Polytropy

On June 7, 2016, I underwent surgical repair of an inguinal hernia. I did not know what to expect. I did not know that I did not know: I did not consider that there was anything in particular to be prepared for. But there was.

The surgery itself was not such a big deal. It was a fascinating experience, but not one that I found myself wishing I had known more about ahead of time. Recovery has turned out to be something else. If a medical website says of recovery, “You may experience some discomfort,” it is practically lying. Discomfort was what I experienced, waiting in a chair, or on a gurney, for the surgery to take place. What I experienced afterwards was searing pain, at least in getting out of bed, with the rather insistent help of a nurse.

I had not stayed overnight in a hospital since having my tonsils removed at the age of five. Back then, my mother stayed with me; now it was my wife. At five, I was a terrible patient. I thought there was reason to be. When a nurse came to insert a suppository in my rectum, of course I resisted; my mother had to hold me down. After the operation, when I woke up from the narcosis, I screamed alternately, “I want my mommy!” and “I want ice cream!”

I wanted ice cream because I was in pain, and everybody had told me that I should be given ice cream for this. The hospital gave out popsicles. Some time later, in a friend’s house, I noticed a certificate inscribed to the friend’s sister from the same hospital, praising her fortitude during her own tonsillectomy. First I felt indignant that I had not received such a certificate. Then I understood that, unlike myself, my friend’s sister must have been pleasant about things.

My spouse has spent a lot of time visiting hospitals this year, first when her father had his last illness, then her mother. During this time, I noticed that something was going on in my right groin. It was not a pain, really, but some kind of feeling. Perhaps it was the same feeling that I had had in college. I had seen the campus nurse about it, but she could not, as she said, “palpate” anything. This time though, I could palpate something myself. There was definitely a swelling. Was I going to die? Probably not: a web search on groin pain suggested hernia as the most likely cause. On Thursday, May 12, in the infirmary of our university building, the doctor felt me up while I coughed. He diagnosed an inguinal hernia, and he directed me to the general surgery department of a hospital.

He directed me: he directed us. For Ayşe was with me, and so, like most Turkish people, the doctor made his comments to her. There are exceptions; but most people speaking Turkish would seem to be embarrassed to look at somebody who they assume does not understand them. In fact I may not understand them well; but I can usually pick up at least something from what they have to say. I might pick up more if they looked at me while saying it.

In any case, following the university doctor’s recommendation, I made an appointment for the next day with a general surgeon at Şişli Etfal hospital. I did this entirely on line. As a Turkish scholar in the United States once observed in an article she shared on Twitter, the Turkish state may try to suppress the media of dissidence; but the use of the internet for providing public services is better developed here than in the US.

Şişli Etfal lies between our university building and our flat in the borough of Istanbul called Şişli. Thus the hospital is ten or twenty minutes from either terminus by foot. I first went to the hospital in the summer of 2012 about an ear infection that I had picked up swimming off Marmara Island. This was the ancient Proconnesus, source of the marble used to build Constantinople. We had travelled from Constantinople to Proconessus by ferry.

The full name of the hospital is Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi. The “Hamidiye” was added only recently, as a reminder that the hospital had been founded under the Ottoman Sultanate of Abdul Hamid II (1876–1909). Etfal is from the Arabic for “children,” and the word seems to be obsolete. The singular form tıfıl is apparently still used. Indeed, Ayşe points out that Aydın Engin refers to his tıfıllık yılları “years of youthful inexperience” in his column of today, Monday, June 13, 2016, in Cumhuriyet. However, the usual Turkish for child is çocuk, the plural being çocuklar; this is formed regularly, like all Turkish plurals, though unlike “children” itself.

So our local public hospital was founded as a children’s hospital. It is not so exclusive today. In the name, eğitim ve araştırma means teaching and research, and I suppose these aspects of the hospital continue. All that is left physically from the 1899 foundation would seem to be the clock tower, which has its own English Wikipedia article.

On May Day of 2014, a year after the Gezi Park protests, Şişli Etfal was the site of a cat-and-mouse game that I observed between water-spraying police and rock-throwing protestors. The former were preventing the latter from marching to Taksim.

