Beyond Angeles

A long, wonderful break

Jefren (and all of us) were home for three weeks without chemotherapy. Jefren had friends over, played with his new computer, watched TV, and ate. It was Christmas break at school, so Jefren had friends over all day.

Then January rolled around. School break ended, his friends went back to school, and Jefren went back to the hospital. This time, it was for surgery: they were finally going to remove his tumor.

Day before the surgery

We went up to Iowa City the day before the surgery. We had learned we could stay overnight at the Ronald McDonald House the night before treatment was scheduled, so Jefren, Janet, and I had a room there. Eli stayed with Rusty, a friend who lived around the corner.

That day, we met with the anesthesiologist as we did before any surgery. We told him Jefren’s story—that he was very responsive, that the first surgery was a disaster, but that the second one went fine. We told him to look in Jefren’s records (now about three volumes) and find out what they did when he got his central line, and do that again.

He agreed, but he explained that, while everyone blames the anesthesia, it’s often the surgery which causes nausea. He told us of a group of patients who didn’t have anesthesia, yet most of them still threw up afterwards.

He also explained that there were so many anesthesiologist at the hospital (forty faculty), that there was almost no chance the one who interviewed a patient would be the one to assist him during surgery.

He said everything in an entertaining, funny way. Jefren had a good time.

He offered to have a block done on Jefren’s lower spine during the surgery. He said that would greatly reduce leg pain after the surgery was completed. Jefren thought about it for a minute, but then decided not to. (I had previously told him about surgery that I had once, and the anesthesiologist seemed so nice, recommending getting the anesthesia in my spine. I agreed because he was so nice. For three days after the surgery, the only reason I took pain killers was for the pain in my spine where they had put in the anesthesia.)

After we left the hospital, we took Jefren shopping. For all the time Jefren spent in Iowa City, he rarely got to do anything fun. We ate out, then went back to the Ronald McDonald House. We hadn’t heard yet when the surgery would be, expecting it would probably be early in the morning. Instead, it turned out to be early afternoon. That made for a leisurely morning, but Jefren couldn’t eat after midnight, so he was very hungry by the time they took him in for surgery.

Day of the Surgery

We went to the hospital around 12:30. Again, while we were waiting, we met with Jefren’s anesthesiologists, the ones who would be administering to Jefren during the surgery. We re-explained Jefren to them, and asked them to check what had been done before. They were sympathetic doing everything they could to ensure Jefren’s comfort.

For any lengthy surgery—and this would be at least four hours— the anesthesiologist usually puts two IV’s in the patient, one which they use, and a second in case of an emergency.

The doctor (anesthesiologist) explained they could use the central line for the first one and put in a second. Jefren asked if they could just use the central line and not use an IV at all. Jefren had a reason for asking: his last IV was three months ago, and he was still having trouble with his hand. The doctor said he’d see what he could do, but if an emergency came up (the first one got blocked up, for instance), they’d have no option.

7 1/2 hours

This surgery was not like our first one. For one thing, there was no outcome we were awaiting. We already knew what would happen: Jefren would be in surgery for a long time, and when he came out he would be in pain, taking painkillers (morphine), and unable to move comfortably because of his cast.

Jefren took this extremely well. He never showed he was nervous at all, and when we asked him, he only said he was “a little nervous.”

Janet and I were both pretty calm, too. We had prayed every day for this to go well: now it was up to God. Trusting in Divine Wisdom, we just let go.

So when we went with Jefren to the pre-operating room, we were all pretty comfortable. We chatted with the nurses (that was where we saw the anesthesiologist), and took it easy. We said one more prayer with Jefren, asking that the doctors, surgeons, nurses, and staff—everyone at the hospital who was in any way affecting us— be open to and receive God’s Divine Wisdom during Jefren’s surgery.

When Jefren was wheeled away, there were no traumas, no tearful good-byes. We told Jefren we’d see him in a while, that we loved him, then we all said bye. Then off Jefren went.

When he was gone, Janet and I went to up to Day of Surgery Lounge to check in. The receptionist told us it would be at least four hours. The lounge was full— I guess there were a lot of surgeries that day. Whether it was from all those people, or vibes from the rest of the hospital, it felt uncomfortable to be there.

