[Contents: TMI, medical, including descriptions of surgery and needles]
So as I mentioned on Twitter and here on Wednesday, I wound up having a cervical cerclage put in, kind of on a surprise basis, just before Christmas. This post is about that day and what happened. It's going to be super long.
So the Friday before Christmas was the last day I was going to be in town, as my plans were to leave Saturday morning with my sister to start the epic drive to our parents' house for 2013 Midwestern Holiday. I had an appointment with my Maternal-Fetal Medicine specialist to check on my cervix one last time before the holidays, and before it was too late to do anything else about it if it had shortened. I was feeling pretty good, and she was feeling pretty good - we weren't expecting any changes, this was just to follow up and double-check.
I get there that morning and walk up to the clinic check-in, where the nice person is very confused because there is no appointment for me in the system. Now, I had booked this appointment in person just the week before when I was in to see my doctor, so I'm confused and my anxiety is already spiking. I walk down the hall to my doctor's office to talk to them.
The receptionist confirms, no, there's nothing in the system for me... zie's going to go talk to my doctor. So I'm waiting around, even more anxious now. The receptionist comes back and says oh yeah, my doctor definitely knows who I am and wants to see me and I should have a follow up and no one is sure why it's not in there when I booked it last week and about six people get involved and twenty minutes later, they've decided it's the fault of the woman who I talked to when I booked it, this is like the third time this has happened and she needs to stop trying to do everything, and they're going to fit me in as soon as they can because the doctor most definitely wants to see me this morning.
So I wait probably another half hour, and I get taken in to ultrasound. I've now seen this tech like four times, so we're joking around and moving as fast as we can to get this done. At this office, they have a giant monitor on the wall so that you can see what the tech sees as you're being wanded and shit, which is kind of awesome, really. So she checks my cervix and measures it, and she doesn't say anything, but I can see the measurements as she takes them, and I know that it's shortened. Shit. Kid looks okay though, and she finishes up and says she'll come back and get me so I can talk to my doctor.
I already kind of know what's coming, but I'm trying to keep it cool and hold it together. My doctor explains yes, my cervix has shortened, which is less than ideal. She says that she recommends a cerclage, but, it's kind of controversial in cases like mine. She says about 60% of OBs would recommend it in this case, and that even in my case, while she would recommend it, she couldn't even say that I was making a mistake or going against medical advice if I refused it. And I'm listening to this and super-upset but trying to hold it in, because I've read the research, I know she's not lying to me, and while I know, just in my gut KNOW, that I need to get the cerclage, it's not at all what I wanted or expected.
I surprised my doctor when I said to her "It's not what I want, it's not what I expected, but yes, let's do it." So she goes over the surgical consent form with me. She'll be performing the surgery, and she's going to work with the hospital to get me in to the OR tonight, since she knows I'm leaving tomorrow for the holidays. I could go in to surgery any time from about 5 to 11 pm, so I can't eat anything after 11 this morning - about an hour from now. There are risks to the surgery, but she doesn't anticipate complications, etc. and so on. We go over everything - I honestly don't remember much of this point of the conversation, because I had already cried a bit and was trying to not cry more - and I sign the consent.
She gives me her cell number, and explains she'll call with an update of when she expects to be able to get me in to surgery, and to call her cell if I have any questions or problems. I thank her, because I know she's going to be scrambling and have a long day today, and I go out to my car. I try to call my mom, but she doesn't pick up. I call The Man, and weep all over the phone as I explain what's going on and that SURPRISE I'll be having surgery tonight. Neither of us is particularly okay, but he's going to try to make sure he can at least meet me at the hospital, depending on what I have to go in.
I hang up, cry some more, then pull my shit together so I can at least get some food. Since I have zero idea of when I'll be able to eat again, I go for as many calories as possible and get McDonald's. I'm also supposed to be picking up my sister from her dorm today, so she can leave with me tomorrow, so I call her to set that up as well as explain that SURPRISE surgery. She says well of course she'll come with me to the hospital, and we make arrangements for me to pick her up later that day.
I go home, eat, and try to distract myself. My mom calls back and I tell her what's going on, and cry SOME MORE, which at this point was frustrating me, because I knew that yes, I was upset because my expectations of what was going to happen were not what was going to happen, but the crying was fucking hormones. Mom and I talked for a while, and thankfully that seemed to get the rest of the hormonal feels out, because I was much calmer going forward.
While I was on the phone with Mom, my doctor called with the update of a tentative surgical spot, as well as which building to report to. I went and picked up my sister, and got another update - no, they still couldn't fit me in, we had to wait some more to see when that would happen, but I'd get another update at 5 pm. 5 came and went, so I called my doctor's cell, and nope, still nothing. Fifteen minutes later I get the call, they're fitting me in at 6, to which I respond "then I guess I'm leaving right now!" as it was just past 5:30. My sister and I hop in the car and drive to the hospital. I call The Man on the way and let him know.
