Wednesday, August 15, 2012

Isthmus

Note:  a few medical details, including mention of needles, today.  The squeamish should look away. You have been warned!

This past Monday, Herself went in to have a biopsy of the thyroid nodule, as was requested a few weeks ago.  Though it was not particularly painful, it was rather an unpleasant experience, and Herself is glad it is over.

After a lengthy (but not unexpected) wait of three-quarters of an hour, Herself was ushered into the biopsy room, and signed the consent forms while the nurse carefully arranged the accoutrements of biopsy: a tray with a dozen or so glass slides; small vials of some unknown liquid; numerous needles removed carefully from their sealed packaging and lined up methodically next to one another.  The nurse quietly closed the door of the room behind her, leaving Herself alone to contemplate the medical instruments, the ultrasound machine, and a mysterious refrigerator with locks on the doors.  Alas, there were not even any elderly copies of Golf Digest or Living with Diabetes to peruse.  Dull, anticipatory waiting.

After another full half an hour, the doctor appeared and answered, a trifle vaguely, Herself's questions regarding the purpose of the biopsy and the strategy for ongoing management of the nodule.  The nurse then reappeared, and it was time.  Up onto the table Herself was arranged, with a pillow under her shoulders and with her head tilted far, far back.  She could see the ultrasound screen upside-down to the right, and had a direct view of the rear corner of the ceiling in the room.  The corner was oddly devoid of arachnid; a spider there would have been a distracting curiosity, to be sure.

The doctor sought to identify the nodule with the ultrasound wand. There was difficulty, however; the nodule is located somewhat unusually on the isthmus, rather than on either lobe as the doctor expected. Time passed and minutes ticked by as Herself's trachea was squashed this way and that by the ultrasound wand. It was difficult to swallow or speak. Not an agony of pain, by any means, but certainly quite uncomfortable.  The doctor did provide a brief tour of the grey blobs of the ultrasound image for Herself:  "Here's the carotid artery; here's the tendons that attach your windpipe; here's the thyroid."  It all looked rather the same to Herself from her upside-down perspective, except for the pretty red and blue of the blood coursing through her arteries.

After an interminable ten minutes (or perhaps closer to fifteen - the clock was not visible from Herself's position), the nodule was located. There it is!  Then, the needles began.  First, local anesthetic.  The nurse kindly held Herself's hand while the doctor numbed the relevant area. (Such a lovely person, the nurse.)  Then, while the nurse held the ultrasound wand in place and rested a reassuring hand on Herself's arm, the doctor inserted the biopsy needle. 

There was pressure and the sensation of movement of the needle; and a sharp push, push.  Sample one of three.  Herself stared at the spiderless corner of the ceiling and wiggled her toes to try to relax while the doctor and the nurse worked on the slides.  She overheard, "See those black spots there? Those are the cells."  Then they were back again for a second biopsy sample. Repeat.  "It's difficult to get a good sample because there is scar tissue.  I don't know why."  A third.  And done. "Put some pressure on here."  The doctor exited.

Herself held a small square of gauze to her bruised and numbed throat. A tiny circular bandage was eventually applied, and Herself was allowed to sit up.  A bit of dizziness washed over her, caused by having had to remain supine for half an hour with her head below her shoulders. Eventually her head cleared.  Herself thanked the nurse for her thoughtful care, and went home.

We shall get the results in approximately two weeks.  With a bit of luck, Herself can avoid another biopsy for several more years.

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