So Janet and I left. We told the receptionist we were just checking in, and that we were going to go to lunch. We figured there wasn’t much we could do sitting in the waiting room, so we went out to eat in the mall downtown.

We did not hurry. We found a comfortable restaurant, sat down and ordered. We ate leisurely, comfortably. When we were done, we browsed in the bookstore briefly. Then we went back to the hospital.

When we got back to the Day of Surgery Lounge, we’d only been gone just over an hour. We asked the receptionist if she’d heard anything. She said no, as we expected. It wasn’t as crowded there, but since we had so much time left, we told her we were going to meditation room to meditate. She offered us a beeper, in case anything came up while we were there. It went off while we were meditating, but it was a false alarm.

We went downstairs— the meditation room, once an old chapel— was on the first floor. We meditated for a while. After I was done, I lay down on the pew to rest. I was almost asleep when a hospital security guard came in, tapping me gently on my foot.

“What you doing here?” he asked. He was not friendly or cross, just business-like.

I told him I was meditating.

“Do you have any business in the hospital?”

“My son is having surgery right now,” I told him.

I didn’t mind him checking on me. It was part of his job, and I took it in stride. Janet, however, did mind. When he asked to see some identification, she blew up.

“Why are you hassling people?” she said (yelled). “Don’t you have something better to do?”

“Janet,” I said, “he’s just doing his job.” I told her he was just making sure the hospital was safe, seeing that anyone who didn’t belong there wasn’t hanging around. He seemed to soften up when I defended him. He asked me nicely not to lay down there, explaining the room was for meditation, which apparently meant sitting up to him. Then he wished us good luck for our son and left.

Janet wasn’t done, so I moved to the back row where I couldn’t be seen from the door, leaned back, and continued resting.

The whole thing didn’t upset me—I was amused: Nature was reminding me I’d forgotten security in my prayers for everyone in the hospital to be open to and receive Divine Guidance and Wisdom during Jefren’s surgery. I laughed quietly to myself, adding the security people to the prayer right then.

When we left the meditation room, Janet asked me about it. I just smiled and said, “Nature was just reminding me to take care of something I forgot.”

Back upstairs

We went back up to Day of Surgery Lounge. By this time, it was around five o’clock. There was still no word from the doctor.

Several times during the afternoon, I “looked in” on the surgery. I did it again then. Each time had been the same: the room was filled with golden light, and a calm settledness, so I didn’t worry.

At Jefren’s Bar Mitzvah, the man who led the service told Janet and I we were the calmest Bar Mitzvah parents he’d ever seen. I did the same thing now I did then: having done all I could, I let go and trusted in God.

The waiting area was almost deserted now. I was delightfully surprised to discover I wasn’t getting zapped just being in the room. It was then I discovered that being on the upper floors of the hospital which was very uncomfortable during the day on weekdays, was fine late in the day or weekends. I guess all the “tense” vibes of doctor/patients happened nine-to-five.

We sat down to read, then decided to watch TV. Around 5:30, the doctor called from the operating room.

“Everything is going fine,” he said, “but we’ll be here some time longer—at least another hour. I wanted you to know in case you wanted to go get something to eat.”

We thanked him. When we told the receptionist, she looked up the phone numbers for us so we could order pizza delivered to the hospital lobby.

Janet went down to get the pizza when it arrived (she had the money). When she came back up, we sat eating it watching “Dave’s World.” It was supposed to be a good comedy show. Sorry, but we were not impressed. Remember, we don’t watch TV at home unless it’s a movie we really want to see, and we rent or own it. We kept watching TV for a while, old re-runs or something.

By seven-thirty, we still hadn’t heard from the doctor. We weren’t worried about Jefren, just surprised it was taking so long. The only other people waiting left around seven. We asked the receptionist how late she stayed. She said she wouldn’t leave us and would stay till we were done. She offered us coffee and refreshments from the vending machines, showed us the rest rooms, was sweet and understanding.

Finally, around 8:30, after seven and a half hours of surgery, the doctor called. He said he was going to clean up, then come right up to see us.

