Jawing About Surgery

Doctors perform surgery of all kinds every day, and for a variety of reasons.  Usually, surgery is prescribed when things go wrong inside your body due to diseases or accidents.  Other times, you may need to have something chopped off like a growth or a foreskin. There’s also the possibility that you are among those of us who are born with some kind of freakish deformity that needs to be corrected surgically after years of ridicule and hateful jeering; perhaps, for example, you have to have your golf ball-sized boob fixed so it’s the same size as your grapefruit-sized boob (I wouldn’t go the other way around–“big naturals” seem to be in right now).

This was my experience–needing corrective surgery, that is, not the boob thing. As a high school senior, during Thanksgiving break, I underwent “orthognathic surgery,” which is used to correct your face when, because of your parents’ bad genes, one or both of your jaws do not line up properly.  This can manifest itself as one of several different types of bad “bites” (tooth alignment)—an open bite in which your mouth doesn’t close right at all, an overbite, or maybe an underbite, which is what I had.  This is when your lower jaw is bigger than the upper, and therefore it sticks out from your face.  None of these are very pleasant to have; prior to the surgery, I always thought I looked more than a little reminiscent of a freshly depilatoried Neanderthal man.

When my grandmother found out that this procedure was on the horizon, she made it a point to video tape the very surgery I’d be having off of the Discovery Channel or something; she made me watch it for some reason randomly while I was visiting her once. This horrifying video was one of the main things that made me decide I could never, ever be a medical doctor, as it graphically detailed the surgeon using a rotary saw, chisels, rubber mallets and other woodshop-looking tools to remove someone’s upper mandible. HE THREW IT IN A BOWL FOR A WHILE. I had to excuse myself at that point.

My surgeon seemed like a much more reliable source of information than some show that my grandmother found on basic cable, so I asked him about this horrifying video during one of the earliest pre-surgical appointments, of which there were many. I asked if he would be using a chisel and mallet to pry out my upper mandible before tossing it into a bowl. He chuckled, and comfortingly said, “Oh, no, no no.” And then he added, “I just use my hands.”

In later appointments, the surgeon (who was sometimes accompanied by my orthodontist as a special guest star) created a number of plaster models of my teeth that were subsequently mounted on a machine called an “emulator” or something.  This contraption, which looked more like a piece of junk that you’d find in the “Free If You Know What It Is” bin at a yard sale than a precision medical instrument, presumably helped my surgeon map out what bones would need to be sawn through and relocated when it came time to do this procedure on my own personal body, though I would not have been surprised if the “tool” had been repurposed into some kind of bizarre avant garde puppet by someone in the university’s art department.

As we got closer to the big day, these pre-surgical appointments began to vary a bit more.  Usually I was only subjected to something relatively minor like an x-ray, but in one instance my face was inserted into what looked like a birdcage without a base.  I had to bite down into a synthetic cinnamon-flavored wax wafer and sit perfectly still while plugs were inserted into my ears to hold the birdcage apparatus in place.  Purportedly, the function of this device was to “take measurements,” though I think it seems more likely that the doctor had a hidden camera photograph me from all angles for the amusement of the staff at the office Christmas party.

While you may not have to go through all the rigmarole that I did prior to your surgery, it is extremely likely that you will be given a “pre-op physical” one to two days before.  Have someone drive you to the hospital and wait in the waiting room with you, because you’ll be waiting for something like four hours before they call your name.  Finally, when they call you in (it may be the next day–my mom and I sat and waited for hours until the clinic thing closed, and we had to come back), a nice if somewhat hands-y nurse will take your blood pressure, temperature, height and weight, as if they aren’t going to do this to you close to four thousand additional times over the duration of your overnight stay in the hospital.  I am told, however, that this initial data gathering session is critical, as the anesthesiologist needs this information in order to determine how to put you to sleep in the most effective way.

