Every once in a while I encounter a life event that really shakes things up for me. This past week it was a visit to the Dermatologist, so without further ado, for Your Wacky Wednesday reading pleasure:
Syncope in my spare time…
I was a little bit nervous walking down Broadway to my Dermatologist appointment on a pea soup fog Tuesday morning in Vancouver. I was on my way to a Dorsal Nose Biopsy procedure, a red bump has been on the end of my nose for two years, the Doctor could not confirm from a visual exam whether it was cancerous or benign blood cell build up.
“It was nothing I could not handle”, I thought, as I stood feeling smaller than I already am, in the high ceilinged, medicated smelling, yet bright clean lobby of The Fairmont Medical Building. I pressed the button that would call one of the four large elevators to take me to the topmost floor. People began to wait in front of the elevators with me. When one of the wide double doors finally dinged loudly and opened people moved out of and into the elevator like blood gushing through a heart, smoothly and efficiently. I pressed the button for my floor first, many other floors were chosen. The ride seemed long, I was beginning to regret having drank coffee that morning. Finally the elevator let me out, I was the last passenger.
The Receptionist was on the phone when I arrived in the office; she finished quickly and greeted me with a smile… “You have a biopsy this morning, that’s an operation.” Stated the Nurse, “You need to sign this waiver and this is your after care sheet.” Since I was having a Dermal Biopsy: Shaving my Dorsal Nose after application of a local anesthetic; I would have to sign a waiver. I read it over and it seemed legit, nothing out of the ordinary, like many other medical and dental waivers before it; I signed. The receptionist took the waiver back and handed me the “Biopsy Care Instruction” sheet. Then she asked if I wanted to book my Pathology Review appointment, seemed like a good idea to get that out of the way so we made the date for two weeks from the biopsy and as I was trying to get all the details put into the calendar on my phone the receptionist requested I sit down. This was not the first encounter at this dermatologist’s office that was, how shall I say… “lacking bed-side manner”, so brushed it off and sat down.
Staring me right in the face was a big blue bathroom key! Perfect, with 10 minutes before my appointment time there was no chance of me holding anyone up by taking a bathroom break. I took the key, this old building has one washroom per floor, each floor is a mens or ladies washroom, I went down a flight of stairs and made it back up to reception. I picked up a tell-all celeb newspaper (they were the only thing available) not my usual read from the table. I had just started reading about the plight of Bill Cosby when my name was quietly spoken into the waiting room.
I followed the, also tiny, receptionist down the hall and into a small examination room with a normally stunning view that was now coated in a thick pea soup style fog. She asked me to have a seat and get comfortable.
There was a rolling tray in front of me with a needle, swabs, and petroleum jelly dab on it. On the storage desk was another tray that held a scapula, a specimen container, spray alcohol, and a vial of what I assumed to be local anesthetic (I never looked at the label, should have though, should have!). As I waited for the doctor I did some calming meditation and breathing techniques. When it was almost ten minutes past my appointment time I snapped some photos and started texting people to distract myself.
*Knock-Knock* the Dermatologist entered and asked me how I was; I replied that I was well. I asked if he was having a busy day. It seemed a pertinent question, seeing as how it was now 20 minutes past my appointment time. He replied with an unfaltering “No”. With that I decided I would just be quiet instead of trying to make congenial small talk. I leaned back in my chair and relaxed any muscles I could feel tensing from the impersonal interaction.
The doctor busied himself with setting up his work station, arranging things carefully on the wheeled tray in the middle of the room. He put on his gloves with two snaps and turned to me, “Are you comfortable in that chair?” he asked rather matter-of-factly. “Yes…” I replied. And that was that, I would sit in the chair for the biopsy, I thought to myself how reassuring that was, just gonna stay sitting upright in a chair. This should be a piece of cake then, nothing to worry about. The doctor unfolded a large white operating cloth and wrapped it around me from the neck down similar to a hairdressers cape but with much less finesse. I breathed and relaxed, closing my eyes as I heard the Doctor filling the needle with anesthesia.
“Just lean your head back against the wall, please.” And at the Doctors request I did, “Keep your eyes closed.” A huge hand came down on the top of my head, I imagine this is what it feels like to be a baseball in a catcher’s glove. Next thing my nose was in his one hand and he was saying, “On the count of three I will give the injection…1…2…3. The cold needle tip went into my noose and I could feel the temperature in my face drop, similar to when you step out of the house into minus forty wind chill. The Doctor was saying something I didn’t quite catch about another injection. The needle felt bigger, colder, more painful than the first. When I felt the needle enter the end of my nose a second time I became very cold, was it just me or was it starting to get darker outside. Fog sure is rolling in hard today…
I was lost! It was so dark, I could tell there was light outside(?); but it was warm and dark like the depths of a mountain cave, where I was. I tried to move, couldn’t feel my limbs, I could not really feel anything. The only thing in the depths with me was the ultra slow beating of my struggling to pump heart. I almost panicked in this dark place; instead of giving in to my creeping fear I concentrated on the beating of my heart, attempting to affect my breathing to supply the little muscle with more oxygen. My breathing did not change, I ignored that horrific fact and continued to concentrate on my heart beat. Eons swept by in the slow pulsing beats, I was counting the beats in and out….9….10…
Suddenly out of nowhere it seemed I felt a great pressure of force coming down on me, almost a sucking down effect experienced while stepping into a sink hole. I could feel the whole weight of the world drenched in a thick fog slamming down on my shoulders… no wait, it was just one shoulder being weighed down. Whose freaking hand is that!!! This time the wave of panic would be subsided, my body convulsed and my arms and legs flailed as I tried to comprehend where I was and who the hell was holding me down. Dim, grey, foggy, light broke into my eyes and an unfamiliar scene was laid out before me. Dingy small operating room??!! Tray with scalpel, sample vial, and needle!!??? Where Am I??? Why am I alone….Im not alone… Who the hell is that guy???!!?!?! I wanted to scream but could not, my muscles were moving of their own volition, I had no physical control over this situation. Tears began to stream down my face, it was the only thing I could do. I cried because I could, My body overheated immediately and a cold drenching sweat covered me entirely adding to the waterworks.
