Chest Surgery Journal

For those who don't know, my partner at the time of my surgery actually had his surgery with Dr. Brownstein on the same day as I did, directly before me. We traveled out there with our friend D so we could save on travel and hotel costs by going at the same time. D's job was to do things like measure the fluids from our drains, open pill bottles, hand us things, help us in and out of our beds, etc. for the first few days after surgery, until we were feeling a bit better. It's important to have someone who can do that for you, especially during those first few days, when you're likely to be feeling tired and weak and generally out of it.
15 January 2004

2:45 pm - I'm in San Francisco, one day post-op. This is the first time I've had the energy and motivation to write, and it seems like a good time to do it. My partner's asleep and D, who came along to nurse us, is resting; we just finished watching X2 on DVD on D's laptop. I am propped up in bed, sore but feeling okay, 24 hours after arriving back at the hotel post-op.

We flew out of Logan Airport at 11:30 am on Monday (12 January), changed planes in Chicago, and were settled in our room by 6:30 pm Pacific time. (Jet lag is affecting us even now.) On Tuesday we hung out instead of sightseeing like we planned; my partner especially was sore from all the walking and hauling luggage and stress of travel. It felt good to take it easy. We did go out to buy a new charger for my partner's cell phone (he'd left his at home) and a few other essentials. At 4:00 we took a cab to Dr. Brownstein's office. He gave us some papers with information about the surgery, showed us what the drains looked like, and looked at each of our chests. He was easygoing and friendly, and I liked him even more than I had when I met him at the True Spirit conference in 2002. We met his daschund Frank and I was very impressed by the huge, plush, yellow and purple throne that he uses as his desk chair. The whole meeting took maybe 20 minutes, and then it was back to the hotel. We ordered delivery from an Italian restaurant and went to bed early.

On Wednesday my partner and I were up at 5:00, downstairs at 5:30, and in the cab we'd called the night before at 5:50. My partner needed to be at the surgery center at 6:15 to prep for his 7:30 surgery. We got there just before 6:00; the door was locked, but a security guard let us in. We signed in at the registration desk; when they called my partner, we gave them the checks for the surgery center and anesthesia fees, and my partner signed a couple of things and they gave him his hospital bracelet. We waited for a little longer and nurse Bob (a very nice, rather gay young man) brought my partner back to get changed and settled in his hospital bed. They let me come back once he was settled, and we hung out until it was time to go. Dr. Brownstein, the anesthesiologist, and another nurse came one at a time to talk to my partner, get his medical history, etc. When they wheeled him off to surgery, I went back to the waiting room.

Maybe ten minutes after I came back out, they called me to the registration desk. I gave them my checks, signed the papers, and got my bracelet. I sat for perhaps 15 minutes after that before nurse Bob came to get me. He said they might as well get me prepped now.

I followed Bob back to the changing room, where he took my medical history and gave me my new outfit - gown, cap, paper booties, and tight stockings that went from my hip to my toes and are supposed to promote circulation. After I changed, Bob took me to my bed, which was in the same spot my partner's had been in, and started me on a sugar IV. He brought me some magazines since I'd be there a while.

I must've been reading "Reader's Digest" for over an hour - my watch was in my jacket pocket and my curtain was drawn, obstructing the clock, so I have no idea - before Dr. Brownstein came in. He told me that my partner was fine, and had me sit up so he could draw on me with blue marker. Then he said he'd see me in the room, and left.

Soon the anesthesiologist came in and chatted with me. She said they'd have to put a mask in my mouth to help me breathe, but only after I was unconscious. She said it might give me a bit of a sore throat.

Not long after she left, the other nurse came to see me. She double-checked my medical history and made a note of the red bracelet they made me wear, which indicated that I'm allergic to Ceclor (an antibiotic). She started me on a new IV, which she said was just to relax me. I asked what time it was and she said it was 10:05, and that my partner had woken up, looked around, and conked right out again.

The nurse started wheeling my bed out, saying that we were going to the OR and I'd need to scoot over onto the operating table, and then they'd start the anesthesia into my IV. She stopped at a big door and went to enter a code - and that's the last I remember. Guess I jumped the gun a little. Whoops.

(Note added later: In all likelihood I didn't actually pass out at that point. I probably was conscious while they got me onto the operating table and started me on an actual anesthesia IV, but my memory just cut out then for whatever reason. It's worth mentioning that my memories come back completely from the point when we got outside into the fresh air; everything from the "relaxing" IV, which was Valium, up until we got outside is foggy or gone.)

When I woke up, I was sitting in a recliner, essentially, with a blanket on my lap. I was sore and groggy, but not nauseous at all. The anesthesiologist had said that she'd give me something in the IV to prevent nausea, and it worked like a charm. I had no sore throat to speak of, either. A nurse brought me some crackers and Sprite and a pain pill; I wasn't hungry but it was okay eating them since I didn't feel sick.

They wheeled my partner over in a wheelchair, and D came in (she'd taken the bus from the hotel so she could sleep in). They instructed all of us in how to empty the drains and measure their contents, and then they got me into a wheelchair and wheeled me out to the street, where a cab was waiting. My partner had to go to the bathroom so D and I waited in the cab, and then we drove back to the hotel. Once we got to our room (it was about 2:30 pm), we conked right out.

DAYS 1-5 POST-OP

I took my Percocet every 4 hours until Friday (two days post-op), when I switched to every 6 hours. Moving my arms hurt, as did sitting up or lying down - it's hard to avoid using your chest muscles. We stayed in bed mostly, watching daytime TV and taking Percocets. I ate a slice of bread every time I took a pill, and I had no nausea at all. All of my pain seemed to be due to the drains - it was very localised. At first I didn't think I could feel them, but then I realised that the pain traced a line across each side of my chest. When I took the Percocet and the pain faded, I could still kind of feel them - it felt like they were pressed between my chest and all the cotton and gauze packing, rather than inside my chest. As long as I didn't sit and think about it, it didn't feel weird or gross, just uncomfortable and painful when the Percocet wore off. It did itch a bit under the packing, which sucked.

