D to the C: Dilation & Curettage

My experience of having a D&C was very positive. The pre-op visit the day before surgery had prepared me: don’t eat or drink anything after midnight. Please shower the morning of. Please take off jewellery, make up, and nail polish, and remove contact lenses. Please check in for your 10:30 am surgery at 08:30 am.

Twitter 07:31 am – It’s a sunny morning in San Diego. Flying past rush hour traffic in the carpool lane. Feeling nervous but calm.

Twitter 08:21 am – Checked in for surgery… god, I’d love a coffee now!

Moments later, my name was called by a very sweet-faced man in his fifties. He smiled as he put out his hand. My name’s Ben, and I’m one of the nurses here. I’m going to get you set up. Is this your husband? He can come too.

Ben led us to a room with vinyl recliners. I sat in one as he wrapped a blood pressure band around the top of my arm, and took my temperature — to DH’s and my astonishment, a quick swipe across my temple, above the temporal artery, was enough. Blood pressure was good, heart rate steady, and I confirmed that nothing had passed my lips since 11:45 pm the night before. I was healthy enough for surgery.

Ben then took us to Exam Room 1, a room with a bed, chair, and basin in it, connected to a Jack & Jill bathroom.  He instructed me to change into the hospital gown and to open the door when I had done so.

I giggled as I put on the gown. I’m almost 6’1″, but it was huge! It had multiple layers of paper in it, and I noticed two flaps covering a thin membrane valve where you could connect a hotel hairdryer-like attachment and fill it with warm air.

Soon after, a doctor stopped by to introduce himself. Good morning! he said brightly. I’m Dr. B. and I’m the anaesthesiologist. We’ll go over your anaesthetic options in a minute. With me are a med student and a first year resident: would you mind if they observed?

I didn’t mind, and actually benefited from the experience. Dr. B. turned to his students and explained that he could already tell I had an excellent airway for intubation:

She has a long neck and a pronounced jaw — some people don’t, you know, and that makes them more difficult to intubate.

He grinned at me and I began to crack up. He asked me to bend my head so my chin almost touched my chest and then tilt my head backwards:

Mobility is important and always look at the face. If there are any cicatrices (scars) around the nose and mouth, we often find that this area (pointing to the fleshy part between my chin and neck) can sometimes be a little ‘woody’, which can make intubation more difficult.

Then he asked me to open my mouth and saw that my front teeth are ever so slightly chipped. He turned to his students to explain:

This is important to note because although this lovely young lady is honest, some people are not and they will claim you chipped their teeth. Also, if there is a loose tooth, it’s better to remove it: if you lose it, you have to find it. I heard of a case where the tooth ended up in the lung and it caused pneumonia.

He asked me to open my mouth a little, then open wide and say AAAAAAAAA, then EEEEEEEEEEEE, then AAAAAAAAAAA again. Apparently this told him a great deal about the position of my tongue:

See how her tongue rises and then falls down again? When you’re intubated, your tongue falls all the way to the back of your throat.

(This part of the conversation was the only part I couldn’t follow, so I can’t tell you why tongue position is so important. But it is. So there.)

Dr. B. listened to my heart and lungs, and then presented me with two options for anaesthesia. I had thought I would have the option of ‘conscious sedation’, but when I learned that it was effectively having an epidural which meant a longer recovery time, I took the doc’s advice and opted for the general anaesthetic — what he would recommend to me if I were his sister.

Alright then, doc, I grinned. Let’s pretend I’m your sister: general anaesthetic it is.

He joked that his sister always buys him lunch. I shot back a “maybe not today…” and we both laughed.

Ben returned to insert my IV line and run a quick blood test.

So, what part of Texas are you from? he deadpanned.

I explained that I am English — born in London, but raised in Spain. He lapsed into Spanish and told me his family is from Barcelona. Suddenly, I could see that he did look a bit Spanish — no wonder I liked him immediately! And, to top it off, we even live in the same part of San Diego.

Ben swabbed the crook of my left elbow and commented, as anyone who has ever taken my blood has, on what good veins I have.  I’ve given blood in the UK (and can’t in the US because I have spent more than 3 months living in the UK and could be infected with… wait for it… Mad Cow Disease… … …) so am OK with needles and usually watch as they’re are inserted, but IV needles are quite large — I’ve had several before. I turned away, but watched him pull out the needle, leaving behind a thin blue tube. He took a blood sample, enough for two vials, and hooked up the IV tubes, and injected a salt water solution which sat in the tube. It was painless, but still a bit gnarly to have all this equipment hanging off me. Sense of humour intact, I tweeted a pic.

