Navel-Gazing
Sometime in 2002, I noticed something wrong with my navel.
It was no longer an innie. It bulged outward, looking as though I'd swallowed — what we called playing marbles as kids — a King Cob. At the time, I had no idea what had caused it. I was heavy then, and I thought excess body fat had distorted the shape of my bellybutton.
It wasn't until a later visit to my doctor that I learned it was a hernia.
A pariumbilical hernia, to be precise.
I knew what a hernia was, but I had to do some research to educate myself on what made it appear around the navel. Ordinarily, an umbilical hernia occurs in babies and small children. Often it spontaneously repairs itself as the child grows. In adults, it's either a long-term abdominal-wall defect that weakens, or a hole that appears under strain. In my case I suspected the former, as I couldn't recall doing anything that would have stressed the area enough to open a gap.
Hell, I didn't even do situps.
No matter the cause, it became apparent it required corrective medical attention: surgery. I needed to investigate how to procure the procedure. In Canada, it would have been a matter of arranging it via my doctor and showing up at the hospital at the appointed time. In Canada, the surgery wouldn't cost me anything. The small quarterly provincial health care premiums I paid would have covered it.
I had no such insurance in Hong Kong. Here, one must either purchase health care insurance, or foot the bill outright. I was concerned because I knew surgery in a private hospital would be expensive, and I wasn't flush with cash. I learned that being married to a Hong Kong citizen entitled me to care at one of the territory's public hospitals, at a bare minimum of cost. The catch was that as in Canada, I'd have to wait in a queue, taking a small risk that in the meantime, the hernia could become strangulated. Were that to occur, I'd go to Emergency and bypass the queue.
I elected to wait and jump through the hoops of the Hong Kong public hospital system.
First I had to obtain a letter of recommendation from my doctor that surgery was warranted. I'd suffered a few instances of minor discomfort, but they were increasing in frequency, and I knew it would becoming a problem. I'd lost a significant amount of weight, yet it didn't seem to affect the hernia one way or another. I kept stripping off the pounds, as I knew the trimmer I was, the easier the surgery and recovery would be.
The next step was to visit the Outpatient Specialist Department (OSD) of the hospital in my area. That turned out to be Ruttonjee Hospital in Wan Chai. I went in mid-January to register and make an appointment to see a physician. I was given an appointment date of June 19, about two weeks before our upcoming vacation to Hawaiʻi. I'd hoped they'd book me in and finish the surgery well before then; I didn't want to be on the beach with a massive outie, looking like a giant toddler.
To my surprise, the hospital called a few weeks later, saying they'd bumped up the appointment to March 6.
When I arrived at the OSD on the afternoon of the 6th, the place was a beehive of activity. Nurses scurried back and forth. The waiting areas were jammed full. Traffic came and went from various hallways leading into and away from the department. Undeterred, I strolled to the registration counter to check in. The clerk handed me a form and directed me to a queue around the corner, where I waited to pay my registration fee. It was a whopping $44, about US$5.60.
Upon remitting the fee, I was handed a ticket with a reference number and sent to the "Grey Zone", an area in the lounge where all the seats were, surprise surprise, grey. Those not waiting for surgical consultations waited in the yellow and blue zones. Two large flat-panel displays adorned the walls on both sides of the waiting zones. The screens announced reference numbers and the corresponding room number where patients were to report. Comparing my ticket number to the numbers on-screen had me wondering if I would be waiting all afternoon, but a sign posted underneath the panel read: "The numbers shown on the screen do not imply any priority." I wasn't able to discern how they determined priority, but it kept people from becoming impatient and unruly.
After 20 minutes my number was called. I entered the consultation room and had a brief visit with the attending physician. After a quick examination, he arranged a surgery date for April 1. He was thorough and explained everything in detail. I was in and out in 10 minutes. From there, I was taken by a nurse to a private consultation room, where she asked health questions for my patient file. She provided additional instructions on how I should prepare for the procedure. I left impressed with the general efficiency of the system.
