Fleshmesh: Or, More Guidelines than Actual Rules…
Specifically, Guideline #5:
Do not drink any wine, beer, or alcohol for twenty-four hours after your discharge from the hospital.
Yeah, right. Like that was ever going to happen.
But I’m back home now, and bedridden again, and all the range-of-motion exercises I was supposed to perform last time (to increase strength in the ankle) are now to be avoided at all costs because they’d dislodge the flesh mesh that’s just been stapled across the wound. (Yes, stapled. You’d think they might have mentioned that little detail during the pre-op briefing.) My leg is to remain immobilized and elevated. I am not to leave this bed except to use the toilet (and even then, only on crutches). Food and alcohol is to be brought to me at my command. All sex is to be taken orally. The most strenuous thing I am allowed to do is play Portal 2 on the 47″ monitor at the foot of the bed.
God, it’s hell being sick.
I shall struggle on, though, because that is what I do. And I shall deliver you pictures, because you asked for them and the operating staff was kind enough to comply. (Although I probably should have briefed them a bit more thoroughly on the use of the Canon Powershot SX20IS; there were a couple of points where they obviously thought they were just taking snapshots where in fact they were taking full-motion video with stereo sound. You do not want to know what these guys talk about when you’re unconscious.)
Anyhow, mindful as always of the weaker stomachs among you, I shall put the actual fleshtones below a cut. This picture’s safe for general audiences, though:
Photo by Dr. Brett Beber
Note the restraints. I never really got a straight answer as to why it should be necessary to strap down an unconscious patient. I also have my suspicions as to exactly how they render said patient unconscious in the first place. Officially it’s a two-stage process involving the injection of something that burns your veins like Drano, followed by gas anesthesia administered via facemask. It’s this second phase that I’m suspicious of: they clap the nozzle over your nose and mouth and tell you to breathe deeply, for all the world as though there is in fact gas flowing in through the mask. I don’t think there is. I kept trying to inhale, but there didn’t seem to be any airflow at all. I wonder in hindsight whether the Canadian medical system isn’t just so overburdened that they can’t actually afford gas anesthesia any more, so they just slap a rubber cone over your airways until you pass out from suffocation. (The bright side, as usual, is that being a Canadian healthcare system, at least you don’t get hit with a $3000 invoice for the use of your own recycled CO2.)
Here’s what the donor site looks like, post-scrape:
Photo by Dr. Beber or one of his team.
Two things surprised me about this site: the lack of actual bleeding during the op itself, and the surfeit of pain afterwards. The deep, gaping staple-studded gash in my calf feels just fine, thank you very much, but this superficial patch of surgical road rash stings like a bugger every time I wiggle my toes.
Here’s the old familiar canyon, freshly clothed in silky fishnet lingerie:
Also by someone on Team Beber.
That pale whitish mesh that looks like J-cloth? That’s actually the skin from the donor site. They scraped it off as a perforated mesh so that they could take a narrow strip and stretch it to cover a much wider area, which I think is pretty ingenious. (Presumably the holes in the mesh fill in over time.) Then they brought out the staple gun (which is a bit too Home Depot to qualify as “ingenious”, but at least looks pretty effective). I’m also wondering how they took this shot; I’m still unconscious at this point, and my leg is obviously not on the operating table. Best guess, they simply flipped me over and swung my leg over the edge for a better angle. It may be a bit undignified but it’s really going the second mile, given that taking tourist photos is really not in their mandate. So I would like to take this moment to raise a salute to Dr Beber and his team, for service above and beyond the call. Even if those staples could have been more evenly spaced.
This one's by me.
And here we are post-op, all VAC’d up again. A closer look, however (which you can obtain by clicking on the image), reveals a couple of new features on the landscape: first, a surgical mesh spilling out around the edges of the wound (not to be confused with the living mesh of cells previously presented); second, the existence of rogue staples visible along the lower-right edge of the Dark Zone. They do not hurt, but sometimes they itch. Especially when restless cats gnaw on them, late at night.
So there you go. Those of you disappointed by the relative inoffensiveness of today’s illustrations can rest assured that the last thing I did before losing consciousness was to drop an empty flash drive into Dr. Beber’s hand. I will be returning to the hospital next week for a follow-up, at which point I fully expect to have said drive returned to me just bursting with gory photos of my leg at its most necrotic, back when this whole thing started. I’m hopeful that they will make even me toss my cookies.
