Major Surgery With No Painkillers: 5 Things I Learned
If you've ever watched a hospital drama, a graphic surgery documentary, or the movie Starship Troopers, you've probably wondered what it would feel like to have your torso unzipped like a suitcase. The intensity of having your guts and bones exposed to the air is so extreme that we just sort of assume that anyone who isn't unconscious and on painkillers for the duration of the experience would just die instantly.
Well, that's actually not true.
Cracked sat down with Vijay Welch-Young, a man who had chest-slicing, cancer-dicing heart surgery without general anesthesia, which means he was awake for the whole goddamn thing. We wanted to know why that happened and what that experience felt like because, holy shit, he was awake when they cut his chest open. Here's how he described the brutal (but life-saving) ordeal:
Sometimes Anesthetic Isn't An Option
When you hear somebody had to have their chest sawed open without anesthetic, you might assume it was some kind of "frantic operation at the scene of an emergency" type thing, where they just didn't have time to do it right. But, as it turns out, there are some regular old surgeries where anesthesia just isn't an option.
In April 2014, I went under the knife in one of the most scientifically advanced hospitals in the U.S. I had been diagnosed with non-Hodgkin's lymphoma. Luckily for me, lymphomas are normally among the easiest of all cancers to "cure." Unluckily for me, my cancer had wrapped itself around my heart like the plush stuffing in a Build-A-Bear. This made my heart work much harder than usual because cancer was essentially putting it in the torture rack like Lex Luger.
Also like the torture rack, the only way to get out of it was a pretty brutal foreign object violation.
Unfortunately, all of the anesthetics the surgeons had on hand were also muscle relaxants, and the heart's a big ol' muscle. If it had relaxed too much, I would have died. So, I needed to have massive, incredibly invasive surgery, but they couldn't risk giving me anything that could make my heart stop. Instead, they would have to cut into me and spread two of my ribs apart while I was completely conscious. You may recognize this as something the Jigsaw Killer would force you to do in order to find a handcuff key.
That said, when you've got freaking cancer wrapped around your heart and the doctors say there's actually something they can do about it, you kind of just have to be grateful.
Music Fights Pain Better Than You Would Think
This was to occur at the Cleveland Clinic, which, as I mentioned before, is one of the most advanced hospitals in the U.S., despite being located in a city that I would call "Ohio's Detroit" if Youngstown and Akron didn't already exist.
Keep on shooting for the stars, Upper Midwest.
My anesthesiologist was a guy named Sergei. He reminded me of a taller, gentler version of the Russian gangster from Firefly: a grandfatherly man with a thick accent (I'm guessing Ukrainian). When he introduced himself, I instantly liked him, even though he was basically telling me that the surgeon was about to fillet me as if he were the Gorton's Fisherman. The main reason why I liked him was his voice. It was like the best qualities of Fred Rogers, Morgan Freeman, and Bob Ross wrapped in an eastern European accent. Listening to him felt like drinking a mug of hot chocolate while curled up in a blanket on the couch, in front of a roaring fire, and with a large, shaggy dog curled up at my feet.
His voice was soothing, is what I'm trying to say. This will be important in a minute.
After Sergei and my surgeon explained the procedure, one of the nurses asked if there was any music that calmed me down, because they wanted to make me as comfortable and calm as possible before tearing my body open and dancing medical carving instruments all over my internal organs. I asked for Mozart's "Don Giovanni." Music doesn't sound like it would have much of an impact on your pain levels during massive surgery, but it actually has proven to be an effective pain-reducer. And when you can't have any anesthesia, anything that even might reduce the level of agony is worth a shot.
"Does yours go up to 11? There's no part of this I want to hear."
One of the doctors in the room (there were so many doctors) told the nurse that he had Don Giovanni on a CD in his office, and she left to get it. They put in the CD and queued it up to my favorite spot before they spread my ribs apart and I started screaming. Then, all of a sudden, Sergei was next to me, giving me pain management techniques, telling me I was doing well, and everything was going fine, and generally being as comforting and supportive as humanly possible while I was starring in my own torture porn.
With Sergei in my right ear and Mozart in my left, I actually managed to stop screaming and calmed down. My heart rate slowed to almost normal (I could hear the ECG beeps, which was another oddly soothing sound), and my mind kept from tearing itself in half with pain long enough for them to do the repairs. Still ...
Getting Your Rib Cage Torn Open Actually Hurts Quite A Bit
Now, when I say "without anesthetic," that's slightly misleading. They couldn't give me any painkillers or anything that would knock me out, but they did use a local anesthetic to sort of numb the surgery site a little. For those of you with no medical knowledge (like me, before this happened), local anesthetics make it so that the immediate area they inject it in feels no pain. But, local anesthetics only penetrate the skin and outer layers of muscle -- they don't go as deep as the bone. And when you're doing any kind of heart surgery, step one is spreading that rib cage.
We'll just leave this here and let you supply the terrifying sound effects on your own.
A surprising number of people believe that bones can't feel pain. However, as anyone who has actually broken a bone can tell you, that belief is hilariously false. Bone and joint pain is among the worst you can experience, which is why conditions such as arthritis and osteoporosis are so debilitating. As they were operating on me, I didn't feel any pain until they spread my ribs to get at the gooey nougat center ("nougat" here meaning "cancer").
Just a heads up: If you ever wanted to eat another Milky Way, the optimal time was before that sentence.
