REAR END REVIEW

REAR END REVIEW

I’m the envy of several toddlers in the airport waiting area. My canary yellow blow-up floatie features pictures of animals and birds and draws their attention like cotton candy. “Look,” says a little girl, tugging at her mother’s arm. “That man has a ducky.” Indeed, I’m a spectacle as I ease down on the donut-shaped toy and try to relax. I smile at the girl, and wish I could explain the reason for my use of an object so much more appropriate for her.

Merely sitting seems a major accomplishment to me, nearly three weeks after a lovely but routine vacation in Costa Rica became a trip I’ll remember for life. Emergency hemorrhoid surgery has that effect.
*****

Is there a worse location on the human body to undergo surgery than the rectum? It’s possible, but I think this is certainly up there in the top two or three.
“How did this happen?” people ask. “Did you know you had a problem?”
Well, yes, a doctor warned a few years ago, during a colonoscopy (now WAY down the list of unpleasant medical procedures, in my opinion) that I had internal hemorrhoids that “someday” might become “inflamed.” He suggested I raise my fiber intake and prescribed a fiber-rich breakfast cereal that looked like worms used to attract birds. I don’t know what real bird food tastes like, but it couldn’t be worse.
I ate the cereal for a few months and tried to be more attentive to water intake.

But, like the fight against crime, inertia set in. The longer I went without an incident, the harder it became to remain vigilant. For occasional bouts of irritation, such products as Preparation-H provided relief. I figured I was simply experiencing a condition that millions of people deal with regularly. In volcanic terms, I considered myself at risk of a minor lava flow. When I awoke in agony the day after Thanksgiving in Playa de Coco, however, my situation resembled the eruption of Mt. St. Helen’s.
*****

San Rafael Hospital in Liberia Costa Rica

I arrived at the emergency room at the private San Rafael Clinic in Liberia, Costa Rica, after riding for fifty bumpy minutes flat on my chest on the passenger side of a Honda Civic. In Costa Rica, health care is available to every citizen in public hospitals. However, for an emergency situation involving a foreigner, the best chance for prompt treatment is at a private clinic. The doctor on staff looked at my “situation” and immediately concluded what my wife, Katie, and I already knew from a quick Internet search; “stage four” external hemorrhoids require surgery. He checked the schedule and told us, in Spanglish, that the surgeon would arrive at 4:00 p.m.
“That’s five hours from now,” said Katie. “This is an emergency.”
The doctor shrugged, at first, but agreed to call the surgeon on his cellphone and explain the situation. Apparently, he must have conveyed he had a “Gringo with a credit card in distress,” because the surgeon agreed to arrive in fifteen minutes. Fifteen became fifty, but the doctor, in jeans and a tee shirt, bustled in. He spoke no English and bore a striking resemblance to El Chapo.
“So this is where he’s hiding,” I whispered to Katie.
I naively thought the doctor would commence treatment immediately, but he pointed out I needed to “prep” for the surgery and that I should go home to do so. He prescribed the same preparation as for a colonoscopy and Katie went to three different pharmacies outside the clinic to obtain the necessary meds, along with eight bottles of Gatorade to mask their terrible taste.

She also satisfied the front desk that our debit card would cover the $5,000 cost of the surgery. Apparently, if you cannot pay up-front, you will not be treated. Never having used the card for more than expenditures measured in the hundreds, we had no idea what our limit was. To our relief, it was sufficient. I rode back to the condo on my tummy and tried NOT to contemplate the meaning of life and death.

 
*****

I was deflated by the time we arrived back at the Clinic the next day. I hadn’t eaten food in nearly 36 hours. Sleep had been fitful, the “prep” had literally drained me, and the pain was unrelenting. In kindness, everyone in the waiting room offered me seats, but the one thing I absolutely could not do was sit. After twenty minutes that seemed like five hours, I heard my name and stumbled into the elevator, faint and sweating. An orderly, who I thought might help me, looked more scared than I.        Eventually, he and Katie helped me balance on one knee for the ride up to the surgical ward.
Upon arriving in the operating room, a diffident nurse tried and failed to attach an IV three times, each attempt more painful than the previous one. Flustered, she apparently called a picador from the local bullfighting arena because a large male strode into the room and jabbed a needle into my arm with no difficulty whatsoever, then strode out with a look of “nothing to it.” I lost consciousness immediately.
I awoke hours later, after the surgery, in my hospital room. Katie sat on a sofa across from my bed. I knew I was alive and, of course, that’s supposed to be good. However, the sensations I felt from head-to-toe were less than life affirming.
“How did this happen?” I asked, generally, specifically and miserably.
*****

Nature has provided duplicates for many functions. For instance, we have two arms, two legs, two eyes, etc. If one doesn’t work, we get by, to some extent, with the other. But nature has not provided any back up for the functions performed by the rectum. What goes in eventually comes out and, after hemorrhoid surgery and its attendant stitches and staples and scarring, there is a tremendous disincentive to go to the bathroom. When something does come out, for the first seven-ten days after surgery, the sensation is positively medieval. Think broken glass. If you’re a woman, think childbirth. Of course, each individual event does not approach the magnitude of childbirth, but childbirth is not a several-times-a-day activity.
We assembled a selection of painkillers and creams and wipes, along with applicators and measuring devices. For the first time in many decades I experienced diaper rash; I’d forgotten how unpleasant it could be. I’ll skip the rest of the blood and gore that dominated the first ten days after surgery. Let’s say it’s enough to make a person change his entire diet to avoid ever doing this again. In addition, Katie and I achieved levels of intimacy neither desired nor desirable. To put the best possible spin on it, I learned everything there is to know about certain anatomy I’d always taken for granted.

*****

On the tenth day, we returned to the clinic for a follow-up. The surgeon grasped the situation, literally, and declared me to be progressing properly. Through the hospital administrator who’d volunteered to translate, he reiterated that full recovery would take three more weeks. He continued the ban on swimming and added specific bans on dairy, meat and, generally, “anything else that might cause constipation.” He prescribed several more creams to salve the pain and good, old Desitin for the diaper rash.
Back at the condo, a virtual convention of Canadian healthcare workers in the pool helpfully offered advice. A pharmacist from Quebec translated the painkillers and regulated my dosages; a nurse from Prince Edward Island formulated a dietary plan; and, a pair of paramedics from Alberta encouraged me to walk, stretch and make initial efforts to sit. Our neighbor from Calgary helped us score the bright yellow blow-up donut from a souvenir shop.

*****
I resumed walking at a normal pace and even sleeping almost normally. Other functions were still painful but not torturous anymore. By Day 19, we planned to travel home to North Carolina via American Airlines. At the airport, when we tried to check in, the attendant demanded a doctor’s note. Apparently, to fly internationally after surgery one is supposed to present such a note twenty-four hours ahead, and no one had told us. But Katie persisted and, through the magic of cellphones and email, the necessary documents were provided. It only took fifty agonizing minutes. And that takes me up to where this story began, in the lounge, making the three-year-olds jealous.

EPILOGUE

Another week has passed. I sat without my donut for nearly half an hour today. My fiber intake is off the charts. My water intake rivals the Titanic’s. Sleep is pretty good, except for disposing of the water. The rash is nearly gone. I see the end of the tunnel. May this never happen again.