Facing my fear of the upcoming surgery

The date for my surgery is set. On the 1st of June at 6.30 sharp I need to register myself at the Women’s Clinic. On the 17th of May, a nurse from the hospital called to confirm the date and inquire about allergies, weight and height.

“You will have a one-hour meeting with the surgeon next week to discuss the operation,” she said. “And the same day you will meet with the anaesthetist, the stoma nurse and the nutrition consultant. In between you should go to the lab for a blood test and a heart film,” she added resolutely.

*

Up until that phone call, the surgery had seemed far away. My unconscious goals had been  to cope with the chemo treatments and their inconveniences and mentally come to terms with the fact that I have a deadly illness. These alone had already caused some sort of cognitive overload leading to forgetfulness. For instance, one day, I had found myself embarrassed standing at the counter in the K-Market, telling the cashier I’d forgotten my pin code.

So, I hadn’t given my operation much thought. Also, I have only had good experiences with surgeries. Exactly 28 years ago, my youngest was born with a caesarean in Heidelberg, Germany. Some years later, I had both wrist and ear surgery in Oulu, Finland. At the time I used to tell myself that many had gone through invasive procedures, whether giving birth,  undergoing wrist fracture management, or a stapedectomy sometimes even in less favourable circumstances. “If they can do it, I can do it,” was my mantra. Looking back, I seem to have been almost fearless in my younger years. 

*

The day after the call from the nurse, 14 days prior to the surgery, I suddenly started to feel anxious. June 1st was getting closer, and I tried to remember what the doctors had told me about surgery during the past five months. “You might get a stoma,” warned a female doctor sometime in January. “Your stay in the hospital probably takes 7-10 days,” said another doctor sometime later. I also remember flashes of discussions with my fellow-chemo goers. “My surgery took more than 10 hours,” one of the ladies proudly declared as if she had taken part in a fierce competition. “After the surgery, you’ll stay in the Gynaecological Ward,” the nurse told me during my fourth chemo treatment.

Snippets of information from different resources aren’t helpful at all. On the contrary, they cause insecurity.

I decided to go online to prepare myself for the one-hour meeting with the surgeon. I looked up debulking, surgery to completely remove visible cancer and CRS, cytoreductive surgery, during which all cancer within the abdominal cavity will be removed. Both operations seem likely procedures for my ovarian cancer with metastasis in stomach and liver. I wrote earlier that Google isn’t exactly a consoling platform. It took some courage to go through the details and try to understand the surgical procedures. Logically, my eyes also scanned the paragraphs about success and mortality rates. In both surgeries the prospects are incalculable. While my brain tried to make sense of the overload of information, I gradually started to freak out.

As always when I feel stressed, I started getting nightmares. For instance, one night, in my pyjamas, I stepped into a doctor’s examination room. I saw a red sofa, the kind of sofa that Freud used for his psychoanalysis. The floor was scattered with broken ampules, syringes and medicinal bottles. The bearded doctor harshly ordered me to take a seat on the sofa. I stood in the doorway, didn’t want to walk barefooted through the glass debris on the floor and freaked out. I woke up in sweat at 4 am.

The next morning, I decided to analyse my fear and started writing this blog post.

 

Preoperative proceedings

I’m not too worried about the anaesthesia. To be honest, I’m rather not aware of what is going on in my body during the operation. I just hope surgeons and nurses will treat my body with respect, but I suppose that is a matter of trust. Generally, I love the drowsy feeling before falling asleep.

 

Surgery

The chance I will die during surgery is low, less than 1 in 100,000 according to Google, but still present. My grandmother died during a hernia operation. “The surgeon made a mistake,” my traumatised mum used to tell me and my sister.  Also, I know that blood clots or heart attacks do sometimes happen during surgery. But then, it doesn’t seem to be a bad way to die as I’ll be unconscious anyway. I’ll just make sure I will call my boys and their partners to let them know I love them the evening before I go under the knife.

 

Post-operative

Concerning the post anaesthetic phase, I do fear the moment I wake up after the surgery. How much pain will I have? How tired will I be? Will my hand feel a stoma on my stomach, or not? Will one of the surgeons come to my bed and tell me they were able to remove all cancer? Or will they regretfully tell me that there are still tumours left behind. Will I be able to comprehend this information? Is it possible to reply adequately, or will I react like a zombie, lying flat on a white hospital bed?

My uneasiness with my post-operative state has to do with potential dependence on the nurses or therapists. Whether bathing, eating or walking, I wonder if I need help? I’m an independent woman and rather take care of myself!