Be sure to ask plenty of questions about whatever procedure it is that you will be having.  Two that I asked nearly every doctor I encountered, whether or not they were involved with administering my healthcare, were:  Will I be naked during the operation?  And possibly more importantly, is there any chance that something, including (but not limited to) flammable plastic tubes or urethral catheters, could catch fire and/or explode inside, on, or near my beautiful, gorgeous body?  Just remember that it is your right as a patient to know this, and don’t be satisfied with half-answers or doctors who skirt your questions.  This is your sex change operation!  The last thing you need after all those long years of hormone therapy and ugly, ill-fitting clothes is for some stupid intern to screw you up because he accidentally lit up the oxygen line instead of the surgeon’s cigar in the operating theatre.

Once all these initial appointments and consultations are complete, it’s time to talk to the business office about scheduling your surgery.  Bring your calendar, though.  Because of rules provided by both the American Medical Association and the area chapter of Surgeons, Physicians and Hairdressers Local 521, your surgery absolutely may not be held on a date that is convenient for you.  Furthermore, it must be scheduled at such a time that you must leave your house at 4 AM or earlier in order to get to the hospital on time; finally, it must be penciled in for two days, at the most, from any major holiday.

The last hurdle is the battle with your medical insurance company.  Though, instead of vaulting over it, you may just run into it head-on like a deer leaping in front of a car.  In most cases, your doctor must obtain something called a “pre-approval” from your multinational conglomerate insurance company; unfortunately, a typical employee of such a company generally possesses the cognitive skills of a marmot cornered in a crawl space.  In theory, this “pre-approval” step should be a simple and painless process, but in reality, it would be exponentially easier to escape from the clutches of Scientology and subsequently successfully destroy the organization.  It will require countless letters, faxes, and phone calls to various agents in India or the Philippines allegedly named things like “Barbee” and “Cyndi” before you will obtain this coveted pre-approval, but in time it should come.  Assuming, of course, that you don’t die from your condition before the surgery can happen.  If that’s the case, you’re screwed, buddy.

Now that all the legwork is out of the way (and sorry, by the way, if your surgery is intended to remove one or both of your legs—that was a terrible pun, and I’m ashamed of it), it’s time to sit back, breathe (assuming that you have lungs—what have I gotten myself into here?!), and wait for the big day.  Remember that you are not to eat anything after midnight the day before.  No carrots, no water, no dust—nothing.  Having food in your stomach while you’re on the operating table will make the earth explode, so please, for the sake of all of us, don’t do it!

Good morning!  It’s 4:30 AM on this cold, dreary and rainy Thursday morning, and guess what?  It’s surgery time!  You should be taken to the hospital, surgical center (that’s “centre” if you’re in Canada), or surgeon’s conversion van down by the river by a responsible adult.  However, if the adult were truly responsible, he or she would point out to you that you probably shouldn’t use a surgeon that operates out of a van, unless you got a really good deal from using a coupon.

Once you arrive at the hospital, you will be given yet another pre-op physical, just on the off chance that you’ve mutated and grown a second heart or third nipple overnight. After this is done, an elderly Candy Striper named Nancy who has some kind of strange infatuation with calling everyone “darling,” “sweetie” or “baby” will push you in a wheelchair to a pre-op holding area, though this unfortunately sounds like a glass cubicle that laboratory monkeys would be stored in.  She will also provide you with a hospital gown that doubtless will have a dozen confusing small puncture-looking holes in the “personal area,” as well as a second hospital gown (but she’ll refer to it as a “bathrobe”) to cover your rear, plus a pair of little compression bootie thingies.  It’s entirely probable that she will insist on watching you disrobe and put these “clothes” on just to make sure that you don’t attempt to, I dunno, eat the booties instead of wear them.

