Day 10. A week and a half. Two hundred and fifty hours since I underwent surgery. So long and yet so very little time for my body to do amazing things.
Close your eyes and think about how the flesh inside your cheek feels. Can you even imagine any feeling at all? Or is it just sitting there?
Over most of my body, I can’t even think how the flesh feels. I might sense a slight breeze on the outside of my skin, or a faint sensation where my clothing or watchband are touching my skin, but inside? Nothing.
But over a whole swath of my left face, from just inside my top lip to where my glasses rest on my nose, and across to below the outside corner of my eye and a triangle back down to the left corner of my mouth, my face is buzzing and alive.
While I eat, while I read, while I sleep, while I am typing this, it feels like someone is touching it with the finest of metal combs, while inside perhaps gnats vibrate the flesh with tiny wings. Something vibrates under my eye, as if loud music playing below my ears’ capacity rattles the bone. If I lift my glasses off my face, it diminishes for a moment and then resumes in a new register.
I suspect this is what tinnitus is like, only mine is silent and sensory.
Healing processes at work
All of this, of course, is the feeling of my body working to heal itself. How astonishing to think of the work my biological system has put in over the last five weeks.
Tiny vessels, working against gravity, carrying red blood cells full of oxygen, white blood cells full of immune components, and lymphatic fluid to bathe the broken bones and bruised tissues from the original injury, leaving pools of the dead cellular army in their wake—the bruises that turned red, then blue, then pink and purple, and then green as their brethren came and scoured the dead away again, gradually moving it back into my veins to be cleaned up in my kidneys and removed from my body, the green and yellow seeping down my face with gravity as the work was nearly completed 10 days ago. Last week, the last remnants of the purple and pink on the top of my eyelid finally faded away.
The responses to external influences as I laid ice packs against the broken areas, slowing down the reaction, and then later applied warm packs to tell it to hurry up and carry away the waste.
“War Games”: Body edition
I picture the involuntary body systems as being controlled by a little cartoonish figure, deep in the brain, who sits before a bank of computer screens, like in the movies about space or war games. Usually the commanding officer has his feet up on the desk, his gaze scanning the monitors as they beep and blink without incident.
After my fall, alarms blared and red lights flashed as supporting forces raced into the room. The blood and lymph systems scarcely needed to be told what to do; they know the drill from every paper cut and elbow bumped on a doorway. But the systems that respond to broken bones—they’re seldom called out of the dull routine of the daily rounds. Still they snapped into action, scratching their heads at the cheekbone in disarray, the nose bone blocking the route to the sinus, the eye socket crumpled and jarred. They shrug like soldiers of an underfunded nation—“We do what we can”—and begin healing the bones where they stand, sending notes back to the brain. The eye’s over here now, so see what you can do to fix the vision so it’s clear again.
And then, just as things were looking good and the officers were privately telling themselves they had done a pretty good job and things were settling back to normal, surgery.
The tiny commander in his olive green jumpsuit takes a look around the command room. Resources are still a bit depleted, but rhythm has been restored. All situations pretty normal, except for the hard lump under the chin—send some more fluid to wash that away, it takes time—and a bit of swelling in the jaw. But then, flashing lights and violent alarms sound.
Imagine a body during reconstructive surgery …
Lying in the OR, the body cools and sleeps and the insults begin anew. Asleep, the brain can’t make sense of what’s happening; the pathways to pain are blocked off by clever anesthetics. Incisions, insertions, “some cautery” (meaning the surgeon is closing off tiny blood vessels by soldering them shut, the reason I had to remove my nose piercing before surgery).
Dr. D “pops the bones back into place,” a euphemism if I’ve ever heard one. Doctors graciously avoid details, but my mind gingerly sketches possibilities. The best time to do surgery is within a week or two after the injury, before the bones heal very firmly. I had surgery at the end of week three, which means there must have been some fairly significant healing done, with the bones in the wrong place, and the “popping” had to involve breaking or cutting through that new tissue to put the bone where it ought to go. Facial surgeons use tools called “elevators,” which aren’t a motorized car that bones step politely in and out of (maintaining social distancing), but rather metal tools that resemble nail files and can slide beneath bones to lever them up as with a tiny crowbar.
Later Dr. D told me my damaged sinus—the front wall shoved in—“was pretty full of blood and stuff,” and by her use of past tense I deduce that she cleaned it out; I picture her bending over me with a dollhouse-sized shop vac between two fingers.