*

Finally, on the 24th of May my husband and I get the details of the operation during our one-hour meeting with one of the surgeons. “My colleagues and I will first start with a laparoscopy in the abdomen to check the intestines. If we find widespread tumours in the small intestines, no more extensive surgery will be performed.  Three more chemo treatments will be scheduled then,” she explains.

If the surgeons can’t find tumours in the bowels, they will perform a CRS (cytoreductive surgery) and remove the uterus, the ovaries, fallopian tubes and ligaments as well as the omentum, spleen and liver nodule. As a precaution, also peritonectomy and bowel resection will probably take place.

“The bladder will stay intact,” the surgeon promises.

*

To overcome my fear, I schedule a last minute meeting with my therapist to ask her for a way to release my post-operative insecurities and fears. “What can doctors and nurses do to make you feel calm in the recovery room?” she asks. For a moment I look at her in astonishment. It never crossed my mind that I could ask for anything and don't know what to answer. “I hope someone will touch my arm and tell me that everything is fine,” I finally say. “Then communicate that with your doctors and nurses,” she states.

I later realise that I do have some sort of control and that I can bring my own pillow, ask the nurses for relaxing music or even a spray of my favourite perfume, lily of the valley, on my pillow. Anything to reduce anxiety can be arranged. I just need to communicate my wishes.

Despite these little actions, it’s clear the outcome of the surgery is unpredictable and that there’s an awful lot I can’t control in the coming weeks. Cancelling surgery is detrimental to my health, so I really don’t have a choice but to face reality, let go of control and hope for the best.

 

 

 

Fairy-tale Friendship

Once upon a time there were seven dwarfs cycling through a lush landscape on an August day. They'd set off from Groningen, a university town famous for its poisonous egg balls and the Old Grey One, a gothic church that was once struck by lightning.

My Birthday card made by K. Biesheuvel (inspired by a Aivax tutorial).

Seated on their little bikes their feet firmly pedalled in a western direction. They passed fields with blooming rapeseeds, grain and sunflowers, but the dwarfs did not seem to notice. They kept their eyes tightly on the slippery clay soil to stay on the right path and didn't say a word.

The destination was an uninhabited, forested area near Appelscha, a town in the northern part of the Netherlands. 

 

*

The dwarfs, all born and raised in places with weird names, Zuidlaren, Rolde, Emmen, Groningen, Leeuwarden, Assen and Middenmeer, were nervous. They had never been in the enchanted forest with its shrieks and croaks and feared that there were rogues and bandits behind the bushes. Anything could happen on the 45 kilometre-long road. What’s more, they were anxious about the arrangements for the week set out by Earl Bob, a real nobleman and his governors.

Although they'd briefly met before, the dwarfs didn't know each other. They'd noticed they spoke different dialects and had heard one among them even speak Frisian, a gibberish language.
 

Some of the dwarfs had reluctantly agreed to be part of the programme and would rather have turned back to their magical mushroom rooms in the city. But they'd all signed a blood oath for a four-year nursing program at the University of Applied Sciences. There was no way back.

However, not all of them wanted to become nurses. Dwarf Karin, never without her camera obscura, fancied a career as a magical photographer. Also, Frederiek in her red overall dreamt of watering cabbage patches and then seeing babies emerge from each cabbage head.

*

The voyage continued and the landscape started to change. Dense woodland with oaks, birches and elms replaced the golden fields. There was just a bit of light in between the trees, but despite the shade, the air felt bloody hot.

Sweat was dripping down from dwarf Petra's face. Dressed in the woolly magical hooded sorcerer's coat, the one that came into her possession after an exchange with Finnish trolls in an old trading post in Taivalkoski, she would rather lie down on a bed of moss. But she clenched her teeth tightly together and cycled on.

Finally, after seven hours and seven minutes the dwarfs arrived in a nearly impenetrable yard. They stepped off their bikes, looked around and noticed a red roofed bread house behind some spruce trees. Despite the darkness, the house looked inviting and neat.

Dwarf Annet, happy to give her sore butt a pause, rushed to the flagpole and climbed up to check the area and find out if she could spot any potential dangers. “There's a ladder,” she shouted. The others heard her melodic voice for the first time.

The grass had not been mowed but the balcony, decorated with ornaments made of ice-cream and sprinkled nuts, made the dwarfs’ mouths water and the green shutters made them long for their beds. They didn't know they would sleep in dirty bunk beds in a nearby storage room. Also, the menu would be beans with whatever the forest would offer for the whole week.