I asked if I really had to completely disrobe, since my surgery didn’t involve anything below my neck.  Nancy merely giggled in a way that I found to be quite unnerving and confirmed that I should strip down to my “birthday suit,” a two-word phrase that I find repugnant–anyone who unironically uses this phrase (I can’t even bring myself to type it again) should be summarily executed. But I digress. It seems that no matter how mundane your surgery may be, doctors cannot operate on you unless you’re completely, embarrassingly naked.  Ingrown toenail? Naked. Hair transplant? Naked. It just makes no sense.  But rules are rules, so I struggled into these drafty and uncomfortably unsupportive “garments,” and waited uneasily for Nancy to take me along to whatever horror would come next.

But Nancy had gone on break, apparently.  Another nurse, a jolly woman named Brenda who had beefy sausage-like fingers, rolled in a cart containing all manner of scary-looking needles and vials of more medicines than most impoverished developing nations will ever see.  She requested that I lie down while she inserted an IV needle.  The first step: “numbing the area,” which is done by spearing you with a large painful needle that is approximately the length and diameter of a broom handle.  You are then pumped full of a generous supply of local anesthetic; this will take the form of a humongous bubble of fluid that ends up looking something like a subcutaneous grapefruit.  Usually when I have blood drawn, I watch with interest; I sometimes try and see if I can consciously control my heart rate so that I can spray the blood out of my vein into the vial in time with whatever music may be playing in the phlebotomy lab, but in this instance I merely screamed like a woman and repeatedly moaned “Lord, take me home!

It just got worse when Brenda began pressing down on this gigantic bubble of fluid that looked like it had been caused by a sting from a bee the size of a Kaiser roll.  Understandably, as a result, my shrieks and hoots of pain became louder and more high-pitched.  Finally the numbing effect of the medication kicked in, and not a moment too soon—it took so long that I was beginning to worry that she’d deliberately injected me with something completely useless just so she could amuse herself [1.].  This is just the first needle in a two-needle process, by the way; actually putting the real IV needle in will take several hours alone to do, as Brenda will tell you that “everyone else has a vein there” and that she “can’t find it,” leaving your arms, chest and thighs pocked with lightly bleeding needle holes, creating the impression that you had some sort of mishap involving tripping over a bale of barbed wire.  The good news is that as soon as they hit pay dirt, so to speak, they will begin to give you drugs.

Once this whole ordeal is done, another nurse (this one, who you might mistake for a man, is actually just a mannish woman) will appear with a wheelchair.  She will firmly grasp your IV bags, attach them to the wheelchair, and then toss you into it.  This is the point at which you might want to have a lawyer record you on tape if you’ve not had a chance to put together a will.  I neglected to do this, but then again, I was so out of it that I started quoting lines from “Star Trek IV” (specifically, I affected a squeaky old lady voice and started saying “There’s the doctor that gave me a pill that grew me a new kidney!” to anyone we passed by), which apparently made this nurse think that I was on kidney dialysis instead of just high.

Your next stop will be in a staging area just outside of the operating room, where you will meet your anesthesiologist.  In my case, he added more drugs to my IV, smeared weird fish-smelling lubricant paste in my nose, and then inserted rubbery yellow “nose trumpets” (or, as the French might call them, trompettes grandes du nez) into each nostril.  These are basically two-foot long latex funnels used to feed nasogastric and nasotracheal tubes into your stomach and lungs after you are unconscious.  The worst part about this insertion process is that you hear disturbing cracking and crunching sounds inside your face, kind of like peanut brittle being smashed, while they’re being forced in–at least I did.  Considering the discomfort involved in their insertion, I remain uncertain as to why they do this while you’re still awake, but they do, and so there you sit with big bouncy yellow cones dangling from your nose like a miserable deformed elephant seal until they roll you into surgery.

