Transformation 45
One of my more quaint and elderly hobbies is listening to American radio drama from the 1930s, ’40s, and ’50s, when radio was the primary form of entertainment. Dramas consisted of voice actors playing parts in various genres, but the most “entertaining” are what were referred to as “mysteries” — mostly goofy crime dramas ending in unexpected twists. Kind of like the precursor to the Shyamalan-style “surprise ending” stuff you see in movies lately. Just as silly, too.
One series dripping with cheesy goodness is called The Whistler. The genre is the aforementioned mystery drama, but the stories are all book-ended with narration by the mysterious “Whistler”, a man who, at the start of every show, whistles an ominous tune to signal the start of another tale filled with mystery and suspense. Each show’s climax reveals an unexpected twist in a final line of dialogue, capped with a two-note beat of a kettle drum to punctuate the drama (and inform the audience that the drama has ended).
A particular favourite of mine is the show from January 9, 1949, titled The Tell-tale Brand. Starting at 10:43, there’s two and a half minutes of hilarious dialogue in which a jilted woman informs her lover–who’s just suggested that they “call it a day”–that despite his efforts to brush her off, “I don’t brush”. As it’s a crime drama involving cheating lovers and murder, it’s all played very straight, and this in combination with her whiskey voice, her incredulous response to his attempt to end things (“Call it a DAY?!”), and the general silliness of it all, it makes for thirty minutes of time wasted in the best possible way.
I have to hear her surprised reaction to calling it a day, all the time. I just have to. So I made an iPhone ringtone of thirty-odd seconds of the juiciest part of this dialogue, and capped it with those booming kettle drums, and The Whistler’s signature whistle. Please enjoy it as much as I have (though I doubt anyone could).
For good measure, please also enjoy a tidier ringtone featuring Johnny Dollar, another show from the era (showcasing the “fabulous world of insurance investigation” — this is no joke), which is preceded by a fifties-style ringing telephone.
On Friday August 26, 2011, I had open left inguinal hernia repair. In the months leading up to the surgery, I’d read a lot of information about it, and was concerned to find mostly negative experiences from those who had the procedure. I decided to document my progress during the first four weeks following surgery, the period after which my surgeon said I would be fully recovered.
Week three
On Saturday, September 10th, two weeks and one day after surgery, Alex and I decided it was time to get back to the trail. We left early and went to Speyside, and spent the day hiking. I moved slowly — very slowly. But I had a chance to find some lovely mushrooms, and spend time in a part of the trail I truly love.
We hiked for about five hours, and covered only about six kilometres, a fraction of the distance we would normally hike in that time. By the end, I was somewhat sore, but the day had been worth it.
This emboldened me, and I felt ready for swimming. On Monday, we went to Angela Coughlan Pool in the evening. I was very apprehensive, although I would only use a pull buoy so I wouldn’t have to kick. It felt strange getting in the water (carefully), and it took about five minutes before I attempted my first length. It was tentative, and I could immediately feel the surgery area.
I did about five laps in total, resting after each length. When I left the pool, the area felt strange, like a pulled muscle, or a strain. I was a bit concerned, but it looked the same. I considered it a success.
I tried again on Tuesday at Centennial Pool, and it went just as well. On Friday, I was back at Centennial, and managed one or two more laps than previously, including a few one-hundred metre laps, and one without the pull buoy.
There was a definite straining sensation on one of the lengths, and I had to quit. Getting out of the pool was difficult. I felt as though I’d have to forgo swimming for the time being.
That evening, I noticed what looked like a slight hernial bulge in the area where the sac had been before surgery. Had the hernia recurred?
Week four
It was difficult to determine what was going on. On the one hand, I was fairly pain-free at the hernia site. However, I’d definitely felt strain at the site while swimming, and there was what appeared to be a sac that was invisible in the morning and appeared later in the day, only to reduce again — sometimes while I looked at it.
It was impossible to decide if I was seeing a natural part of my anatomy, or something anomalous, and the only solution was to see Dr. Chemparathy. I was asked by the surgeon to follow up with him at some point, so I decided to wait until four weeks had passed, after which I’d make an appointment.
