My Liver Biopsy
by Ed Dewke
posted September 2002

The systemic drug Methotrexate is often prescribed for severe psoriasis and psoriatic arthritis.  The drug is known to cause liver damage; therefore, frequent blood tests are performed.  Additionally, after accumulating doses up to 1.5 grams a liver biopsy is typical.

I drove myself to St. Joseph’s Hospital for my liver biopsy.  I had asked a nurse if I needed a companion before, during or after this procedure and she told me “Probably not.”  In retrospect, I wonder if “probably” qualified the procedure or me?  I parked a half a football field’s distance from the hospital’s entrance at 7:50 a.m., ten minutes before my appointed time.  At the hospital’s entrance a life-sized bronze statue of a pioneer woman, sitting, legs and arms spread in that universal gesture that says, “Come to me little children.”  I read at the base of the statue that this was Sister somebody-or-other, from the Catholic Order of this-or-that, founder of the health dispensary in the early 19th century that was to become this edifice, this hospital, this provider of liver biopsies.  From a distance this beckoning statue was poignant and satisfying.  Yes, I’ll let them puncture my gut here in this safe harbor!  Close up, though, something was amiss.  The sculptor had put beneath Sister somebody-or-other’s bonnet the face of a little girl.  I am appalled by this child, dressed like a woman, offering, really — what?  A lick of her Tootsie-Roll?  I am too old to find comfort in this bronze child playing dress-up.  A chill rippled down my spine as I entered the lobby of St. Joseph’s Hospital.

At the information carousel in the hospital lobby I was directed to Outpatient check-in, which is a lobby off this lobby, glass enclosed like a smoking area in an airport concourse.  The lobby of Outpatient check-in has its own information carousel and a young, muscular man asked my name and fingered through a stack of papers until he found my set.  He instructed me to be seated until I am fetched.  I was drawn to a back issue of Modern Maturity magazine but had barely cracked the cover when a dazzlingly beautiful black woman wearing pounds and pounds of jewelry called my name.  She was my height or perhaps an inch taller.  I was mesmerized by her jangle as she led me past occupied cubicles and into her own.  It was fascinating to watch her use her terminal keyboard with such long, lovely nails.  As she punched in my insurance information I found myself anesthetized by the click click click of those nails on the keys.  Though I knew she knew, she asked at one point, “And what are you here for today, Mr. Dewke?”  I said, “A liver biopsy,” and she blinked slowly and smiled vaguely.  I think I passed a test.  I proved myself cognizant.  The name plate on her small desk-like appliance announced “Mochelle” and, had I another moment, I think I would have asked if it is pronounced Mo-shell’ or Mo-shell-EE’.  But, alas, it was a wrap.  She handed back my insurance card and suggested I return to the Outpatient check-in lobby, where somebody would find me and take me up stairs.

I could not relocate the issue of Modern Maturity that had caught my eye before Mo-shell-EE’, and it was probably just as well.  At a few moments before 8:00 a.m. patients weren’t stacked up as they no doubt would be later in the morning.  Almost immediately a conversational older volunteer lady hailed me.  She talked non-stop, down the hall to the elevators, on the ride up to the third floor, down another hall, through doors that grind open when you swat an oversized button on the wall.  She barely paused her monologue to announce, as we sauntered past a nurse’s station, “Mr. Dewke heading for 380 bed two.”  A nurse hollered back, “Thank you, Gladys,” and that’s how I came to learn her name.  Gladys and I had to breach a family unit in and nearby bed one in room 380.  The large young man in the bed was, I would guess, in his twenties.  The man and woman clutching coats and looking nervous were about my age.  All of us were younger than Gladys, who said, “Excuse us,” and quickly pulled a curtain around herself and me as we flanked the not-so-inviting bed two.  My roommate and, I’m assuming, his parents, halted their conversation to listen to Gladys and me behind our privacy curtain.  Gladys pointed to the crisply folded garment laying at the foot of bed two, “This is your gown.  You must remove all your clothes except your shorts and, if you want, you can leave your socks on, too. And then put on this gown.”  I said, “Thank you, Gladys,” and then there was an awkward moment.  I was about to end it by saying something dismissive but Gladys saved us both.  “Your nurse will be here in a moment.  I hope everything goes well for you.  Have a nice day.”  All I had to say was “Thank you,” again, and Gladys was gone.  But she paused on her way out long enough to say, to the family belonging to bed one, “How are you all doing?  Is everything okay here?”  And I heard three voices say “Fine.  Thanks,” and then the room diminished as Gladys left.