Twitter 09:23 am – Ben the nurse hooked me up, wacka wacka! Having a general anaesthetic…

A man in scrubs appeared in the doorway. He introduced himself as Jeff, the anaesthesiologist nurse, and asked if I had any questions. I didn’t. He said that when I got to the OR he’d give me some “I-don’t-care-anymore drugs” intravenously, and reassured me that everything would go smoothly.

Later, a 4th-year resident, Dr. L. came to introduce herself. Her face was as happy as a sunflower and she was sympathetic to why I was here. She told me not to worry, that D&Cs are among the safest and most often performed procedures they perform. She said that Dr. D., who would be performing the procedure, was excellent and very kind.

Dr. L. asked if I had had any pain. I explained that the night before I had been in excruciating pain and had passed one of the largest clots yet. It was decided that I should have a final ultrasound to make sure I still needed surgery.

A med student wheeled in the ultrasound machine, and was followed by Dr. D., the OB/GYN surgeon. I liked her immediately. She was kind and confident, but didn’t come across as arrogant.

An abdominal ultrasound didn’t reveal much, so Dr. D. apologised and said we needed to to a trans-vaginal one.

Don’t worry, this will be trans-vaginal ultrasound number six… I told her. She was almost impressed…!

Drs. L. and D. hummed and hawed as they examined the contents of my uterus. It appeared that I had passed quite a bit the night before, as the lining of my uterus measured thinner, as did the tissue.  However, they couldn’t be certain that the remaining tissue, small though it was, didn’t have any blood flow through it. I was told that I had the option of letting it pass naturally, if I wanted.

I thought about it for a few seconds. On the one hand, I don’t believe in subjecting oneself to unnecessary surgery. What if something went wrong? WHAT IF… I ended up needing an emergency hysterectomy just for a blood clot? Then I thought about all the physical pain I had been in, how much it had interfered with my life the past 8 days. And as for the emotional pain… how could I move on before passing everything? I decided I couldn’t delay my healing any more and said I’d like to proceed with the D&C.

I had a tiny flash of regret based on the WHAT IF, but reminded myself I knew my body and I am very in touch with it. I pushed aside my fears and felt I had made the right medical decision for myself.

I was mulling all of this over when Rudy the OR nurse came to introduce himself. Like so many others, he asked if I had questions and explained what was going to happen, adding that when I went into the OR we would have a debriefing.

Rudy left the room, and shortly thereafter Jeff, the anaesthesiologist nurse, returned with a blue shower-cap for my hair, and then it was showtime.

DH and I hugged and kissed each other and turned to walk in opposite directions.  As I followed Jeff, we walked past half a dozen med students and residents who were all watching me. I joked to myself that it was rather like being a celeb on the red carpet. Except it was a shiny linoleum floor and we were all wearing similar outfits.

As we get to the OR, it gets colder and colder, Jeff said. We pushed through heavy doors that said AUTHORIZED PERSONNEL ONLY. STERILE AREA. The drop in temperature was immediate. To our right was a trough for doctors to scrub up. Jeff led me through doors opposite, into the OR.

I have always been fascinated by medical stuff — my brother just loves teasing me about it. (There’s a part of me that secretly wants to be a doctor, I guess — could you tell from this post?) I took a good look around in the OR. Metal cupboards with glass windows spanned the length of one wall. Opposite, a white board with the medical team’s names and other information I didn’t have time to take in.

I was instructed to lie down on the gurney and as I sat down I saw a tray of un-scary-looking instruments laid out. Classical music was playing. Ah, Dr. D. enjoys a little Mozart as she works. I liked that. I lay down and looked up at the three giant white arms each holding a giant lily pad of flood lights overhead. I felt quite calm but noticed I was shaking with adrenaline. Someone strapped my legs into neoprene legwarmers — the ultimate anti-embolism socks.

Rudy took charge momentarily:

We begin the debriefing. Can you please confirm your full name? Date of birth? Are you here for a Dilation and Curettage, also known as a D&C? And you consent to this procedure and are aware of the risks?