On May 13 of 2016, my appointment at the hospital allowed for a fourteen-minute consultation. That’s not much, but apparently it is all that can be managed when anybody in Turkey can be seen at any hospital, for free. When we went, patients lined the corridors; but all you had to do was watch for your name to appear on the screen outside your appointed examining room.

My name came up, and Ayşe and I squeezed into a tiny office. On the wall was a poster about hemorrhoids: it used the transliteration hemoroid rather than the simpler Turkish (derived from Arabic) basur. I explained my own problem in my halting Turkish, and the doctor invited me to speak English. Ayşe’s researches had shown that he had spent time at Yale University. I dropped my pants for him, and he said he would call me later about repairing the hernia at the beginning of June.

To prepare for the operation, I got in the blood queue. Judging from the appearance of the people in front of me, I thought Şişli’s other bourgeois university-educated residents must all go to private hospitals. The people in front of me seemed to be mostly peasants. I mean this not pejoratively, but in the precise technical sense: the other patients had the appearance that I associate with folks living off the land in a village. They may well have come to the big city, just to get treated at a reputable hospital. When I would actually have my operation in June, my roommate would turn out to be an old man from Kastamonu province with a cancerous liver.

Meanwhile, when I had reached the head of the queue, the woman who drew my blood wore a headscarf. So did the woman who took an electrocardiogram. Regardless of whatever conservative religious convictions were symbolized by the headscarf, this woman placed electrodes on my bare chest.

Before the AKP came to power in Turkey, only people of sufficient status could have used Şişli Etfal hospital: university professors, but not university janitors. Not me either, since as a foreigner I had the status of a janitor. Moreover, hospital workers would not have been allowed to wear headscarves. So I would say that conditions have improved in these respects. As I recall a Turkish friend to have suggested to me once, the real issue in a hospital should not be whether a woman wears a headscarf, but whether all medical workers are willing to treat all patients, regardless of sex.

“My” surgeon did ring my mobile on Wednesday, June 1, to ask (in Turkish) whether the following Tuesday would be suitable for my operation. Ayşe was impressed that I was not simply told that Tuesday would be the day. In any case, I accepted the day. (I also handed the phone to Ayşe, so she could make sure of the details.)

I was to go in Monday morning at 8:00 for some final preparations. There were release forms, along with a checklist for proper administration of anaesthesia. Also, while the four vials of blood that had been drawn the previous month may have been tested, they had not been tested for my blood type. One more vial was needed. So the nurse at the desk took me to another room and jabbed my arm somewhat recklessly as she chatted on about never having liked mathematics or English in school. She did not wear a headscarf. Neither did any of the other female nurses whom I would see on that floor.

I was to come back to that floor the next day at 7:30 for the operation itself. If the operation had been an airplane flight, I would have fantasized about its cancellation. In fact the operation did not make me nervous like an airplane flight. I thought maybe it should. I had a memory from childhood of a television drama in which a patient was going to have a heart operation. The patient put on a cheerful face; but somebody observed that the patient was quite anxious. The observer chewed out the surgeon, because apparently the surgery was not really needed.

So TV taught me that operations could be scary. I might have gone on living with my hernia. It did not really hurt me. However, it had kept me from engaging in much physical activity, like hiking in Şirince during this year’s Antalya Algebra Days at the end of May. So I was keen to get the operation over with. I was going back to the Nesin Mathematics Village in July for a research workshop.

For the operation, I was disappointed to have to shave my groin and my thigh. But the task did not turn out to be that hard. I remembered Anastasia M. Ashman and Jennifer Eaton Gökmen (edd.), Tales From the Expat Harem: Foreign Women in Modern Turkey (Istanbul: Doğan, 3rd ed., 2006). In a contribution called “The Goddess Metamorphosis,” Karen-Claire Voss described being pleased to join a bridal party in a hamam in Capadocia; but when the party disrobed, the American’s unshaven bush was revealed, and all of the Turkish women were appalled. One of them handed over a razor, and Ms Voss set about hacking away at her thicket. She ended up feeling like a goddess. In freeing myself of hair on one side, I did not feel like a god; I just felt prepubescent.

I was not allowed to eat or drink after midnight. I went to bed around ten o’clock feeling what I thought was full enough. Visiting the loo at around 2:30, I found my urine to be somewhat dark. Oh no! I had not drunk enough water, and now it was too late! But I would survive.

