nullalux | As for the pain...perhaps it is a medicine that will cure the soul of its greed for love.

The Break (A. Sexton)

It was also my violent heart that broke,
falling down the front hall stairs.
It was also a message I never spoke,
calling, riser after riser, who cares

about you, who cares, splintering up
the hip that was merely made of crystal,
the post of it and also the cup.
I exploded in the hallway like a pistol.

So I fell apart. So I came all undone.
Yes. I was like a box of dog bones.
But now they've wrapped me in like a nun.
Burst like firecrackers! Held like stones!

What a feat sailing queerly like Icarus
until the tempest undid me and I broke.
The ambulance drivers made such a fuss.
But when I cried, "Wait for my courage!" they smoked

and then they placed me, tied me up on their plate,
and wheeled me out to their coffin, my nest.
Slowly the siren slowly the hearse, sedate
as a dowager. At the E. W. they cut off my dress.

I cried, "Oh Jesus, help me! Oh Jesus Christ!"
and the nurse replied, "Wrong name. My name
is Barbara," and hung me in an odd device,
a buck's extension and a Balkan overhead frame.

The orthopedic man declared,
"You'll be down for a year." His scoop. His news.
He opened the skin. He scraped. He pared
and drilled through bone for his four-inch screws.

That takes brute strength like pushing a cow
up hill. I tell you, it takes skill
and bedside charm and all that know how.
The body is a damn hard thing to kill.

But please don't touch or jiggle my bed.
I'm Ethan Frome's wife. I'll move when I'm able.
The T.V. hangs from the wall like a moose head.
I hide a pint of bourbon in my bedside table.

A bird full of bones, now I'm held by a sand bag.
The fracture was twice. The fracture was double.
The days are horizontal. The days are a drag.
All of the skeleton in me is in trouble.

Across the hall is the bedpan station.
The urine and stools pass hourly by my head
in silver bowls. They flush in unison
in the autoclave. My one dozen roses are dead.

The have ceased to menstruate. They hang
there like little dried up blood clots.
And the heart too, that cripple, how it sang
once. How it thought it could call the shots!

Understand what happened the day I fell.
My heart had stammered and hungered at
a marriage feast until the angel of hell
turned me into the punisher, the acrobat.

My bones are loose as clothespins,
as abandoned as dolls in a toy shop
and my heart, old hunger motor, with its sins
revved up like an engine that would not stop.

And now I spend all day taking care
of my body, that baby. Its cargo is scarred.
I anoint the bedpan. I brush my hair,
waiting in the pain machine for my bones to get hard,

for the soft, soft bones that were laid apart
and were screwed together. They will knit.
And the other corpse, the fractured heart,
I feed it piecemeal, little chalice. I'm good to it.

Yet like a fire alarm it waits to be known.
It is wired. In it many colors are stored.
While my body's in prison, heart cells alone
have multiplied. My bones are merely bored

with all this waiting around. But the heart,
this child of myself that resides in the flesh,
this ultimate signature of the me, the start
of my blindness and sleep, builds a death crèche.

The figures are placed at the grave of my bones.
All figures knowing it is the other death
they came for. Each figure standing alone.
The heart burst with love and lost its breath.

This little town, this little country is real
and thus it is so of the post and the cup
and thus of the violent heart. The zeal
of my house doth eat me up.

So here's what happened with the surgery on 9 June. We completed everything on my to-do-before-the-surgery list by the previous night, and I went into the hospital with

tutordennis in the wee hours of that Monday morning. I was excited and a bit apprehensive, but ready. Staff at the hospital were friendly and helpful, and the pre-op procedures were smooth. Smiling and waving, I let go of his hand as they wheeled me into the operating room. Stereotypically, the last things I remember seeing were my main surgeon, my anesthesiologist, and a half-dozen other masked faces over me, and the bright lights above the table.

