5 AM - I'm not a morning person, and 7 AM sounds early to me.   But today, the alarm sounds at 5 AM. It's dark.   I don't get up in the dark, so I "let" my wife Michelle shower first in order to buy me 10 more minutes of sleep. Well, not sleep, tossing. When I finally crawl into the stall, I wonder when I'll be able to shower again.

There's no breakfast for me. Docs want my stomach empty for surgery because there's less chance of nausea and regurgitation. That's an easy task for me because I have felt hungry only once in the past year.   This low-carb diet seems to control food cravings for me.

6 AM - We move stuff into the car, and we're off. The sky has lightened. I joke with Michelle about finally seeing a sunrise together, something she wanted to do on our honeymoon. Back then, all I could manage was to lift my head off the pillow and glance bleary-eyed out the window of our suite. I grin and tell her she wore me out.

7 AM - We arrive at the hospital and ride up to the reception area on the 3rd floor.   There's no representative in the waiting area, just patients and their friends. Michelle has enough hunger for the two of us, so she wanders off to find some breakfast. Before she returns, my name is called and I'm escorted with two other patients to the prep area. It's a long walk down a barren, sterile hallway that needs potted plants, paintings or something to make it less intimidating. Finally, we get to the bend which opens into the surgery prep area, and the eyes of about 10 medical workers scan us. One of the other patients grimly whispers her take on their thoughts "And, here are today's test subjects!"

8 AM - In my own little curtained area, I'm told to disrobe and put on the obligatory hospital Gown That Leaves Your Butt Hanging Out and lie on the bed. "Oh, and put these on your legs." What the heck? They're white elastic thigh high stockings designed to help prevent blood from pooling in the legs. Soon assorted nurses walk in to find out who I am (like their chart doesn't show it).   My feeble attempts at humor by claiming that I'm Brady Anderson or Mike Mussina fail miserably when the nurses' blank expressions reveal they aren't Orioles baseball fans.    But they do chuckle when I tell them I've been trying to get my wife to wear stockings like these for years. A stint is placed in my arm to provide a site for easy future injections.

The anathseologist walks in and discusses a few random facts with me. "Any allergies?" "Any reflux problems?" etc. It's good they confirm this. Another anatheseologist comes in later and we repeat the same process. My wife and father are allowed to visit my curtained area. There's the briefest awkward moment as they politely try to measure how I'm feeling. To break the ice, I show them my new stockings, "If I'd have know they were going to give me 'kinky underwear', I'd have signed up for this surgery sooner!" I'm glad they are present. It feels comforting to hold my wife's hand.

9 AM - I say goodbye to my dad and wife and am wheeled on the bed toward an operating room. Wow, looks like I'll have one all to myself!   "OK, climb down off the bed and walk this way." Gosh, for all this money, they can't carry me? I walk into the operating room, where it's freezing cold and climb onto the table; someone quickly covers me with a walk blanket. A moment later they inject something into the stint, which I think was a sedative, and I feel dizzy. I can't control my eye movement. "Umm, guys, am I supposed to be asleep yet, because I'm not." I seem to recall someone saying "OK, you will sleep..." now. I was out immediately.

12 Noon? - For an incredibly brief moment, there is no pain.   None of my multi-year ailments are bothering me. I'm in a world of suspended animation. Then I hear a voice "He's coming to." Some kind of machine is beeping an alarm. "His heart rate is below 40, but it's improving."   I try to open my eyes, but they are weighed down with bricks. I can see a little light but the world is very blurry.  I swallow. It's painful, but not as bad as I expected. Most of the pain is down low, below where a ususal sore throat is. The pain is like a cramp, not like the sharp pain of a sore throat of the flu. "Steve, how you doing? The surgery is over. Can you speak? Can you say something?" I manage to grunt a reply, and realize that I still have a voice.

My body aches and, while the incision hurts, it's not as bad as I had expected. For awhile, I simply want to crawl back into suspended animation.   That brief period of non-existence, non-pain seems much more attractive than the reality in which I'm presently stuck. It's too painful to lift my head off the pillow, my arms are encumbered by various tubes, and each of my legs are encased within some heavy machine that periodically pumps in air to put pressure on them and keep the blood moving.   I can't get back to sleep, but I've always found it difficult to sleep on my back.

I can hear everything going on around me, but can't participate in the conversation. I'm uncomfortable, but still too spaced out to conceive of doing something about it. And, somehow, I'm already bored. My body sags with disappointment and the heart monitor starts beeping again. With my blurry vision, I can see shadows as someone approaches to check that I'm still alive and reset the machine. "His heart rate keeps bouncing around."