How many people walk from home to their hernia operations? In the morning there was a light rain, but still we walked to the hospital, and we were on the fourth floor at around 7:25. Many people were already there, slouching in the chairs that surrounded on all sides the bank of elevators. The general surgery ward did not let us in. A room was not ready for us. We would be called.

It transpired that my doctor had been looking for me at 7:15. He had four operations to do that day, and he had wanted to do mine first. Since I hadn’t been there, he had taken the next person. So I sat and waited. I happened to be reading Sense and Sensibility. My own sensitivities were not actually that outraged; however, it did annoy me to think that I could have been at the hospital at 6 o’clock or earlier, had I known the doctor might take me then.

After a couple of hours, my room was ready. We had been told to expect a single room, with accommodation (of course) for an accompanying person. When we went into the actual room, we found two hospital beds. The one nearer the door was occupied by an old man, who was accompanied by his wife and daughter. I got the window bed, and the curtain between the beds was pulled. But the curtain did not hide the family’s conversation. The daughter stepped over to talk to Ayşe anyway; they may have been the same age, and apparently they had met in the hospital on the previous day. The woman wore the headscarf and long overcoat that signify some kind of conservatism. The family were from Cide, a town on the Black Sea where Ayşe and I had stayed with her parents in 2010. The beautiful cove of Gideros was mentioned; this was the ancient Cytorus, and I had created its Wikipedia article using Homer and other ancient references.

A nurse came with a hairnet and a gown, which she told me to don after doffing everything but my lower underwear. I questioned why I should keep my boxers on, since my operation was going to be on a part of my body that my shorts covered. The nurse said something about how the gown did not provide full body coverage. On the way to the operation, I was going to be exposed to a lot of people.

A cheerful fellow with a white mustache brought a gurney. I got on and was wheeled out to the bank of elevators, accompanied by Ayşe. The man said he was called Nazım, like the poet Nazım Hikmet (who is buried in Moscow). I said that I had read the poet’s Memleketimden İnsan Manzaraları. In fact I had read the translation by Randy Blasing and Mutlu Konak, Human Landscapes from My Country: An epic novel in verse (New York: Persea, 2002). Nazım had written it in prison in the 1940s, using the help and the example of his fellow inmates to sketch a broad portrait of Istanbul and Anatolia. The orderly called Nazım said the elevator for gurneys could be accessed only by authorized personnel, and it had been called for me; still, we waited a long time for the car to come. When it did, I had to wave good-bye to Ayşe as I was taken down alone to the depths.

On the lower level, my gurney was placed next to some orange bags of medical waste. Soon I was wheeled into a large room labelled Yarı Steril Alan, “half sterile area.” I was parked next to another fellow with a white beard, presumably older than I, and we waved at one another. I observed to him in Turkish that one had to wait, everywhere in the hospital. I left any further conversation to him, but none was forthcoming. We just watched personnel and patients come and go. Doctors seemed to wear green, and others blue – or was it the other way around? One queenly woman in magenta would stride serenely between the recovery room and the vestibule where I had been brought in.

One orderly looked at the cardboard envelope resting on my legs, but gave my person neither a word nor a glance. Eventually I saw my surgeon, who came up and apologized for the delay, or at least acknowledged it. He said he would be ready for me in fifteen minutes.

It was a junior doctor who fetched me to the operating room. He reminded me of the “pool boy” in the Seinfeld episode of that name: the worker at the gym who turned vindictive with a swimming pool skimmer when Jerry declined his friendship. The young doctor asked me in Turkish what my problem was and what side it was on. He told me to raise my arm on that side. I didn’t know if he was testing my Turkish or my awareness. When making the rounds next morning, saying Aç bakalım “Open let’s see,” he would rip off my bandage to look at his suturing job.

Meanwhile, just outside the operating room, it must have been the anaesthesiologist who asked me in English if I spoke Turkish. When I gave a qualified affirmative, he continued in English to ask whether I preferred general anaesthesia or a spinal block. I had expected general anaesthesia. Indeed, I had been looking forward to the experience of having a mask placed over my face, then waking up the next moment with the operation complete. But evidently the anaesthesiologist preferred a spinal block. He also said something about two or three hours. Holy shit! I had already waited long enough, hungry, for the operation; I didn’t want to lie awake, hours longer, while the operation actually happened.