The Doctor said nothing, his large mitt of a hand was a lead weight on my shoulder while I convulsed and panicked. Time had picked up considerably from the molasses pace it had just been when I could not comprehend my surroundings. It seemed like hours to me before an unemotional voice informed me that I was “going to be fine.” The huge hand moved to my forehead pressing my skull into the wall, something flashed in the other hand and I instinctively closed my eyes. The pain was like ice running into my veins, my limbs began to flop around again as the hand on my head returned to its perch on my shoulder. My eyes remained scrunched closed as tightly as I could; little annoyed noises escaped my lips as I gulped at air to fill my lungs, calming my shocked body. I could feel the Doctor moving around but decided it was wholly unnecessary for me to watch him put part of my flesh into a glass bottle. Sweat poured off of me like the cascades of the Horseshoe falls as the doctor walked through a pocket door inset in the wall behind me.
“I’m going to lance your nose.” Came the Doctors, again, very matter-of-fact statement. I opened my eyes for a second and regretted it immediately. A large white wand with what looked like a soldering iron tip on one end and a power cord on the other was coming down from the sky towards my face. My eyes fluttered, I jolted under the weight of the doctors heavy hand as the cauterizing machine seared what appeared from my viewpoint to be a crater on the end of my nose. Sizzling, popping, and smoke (a cloud of smoke billowed from the tip of my nose) filled the tiny room and made my stomach heave like the waters along the seawall. There is no smell more sickening in the world than the scent of your own flesh cooking, this was not the first time I have had the chance to smell this but I sure hope it was the last. I could feel the Dermatologist passing off the wand. The pocket door vibrated the wall behind me as it was pulled closed on its track once more.
Finally the C clamp clench of the hand on my shoulder released, I was in the Dermatologists office, the procedure was over, now coherent and drenched in my own sweat I sat shivering and gulping shaken severely by the whole experience. The doctor looked at me with a strangely blank expression as he painfully pressed ointment and then a dot of an adhesive strip onto my nose, “Your going to walk over here and lay down on the table.” The hand returned to my side and gripped my arm like it was a walking cane. Struggling up out of the chair I literally dragged myself the 3 steps across the room to the table and almost tripped as my leg would not raise to the level of the step that would help me reach the tables level. The hand squished tightly on my arm and cut off blood circulation as I wobbled and righted myself. “Sit down and swing your legs out to the end of the table, then lean back and lay down… NURSE!” As soon as my legs were up the blood was restored to my released arm as the Dermatologist stepped over to the desk and fiddled with the sample and papers in my file.
The nurse entered and the Doctor barked his instructions at her as if I was no longer there in the room, “She’s had a Vasovagal reaction, I’ll need you to watch her for a couple minutes while she recovers.” The nurse nodded yes and sat quietly, I looked at her and the doctor. I was cycling between sweating profusely and shivering, what the heck had happened? No one said anything to me.
For the next ten minutes the Dermatologist stood in the room with both of us, all in silence(well except for my whimpers), while he finished up his paper work. The Doctor then turned to the nurse without saying a word to me and said, “I think that’s fine now, you can go back to your desk.” She replied a quiet yes and left the room.
“Stay laying down until I come back and tell you, you can go.” I mumbled my compliance with this request as I marveled at how odd and cold my face felt when I spoke. The pocket door to the hall way on the tiny office was slide closed behind the Doctor, I was all alone. Tears streamed down my face as I wondered what a ‘Vasovagal Reaction’ was, my mind is not so great at memory so I was attempting to burn this strange term into my memory. What is a VasoVagal response? Why would the Doctor not inform me as to what had just happened. I thought back to the waiver I had signed and the section on allergic responses… well I had been warned I suppose, though not in much detail. My mind raced with possibilities of what could have possibly happened. A knock on the pocket door, signaled the Doctors re-entry “Just leave the sheet on the exam table, You can go now.”
“Thank You.” I quietly and confusedly mumbled. I was Thankful it was over. I rolled myself off the tall exam table and fought my coat over my sweat chilled arms. I trudged out of the exam room, down the hall, and avoiding all looks from the patients in the waiting area I slipped out the office door. In front of the elevator bank for this floor just a couple steps down the hall were two wide benches. I slumped down onto the bench pressing my back against the cool wall, taking deep cool gulping breaths.
That is what it felt like to me to have a syncope vasovagal response.
To see the scientific explanation of a Vasovagal Response please see the link below:
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