The news

When Dr. Gladstone came in, he was buzzing.

“During treatment,” he said, “there are good days and there are bad days. This was a Very Good Day.” he beamed.

“It was good for three reasons: First, Jefren went through major surgery —seven and a half hours— with no complications. Second, we were able to completely remove the tumor. Thirdly, we replaced the bone and attached hardware to hold it in place until his leg completely heals.”

The doctor was so excited. Jefren didn’t even need a blood transfusion!

And a big plus— when we asked about the nerve that went through the tumor, he told us it was fine. Assuming it healed properly, Jefren would have complete feeling in his leg and foot.

We asked him how he did this, and he said they removed the cancer cells one cell layer at a time. Amazing!

We asked if there was a tourniquet what— how did they kept him from loosing too much blood? He said they did have a tourniquet in place, just in case, but they hadn’t needed it. Dr. Gladstone said it was a good question.

“We tied off each blood vessel in his leg,” he said.

I said that must have taken a good hour or so.

“At least,” Dr. Gladstone said.

It probably took most of the first few hours they were in surgery.

Dr. Gladstone showed us which bone they replaced on the whiteboard in the conference room. He explained how the hardware (screws, metal plates) were attached. When I asked if the surrounding muscle would attach to the new bone, replied, “That’s what we’re hoping.”

Then he explained how, to make room for everything (muscles, hardware), they had taken off the top four inches of the fibula (the smaller calf bone) and didn’t replace it.

I was a little disconcerted at that, but he explained the bone was only as thick as my finger, and that it shouldn’t cause any difficulty with it gone. We also learned that the blood vessel he had told us Jefren would loose was gone. Dr. Gladstone just kind of shrugged that off, though (he’d told us previously the other one would probably pick up the difference), so I let it go.

“How do you know how to do all this?” I asked, waving my hands at the diagrams.

“You know,” he said, “People ask me that all the time. And you know, I don’t know.”

“If it were a hip replacement, it’s easy—it’s all in the textbook, you just go and learn the steps and plug in the parts and do it.” Kind of like a recipe, I thought.

“But with something like this,” he said, “I just don’t know.”

All I could think of was dharma. Dharma is usually defined as duty, but it actually means “natural duty,” and entails much more than that: responsibility, effectiveness, position in life on all levels: physical, mental, spiritual, family. People in their dharma have always impressed me. They are always successful. They do what they do comfortably, naturally, spontaneously. For them, what they are doing is absolutely effortless—they know what to do, automatically, without having ever been told. These are the people who set the standards for success, but it’s natural for them—they never try to be better, they just are.

After all I’d seen of Dr. Gladstone, his not knowing how he knew what to do brought home the point: here was a man born to orthopedic surgery, Divinely inspired, attuned to the working of nature on a most subtle level.

No wonder he was one of the ten best in the country!

Credit where credit is due: God’s Divine Wisdom was at work too. Especially in Dr. Gladstone, but also in everyone involved in the surgery.

We were very grateful for the results. I said prayers of gratitude right then. I suspect Janet did the same.

All the while Dr. Gladstone was talking to us, he was excited and happy. He was truly pleased with how well things had gone that day, and told us several times.

He was very optimistic about Jefren’s complete recovery. He still spoke cautiously, of course (full disclosure and all that), but it was obvious he was delighted.

“Whatever happens after this, whether things work out or not,” he said, “today was a Good Day!”

On to Jefren

When Dr. Gladstone was done telling us everything, he walked with us downstairs, showing how to get to the room Jefren was in. Once we were on the right track, Dr. Gladstone left.

Jefren was in second stage recovery. It was well past nine by now, and, except for one other patient, the room was empty. Jefren was still out of it, under the anesthesia. His leg was in a thick cast, and he had a drainage tube (to keep the swelling down) coming out at his heel. For the next hour or so, Jefren mostly slept.

Janet and I stood around, chatting with the night nurse. After a while, the two residents currently working with Dr. Gladstone came by. One of them had been in the whole surgery, the other in and out. Both said everything went well during the surgery.