In the bathroom, which was fortunately on my side of the room, hence enabling me to avoid the family belonging to bed one, I faced the issue of the gown.  I knew how hospital gowns were to be worn: open in the back.  But I thought, This will be awkward for the biopsy.  I assumed they would head for my liver through the front of me, or at worst the side of me.  So it seemed rational for me to try on this gown backwards.  It worked fine, like a short bathrobe actually.  I’d hung my clothes in my closet, removed a book from my satchel before closing it in the closet, too, and was reading peacefully while trying to make out from the whispered conversation around bed one what procedure the young man was here to undertake. 

I was perched comfortably above the covers of bed two when Nurse Kristi came to me.  The first thing out of her mouth:  “You have your gown on backwards.”  But before I could defend this, she added, “But I see it works fine.  Fine, then.” And she was off on her spiel:  “I’ve looked at your chart and, well, did they tell you whether you were going to get a CT scan liver biopsy or an ultrasound liver biopsy?”  I had no idea these kinds of liver biopsy existed, I shook my head and widened my eyes.  Knowing that I was in for something here, I dog-eared my page and closed the book in my lap.  “Hmmm,” Kristi mouthed.  “Well, they’ll just have to decide downstairs.  I have these forms for you to sign.”  She handed me the forms on a clipboard and continued to talk, “Dr. Abernathy is the radiologist who will do your biopsy he’s very good you will like him the way it works is this they numb your skin and go in with a needle that’s hollow and get a core sample then you have to lay on your side for a couple of hours and if there’s no unusual bleeding then you get to go home.  Questions?  Why are you getting a liver biopsy Mr. Dewke?”  My mind was about two phrases behind her rapid-fire delivery of this information.  It raced right beyond the question about questions and eventually landed at “why a liver biopsy?”  Suddenly I thought it was very important that I make Kristi understand this was just routine.  “Methotrexate follow-up,” I said.  This did not seem to illuminate her.  “I’ve been on methotrexate for quite some time now and standard procedure is to do a biopsy to make sure there’s been no liver damage.”  She blinked.  It was a sign of something.  She said, “I see.  Well, relax now.  Your transporter should be here within an hour.”  “Transporter?”  “Uh huh.”  “You mean like the machine in Star Trek that beams people from one place to another?”  She grinned, but not much.  “No, this is some muscle-bound ex-football player who pushes gurneys around between smoke breaks.  I wish we had the Star Trek kind of transporter.”  When Kristi slowed down she was quite likeable. 

The family occupying and surrounding bed one had quieted down while Kristi was with me.  Now that my side of the curtain was silent, the family evidently had nothing to talk about.  I could hear some slight movements — limbs under a sheet, chairs creaking — but they were not talking.  I had just reopened my book when another nurse came in wheeling a vitals machine on its pole.  She took my blood pressure and my temperature.  This woman was, I guessed, my age and not interested in chit-chat.  She asked, “Have you been fasting, Mr. Dewke?”  “Since about 8:00 last night.”  “Very good.  How about medications.  Are you taking any?”  I recited my short list.  “Are you allergic to any medications?”  “Sulfa.”  “All right.”  Then she had a check list of mankind’s ailments that she read off.  I retorted “No” to each save the errant few, at which point she was forced to flip a page on her clipboard, ask for elaboration and, evidently, reduce my explanation to a word or two.  I’ve gone through this checklist so many times in so many places, I’ve always wanted to say, at the end, “What about scurvy?  You didn’t ask about scurvy?  Don’t you care about scurvy?”  I imagine the nurses responding — somewhat perplexed, of course — “Have you had scurvy?” at which point I would say, “No.”  But when opportunities like this come along I always chicken out.  What if the poor nurse had a close relative who really died of scurvy?  How terrible would I feel to make light of it?  What if she broke down crying?  My thoughts were similar this morning so, once again, I chickened out. 

“Okay,” this nurse said when we had finished the survey.  “I need to give you an IV.”  She withdrew paraphernalia from her large pockets and dealt this out card-like on my tray table.  “Let me have your left hand,” she said.  “Why am I getting an IV?” I asked.  “It’s a precaution,” she said.  “We just get it in place beneath your wrist, here, on the back of your hand, and then tape it down and cap it off.  If, later, they need to give you any injections or draw more blood or something, they can do so quickly and easily through this rather than sticking you again.”  She ended with a broad smile.  “You’re installing a spigot, then,” I said.  “Yes.  I guess.  In a manner of speaking.”  From this point out I watched in silence.  Remind me to partner with an ex-nurse in my next crafts class — probably when I’m living in a nursing home somewhere.  They are simply remarkable with invisible tape.  By the time this nurse was done with my IV, it was a part of me.  I think I could have boxed or wrestled and this device would have remained secure.  A few minutes after the needle was inserted I forgot that it was there.  I felt like a bathroom, or a kitchen, with a new appliance plumbed into me.