For the first 24 hours, D emptied our drains every 6 hours and measured how much fluid was in each drain; after that, we just empted them when they got half full, which took about 24 hours.

I left the room twice to walk across the street for food; I was too sore to want to do much, and the Percocet made me sleepy. By Friday night I could (carefully) lie on my side, which was nice.

DAY 5 POST-OP

My partner got his drains out before I did. It was uncomfortable and did hurt a bit, but it only took two seconds - literally - on each side. I thought it would be much longer than it really was. It felt exactly like a plastic tube being pulled out of my chest via a small hole; there isn't any other way to describe it really. The most painful part was the soreness I felt for a few minutes immediately after each drain came out. Dr. Brownstein cut off the hard balls of gauze that were attached to my nipples - again, uncomfortable, but not really painful - and said my nipples looked good; the right nipple was flat due to the pressure from the gauze, and he said the left one would probably crust over but it was nice and pink.

Dr. Brownstein gave me my T shot. He had been joking with me about how doctors are the worst at giving shots, and said that it would cost me another $200 - unless it hurt. I barely felt the shot, so I guess I owe him some money. He said to call him if I start to hemorrhage. Funny man. I really like Dr. Brownstein - his sense of humour is just like mine, very dry, and I've never met anyone else who mirrors me so well in that way. I trust him completely, and respect the hell out of him. Before surgery, he gave us his work, home, and mobile phone numbers in case we had any questions or concerns at any time.

Dr. Brownstein arranged new cotton pads over my chest and put the binder back on. He said that he hoped it would be small enough to fit me - I'm a scrawny bastard. I was a bit worried about it slipping down, but it was easy enough to take off and put back on. It did constantly feel like it was slipping, mostly because it was so wide - almost the length of my torso from armpit to waist. But it did slip a bit, especially when I walked around.

It felt great to have the drains out and not have to wear all that packing, but I didn't really have any more range of motion at first - I was still pretty sore, and it felt tight when I tried to reach for things.

DAYS 6-7 POST-OP

We were sore on the sixth day (Tuesday) as our bodies adjusted to not having drainage tubes taking up space where tissue should be, but we manaed to catch the trolley-bus-thing from right outside the hotel to the Castro for a few hours. We walked up and down a few blocks and got Mexican food, then rode back and crashed.

The next day we were tired and sore from our brief jaunt, but took a cab down to Dr. Brownstein's to get our stitches out. It really didn't hurt; the nipples I didn't even feel.

I was expecting Dr. Brownstein to cut a stitch and pull out a row at once, but he cut and removed each stitch individually. It still didn't take long. The most painful part was when he pulled off the medical tape holding the gauze on my nipples. He put freshs 2x2s on my nipples and taped my incisions, and put the binder back on nice and tight - this time without the cotton pads. I think they were the cause of my binder constantly slipping down before, especially when we walked around the Castro - it made it down to my waistline, barely still covering my nipples. Without those cotton pads, it slipped much less, even when I stood up much straighter than I had felt able to with them in - I'd looked like the Hunchback of Notre Dame.

We flew home the next day (Thursday, 22 January) and got home after midnight.

HEALING POST-OP

I showered the morning after we got home - my first shower in 9 days. The gauze on my left nipple stuck very slightly, but it came off easily enough. The outline of my areloae were scabbed over, the nipples were sticking out, and they both looked quite good. I kept my back to the shower and washed around but not over the nipples and taped incisions. I soaped them up with my hand and then used a wet washcloth to rinse them; it worked quite well. Felt good to get clean.

That same night (Friday, 23 January), I slept on my stomach for the first time. Sometime during the following week, I was able to lift my arms enough to wash my hair in the shower like normal, tilting my head back into the water instead of forward into the sink like I'd been doing since surgery.

I wore the surgical binder until a day after my two weeks post-op date - 29 January - and then wore it only at night for two nights, until I heard back from Dr. Brownstein that I didn't need to wear it at all. (I'd e-mailed him to double-check that I really did need to wear it at night.) 31 January was my first night sleeping in my own body, no binder, no chest protrusions.

At four weeks, on 11 February, I noticed that my incisions felt tougher to the touch, like some real scar tissue had built up. I was still putting Kelocote (from the sample Dr. Brownstein gave me) on the incisions, drain hole scars, and nipples, but only the incisions had that real noticeable toughness. When I ran out of Kelocote, I used cocoa butter.

At 16 weeks I e-mailed Dr. Brownstein because it had become clear that my scars were hypertrophic (not keloids, which he says are exceedingly rare). He told me to put silicone sheeting on them, which I did starting on 07 May. They cost $35 (for the Neosporin brand) at CVS. He told me that I could also put them on my areolae (not the nipples themselves), given how raised they were as well; I started doing that on 11 May. They were starting to look a bit flatter by 21 weeks (09 June), but I had to buy a second box because I was using three sheets at a time.

I finished with the silicone sheeting in August, after 12 weeks of it and about 30 weeks after surgery. The scars and areolae were flat for a couple of days, but then parts of them started to pop back up again. I'm not sure if the sheeting helped at all, but I think parts of my scars did flatten out more than they would have without it. It's just frustrating that a few spots went right back up again once the sheeting was off. I'm not worried, though; I had the same thing happen with another scar on my back, which is now over 8 years old and starting to noticeably flatten. Its discoloration faded ages ago, though. And I don't have a big problem with visible scars.

For more details, check out my transition journal.
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