By this point, everyone was in the OR, only recognisable by their eyes. Dr. L. leant over with her dancing eyes and patted my arm. We’ll take real good care of you. Dr. D’s mane of pre-Raphaelite blonde curls was swept up under a showercap, but I recognised her by her deep blue eyes with friendly crowsfeet. She smiled and said We’re going to take good care of you. Right then, I said to her that the only thing I was scared of was waking up and finding out that I had needed an emergency hysterectomy. Her eyes crinkled kindly and told me she was almost certain that wasn’t going to happen.

Jeff hooked a hotel hairdryer pipe to the gown flap over my left shoulder. He said the air would feel cool for a second but would immediately warm up and keep me warm. There was a whump! and my gown instantly inflated. I burst out laughing and said, Jeez, it’s like a circus in here — and I’m the Big Top! I was glad everyone laughed.

Rudy asked if he could take my glasses. With that, Jeff slowly lowered an oxygen mask over my face. This goes over your nose and mouth. It delivers pure oxygen to help clear your lungs. Breathe deeply.

Hey, Jeff? I said, I think I just got high…

Oh yeah, I just gave you a nice adult cocktail of drugs. He was serious, of course, but I could hear the grin in his voice.

There was no counting down from ten. The next thing I knew is that I had been dreaming about WordPress (eh?) and remembered I’d had surgery. I was in the Post-Anaesthesia Care Unit (PACU) and was surprised and groggy.

The nurse next to me, Rosalee, checked my sanitary pad. I wasn’t bleeding, and my vitals were good. Dr. L. came over and we had a short conversation. All I remember her saying was that it was a good thing we did the surgery because the remaining tissue was ‘sticky’ and I might not have passed it myself.

I could have easily nodded off again, but forced myself to stay awake. I felt alert, but aware that my short-term memory was fuzzy. I asked Rosalee what time it was. Something about her smile made me ask if I had already asked this question. She laughed and said yes. It was 11:20 am, and Dr. D. was telling DH that my surgery had gone very well. He, my DH, would be along in a minute.

Along he came, looking relieved. I asked him to take a picture of me which I texted to my mum in Spain, dad in Bulgaria, brother in London, and best friends in New York and Portland.

And suddenly, it was 12 noon. Forty minutes had passed in the blink of an eye. Could I get dressed? I thought I could. DH took my arm as I sashayed ungracefully to the bathroom. To his surprise, I was able to balance on one leg as I put on my leggings. That’s what a year of Tai Chi will do for you! he said admiringly. He was right. (I can’t wait to tell my Sifu.)

I returned to my PACU bed and informed Lester, the new shift nurse, that I had been able to pee. He removed my IV line and gave DH discharge instructions. DH went to get the car and I waited for an orderly to bring a wheelchair.

Twitter 12:36 pm – About to be discharged. Surgery went well, phew!

I felt like a bit of an idiot, being wheeled out of the hospital. I was too out of it to feel irritated, but noticed I was probably feeling a bit defensive. I was hiding a sad thought. I realised I felt like this because my arms were empty. I had imagined this moment happening six-and-a-half months from now, with a little bundle in my arms. The chair felt very large. It rumbled across different surfaces. I was glad I didn’t have to live in a chair, like some people do.

The orderly didn’t say much, and I was glad not to have to make conversation. When we reached the curb by the valet, she took out her phone, and I enjoyed the sunshine on my face and the warm breeze on my hair.

DH pulled up and I was wheeled to the car. I stood up and thanked the orderly who told me to have a nice day. I don’t know that it was a ‘nice’ day, but it was certainly a better day than many I’d had in the past 2.5 weeks.

When we got home, there was an anxious and excited dog to greet me. He’d refused to eat while I was gone but tried to pull off my Jizo and Chibi baseball cap. I stumbled into bed and he jumped up, and curled himself into a ball next to me. We slept like that for three hours.

When I woke up, I felt more like myself than I had in a couple of weeks. The pain was gone. I wasn’t even bleeding. The only difference was that I wasn’t pregnant. My pregnancy was gone but in its place was an acorn. A little nugget of something that I think will grow into wisdom of some kind. I re-read some of the old emails and messages I’d received, and saw I had some new ones.

I am not alone. You are not alone. We are not alone.