As for the hernia, I was happy to learn the opening in the abdominal wall wasn't large. The chances were a small incision would be required, which in turn meant I could get by with a local, rather than a general anaesthetic. I loathe going under. Forced unconsciousness bothers the Hell out of me; I prefer to know what's going on. I don't enjoy the grogginess and disorientation during recovery that goes along with general anaesthesia. Sometimes a general produces the undesirable and unpleasant side-effect of making one vomit, not something I'd want to experience after having my belly opened up.
There existed the possibility the surgeons would need to excise my navel; from time to time pariumbilical hernias require its removal. I didn't how that would look, but I didn't want to find out.
Only one thing about the system irritated me. It was the way everyone pronounced umbilical. All the doctors and nurses I encountered insisted on saying it as: UM-bull-EYE-cal. Not only did they screw up the emphasis, but that long "i" was way off base. I have no idea where they picked up that pronunciation, but it rubbed me the wrong way.
As the date drew near, a snag appeared in the form of an outbreak of atypical pneumonia known as Severe Acute Respiratory Syndrome, or SARS. The first reports revolved around three hospitals, none of which were Ruttonjee. I scoured the news to determine if any cases had been found there, but at the time, there were none. I called the hospital to confirm and was informed it was set to go ahead as planned.
The day before my surgery, I shaved the front of my body in preparation. I felt I was more skilled with a razor than any nurse, and I didn't want to risk a cut or nick in an environment where staph infections are common. Had I not done it, they would have, and I had no idea how far they'd go. I wasn't about to let some amateur near my sensitive parts with a sharp object.
My wife and I awoke at 0600 on April 1. We showered and dressed with haste; we had to be at the hospital by 0800. Mabel, bless her heart, came with me for support, as well as to look after my personal items, such as my wallet. It would suck to come out of surgery to find my ID and cash missing. It was a public hospital; I'd be in an open ward. Personal privacy would be at a minimum.
We arrived at the hospital 15 minutes ahead of time. The hospital was deserted. Nothing moved. I checked in at Admissions; the clerk said little, processed the paperwork and sent us around the corner to wait. Two minutes later, an orderly arrived to escort us to the 8th floor surgical ward. As we approached the lifts, I spotted an electronic sign out of the corner of my eye. The tail-end of a scrolling message told me all I needed to know.
The hospital had cancelled non-essential surgery as a result of the SARS outbreak. No wonder the place was empty.
I would have been upset, but I knew my surgery couldn't wait much longer. During the previous two weeks I'd experienced frequent pain and discomfort, along with some nasty cramps that made my abdominal muscles feel like solid marble. I'd be damned if I let them send me home. My wife had taken a vacation day to be with me, and I wasn't going to allow them to waste her time.
When we arrived on the ward, they informed me they'd tried to contact me several times to reschedule. They were intent on trying to scare me off from having surgery, citing the outbreak. I told them it couldn't wait and that I wasn't all concerned. The wards were more than 65% empty. What better way to avoid the disease? The fewer people around me, the better. I told them to book me a bed.
Realising I was serious, they set about their routine. They jabbed a thermometer at me. I put it under my tongue. They wrapped a blood-pressure cuff around my arm and asked a list of questions regarding my personal health history. Was I taking any medication? Was I allergic to any medications? Did I have any existing health problems? Did I have tuberculosis? Did I suffer from hypertension? At that last question I laughed and pointed at the sphygmometer.
117 over 64. Not what I'd call worked up.
From there the wait began. Between 0800 to 1400, I spent long, quiet periods reading, punctuated by a variety of nurses visiting my bed, asking me the same questions I'd answered when I entered the ward. They took more blood-pressure readings, as though they didn't believe the results. A doctor came by to examine the hernia and to discuss the procedure. An anaesthetist dropped by to explain what he'd be doing, then quit when he read my chart and realised I wasn't to have a general. His bedside manner was obnoxious. Later, the first doctor returned on his rounds, followed by nine or ten interns, looking at me not unlike a bug under a microscope. Nurses came and went, but no one gave me any idea when the operation was to take place. I waited and kept reading.
On the ward was a handful of other men, most of them elderly. I was the lone foreigner in the joint. The kid in the bed on my right awaited removal of his appendix. Two old men across from me appeared to be convalescing. One ancient-looking dude two beds left of mine was the 82-year-old equivalent of a two-year-old having a series of temper tantrums. He wasn't disoriented or suffering dementia; he wasn't getting his way. For two hours I heard him beg, whinge and whine to anyone who would listen. Later, when a middle-aged woman, likely his daughter, came to visit, he persisted in behaving like a child. He became petulant and pouty and began to strike her. She soon grew frustrated with him.