On Sunday, September 18, we spent the day in the Niagara wine region. Everything seemed fairly normal, although I was slightly sore. On Tuesday, Alex’ father Serge came to stay with us for a few days. A hike through Bronte Creek Park was not as comfortable as I’d hoped it would be, or indeed, as it had been previously.
The bulge still seemed to come and go over the following few days, with no serious indication that the hernia had recurred. I made the follow-up appointment with my regular doctor for the following week.
I had progressed fairly well up to this point, with no severe pain issues, and perhaps some expected discomfort while engaging in more strenuous activity. The presence of what appeared to be a bulge was only slightly concerning, as recurrence so soon after surgery is very rare. It seemed that I had, indeed, recovered completely at week four’s conclusion. I was satisfied with the entire experience.
Until that weekend.
On Friday August 26, 2011, I had open left inguinal hernia repair. In the months leading up to the surgery, I’d read a lot of information about it, and was concerned to find mostly negative experiences from those who had the procedure. I decided to document my progress during the first four weeks following surgery, the period after which my surgeon said I would be fully recovered.
The day after
On the day immediately following surgery, a Saturday, I had quite a bit of discomfort on waking up. Getting out of bed from a half-prone position was probably the most difficult and time-consuming part of being active, but walking had its discomforts. Going downstairs was also fairly painful. I took ten milligrams of Ketorolac for pain and swelling.
I started eating normally right away, but changed my diet to one of mostly fibre, including fruit, vegetables and whole grain. I increased my water intake to at least ten glasses per day. This was essential to maintain bowel function, which, if interrupted, would be quite painful.
At 10:00AM, or about twenty-four hours after the surgery, I removed the dressing. The wound had bled somewhat throughout the preceding day, and the dressing was blotched on the outside. I understood that to be quite normal, and it had stopped bleeding entirely by the time I removed the dressing, so I wasn’t concerned.
My activity was seriously reduced on the day following surgery. The pain was more severe, perhaps a six out of ten. The local anesthetic had completely worn off, and I was not going to take the Percocet prescribed to me. I needed to keep moving, though, to ensure a quicker recovery time, and so I walked when I could, and moved around the backyard somewhat.
At some point, I needed to move my bowel. Unfortunately, I hadn’t anticipated that the manipulation of the bowel during surgery would lead to a disconcerting halt in peristaltic activity — not quite ileus1, but something too close to it to be encouraging. Any kind of straining was perfectly out of the question, as the pain was excruciating. It wasn’t painful at the site, but in an area about five centimetres above the highest point of the incision. That seemed worrisome.
There were more than a few frustrating and fruitless visits to the bathroom, and the scenarios I was imagining for the future were not pleasant. Warnings in the literature I received from the hospital, together with the totality of despair brought on by some (ill-advised) online reading of patient experiences, conjured up images in my future of an intimate afternoon with the surgical equivalent of a corkscrew. I was not happy. As a safety measure, I started taking the Docusate Sodium tablets as prescribed, though potentially they would not activate for another three days.
Happily, all was resolved by day’s end, at least for the time being.
By the time I went to bed, I had needed all four doses of Ketrolac, for a total of forty milligrams for the day. The pain, once again, was not always excruciating, but it was bad enough to medicate.
The rest of Week One
I was feeling cooped up already by the third day, a Sunday, and Alex took me to Bronte Creek Park. I couldn’t walk very far. There was terrible cramping in the area five centimetres above the wound. I couldn’t walk upright, and couldn’t keep moving for more than a few minutes. Unhappy, and shuffling around like a ninety-year-old, I aborted the walk in the park, Alex’ face all drawn with worry.
What seemed to accompany pain in this area was an extreme feeling of bloat. I had never felt so completely bloated before. Although I also have IBS2 and thus experience bloating, this was unlike anything I’d ever gone through. With what I could only deduce was pressure from bloating at the interior surgical wound, the pain was the worst I had experienced yet — at least a seven out of ten. Walking became harrowing. Three steps were all I could manage before having to stop, half hunched-over like an osteoporosis patient.