I only live about fifteen minutes from the hospital, so we got there and parked just before 6. I check in at the front desk in the building lobby with a very very nice person, who checks me in, then explains that she's let surgery know I'm here, and when they call down that they're ready for me, she'll walk me up there. She asks if I have family with me, and I explain that my sister is with me now, and my husband will be meeting us here. She says that's great, and explains they'll wait down here while I'm getting prepped, then when I'm ready she'll escort them up so they can see me before I go in. She's calm and matter-of-fact, and that helps me keep it cool, too. My sister and I sit down and wait, and about ten minutes later, I'm escorted up.
I'm taken up through a maze of corridors and floors and goodness knows to the prep room. They explain that since they're busy and fitting me in, I'm going to be prepped in this room where they normally do the recovery for patients who need intense watching. The nurse asks me if I need to use the restroom, and I laugh and explain of course I have to pee, I'm five months pregnant, and she laughs with me. When I'm done, she gives me a gown, socks, and bag for my clothes, and explains I have to take everything off, then closes the curtains around the gurney to give me as much privacy as she can while I change.
I hop up on the gurney and at this point, I honestly am calm. I know what's going to happen, I chose this, it's all going to be okay. The nurse comes back and takes some vital signs. My doctor comes back to talk to me as well, explaining what the surgery will entail - I'll be given a spinal block for anesthesia, there'll be a drape so I can't see what's going on, she'll have to use retractors to get at my cervix, she'll stitch it, and done - she expects the surgery to take maybe fifteen, twenty minutes. I'll be given some anti-inflammatories to make sure I don't have contractions afterwards, and some painkillers if I need them, but most people don't. No, she doesn't anticipate I'll be at high risk for a C-section, and no, she doesn't expect that I'll definitely need a cerclage for my next pregnancy. If and when I get pregnant again, we can either put one in right away, or wait and see, but she doesn't expect my odds of needing one are higher than 50% either way.
She goes to scrub in, and the nurse takes more vital signs and starts checking me in and asking about my medical history. Another doctor comes in, introduces himself, explains that he'll be doing my anesthesia with his colleague (I got introduced to about a dozen doctors and nurses in twenty minutes) and he's going to put an IV in my arm while other nurses check my vitals and continue my history. I'm hooked up to a blood pressure cuff, a pulse-oximeter on my finger, and have leads for an EKG put on. He has no trouble finding a vein in my left arm and I barely feel it go in, which impresses me and I make sure to tell him. Now I have a saline drip going.
At this point they let my sister up. I give her my purse, because important shit like my driver's license and wedding ring are in there. I get asked if I have contact lenses and WELP yes I do, and it's explained that oh, I have to take them out. They can get me a container - which is a sterile urine collection container with some saline. This won't work for me, because I wear different prescriptions in each eye. Since I have a spare pair of contacts in my purse, I opt to just toss the ones I'm wearing, since they're disposables anyway. I whip those out just after my husband gets there.
The Man is nervous as hell, I can see it. So I gently suggest to him and my sister you know, how about you guys go get something to eat, and they're going to call you as soon as I'm in recovery and you can come up and see me, and it's going to be fine. I know my sister, who is also calm with me, will make sure to drag him to eat something. I kiss them goodbye.
The other anesthesiologist comes up and talks to me and explains the spinal procedure. Yes, they are going to stick a needle in my lower spine, which will cut off all feeling below the waist, and I won't be able to move my legs for a while. I ask if it makes a difference where she's going to go with the needle if I tell her I have a history of herniated disks. She asks which ones - L4-L5 and L5-S1 I explain. Yes indeed that makes a difference, she's glad I told her! We go through a few more questions, and then it's time.
I get wheeled to the OR. This was a trip because I had no contacts in, so everything was a blur, and here's me laying a gurney just being whisked through a hospital doot doot doot. We get to the OR and it is COLD AS HELL in there. They put more warm blankets on me. Everything is brightly lit and there's monitors everywhere and I'm hooked up to a bunch of them.
First things first: the spinal. I had to sit on the edge of the gurney, try to keep my spine as straight as possible, hug a pillow, and hunch over to open up the spaces between my vertebrae. I had a nurse in front of me on my right side, holding my hand and reassuring me, which really did help. The anesthesiologists were behind me, explaining what they were doing. The first few attempts did no go well. I had trouble relaxing and getting the right position. They kept hitting various things, and I yelped a few times. Where did you feel that one. Left I'd say, or middle. I had to take a break and sit up, and after I did the second time, I was able to loosen up enough and droop so that they could pop right in - in a second choice, higher location. It's not an experience I really want to repeat.
