Propofol dreams and paper drape indignities

Some reflections on when healthcare goes right, and when it goes wrong...

I woke from my colonoscopy/upper GI endoscopy in the midst of a vivid, realistic dream. It was such a strong vision, an immersion in another world that felt so much like the real world. I told the nurse about it, trying to remember where I’d been, what I’d been doing, who was there. She left to get me some water and collect my husband, as I slowly came back to this world. The dream faded. I could remember none of it. Not a single detail, not even a vague description.

A few minutes later, sipping my water, the nurse chatting with me and John, she said that I was sounding much better, that when I first woke up I was very chatty but very mumbly. All that world sharing I’d been doing and not a word of it comprehended. I wonder where I was. Where we go in that twilight of anesthesia. What worlds we inhabit.

After a night of not sleeping much (if you’ve had a colonoscopy before I’m sure you can relate), the propofol nap was refreshing. This was my second colonoscopy but first upper GI endoscopy, thus first time with cameras going in both ends. Not at the same time, of course. They do the upper GI first then spin you around (well, spin the bed around). I was assured they’re different tubes but they do the upper GI first just in case - harharhar.

Before the procedure started I put on the soft, warm gown straight from the heated compartment, and was covered in a couple warm, heated blankets, too. I was as cozy as you can get in a hospital. After being wheeled into the operating room, I was asked to lie on my left side, with a pillow to hug and a bolster at my back to keep me snug, still covered in those toasty blankets. It was comfortable. Dignified. I didn’t feel exposed or vulnerable, despite the imminent tubes going down my throat and up my ass. It was pleasant, all things considered.

That comfort and dignity were all the more evident as I reflected on the how undignified my pre-operation consultation was with my gynecological oncologist that performed my oophorectomy. Just a consult, no tubes going into me, no procedures to be done. She was a highly recommended by my genetic counselor, and has stellar reviews on HealthGrades and whatnot. We’d talked on the phone for our initial consult and I’d liked her. I was pretty sure she’d told me she wouldn’t have to do an exam for the pre-op consult, but when you’re being treated for cancer it’s hard to remember everything. At least for me it was hard. I never felt quite sure of things, just trying to get through each thing.

So when I was led to the exam room and told to strip down below the waist and cover myself with the paper drape (not even a gown!), I did so. This after driving an hour and forty minutes for the appointment, after being weighed for no clear reason, after already having had a lumpectomy and lymph nodes removed, after a month of radiation. I just did what I was told and didn’t say ‘I thought there wouldn’t be an exam…”

So I sat there, cold, with a paper drape on my lap that crinkled every time I moved, so I tried not to move, as the surgeon came in. But not just the surgeon, also the nurse that would take notes, and a young male medical student, and I think one other medical person as well. And John (my husband). I asked John how many people were in there and he said 3-4 as well, we both sort of remember a fourth person, but don’t really remember who the fourth person was.

So four people. I was introduced to the male medical student but not to the other two. I was asked if it was okay that the medical student was in the room. It’d have been hella awkward to say no, you know? Five people if you include John. Six if you include me. A lot of people in a small exam room.

But I was the only one sitting there naked from the waist down, crinkling and sweating on the paper beneath me, with more paper crinkling and covering me up. I tried so hard not to move, to draw attention to all this paper, to me.

The surgeon, upon seeing me, said that she didn’t need to do an exam, so ‘they shouldn’t have made you get undressed.” Who the hell is ‘they’? Aren’t they a part of this medical office? Aren’t they also on the team? What a weird thing to say. I can’t help but think that it reflects that they are not a part of the team. That they are also othered. In addition to blaming ‘them’ for my predicament, she also did not offer for everyone to step out for a minute for me to get dressed. She just sat in front of me, while everyone else stood over me (except John tucked sitting in the corner), and started talking about my upcoming surgery.

I sat there naked and vulnerable and supremely self-conscious and tried to listen, but it’s sure hard to feel like an equal partner in your care when you’re sitting there half naked and you DON’T EVEN HAVE TO BE. It was awkward and unnecessary and undignified.

Contrast that with my colonoscopy/upper GI endoscopy where I very much needed to be exposed, yet I was given a soft and comfortable cotton gown and was covered in warm blankets. Literally warm, they came out of the blanket heater thing and they were so nice, so cozy. I did not feel exposed at all. The bolsters and pillows cocooned me, I felt comfortable, cared for, respected, dignified. And tubes were about to go down my throat and up my butt! I was comfortable even after a night of no sleep because prep and no food for 24 hours! I was so comfortable I wasn’t even hangry!