I decided that perhaps the Ketorolac was to blame for the bloating, and so my first ten milligram dose on Sunday was to be my last. I also refused to take Advil, or any other NSAID. In total, I took eighty milligrams of Ketorolac over three days before stopping all medication. I even stopped taking the Docusate Sodium.
The bloating continued nonetheless. Frustratingly and frighteningly, bowel function did not improve over the weekend. Finally, on Monday, it returned completely to normal with the help of psyllium cereal.3
We tried the park again on Monday, but the pain and bloating were unbearable. There was also severe pain near my left hip, far above the surgical site. It seemed distressingly unrelated to the wound or the hernia site, but was just as intense. At times, it was excruciating, and made walking very difficult.
As an avid hiker, one who can easily walk twenty or twenty-five kilometres without stopping, who loves the outdoors, who loves trekking the Bruce Trail, being debilitated in this way, even temporarily, was depressing. I decided to stay away from my beloved Bronte Creek Park until I was well enough to walk properly.
Each day brought minimal improvement. I could walk more quickly, and by Tuesday or Wednesday, I was walking the stairs normally, albeit slowly. In the evenings, I forced myself to walk around the block. It was uncomfortable, but it helped me to improve. Sometimes while walking, I found that if I held my hand gently but firmly against the part that hurt the most, I could walk more easily.4
However, progress seemed too slow. The bloating and cramping continued. It seemed to be minimally getting better, but at least it wasn’t getting any worse. When September 2nd came around, seven days after surgery, I wasn’t as far along as I’d hoped, although I had started driving again that day.
Week Two
We tried the park again on Sunday September 4th, but we didn’t get far due to rain. On Monday, I seemed to relapse somewhat. The bloating and cramping was really terrible, and I was feeling stranded at home. Out of frustration more than anything else, I decided to go to Bronte Creek Park in the evening, on my own. Alex was a little worried, but I decided I just had to start moving a little further.
It was a complete success. The bloating, cramping, and pain began as badly as ever, but I kept walking, making my way into the woods. As I searched for and found my beautiful mushrooms, I relaxed quite a bit. The pain eased. I got caught up in taking pictures, and enjoying the autumnal solitude of the woods, which I’d been haunting for thirty years. I felt home. The trees, the leaves, the mushrooms, what summer songbirds were left, the other animals, were all important in helping me forget the discomfort and get moving. It was activity that ultimately healed me of the cramping discomfort I was going through. I was out for more than an hour that evening, and I returned home rejuvenated. I repeated the trip and stayed out longer the next evening.
Follow-up with surgeon
On Tuesday September 6th, eleven days after surgery, I had a follow-up appointment with Dr. Prodger to remove the staples. The pain and cramping were normal, he told me, and so long as it wasn’t getting worse, it would eventually dissipate. I asked about the site of pain a few centimetres above the wound. He said it too was normal, as was a hard lump I found under the skin in the area, where, it seemed, scar tissue was forming. The pain near my hip was probably a result of bruising where the local anesthetic needle was inserted in an artery after I was put under general anesthetic. He said that overall, the expected swelling in the whole area was far less than what is usual, and that I could return to all normal activities, including swimming.
Needless to say, it was very encouraging. I was sure I would start swimming again shortly, and I did, in week three.
But swimming that soon was probably a mistake.
- A morbid obstruction of the bowel caused by a halt in the natural waves that pass food through the digestive tract. [↩]
- Irritable Bowel Syndrome; a chronic, usually lifelong condition that causes some bloating and bowel dysfunction, and which is thought to be activated by mood and diet. The instance of IBS I have is mild to moderate. [↩]
- I used Kellogg’s All-Bran Buds with Psyllium. I’d recommend anyone having this surgery to use it, and to start eating it a day or two before surgery. A third of a cup in milk once a day is sufficient. Drink a full glass of water during the meal, and finish the entire box over the course of two weeks. Surprisingly, it was one of the best things I did to help myself recuperate, aside from walking. [↩]
- This is known as “splinting” the hernia site. It should also be done by hugging a pillow snugly against the area when coughing, sneezing, or vomiting — none of which, by everything in the universe that’s good, I had to do during all the time of my recovery. [↩]
Inguinal hernia in men, especially on the left side, is very common, and hernia repair with a prosthetic plastic mesh is the most common surgery performed. But searching online for information about hernia repair and recovery is frightening. There are an alarming number of stories of chronic debilitating pain, “meshoma”, reduced sexual function, severe reduction in normal activity, not to mention sports activity, and a general degeneration in quality of life. One oft-quoted statistic suggests that as many as twenty-four percent of hernia repairs result in chronic pain and other serious complications. The personal stories on many medical websites are heart-breaking.