My feet started tingling first. I have some residual numbness in my toes, but this felt like they were going to sleep. This was a good sign. Before I lost control of my legs, I was moved to the surgical table. This had a kind of sticky, thick memory-foam-ish cushion that went from my head to just about the top of my ass. I had to scooch down, kind of like you do when you get a pap smear, so my ass was hanging off of it. My legs were put in RIDICULOUS stirrups - my calves were parallel to the floor and above my head - my knees and hips were at 90-degree angles. Nurses had to move them, because I couldn't pick up my legs so good anymore. They put compression cuffs on my calves - these inflated and deflated throughout the surgery to keep the blood flowing.
My arms went on special padded supports to my side, and a drape was put over my middle. The anesthesiologist was at my head, monitoring me and checking in to see how the spinal was working. I was told that I would feel some pressure during the surgery, but no pain, and if I felt pain, to tell her right away. We chatted for a while; she was about 22 weeks pregnant with her first, so we were comparing notes.
Did I mention the OR was cold? It was cold. I was shivering through most of the surgery. Unsurprising, considering fully half of my body was completely fucking naked. My doctor checked in, they confirmed my name and date of birth and everything one last time, and we were really off. They soaped me up and cleaned me off, and after that, just went at it.
I know what happens during a cerclage - you have vaginal retractors inserted to make sure your surgeon can get at your cervix, they use a special tool to grip the cervix and pull it towards them, then they suture it shut. Sometimes they have to put some stitches in at the top of your vagina to move tissue out of the way. I'm not entirely sure what all was done in detail with me, although I know I had a Shirodkar cerclage put in. It did seem like it took forever, but that might be because I was laying on my back, staring up at a ceiling I couldn't really see, shivering no matter how many warm blankets were put on me, and trying to breathe normally. I could just see the monitor with my heart and respiration rates on it. I'm not sure if this was good or not, but it did give me something to focus on.
I could hear the surgical team talking, but not what they said, except when my doctor asked for the table to be moved. The position you're in for this is called "Trendelenburg" - basically, ass over teakettle. The table dipped down by my head - hence the sticky cushion, so I didn't fall the hell off.
The spinal worked a treat. It was trippy to be able to tell that there were multiple people all up in my bits doing fuck-all knows what... but not feel any pain or sensation, really, beyond just "oh yeah, that's being manipulated in some fashion, huh". I tried to wiggle my toes once in a while, but a few minutes in to the surgery they stopped responding. WELP. I kept wiggling my fingers, trying to keep them warm and keep blood flowing through my arms. The blood pressure cuff I was hooked up to was ridiculously tight; it hurt and started cutting off circulation every time it inflated.
Finally they were done. My doctor came around and said that everything went well. Nurses took my legs out of the stirrups and laid them on the table, which was uncomfortable because then I was flat on my back with my feet lower than my spine, which made my lower back unhappy. I got unhooked from the EKG and blood pressure cuff, and had about six bazillion more heated blankets piled on me because did I mention I was cold? BECAUSE I WAS COLD. My teeth were straight up chattering no matter what I did. Other than that though, I was okay.
Since I still couldn't move my legs, I was moved on to the gurney. That was fucking slick as hell. Four people - one at your head, one at your feet, one on each side. The person at you head holds your head, and as everyone else rotates your body on to its side, makes sure your head rotates with it. You just have to stay chill. They slip a board under you, roll you back, slide you to the gurney, and slide the board out. It took about fifteen seconds, tops, and was kind of amazing. Not amazing enough I want to go through surgery again to experience it, but seriously, AMAZING.
My doctor and a nurse wheeled me to the recovery room, my teeth still chattering. But I could wiggle my toes again. I met two more nurses in the recovery room and we hit it off famously. They tested how much of the spinal was still in effect with an ice bag, and were a little surprised that the sides of my boobs were a little numb. I explained that yeah, they'd had to put it in higher than originally planned, but hey, my toes wiggle now. They were excited for me. The anesthesiologists came in and checked on me, were also pleased that I could wiggle my toes and exert at least a little pressure with my feet, mentioned yeah, they didn't use that much on me, and I should be good to go pretty quickly.
I was hooked up to an EKG and blood pressure cuff again. My vitals looked great, so I was taken off those pretty quick. Saline drip was still going. I was told that I wasn't allowed to leave until I had walked to the bathroom myself and peed, to make sure the spinal had worn off and that I didn't have any injury to my bladder. Okay fine, I says. One of the nurses flushed my saline tap and oh fuck did that burn and I yelped, which I could tell scared the person across the aisle from me, so I explained IT'S COOL, I'M COOL. Which made many people in my immediate vicinity laugh.