A few minutes later, quite to my surprise, my wife, Clara, popped in on me.  She had dropped her father off for a doctor’s appointment in another part of town and was on her way for a routine breast x-ray at another hospital.  She was having one of those “days off” that aren’t: more work to do in stacked-up chores than a normal day at the office would contain.  At first I thought, She’s worried.  What does she know about liver biopsies that I don’t know?  But then I didn’t ask the question.  We chit-chatted for a moment about this and that, including who was most likely to beat whom home that day.  Then these few moments of respite were finished; Clara needed to dash to make her appointment.

While I lay waiting for my transporter, one came for the young man in bed one.  I witnessed the whole thing aurally.  The gurney was nearly quiet, but I saw it push against my curtain.  “Can you stand to move onto this?” a man’s rough voice asked.  The young man in bed one said that he could.  I heard his parents stand and shuffle a little, and I heard the thin mattress on the gurney pop when the young man climbed aboard.  The transporter must have slung a sheet over him.  I heard the woman say, “Let me help with that,” and then someone brushed against my curtain, I imagine it was her, in her motherly attempt to help tuck her son in.  I heard sounds that I imagined were this crew shuffling out of the room, and then there was silence. 

Another thirty or forty minutes passed and then another transporter came for me.  I, too, moved from bed to gurney under my own steam.  My pilot was a man slight of build and short.  It would have been interesting to see what he would have done had I said, No, I’m unable to stand or walk.  But what if he’d checked this before coming?  This is something he could have easily ascertained at the nurses station where my chart was kept.  He would know that I was lying.  “Bullshit, Dewke.  Get your butt on the gurney.”  Small men like him were often my superiors in the military and I’m in no hurry to ignite a similar relationship in this kinder, gentler period of my life.

Many years ago my sister worked in a hospital and she told me that when people pass away their heads aren’t covered by the sheet to transport them to the morgue or temporary storage area.  They transport them with their heads uncovered and most people never realize some of these people on gurneys are dead.  Things remain a lot more peaceful that way, my sister said.  On those many opportunities when I’ve been in hospitals and seen people being transported on gurneys I’ve always recalled this.  I stare at them from the moment they come into my view until they leave, trying to determine if they are alive or dead.  Of course, movement of any sort is what I’m looking for.  I’m afraid my curiosity may be obsessive.  Perhaps half a dozen times since this obsession began I have been the person on the gurney, as I was this morning on my way from Outpatient holding to radiology.  When I am the one on the gurney, I want there to be no doubt — by anyone, anywhere — that I am alive.  I wriggle and wave and smile and talk loudly and in more ways than I am probably aware, embarrass and upset my transporter.  On this trip back down the elevator, I and my transporter were accompanied by two doctor-looking fellows and a nurse-type woman.  I said, “Are we on our way to radiology or the morgue, and will you tell me the truth?”  The small man with his hands on my gurney said, with no sense of silliness in his voice, Radiology.  The nurse-type was grinning and patted one of my spasming feet.  “You’re much too lively for a visit to the morgue, deary.”  This was a satisfying response, but then a shadow overcame me.  I was beyond the point of no return.  I was on my way to wherever it was they were going to open me up and take out a piece of my liver.  I could feel the color draining from my face.  Is methotrexate worth all this?

The waiting area in radiology was the darkest of any part of the hospital I’d been in.  My transporter wheeled me into this dark enclosure and left me in a corner.  It is awkward, when you are flat on your back on a gurney, to watch the goings on across a room.  Your attention is physically directed to the ceiling.  From the ceiling of this dark place I learned that I was once again somewhere built for curtains to be drawn around narrow beds — the rails were there, but there were no curtains.  At some time, it would seem, someone decided privacy between gurneyed patients waiting here was unnecessary.  It certainly was unnecessary while I lay there, for I was quite alone.  In spite of the logic, the lack of a curtain on the ceiling rail above me depressed me.  I imagined there weren’t curtains on the ceiling rails in the morgue, either.  These dark imaginings were interrupted by the entrance of a man in green overalls.  Was he Dr. Abernathy?  Though it was awkward, I arranged myself on the gurney so I could watch the goings-on at the other end of the room.  The man in overalls proceeded to move back and forth between an attached room and the computer monitor on a desk in this large area.  I deduced he was a repairman, or a technician from the hospital’s IT department, fixing a problem.  To kill time, I concentrated on further deducing what that problem might be, but I was barely into this exercise when a young woman in colorful scrubs appeared at my side with another clipboard. 

“Mr. Dewke?” she asked.  “Why are you having a liver biopsy today?”  Previously I’d thought this question was a test of my state of mind, but the puzzlement on this lady’s face betrayed her true need to know.  I told her I’d been taking methotrexate for over a year and it was standard procedure to do a liver biopsy and check for medicine-related damage.  She’d listened but written nothing during my explanation.  “What was the medication?” she asked.  I had to spell it for her.  “Why do you take this?”  I told her that I had psoriasis.  “How do you spell that?”  I spelled it for her.  As she turned to leave she said, “We’ll be with you in a minute.”

