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The Gory Details, Part 3: Pin Cushion

One of the things we asked Dr. Chen at Monday's office visit was whether there was a certain point at which I should stop eating and/or drinking. I knew that HUP had a policy of preparing for a C-section under general anesthesia, even if general anesthesia was a slim possibility. In our case, if we went ahead with the external version, the possibility wouldn't be quite so slim, so respecting any restrictions on eating and drinking could be very important. Dr. Chen said I needed to stop eating 6 hours prior to surgery, and to stop drinking 3 hours prior. Surgery was set for 9am, provided there were no emergency C-sections that took precedence. Technically this meant that I could eat up until 3am.

As I mentioned in the previous installment, we went to bed at about 9pm on Monday night. Since my thyroid medication had to be taken on an empty stomach, I'd last eaten at 6pm. Between 5:30am and 6am on Tuesday morning, I drank as much water as I could suck down and then cut myself off. We left for the hospital around 7am, parked the car at Penn Tower, and headed up to Labor & Delivery. After signing a bunch of insurance and consent forms upon check in, we waited for a little over an hour for someone to come get us or to tell us what to do next. While we waited, Al snacked on turkey jerky while I tested posting to the blog from his blackberry, chatted with a woman we'd met at childbirth class who was in for some tests, and started making lists of food I would eat when I was finally allowed to eat again.

At 8:30 a nurse came to show us to the room we would wait in until the surgery. She gave me a gown to change into and said that someone would be in to talk to us shortly; they were fairly busy that morning, and both ORs were currently in use. Dr. Chen came in and asked us what we'd decided about the version. We said we were leaning against it, but we wanted to see the results of the ultrasound and get some odds on whether the procedure was likely to be successful. He said OK.

We sat around waiting for a while longer, and then I finally got into the hospital bed and went to sleep. I think it was close to 10am when a nurse came in to hook me up to the monitors and to try to place an IV. Well, she got out all the supplies to place an IV, anyway, and then we never saw her again. Another nurse came in a while later and said that she'd be with us through the surgery. (She was, and she was great.) She searched my arms for a suitable vein, but since my veins aren't exactly "available" under the best of conditions, and I was now completely dehydrated, she had some difficultly. Apparently my veins are also very "valve-y", which means that while a few would have been suitable for drawing blood, almost none were good for placing an IV.

Consequently, this nurse (Erika) blew the first vein she tried. Rather than turn me "into a pin cushion," she called another nurse to come in and give it a try. Boom, another vein blown. This nurse decided to try a second time, using the same vein Erika had tried, but from several inches further up. Boom. (Sixteen days later, the bruise from that double stick has yet to fully dissipate.) They then called in a nurse with 42 (yes, *42*) years of experience, and she was able to get a line in near my thumb on the first try. (It did jam up later, but Erika was able to flush it.)

Meanwhile, the monitors showed that the baby was fine, and I was having fairly strong contractions on a regular basis.

I can't remember what time the obstetrical resident came in to perform the ultrasound and measure the amniotic fluid, but it was probably around noon. She confirmed that the baby was frank breech (butt down, in pike position), and she reported that the amniotic fluid index was 55. I have no idea what the scale is or where 55 falls, but from her tone and expression, we surmised that she agreed with Dr. Beshara that there wasn't enough fluid to attempt a version. She said she'd report the index to Dr. Chen.

While we waited for Dr. Chen to come back, the anesthesia resident came in to talk to me and take my history. I mentioned that I was one of those people who needed three shots of novocain (or whatever cain it is that dentists use) to get numb... and then I'd be numb all day. My numbness threshold just seemed to be higher than the average person's. I also mentioned that it always puzzled the dentist that my lip wouldn't get numb on the first or second try. I gave my height and weight, answered a bunch more questions about my medical history, and signed more consent forms.

Dr. Chen finally came in and asked us if we wanted to attempt the version. We were surprised that it was still an option in his mind. We said that we didn't think we wanted to bother, since we didn't have any faith that it would actually work. Al again mentioned odds, and since Dr. Chen didn't seem to have any good ones to offer, we decided that we'd skip the version for sure. We'd be going for the C-section in about an hour, as soon as the OR opened up.

At this point it was about 1:30 or 2pm, and Al, despite the turkey jerky, was starving. (So was I, but I couldn't eat any of the foods on my now quite lengthy list of cravings.) I asked somebody (I can't remember whom) if he had time to go get something to eat, and whoever it was said yes. He ran out to the lunch carts outside... and within about 10 minutes, Erika came back to take me to the OR "so they can place your spinal." I said I thought I was getting an epidural. She said she could swear the anesthesiologists had said something about a spinal, but she might be wrong. I called Al on his cell and told him that I was going to the OR but not to worry; he should come back to the room, eat his lunch, and change into the outfit they were leaving for him, and that somebody would come get him when I was all prepped.

When I got to the OR, it was FREEZING. Yikes freezing. Erika got me a blanket straight from the warming oven, which took the chill off for about five minutes before I started shivering again. Meanwhile, I found that Erika had been right about the spinal: the attending anesthesiologist had decided that since this was my first pregnancy and the surgery was likely to go quickly, a spinal made more sense. So I assumed the position (hunched over, hands in lap) while they placed the local. For some reason it made me light-headed, so I asked if I could put my head on Erika's shoulder. She said sure. Next the spinal needle went in, and then they laid me back on the table and waited for it to take effect.

It did, but strangely—just like the 'cain at the dentist. One leg—but not the other—went completely numb. The attending tilted the table. Finally the other leg started to get numb. Meanwhile, Erika shaved my abdomen. "Can you feel this?" she asked. Me: "Yep." The attending kept testing me with alcohol-soaked cotton balls swabbed along my ribs, chest, and arms: "Does this feel cold? Does this? Does this?" The answer was always yes. After about 10 minutes, he finally admitted defeat and decided to place an epidural. "You've got a great block for rectal surgery, but abdominal surgery would probably be pretty painful at this point." The resident leaned over and said, "you told me this would happen." Me: "Yes, I did."

So anyway, they propped me up, slumped me into the position, and placed the epidural (again, with two shots). By this time, my teeth were chattering. Once again I was laid back on the table, tilted this way and that, and swabbed with alcohol. Finally, I got numb enough for the surgery to start. The resident injected some painkillers into my IV bag, noticed that I was shaking and chattering, and got me a plastic drape that was hooked up to something like a hair dryer to warm my shoulders. Al came in, and all systems were go.