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Rant #263
(published January 26, 2006)
On What It Feels Like To Have A Large-Ish Tumor Cut Out Of Your Back When You Are Awake
by Morgan Johnson
First off, let me be clear in that this is not a complaint or an indictment of what the surgeon, the nurse, or anyone at Kaiser Hospital did. I'm healing great. I feel better. I went into with pretty good knowledge of what would happen.

Still, it hurt like a mother.

I felt this needed to be said for other people who may be looking at having lumps removed or who are at least a bit curious as to what is involved in the procedure.

And so it goes:

About five months ago, my girl and I joined a gym. 24 Fitness down in the Castro district of San Francisco. We just picked the closest one, really. We went in for a few training sessions and were classified as total beginners to fitness—utter newbies—and put in the gym equivalent of Special Ed. We planned to go three times a week, but were happy with two. Even with this small amount of exercise, I noticeably got stronger and fitter.

This is where my problem began.

The more I worked out, the more my lower back hurt. I wrote it off to inexperience, to not having worked these muscles in a long time, to most probably using the machines wrong and doing something stupid and injuring myself. And while these may have been causes of some of the pain, they were not the chief cause.

One night in early December, while complaining loudly about my back, I rubbed the sore area—near the spine, along my beltline—and felt a lump.

A lump. It was soft, the size of a large grape, and near-ish my spine.

My mom is a nurse. I was raised with a fairly good knowledge of medical stuff and what-not. When you find a lump, you get it checked out as soon as possible. "Early detection is the key," is how I was brought up. I called Kaiser Hospital that night, spent about fifteen minutes navigating the phone menu, and after three dead ends finally found the Human in Charge of Appointments. Now I don't know what your health care situation is but with Kaiser you describe your symptoms to some guy over the phone and he sets up an appointment with the right kind of doctor. In theory.

So the next day I head over to Kaiser and wait around for a while and finally see a "Doctor Olsen." I had told the Kaiser phone guy that I had found a lump in my back, that it was a bit deep, and that I had no idea what it was and Dr. Olsen was where he sent me. A nurse meets me, takes my blood pressure, hands me a skimpy gown and tells me to strip. After five or six minutes of sitting alone in the room, Dr. Olsen comes in. She looks like a stern librarian: Hair in a bun, glasses perched on her nose, etc. Dr. Olsen has me stand, feels my back and says in an accusing voice, "this isn't a cyst."

"Um, okay. Is that good?"

"This isn't a cyst."


"I specialize in cysts. I remove cysts. This isn't a cyst."

"Well look I just told the phone-guy that I had a lump, I didn't say-"

"This isn't a cyst."

And so it went. What it came down to was I had to go home and call again and make an appointment with the surgery department, which I did.

Though at one point an odd thing happened, she asked me: "So what's going on?"

"Excuse me?""Healthy 29 year-old boys don't rush to the hospital the day after they find a lump. What's going on?"

This surprised me. Wasn't this what I was supposed to do? You find a lump, you see a doctor: that's the way it works. I told her that my mom was a nurse and that I was raised with the idea of "early detection" being important, but she didn't buy it. So I told her that one of my co-workers had cancer last year, and that he was only a few years older than me. This wasn't at all a factor in why I came in, but I knew it was the kind of thing she wanted to hear. After I spun her this story she agreed to let me make an appointment for a surgeon.

The very next day I return to Kaiser and make my way to surgery, fill out forms, pay my twenty bucks, wait and wait and wait. The nurse comes and greets me and takes my blood pressure. It's good and in the low-end of average. I'm told to strip again and left alone, in a flimsy gown, in yet another room.

After a solid fifteen minutes Dr. Shaw arrives. Dr. Shaw seems to be a short, old, jewish transsexual. This, by the way, is the detail that surprised my parents and lots of other people, though after living in San Francisco, it's really hard to be surprised by this kind of thing anymore. Shaw checks out my lump, says that it is pretty deep and recommends putting me under for the operation. "It's close to the spine, " she says, and it might be pretty painful to use just a local. I agree, and Shaw says that the nurse will be back to schedule something. At this point I feel relieved and scared, which you might expect.

I get dressed and sit in my civvies for about twenty minutes, when the nurse returns and tells me that my operation will be on December 23rd and a follow-up will happen on December 29th. That's it. No "what time works for you?" or "how are these dates?" just a pronouncement. Immediately my Irish starts to get up. "Those dates don't work for me. I'm not going to be in the state for either of those dates." The nurse nods, then looks really worried. She says, "Oh. Oh! Oh no. I'll, um, I'll be right back." And then she leaves me alone for another twenty minutes.