A leprechaun with a pointed hat came out of a nearby shed to welcome the group in a bass voice. “We'll make a campfire and tell you the rules so that you won't lose touch with your hygienic rules or fall prey to dubious medical quacks,” he said.

Despite his dark voice, the leprechaun didn’t seem unfriendly. The dwarfs heaved a deep sigh of relief and unpacked their bike panniers. Sleeping bags, shorts, raincoats and toothbrushes were all they needed for the week. 

The Introduction Week had started. 

* 

Forty years ago, Joyce, Annet, Petra, Frederiek, Karin, Gea and I met during the Introduction Week in a forest near Appelscha. Together with 60 other students we tried to get a grasp of what the educational program for the next four years would contain. In our case there was no forming, storming, norming and performing or any other stage of development needed. We sang some songs and that was basically the start of us as a homogeneous and stable group of seven girls.

In the next four years, we studied nursing theory. We practised administering injections and inserting catheters. We matured in health care law and organisational hospital changes. Without exception we disliked InterVision, group sessions in which we had to endlessly talk about ourselves, and we all nodded off during the “transcendent” philosophy lessons.

Still, we enjoyed medicine and vividly remember the bearded teacher who turned our classroom into a uterus while explaining the growth of an embryo during pregnancy.

We did not only meet in college. We made several trips to the Wadden Islands, an archipelago off the coast of the Netherlands. We canoed, cooked, dined together, and we danced.

We also got acquainted with each other’s families. I recall camping in the garden of Karin’s family. In 1985 we sat together on the king size bed of Frederiek’s parents, watching the Eleven Cities Tour, a skating event on TV. We had tea with Petra’s mum and sailed on the Frisian lakes with her brother as captain on the ship.

Some of us stayed in touch after graduation. Annet and Frederiek supported each other after their breakups with former partners in Switzerland and the Netherlands. Gea came to help during the birth of my children in the Netherlands and Germany. We were present at wedding parties and wrote each other cards and letters.

Careers
Gea moved to The Hague and became a district nurse. Some years later she specialised in dialysis nursing. She is now a district nurse in a village in the province of Drenthe.

Also Petra moved first to The Hague where she worked for one year on neurology. She then specialised in paediatric nursing and worked for some years as head nurse. Feeling burdened in an overmedicalized ward, Petra decided to take a break from nursing. She now works with youngsters on a nature based care farm.

Joyce is employed by the University Hospital in Groningen and has worked on nephrology for 34 years. Annet initially became her colleague in the same hospital. She started at the ear, nose and throat ward, switched later to gynaecology and then moved to Switzerland where she worked on rheumatology. At present Annet works in a town near Groningen.

Frederiek also started her first job in Groningen and became a nurse on the neurology ward. She later moved back to Friesland and became a maternity care nurse. After some years of employment, she decided to dedicate her life to voluntary work.

Karin started as a district nurse but evolved to a youth nurse. Currently she advises parents with children up to four years in Middenmeer, her hometown.

Last, I started my career in different psychiatric hospitals but later changed to internal wards, first in the university hospital in Groningen, and later in a deaconess’s hospital in Heidelberg, Germany. Not being able to get a work permit, my career as a nurse ended in Canada. In Finland I became a bureaucrat, again involved with helping others.

Commonalities
I asked the group what we have in common. According to Petra we all have good social skills. “We accept each other despite our differences,” Gea claims. Joyce and Annet, Karin and Frederiek agree. “We’re not like-minded, the base for our friendship was laid during our forming years in Groningen” Annet writes. Karin thinks that our northerner adagio “just act normal, then that you are crazy enough” says it all. “We accept each other’s lifestyles and we’re always interested in each other” Frederiek concludes.

I agree with my friends, however, having lived abroad for over thirty years, I don't think we are that different. Bottom line, we all want to make a difference in the lives of others either professionally or privately.

May 2019, Rolde

Almost every time I travel to the Netherlands, we reunite. We arrange a hike, a city tour or we meet in restaurants, and it always feels as if we are foolish dwarfs again.

Nevertheless, we are old hands too. During dinner we criticise modern nurses for their poor writing skills, we find the privacy laws these days incomprehensible and complain about too much bureaucracy in healthcare.

We don't take our friendship for granted. Last November, two months before I was diagnosed with cancer, we discussed how special it is that our group is still complete.

For my sixtieth birthday, I received a supersized postcard with us pictured like dwarfs in a fairy-tale landscape. The image brought me back to where our friendship started and made my imagination flow.

We stand around you, they had scribbled on the inside of the card. My nursing friends, they’re generous with their support and good at comforting me during hard times.