actually forget to take the Motrin I've been prescribed for inflammation. I took the 4 East team a basket of fruit and homemade banana bread in appreciation for all the great attention and care. Plus, they really need some decent food in that place.

I've received so many calls and text messages, and even a home-made e-card (she sent a photo of a homemade get-well card - how cool is that?!) from a girl I only recently met, who was kind enough to take a moment to send well-wishes my way. Some people, like the girl who shares my name and lives in Toronto, Canada, called several times before getting through, just to wish me well and tell me that people were praying for me. I feel so very rich and blessed and very humbled by all this concern. Thank you all.

The past two weeks have really reinforced to me that attitude is everything, and that there is no substitute for caring, loving people. So if you get the chance to be a caring, loving person, I don't care who you are, I guarantee you, there is someone close by who could benefit from the gift of you.

I've told this story because I know I'm not the only one who has faced endometrioma, or difficulties getting pregnant, or adoption, or disappointment. Be encouraged. Make an effort to stay connected. Choose not to despair by dwelling on the positive things that you have control over.

For additional encouragement, everyone should read The Last Lecture, by Randy Pausch.


More Adventures On and Off the Bike coming very soon. Watch this space!