[ 2018 – A trip that was not on my bucket list ]
“Hi, my name is Gail. I’ll be doing your port placement,” I think that’s what she said. And I thought “Interesting, they want to insert this piece of hardware into my body, and the procedure is not even done by a doctor. It must be so common for them, so standardized, so repeatable that the doctors feel comfortable delegating this task to a nurse practitioner.” It was not their first time, but it surely was mine, and it came with all the anxiety and anticipation of it. I remember that Gail also mentioned that she had just moved here from New York and still got lost at this hospital, but that she had done port placements for twenty years already. It seemed an incredibly long time to me, and the port placement procedure was probably even older than that. Twenty years ago, I was in my twenties. I was young and everything was still possible.
Twenty years ago, I hadn’t even experienced my first angst of losing a limb. This happened a few years later on a sunny afternoon when I lost balance while crossing the light rail tracks. The velcro on my sandals had come undone unexpectedly. During the fall, the joint of my left ring finger hit the edge of the track so that the upper section of the finger was pushed out of the joint. After the fall, I straightened myself up rather quickly – totally unaware of what had just happened to my hand. Only when I looked all around me and at my body did I notice that one finger looked different than the other ones because part of it was sticking out to the left by an angle of approximately 30 degrees. Only then did I let out a scream that my friends later qualified as ‘hysteric’, not in a dismissive way but full of understanding that the angst of losing a finger could trigger a scream of that kind. In a split second, I had assumed that a finger sticking out in such an incorrect way meant that it was lost. Although there was no blood and not even pain, the awkward position of this one finger of mine had been enough to cause my brain to release all kinds of chemicals to create this scream. My friends had to calm me down, reassuring me that, most likely, the finger had just been dislocated and could be set right again quite easily by a doctor. They were correct about that, but nevertheless, my finger has never been the same. Despite physiotherapy, the joint remains swollen and the finger crooked, though not in a 30 degree angle to the left but rather in a 15 degree angle inwards. I can still play the piano but I cannot wear a ring which means that the left ring finger lost part of its identity. Much later, or rather recently, this hysteric scream had come back more like a feeling than an actual sound when I was forced to go through surgery to remove a tumor at my right ovary. The surgeon had to cut me open lengthwise to get the rather big tumor out without breaking it. The thought of losing a part of my body was topped by the experience of a long incision that divided its core in half. I had lost the integrity of my body. For weeks after, I was haunted by the horrific idea of my body breaking open and falling apart.
Now, the port placement procedure was not about losing a part, but about adding something to my body. “We place a piece of hardware in your upper body,” is what Gail, the nurse practitioner, told me, “you won’t need a full anesthesia, we’ll just put you on what we call twilight.” And when I explained to her how groggy I had been after my last twilight experience, actually feeling much worse than after a surgery with full anesthesia, she recommended that I talk to the nurse about going light on the sedation. “A nurse,” I thought, “I guess, this will be a medical procedure with no doctors present.” After a while, the nurse stopped by and introduced himself as Jeremy. He was wearing blue hospital scrubs and a red-and-black bandana of the Alabama football team. I couldn’t help thinking: “What if Alabama is the rival of my favorite team? Would I then ask for a new nurse? Or just for stronger sedation?” I remember that I enjoyed listening to his Southern dialect that sounded so different to Gail from New York or the way Californians speak. I want to say that he showed some surprise at my request to go light on the sedation but if anything it was very subtle or pure imagination on my end.
When Jeremy wheeled me into the operating room, I noticed that a radio was turned on. I heard the chitchat and music announcements of the radio hosts interrupted by some pieces of pop music. “Really,” I thought, “this is what an operating room sounds like? Can we go down to business here? We are not hanging out in somebody’s kitchen preparing spaghetti and tomato sauce.” Jeremy introduced me to each staff member by first name and announced that I had asked to go light on the sedation. Again, I felt like sorted out from the normal, thinking something like “Why does he make such a big deal out of this request?” Then one staff member applied a tool to detect the arteries on my neck while the others built what they called a tent around my head whose only opening was to the left. So during the actual port placement procedure, I could see Jeremy with his Alabama bandana and hear Gail from New York telling me what she was doing to my body. Every so often, he asked me if I was ok and if I needed more sedation. After a while, I noticed that they had turned off the radio. And a long while later, I noticed that Jeremy had put on some heavy long apron in bright colors. “Why are you wearing these funny clothes,” I asked him. “Oh, this is to protect us from radiation,” was his answer. Only then did I realize that the procedure was done with live radiological support to guide the port placement. After all, this port needs to sit at the right spot above my breast so that its tubes connect with the artery that leads directly to my heart. The department’s name ‘Interventional Radiology’ suddenly made a lot of sense.
And ‘interventional’ is also a good way to describe my experience of this procedure. The integrity of my body was threatened again. And the closer the ‘intervention’ got to the core of my body, the more vulnerable I felt. Placing a piece of hardware inside me brought me closer to science fiction inspired ideas of machine-human integration. There it was, my angst of my body being ‘invaded’ by something artificial. We are all used to some mild forms of intervention – a blood draw or an IV, and they might not feel like an invasion because they are temporary and limited to upper extremities. A medical port however is positioned incredibly close to your own heart. It’s there to stay and to facilitate several rounds of chemotherapy and related blood work. It’s meant to spare patients from having infusion nurses search for appropriate veins time and time again and from accumulating injection spots all over their arms and hands. It does dilute chemo medication more quickly and causes less pain than getting chemo through a small vein in the arm. So it does come with a lot of benefits. But still, with this port, I felt reminded of an old David Cronenberg film where humans get a port placed on their lower back to hook up to pods that connect them to each other and to some kind of virtual reality game called eXistenZ. I had seen this movie almost twenty years ago, and its vision of hardware that looked and felt natural, of bio-ports and bio-pods that blurred the line between human and machine, had left quite an impression. If I can’t even tell anymore what is me and what is not, how can I define my own body? Of course, this movie had taken the whole notion of integrity, of inside your head and outside of your body to extremes. In the end, after a lot of gratuitous action, everybody inside the screen and outside, gamers and spectators had been totally lost and incapable to distinguish between real and virtual reality.
So, maybe it was a good thing that I had decided for light sedation. This way, I got a glimpse of the twilight zone from the safe place of being awake. No getting lost this time. And this left me a chance to remind myself of our chat with Gail when getting ready for the procedure. She had wanted to know if we had anymore questions and my husband had asked if there was anything that he could or should do when I was back home. “ Yes, cook her a nice meal and clean the house,” had been her answer. And then I thought of what she had said at the very beginning: “Hi, my name is Gail. I’m so sorry that you have to be here.” After that she had sat down on the foot of my bed and had started stroking my legs and explaining about her doing my port placement. Her presence had felt as real is it could get.
California Journal 