Not too long after I was able to push myself up to sit up, which was way more comfortable. Feeling slowly returned in my legs, and I was able to pick my legs up, bend my knees, etc. and so on. The nurses checked my progress pretty regularly. They also made my freaking night when the asked if I wanted a box lunch to eat. OMFG YES I'M FIVE MONTHS PREGNANT AND HAVEN'T EATEN SINCE 11 THIS MORNING YES PLEASE I WOULD LIKE FOOD. They laughed, and explained that they get a roster of who's having this surgery each day and order them, because yes, they know. Sure, it was a plain turkey sandwich, and milk, and applesauce, and some chips, but OMFG DELICOUS. They also gave me some graham crackers and ginger ale. They were definitely pushing fluids to make sure I had to pee at some point.
The Man and my sister were allowed up as I was finishing box lunch. I had to hold shit right by my face to see it so I could eat, GOOD TIMES. We chatted, I reassured everyone yes I am okay. My doctor came by to check in, and go over aftercare instructions, which included nothing in the vagina for at least a week, and oh by the way you're probably going to be bleeding for about a week too, don't panic unless it's really heavy or you have bad cramps. Okay cool.
After a while I felt like yeah, I probably could stand up, and maybe I had to pee. I was not allowed to just get off the gurney. I was helped to sit all the way up and swing my legs over to the side, and I had a nurse holding either elbow as I tested to see if I could hold my weight. I could, so off we shuffled to the bathroom, the nurses kindly making sure my gown was closed in the back, because that and the socks were literally all I was wearing.
Peeing round one did not work. I did, however, bleed all over my legs and the floor when I stood up afterwards, welp. I apologized, the nurses reassured me nope, that's fine, and hooked me up with some terrible mesh panties and an industrial pad, then helped me clean off my legs when they got me back in to one of those sweet padded and wheeled hospital recliners outside of the bathroom. Then I got another heated blanket AW YES. I got wheeled back to my recovery cubby and told to drink more fluids, which I proceeded to do. I also got to have a resident pop in and check to see how much I was bleeding. Yes, she pulled down the mesh panties and looked at the pad. Pregnancy and surgery! Hope you like people in your bits. Because they will ALL BE UP IN THEM.
I eventually put in my spare contacts. Drank more ginger ale. Chit-chatted with the nurses when they were checking on me. A while later I had to pee, so off we went to the bathroom. They have to make sure you pee, so they actually put a little plastic collector in the toilet. It took a while, but I PEED. I felt super fucking victorious. I also bled more YAAAAY. Fresh mesh panties and pads for me! Once I peed and was confirmed that yes, I could control my legs, no I wasn't in horrifying pain, no of course I wasn't going to drive myself home nope totally (I was totally going to drive myself home), and everything was signed, I got to get dressed and leave.
I 100% made The Man and my sister wheel me downstairs in a wheelchair, then The Man paid my parking and got my car. My sister doesn't drive. I already knew from my doctor, because I'd asked that morning, that yes, I was fine to drive home if I wanted to, and hell yes I wanted to. I was tired as hell, and starting to feel really sore, but I was with it. We dropped The Man off by his car, which was on the other half of the hospital campus because he read "east" in my email to him with the details as "west" because that is his life, and we drove home.
I was not allowed to shower for 24 hours, so I put on pjs and my own underwear and my own much nicer cloth pads (seriously folks, flannel on your bits, it is amazing), and begged The Man to get my prescriptions. Which he kindly did, after I found a 24-hour pharmacy. Once he got back home, I opted for a Percocet, because while I wasn't in pain, so much, I was overtired, sore as hell kind of everywhere, and I knew that would knock me out enough I could sleep. Which it did.
Showering the next day was awesome. It took me about a week to get all of the sticky residue from the EKG pads off.
I did bleed off and on for about a week, and my labia were seriously abraded. Peeing was hell from Saturday through like Tuesday, and I had to be careful how I sat. But I didn't need the Percocet after that first night, and from Sunday through Monday, I drove about 1,000 miles to Midwestern Holiday 2013.
And better yet, it seems to have worked and all healed up nicely.
If I get pregnant again, I do think I'm going to opt for "let's wait and see", because I suspect that some of my complications this round are because really, my thyroid and other hormone levels are still stabilizing after probably 20 years of being fucked the fuck up. And while this is not an experience I want to repeat, it wasn't that bad. Yes it was stressful, yes it made hormones leak down my face (h/t to Commander Logic for that phrase), yes I got a $5,500 bill in January because even though I pre-registered they didn't bill my insurance, and yeah, ugh, surgery... but it's manageable for me, you know? I can handle this.
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