It was much longer than a minute.  While I waited in the shadows at an edge of this gloomy room, two more females in scrubs and one dressed in business attire appeared.  They ignored me.  “Get this,” one said to the group.  “We’ve got a liver biopsy coming under general anesthesia.”  I almost shouted this was not me, but before I could gather the breath another one pointed in my direction and asked, “This one?” and the woman who had made this announcement said, “No, our eleven thirty.”  “You’re kidding,” another voice said.  “Huh-uh.  General anesthetic.  So we’ve got to wait for an anesthesiologist and we’ll probably be backed up all afternoon.”  Their conversation became uninteresting after that and I was left to reflect on the patient scheduled to undergo the procedure I was waiting to have, but insisting upon doing so knocked out.  This was not a good topic of thought while laying alone in the shadows of a gloomy room.  What did this other fellow — though it might be a woman — know about liver biopsies that I did not know?  Perhaps he’d undergone this before and sworn never to do so, awake, again.  I thought about my current attitude towards prostate biopsy, a procedure I’d undergone about a year earlier.  I hated the urologist who administered it, hated the procedure, hated being lied to about the discomfort involved, felt violated by it, hated pissing blood for days afterward, swore never to let it be done to me again … yes, I would insist — maybe — on a general anesthetic if they told me I must undergo it again.  Maybe.  But what kind of coward refuses to be awake for a buggering towards the betterment of his health?  What kind of man would insist on being put to sleep for these sterile woundings under such careful circumstances?  How could a man who hadn’t the courage to get jabbed so that his docs might study an itsy-bitsy piece of tissue look at himself in the mirror?  I laughed aloud.  Not me!  Don’t even bother with a local, dear ladies in waiting.  Lay me down, put me under the knife — yes, a bullet to bite down on might be wise, and a slug of whiskey for everyone involved….

“Mr. Dewke?” It was another young woman in surgical green scrubs.  “I’m going to take you to the CT scanner room now.”  Oh hell, I thought.  I’m not ready. I was kidding about not wanting the local.  Is a general anesthetic a common option? I thought but didn’t ask these things as she wheeled me back down another hall and into the room with the huge metal and fiberglass doughnut that clicked and whined and waited patiently to consume me.

*****

Computed tomography and I have a history, and one that doesn’t have me slipping through the doughnut — the gantry — but has me working with the scrub-clad techs and docs.  In the late 1970s, CT scanners were new, expensive, and owned mostly by the wealthiest and largest hospitals and medical institutions.  They combined x-rays and computer imaging to generate cross-sectional  pictures.  The third dimension, the z-axis, to a complete three-dimensional image of the human body is provided by the gurney moving with exquisite precision through the gantry — this combined with the two-dimensional cross section images provides images of a torso, like a stack of pancakes.  Computer tomography endowed the industry of radiology with the ability to pin-point objects inside the human body without cutting and prying anything open.  Even in the late seventies, when radiologists were learning how to read the shades-of-gray imagery of computer tomography, the technology was coveted well beyond is availability (and affordability). 

I was a contractor to NASA at this time, helping them execute experiments on a new telecommunications satellite.  We had a strong constituency of experimenters among the health professions, including radiology.  This contingent asked if it might be possible to separate the gantry from the processing computer and link them via satellite.  The vision was that, if this separation worked, a number of gantries could operate like satellites time-sharing one central processing computer.  The gantries, being less expensive singly than when combined with a processor and other peripherals like storage devices and printers, might be afforded by smaller hospitals and clinics in more sparsely-populated areas.  We rigged some experiments and successfully demonstrated that information — digital streams — generated by the gantry sections of the CT Scanner could survive a 44,000 mile round trip into space and back to become useful images through a CT Scanner’s processor section located across the street or on the other side of a continent.  Our experiment was a success, but that’s as far as it went in 1978.  The vision was snubbed — I learned second-hand, some time later — by both the radiology community and the manufacturers.  Radiologists were worried about malpractice.  If an image were misdiagnosed at a remote facility, was it the fault of the radiologist there or the people responsible for the physical operation of the image capture back where the patient was located?  I’m not sure the manufacturers of CT Scanners were explicit in their concerns, but what wound its way back to me was grumbling about the diminished profit margins that would result from selling multiple gantries and fewer processing units — and the inevitable problems associated with maintenance.

This reminiscence replayed in my mind like a ragged 16 millimeter film while two nurses, both of whom would have been in elementary school while I was working with NASA, helped transfer me from my transport gurney to the narrower version that was a part of the CT Scanner gantry.  My inner-vision movie was interrupted by the problem of what to do with my arms.