As my brain continues to slowly waken, a somewhat perverse form of entertainment dawns on me. I relax my body and decrease my breathing, and sure enough, the heart monitor starts beeping again. I can communicate with the world! Someone approaches to give me attention! Wow! I can only play this game two or three times before my body wakens enough that I can't get my heart rate down low enough. Either that or they got wise and decreased the machine's warning trigger level.

1 PM - "OK, Steve, we're going to move you into a chair." I manage to open my eyes enough to see everything in blurry form, and, it seems incredible now that I look back on it, I get out of bed, stand briefly then lower myself into the chair. The change of position feels good for a few minutes, but soon becomes uncomfortable.   I want to wake up, but can't convince my eyelids to participate. I can vaguely remember that someone puts some oxygen tubes at my nose, and a cup of water at my side. I sip water now and then. Another surgery patient is rolled into the recovery room, and she is screaming and sobbing from the pain she's getting. From what I can recall from my cloudy memory, she had some kind of knee surgery. I feel sorry for her and lucky that I'm not in lots of pain. They find some pain meds for her and she calms down.

2 PM - Someone says "I think they gave him too much anti-nausea drug" to explain why I'm so sluggish about coming around.   I discover the chair is a recliner, and I have enough strength to push so I lean back a bit more. But, 30 minutes later I discover I've painted myself into a corner. As long as I don't move, I'm not in any real pain, but my muscles are uncomfortable and I decide I want to lean forward. I try to raise the recliner by lifting my head. Owww! The incision quickly lets me know that no such movement will be permitted. I try to support my head by putting my hand behind it, but the tubes and junk prevent me from reaching back there.   So, I just sit there thinking "You know, this is uncomfortable."   "Wow, I'm uncomfortable sitting like this." "Boy, I wish I wasn't so uncomfortable." My mind isn't focusing, so it never occurs to me to flag someone for assistance. That twilight zone of anesthesia recovery is bizarre!

At some point Dr. Koch visits. He tells me that they only took out part of my thyroid. I recall looking up at him from my recliner, and his information gets into my brain, but I can't think of any useful reply. In the twilight zone, I just sit back and absorb the info without really processing it. I don't know if I said anything coherent to him.

3 PM - They let Michelle visit briefly. As I had requested of her in advance, she tells me they only took out part of my thyroid. I'm very uncomfortable by now and I blurt back "Yeah, I know".   The politeness center of my brain still hasn't woken up, but I do manage to let her know my body's aching.   She figures out the problem and helps me un-recline the chair. Ahhh!   I'm also feeling chilly and she gets someone to bring a wamr blanket. Ahhhh! I tell her they put Vaseline over my eyes, and she wipes it away so I can see clearly again. Ahhhhh!   I love my wife!

4 PM - The lead weights are still holding down my eyelids, but in the new chair position, I'm feeling a tad more comfortable, and now realize just how exhausted I am. While under anesthesia, I doubt the body is faked into thinking it's asleep and so gets none of the accompanying benefits.   I've been up since 5 AM! I think I manage to drift off into a few very brief periods of sleep. Somewhere in between, my Dad stops in. It's comforting to know he's there, and that lets me nap a bit more.

5 PM - Either the anesthesia is finally wearing off, or those brief naps have energized me, relatively speaking, because I can now open my eyes most of the time. They suggest I eat something and supply a few saltine crackers. Wow, they are dry, but I choke them down with help from the water.

They are anxious to send me home, but want me to urinate first to prove I can. About 5:30, Katherine, who has been a great nurse, escorts me to the restroom so I can create a sample. I manage to walk there and back, probably 300 feet total, without much trouble.   Right after that, they remove some of the tubes, find me a wheelchair and wheel me down to the lobby where Michelle is waiting with her car.

6 PM - Foolishly, I had brought a pull over sweater rather than a coat. There's no way I'm going to reach in and get that sweater over my head and drainage collection container. (The container is connected by a tube which runs under the incision.) My Dad kindly drapes his jacket over my shoulders. I climb into the car and lean back in the seat a bit, using my arm to prop up my head. After I discover that stopping, starting and bumps in the road are not particularly pleasant at the incision, I ask Michelle to drive gently.

7 PM - We get home and I feel incredibly tired. I walk myself upstairs and carefully get into bed, using my arm to support my head as I lean back.  My head feels like it's a huge, heavy, uncontrollable bowling ball on my shoulders. I manage two naps of 20 minutes each. That rest gives me some energy, and I climb downto the kitchen. Michelle makes me some soup and I eat about half.

8 PM - Michelle and I sit together and she comforts me.   I don't know what I'd do without her.

9 PM - I'm ready for sleep. Both of us are pretty tired. She helps me disrobe and we pin the collection container to my sleep shirt. To my surprise, I manage to fall asleep quickly. Wow, what a day.