While the anesthesiologist is doing his thing, yet another nurse, whose name is always “Helga” (or possibly in some instances “Olga”), will come in.  Generally she will weigh about as much as your average Coca-Cola vending machine.  She will give you a bouffant cap and will very, very casually mention the fact that in the event you need a catheter [2.], she would be the one to administer it. I know she’s scary, but don’t cry! Instead, do what I did.  Act with indifference and arrogance as best you can, considering the four cubic meters of morphine that are sloshing around in your bloodstream.  Occasionally adjust your bouffant cap indignantly.  Fluff it defiantly; declare that you are a world-class pastry chef, and that no one speaks to you that way about your urinary tract.  It’s also fun to rattle your IV bags around and demand that the chauffeur drive you about the block another time.

If the staff of the hospital doesn’t appreciate this behavior, they will increase the drug levels so that you’ll shut up.  That is why after that point I do not remember anything.

Since I just skipped a line before beginning this paragraph, we’re going to assume that your surgery was a success.  Otherwise you’d be dead or in a vegetative state, and obviously wouldn’t be reading this.  The first person that you will see once you regain consciousness will be an ethnic-looking nurse named something like “Moomba” who will be wearing a muumuu beneath her amply-sized lab coat, as well as a polyester leopard-print head wrap. She will probably be taking your blood pressure or temperature for the trillionth time that day, but when she realizes that you are awake, she will try to explain to you in broken English what exactly the urinal is, as well as how to use it.  This will involve a variety of hand gestures and suggestive pantomiming uncomfortably close to your penile region, which should thankfully be catheter-free.

The nurse may also try to explain how to use the bedside remote control, which is one of the most moronic devices ever invented.  It’s common knowledge that most hospital rooms have TV sets in them, but because the remotes are designed to control virtually everything in the room—the bed, the lights, the “nurse, come hither” light outside the door—space is at a premium, so these remotes were designed with only a single “TV” button, which seems to control only the channel.  So, to turn the television set off, you have to continuously press “the TV button” until you reach what should be channel 68, and once there, the set will power down.  Unfortunately, if you press it again by accident, the TV will pop right back on, and you’ll have to repeat the whole process all over again.  It’s easier to read a book, considering that there’s also no way to control the volume, unless you rig up some system of pulleys and weights and suction cup-tipped sticks to do just this, but if you were able to make such a Rube Goldberg contraption, you probably wouldn’t be in the hospital to begin with.

Also, don’t be too surprised if you wake up and find that you have one or more tubes up your nose.  I, for instance, still had my nasogastric tube in, and it’s no fun.  It runs all the way down to your stomach and is intended to keep you from throwing up, which is ironic because that’s exactly what you feel like doing the entire time it’s in place.  Several excruciating hours later, the doctor decided that it was OK to remove it, so he told me to breathe out while he pulled out the tube, which was easily as long as a football field.  It felt as though it ran the entire length of my digestive system.  Fortunately, I did not throw up, though it was hard not to when the doctor dropped the entire slimy and bloodied bundle of tubing directly on my stomach.

One of the unfortunate side effects of surgery is that you will probably be in a lot of pain; the nurses will do everything they can to help you, which will be limited to adding “pain medication” to your IV.  This alleged pain medication, though, is approximately the same strength as a teaspoon of diluted baby aspirin, since a doctor must prescribe anything stronger, but since doctors are apparently impossible to find in a hospital most of the time, there’s virtually no chance of getting a stronger prescription in a timely manner.

Speaking of our good friend the IV, nowadays hospitals use fancy electronic IV pumps.  Apparently just hanging up a bag of fluids to drip via gravity into your body isn’t good enough anymore.  These new pumps have a variety of useful features, such as making irritating grinding noises for no apparent reason!  They also have a very helpful “constant beep” function that might lead one to believe that an earthquake is being detected somewhere in the Pacific Rim, or perhaps that someone’s baked potato has finished cooking.  The particular IV pump in my room had a number of unlabeled buttons that the nurse would randomly push every single time she came in; they would light up and make beeping sounds while simultaneously making no discernible difference in the medication dispensation rate, so clearly it was important.