Probably those hours were the time it would have taken to regain full consciousness after general anaesthesia. When I was finally wheeled into the operating room, and the surgeon told me the operation would last thirty or forty minutes, I said a spinal block would be fine.

The surgical team went to work on me. I could not count how many they were. An IV drip went into the back of my left hand; a blood pressure cuff went around my right arm. I was sitting on the operating table. Somebody palpated the cyst over my left shoulder blade. I was made to curl forward so that a needle could pierce my spine. It did not hurt. The anaesthesiologist tested the result. Did I feel a pinprick on my shoulder? Yes. Did I feel one on my leg? Yes at first, then no. I was laid down on my back. Soon the anaesthesiologist was telling me, “They are starting to cut into you.”

I was oblivious. A sheet kept me from seeing the action. I realized at some point that I could see images in the plastic protector of the reflector of the big operating lamp; but the only images I saw were of the covered heads of two surgeons – presumably the one I knew, assisted by the Pool Boy.

I had been told that I would have dull feeling. I could feel that the operation involved some violent stretching of my insides. This would later explain my soreness when the spinal block wore off. Sometimes a heavy weight was laid on my chest. I imagined that I could move my foot if I really put my mind to it; I chose not to do so, since I did not want to disturb the operation. Eventually I understood that my foot really was beyond my control; but still I could flex the muscle of my left thigh.

I listened to the beeping that must have registered the beating of my heart, as detected by the clip on my left thumb. The cuff on my right arm periodically inflated and deflated. If I thought about it, I took deep slow meditative breaths; but I did not think about it much. Mostly I was in awe that, on the other side of a sheet, my guts were being exposed like butcher’s meat.

When the head surgeon told me in English the operation was over, I said in Turkish, “Health to your hands” (Ellerinize sağlık): it is the compliment paid to the cook of a meal that you have enjoyed. The surgeon chuckled. Apparently I still had to be sewn up; but the assistants did that.

I had moved myself from the gurney to the operating table; now the assistants had to move me back like a cadaver. I was wheeled into the recovery room, where presided the queen in magenta. But then I was asked what kind of anaesthesia I had had, and it was understood that I did not need to be there. I was taken upstairs, where Ayşe was waiting. She was amazed to see me so animated, until I explained how I had been awake through the whole affair. Nazım and somebody else transferred me to the bed by the window. My poor roommate’s surgery got postponed to Thursday; we would hear him explaining to his friends on the telephone that this was because of the terror bombing elsewhere in Istanbul that day.

The floor nurse told me not to drink until I had urinated. In fact I did not feel that thirsty: the IV drip must have been taking care of my needs. But when the surgeon dropped by, he told me to drink copiously, to prevent the headache that could be a side effect of the spinal block.

I was wondering how I was going to urinate. Over the hours, I regained control of my feet and legs; but my penis remained absolutely numb, as if it could be cut off like a fingernail. This was an unsettling feeling. Perhaps a local anaesthetic had supplemented the spinal block. In time I noticed that urine was dribbling out involuntarily. Ayşe found me a bottle to pee in, and I just held it between my legs to catch the drips. I could not micturate by force of will. Later in the evening, when I was able to stand, the bottle filled up quickly by force of gravity. Before we called it a night, bladder control had returned.

The timing of my operation may have been perfect. Classes were over at the university, but the heat of summer had not arrived. The hospital was not climate-controlled as I would imagine an American hospital to be. Ventilation was by opening windows. Through my own window, I could see another wing of the hospital, where patients might sit and look out of their open windows.

On Wednesday morning I was seen by “my” surgeon, the Pool Boy, and a third doctor, a woman, who spoke English and gave me my discharge papers and a prescription for three drugs:

1. Sef (sefaleksin, that is, cephalexin), an antibiotic, produced by Mustafa Nevzat drug company;
2. Minoset Plus: Her tablet 250 mg parasetamol, 150 mg propifenazon ve 50 mg kafein içerir “every tablet contains 250 mg paracetamol, 150 mg propyphenazone, and 50 mg caffeine”; produced by Bayer;
3. Lansor (lansoprazol) proton pompası inhibitörü, apparently to keep the Minoset Plus painkiller from irritating my stomach; produced by Sanovel.

All of these drugs were manufactured in Istanbul.