There's one on every ward, it seems. It was an unpleasant reminder of the only other time I was in the hospital for surgery, 22 years ago. There too I was stuck in a room with a guy whose injuries weren't that bad. He'd had his jaw broken in a fight and it had been wired shut. He moaned and groaned for hours at a stretch. After my surgery, my throat was blue flame, but I didn't spend my time bitching about it. Some people are such babies when it comes to pain.
But I digress. Not long afterward, the old guy freaked out. He shouted he wanted to leave. From there he progressed to screaming. No matter how many people came to calm him down, he grew worse. He had one of those grating, wheezy, high-pitched voices that got on everyone's nerves. He disrupted the entire ward. At one point, he stood up and nearly fell over. Had it not been for the orderly who'd been standing there, he would have. I kept wondering why someone didn't give him a sedative for his own protection: "Here you are, Sir... a nice, hot cup of Shut-the-Hell-Up."
Soon thereafter they bundled him up in his clothes, plunked him into a wheelchair and rolled him off the ward so other patients could get some rest.
Just after 14.00 I was subjected to yet another blood-pressure and temperature reading. This time I knew it was in preparation for surgery. I'd observed another patient being prepped in the same manner prior to his operation. Another nurse came by and handed me a yellow gown, a white cap, a pair of white socks, and what appeared to be a cross between a thong and a diaper. It was purple.
She ordered me to change into the surgical garb, but didn't draw the curtains around the bed. In fact, she just stood there. I shrugged, stripped off my t-shirt, buttoned the sleeves of the gown and put it on. I was about to drop my pants when she snapped out of her reverie. Once she pulled the curtains closed, I put on the rest of the gear, including the gauzy cap, which was silly as I had a freshly-shaved head and didn't need it. She popped back in to help me tie up the gown at the back.
Again I was peppered with the litany of questions, the same half dozen I'd been asked umpteen times since I set foot in the ward. It was getting old. Next, they rolled in a gurney, which I hopped upon, and they took me out of the ward toward the lifts. As they wheeled me into the lift, the four medical people inside stopped talking. For my own amusement, I waved at them when we exited to the surgical floor. When we reached the antechamber of Operating Theatre #20, they asked me my name and yet again, you guessed it, the Questions. Satisfied, they moved me into the theatre proper.
They wasted no time once inside. Four people lined up the gurney next to the operating table and 1, 2, 3! hoisted me onto it. I warned them I was heavy, but they managed to move me. I was impressed. Next, they stretched out each of my arms on extendable platforms. One nurse attached a pulse meter to my right index finger, inserted a catheter into the back of that hand for administering drugs and antibiotics, and then secured the arm. Another nurse wrapped my left arm with a blood-pressure cuff and secured it.
Someone yanked up my gown, tore open the velcro on the Prince-brand diaper-thong thing and folded it down. I was nude in front of several people. Call me crazy, but everything stopped for a few moments, as though they'd never seen a naked gwai lo before and they wanted to check me out. It was only uncomfortable because the air conditioning had been cranked up and the room was frosty. After the lull, they swabbed my entire torso with cool disinfectant, from my nipples down to the old oak and acorns. Next came the draping, along with the application of some sticky, ice-cold patches on my waist that were to collect any spilled blood. In a matter of minutes, they were ready to go.
That's when the needles came out.
They'd warned me before inserting the catheter into my hand that it would hurt. I barely felt it. They warned me it would hurt when they opened the drip for the antibiotics. I felt nothing. I'm not squeamish about needles in general, but I was apprehensive of the ones they were about to jab into my belly, because I couldn't see them. I would've felt better if I'd had an idea what was coming. When they injected me, it wasn't that painful; I've had bee stings that hurt worse. All I wanted was for the local to do its job. At the outset, the surgeons advised me that if they found they needed to go deep, they'd be forced to give me a general. Otherwise, I was to inform them if I felt any pain while they were working, and if so they would make additional injections.
Soon it was time to cut.
