The night before.
I like the night time. Something happens when the darkness slowly creeps in and quietly wraps its arms around you, your hopes and fears, and holds on tight. The lights you see then, are warmer and brighter, holding the promise of illumination into the darker corners of your life. Ideas and thoughts become more clear and focused, promising illumination into the darker corners of your mind. It is the kind of focus that is difficult in the harsh, unforgiving light of day and the cacophony of noise that comes with it.
After I said good night to Joanie, I walked back to the Radisson, picked up a beer at the bar to take to my room, got comfortable, took up a place at the table by the window, the one with the view of the top floor of the hospital, lit up a cigarette and thought about what had happened on this day, and what was to happen tomorrow.
My first thoughts were about her, alone, lying on a bed on 7C, and wondering what she was thinking now, on the eve of the day when her life would change. When you are married to someone, you often say, “Well, I know her.” But really, what you are saying is you know some concrete things about her. The rest of your knowledge is based on the shifting sands of the assumption that you know more than you do, or can. Tonight there were a few things I assumed I knew. I assumed I knew she was dreading it more than she let on to any of us. I assumed she was afraid, and I assumed she was praying. I was to find out later these assumptions turned out to be true, but I only found out they were after she told me they were. I knew that.
I thought about what Ginny had said about Joanie’s courage in the face of this surgery. I had always told Joanie she was stronger than she thought she was, and she was proving it to all of us now. I wondered then if I was faced with a similar circumstance I would have been as strong. One of the things about Joanie’s character that was more clear than ever, was the determination she was showing in the face of adversity. Once she had made a decision to do this, in spite of her fears, she would devote every fiber of her being to seeing it through and because of that, the bird courage took flight. Ginny said it could be a family trait. She said, “It might be in her genes.” All I knew that night, was I was proud of her.
As I sat there staring out the window looking toward the hospital, I began to go over the surgery again, in my mind, as I understood it from a layman’s point of view. Both of us had heard Dr. Carson’s explanation in January, and we both heard Dr. Cosin’s briefing today. From what I understood, this is what was going to happen when she entered the operating room on Thursday morning. I think, for me, going over it again would help me make it through the next day.
There were to be three teams of doctors, and the surgery was to take from 12 to 14 hours. The first phase, I hadn’t focused on before was to be exploratory. They were going to open her up, take lymph node samples, tissue samples, look at the pelvic sidewalls and organs in her pelvic area for any signs of cancer that might have spread, in an effort to insure that there would be a cancer free margin after the surgery. I hadn’t focused on the fact that were they to find something that would make that impossible, they would not go ahead with the surgery. That would be bad news. I never told Joanie until long after she had healed up, but I began to understand Carson’s words better now when she told us “not everyone is a candidate for this procedure.” So, the first hour and a half of this surgery was going to be the key to Joanie’s long term survival.
Assuming they had their margins, what they call the exenteration phase would start. They would begin to remove her ovaries, fallopian tubes, uterus, cervix, part of her vagina, appendix, bladder. Part of her lower intestine is also involved which accounted for her facing an ileostomy until she had sufficiently healed at which time they would hook it back up and take down the ileostomy.
Next would come the reconstruction phase. They would use part of her colon to create what they call a continent urinary pouch. The nickname they used for that was “Miami pouch.” They would hook up her ureters from her kidneys to the new bladder, and she would then use catheters to drain the pouch through her belly button. They would construct a neovagina using part of her stomach muscles to graft to the part of the vagina that was not involved in the cancer. The ileostomy would be created, and they would sew her back up and take her to recovery.
It was getting late, but I wasn’t tired, and I think my night time reverie had made it so. I looked at the clock, and decided to call Joanie. I was surprised she answered after just two rings, so I knew I hadn’t woken her. She said she hadn’t been able to sleep yet either. She asked me what I wanted, and I just said, “I wanted to say good night again, and tell you that I love you.” She paused, and told me she loved me too, and then said, “Good night and now go to bed, I’ll see you in the morning.”
Her tone of voice told me she was going to be okay, and after I set the alarm, I did as I was told.