#surgery prep

I look up at the doctor and give a slow nod. I start to get scared and I feel my pulse begin to race again. 'Dont worry, one of the nurses will stay next to you the entire time and just tell me to stop if you feel something unpleasant at any time during the exam.' They help me to over to the gynecological chair and prepare me for the exam.

Everyone leaves the room except one of the nurses from before. She stands next to my bed and places her hand on my shoulder, it gives me some sense of calm. Dr. Guttman proceeds to lift my legs into the stirrups, exposing me. He places one hand on my left thigh before he proceeds to insert two lubricated fingers into my vagina. He moves his fingers to the left and right to identify my uterus and cervix. This also helps him identify any abnormalities. Next he place his left hand on my stomach and press down to further examine my uterus. I let out a short scream as the pain shoots through my abdomen.

He quickly removes his left hand and reassures me that this is necessary. He orders the nurse to give me 50 micrograms of fentanyl and waits until it has taken effect. He then finishes the bi-manual exam. Moving his fingers a little bit deeper into my vagina and pressing down higher up on my stomach to examine the ovaries. Shortly after he removes the fingers and changes his gloves.

He then grabs the metal speculum laying on the table next to me, warming it in his hands for a few seconds. 'This could be a bit cold and uncomfortable' he says as he lubricates the speculum. With his left hand he spreads my labia apart and inserts the cold metal speculum, carefull but firmly. Pushing it deeper into my vagina and then opening the blades. I can feel my vagina stretching and the pressure from the blades, then he manipulates the speculum a bit in order to see better. 'I dont see any abnormal tissues och signs of bleeding or infection, which is good.' He adjust the speculum to inspect the vaginal walls before slowly closing the speculum and removing it.

'I will need to perform the vaginal ultrasound as well.' He says and start the ultrasound machine. Placing a condom and some gel on the probe he gently insert it into my vagina. Moving it around to examine the uterus and ovaries and surrounding organs. Guiding the probe left and right. He slowly removes the probe and turns the machine of. 'I see some unusual tissue on the ultrasound, simillar to what we could see on the CT scan. With these findings and the amount of pain you are in, i recommend an exploratory laparoscopy to identify and hopefully treat what ever this is.' he says. 'Lets admit you to the ward and i will plan for a surgery in the next 24 hours. I will order pain medication to be given to you on the ward if needed.' He walks over to the computer and prepare my admission.

-----------------------------The next day-----------------------------

I had to get pain meds throughout the night. I get woken up a few hours later and was told i will be the first patient to go down for surgery today.With the help of another dose of meds and a nurse assistant i walk over to the shower and am told to shower with antibacterial soap. The nurse assistant brought me a gown and a pair of underwear to put on after the shower. I also got some knee high socks and blue foot covers. When i'm dressed i enter my room again and the staff has clean my bed. I'm told to remove the blue foot covers and lay down on the bed. A few minutes later i get wheeled down to the OR floor by the nurse and nurse assistant.

In the waiting room of the OR-unit i transfer over to the OR bed, the OR staff lays a warm blanket over me and fastens two straps over me. As i'm wheeled down the corridor i count the lamps in the ceiling. One, two, three, four. We then enter the OR room, i see the bright lights, different equipment and a few other OR staff. I could smell the strong smell of desinfectant and cleanliness. The bed is placed in the middle of the room. An anesthesiologist steps over to me and introduces himself. ' Hi, i'm Max and i will put you to sleep and make sure your doing well during the surgery. Before this we just need to attach some monitoring equipment to you, okay?'

Picture from getty images

Max and one of the nurses opens my gown to place five ecg leads on my upper body, the nurse lays my arm on the armrest and place the blood preassure cuff around my right arm. Next she secures my arm to the board. Meanwhile Max place the pulse ox on the left hand index finger, he also hooks me up to an infusion line. He then moves my arm out onto the armboard, securing that to the board aswell. The monitor start beeping to the rhythm of my heartbeat and i can feel the blood pressure cuff tightening around my arm. 'Great, your blood pressure looks good, your pulse is a bit elevated but nothing to worry about. Your saturation also look good. Are you doing okay Annie?' I nod slowly. 'Then let's begin the anaesthesia.' Max says.

He places a blue mask over my face and tells me it's 100% oxygen, i breathe the oxygen for a few minutes before he orders the nurse to start the induction. ' 100 micrograms fentanyl is given.' the nurse says. I start to feel relaxed. 'Now you will get the medicine that will make you fall asleep. Try thinking of something nice.' She proceeds to slowly inject the propofol through my iv and a few seconds later I start drifting of to sleep.