I developed left inguinal hernia in late 2010, and did the usual online searching about the condition. I came across story after story of people whose lives were disrupted, sometimes in horrible ways, from their hernia repair surgery. But the chances of complication were generally reported to be very low. In addition, hernia cannot heal on its own. The only “cure” is surgery. It seemed I had no option, so despite the online warnings, I decided I would go ahead with surgery. This and subsequent articles detail my experience with hernia repair surgery, and how it compares with others.
Discovery and diagnosis
In December 2010, while showering, I discovered a medium-sized painless lump just above the left side of my groin. I thought at first it was a very enlarged lymph node, but soon decided it was a hernia, which was confirmed after a visit to my GP, Joseph Chemparathy. He scheduled an appointment with a general surgeon named Dwight Prodger.1 “He’s the best,” my doctor said, “though you may have to wait longer for an appointment.”
I finally managed to see Dr. Prodger in May 2011, after my initial appointment in April was moved by his office. A quick and uncomfortable exam confirmed hernia. He warned of an approximate 2.5% chance of infection, and a greater than 3% chance of bleeding. He said recovery time would be four weeks. No other complications were hinted at. I decided to schedule the surgery.
I opted for a date of August 26, so that my planned summer of hiking toward the Bruce Penninsula would not be interrupted. If I had to do it again, I would opt for the soonest surgery date available. Over the course of nine months, the hernia got progressively worse, probably exacerbated by weekly seven hour, twenty-plus kilometre hikes along the Niagara Escarpment. I had almost continuous pain through August, and increasingly acute incidents while bending when I could feel a portion of the small bowel move in and out of the hernial sac, the visible protrusion of the hernia.
I also swam up to two kilometres a night three nights a week, but I actually think that helped the reducibility of the hernia. That is, the intestine and other tissue usually returned to the abdominal cavity from the hernial sac after swimming, probably due to the horizontal stretching action taking place.
Day of surgery
My procedure was open repair of left inguinal hernia, with a prosthetic plug-and-patch mesh installed. It required general anesthesia, which surprised me, since it seemed to me that most repairs were done with only local anesthetic. When I asked Dr. Chemparathy about this, he suggested that my mesh repair required “extensive dissection” which required general anesthesia.
Mesh was placed behind the abdominal wall at the site of the hernia, a mesh plug was inserted into the hernia, and mesh was placed over the abdominal wall at the site. The surgical wound was closed with seven staples. The procedure took about forty-five minutes.
Immediately after waking up in the post anesthetic recovery ward, I could definitely feel the surgical site. It wasn’t excruciating pain, but it wasn’t comfortable. It felt almost as though I had a severe cramp in the area.
The nurse asked if I felt pain, and I answered that I did. “Are you sure?” she asked. “You got quite a lot of anesthesia in surgery.”
“I feel pain, but it’s tolerable,” I answered. She offered morphine, which I accepted. I got the sense that her question about pain was routine, to ensure that I actually needed morphine. Understandable, but odd, because yes, I was sure I was feeling pain.
Immediately after morphine was administered via the IV drip, the pain subsided, but was still noticeable. I was in the ward for about forty-five minutes, and was administered another round of morphine before being sent to the general ward. It hurt much less after the second dose.
As mentioned, the pain was tolerable. I’d describe it as moderate, or perhaps a five on a scale of zero (no pain) to ten (worst pain I ever felt).
In the general ward, a nurse gave me a prescription for Ketorolac, Percocet, Docusate Sodium tablets, and Lactulose liquid. Ketorolac is an anti-inflammatory and pain medication; Percocet is a morphine-based opiate, which, I was warned, can cause severe constipation. Docusate Sodium is a stool softener. Lactulose is a no-kidding-around laxative.
