Cyst Removal, Part One

Back in March, I finally got in to see a Primary Care Provider, after procrastinating for the last ten years (and no, I’m not exaggerating). On the list of things to check on was this lump on my finger that had been there for however long. At least 2010 — no, it was there in 2008 and even 2007. So, yeah, at least eight years this thing had been on my finger.

Cyst

My CNP referred me to “her hand guys” at UTMC Orthopaedic. 

I ended up seeing Dr. Jain, who is not, in fact, a guy.

Before I get ahead of myself, though, I should point out that the UTMC Orthopaedic Center is modern, comfortable, professional, and accommodating. They take privacy seriously: when I walked in the front door, I was greeted by a gentleman in a shirt and tie standing behind a podium. On the podium was a clipboard; on the clipboard was a blank sheet of paper. Underneath that blank sheet was the list of expected patients for the day, which he carefully checked when I gave him my name.

During my very brief wait to be checked in, I got a complimentary cup of Starbucks Blonde Roast, but passed on the free donuts. Which is just as well, because I didn’t have long to wait: I brought my coffee with me to the private check-in cubicle, and after that to Waiting Area C.

Free Starbucks

All the waiting areas are clearly labeled and have many different seating options: standard relatively comfy waiting room chair with arms; extra-wide loveseat-style relatively comfy waiting room chair with arms; or elevated relatively comfy waiting room chair with arms and a footrest. If you’re coming to an orthopedic center, you may or may not have any number of ambulatory issues, and UTMC has a waiting room chair to suit your needs.

Fast-forward past the waiting room, the nurse, and the resident, to when I actually got to meet Dr. Jain.

She greeted me with a handshake and a super-friendly smile, and asked for the history of my cyst. Then she looked at the lump — kind of moved it around and poked at it with her fingers — and took x-rays of my hand to make sure the lump wasn’t attached to any major structures, like a tendon or bone or something. Initially, she diagnosed it as a ganglion cyst, and told me that while we did have the option of just draining it and hoping it didn’t fill up again (or whacking it with a phone book to rupture it), the most effective way to keep it from coming back would be surgical removal. I agreed, and the nurse came back in to schedule the surgery.

Because it makes me sound much more erudite than I actually was in person, here is an excerpt from my Patient Care Summary:

Discussed the differential of this mass which includes benign lesion such as a ganglion cyst, giant cell, lipoma and, rarely, malignancy. Treatment options include observation or excisional biopsy. Patient is bothered by the mass and notes that it interferes with her activities and is unsightly. She requests excision. Risks of surgery including risk of recurrence, bleeding, damage to adjacent structures and infection are all discussed and informed consent is obtained. We will proceed to the operating room at the patient’s convenience. All questions answered.

Dr. Jain was scheduled for some upcoming vacation time, so the first available date for surgery was in three weeks — April 30th, a Thursday. I specifically requested an afternoon slot once I learned that my husband would have to drive me to and from surgery. (He works nights, and doesn’t get to bed until 4am, so I didn’t want him to have to drive me out there at the butt-crack of dawn after only a few hours’ sleep.)

That request very nearly bit us in the ass.

But, again, I’m getting ahead of myself.

I was under orders to cease taking the anti-inflammatories that had been keeping my neck pain at bay during the week prior to surgery, so that was sort of a trial-by-fire to see how the physical therapy had been working. As it turns out, that wasn’t so big of a deal.

I was also under orders to take nothing by mouth (except a single glass of water for my vitamins) starting at midnight the night before. That was a bigger deal, as I became seriously light-headed and lethargic — but not as cranky as I’d expected, especially after working half a day the morning of the surgery. (Someone brought in donuts that day, too, and I had a joyous moment of Hey! I didn’t have any breakfast, so I should totally — oh, right.)

We arrived at the surgery center at the specified time, which we later learned was one hour before the scheduled surgery time. All the standard check-in things happened — a nice lady took my information, then we sat in the waiting room until my name was called.

One cool thing about the waiting room at the Isaac Surgery Center was that they have airport-esque status screens that show whether your loved one is in pre-op, in the OR, or in recovery, and they do so with a coded combination of last name, birthdate, and first name.

Monitor

So, when they called me back, they continued doing all the normal things: height and weight and blood pressure and — pregnancy test? Really? Yeah, just in case. OK. While I stripped and dressed in the surgical gown they provided, a nurse on the other side of the privacy curtain asked me questions about my medical history, some of which I really, really wished I could have given snarky answers. Instead, I expressed my desire to give snarky answers, and the nurse appreciated that more, I think.

Finally, the Q&A was over, I was dressed, and all my belongings were in a plastic bag. Next came the epic trial of starting an IV in the non-dominant arm of a woman who hasn’t had anything to eat or drink for about 14 hours.

That didn’t go well.

It finally worked, of course, after two or three different nurses tried three different sites with at least two different gauges of needle… but the end result was mighty uncomfortable until I got back into the OR, much later.

Then Dr. Jain marked up my hand to show exactly where the surgery site would be, and a nurse brought Aaron in to hang out with me until they were ready to take me back to surgery. Should have been any minute, we thought.

It was an hour later.

Waiting in Pre-Op

To be continued…

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