Wednesday, 10 October 2007

I've been meaning to write this for weeks. Hopefully I can still remember everything.

So Sarah had a c-section the day before we were scheduled to have our c-section class. We'd both read a bit though, so it wasn't like we were going in totally uninformed and unprepared..

Firstly, Stanford Hospital's operating room area is rather mind-blowing. Sarah was transferred from Lucille Packard Children's Hospital to Stanford because they could get an operating room there sooner. The transfer was trivial, just roll the whole bed down the corridor, through the magic double doors into the operating rooms. The doors in question have a whole heap of video cameras pointing straight down, so they see everyone that gets wheeled in and out, which I found interesting. Good for records of patient movements I guess.

Anyway, through those doors is a maze of corridors. There was a light-up board hanging from the ceiling in the middle of the main corridor with lights for all of the ORs. I think there were about 20. The illuminated ones were available. We went down a corridor, and past a few ORs. Outside of each one is a big stainless-steel scrub area.

We got to "our" OR, and they transferred Sarah onto the operating table. Because of her heart condition, they wanted to have an arterial line in her for the duration of the procedure. This is some sort of gadget that goes into an artery and monitors your blood pressure beat by beat.

The "interesting" thing with the anaesthesiologist was the New Zealand woman that we'd seen when we had an anaesthesiologist months prior, but the appointment was with a different anaesthesiologist, and this New Zealand woman was "observing". At the time, the anaesthesiologist we had the appointment with told us that she was going to be on vacation at the time of the delivery, so she wouldn't be attending. So I don't know if the Kiwi woman got promoted out of "observing" to "doing" in that period, or what, but she reintroduced herself to us in LPCH prior to moving to Stanford as being our anaesthesiologist for the delivery.

Anyway, in the OR, they handed her the arterial line, in it's plastic packaging, and the first thing she asked was whether it came with anything else to put it in. At this point I figured she hadn't put one of these in before. (The answer to her question, by the way, was "no")

She then proceeded to have a terrible time getting the line into Sarah's arm. Normally intravenous lines go into a vein, but this has to go into an artery. Apparently when you go poking an artery, it spasms. It then becomes very hard to get it into a moving target. She had a few goes on one arm, then gave up, and had to move over to the other arm.

Sarah doesn't like needles at the best of times, and getting this honking great big thing in was no picnic. The bruising on both her wrists afterwards was phenomenal. She tends to bruise fairly spectacularly whenever they stick a needle in her. I almost stepped in and asked if it was really necessary that she have it, because they were having so much trouble getting it in, and it was clearly hurting Sarah. I think someone else ended up getting it in, not the anaesthesiologist. Not "that" one anyway. There were heaps of people in the OR.

Next, came the epidural. Again, we had the inexperienced anaesthesiologist. This time she said to someone else how she was so nervous because there were "too many eyes". Not really reassuring. They gave Sarah a numbing injection first, and then proceeded to poke her in back with the epidural catheter needle thing. Sarah was flinching when they did it, and they kept yelling at her not to move. Apparently it didn't hurt, but it caused discomfort every time they tried to get it in. Eventually the associate professor of anaesthesiology stepped in and got it in. Later, they said that Sarah had a slightly curved spine or something, and that had made it a bit more complicated.

I'm not begrudging the obviously inexperienced anaesthesiologist for anything. Stanford is a teaching hospital, and doctors have to get their experience somehow, but I think that when the patient is conscious, it's important to come across a little more confident.

So once they got all of that sorted out, they could get her lying down on the table and get down to business.

Apparently one of the side-effects of the epidural is that it can cause your body to think it's got hypothermia. Part way through the procedure, Sarah started shaking uncontrollably. I can't remember whether she complained about feeling cold or not. She also got a really itchy face. Apparently that's a side-effect of morphine.

Sarah also doesn't tolerate anaesthetics very well, and started feeling nauseous part way through the procedure. Sure enough, as has happened countless times previously post-operatively, she threw up. At least we had warning and I got a kidney dish in place in time.

That was about all the eventful surgical stuff. They had the usual screen up from about her neck area, so I couldn't see what they were doing. After Joshua was delivered, one of the nurses asked me if I wanted to see him, and took me around from her left shoulder where I'd been sitting to around below her right foot, to where they had him in one of those perspex portable crib things. I could see a lot of red out of the corner of my eye, and I could have seen a lot more if I'd bothered to look, but I was more interested in seeing my son at that stage.

They let me bring him back around to where I'd been sitting previously, to show Sarah, but it was hard getting him up to a point where she could see him properly, and she was partially out of it by this stage. I think she dozed off for a little bit not long after that.

I forget what time we got into the OR, but they started the operation in earnest at about 10:00am, and we were out of there by 10:45am if memory serves. The nurse in charge of the recovery room really didn't want me there, so I went back to LPCH with one of the nurses to spend some time with him while he was weighed and measured, and I took some photos, and held him. This was good, because I got to have a good cry on my own with him.

So overall, in my "I'll never be squeezing a watermelon out of my nether regions" blokey perspective, having seen what Sarah went through, and how much discomfort that it looked like she was going through, both in the OR and afterwards, I'm not convinced c-sections are any less painful than a vaginal birth (taking the average case of both). I think you're trading some "short term" (depends on how long your labour is I guess) pain for some "long term" pain while you recover from your incision. Granted, Sarah wasn't really laid up all that badly for all that long, but it still didn't look all that pleasant.