Then, when they started cutting, what I did feel was bizarre, to say the least.
The local anesthetic they used only numbed the pain receptors, not the nerves that govern touch. The sensation of a scalpel cutting into you, without feeling any of the normal indicators of pain, is just ... really, really strange. It's profoundly difficult to describe to anyone who hasn't felt it before, and those who have always say the same thing: "I know! It's so weird!" The closest approximation I can think of is that it was like someone was pushing on my skin with their finger, just hard enough to be slightly uncomfortable without hurting, and drawing a line across me. Where they passed, there was a weird sensation of release, followed by a chill as my insides, which had never been exposed to open air, suddenly felt air passing over them.
While the whole thing took about 45 minutes, it felt like a hell of a lot longer during the surgery. And, afterward, it felt like it was almost instantaneous because the pain distorts your perception of time.
I can totally understand all that gibberish McConaughey was spouting in True Detective now.
Please take a moment to enjoy that, before we proceed to this next part ...
Recovery Is A Long Road
Finally, they finished, stitched me back up, and gave me fentanyl. Wonderful, wonderful fentanyl. I was on a pump of that stuff for a little while afterward, and it was more beautiful than any sunrise or newborn baby or anything else people waste the word "beautiful" on when they haven't had a fentanyl pump.
After the surgery, I expected to see the doctors constantly. I just had cancer whittled off of my heart while I was still awake, after all. But, while I was recovering in the clinic, I rarely ever saw any doctors. A squad of doctors had operated on me and set my treatment plan, but after the surgery, the only time I saw them was during their rounds. It was like sitting in a haunted house, waiting for a ghost to appear.
Once a day, a doctor would come into my room, surrounded by a small flock of doclings, and ask me how I was feeling. They would tell me that I was doing well and then leave. That was it, with the exception of the first day, when my Indian doctor (in addition to the standard "how are you feeling?") asked me why I have an Indian first name but an American (or 'Murican) last name. It's because I'm part Indian, by the way. Apparently, you need something more than a doctorate to figure that one out.
"Ah, yes ... college ... which I absolutely went to ..."
I spent the rest of each day with nurses. Nurses administered my medicines, helped me to the bathroom, brought in my food, changed my IV bags, X-rayed me with a portable machine that was super cool-looking, and basically waited on me hand and foot. To make it even more impressive, after I got out of the ICU and went to the oncology (cancer treatment) building, all of those duties were served by one nurse alone, who was nine months pregnant. She worked a 10-hour day, every day, until she finally started going into labor, which happened the day before I was discharged. Her reasoning for working such long hours while so far along in her pregnancy was, "If I'm here already, I won't have to go anywhere when it's time." So, yeah, I'm super glad I had that lady taking care of me.
After That, Everything Is Much Easier By Comparison
After they took away my fentanyl pump (I'll miss you forever, fentanyl), I had to ask for pain meds "as needed," which is another way of saying "all the time." The first time I asked for painkillers, my nurse asked, "How bad is your pain on a scale from one to 10, where 10 is the worst pain you've ever felt?"
Whimpering through a fog of severe pain, I replied, "Two?"
She said, "Two? We normally don't prescribe these things unless it's over a six. Are you sure you need painkillers?"
"We don't enforce a totally arbitrary rating system just for our health, pal."
Now, what I should have told her was, "Two days ago, I had surgery without anesthetics. The memory of that pain is forever seared into my mind like a white hot-iron spike. As such, my 10 is a lot higher now. Judging by my pre-surgery scale of pain, this would be more like a seven or an eight."
Instead, what I did was continue to moan and cry.
Thankfully, the nurse saw that I might be lowballing myself and looked more closely at my chart. Then, she found out what had happened to me and said, "Oh. Oh God, that sucks," and immediately got me some oxycodone. After I'd taken the meds, she advised me that, whenever I was asked, I should always say that my pain level was a six.
So there you go: a life hack that actually helps with something.
I went into oncology firm in the belief that chemotherapy would be another hellish ordeal, which I assumed would leave me in agony, constantly nauseated, and so fatigued that I couldn't leave my bed. In reality, I had some nausea that they fixed with medicine; I had some aches that they fixed with medicine; and I had some fatigue that I fixed by getting a few hours more rest than usual. My hair fell out, and I didn't care (although I was bummed about losing my beard, as it is the source of my earthbound strength).
"These could save your life, but at the cost of your facial hair."
"Can I have a day to think it over?"
My hair and beard regrew in the month between chemo and radiation, and I was told that radiation would have even fewer side effects. My only side effect was a little bit of heartburn during radiation and for about a week afterward, because the radiation weakened the valve inside me that keeps my stomach acid down. All things considered, I think that's a pretty fair trade for "not dying."
I have been cancer-free since November, and people I know still talk about how optimistic I was during the whole after-surgery healing process. The thing is, optimism didn't have much to do with it. I was just relieved that I would never have to experience the reality-shattering pain I had endured during surgery ever again. Nothing a human being can survive will ever hurt that much, and the catharsis of that realization has made me a happier person. The brutalizing pain put everything else in perspective.
Consequently, I feel like a huge weight's been lifted from my chest, although "carved" might be the more accurate word.
For more insider perspectives, check out 5 Ways Life Changes After a Near-Death Experience and The Gruesome Truth About Getting Shot (a First-Hand Account).
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