I keep saying variations of "the doctors drilled a hole into my skull." In fact, they did a bit more than that. What follows may be a bit disgusting, but hey, you're only reading about it. I had it done to me.

Despite the plethora of road accidents — it was a black ice kind of day — we (Mom drove, of course) got to the hospital a few minutes after 7:30 that morning, and let the valet parker take the truck. I've never noticed valet parking at a hospital before, but it makes sense.

I plopped into a wheelchair and we headed to the part of the facility where the pre-operative screening is done. We waited for only about three minutes to be called; you'd have thought there was some sort of hurry. The nurse who did the screening had paperwork for me to fill out, and a lot of "are you allergic" and "have you ever" questions for me to answer. Blood was drawn at least once, and then we were off to Radiology, where X-rays were taken of my head. Interestingly, that was the first time since this whole thing began over a year ago that plain old X-rays were taken.

Then we were off to the pre-op waiting room. At Duke, this meant a trip by tram from one building, half a mile to the next. They're sort of spread out, there.

There were a lot of people at pre-op, waiting for whatever particular doom had summoned them to the hospital that day. Once I'd checked in at the desk, we (still Mom and I) waited with all the other folks, but I was getting pretty uncomfortable; my legs were in a bad way. One of the nurses graciously asked it I'd like to go lay down, so at that point Mom and I parted — I didn't see her again until well after the operation.

The moment of fate had arrived. It was time to switch out of civvies and into hospital uniform: the standard ill-fitting and all-revealing gown, complete with footies that didn't come close to covering my size-15s. I was wheeled into the pre-op room, in which there were about a dozen other folks already on gurneys waiting for their respective procedures. I was set up with an IV jack in my hand (no actual drip at that point) and waited.

The anaesthesiologist dropped by, asked a few questions, had me fill out some paperwork. The surgeon dropped by and drew an X on my head with a magic marker. At least I think it was an X. It might have been a smiley face, for all I know — I'd removed my contacts by then, and in any event I could not (and, amazingly, still cannot) see my own scalp without a mirror.

Suddenly, it was time. A pair of burly orderlies came along, plugged a bag of something into my IV, and wheeled me off to the O.R. In under a minute I was on the operating table with a mask on my face being asked to take four deep breaths. I managed two before the lights went out.

This is where I would describe the procedure in minute detail, if I'd actually witnessed any of it. [Update: see my followup post.] The macro details, I can tell you about.

The shunt was installed above my right eye, at about the "one o'clock" position above my forehead. I haven't actually seen one, but it's a piece of hardware that feels like it's maybe 3" x 0.75". The big part is under the skin, flat against the outside of the skull; some smaller bits go inside the skull. The shunt is magnetically adjustable; they can increase or decrease the flow rate as needed without opening me up again. In case they ever need it, there's a facility for the extraction of cerebro-spinal fluid via syringe through the shunt.

As Steve notes, perhaps it would have been nice if they could have installed a device to allow the direct insertion of booze. I wish I'd thought of that.

From there, a tube was run under my skin back past my right ear. In order to get the tube to its final destination, a hole was made in the skin behind my ear, and using (I presume) some sort of long rod, the tube was driven down my neck behind the ear, then over my collarbone, down to my abdomen — all under the skin, of course. To get the tube into my abdominal cavity, the surgeons opened me up just under the ribcage, got the tube inside the cavity, stitched the muscles up, then glued the wound shut. It looks quite a lot like a gallbladder surgical scar.

I'll leave you with a photo of the aftermath:

[If I'd thought about it, I'd have asked them to shave my whole head, but they clearly shaved only what was necessary. The combover to handle such a tonsorial disaster hasn't yet been built, so once the bandage in the photo came off, I shaved the rest of my head to match.]

I woke up in the recovery room. My mouth was as dry as the Sahara after a particularly severe drought. I was, of course, rather fuzzy-headed; they had, after all, shaved part of it... but I was somewhat addled, too. After an hour or three — I have no idea exactly how long it was — they were relatively certain I wasn't going to be bleeding all over everything and everyone, so I was wheeled off to my room, where I was pumped full of antibiotics and kept overnight before being released. Mom was there waiting, the very soul of patience.

And so I was home. It's been a week, and I'm vertical most of the time now; I periodically get light-headed enough that I have to go lay down, but that's happening less and less often. I'm off the hydrocodone, and despite the dizziness episode a few days ago, I think I might actually be ready to go back to work in another week.

This is not something I would have wished on anyone.

Posted by Russ at 05:05 PM, December 16, 2007 in Health