Volume 18 Number 1 Winter/Spring 2001

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my life under the knife

A meditation on the experience of surgery.

BY JOE GUZAITIS

I AM A 61-YEAR-OLD MAN WHO HAS had many surgeries, some at Stanford Hospital, some elsewhere. This winter I emerged from my latest, a procedure known as deep brain stimulation, which has alleviated many symptoms of my Parkinson's disease. Now, as a veteran of more than nine surgeries I find myself in the mood to reflect and offer vignettes of some of my experiences under the knife.

Age 6 -- Tonsillectomy

A BUNCH OF CUTTHROATS

The conventional wisdom of the 1940s was that the tonsils were a liability. They were believed to harbor bacteria and viruses
responsible for the chronic infections that plagued the young. When mine were snipped out on a cold Chicago day, my father was peeking through the operating room window and saw nurses soaking up copious quantities of my blood with towels. After my tonsillectomy, I was left anemic and fearful of anyone in a lab coat. Not an auspicious beginning to my odyssey as a surgical patient.

Age 28 -- Vasectomy

TAKING THE WORRY OUT OF BEING CLOSE

After our fourth child was born to my wife, a Catholic who was trying to remain in good standing with the Vatican, we projected our current birth rate out over the next dozen years and found that we would end up with 20 children, give or take a few. "I would go mad well before then," she cried. I couldn't let that happen.

The next day I began to look for a clinic that would do vasectomies. I could not find one in northern Illinois (where I lived then). I found that very strange.

Planned Parenthood could not refer me to anyone. They said the law was vague in Illinois on "that procedure." I was puzzled at first, then outraged. However, I heard that it was not illegal in Indiana, our sister state to the east. I checked the phone book and the proof was there: I saw an inordinate number of listings for urologists in Indiana's border towns. I made an appointment with a urologist, who asked me to bring a note from my wife indicating her approval of my decision. (Apparently, some men approach this matter clandestinely.)

The whole procedure took perhaps an hour and was almost choreographed. A nurse was secreted behind a door while I undressed and the good doctor prepared the sterile field. Then he said, "Dorothy, you can come in now" and the nurse appeared, having been spared seeing me fumbling with my clothes. A small thing, perhaps, but appreciated.

The procedure was simple enough. A local anesthetic was used. At each point in the procedure, the doctor explained what he was doing and why. At the end he told me how to take the sutures out myself if I didn't feel like having him do it. He remains one of my model surgeons to this day -- friendly, instructive, accommodating -- he is a credit to his profession.

Age 50 -- Penile implant

NO HARD FEELINGS

Few people realize that atherosclerosis (hardening of the arteries) affects other arteries besides the coronaries. In its insidious quest to cripple the body and eventually hasten death, atherosclerosis impairs the smaller arteries in the male groin that feed the penis and make it capable of maintaining an erection. Erectile dysfunction, or ED, eventually affects 30 percent of all males. It had claimed me in its number. It began in my late 40s and by 50 was fully advanced. By then I had run out of excuses, was tired of self-pity and was getting mad. I had also deprived my wife and myself of many rewarding moments of consortium.

Urology came to my rescue again -- this time it was a specialist in Monterey, Calif. I decided on a flexible rod implant and I have no regrets. The surgery involved is very simple and straightforward and the only drawback was that I had to wait to heal for a month before I could use the device. My message to my fellow sufferers: find a competent urologist/surgeon and avail yourself of the excellent prosthetic devices available for ED.

Age 54 -- Coronary bypass

CABBAGES AND KINGS

I had known since 1976 that I had atherosclerosis. I carried my
nitroglycerine every day to ward off the chest pains. However, I started having chest pains at rest -- the sign of an impending heart attack. The remedy offered to me was the coronary artery bypass graft, or CABG -- a procedure whereby abundant leg vessels are "harvested" to be sewn in to bypass the clogged segments of the coronary arteries. This is equivalent to sewing wet pasta noodles together end to end and then having your handiwork put to a pressure test.

I had my open-heart surgery at Stanford. The surgical team's members visited me before and after surgery and did everything possible to make the procedure painless. I found this team of clinicians to be supremely talented technically and warm and personal privately. It was an honor to have them lay hands upon me. In my mind, one of medicine's crowning glories is that this procedure is available to (by now) millions of grateful recipients.

Age 59 -- Laser eye surgery

SAY, CAN YOU SEE?

Certainly the most comfortable surgery I encountered. You stay in your street clothes and sit upright in a chair. I'm talking about laser surgery on the eye. One day I awoke to see blinking spots in the early morning gloom. To make a long story short, I ended up being examined by a Monterey ophthalmologist who said I needed laser "spot welding" on some arteries in my right eye's retina. Apparently, these were a result of the atherosclerosis also.

The doctor explained the laser beams would propagate down the arteries to clean them out. This explanation confused me. Normally I'd persist in my efforts to grasp the basics of the medical technique but this time the barriers to understanding were too great. There was the doctor's barrier of not finding simple enough analogies to explain complex processes. Then there was my barrier of not preparing for our sessions more thoroughly to get the most out of them. But despite all of that, I am grateful to him for helping me avoid glaucoma.

The sensation of having your retina "spot-welded" is not as unpleasant as it would seem. These rays were very fine and they felt like tiny pinpricks in the back of my eye. Ten minutes later I was out of the chair.

Age 61 -- Deep brain stimulation

PICK UP THY

PALLET AND WALK

For the past 10 years, I have limped and lurched about with Parkinson's and wondered what to do. Then I heard about deep brain stimulation. This new procedure involves inserting two probes in the brain, one in each hemisphere, and running wires from these probes down to one's chest where two "stimulators" reside. The stimulators deliver a small, continuous current to the brain to stabilize the erratic electrical activity there that causes Parkinson's symptoms.

I made my way to Stanford after learning that neurologists there are skilled in the procedure. After many interviews, tests and two 10-hour sessions of brain surgery, I finally reached the
moment of truth this winter: I was told to stop all medication and come in for the final evaluation and inauguration of the stimulators. I still harbored some skepticism. Then the stimulators were turned on with large magnets. The computer started clicking, adjustments were made and then I was taken for a walk.

Suddenly, I begin walking smoothly. Here comes a doorway where I used to stop, frozen. Now I breeze right through it. As I walk, all the bad memories of a decade of humiliation begin flooding in: my fear of falling, the torn pants, the bleeding knees, the ill-fitting knee pads I tried to wear under my pants. Then the memories retreat. I'm left with a feeling of great relief and comfort to have my equilibrium and control restored.

Back at home, friends congratulate me on my relaxed gait, the walk they remember. I do a pirouette to show off. I am human again! I can navigate through a crowd of people once more. I can leave the opera or a movie at the same time as
everyone else. Before, I cowered along the edges, afraid someone might bump me and knock me down. I can board an airplane with the others -- no longer having to wait until they are seated so I can inch my way up the aisle.

Heartfelt thanks to Drs. Gary Heit and Helen Bronte-Stewart and nurse Kay McGuire as well as the myriad staff members in neuroscience at Stanford Hospital who make this miraculous treatment possible. Thanks to all the others who are busy
saving and extending our lives and increasing the joy of our
experiences. SM