Post-Op: Day 25

   "You look good. Your color is good," my surgeon, Dr. Guru, said Friday afternoon as he strolled into the examination room in the Urology Department at Roswell Park Cancer Institute. "I wish I felt as good as people say I look," I said. I'm still fatigued, I explained. I don't have enough energy to be up and doing things for more than a couple hours or so.

   This, he said, is normal. It will get better. As for the other complications -- the leaking surgical incision, the blood in the urine last Sunday -- those have stopped. And my blood work Friday, that was good. 

   The urine sample last Sunday, on the other hand, showed bacteria. Not unusual, he said, since we joined together body parts that aren't meant to go together. The section of intestine that collects the output from the kidneys still wants to act like an intestine, not a bladder, and it will have bacteria. To protect from infection and be on the safe side, he prescribed 10 days worth of Cipro.

   As for that feeling that I still have compression stockings on my toes, Dr. Guru said that also was not unusual, a leftover from the surgery, when my body was feet-up for hours. This too, he said, will pass. 

   To the doctor's amazement, neither health proxy Bill Finkelstein nor Monica had any questions. We'll see you in six weeks, he said. And after that, check-ups twice a year. Or maybe only once a year. All that's left to do is hydrate heavily, rest and recover. Wonder how long recovery road is going to be. From here, I can't yet see the end of it. 

Post-Op: Day 20

    First the stuff in the urostomy bag Sunday afternoon looks like Hawaiian punch. Then like cranberry juice. Then like dark cherry juice. I call health proxy Bill Finkelstein. Send a picture to my phone, he says. 

   Shortly after 6 p.m., just as Monica is about to put dinner on the table, Bill calls back. Get down to Roswell as soon as you can, he says. Dr. Syed is there right now. Last week there was one emergency weekend run to Ward Seven West. And now this weekend, two. I'm a little alarmed. Will I have to stay the night?

    With Monica and Bill looking on, Dr. Syed sees dark red goopy things in the bag and proposes that this may be partially clotted old blood that's decided to move out. He sticks a tube into the stoma (no feeling there ... amazing), draws out a sample of what's inside and designates it for a lab test in the morning. I'll be going home. Keep an eye on it and keep hydrating, the doctor says. Pointing to the bottle of water at my side, he adds, "That's your buddy."

    Today, Monday, the colors begin as pink grapefruit juice and evolve into lemonade. Only drama comes when I stand up abruptly from the computer this evening and catch the edge of the bag against the edge of the dining room table, separating the front of it from its adhesive backing. A quick replacement is in order. Though I can probably handle that by myself, I'm grateful I'm not home alone.

    Meanwhile, I take my longest walk since the surgery this afternoon -- 4 1/2 blocks to the M&T Bank on Elmwood Avenue and back, unaccompanied and a little tentative, picking out the shadier sides of the streets. I come home hungry and ready for a nap. 

Post-Op: Day 18

Recovery is not a straight line, my surgeon, Dr. Guru, said Thursday in Roswell Park Cancer Center, moving his hand up and down to illustrate. Seeing one of the downs before him at this first post-release examination, he declared me dehydrated and ordered an infusion of saline solution. 

So the two-hour visit went into overtime -- a morning-long IV session, with a half-hour search for a workable vein ending at the base of my right thumb. Please, I entreated the gods who look after you in situations like these during one of my gassy abdominal cramps, don't make me deal with a bowel movement while I'm hooked up. 

The IV worked. My weary voice perked up. My shuffling step was springy enough that I turned down a wheelchair and exited on my feet. Nevertheless, on Friday, when a technician was checking my sleep apnea machine to see why it was drying out my mouth all the time, he turned to me and said, "You look dehydrated."

So I have renewed my quest for fluids I can swallow in quantity. Beer doesn't count, I'm told. What a shame. I've fallen back on Vitamin Water (about to polish off my second of the day) as an alternative to just plain Poland Spring. Health proxy Bill Finkelstein bought me a mango-pineapple smoothie from McDonald's, recommended by one of the bridge players who relied on that while recovering from colon surgery. Could be a winner. It has real fruit in it and it's definitely tasty.  Recommendations, anyone?

Recording my fluid intake now, with the goal of least three quarts a day, I see all I need to do is six to eight ounces per waking hour. Doesn't sound that hard. But it is. 

Anyway, once I was hydrated, the leak revived through the small incision scab next to my navel. Coincidence? And once again, the struggle was on to patch it up and keep it from soaking me from the waist downward. 