On this narrow bed it was impossible for me to leave both arms at my sides and still expose the area of interest, which I learned was between some lower ribs on my right side.  The issue became, should I place just my right hand up and behind my head, or both my right and left hands?  Or, should I hold one or both across my chest, corpse-style. In spite of the IV spigot on the top side of my left hand, I was able to place this hand, along with my right, under my head, and remain comfortable.    I was feet-first toward the hole in the doughnut but was reassured, when I asked, that I would never pass entirely through, therefore my elbows, spread wing-like to the right and left of my head, posed no hazard to passage through that narrow aperture.

One of the green-scrubbed nurses attending me:  “We’re going to take some pictures of your liver now, Mr. Dewke.  Lay very still.”  Then she and her colleague disappeared.  There was a smoked glass window, about six inches by eight inches, in the gantry, directly above me.  A red light illuminated behind the glass, the sort used in laser sighting.  There was some text beneath this window that I could not read until I was sucked part-way through the aperture.  The machinery inside the doughnut began to whir and click.  In a moment the gantry jolted slightly then began to move me very slowly through the aperture.  All the while I stared at the red light in the smoked-glass window.  Many seconds passed until I was half-way through the gantry.  Now I was close enough to the aperture to read the text beneath the smoked-glass window.  “Do not look at the laser,” it said.  I looked at the laser — the one I had been looking at all along.  Then a recorded voice interrupted my revery:  “Take a deep breath.”  I did.  Then, “Hold it.”  I did.  Then, “Breathe.”  I did.  The gantry moved ever-so-slightly.  “Take a deep breath.”  I did.  And so on.  They took perhaps half a dozen x-ray slices of me.  I was becoming woozy from all the taking and holding of breaths.  Then I heard the scrub nurse behind me.  “Stay very still, Mr. Dewke.  We’re going to back you out and put some markers on your tummy.  Don’t move your arms or anything.”  As the machine slowly slid backwards, extracting me from the gantry, I stared at the laser light and, peripherally, at the little bit of text instructing me not to.

I could not tell exactly how the nurse marked me, but it required the application of two parallel strips of tape perpendicular to the ribs on my right side.  While she was doing this she said, “Dr. Coleel is on his way and will be here in a minute to take the sample.  In the meantime it’s very important that you remain perfectly still.  He’ll be using the pictures we took to guide his probe, so you can’t move.”  I said, “What happened to Dr. Abernathy?”  “Who?”  “Dr. Abernathy.  I was told Dr. Abernathy would be conducting my biopsy.”  She pouted her lips and furrowed her brow and shook her head slightly.  “No.  Nope.  It’s Dr. Coleel.  You’ll like him.  He’s a good doctor.”  I did not like him at that moment.  I did not like this change of players so near the kick-off.  What happened to Abernathy?  Was my case too risky for him?  She finished applying the tape markers and said, “Okay.  Once more through.”  Then she disappeared and the gantry came to life again.  I was moved in while I stared at the laser light and finally the recorded male voice said “Take a deep breath.”  I think they imaged two or three slices of me this time.  As I was pulled back from the aperture I sensed another presence behind and to the right of me, and then I saw the man lean barely forward, reaching around and over me, and I felt a very slight tickle between the tape strips over my ribs.  A touch and then a second touch.  I believe it was a felt-tipped pen marking an “X.”  The nurse’s familiar voice came from my left side.  “Now stay very, very still.  Try not to move a muscle.”  Then Dr. Coleel — the man who had marked me — stepped forward on my right side so I could get a good look at him.  He was much too young to be a doctor.  Perhaps a high school gymnast?  He had rugged good looks except for his glasses which were of the type we used to call “bottle glass spectacles” — so thick they made the eyes behind them look oversized.  I thought to myself, A nearly blind radiologist.  Great. 

“I’m Dr. Coleel and I want to tell you about this procedure.”  He talked for several minutes and imparted a great deal of information.  To the best of my recollection, these were his key points:

• He would numb the skin at the site of the incision (or was it “puncture?”)
  

• He could not numb the sack containing the liver nor the liver itself, so I would feel some pressure in these places
  

• A hollow needle would extract the actual tissue sample, and it would sound like this — clack! — when it actually did the extracting … (I told him I was familiar with that sound from my most unpleasant prostate biopsy)
  

• There were some dangers such as (1) piercing a major blood vessel causing more internal bleeding than expected
  

• (2) piercing a major bile duct allowing bile and blood to intermix
  

• (3) piercing the pleural sack to a lung, hence causing the lung to collapse
  

• The entire procedure, including any of these accidents, should take less than a minute.