If you feel like it, you can have visitors come in to see you right after you get into your room, although chances are extremely good that you won’t remember them having been there, and will probably admit some embarrassing and horrifying secret to them while you are still recovering from the anesthesia.  Fortunately this was not a concern of mine; after my surgery, I was able to sort of mumble through my teeth, though they were quite literally wired shut with a plastic tray between them, so I sounded like I’d been feasting on peanut butter and was thus largely unintelligible.  It wasn’t much different from how I normally speak, actually.

Having company following major surgery is a good idea for psychological reasons, too.  According to my doctor, one of the side effects of general anesthesia as it wears off is that it can cause you to feel horribly depressed and sad.  My face, for instance, was as swollen as an overripe tomato, and so I had been outfitted with an ersatz facial pressure garment—a kind of elastic head wrap thing, probably similar to what Carmen Miranda used to hold all that fruit on top of her head. That, or it was actually just an Ace bandage. I don’t remember.  I felt lousy and looked in a mirror only once, and because my face was not only grotesquely swollen but also the consistency of congealed yogurt, I broke down in tears; the anesthesia had clouded my mind and made me believe that the operation had permanently left me fat-faced and disgusting, and that I should give up on ever looking (at least) semi-normal ever again.  My dad, who hadn’t been present when I’d been told that the anesthetic would make me believe such things, unhelpfully informed me that I was being a baby, and also suggested that I seek psychological help; this just made me cry more, and so my mother made him leave the room.  Of course, I may have imagined all of that, too, seeing as how I was still under the influence of heavy medication.  But it’s OK to cry—especially when you find out that Helga actually did put a catheter into you.

Something weird happens after you’ve had surgery.  Usually, if the surgery successfully fixed whatever it is that was wrong with you, you may have a follow-up appointment or two with the surgeon, and maybe (in my case) a photo shoot to finish out your very own set of “before and after” photos—I wore a delightful silk Burberry tuxedo with matching top hat and Swarovski crystal-encrusted cane for mine—but beyond that, you’re “fixed.”  All that attention that you were being lavished with before the surgery just kind of vanishes, which is kind of a relief.  Since your body is working normally again, your life just kind of picks up where it left off.

I am happy to say, by the way, that the swelling in my face did eventually diminish and disappear, and the only lasting remnant that I have of the procedure (aside from the fact that my entire face looks different) is that the nerves leading to half of my chin were permanently stressed, so I feel things in “reverse” down there; that is, if you touch the bottom part of my chin, it feels to me as if you’re touching just below my lip.  It’s very strange.  I also have some little tiny L-shaped plates and screws holding my upper jaw on, which is fun to tell people about, especially if they’re squeamish.  I used to freak my mother out by rummaging through my father’s toolbox for a screwdriver and then announcing that I was going to go in the bathroom and “adjust” my jaws.

The best part, though, about a surgical visit and a hospital stay is when it’s all over.  Fortunately, surgery is a rarity in most people’s lives, and it’s easy enough to get back to normal after a reasonable recovery period.  But as for those people who just can’t seem to get enough plastic surgery, they deserve all the pain and suffering that their doctors (and catheters that Nurse Helga) can dish out.

—Revised 2004 (Original ca. 1999)

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  1. I understand that it is popular for young ladies who attend parties thrown in certain circles (e.g., the Dr. 90210 set, or perhaps weirdos with a medical fetish) to have their breasts injected with a semi-large quantity of saline because it temporarily makes them appear larger.  The name for this procedure is, grotesquely enough, “party tits.”  While the appeal is lost on me, it does occur to me that “Party Tits” would be a great nickname for someone like Anna Nicole Smith, or perhaps Dolly Parton—if she were really drunk.[]
  2. Which… I mean… shouldn’t she know whether that’s supposed to be part of the plan already, or is it more of a spur-of-the-moment type thing where they jam one in if you start peeing unexpectedly? Or if they just want to mess with your weiner for entertainment purposes?[]