'150 mg propofol given' she says. Max then starts the continuous infusion of propofol to maintain the sedation. Slowly raising the speed to a good level for anaesthesia maintenance.. I can feel the anaesthesiologist lifting my head to open my airway more, he tightens the grip around my face and the mask. After a couple of minutes i can feel him touching my eyelashes, but i give no reaction. 'She is sedated, now go ahead and give her 85mg rocuronium.'

A minute pass before Dr. Max removes the mask from my face, he then picks up the LMA with which he will secure my airway. He slowly adjust my head into the 'sniffing air' position, my mouth is agape. He then place the LMA on the palate of my mouth and follows the curvature, pushing the LMA deep down my throat. He uses his other hand to hold the tube in place as he removes his finger from my mouth. He gently push it just a little deeper before grabbing a syringe full of air to inflate the mask. I can feel the LMA adjusting its position as he inflates it, he then connects me to the anaesthesia tubing and I start to breathe in unison with the machine. I then feel him placing tape on my left cheek, twisting it around the LMA twice before securing the tape on my right cheek. He tapes my eyes closed as well. As I'm now sedated and intubated Max connects another continuous infusion to my iv, containing the medication Remifentanil to maintain the anaesthetic.

I then feel the other staff removing the blanket over me and opening my gown even more. They also place my legs in stirrups to get a optimal position for the surgery, they lower them into a low lithotomy position. One lady begins to wash my pelvic area with an antiseptic solution, the cold solution touches my body and i feel like I'm getting goosebumps. After a thorough cleaning she place a urinary catheter into my bladder. I feel the tube slowly entering my urethra as she advance the tube deeper and deeper. My urine flows into the bag when she reaches the bladder. Filling the balloon with water before gently tugging at it to make sure its secure. The bag is hooked on to the bed to allow the urine to drain. She then begins to wash the surgical area, from just under my breasts down to my pelvic area. Going back over the same area a few times to really clean the surgical field. Later a man steps up to the table and place drapes on my chest, one on each side of me and one over my legs.

Dr. Guttman has now finished washing his hands and enters the room, getting gowned and gloved by the other man. He then steps up to the table and makes the first cut. He places a camera port in the first incision and then makes three more, inserting a c02 line in one of them and tools in the others. He has to spend some time looking around and moving my internal organs to be able to inspect the presence of any abnormal tissue, behind my uterus he finally finds a large area of what looks to be signs of endometriosis. The tissue is removed and placed in a container. ' Location, posterior uterine wall. 1 cm times 2,5 cm in size. Send this to pathology so they can identify what this is.' Dr. Guttman spends another 30 minutes inspecting every nook of the abdomen before ending the procedure. Removing the tools and camera port, suturing the incisions and placing a small bandage over them.

pictures from getty images

Dr. Max stops the propofol and ramifentalin infusions and begins to wake me up. He gives me some time to emerge and tries to get me to open my eyes. I slowly open my eyes just for a second but I'm still not totally awake, I still need the LMA to maintain an open airway. A few more minutes pass before he succtions my back throat from secretions before deflating the LMA. He removes it in one fast movement before placing a Guedel airway in my mouth and then the mask over my face. He keeps a steady grip of my face until I'm more awake,it takes about 10 more minutes, but he is keeping me safe, with his firm grip of my face and the mask. Helping me take some breaths by pressing the handheld ballon 'Good morning Annie, the surgery went well, we are slowly going to transfer you to the post op area soon.'

When I'm completely awake in the post op area I start to remember things from the surgery. Not the time before, I remember feeling every thing they did to me. I remember feelling as if i was in an alternative state. I was aware of everything but unable to feel the pain. I felt the intubation, every breath being pushed down the LMA into my lungs, i had no control. I felt the tools inserted in my abdomen and as the doctor moved them around. I could feel the pressure in my abdomen from the carbon dioxide gas.

I suddenly realise I must be odd, being able to feel all of that. It's not normal to be aware of everything during a surgery. This feeling exhilarated me and I felt a sudden desire to go through it all again. Every step, from the vaginal exam before to the anaesthesia and intubation. How each breath is pushed down my airway and making my chest moving up and down. The thought of having someone else helping me breathe. I started thinking about what i could do to end up in the operating room again. The desire grew stronger and stronger by each passing second. I needed to experience that arousal again.

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I tried to describe to you how I imagine my dream medfet scenario. From the detailed vaginal exam and ultrasound to the sedated but aware patient under anaesthesia. I imagine a feeling of being exposed and vulnerable and having no control which is what I think is fascinating and something I wish to experience myself. To be totally in the hands of an anaesthesiologist and the surgrical team. The dosages of the meds are calculated to my weight to make it a bit personalised to me :P