Apparently, my mandible (lower jaw) is very slight (i.e. not very thick). In addition, the bone is quite dense (i.e. there's no marrow or spongy middle). Both of these issues, not ascertained during pre-op scans, caused surgical complications so that the left side of my jaw shattered into three pieces during the osteotomy. Rather than risk something similar on the right side as well (and possible permanent nerve damage), the surgical team chose to screw the bone back together without moving the jaw forward. The main surgeon even called in two reconstructive maxillofacial surgeons to make sure the double fracture would not have additional adverse effects. It took them several hours to wrap that up and then complete the osteotomy and bone graft in my chin. Unfortunately, this means that I am having to undergo the same long recovery process as we had anticipated even though the mandibular advancement was unsuccessful. The surgeon explained the situation to

tutordennis and my grandparents while I was still under general anesthesia in the PACU. When I awoke, my surgeon was there to tell me that they had been unable to complete the surgery, but I wasn't really clear on what had occurred or what that meant. Staff took me to my hospital room, where my family was waiting, and after a while the main surgeon arrived. When she explained that the mandibular osteotomy had failed in a spectacular fashion, and that there was no chance of trying again, I had no energy to do anything but close my eyes and cry. We've been preparing for this surgery for almost nine years, and I've been undergoing various invasive pre-op treatments for almost a year now, at an out-of-pocket cost of nearly 10K. I had been aware of possible negative outcomes like permanent nerve damage, scarring, or eventual regression, but we were completely unprepared for something like this.

The immediate situation was further complicated by difficulties with pain medication. Thankfully, there was very little nerve damage, but this also meant that I could feel everything. First, I was given ketorolac (Toradol, a muscle relaxant) by IV, and then oral hydrocodone (Vicodin). Nothing, and by that point I really needed enough relief so that I could sleep for a few hours. Sleeping pills are contraindicated with this type of procedure, since, in conjunction with the swelling of the respiratory passages, there's a danger of suffocation. So they administered dextropropoxyphene (Darvocet) and Promethazine (Phenergan, a sedative) via IV, promising that this combo would knock me out. No such luck. The next step was morphine, and surely, I thought, Morpheus of the Oneiroi, son of Hypnos, would smile on me then. But even after multiple doses through the IV, I was still awake (and in pain) hours later. Finally, after the cumulative effect of all these as well as oxycodone (Percocet) and diazepam (Valium), I was able to rest on Tuesday. Because of the complications, my hospital stay was extended through Wednesday. These were a couple of dark days, and a few more followed. Although we had a great deal of support from our friends and families during this time, one face was missing. A friend had let us down. As my room filled with flowers and cards, and we received frequent visits and assistance from loved ones, however, I realized that I needed to let go of these disappointments and focus on the physical healing before me. There would be time enough to discuss other treatment options and to forgive mistakes.

Still, this is easier said than done, and it is a process, not something I can do once and for all. I couldn't bring myself to post about what had happened with the procedure, here or in my orthognathic surgery community, for some time. But even as I trembled in mind and body, many things brought me joy. Much gratitude, of course, to

tutordennis, who has rarely left my side. Visits from

shoutingboy,

teawiththecheat,

fan_boy,

karenbynight, and

shaix continue to buoy my spirits immensely, and many others are sending notes and expressions of care. I had absolutely no post-surgery nausea, a common complication we'd been hoping to avoid. My jaw is healing rapidly, and I'm not wired shut (although I must still adhere to the six-week liquid diet). The osteotomy and bone graft in my chin were successful, and I have a more balanced profile. I look just fine; the bruising faded quickly, and the little bit of swelling that remains should fade completely over the next month or so, and isn't really noticeable now unless one knows my face. I only have one teeny place where I feel a bit numb (on the right side of my chin), and it will likely not be permanent. My incisions healed cleanly, and I've been able to do an excellent job brushing with my infant toothbrush (I chose the popular 'duckies' theme, although the 'ladybugs' were also a strong contender). I've unfortunately lost 10 lbs in the last three weeks (which my doctor isn't thrilled about), but my meals have been varied and healthful. Several relationships have strengthened during this time, and in particular, the cats have been more than happy to minister to me during my convalescence. Looking back over the past month, I am pleased with my progress, both physically and mentally. I shall save discussion of my treatment options for another post, but I know they're there. My surgeon required me to take a fourth week off work, but I look forward to returning on Monday, 7 July.

Also, I now have awesome-looking x-rays.

Current Mood: finding my Mercy Street
Current Location: alternating treading water and deadman's float
Current Music: kicking the heart with pain's big boots running up and down

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Date: 2008-07-03 12:03 pm (UTC)

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