Stay tuned.
That’s very interesting, Peter. It looks like a very cleanly done job. Keep up the good spirits. I have, for more than 2 1/2 years so far, 14 months to go. And oh yes. I survived and was spot-on about what happened. So keep yourself and your healthcare system well.
So, first arrest on felony charges, then an attack of skin-eating bacteria. How will you top this in 2012?
Very cool! – mind you, at the rate you are going, you’re not even going to end up with a really gnarly scar with which to win free beers in the inevitable “Oh YEAH, well I got this … (insert incredible story here)” contests that have been know to occur in the wee hours of the morning!
Hang in there – hope you’re up and about soon …. or not.
Hope it heals well.
Wow! that is so cool! scraping off a mesh of your skin for the other site. Somehow I had imagined a skin graft working completely differently.
why do they have to use staples?
also, it’s nice that you are able to go home so quickly. I thought you’d be laid up in the hospital for a while. I guess skin grafts are not so alarming as to require a long stay.
Filled with awesomness you are.
Glad to see you made it through. Interesting to see how they do things in the OR. Hope you heal up well from here on out, barring any feline tampering.
Itching is a good sign. It means things are trying to heal. I had an operation about two years ago, and learned a lot about how the body heals.
I did lose sensation in some areas of the surgery site, but there’s still a chance the nerve endings will regrow in time. Once in a while, I’ll get what feels like little electrical zaps shooting through the numb areas, and I was told that’s a good sign that things are coming back online.
It’s strange experiencing first hand the nature of the organic machinery we’re made of. Might make for good writing fodder later on.
You’re right Peter. That staple job is atrocious. I think Dr. Beber and team could use some lessons from a really good upholsterer I know. The important thing, is that the procedure went smoothly. And now that you’re home, it would seem that you have things well in hand. So, just get well.
Having worked in a hospital for 30 years – and yes, the burn unit too, I have to say you’re looking pretty good and it looks like you are in good hands.
Would you like me to tell you a few stories? I can curl whatever hair you have left. It’s not really a bad idea either to compare your situation with that of others. Puts things in “perspective”.
You are doing really well and I hope you recover soon.
Sheila asked — “why do they have to use staples?”
Staples are superior to stitches for large incisions. They hold the skin together much better. I have seen patients with many many more staples than Peter has here. The big baby. (Men are the worst patients) If you ever have arthroplasty of the hip or knee you will have staples. I have seen patients with quite long surgical scars w/ over a hundred staples. Looks like a big zipper running up your leg.
Perforating the donor skin so that you can stretch it and have it cover a larger are is very routine. They’re been doing that for… forever, long as I can recall. And yes, the skins cells will get to work and start multiplying and fill in those voids.
They could have used pig skin.
i second that there could have been way more staples. when I got grafted for burns, it was a larger area, but it was also an unbelievable number of staples. the real pain is when they snip then out. I wouldn’t wish it on anyone.
glad it went well Peter!
The reason it doesn’t feel like there is anything flowing into the mask is because the gases and vapours from the anaesthetic machine are fed into a reservoir bag connected to the breathing system and mask. The tubing is wide bore and low resistance and the bag empties and fills really easily. Unless the gas flow is very high you don’t feel it.
During the surgery they may have to tilt you from side to side/head down/feet down/drop your leg off the table etc.. The restraints are to stop your inanimate dead weight from flopping off the table under gravity. We tend to do it after induction of anaesthesia where I work. It saves on the raised eyebrows…
Here’s another reason to strap the patient down – if he partially comes to, disoriented, in pain, while someone is cutting into his flesh, etc., he might flail, hit the doctors, nurses, equipment, at the very least, yank the IVs out.
I’d imagine the last thing you want is a patient flailing half- anesthetized. I made that joke when attending a surgical procedure with my husband. (They were strapping him down.) I demonstrated for the doctor what it would look and sound like if he came to mid-procedure – the doctor laughed. The anesthesiologist was Not Amused.
Thanks for satisfying our collective ghoulish curiosity, Peter. I will be here with bells on for the next chapter in the gorefest.
Andrew, I had minor surgery under general a couple of months ago and I also had problems with the mask. It really did feel like I was suffocating when they had the mask on me firmly, so my awesome surgical team held it a bit above my face so I could get some free-range oxygen along with the anesthesia. It took a little longer to put me out, but I’m sure they clamped down once I got seriously woozy.