I could imagine that somebody was sitting by the elevators, as I had done the previous day, waiting for my room. But I did not feel ready to leave. I felt more like vomiting, though it would cause agony to my groin if it actually happened. I wanted to be at home, but did not know if I could handle getting myself in and out of a taxi. The previous day, I had been given paracetamol by IV drip; but on Wednesday I was not given this until Ayşe went and found somebody to do it. Ayşe asked for a wheelchair too, but there was none at hand; somebody had to go hunt for one. Eventually I was wheeled outside, and then around to the emergency entrance, where a taxi was finally found. I got in and out of the taxi without much trouble. I probably could have climbed the three flights to our flat as usual, but I took the lift instead.

I went to bed and spent most of my time there. I could see the blue sky and feel the cool breezes through the open window. Ayşe tended to my every need. I finished Sense and Sensibility. Researching Minoset, I found that a similar product was marketed in the US as Saridon. In an earlier formulation this had been known familiarly as APC, for aspirin, phenacetin, and caffeine. Now, finally, I understood an obscure reference in Robert Pirsig, Zen and the Art of Motorcycle Maintenance.

After a first night on the road, Pirsig is up before everybody else, and he gives us readers his lists of things to take on a motorcycle trip. Under “Personal Stuff,” one entry is “APCs for headaches.” So now I knew what Pirsig was talking about: it was basically the drug I was taking for my own pain. His book starts out so pleasantly that I started reading it again. On Friday, I recommended that a Twitter friend should at least read the first chapter, since she had called herself a “technopeasant”: I thought she meant she was like Pirsig’s cycling companions John and Sylvia, who know nothing about how their BMW motorcycle runs and don’t want to know.

My usual vegetarian diet is full of roughage. As in a song that was once performed at a monthly environmentalist gathering in Washington,

An ordinary toilet flushes seven gallons,
A not inconsiderable amount.
I’ve got a low flush toilet and a high-fibre diet
And I make every gallon count.

Back home after the operation, I made sure to stick with the whole foods. I started reading about constipation as a normal consequence of surgery. My bowels were full, but I was not supposed to evacuate them by force, and it would be painful to do so anyway. They finally moved themselves on Thursday evening.

I tried sitting up to write on Thursday and Friday, but could not do so for long. The problem was not in my groin, but my head. I just started feeling ill. By Saturday though, this feeling had passed. Finally I felt as if I were recovering. However, the skin around my sutures was swollen and sore. My penis and scrotum were simply swollen. I had noticed the swelling on Friday; it increased on Saturday, enough to cause a slight ache to the testicles. However, I found a website full of comments by hernia patients saying their genitals had disappeared into black masses the size of footballs, and this was supposed to be normal. My own swelling seems to have reached its peak, and it is not that bad. Apparently I shall have to wait it out. I see the surgeon anyway on Thursday.

Perhaps a private hospital would have provided me with more information about what to expect. For now I just feel glad to have survived the same treatment that might be given to any Anatolian peasant.

Update

A few hours after originally posting this article, I added some of the photographs. Now, three days later, on June 16, 2016, I have added more photographs. For I have come for the first time to my office, where the desktop computer makes editing easier. I have made a few changes to the text, mainly additions that are supposed to clarify some things; these additions may appear underlined, since I have used the code tag for them.

Another change I might make is to give my surgeon a name, such as Dr No.

In searching for the complete lyrics to the low flush toilet song, I found a web article called Death by Fiber claiming,

for people who already have constipation issues or IBS, fiber not only doesn’t help, it makes things worse. I learned this first hand after dealing with the nutritionist. If things are already not moving, adding more bulk just makes that worse … because nothing is moving!

Evidently this does not apply to me.

The searing pain that I mentioned at the beginning happened for a few days in the process of getting out of bed and standing up straight. It gradually got less. I stopped taking painkillers over the weekend. The deep pain had pretty much ended. Now it was the fluid buildup – the seroma – under the incision that caused pain, at least when put under any pressure by clothing. This pain too goes away bit by bit every day. After waiting more than an hour today, standing, to see Dr No, I was told what was expected: that the seroma will probably go away by itself. I should walk more and more each day. Unless there are signs of infection, there is no need to go back to the doctor.

Added December 5, 2016: There was no infection. The seroma went away, over the months.