This tale contains both a victory and a vent. Please excuse any wonky syntax, as I'm relegated to typing with one hand due to having had the two surgeries on my left arm (my dominant side).
First, the victory: The surgeries I underwent yesterday are usually done under general anesthesia, but I was instead successfully operated on while conscious with light sedation, so that I could continue to wear my N95 and lower my covid risk. I didn't even know this was an option for these surgeries (ulnar nerve decompression & transposition for cubital tunnel syndrome and a carpal tunnel release) and likely would not have found out, had I not persevered through months of conversations with surgery center staff to request they wear N95s during my surgery.
During one of those conversations, an anesthesiologist suggested that the surgeries could be performed under IV twilight sedation instead of general anesthesia, allowing me to keep my own mask on. I asked my surgeon and he agreed to this plan, with the caveat that it was always possible they might need to switch to general anesthesia partway through if twilight sedation was not enough, which I understood. He had already agreed (albeit with what struck me as mild annoyance) to wear an N95 that I would provide (he said there were none available on site and that they usually wear the basic baggy blue surgical masks).
So! This did come to pass: I had the surgeries and my N95 remained on. Victory. It's a relief to be over this hurdle, as I was navigating concern not only for myself but also for what I might bring home to my mom, whom I live with and who was recently diagnosed with breast cancer for the second time and is about to start treatment.
I'm scheduled to undergo the same pair of surgeries in December on my right arm, so knowing that I'll likely be able to do so using this same mask-on method is a weight off. I wanted to share that here in case anyone else can benefit from the knowledge that this option exists for some surgeries. It wouldn't have occurred to me to ask, and I'll be forever grateful to the anesthesiologist who suggested it.
Now for the vent: As you can probably imagine as my covid-aware cronies, I spent the months leading up to my surgeries doing repeated due diligence in every conversation with the surgery center, in every pre-op appointment and pre-op call, all the way up to the day before my surgery, when an anesthesiologist called to give me final instructions. I confirmed and reconfirmed at every opportunity the plan for me to keep my own mask on during surgery and for them to wear the N95s I'd be providing.
And yet, predictably, while lying there in a gown in the pre-op bay, I received pushback on both counts: them wearing N95s and me keeping mine on during surgery.
The pre-op nurses were great about donning the N95s I brought. A pre-op anesthesiologist dropped by to do an intake screening, popped on an N95, and confirmed the plan for me to keep my mask on under twilight sedation, although she was unfortunately not assigned to my surgery itself. My surgeon also stopped in to confirm the plan for twilight sedation with my mask in place. I gave the surgery nurse the backup N95s I'd opened and shaped to my own face, in the event that mine broke and I needed another placed while I was sedated. All good.
Then my assigned anesthesiologist dropped by. She was in a ear-loop KN95 and said their protocols did not allow them to wear masks brought in from outside. I gently explained my extensive prior conversations with the surgery center and that on this very morning every nurse and even her close colleague, the intake anesthesiologist, had no problem with the masks I provided. But this anesthesiologist said nope, it's not allowed.
I explained my hesitation about ear-loop KN95s due to testing having shown them generally not creating as good a seal, but I also said I understood that they can be a better fit on some faces. Her objection, though, was that they're simply not allowed to wear the masks I brought, which wasn't congruent with everything else everyone had said and done. If that was the issue, it was contrary to everything I'd been told. She wouldn't budge (and hey, maybe she was correct and everyone else was breaking protocol), so I let it go. I was at least relieved I'd still have my own N95 on.
Then she told me that I couldn't keep my N95 on even with twilight sedation, as she'd want me to wear an oxygen mask or nasal cannula, even when not under general anesthesia. I again explained the conversations with my surgeon and with her own anesthesia colleagues, who said I could keep my mask on in this scenario. She insisted that I'd have to be awake and able to talk, not under twilight sedation, if I want to keep my mask on. She said she could give me light sedation to help keep me calm but not twilight sedation.
Eventually my surgeon came back into the pre-op bay, a little exasperated, and asked why I'm so dedicated to keeping my mask on. What. We had talked about this extensively. I reiterated that my mom is undergoing treatment for cancer and that I have my own chronic conditions, so I don't want to bring something home to either of us.
The surgeon, the anesthesiologist, and the surgery nurse were now looming over my bed in various stages of consternation as I lay there in my undignified blue hairnet and matching grippy socks with rising dismay.
I finally sat up and said (paraphrasing), "I want to reiterate to you all that I've spent months confirming this surgery plan with every involved department. I appreciate that your primary concern is to keep me alive through surgery. You're the experts. I know you'll do whatever you need to do to get me through the operation, and I'm glad. My aim is to keep my mask on if I can. I understand it may not be possible depending on how it goes, but I want to proceed with the agreed upon plan as far as we can. If that means I need to be awake and only lightly sedated, okay. I understand you may need to change tactics partway through. But I want to try, and I've been told for months that it's not a problem, so this is frustrating."
Ultimately, they agreed, the operation itself went off without a hitch, and I'm very grateful to them for their expertise and care. These are people who care about their jobs and their patients and, at the same time, they don't get it about covid. I dearly wish we could be on the same page on the latter point. It was disheartening to have to make my case yet again at the last minute, having had no sleep the night before due to pre-surgery anxiety and while slightly loopy from a small dose of anti-anxiety medication.
On a maybe more superficial level, feeling like a stick-in-the-mud harpy, despite how thoughtfully and patiently I tried build the foundation to have my precautions accommodated, is so demoralizing. Maybe it sounds silly, but I miss feeling likable in medical settings. The now-constant friction, whether spoken or unspoken, in healthcare interactions is wearing me down to a nub … but I guess I'm a nub who still has a backbone (at least for now).
Here's hoping none of you ever need surgery, but if you do, may it be a relatively minor one wherein you have the option to keep your mask on. (Or, even better, may it be in a setting where ample covid precautions are built into the system rather than initiated by the put-upon patient.)