So it wasn’t the sensation of “Hey, shouldn’t there be a strong flow of gases here?” but more like “There is almost nothing to breathe here at all.” Surprising and not terribly pleasant.
That stuff that burns like drano was probably propafol, the same stuff that did in Michael Jackson, but that was because his idiot doctor gave him a shot and then left him alone to die alone. Propafol is one of the better anaesthetics out there, in terms of being able to put a patient entirely down, as in, just not the least fucking bit conscious. Yet it can also be light enough for a sort of twilight-sleep. One thing for sure, it is in fact widely known for the horrible “my veins are on fire” sensation. Peter is not exaggerating. The first time I had cataracts surgery, I must add here that I second Peter’s remarks about “you don’t want to know what they’re talking about”. It’s not that it’s necessarily mean or offensive, but rather that it can be appallingly banal.
For me, I told them I’d had problems before with premature emergence, but evidently they didn’t listen. But this is the joy of propafol, feeling like drano or not: The surgeon and the medtechs are talking about the music on the overhead speakers, and thought it was Elvis Presley. I pointed out to them that this was a reasonable mistake, as the guitar player in the “Roy Orbison and Friends” soundtrack “All I Can Do is Dream You” was none other than Elvis’s longtime guitarist James Burton, furthermore with backup by not just Bruce Springsteen but also Bonnie Raitt. The freakish bit was that this announcement was made at the same time that their little ultrasonic vibratey-swirley artificial cilium was shredding the damaged lens inside its capsule and then sucking it out. Then when they wanted to pop in the new artificial lens, they said “be quiet please, and look down” and I did. The problem here is that propafol doesn’t much kill pain, from what I can tell, just makes you unconscious, and babble in free-association mode. Hence the gas as a painkiller rather than a knockout dose. For my eye, the painkiller was, of course, cocaine hydrochloride otic solution… that being pretty much the sole legitimate medical use here in the States.
Peter, you poor poor man. But savor the itching as it means you’ve got nerve endings where they’re supposed to be. Staples or no, you’ll be surprised how fast that mesh puts a surface on the crater. And the VAC thing can quickly go into the closet until next Hallowe’en or next Convention, whichever comes first. Hopefully it’ll be the Convention, and soon. Best wishes and post icky pics soon, k pls thx!
And PS, it only feels like drano. Apparently it doesn’t actually do that sort of vein damage. 😉
Glad to see everything went smoothly, Peter!
Who gets the honor of playing the terrific Portal 2 Co-Op campaign with you? It’s important to choose the right person, as it’s never the same after you’ve figured out all the puzzles, so you need the proper dedicated wing-man or woman for that.
Now you rest up and take your oral sex like a good patient. (Is that also part of the Canadian healthcare system? )
I’m glad it all went well. Speedy recovery!
Glad all seems to have gone well. You know, if you can play video-games from your sickbed, you could probably also — ahem — you know, write.
Seriously though, get well quick.
Hope it all continues to go well and the skin graft takes. I can’t help wondering about how they remove those staples though…
I wish you a speedy and hopefully unboring recovery.
Here, some entertainment:
Jason Scott at Arse Elektronika 2009: The Atomic Level of Porn
http://vimeo.com/7088524
Geeky musings on electronic art, bandwidth, and boobies. Not kidding.
I’m surprised they’re still doing the vacuum packing thing on top of the flesh mesh, it doesn’t look sturdy enough to resist such treatment, you’d think it would tear.
The road rash looks cleaner than expected.
I’ve been stapled when I was young, and I believe it’s WAY better than being stitched.
I was as surprised just like you, but it proved very comfortable and very efficient.
In my case, when they removed them it was simply a matter of 2 minutes, during which I sensed no pain (not like idleprimate, but I’d guess the wound origin is also involved in the post-operation thing).
Glad that it went down so well. Given your run of bad luck, one would think you’d end up improperly anesthetized – conscious, aware of the surgical procedures, feeling everything(especially the pain, I’m told) but being unable to move…
Something like that happened to one of my relatives, ironically a doctor herself.
Three cheers for modern medicine!
Hope you have a speedy and painless recovery.
Guideline 18: Do not draw eyes and a nose above your wound to turn it into a “monster”.