Overnight I keep getting up every two hours to urinate. Either my bladder was stunned from the anesthesia or my prostate was swollen because the urine flowed very slowly, and the urge returned within two hours. Otherwise I slept fairly well, and was ready to get up by an hour after my usual time.

I decided to try to resume a normal diet as soon as possible. Michelle made me half my normal breakfast, but that was a struggle to get and keep down.  I took one of the oxycodone pain killers they gave me, plus the antibiotic. I think the latter was making me more nauseated than usual. Swallowing was difficult, but not overly painful.   Again the pain was not like that of a sore throat of the flu, but instead a crampy type pain from lower down.

Our cat, watches me carefully while I eat breakfast. She passes by to give me a careful head butt. She can sense things are not normal.

I had to return to Hopkins to have the drain tube at the incision removed. I didn't like needing to make the trip because travel makes me dizzy, but there was no alternative. The actual removal was quick, with only some brief stinging at the site. While I was tempted to look at the incision when I got home, I didn't have the stomach to do so.

I spent most of the rest of the day propped in the recliner in front of the TV. I dislike resting in bed because I think it confuses the body when time comes for nighttime sleep. Lunch was half a bowl of soup, half what I normally eat. I noticed my sense of smell seemed altered, more intense.

TV is too boring for me; I need more mental stimulation than it provides. By mid afternoon, I couldn't take anymore and climbed the stairs up to the "office" computer to check email. I composed the briefest of messages to send to a few close friends to let them know I had survived. I felt too headachy to continue for more than a few minutes.

Dinner, like the other meals, was only half that normal amount I'd eat.

Woke at night with a headache, which is strange for me. I think the pain killers were wearing off. Still was not eating a normal full meal, but perhaps 3/4 of one.   Urination was returning to normal. I decided to stop the oxycodone painkiller, and I felt it this day. I was achy, sluggish and uncomfortable but determined not to rely on the painkillers.

After two days without a shower, I was feeling icky, but showers were out because there was to be no water at the incision. Michelle prepared a bath, and I sat while she soaped my limbs. Ahh, can you do my back some more? To wash my hair, we invented a waterproof scarf by cutting the bottom from a plastic supermarket bag. After sliding it over my head, we taped it so it was snug around my neck and draped over the incision area. Then I knelt outside, but next to our shower stall, with my head dangling in. Michelle got inside the shower and was able to spray my hair with water easily via the removable shower head.

I still didn't want to look at the incision.

Dr. Koch calls late.   He tells me the pathology test from the removed tissue is suspicious for cancer and that he's sending the sample to a lab in New York for review.   He also schedules repeat surgery for 11 days in the future. *sigh* Do I really have to go back under the knife?

Noticeable improvement all around. I continue to wear a coat while inside the house, though, because I find myself feeling a bit cold.

Michelle and I went to the park for a short walk around the football field. I was not exhausted, but glad to get back to the car and sit down.

I tried moving and turning my head more to stretch the muscles. And, gasp, I looked at the incision. Not the prettiest thing in the world, but not awful. It's a "smile" just above my collarbone and about 6 inches across.

Continued improvement.

I notice that I unexpectedly "hit the wall" at a random time during the day, usually the afternoon. By this, I mean I suddenly run out of energy. I might be sitting doing nothing when I suddenly feel completely exhausted and all my limbs seem to become very weighty. This malaise tends to wear off within about 30 minutes. I suspect it has to do with varying thyroid hormone levels. I'm not on any hormone supplements, but my thyroid is likely still in "shock" from the surgery.

No word yet about the additional path report. Michelle arranges for a second path opinion from a friend.

My energy levels are better and my body isn't as achy. I begin to resume "normal" activities like cooking for myself and doing a few errands around the house (like taking out the garbage).

If I were working normally at a desk job, I could probably return to work today, though I'm sure I'd feel pretty exhausted by the day's end.

I discover the thyroidmanager.com site. This site has a great selection of thyroid info written in a somewhat technical nature, but it's not over my head.

I see stats that show for my stage 1 (presumed) cancer, there is a 20 percentage point less change of recurrence 30 years after a total thyroidectomy than after a partial.   That convinces me that total removal is the way to go.

Still waiting on path reports.

Still no path report from the place to which Hopkins sent my tissue. Michelle's trusted contact however does conclude "papillary carcinoma" of "limited extent". His opinion is to not do more surgery, and instead watch it closely.

Dr. Koch recommends surgery soon because otherwise scar tissue will build up in the throat and make later thyroidectomy tougher to do without complications.

