Waterloo Birdhaus: February 2009

My first surgery

I wanted to post about my trip to the hospital a few weeks ago. As with pretty much every appendectomy, is was a quick surprise thing. I’d never had real surgery before (unless you count wisdom teeth removal), and I’d never had an extended hospital stay. I’ve always kind of romanticized the idea of spending a few days in the hospital – with nurses and doctors doting over you – not having do anything but eat, sleep, read – having visitors come with gifts – almost like you could let reality go for a few days and have absolutely zero responsibilities or something – with sweet people attending to your every need. But now of course that image is shattered. This was nothing but stress and frustration. Not necessarily that I wasn’t at a good hospital, or that the German way of doing things is any different (I wouldn’t know of course without a frame of reference). But I’m certainly not left with a warm, fuzzy feeling. I came

into the ER late on a Thursday night with severe abdominal pains and vomiting. This has happened before to me – but never this bad. Thankfully I have a good friend, Alex, that has car and is German, and could take me in and also help navigate the system in my delirium. Actually her help would be invaluable throughout the next week for helping me prepare for my stay and eventually get home.
After a time of moaning and rolling around they hooked me up with an IV and gave me some "pain killers" (salt water?). I’ve run into this before. In Germany they REALLY don’t like to give you pain killers. It’s probably a good thing in general, when compared to the US, where vicodin prescriptions are written with wild abandon. But it really sucks when it’s you and you’re really in pain. First they gave me what I think was just fortified water in the IV, and after a while of complaining and moaning and intense pain, they bumped it up to metmizol, an NSAID, a bit stronger than ibuprofen or naproxen. Another 45 minutes or so later with no relief they gave me Buscopan, which is not a pain-reliever at all per se, but a kind of muscle-relaxer to prevent spasms/craps. Basically the intense pain reduced to a moderate level on its own, after like 4 friggin’ hours, my moaning and begging having no affect on the doctors. I can’t explain how much this sucked and the level of pain. While this was happening they did an ultrasound, which was inconclusive, and I spent the night at the hospital.
The next day the doctors determined that although without fever, my white blood cell count was rising quickly, and the region and type of pain was consistent with appendicitis. The night before they actually said they thought it was NOT appendicitis, but the surgeon they brought in the morning had a different thought. I actually felt much better in the morning, and the last thing on my mind was having surgery. I was just waiting to leave. My doctor came to the conclusion that, while not certain, it could be appendicitis, and I gathered the thought was that it was too risky not to go in, and if it was something else then they may see that too when they cut me open.
Let me say here that the communication here was mostly in German. About 100% German with the nurses and some doctors, and about 50/50 German:English with the other doctors. The

latter is still frustrating because neither of us could really express ourselves comfortably as well and accurately as we wished in our non-native tongues – a situation you don’t want to be in when they are deliberating cutting you open. It makes the conversations very short.
At some point a nurse came in and says they have decided I probably have appendicitis and they want to have surgery without delay, that night. But don’t worry, it’s a standard procedure to take the appendix out – just three little cuts and they go in and it’s 20 minutes. The doctor came in later having somehow found an English version of some papers explaining the procedure for me to read and sign. I noticed there were two boxes for “open appendectomy” and “laparoscopic appendectomy”, and the “open appendectomy” was checked. This did not make me feel good. Why not the laparoscopic like the nurse described? It’s supposed to be better for recovering, healing, less certain complications, smaller scars, etc. I asked the doctor about it when I saw him again. He said something vague about the facilities...they don’t like to do that here…if something goes wrong... it wasn’t really clear. Then he said plus, we usually do that for women and not men. I asked him “why” and he literally just stared at me silently for 5 full seconds like “you need to stop asking questions. right. Now.” Maybe he was just frustrated because I was having him trying to explain it in English. I can’t remember what he said eventually but it was nothing that made sense to me. But it was clear he was not going to go for the laparoscopy. This did not instill confidence in me. Especially the part about not having all the facilities if something went wrong. Because I no longer was in pain, I felt it may be worth trying to get a second opinion. Or at least somewhere where they would be able to do laparoscopy. I thought maybe there was another good hospital in Dresden. I called my boss from work, with hopes that he may have some advice on where to get a second opinion. He said that he didn’t personally really think the other hospitals were any better, this was the biggest, the university hospital, and all the doctors he knew worked there. But said he’d make some calls. Soon after a nurse came in to get the signed surgery consent and get things rolling. When I told her I had not decided if I wanted to have the surgery or not she was not happy. She stormed off saying,