And added plus

While we were talking to the doctors, we found out they had done all the anesthesia and pain-killers through Jefren’s central line. They never even put in an IV. We knew Jefren would be happy about that.

After about an hour, Jefren woke up enough to recognize us. We told him he did well, but he was so drugged with morphine he probably didn’t hear. But we were very enthusiastic about how well everything went, so maybe he picked up a little of that.

Just before 10:00 p.m. they felt he was coherent and stable enough to go to his room. We made sure he had all his belongings on the shelf under the bed they moved him on, and walked next to him as they took him to the ortho floor: 3 Carver West.

Adjusting

Jefren was pretty out of it all that first night. Even though everything had gone well, he’d still just had major surgery. He had tubes everywhere— a catheter for going to the bathroom, the drainage tube to draw excess blood and prevent swelling in his leg where they had operated, and, of course, medicines: pain killers and something to prevent muscle spasms going in to his central line.

But that was all. Nothing was going into his mouth, nose, or arm. Everything was under the covers, so it was manageable.

Jefren also had a cast on his leg, from his hip to the base of his toes. Every so often, a doctor or nurse would ask him to wiggle his toes, and he would. Or they’d ask if he could feel when they touched the toes. He could. All was going well.

After we got to his room, they had to transfer him to a bed. It was a special orthopedic bed, with bars around it to hang cables or appliances from. Fortunately, Jefren didn’t need those. But he wasn’t happy when they moved him—- or when he found out he needed two nurses to help him just to roll over.

Overall, though, he was doing well. His nurse, originally from Jamaica, was great: positive, supportive, confident. When we told him we wanted to play Gandharva-veda music to Jefren’s leg through his cast, he said, “I’ve been here many years, and one thing I’ve learned: If you think it will help you get better— no matter what it is— it will help you get better.”

He even offered to change the tape for us.

Janet stayed with Jefren that first night, to comfort him. Before I left (to go to the RM House for the night), I hooked up a cassette player to Jefren’s leg by putting the headphones around his cast. Then I put in the gandharva tape and turned it on.

We wanted to start Jefren’s leg healing as quickly as possible, to put the right “spin” on it towards perfect healing.

We knew sound can have a soothing, healing effect, and gandharva was supposed to bring different laws of nature into balance. Over the next several days, we played gandharva music to his leg whenever we could. We had several tapes, each one for a certain time of the day which enlivened specific qualities lively at that time. At one point, I became aware that his leg was doing well, but it had enough of a certain “vibration” and needed something different to heal right. So I switched the tape. Several hours later, I checked again, and everything was all right.

Eli, Randy come to visit

Bob, Randy, his sister and her friend all came with Sandy to visit Jefren the day after his surgery. Eli had spent the night at another friend’s, then came with them. (When we called to tell Eli the surgery had gone well, his friend’s mother didn’t even know Jefren was having surgery that day. I thought we‘d told her.)

Randy brought colored balloons and cards, and good wishes. They stayed with Jefren for a couple hours. He couldn’t get out of bed, so they talked and watched TV. Around dinner time they left.

Eli stayed, spending the weekend with us at the Ronald McDonald House. Sunday, we spent the morning and early afternoon with Jefren. After two, when we discovered a new episode of a TV show we loved and thought had been canceled, Eli and I went home.

Even with staying at the Ronald McDonald House, I was exhausted. The night of the surgery, I didn’t get there till after midnight. I didn’t realize how exhausted I was until driving home. Halfway back I was falling asleep at the wheel. Not just tired, but dangerously so—head nodding, couldn’t keep my eyes open. I opened the window, hoping the brisk winter air would revive me, and it did briefly. But pretty soon, my eyes started to close again.

We pulled over at a grocery store and parked. Eli had been complaining he was hungry, and I didn’t feel it was safe for me to drive anymore.

We went in to the deli. Eli got some fried chicken, and I rested, head in my hands, eyes closed. After twenty minutes or so, Eli was done and I felt better, so we headed home.

Falling asleep on the way home happened several times. Every time, it was so powerful I had to pull over and rest before going on. So I did.

Janet stayed at the hospital with Jefren.

© David Adelson. All rights reserved.