I wonder:  How is one supposed to feel in the seconds between this full disclosure and the actual deed which, by now, is wrapped so tightly in a black veneer of fatality? 

“Do you understand?” Dr. Coleel asked.  I got the feeling he’d asked it a few times, but my mind had been elsewhere.  I said that, yes, I understood.

I felt something cold and wet, like a sponge, wiping down an area between two of my lower ribs on my right side — the area Coleel had marked with his pen.  Evidently this was the local anesthesia, too, for a moment later he said, “I’m going in, now” and I felt almost nothing; a little pressure is all.  In my peripheral vision I saw the doctor turn away from me.  At the moment I felt something cold and wet drip down my right side.  “Something is leaking,” I said.  The doctor turned back.  “I made a little incision.  That’s just a little blood.”  “But it’s cold,” I said.  “That’s what the local anesthetic makes you feel.”  A moment later he said, “Okay.  Now you will feel some pressure and then hear the clack.”  I felt a hand on my left shoulder and moved my eyes.  It must  have been one of the scrub nurses.  Was I being braced?  I said to myself, Men get stabbed all the time… and then there was the push and the clack and, in the same instant, it seemed, the withdrawal.  The push in made me flinch, but just slightly.  Even so, I was embarrassed.  But, there it was — over!  Or so I thought:  “I’m going to go in and get one more sample,” Coleel said a moment later.  He’d had time to check something with his back to me.  Perhaps his first attempt had failed?  He didn’t give me a chance to question anything.  “Okay, here it comes, push … and … clack … and there we are, all done.”  I flinched that time, too.

I heard Dr. Coleel tell the scrub nurse to wash the wound with something-or-other solution and put a number something-or-other bandage on it.  Then he turned to me for the last time.  “They’ll take you back up to your room as soon as we get you bandaged up,” he said.  “I want you to lay on your right side.  The pressure of your liver bearing down on the wound will help stop any bleeding.  We’ll keep you in your room for a couple of hours, until we’re sure everything is okay, then you can go home.  We should be passing the results of this biopsy back to your physician within three to five days.”

The process of getting “bandaged up” required both scrub nurses and more cold swabbing.  During the process I was gabby — relieved and gabby.  “I was told,” I said, “that compared to a prostate biopsy this liver biopsy is a piece of cake.  I was told right.”  One of the nurses said, “Is that right?”  “Oh yeah.”  A pregnant pause while they worked.  Then, I said, “I hope I haven’t been too much trouble.”  The other nurse said, “You’ve probably been the highlight of our day.”  I didn’t ask, but I’m sure she was making indirect reference to their 11:30 liver biopsy — which was about now, I calculated — and this patient’s requirement to be under a general anesthetic for the procedure.  I hoped I would pass this person on our transport routes; that somehow I would know who she or he was; that I would have the presence of mind to say, “You really should stay awake.  It’s a piece of cake.”  I said to the nurses, “I was smart to wear this gown backwards, you must admit.”  “Oh yes, that was very clever, Mr. Dewke.” 

I felt so good I literally catapulted myself from the CT Scanner back to my transport gurney.  “Whoa there, Mr. Dewke!  Let’s not rattle your organs so much.”  Once on the gurney, I laid on my back, contrary to instructions, but neither nurse said a word. 

I was rolled first back to the gurney parking area in radiology receiving.  The nurse patted my feet and said, “Your transporter will be here in a minute.  I hope you have a nice rest-of-your-day.”  I smiled and thought to myself, The next two hours are going to be long-g-g-g.  Why do healthcare providers instinctively pat a supine patient’s feet?  I think they should be trained in foot massage — make this little fetish of theirs pay-off more.

Before my transporter arrived to wheel me back to room 380, bed two, Dr. Coleel goose-stepped his way through on his way to somewhere else.  He probably wouldn’t have noticed me lying in the shadows in the corner.  I said loudly, “Dr. Coleel!  Thanks for a smooth procedure!”  He looked over at me and tilted his head up and down slightly in that characteristic way people wearing bi- or tri-focals always do.  At last he smiled in recognition and wagged a finger at me.  “Right side, sir.  Lie on your right side.”  Then he was gone. 

I decided that I was not going to lay on my right side for my gurney ride back to room 380, bed two.  I could not recall seeing anyone — alive or dead — wheeled through hospital public places lying on their right side.  Being as broad-of-beam as I am, that would cut a weird feature under the sheet.  Draw stares.  Now that my procedure was behind me, that I was merely waiting to be discharged, it no longer mattered if people recognized me as alive or dead.  In fact, I didn’t want them to recognize me at all.  I determined to lie on my back, quiet and still. 