I drive for the first time and go shopping for a Christmas present for Michelle. I'm pretty exhausted by the time I get home. I guess I won't be shopping for everyone else.

My neck hurts some more today, probably due to the twisting necessary to drive.

I read assorted "horror stories" on the Web about people who had RAI and regretted it, as well as other stories about how tough it has been to get their synthetic thyroid hormone properly adjusted. I have to remind myself that the people are are NOT having trouble generally don't write about their wellness on the Internet. Thus the data sample is seriously skewed toward those people who aren't having much success.

Even so, for the first time, I get shakey and worried about what I'm getting myself into. Once the thyroid is gone, it's not like you can put it back in. I am not looking forward to this. I find comfort from prayer.

The incision is healing up well. I wonder if they are going to go back via the same place, or cut me yet another smile.

Path report Hopkins had ordered never shows up. But, they tell me if they don't tear into me now, too much scar tissue will build up and complicate matters if surgery is needed in the future.

Reluctantly, I proceed on schedule for surgery #2, worried about complications.

Here we go again.   This time the walk down the hall to the pre-op room doesn't seem as long. I know the routine, and this time I'm not in as good a mood. I find it tougher to joke with the nurses.   This time I know they are going to take out the whole thyroid. There is no going back.

10 AM - We go through all the same pre-op discussions. I let them know how groggy I was in the recovery room last time.

11 AM - They wheel me into the OR. In some ways its more scarey and others ways not. It's sorta like I'm just back, resigned to doing something again that I'm not going to enjoy.

Noon - The anesthesia puts me out in seconds again.   I can't tell the passage of time

2 PM - My eyes blink open for a moment, and I'm still in the OR, but they are lifting me off the table. Was that pain I felt?

A few minutes later I come to again. Now I'm in the recovery area, gasping for air. I can't breathe! I make wild gestures at my throat, but the people standing around do nothing. Am I dead? Can't they see my struggling? I discover I can get air by inhaling through my nose.  Have they put a tube in my throat? I try to speak but very little comes out.

This time my throat hurts, a lot, down where the removal was done, as well as in the back by my tonsils where the breathing tubes must have been. Swallowing is very unpleasant.

I'm quickly wide awake, even though with the pain I'd rather not be. At least my vision doesn't seem obscured this time.

Before I realize it, Michelle and my dad are at my side. She runs her fingers through my hair and over my scalp. It's a good distraction from the pain. They've put some pain killers in my IV and that's helping. But breathing is still a chore. If I breathe through my mouth, I wheeze and cough and choke. Wow, this is MUCH worse than the first surgery.

4 PM - I'm awake and aware enough that they roll me to my room. I'm going to be held at least one night so they can monitor my calcium levels to check if the parathyroids are working properly. I think I rode in a wheelchair then climbed into the bed under my own power. As with the first time, my head feels like a heavy weight, a bowling ball, perched on my shoulders. When I lean back into bed, I must support it with a free arm.

6 PM - Despite the pain, I'm surprised I'm actually a bit hungry. I eat small bits of dinner, and learn that swallowing is both painful and tricky.   It's difficult to control the muscles properly in my throat.

8 PM - The endocrinologists come in to visit.   They talk about doing RAI treatments, which I've already discussed with Dr. Koch that I want to delay at least until I can get my damaged tooth fixed. But, they don't know about that and at the moment I can't speak loud enough for them to understand my protests. The pain is pretty bad, and finally I give in and accept some morphine via IV. Wow, that stuff works fast! Within a few minutes, my pain reduces to a more tolerable level.

10 PM - Michelle and my dad are pretty exhausted, and they depart, leaving me to experience my first night incapacitated in a hospital.   Simply reaching the up/down buttons for the bed are quite a challenge with the tubes in my arms and aching muscles, but I don't have much choice. Is this what all elderly sick people face?

Midnight - I leave the Weather Channel on quietly in the background to bore me to sleep; just as it begins to have an effect, the parade of various techs begins. The first wants a blood sample. Then the nurse comes in and I'm able to get some more morphine.

Overnight - Blood pressure checks, samples, measurements, etc. I doubt I sleep for more than 40 minutes uninterrupted. I notice that the female techs don't turn on the room lights when they come in (relying on light from the hall) but the male techs don't have such patient concerns. I also crawl out of bed every urinate, thanks to all the IV fluids going in. The process takes about 20 minutes: 5 to roll carefully out of bed, 5 to actually urinate (my bladder is sluggish just like after the first surgery), and 10 to carefully climb back in. The process repeats every 2 hours. Again, I have a headache. Around 3am I ask one of the nurses for something for the headache, but over the next hour she doesn't return, and finally I fall asleep for a bit. It's a long night.