Monica finally turned to a mini urostomy bag like the one that worked so well after Dr. Syed applied it at Roswell a week ago. But the bag caught nothing. The incision still leaked. Maria, the visiting nurse, gave it a try this morning (Saturday), using some paste to improve the seal, but again no luck. Finally, Bill set up another visit to Roswell, where a nurse on my last ward, Seven West, determined that the nearby bag collecting urine might be the culprit. Now, with two new bags, so far I'm dry. Bliss. 

Post-Op: Day 12

    Gee, but it's good to be back home, even though everywhere I look, there are things I want to clean, weed or rearrange, but can't. In the meantime, Monica has decided to thin out my wardrobe while she has the energy advantage. "Strike while the iron is weak," she told a phone caller.
    But the pleasures of home have not been without other complications, as well. Not with the basics, thank God. The urostomy is working fine. The 17 stairs to the second-floor bedroom? Not an obstacle. What to wear? T-shirts and sweatpants with elastic waistbands. No, the complications came up elsewhere:
    1. That sore left foot (Monica's diagnosis: plantar fasciitis), which inhibits walking as much as I should.
    2. Constipation (I'll resist dwelling on the delights of strawberry Milk of Magnesia).
    3. The leaky incision just left of my navel, which put Monica's talents as a teenage candy-striper to the test. To soak a succession of T-shirts, bandages, towels and improvised plastic barriers she deployed, it generally took two hours or less.
    And 4. Surprise! Low blood pressure, by-product of the switch from hospital blood pressure meds to the stronger ones at home. The visiting nurse took a reading Friday and it was fine. Had it been checked after that, I might have guessed why I felt so light-headed and listless.
    It was health proxy Bill Finkelstein's alarm at Monica's last-gasp leak treatment -- an Ace bandage around my waist with a towel tucked inside it, on top of the usual little taped-down pile of gauze -- that prompted the phone calls which took us back to Roswell Park Cancer Institute Saturday evening, to the ward I left 48 hours earlier, Seven West. One of Dr. Guru's associates, Dr. Syed, agreed to meet us there around 8 p.m.
    His solution -- a small urostomy bag to fit over the leaking incision. While we waited for one to arrive, I asked for a blood pressure reading. When it came up 71/52 and 72/51, the health care aide thought the computerized testing machine was malfunctioning, but an old-fashioned pump-up cuff yielded the same results. A few laps around the ward lifted it to 90/62.
    Meanwhile, the bag worked. Thank you, Dr. Syed. Once in place, it immediately started filling. And today, Sunday, the seepage seems to have stopped entirely. As for blood pressure, now that my blood pressure cuff at home has been located, the readings are improving, but they're still low. No more pills till they climb some more.

Post-Op: Day 9

    In a few hours, I'll be home after eight days in Roswell Park Cancer Institute, but not without a few anxieties. How will clothes go over the urine-collecting bag? What about the 17 stairs to the second-floor bedroom? And will I have another evening like last night, Wednesday?

    After room service removes the dinner plates, I notice a big wet spot on the front of my hospital gown. The collection bag, changed earlier that day by Katy, one of the ostomy nurses, must be leaking. Another bag change and a new gown, but it also gets wet. The leak isn't in the bag and it's not yellow. It's that reddish lymph fluid, coming from one of the surgery incisions, the one closest to my navel. Lots of gauze and tape are applied and I get another new gown. It works. From there on, only the gauze gets wet.

    Then, as I leave my chair for the evening to brush my teeth and go to bed, I leave a trail of liquid behind me, culminating with a big spill in the bathroom. A major mess. It's from the urine collection bag, a new model with a different kind of release valve that was sent up to us here on 7 West from supply central downstairs. The new valve clicks into the connection with the old overflow bag, but it doesn't hold. 

    The nurse, tall, blond Christie, who used to work in television -- AM Buffalo and the Channel 2 morning news show -- but went back to school to change into a career where she could get the feeling that she was helping people, applies copious amounts of tape to the connection and gets me still another new gown. It works. I doze off to Rita Hayworth's first movie, "The Outlaw," and sleep well until the morning blood draw. 

    Even though Christie ties the tightest tourniquet in Roswell Park, my elusive veins do not show themselves for her. She pokes my arm twice without success and calls for another nurse, who tries once and fails. The third nurse, who announces that she's the one they bring in for difficult cases, finds a promising prospect at the base of my right thumb and nails it. My veins and I will not miss the morning blood draw.