“well, we’ll have tell the doctor about this as soon as possible!” Yes, fine, whatever. Then I got a call back from the boss. He said he had talked to some people, and basically got in touch with the head of surgery for the hospital, who was of course at home at this hour on a Friday night. He said the chief was going to call the hospital and see what was up. A few moments later my doctor comes back in, says “Well, I just got off the phone with Dr. so-and-so (the head of surgery)” in a very accusative voice. “You know, if you really want laproscopic surgery, fine, we can do it”. He was clearly not happy about what appeared to be me going over his head and getting his superior to force him to change the procedure. In a way that is what happened, but I didn’t know it was happening. I tried to explain it wasn’t my call that things went this way, mainly because I didn’t want this guy who’s about to cut me open fuming. I tried to discuss with him again why he wanted open vs laproscopic in the first place and again never really got a good answer. My feeling it that it may have a been a combination of a)open is easier and faster for the surgeon and b)he wasn’t 100% sure it was appendicitis and if it wasn’t he could see around better for other things with open, versus having to make a while new cut and start over with a new surgery if he started with lapro. I don’t know though. But at least it was settled, and I could rest a bit easier. In the meantime however, I heard that nurses were not impressed with my second-guessing and hesitation on the matter, and were in fact gossiping about me outside in disapproving tones. And hence I would become the bad guy for the rest of my stay….
This wasn’t just my imagination either. Before this last episode a nurse was asking me questions and being very friendly and happy. Afterwards she was not. I was trying to be as nice and humble as possible, but it was not changing their minds. Meanwhile my roommate was practically cursing at them and they seemed much more eager to help and be friendly to him. Maybe part of it was my surely tortured-sounding German. And the fact that they needed to speak a bit slowly to me and lose the Sächsisch accent.

The meal Frau was exceptionally nasty. And the rations she would bring atrocious. After basically two days of fasting (except for what came in the IV), I was eager for my first food at lunchtime. A big bowl of potato soup, I was psyched. Until I tasted it. Wow. Didn’t know you could do that to potato soup. Especially in Germany. It still didn't, by the way, prepare me for what came the next breakfast - double brown surprise (pictured). I ate some of the potato soup anyway (can't say that for the breakfast) since I was pretty hungry. But it would be fair to say afterwards I was really looking forward to some dinner. The meal-frau came in and asked if my roomie and I wanted dinner. He said no, and she said something to me like “and you don’t want any either?” Which is one of those questions to which I never know what ‘yes’ or ‘no’ really means…. So since he had said “nein”, I went with “ja”, with a nod of the head to make sure. I figured it would be unusual to refuse dinner so even if there was some question she would err on the side of bringing me dinner. Apparently not. Food never came. She came in a few hours later to bring water or something and I asked her if there wasn’t going to be any dinner this evening. Then she said I told her I didn’t want any. So I said, no, he said “no” and I said “yes”. To which she kinda shrugged it off saying there was a misunderstanding. So she started to leave and I had to stop her to ask her if I could have some dinner. But right at this moment a very poorly timed chance coincidence happened. See, my bed was not long enough to fit me. And there was a large board at the end, which my feet would press up against. Well, just at this moment, the bed finally did not want to contain my legs anymore, and the board broke off the end and came crashing to the floor right at the woman’s feet. I’m sure there was no question in her mind that it was intentional. But it wasn’t! Anyway, it made such a crash that a couple more nurses from outside came in, looked at the board, and the looked at me in a kinda of “yup, this one” look. Now the food lady replied that there was in fact no more to eat. And of course now things were getting a little contentious and it was getting harder to understand her as she

spoke faster and got frustrated. I would tell her I wanted to eat and she kept asking me a question I could not understand. So I said “ah, mein Deutsch ist nicht so gut, können sie bitte langsamer sprechen?” To which she simply repeated what she said exactly the same, but REALLY LOUD with an angry tone. So I calmly said “nicht lauter, aber langsamer and deutlich, bitte”. Which didn’t make her want to help anymore so I just said “ja” to her question assuming she was asking if I wanted something in particular. Well it turns out she was asking I guess if I wanted “zwieback”, because that was my dinner. 3 small hard bread crackers. Fortunately a nice nurse came in an hour later and asked if I got dinner, I told her no and told her about the food-frau and she kind of rolled her eyes, and my roommate interrupted to tell her the woman was very unfriendly. So fortunately she was able to find me some decent food that apparently the food-schwester did not have access to or something.

Lunch the next day was actually a surprise. A genuine heavy German meal, complete with sauerkraut. But then the next two dinners consisted of nothing but two pieces of bread. And one day a slice of cheese on top.

I ended up in the hospital for about 5 days total. Right as I was going into surgery my doctor said I would be able to see the video of the surgery afterwards. But upon asking him each day after I came out, he always said it wasn’t possible, it wasn’t easy, they don’t usually do that. Which made me wonder what changed his mind. He eventually showed me a still photo of my appendix before it came out. As they were ushering me out (to go straight home to my couch, I could hardly walk) they provided me with all of TWO pain pills.

I asked if I could get some more and they told me I needed to see my general practitioner for that. I also asked how long I should stay at home, when I should resume activities. They also said to go to my general practitioner, who hadn’t seen me in a year. Nevermind the fact that I would eventually have to drag my ass in that state halfway across town for this appointment, why on earth should he be brought in to this situation he knows nothing about? The next day I made it in, he took a look at me and was kinda like “yup, looks like you had surgery.” He game me a prescription for more metamizol and asked how long I wanted a note to get out of work for.