Yesterday morning I had my retroperitoneal biopsy at Mt. Sinai Hospital. It was undertaken by radiologist Dr. Colin Roscher (“pronounced [roʃˈʃe] just like the chocolates”, he told me). He assessed that it could be performed using the ultrasound machine, which was next to me, and I did not have to be moved to the CT scanning room.
The procedure involved the insertion of a needle deep into my lower right side. In order to get into position I had to balance on my left side while holding onto the raised barrier of the bed. This was not difficult and was easy to maintain position. I was administered lidocaine, a local anaesthetic. I was gripping the barrier as tightly as I could and my palms were sweating. It was truly a white-knuckled experience. The pain of the needle’s insertion was making me bend my knees and stiffen up and the doctor asked if I was in pain.
Now I have always had a problem with this question. Even while in agony I am far too concerned with answering the question philosophically. Such are the pains of being a literalist. To any reasonable person suffering from pain what I am about to say must seem ludicrous. Even while experiencing the agony of kidney stones in 1999, I was telling the doctors that this was the worst pain I had ever experienced in my life, but in response to their question to rate how bad the pain was, I said that I supposed I could withstand more, in spite of my dry heaving and crawling against the walls. So I didn’t want to rate it “ten out of ten” in pain intensity because, philosophically speaking, the upper limit was ten and that was the ultimate in painful suffering. I have told doctors this–several times even during this ordeal–that patients like myself find such subjective painful assessments to be meaningless. My mind does not grasp the medical concept of assessing my own pain through relativism. Patients who stub their toes can rate their pain at ten out of ten and demand to see a doctor immediately. However when I first experienced the pain of kidney stones I didn’t go to emergency right away, and after I broke my wrist now close to a year ago I slept on it before I went to the hospital the next day (and only because the sight of my bruised and swollen right forearm the following morning had me convinced it was afflicted with necrosis).
So as I was trying to pulverize the side barrier of the bed Dr. Roscher said to me that he couldn’t perform the biopsy if I was convulsing in agony and that “You have to tell me how you feel.” I have had many needles during this ordeal, as I gave blood and had IV’s inserted during my CT scans. There is always a prick of insertion yet it never lasts long. I expected the biopsy needle wouldn’t be any different; thus I would feel it go in, and that was how the procedure would be conducted. While I was lying there feeling the needle probe inside the thought went through my head that this is how operations must have been like two hundred years ago without anaesthetic. I felt the needle break through a membrane and the doctor could see my reaction. He said that the needle had broken through my abdominal wall but that I wasn’t supposed to feel it. In fact, I wasn’t supposed to feel the needle enter my body at all. He ordered 50 μg of Fentanyl and once I had that, the pain disappeared immediately. I felt so relieved and the rest of the biopsy proceeded pain-free. I told the doctor that I still could feel the pressure of the needle probing around, but that it was not painful and thus not relieved by painkilling medication.
Dr. Roscher informed me in advance that each sample he took would be accompanied by a “stapling” sound. Some patients might find that sound unnerving. I found it rather funny–maybe it was the Fentanyl–and imagined a giant stapler inside my body stapling off bits of tissue. He took about ten samples.
As I was facing the opposite direction I saw none of the procedure, and didn’t want to. I asked about the size of the needle, and the doctor said it was 10 cm, but that was not a long biopsy needle by any means.
I relaxed after they bandaged me up and attempted to read my book, but the size of the print was far too small to read in the position I was in so I just lay there, but did not fall asleep. Suddenly my arms started to tingle all over, and I knew that something was not right. I did have a blood pressure monitor hooked up and a clamp attached to my left index finger. I heard the beeping of the monitor accelerate and as my arms went numb I had the idea of calling out for help but before I could do anything I had fainted. Before I reopened my eyes, I recall hearing nurses saying that I looked pale. When I came to, I saw four faces looking over me and I had no idea what was happening or where I was. I was genuinely scared and my mind was still out of it as I was slurring as I answered their questions. My brain wanted to answer lucidly yet my mouth was not keeping up. It was then that they told me that I had fainted and shortly after that I started heaving. They raised me so I wouldn’t vomit in a prone position and placed a kidney-shaped bowl under my chin. Since patients are not supposed to eat or drink anything after midnight prior to their biopsies, I had nothing to bring up except stomach acid.
Dr. Roscher stated that my “delayed vasovagal reaction” was normal and happens often enough after biopsies. The trauma of the vomiting was a normal reaction as everything inside is interconnected, and the needle poking around was enough to stimulate the stomach to regurgitate. No wonder they tell you not to eat or drink anything on the day of your biopsy.
Because I had fainted and needed to wait until the Fentanyl had worn off, they wouldn’t release me till 12:30. I ended up waiting till 1:15 because a porter had to wheel me out and the porters were overworked and in short supply. I was not allowed to walk myself out. After I recovered from fainting, a nurse called Mark to tell him where and when to pick me up. After waiting for me since 12:30, Mark had to move his car and parked a few blocks away. I could not find him when I was released. I waited for him and was about to walk to the University Avenue side of the hospital thinking perhaps he was there (in spite of being told he would be waiting for me at the Murray Street entrance) when I saw him coming back. I was fine to walk to his car with him. Since I had eaten or drunk nothing that day, by the time I got home I was starving and had breakfast for lunch. My right side was quite tender and it felt as if I had a permanent stomach cramp. That was normal, and I was to take Tylenol for the pain as the stinging of the needle was starting to come back. By the evening I was exhausted and went to bed early. Now, twenty-four hours later, my bandaged side is still tender to the touch and stinging. Each time I shift position in a chair it feels as if I am bringing on a cramp. I should be fine in three days.