Constipation is not something one wants to deal with immediately after abdominal surgery. In the many months leading up to my operation, I’d read virtually everything about the surgery. I knew about its potential complications both acute and chronic, the recovery period and what I might expect, and the average long-term outcome, but I hadn’t anticipated an interruption to bowel routine at all. It turned out that its prospect was probably the worst thing I had to endure.
I was discharged from hospital after another forty or fifty minutes. Alex helped me dress. It would have been impossible to do so alone. It was difficult to stand; the pain was more severe when standing or sitting. Getting into the car was difficult, but not as problematic as I thought it might be. Driving home over a less-than-perfect road was probably the worst part of the day, since each pothole sent me swerving side-to-side in my seat, putting pressure on the surgical site. Not pleasant.
I was in hospital a total of about four and a half hours, from being admitted at about 8:00AM, to surgery at about 10:00AM, and finally being discharged sometime after noon.
At home
I was able to walk around somewhat when I got home, though it wasn’t very comfortable to do so. I lay on the couch in an upright position for a long time. This was the only position that was possible. Sitting was out. Standing for too long was out. Walking was painful. Lying upright was most comfortable.
I had some food, and stood in the back yard for a short while, but eventually I had to make my way upstairs to my bedroom. Climbing fourteen steps was difficult — it had to be done one step at a time — but much easier than I’d anticipated. I laid in bed for another long while, then made my way downstairs in the evening, where I did some light chores — moving dishes around, that sort of thing. I’d read that walking was absolutely essential in the first few days, to keep the blood circulating, to prevent constipation, and to generally help the surgical site heal more quickly. It wasn’t very comfortable, but I was determined to stay as mobile as was possible.
First night of sleep
I was in bed by about 10:00PM that night, and had taken three 10 milligram doses of Ketorolac by then. I’d decided against the Percocet, since I thought the side effects were worse than the benefits. I didn’t take the Docusate Sodium or Lactulose, as I didn’t think I’d need either.
The only possible sleeping position was lying upright, with my back supported by the headboard. Lying flat was not possible, and lying on either side was absolutely out of the question. I was asleep fairly quickly.
I awoke about 4AM, and had to use the bathroom. By this time, the local anesthetic as well as the Ketorolac had largely worn off, so I was in some discomfort. Getting out of bed from my half-lying-down, half-seated position was very difficult, shuffling to the bathroom was unpleasant, and trying to sit down once arrived was excruciating. Only by supporting myself on an ideally-situated toilet paper roll holder and the edge of the bathtub did I manage to ease down enough to go.
I was happy to go — one of the complications I’d read about was swelling at the site that pressed against the bladder and resulted in urinary retention, requiring a trip to the emergency department for insertion of a catheter. I was actually very apprehensive about that, and so was glad to pee, painful as everything was. Getting back into bed was also difficult and uncomfortable, but I fell asleep fairly quickly until about seven-thirty.
There were some surprises in store for day two.
I liked Jack. And, liking him, I have no problem calling him “Jack”.
I’d never spoken with him. I saw him only in restaurants in the nineties, and spotted him once in 2009 as he walked alone down University Avenue past the Horton’s I was attending. (Is there another first-world nation where the leader of a federal party can do the same? And where the citizen observers are merely curiously surprised?)
Naturally officious and aloof, I’ve never felt the same inspiration for familiarity with any other public figure, no matter their story. Jack was different. Palpably sincere, plainly dedicated to the values he held, he invited casual personableness. His performance during the last election — the easy smile, the genuine delivery on message — made it clear: to most Canadians, Mr. Layton was, in fact, “Jack”.
For this reason, Christie Blatchford’s column in the National Post seems especially sour, and sadly oblivious of the mood of the people.
I don’t begrudge her the observations of Jack’s beautiful last letter (except for the unusually harsh accusation of “sophistry”). If I am meant to ignore her partisan praise of Stephen Harper as some kind “real hero” in the story of Jack’s passing, I, too, was uncomfortable with the letter’s final testament of politicking, although I share his view of the dire direction taken by the Conservatives. Jack must certainly be considered one of Canada’s best politicians, and his final public words should be viewed through that lens.