The wait for the return of my transporter lasted a quarter of an hour.  By the clock on the wall in the radiology receiving area, I did not start the journey back upstairs until 11:45.  I had been “recovering” in limbo for a quarter of an hour.  I hoped Nurse Kristi would take this into account when calculating the time of my discharge.  I did not want to pay the price of another quarter of an hour for the privilege of loitering in the shadows of radiology while waiting for a ride.

*****

Bed one in room 380 was vacant and made-up like new, ready for another patient.  When I transferred myself from gurney to bed two (declining assistance from my transporter), I noticed a twinge of discomfort where my wound was.  My transporter left and it occurred to me I needed to urinate.  Though no nurse was in sight, I figured one was on the way, so I decided to go quickly, while the opportunity existed.  In the bathroom, after my pressing business was done, I examined the wound site, which was completely covered by a bandage about 6-inches x 6-inches.  I could see where blood had soaked into the bandage.  I probed gently with my fingertips.  I decided the twinge of discomfort I had felt was probably not from the wound, which may or may not still be numbed, but from the bandage itself, which gripped me tightly on all sides with a glue that I anticipated would make it unpleasant to remove.

“Mr. Dewke?  Are you doing all right?” 

It was Nurse Kristi’s voice.  “Fine,” I said, then sucked in my gut and made my way bravely back to bed.

Nurse Kristi determined that I would be ready to check out at 1:30 or 2:00 p.m., if all went well between then and now.  She hooked me up to the blood pressure machine and left the cuff on, setting the device to take a reading automatically every 15 minutes.  Then she said, “You haven’t eaten all day.  May I bring you a snack?”  I asked what she had in mind.  Coffee and Danish were among my options, and I requested these.  The sweet icing on a Danish normally makes it a bad thing for a diabetic, but my blood sugar levels were, I knew, a mess anyway from the fact that I had neither eaten nor injected any insulin that morning.  My attitude about the Danish was best described as OhWhatTheHell.  After my ordeal a certain latitude is earned, don’t you think?  The first reading of the machine gave my blood pressure as a tad high on the top end and a tad low on the bottom end.  My baseline is typically a tad high on the top and about normal on the bottom, so it seems my procedure hadn’t affected my circulation much.  Nurse Kristi left to fetch my snack and I dutifully tried to lie on my right side, while keeping the blood pressure cuff and hose unobstructed, and re-opened my book to read.  But I hadn’t finished a page when Kristi returned with my coffee and Danish, so I had to reposition myself, no longer on my side, half reclining with the bedside table positioned above my lap.  The coffee was just this side of awful, the Danish was of the vending machine variety, not zapped in a microwave, so characteristically cold and hard.  It tasted sugary-sweet and wonderful.

I had just pushed away my bedside table, turned back onto my side and opened my book again, when another lady burst into the room with a meal tray.  “Ready for lunch?”  I did not have to act surprised because I was.  “I didn’t know I was getting lunch.  Are you sure that’s for me?”  She pulled the card from the tray while setting it on my table next to the empty Danish dish and coffee cup.  “Dewke, Mister, room 380, bed two?”  “That’s me,” I said.  “Says here, ‘Standard meal.’”  “I’m not complaining,” I said.  She left as quickly as she had come in and I rearranged myself once again to eat my meat loaf — I think that’s what it was — with green beans, slice of bread, tossed salad with ranch dressing, and a 1-inch x 1-inch x 1-inch cube of something sweet and dark brown.  Maybe a brownie, or a heavy un-iced chocolate cake, or something with a name I don’t know.  I ate everything, every crumb.  I drank the tepid tea (judging from the glass it was supposed to be iced tea, not hot tea, but it could have been either).  And, after all this sin, I could not see my way clear to lying on my side any more.  The television associated with my bed’s TV controls didn’t work (or was turned off at some master switch).  There was no clock in my line of sight.  I had not brought a watch.  So I had to guess I had an hour or slightly longer to wait before discharge.  But then I remembered the blood pressure machine standing on its wheeled pole beside my bed.  I grabbed it and turned it so I could read its glowing green screen.  As I hoped, the quarter-hour readings were accumulating log-like on the screen.  The first reading had been at 12:07.  The next one came at 12:22; the third at 12:37.  That had occurred just as I was finishing my lunch.  The next would occur at 12:52.  I figured I should be here until 1:30 or 2:00 at the latest.  Less than an hour more.

The reading wasn’t holding my attention, so I gave up and closed the book.  I was alone in room 380, realizing how gawdawfully-long a quarter hour can be.  I was experiencing another version of watched-pot syndrome.  So, I tried to anticipate what check-out would be like.  The last time I was hospitalized I wasn’t an outpatient, I was an inpatient.  I remembered papers to sign and a wheelchair ride to the front door.  I felt it was a good bet there would be more papers for me to sign, but I would probably not be wheeled out.  Would Mochelle and Gladys and Nurse Kristi and Dr. Coleel all be lined up in the lobby to smile at me, wish me well and say goodbye? …

“Mr. Dewke?”