Dr. Shaw returns and explains that she is on loan to this hospital up through the end of the year. She is a temporary doctor, in town from Maine. And that if I want to have surgery, these are the only dates available. I'm angry—Irish, remember?—so I raise my voice and I ask what the hell am I supposed to do now? This is my second day here at the hospital and how many more times do I have to come here, anyway?

I get passed back to the nurse. Who, by the way, is very nice. It's hard to get too mad at adults with braces.

She schedules me for an appointment on Monday with Dr. Constant. She assures me that he is not a temp doctor and the he will indeed be around in January. I tell her that this is really annoying, to have to spend three days at the hospital like this, and ask her if I really have to pay again for the visit. The answer, of course, is yes. I saw a doctor, so I pay the fee. Cut and dry.

Monday was my third visit. And it began just like the others: a walk to the hospital, a long wait, greeted by the exact same nurse who again took my blood pressure. This time, though, I didn't put on the stupid gown while I waited. The surgeon showed up after the usual long wait and began to give an introductory speech about his name was Dr. Constant and all, but then he saw my t-shirt and stopped.

He recognized the "ICHI" peaking out of my University of Michigan shirt. It turns out he also went to U of M, and not only that but he went to the same small school within Michigan—the Residential College. Odd coincidence, sure. And yes it made me feel better.

He checked out my lump and said it was probably a Lipoma, or a tumor of fatty tissue. He said it wasn't too deep and it could be removed in about 45 minutes in his office. Totally routine. Local anesthetic. He was very calm, very confident. He was everything I want to see in a doctor. He even told a story about a former partner in a practice who had 35 lipomas in his body. The guy was skinny, and you couldn't see them if you looked at him, but if you were to grab his arm or leg or back and squeeze you would feel dozens of grape-sized lumps in his flesh. He lived with them without incident, forever.

There is no agreement as to how or why lipomas form. Some claim that weight gain creates them. Others say it's weight loss. The classic scenario is that someone begins to exercise, loses weight and discovers them. Which is exactly what happened to me. My lipoma, it turns out, was deep in my back—three inches deep—which was not immediately evident to Dr. Constant. It was sandwiched between two plates of muscle. I would later find out that it was larger than expected—bigger than a golf ball, but smaller than an apple. It was also five years old. As my muscles got stronger and I lost weight, the lipoma remained and the muscles squeezed it. It distended my back like a bowling ball dropped onto a stretched blanket. This is why my back hurt.

I waited a month for my surgery appointment.

I went back on January 6th and was led into the surgery room by a very chatty and nice nurse named Minja. Minja was awesome. She talked to me constantly, asking me about my girl, my job, telling me stories about her son and nephew and how they couldn't meet any nice girls. I realize now that she was trying to keep my mind off the terror of surgery. And it totally worked. I didn't think about it at all, just concentrated on her stories and answering her questions. It was great. I took my shirt off, but thankfully left my pants on and hiked low. Minja explained that they would be using an electric device to cut me, so she had to attach a conductive pad. She tried to put it on my leg, but I am one hairy motherfucker, so she put it on my side. I would swear that the pad had been refrigerated it was so cold. Minja then located my lump three times and drew a circle around it with a sharpie pen. she then shaved a patch over it (see above re: my hirsute-ness).

I lay on my stomach, on a table in a room that looked like every other doctor's office anywhere. Minja scrubbed down, put on a cap and gloves and big plastic glasses. Doctor Constant arrived and did the same. During the whole procedure he too talked constantly about his wife, how they met, music and Michigan. He turned on the radio before the procedure and at one point, while he had his hands deep inside my back we even got into an argument about whether Run D.M.C. or the Beastie Boys covered Aerosmith's "Walk this Way." It was totally Run D.M.C., but I fake conceded that maybe the Beastie Boys covered it at some point. I realized halfway through the argument that maybe it was bad form to piss off your surgeon.

There was a small table near my head with a variety of surgical tools on it, including a large bowl full of clear fluid that looked like nothing so much as chilled vodka. He dipped a syringe into and stuck it in my back. This hurt. A lot. Now I feel some context at this point is important. I know a bit about pain: I've pulled my back, I've broken my wrist. I twisted an ankle so bad once while drunkenly dancing to ska music in Ypsilanti that I had to be on crutches for seven weeks. Once, a Dodge Pickup fell on me. I've broken my collarbone. I've had my wisdom teeth removed. I've had my ears pierced. I've had my nipple pierced. So believe me when I say that this shot hurt like a bitch. Although much less than what was to follow. He gave me a few more shots, then waited a few minutes and pulled out the cutting torch.