Guideline 43: Do not constantly refer to the person bringing you your meals as “Jeeves”.
Guideline 49: If you are approached to do a nude photospread for “Hot Post-Surgical Patient Weekly”, be warned that it is a scam. You will NOT be compensated.
@ Peter Watts: Hope the graft grows well. Best wishes!
Do you know about the movie “The Doctor”? In the opening scene a “star” heart surgeon is kidding during an operation. Later he gets diagnosed with a malignant tumor and has to taste his own medicine …
Medical humor could be somewhat extreme. Check out http://www.ribspreader.com if you like (insider cartoons made by an anaesthesiologist).
@ Nestor: Look at the last picture: an artificial mesh is separating graft and sponge. The vacuum maintains a better contact between host and graft, I suppose. And as I read it’s improving blood/oxygen supply of the wound, too (think of a permanent hickey …)
@ David S: They’ve got a special tool for this job http://www.youtube.com/watch?v=I5xkpmyt
Works well (having own experience, too)
On a complete irrelevant side note, Congratulations on your nomination for the Short Story Hugo for The Things!
Ah yes I had noticed the mesh but didn’t realize it was between the gauze and the graft.
Andrea, your YouTube URL didn’t work, but I found this. OMFG.
The surgeon provides a voiceover in an endearing accent, but steel yourself for the sight of a strip of skin the size of a lasagne noodle being peeled off in one slice with what looks like the world’s largest pedicure tool. It isn’t stripped and perforated in one go: they put it through something like a pasta machine to turn it into human skin mesh. Then they show the stapling.
But the whole thing is grimly fascinating. There’s even an early shot of a vacuum packed wound.
Crap! Sorry, forgot to close the a tag.
I’m delighted that your operation went so well. It is known that nerves can regrow – for example, the late Christopher Reeve was regaining some feeling in his body as well as movement in his fingers. See –
Link to Guardian
Re medical personnel and what they say privately – it’s not only them. The police use a lot of black humour to relieve stress when the situation is really ghastly, and say things that anyone from the general public would find offensive.
A modest proposal for your next achievement in 2012- climbing to the top of the CN Tower. For the rest of 2011 – peace and a rapid recovery, perhaps letting us see drafts of works in progress and allow us to watch them evolve. Getting interviewed in Second Life like Cory Doctorow. And of course more more pictures, some with kitty goodness.
With all due disrespect, and uncustomary brevity 🙂 let’s see some icky pics!
Seriously, Peter, you’ll be good as new in two fortnights. Or at least you’ll be running again, however limpingly.
Whatever happens next year, of course, is the subject of at least a few betting pools.
Normally they probably wouldn’t. But when you’re dealing with one of the infected, you can’t really take too many precautions, or before you know it–Zombie Apocalypse. And then everyone has a really bad day.
Or it might have something to do with this picture:
http://www.flickr.com/photos/mcwetboy/5609761754/
Have you considered the doctors’ sheer terror of your freakish size to be a factor? How are you going to bring down an enraged Sasquatch if he decides to run amok and start crashing through walls, popping doctors heads off like dandelions? It’s almost certainly going to involve military intervention. And possibly biplanes. Does Canada have many biplanes in active service? Seems like a hassle to me.
Sorry, I’ve to be more careful here. This is the correct link: http://www.youtube.com/watch?v=I5xkpmyt-ig
Thanks for showing the whole procedure. But it seems to be new applying VAC afterwards, too. “Medicine is an ever-changing science undergoing continual development. …” written as a disclaimer in the imprint of all magazines I’m involved in (page layout).
Looking good Peter. Since you broke the no alcohol after surgery guideline, I hope that you purchased a premium beer.
Those are pretty cool pics–and much more reassuring than the pastry. Also, congrats on the Hugo nom.
all the best with your recovery and LOL at your writing on this post, made me and my wife laugh lots, you have a great sense of humour!
Is there a reason you did not get a local anaesthetic?
As to the restraints; first time I was put under general anaesthetic was to put a cast on a broken leg. When I woke up, I noticed that one portion of the cast was rough and gnarly, unlike the smooth surface of the rest of it. My father told me that in the middle of the procedure, I’d started fighting the doctors and I’d tried to take the thing off. I was ten years old, probably under 100 pounds. You are kind of the opposite of that. Jus’ sayin.