Monday March 19, 2007 10:13 PM

I had horrific trouble falling asleep last night...I was so anxious about Jim's procedure today. So I debated popping a valium, but that stuff clogs you up something awful, so I debated for awhile...sleep...clogged up...sleep....clogged up. I decided that sleep was more important. Woke up at 5:45 and was wide awake then, so I got up. Jim calls me at 7:00 and tells me that they moved his room again...he's in the basement now. I keep telling him there's no way he could be in the basement, but he's insistent. So I humor him and say o.k., then call the nurses' station to check. They say, no, he's still here. 10 minutes later Jim's calling me again, "You're worried about me?" he says. Of course, I tell him, because you're losing your mind. My mother thinks he's just having flashbacks to his prior surgeries. I don't know...I think it's just like the nurses' said: hospitalitis. You're here too long and your mind plays tricks on you.

So at 8:30 when the ENT clinic opens up I call to check what time his procedure is going to be. They don't know yet, but promise to call me when they know more. I really want to be there for the procedure, partially because Jim can't speak well yet and may need someone to speak for him, and partially because if he goes on his own his mind is so screwed up I'll never get the real story out of him about what happened and what the doctors said. I sit here and try to do some work in the meantime but can't concentrate on ANYTHING. At 9:15 I get a call that they're going to fetch him now and I should come on down. I got there about 9:45 and there he is, sitting in his wheelchair in the ENT clinic. I met the doctor doing the proceudre...Dr. Anderson. Apparently this is his specialty. So to remind everyone, since half of Jim's larynx will not move, and never will because the nerve has been cut, the plan is to inject collagen into the side that won't move so that the other side can touch against it, and he can eat again without inhaling his food. They bring me into the room, and it's crowded with all the other ENT doctors who want to watch the procedure, because this is not the kind of thing you see everyday. I asked Dr. Anderson about how long this collagen lasts. After all, if you get collagen in your face it doesn't last forever...will Jim have to come back periodically to get this re-done? He tells me there's two different kinds of collagen. He uses one with a more "bony" property and it should last forever. They start the procedure and make Jim sing an "E". He sang an E pretty good for a guy with one vocal chord.

Now of course, Jim always has to be different. Normally they can just do this in the office, but they discover quickly that Jim has a terrible gag reflex, so Dr. Anderson stops and says he has to do this in the Operating Room and sedate him. And he's going to use the regular collagen instead of the "bony" type. I just sink. Another intubation that will screw up the good vocal chord again? Oh, no, they tell me- this will be quick- we don't do any damage. I tell them, yeah right...I've HEARD that before. He says the only other option is to make a small incision in Jim's neck and go in that way. I tell him, NO! No more incisions in his neck. We don't need any more neck infections! They also tell me that they often run into someone with this gag reflex so it's not unusual. Good God. So they had an opening the the O.R. and they take him right down. Now I've got to wait around again.

I go the family waiting room. And I'm waiting. And I'm waiting. And I'm waiting. I leave for my 11:30 shrink appointment. Then I go back to the waiting room again. And I'm waiting. And I'm waiting. I talk to the nurse there and tell her, Jeez...this was supposed to be a 10 minute procedure, what's going on? I've got visions of Jim having to go back to intensive care afterwards instead of back to his room. The nurse tells me that even though they TAKE you into the O.R. it might be over an hour and a half before they actually START the procedure. FINALLY Dr. Anderson comes out, He tells me everything went great. He used a little extra collagen and built the laryx up extra large, but as the other vocal chord comes down against it it will break it in, so to speak. Kind of like new brake pads on a car. So his voice may take a couple weeks to a month to get to it's strongest point. If Jim becomes less groggy by the end of the day they'll do a swallow test today. If not, they'll wait until tomorrow. Since they used the regular collagen, Jim will probably have to have this re-done in about 6 months to a year, but at that time they'll use the more durable collagen. He also mentioned that he thought of something else toward the end of the procedure but they had already pulled the intubation tube out so he decided not to do it. He may have to stretch Jim's esophagus a little. It apparently also got some damage from the nerve being cut, but if he decides they need to do that he can do it right in his office. So they must stretch the thing like a new pair of shoes. Whatever...I don't care. I just need to get him out of here.

It was two more hours before they brought Jim up to his regular room. He was feeling loopy from the anesthesia but not choking, and not using his suction wand. He says he can swallow his own spit now. But they didn't do a swallow test today. It was 4 o'clock by the time they got him back upstairs. I let him sleep it off, then came back in the evening after dinner.

Now of course his throat is very sore. Well, sure. They practically combed it with a cheese grater. So I waited for the nurse to get him some pain meds and get him settled in for the night, and then I left.

I also stopped by Dr. Jewell's office today. I had said earlier that they had to cut the 12th cranial nerve to get Jim's tumor out. I was wrong...it was the 10th cranial nerve, also know as the Vagus nerve, which comes from a Latin word which means travelling. This sucker looks like a bunch of spaghetti...it branches off all over the place and it "travels" to a lot of places in your body. I know that it crosses through the inner and outer carotid arteries, so I'm assuming that's where they cut it, but I'd like to know for sure. This thing controls part of your colon, part of your heart, a whole mess of stuff. I'd like to know if they cut it before it travels to these other areas of your body or not for the simple reason that I'd like to know what other things to watch out for in the future. And doctors love to show you that stuff. They're all geeks anyway. So Dr. Jewell will be in the office tomorrow and I'll stop by again, or he'll call me.

So I'm confident that Jim will pass the swallowing test. If he can now swallow his own spit, he should be able to swallow food. They were putting him back on the tube feeds tonight so they must not be worried about him aspirating like they were over the weekend. I'll know more tomorrow, hopefully.