A gentle voice nudged me awake.  There was my book, unopened, weighing heavy on my chest.  Nurse Kristi moved around to my right side.  “We need to change this bandage before we let you go home.”

“I guess I fell asleep.” 

“Uh huh. This might hurt a little bit.”

R-r-r-r-r-r-r-r-rip.  It wasn’t that bad, really.  Not as bad as I had figured it would be.  I caught a glimpse of the bandage.  There didn’t seem to be an awfully lot of blood on the bandage, either.  Obviously my liver wasn’t trying to liquefy and seep out of my gut through the puncture. 

“Hmmm.  What’s going on here, I wonder?” Kristi said.  She was looking at my navel, which is quite a ways away from my wound site, but exposed at the moment nonetheless.  My navel (an “inny”) and its surrounds have become one big psoriasis lesion.  It looks, on days like this, like a four-inch diameter crater in my stomach: an aperture (my navel is quite deep and mysterious) surrounded by a red, flaky, painful-looking debris field.

“Oh that,” I say.  “That’s where the alien came out.” 

This is always a risky line.  Unless the recipient makes the connection with the Alien movies, starring Sigourney Weaver, the remark is not interpreted as a joke.  There follows an uncomfortable few seconds during which the recipient of my jest is about 50 times more uncomfortable than I am.  I might have to quell their pain by saying, “That was a joke.  There was a movie, you see….”  But that wasn’t necessary with Nurse Kristi.  First, she stopped applying the clean bandage, which she had been doing more or less robotically.  Then, she looked at my face.  I’ve no idea what my expression told her.  Her cheeks started to balloon and turn red and I thought I would become victim to one of those belch-like guffaws that tend to spray spittle everywhere.  Then she took a deep, chest-expanding breath and deflated her cheeks gently, with control.  She narrowed her eyes and said, with quiet intensity, “Wow, you’re lucky.  So few people survive those alien births.”  And it ended up being me who did the spittle-spraying belch-like guffaw thing.

*****

The end of my ordeal was anticlimactic and I had anticipated in error.  There were no more papers for me to sign.  Nurse Kristi finished applying a fresh bandage, which she instructed me to keep on until the next day, at which time I could remove it and use regular band-aids after that, if necessary.  (She doubted it would be necessary.)  Then she removed the IV from my left hand.  “I should rejoice that it never had to be used,” I said.  “Amen,” Nurse Kristi said.

Finally, Nurse Kristi said, “Take your time getting dressed.  If you’re at all light-headed just lie back down.  We’re not kicking you out of here.  You stay as long as you need to.”  I was sleeping soundly.  Would they mind if I resumed that nap — just see it through to its natural conclusion, so to speak?  “But when you are ready to go, make sure you have collected all your things and stop by the nurses’ station on the way out to tell us you’re leaving.  Okay?”  The room seemed too quiet and pointless after Nurse Kristi’s departure.  I was no longer sleepy.  Without thinking too much about anything, I got up, got dressed, gathered my things and left room 380.  At the nurses’ stations I recognized no one.  To the closest nurse I said, “I’m Dewke checking out of room 380 bed two after a smooth and pleasantly unremarkable liver biopsy.”  She looked at me blankly.  (Lots of people do this, I’ve noticed.)  After scanning my face evidently yielded no more information, she turned to her computer terminal and punched something up.  “Okey dokey,” she said and hit the enter key with just a little too much flourish.  I wasn’t entirely ready to give up on her.  “I’m glad to be walking out,” I said.  She blinked.  “Most people don’t want to hang around longer than they have to.”  I gave up and headed for the elevator.

I was in a crowded but silent car on the ride down to the ground floor.  I was thinking about Mochelle, back at outpatient check-in, and wondering if any of the patients ever stopped in to say “goodbye” on their way out.  I saw through the glass wall that separated the hospital’s main lobby from the outpatient lobby that it had become full since my arrival.  It looked as though every seat was occupied.  I wondered how many anxious liver biopsy patients were sitting in there.  What would anyone say or do, I wondered, if I just went in there and announced: If you’re having a liver biopsy today, please raise your hand.  Then, I would gesture for those who raised a hand to gather around. “I know you’re anxious.” I would say.  “It takes a minute, and by the time they get around to that minute, you’ll really be anxious.  But there’s nothing to it.  Look at me.  You wouldn’t know I was stabbed a couple of hours ago, would you?”  And then, for the dramatic ending, I would feign a faint, collapse dead-away right in front of them and play dead until the screaming and shouting began. 

P.S.  A week later I heard from my dermatologist.  My liver biopsy revealed everything was fine. -Ed