After a lot of soul-searching, Laurel has decided to have a hysterectomy. Recalling what I knew about Hippocrates, at first I thought this meant she would never get hysterical again, like she does when I fail to properly clean dirty dog paws before letting Serena into the house or neglect to rinse food residue from the bottom of the kitchen sink into the garbage disposal.
But, after whacking me on the side of my head for my patriarchal ignorance, Laurel explained that it isn’t a “wandering uterus” that is creating problems, but a uterus that gives her debilitating menstrual cramps. So it needs to go, since she’s tried every other treatment option known to womankind.
(An aside: we were watching a PBS “Now” episode last night; a woman being interviewed said something like “never in the history of womankind has....”; she said it so smoothly my mind didn’t register the unfamiliar language for several seconds, until a “what, womankind??!!” popped out of a surprised macho corner of my psyche.)
I don’t understand the whole mysterious area of female problems very well. When Laurel talks with her middle-aged women friends about menopause, estrogen, progesterone, menstruation, cramps, hormone balancing and so on, I feel like someone from the dark ages who’s been transported into a Perl programming seminar. The words being spoken are vaguely familiar, but I have just the barest understanding of what they’re talking about.
Extending the computer metaphor, my impression is that the female reproductive system is a lot like the Windows operating system. It’s hellishly complex; it’s unreliable; no one really knows how it works; often the best you can do is patch it up (literally) and hope the damn thing doesn’t crash.
In Laurel’s case, she needs hormone replacement to relieve some pretty nasty symptoms of menopause. But if a woman stays on hormone replacement she may very well keep on having periods for the rest of her life. If horrible cramps come with the periods, then the same hormones that are relieving menopause (or post-menopause) symptoms and providing future health benefits also are enabling the continuation of pain from dysmenorrhea.
So, assuming I’ve managed to explain the situation halfway accurately, that’s what led to Laurel and me sitting in Dr. Philippa Ribbink’s exam room yesterday, having a pre-op conference. Dr. Ribbink is associated with the Everywoman’s Health Center at Legacy Emanuel Hospital.
No doctor in Salem performs the sort of laparoscopic hysterectomy Laurel is going to have. That’s why we ended up with Dr. Ribbink, who is marvelously competent but looks to be only about twenty years old to our born-too-long-ago-for-Bush-to-cut-our-Social-Security-benefits eyes (which is just about the only bright side to having a birth date in 1948 or 1949).
I liked how every time Dr. Ribbink talked about a possible complication of the surgery, she’d lean over and strike her knuckles against the wood edges of a cabinet I was sitting next to. My mother used to do the same thing, “knock on wood” to ward off untoward consequences and bring good luck. It was nice to see a 21st century medical wizard engaging in some pre-scientific folklore.
Laurel had several pages of questions to ask Dr. Ribbink, who acted as if she had all day to spend with us—a welcome change from the usual rushed, impersonal doctor-patient consultation. I had just a single two-part question: “Do you play music in the operating room? If so, who gets to choose what is played: you or the anesthesiologist?”
Since we’re fans of Fox’s “Nip/Tuck,” and the two plastic surgeons in this TV show always have music playing when they operate, this was my subtle way of making sure that “Dr.” Ribbink was who she claimed to be, and not a sophomore at Reed College who was acting out some sort of weird medical care performance art. Fortunately, I got some convincing answers.
“Yes, we always play music. The anesthesiologist usually plugs in an Ipod right away. Most of the time he or she chooses the music. I have a veto if it is the ‘Sound of Music’ soundtrack or such, but most of the time I let them play what they want.”
Another sign that we were talking with a real live doctor is that we left Emanuel with no clue about what this whole shebang was going to cost. Who cares? After our deductible is met, our insurance will pay 70% of the bill, though the remaining 30% still will amount to about a jillion dollars, more or less.
After we left Dr. Ribbink’s office Laurel went through the pre-op procedures at Emanuel’s Diagnostic Center. While she was engaged with getting an EKG, chest x-ray, and blood work, I practiced my pre-op napping in the center’s waiting room, preparing for playing my part when the big day comes on February 16 (Happy Valentine’s Day, Laurel! Here’s your present: two days in the hospital!”).
Laurel is doing her own mental pre-operation preparations. Every day she listens to a CD called “Successful Surgery” that contains guided imagery intended to reduce complications and promote quick recovery. A 2002 article in the AARP magazine said that Blue Shield of California sends members a similar tape as studies have shown “that patients who listen to the tapes experience less anxiety before surgery, and less blood loss and pain after surgery.”
Dr. Ribbink said that Laurel will be able to listen (via headphones) to an associated music track during the surgery that supposedly reinforces the affirmations in the patient’s mind during the actual operation. Interesting.
They also should have a guided imagery CD that the person who opens the bills, namely me, can use to prepare himself for the day a final post-op statement comes from the Legacy Emanuel accounts receivable department. That's when I'll need relief from blood loss (a fainting brain), and pain (when I wake up and think of our impending checkbook balance).