I guess really only the women who have done both delivery methods can really comment. All I know is I found it very difficult watching Sarah go through so much pain. So much so that I'm not really looking forward to that again.

Maybe, hopefully, after her aorta is repaired, they'll let her delivery vaginally next time. I'm not holding much hope though. The high-risk obstetricians are fairly paranoid. There's also the possibility the baby will make the decision very easy for everyone by being breech.

Sarah raised an interesting point today. Why didn't they just knock her out with a general anaesthetic? There was no need for her to be conscious for the delivery. That would have spared her the pain and suffering of getting the arterial line in, and they wouldn't have needed to bother with an epidural. One for her to ask the obstetrician at her follow-up appointment.

We went to see Sarah's cardiologist the week after she was discharged from hospital, and he said that looking back over all of the echocardiograms that have been taken in the 18 months or so that he's been following her, it looks like her aortic aneurysm has gotten a little bit bigger.

It's still below the size that they'd normally operate at, but he said that in his opinion it should be repaired before attempting another pregnancy, to play it safe. He even said that afterwards, Sarah could go back to doing triathlons, which is a big step back towards a normal life.

So on Monday, we had an appointment with Dr Craig Miller, who is apparently the best cardiac surgeon in the US, and one of the top three in the world, when it comes to aortic aneurysm repair whilst being able to save the heart valve.

We'd done a heap of reading up on Dr Miller before the appointment, and the cardiologist's clinic administrator had told us about him as well. Apparently he's a real character. He certainly looked it from the staff photo (linked above). In reality he looked much more like this.

But he's certainly a real cowboy type. We saw his nurse practitioner on Monday before we saw him, and his nurse practitioner was this moderately pierced, cowboy boot wearing, "y'all" speaking kinda guy, who really knew his stuff. In fact we exhausted all of our questions that we had for Dr Miller on him before we even saw Dr Miller, because he was running a bit late with the previous patient.

This is where Sarah's got a pretty detailed write-up of what they're planning on doing. They're going to replace more of the aorta than they would otherwise (because the enlargement seems to be continuing further up the aorta), which makes the surgery a little more involved, in that they're messing with the arteries that lead up to the brain, so they've got to some more funky bypass work, and lower her core temperature so her brain copes with the blood flow being monkeyed with.

Dr Miller was very softly spoken, and a lot older looking than I'd expected, given the whole cowboy hat thing. He seemed really nice and thorough, and explained everything. He also showed us what a mechanical valve looked like.

The reason sparing the valve is so important is that the alternatives if they can't are either a pig's heart valve or a mechanical one. Both have their drawbacks.

A pig's valve won't last the rest of Sarah's life. She'd need to have valve replacement surgery at some point down the track (I think they said about 8 years, although they wear out faster in younger people).

A mechanical valve requires you to take blood thinning drugs for the rest of your life. One of the side effects of these drugs are birth defects. It's also audible from outside the body.

We got to see (and keep) a sample of the Dacron tubing that they use to replace the part of the aorta they're removing. I was totally taken aback by the diameter of it. I hadn't sat down and really thought about what 4.4cm (which is about what her aneurysm is currently at) really looked like.

The operation is likely to take 8 to 10 hours. I'm not looking forward to that waiting game. Dr Miller said the procedure, whilst sounding pretty bloody scary has about a 1% risk. I'm not exactly sure what that is a risk of though.

Sarah's booked in for January 3 next year.

The road ahead is still long.

It's funny. I was reading Planet Debian, whilst I sat on hold with Dell myself, and I read John Goerzen's post, which prompted to write this one, when I wouldn't have otherwise bothered.

Dell's customer service has completely degraded over the years, I think.

I've been trying for a few days now to get pricing on replacement hard drives for my PowerEdge 1850. When I bought it, I made the mistake of skimping on getting the 140 Gb disks because of cost, and the 70 Gb ones are approaching capacity. As I'm going to be back in Australia soon, I'll have an opportunity to visit daedalus and physically upgrade the disks, so I thought I'd start looking into ordering some new disks now.

I called the Australian 1800 number. It went something like this:

Dell: Press 1 for sales and pricing information

I press 1

Dell: Press 1 for home crap, 2 for small businesses with 3-400 people, press 3 for education and businesses with 400+ people

I press 2 since I figure home users don't buy PowerEdge 1850s.

Dell: "Dell switchboard this is blah, how may I direct your call?"

Me: "I'd like to get pricing on some replacement hard drives for a PowerEdge 1850."

Dell: "I'll just put you through to sales"

Dell: "Home sales, how may I help you?"

Me: "I'd like to get pricing on some replacement hard drives for a PowerEdge 1850."

Dell: "I'm sorry, you'll need the server people, let me transfer you"

Dell: "Dell switchboard this is blah, how may I direct your call?"

Me: "I'd like to get pricing on some replacement hard drives for a PowerEdge 1850."

Dell: "I'll just put you through to sales"

Dell: "Home sales, how may I help you?"

Rinse and repeat something like three times before the switchboard operator couldn't hear me and hung up on me. I swear I got the same sales droid in Home Sales at least once. Retards.

So I called back, opted for the 400+ employees option, got the same thing, but this time the switchboard operator put me through to spare parts, where I sat on hold for a while and then hit voicemail.

Maybe I'll be lucky tomorrow.