As the surgeon proceeded, I felt the pressure of the scalpel, but no real pain. The local was still sinking in, and the first slice felt like a light paper cut. By the second slice I felt nothing; the area was numb. Before long, they were tugging and pushing and doing God knows what else. I couldn't see as my torso was draped off, but I felt all of the movement. I told the head nurse I wished I had a mirror so I could watch. Her reaction suggested she thought I was nuts, and then she said I wouldn't want to see what they were doing.
All the yanking and pulling reminded me of that scene in Braveheart when William Wallace was being quartered, and I was glad for the anaesthetic. I was relieved none of the instruments in the operating theatre was a huge iron hook.
I felt twinges a couple of times, and I let them know so they could zap me with the local. Otherwise, I had no serious pain. Once my intestines were returned to where they belonged, the surgeons began stitching. There was a lot of tugging going on, and though I couldn't feel the sutures going in, the vibrations I picked up made it feel as though they were using coarse steel cables. It was a strange sensation. They closed the skin, slapped on a dressing and unhooked me from the gear.
1, 2, 3! and I was back on the gurney.
In the recovery room, I was hooked up to another sphygmomanometer. Blood pressure: 117 over 63. Pulse: 62. I was cruising. I chatted with the nurse for a bit while cleaning staff moved about the ward, wiping surfaces and disinfecting the floor.
By 16.00 I was back on the ward. When the doctor made his rounds at 16.30, he said I could go home if I so chose.
I chose. I didn't want to spend one second longer in the hospital than I had to. I changed clothes without difficulty as the local was still working. We left the ward and went to the hospital pharmacy to pick up some prescribed painkillers on the way out. From there we caught a tunnel bus, left the island and connected to the train on the Kowloon side. The train ride to our station in the New Territories took about 20 minutes.
I was all right while on the train, but we had to take the shuttle bus from the station to our estate, and by then the local was wearing off. Worse yet, the bus ride was bumpy, with lots of turns. The level of pain I felt wasn't up to agony, but I couldn't ignore it either.
The journey was short, but not short enough. I didn't notice until later that I'd sprung a leak.
The dressing had been pristine on the train, but now it was seeping blood and hurting. I grabbed some tissue and applied as much pressure to the area as I could stand to stop the bleeding. I hoped the bus ride hadn't torn the stitches. A short while later, when it seemed the bleeding was under control, I applied a butterfly bandage overtop of the dressing.
I decided to take a painkiller and get some sleep. I'd been running on five hours' sleep, and that, combined with fasting for the surgery, the operation itself, and the sedative effect of the drugs, had me exhausted. I fell asleep with my hand on my belly and stayed that way for the next five hours.
The next morning I awoke at 05.30, and set about trying to get out of bed. It wasn't easy. In an instant, I acquired a PhD in physics as I calculated the leverage required to become vertical with the least amount of pain. I didn't want to wake my wife, who was sleeping like a baby. I was sore, and it hurt to move even the tiniest amount, but it wasn't excrutiating. I'd expected it to be much worse. After a trip to the washroom, I didn't feel like going back to bed; sleeping in one position for so long had stiffened my back muscles, and they ached. I sat at my computer for a little while, but no matter how I sat, it hurt too much.
When the pain increased, I took another painkiller. Soon afterward I began to perspire and was hit by a strong wave of nausea. I prayed I wouldn't throw up. I didn't think the stitches would take that kind of punishment. I made for the washroom as quickly as I could and fought off the queasiness. I went back to bed where I slept another six hours. When I awoke, I felt much better.
Since then, the pain has abated a little more with each passing hour. I'm able to sleep on my side, which I prefer. I'm gaining mobility and I'm able to stretch and massage my abdominal muscles. I can sit for longer periods without much pain. Next week the stitches come out. I'm curious to see what my bellybutton looks like. I hope they didn't mess up my innie; it was a good innie.
Within two to three weeks I should have full mobility. I should be able to resume Tai Chi. Within four weeks I should be able to return to the gym. The doctors told me there is a small chance of recurrence, but I hope that's not the case. One operation is plenty.
I've done enough navel-gazing.
April 3, 2003
Next Tale: Touching The Past
Learn to create beautiful images with digital