Her accusation of deathbed vanity can be excused. Not sharing his political worldview, how can Ms. Blatchford recognize the plainest of statements about a lifelong need to assist those lower in the social stratum than oneself?
I can even overlook her remark about Jack’s letter as replacement pap for an uncharacteristically mawkish media. The spine of conservatism runs straight as an arrow. It is little bent with the everyday concerns of insignificant people, or their expressions of sentiment in the face of ordinary pain. Much of the media has registered and is reflecting many people’s sense of sudden loss; Blatchford seems merely incapable to do so.
For me, what is unforgivable about Ms. Blatchford’s column is its resolute coldness, and its insistence on the shallowness, the insincerity, the vacuousness of the public display of affection for Jack. Grotesquely, she hints that what is lost for us is celebrity. Shame. Oh, for shame.
I run the risk of glutting myself on cliches, but if anyone ever was — if any politician ever could have been — Jack was a true man of the people. He loved people. His entire social and political career is a plain testament of his love for people, especially those not as privileged as himself (or Ms. Blatchford).
I was in Toronto this afternoon, and stopped by City Hall, where, despite Blatchford’s best efforts to describe it otherwise, a spontaneous remembrance to Jack Layton and his legacy of hope has arisen since his death. Across almost the whole grounds of Nathan Phillips Square, people have scrawled their feelings for Jack on the cement, and offered their written sentiments on what he was all about. It’s a touching, loving, unbidden memorial, ephemeral, as it is written all in chalk, and full of the hopes and, now, perhaps lost dreams of the youthful electorate Jack attracted. There were writings in several languages and in several scripts — English, French, Ukranian, Chinese, Urdu, others.
There were countless notes of thanks, from dozens of simple notes that said “Thanks Jack”, to gratitude for specific projects he started, such as the White Ribbon campaign to end violence against women. There were many, many declarations of political awakening because of Jack: “Jack Layton was the reason I started voting”, “The reason I vote is you”. And there was chiding of, and warnings for, other politicians: “This wouldn’t happen for just anyone”, “Take a look Mayor Ford at a true man of the people”, “Attention politicians: represent people not money and we will honour you like this”.
But best of all, loveliest and most poignant of all, were the declarations of love.
Yes, love. The initials “JL” set in brilliant crimson chalk hearts, manifestos of thanks punctuated by hearts, ideograms translating to “Jack Layton equals Love”, and simple, sad little sentences: “I love you”. People of all kinds–and Blatchford is absolutely correct on this–complete and total strangers to Jack, expressed love on the cement of the Square.
Isn’t this exactly representative of the kind of world we want to live in?
I ask you: what Western politician can possibly inspire individuals to suggest feelings of love? Easy answer. The one who inspires real, meaningful, deep and lasting hope for change to a better life, for all of us, through social justice arrived at by the political process. His passing is a passing of a certain kind of hope; all at once, our country is somewhat darker.
Only the most unrepentant curmudgeon could show up at Nathan Phillips Square with her cynicism intact. Instead of sourly looking on this phenomenon, and on this particular instance of this phenomenon, as some kind of Internet-fuelled inward-gazing display of sycophancy, why not read it for what it is: the most appropriate, the most public recital of affection for an individual — a politician, no less! — who deserved it.
Death crowds around us at every opportunity. Not only are we meant to die, but we are destined to end our life in suffering, to watch everyone we know and love pass away, and to experience the cavernous moments just before we enter the finality of the nothingness that awaits us.
It didn’t take long for the message to disappear in the din of partisan opinion-making, but in Jack’s last days, he, or he and his wife, or the pair and the party team, managed to glimpse a moment of truth about what’s really important in life, precisely because of the fact of our transitory nature: that love, hope, and optimism are better states for humanity than any other. They are the only meaningful goals that we, each of us as individuals, can possibly hope to realize by the end of our little lives.
If Jack is remembered for nothing but the beautiful simplicity of those final words, I would consider his life sublimely complete.
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