The torch was a green plastic pen attached by a plastic cord to a metal box on a stand. It looked like a tiny soldering iron crossed with a bic pen. He began to cut me with it, and I felt it distantly as an uncomfortable sharpness. He stopped and gave me a few more shots. Then he began to cut in earnest.

Going in, he didn't know how deep the tumor was. He was hoping it was near the surface, but found that it wasn't. As mentioned earlier, it was three inches deep, buried between layers of muscle. Dr. Constant didn't want to cut the muscle and didn't want to leave me with an enormous scar, so he told me. The plan was to cut a hole in my back through the fleshy bits and to pull aside the muscle with clamps. Then he would cut all around the tumor and extract it.

This sounds good, right? This is a plan. It makes sense. Inspires confidence.

It actually went like this. He cut through the fleshy bits fine, and then had to cut around the tumor a bit before spreading the muscles. He would cut and cut and cut until he hit a bit of my body that hadn't been numbed. Until he hit a part where I was had total feeling. Then I would scream out in pain, he would apologize and inject me with more anesthesia.

This is how it went for at least half an hour. Cut, cut, cut, scream, apologize, inject. He had to refill his bowl of anesthesia three times. There were seventeen shots in all. Which means somewhere between ten and fourteen screams of pain. I lost count. I could feel the electro-blade cutting all the time, really, but when it hit numbed flesh it didn't hurt. It just felt like being gently prodded in the back with something sharpish. And then he would cut into tender, awake flesh and it would feel like searing, like grabbing a hot pain and burning yourself, only inside your back. Inside my back. So it became a waiting game. A fun, fun waiting game. Time stretched on as it only can when you are having surgery. I waited for each cut to be the one where I would tense and scream out.

After half an hour, I began to wonder if we were almost done. Dr. Constant pulled out the clamps and the spreaders and told me we were almost halfway done. He put the spreaders into my back and pulled the muscles apart. This I couldn't feel at all, but I could feel the steel of the clamps resting against my back. Then he cut some more.

And more.

And more.

Then there was more cutting, screaming, twitching. He made comments about how deep the tumor was. And at this point I realized that we had stopped chatting and I was started to get really cold and beginning to, well, freak out. So I began to ask questions about the tumor. Something to distract my mind from the inevitable next cut into raw body. He explained that it was basically a lone fat deposit that grew really large. This was called a capsule. I kept asking about it, so he actually scooped some fat out of my back and held it up to my face to show me. This was really fucking gross.

After the cutting was done, there was the pulling. He put his hands into the hole in my back and yanked on the tumor, trying to free it. The way this felt was exceptionally odd. It made squishy noises like stirring jello. It felt like he had his hands on my belt and was trying to lift me bodily off the operating table. But it wasn't my belt, it was my back. He was lifting me off the table by the flesh of my back. He had only cut around the sides, not the underneath—which would be impossible unless he had some sort of medical melon-baller, which he didn't have.

He yanked it out, and since I had shown so much interest earlier, he dropped the tumor right next to my face—maybe five inches away—and pointed out the different bits of the tumor to me. He took a chunk of my body out of me, and showed it to me. How hardcore is that? He then produced what appeared to be a shot glass of anesthesia, and then he poured it into the gaping hole in my back. This also was cold, and felt like the internal equivalent of having snow shoved down the back of my jacket.

I was stitched up with two layers of stitches, one for the tissue and one for the skin—twelve stitches in the outside layer, by the way. Then there was glue and bandages. Minja gave me a handout with scribbled instructions on it and told me that they would not prescribe any pain medication and that I should only take Tylenol Extra Strength. Which I did, often and copiously.

I stood up, after they were done and saw surgical tools littering the floor. There was also chunks of flesh, like small red grains of rice, spattered around the room and across Dr. Constant and nurse Minja. The doctor then asked if I had a cell phone with a camera, which I did, and if I would like to take a picture of the tumor, which I did.

It's been almost three weeks, and I'm doing a lot better now. The tumor was benign, I can wear pants again, and I have a bitchin scar.

And because you've read this far, and because I know you're curious, here is my tumor:

His name was Tony; his name was Tony Johnson. And he lived inside me for five years.

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