    Dr. Hanzly, Dr. Guru's associate, arrives for his daily visit in the 8 o'clock hour and says that, despite the leaky incision, I'm better off at home. The longer you're in the hospital, he says, the bigger chance of infection. With that, he extracts the line leading to the Jackson-Pratt Drain, which has been pulling lymph fluid out of my abdomen for eight days, and assures me I'll go home with plenty of supplies to soak things up. I'll need 'em. The former drain has been quiet, but not the incision site. It's still oozing like a basement wall in the rainy season. 

Post-op: Day 7

My surgeon, Dr. Guru, walks in with his associate about 4 p.m. today, Tuesday, hands me a stapled print-out entitled "Patient Report," points out the areas highlighted in yellow and declares that I should be pleased.

The bladder? Cancer-free, according to the lab report. The chemo and the TURBT procedures took care of it. The two nearby lymph nodes he removed? They were OK. The bladder cancer hadn't spread. No problem. The prostate gland? 10 percent cancer. It hadn't spread either. Now it's gone. Once I recover, I'm going to be fine. Healthier than before.

The next question -- when should I go home? The associate said a few days ago I could probably leave on Wednesday. Dr. Guru said he wanted to be sure that the now-pale pink fluid draining from my abdomen had decreased to acceptable levels. 

My opinion, having seen the nurses and aides empty the little grenade-shaped plastic collection bulb for the Jackson-Pratt Drain, was that I wanted to be cautious and not remove the drain too soon. My health proxy, Bill Finkelstein, had gone home with a JP Drain still in place after abdominal surgery a few years ago and was back in the hospital with an infection three days later. Fine. The drain can stay for another day. I'll go home Thursday. 

Monday's move to a smaller private room in a regular ward on the seventh floor was accompanied by my biggest parade of visitors. There was Bill, of course, and bridge players Sandi England and Jerry Geiger -- a jolly collection. All we needed was a deck of cards.

Following them were good friends Jack and Shelley Dumpert, who promised to weed my garden Tuesday (but had to postpone it due to the cold rain and fog). Then, surprise, Richard Allmond, a friend from the Lost Expedition pub crawl I led back in the 1980s. And finally, Monica and another good friend, Marti Gorman, who showed up just as I was reaching another recovery milestone -- my first bowel movement. Guess I'm almost ready to face the world again. Except for the JP Drain, all my medical missions are accomplished. 

Post-op: Day 5

How am I doing? Wrong person to ask. I'm just the patient here, with no frame of reference as to what's good or bad, aside from the fact that I hurt less than I did yesterday. And that was less than the day before. 
Still, in many ways, I can tell I'm making good progress on that road to recovery. One milestone -- passing gas. Hooray! My lower intestines are working. That was Friday afternoon. Another marker -- eating food, which off limits until I got gassy. Up to then, all I could do was wet my mouth by dipping a sponge on a stick into a glass of water. But now that I can eat, I'm not really hungry. So far I'm just doing soup, yogurt, apple juice and gelatin.
Ask Dr. Guru and his associates and they say I'm ahead of schedule. They say the surgery went well. They say I'm healing nicely (although the right side of my abdomen still kind of burns when I get up from bed or from my chair). And I'm ambulatory. I walk laps around the ward -- 6-East, the intermediate intensive care unit at Roswell Park Cancer Institute -- and I've gone down to the ground floor (by elevator) and out to the garden. Today, however, is the first time I've felt clear-headed enough to write.
Meanwhile, no problems with the urinary arrangement, although it seems very strange not have used a toilet since the surgery. Problem area instead has been the line draining a reddish Hawaiian-punch-like fluid from my abdomen. On Friday, a leak developed around the incision. The nurses finally resolved it by altering a stoma patch, like they use for the urinary opening, Right now, I'm dry.
Monday it's off to a regular ward -- 7-West -- where they won't be checking my vital signs so frequently. Nevertheless, the nurses and health care associates here on 6-East, which is nearly vacant at the moment, have been supportive and attentive, although even they have had trouble finding veins on me for drawing blood. Still, I have no complaints. When can I go home? Maybe as soon as Wednesday. It all depends on how soon they can remove that drain from my abdomen.

Surgery Diary: Day one minus one

     the trepidations crept in on me last night. after all, it's major surgery. what if i don't wake up? what if i do? what put the fears to flight finally were all the good wishes from you folks out there in the electronic ether and the hugs from my colleagues at the news monday night and my bridge-playing buddies at the tuesday game. 
     meanwhile, i got the flowers planted that i bought at mischler's over the weekend and had an evening of fun at "the book of mormon," which opened tuesday night at shea's performing arts center downtown. thanks again for all your encouragement. my proxies will provide updates for the next day or two.