Which shows how much I did NOT need to feel naked, exposed, vulnerable, and undignified in that pre-surgical consult for my oophorectomy. And it was a male doctor and a male nurse anesthetist for my colonoscopy, so it isn’t that I only felt more vulnerable because of the male medical student - it was the male medical student being a surprise as I sat there naked and covered in paper and asked if it was okay that he was there. There’s a big difference being introduced to someone while you’re cozy under warm blankets and they seem like they care, then being introduced to somebody while your sweaty ass is crinkling the paper beneath you in a freezing room under harsh fluorescent lights.

If I wasn’t undergoing treatment for cancer I would have been more furious at the time at all the unnecessary indignities. It didn’t help at all that for the actual oophorectomy itself, no one came to talk to us afterward. No one. I mean, we had the recovery room nurse, but no one from the surgical team came to check on me, to tell me (or John) how the surgery went, what to expect or what to be concerned about. The recovery room nurse pretty much just told us we were free to leave when I felt up for it. So we left, and I had assumed someone from the surgical team had talked to John while I was still zonked.

Nope.

What the actual fuck? We’d driven two hours to the hospital the day before. We paid to stay overnight at a hotel so we wouldn’t have to make the long drive in the morning. It was stressful to be undergoing yet another surgery, just three months after my previous surgery and only two weeks after I ended a month of radiation. And no one seemed to care about me at all.

Contrast that with my lumpectomy and lymph node removal three months prior. My surgeon not only chatted with us extensively after my surgery, she wheeled me out to our car when I was discharged! She called me from her cell phone later that evening to see how I was doing. I also chatted with the anesthesiologist after that surgery. Two members of the surgical team talked to us, compared to zero! Come to think of it, I think a surgical nurse did as well. So much care! After my follow-up appointment, my surgeon hugged me! She was so wonderfully human and humane.

All this to say, there are ways to care about people while caring for them. Ways to make people feel respected, dignified, human. Not just meat sacks to be weighed, examined, poked, prodded, cut, manipulated, etc. Hell, I was just a meat sack to be talked at at that pre-op appointment! It would have been SO EASY to give me a minute to get dressed. A minute so that I could actually focus on what the surgeon was saying rather than focusing on not moving so my bare ass didn’t crinkle the damn paper. How can you pay attention when you are half naked and DON’T NEED TO BE. I just cannot stress the humiliation and indignity of that enough.

I wasn’t as upset then as I am now - I was more bewildered and overwhelmed and disbelieving. Especially as I had to sit there while that medical student hovered over me while he was learning how to be a doctor, a surgeon, a health professional. What kind of surgeon will he become? Did he sense my humiliation? The loss of my humanity? Did he think that was just how things are done and therefore okay? Did he think he’d like to do things differently?

I hope so.

I hope that medical student recognized that things can be done differently. I hope he was exposed to mentors that modeled a different approach. A more compassionate approach. An approach that recognizes our shared humanity, the scariness of cancer, the need (and desirability) to free up as much capacity in the patient as possible (so they can actually hear, and maybe even take in, what you’re saying!) by making them as comfortable as possible during a very vulnerable and discomforting time.

I hope he had some folks like my previous breast cancer surgeon, anesthesiologist, and surgical nurse. Like the doctor, nurse anesthetist, and surgical nurses at my colonoscopy. Or my hip surgeon, who made me feel seen, believed, human, all those years ago in the work comp system, where I so often felt invisible, doubted, less than human.

I felt cared for and cared about by all those folks, so I know it is possible. And I hope they all felt cared for and cared about while they went about their good work. Compassionate, caring systems aren’t just good for patients, they’re good for all of us.

I still wish I remember what I told the nurse about my propofol dream. After she told me I was super mumbly, I remarked that they must hear some crazy shit when people are waking up after surgery. She just laughed. I told her she should write a book. Before I was discharged, she relayed to one of the other nurses the book idea.

Maybe my propofol dream will make it into print someday.

Hey folks, thanks for reading. When so much right now is inhumane, when empathy is spoken of derisively and framed as our downfall, it can seem pointless to write these posts hoping we can do better in healthcare. I sometimes wonder if I should write at all, but I recognize that is despair talking and I will not, can not give in to it. Because I do have hope that we can build something better. Something more humane, more compassionate. Something rooted in kindness, respect, care, dignity. Rooted in love.