She also “put in some plates,” which are tiny titanium bars with holes punched in them, like a stencil or a pasta measurer I used to have. “Putting in” sounds like she just set them in place, but in reality she must use a teeny screwdriver to bolt them down with titanium screws the size of eyeglass screws (smaller? who knows?). Before this, I had no idea what titanium is, other than a desirable material for men’s wedding rings, but the story of titanium implants is quite interesting. Titanium is stronger when it bends, and it’s one of the least likely metals to cause a reaction in the body; the screws, in fact, can fuse with human bone and are harder to remove than they are to put in. Fortunately, for most people, they never need to be removed; I strongly hope I am in the majority here.
Dr. D also “tried an implant” in my ocular floor—a teeny wire mesh piece that would shore up the eyeball from beneath—but decided it didn’t look right; it raised my eye too high, and after she had put all the other bones in place, the paper-thin piece of the ocular floor that had dropped in the injury “kind of went back into place on its own.” All a bit fuzzy, but it’s horrible to think of her working away, snapping the mesh into place, perhaps popping open my eyes (someone else would have to help, wouldn’t they?), scratching her chin with a scrubbed and gloved finger, shaking her head, and pulling the mesh back out.
(Here I will pause and note that in my pre-surgery exam, I mentioned something about my knowing my hand-eye coordination was working because I could grab a Japanese beetle as usual and throw it in soapy water, and Dr. D said, “Yuck!” This from a woman who literally cuts people’s faces open for a living.)
Then she threaded a tiny needle with navy thread and stitched me up under my eye, and threaded a different needle with fat white thread and stitched me up inside my lip/gum/cheek. She pasted a bunch of bandages around my eye to keep the muscles from jostling the incision as it healed. They must have washed me up, bathing the blood away. (On the Netflix series “Lenox Hill,” which I was watching before my accident, it moved me to see the brain surgery teams washing the patients’ hair after their procedure to get the blood out before their families see them—a small gesture that had never crossed my mind.)
All the while, she was working around the infraorbital nerve, a band I imagine like an old-timey electric cord supplying power to my lip, nose, and cheekbone, moving it here and there, bumping up against it, bone rubbing and bruising, causing tiny, unavoidable injuries to nerve cells and connections.
Recovery means starting over
While Dr. D cleaned up, drove home, and slid into bed, nurses and technicians moved me from the table back to my bed, rolled me to imaging, moved me to the CT scanner and slid me in. Moved me back to my bed again and settled me into a recovery bay. Mike, the anesthesiologist, made sure I was waking up and then clocked out for the day.
As I came to, asked about my state of mind as I’d awakened, and flipped through my Spotify to find Lucinda Williams’ familiar reassuring rasp, deeper physical signals started sluggishly reaching my brain again. Wounded messengers trickled into the command room, reporting a serious situation at the site of the previous assault. “Things are even worse this time!” they announced. “The overall profile is more like it was originally designed, but we’ve experienced extreme blood loss, multiple lacerations, widespread tissue damage, severe casualties to the nerve, and vast areas of foreign substances,” from the titanium plates to the suture thread to the painkillers and antibiotics flooding my bloodstream.
Ultimately, the healing has actually been faster this time. Maybe already-activated systems worked more smoothly. Maybe weeks of excellent nutrition and rest had me primed for recovery. Perhaps it was quicker to have my pieces reassembled by a highly educated expert—Dr. D—instead of lying haphazardly where the accident left them. On Saturday, I didn’t look too bad. On Sunday, fluid had swelled my facial tissues so the left side of my face was massive compared to the right, the skin stretched taut. By Tuesday, I was down closer to normal dimensions. By Friday, the bruising had already turned green—a degree of external diminishment that took two and a half weeks the first time, compared to a week this time.
Today, day 10, there’s scarcely any green left. Last Friday, day 7, Dr. D snipped out my stitches, and after applying some gentle salve and a cool, damp washcloth overnight, I was able to carefully flick away the dried scabs; my body had re-glued the skin back together with its own cells, a not seamless but barely visible scar in the crease beneath my eye, as promised.
My cheek is still swollen inside; though it’s hard to see, I can feel it, a thickness and immobility that doesn’t match the plasticity of the right cheek. My smile remains crooked; I remind myself the original healing looked much closer to normal after three weeks, which is still 11 days away—longer than the time I’ve spent on healing, round 2.
Why I’m still so tired
I want to feel normal—I kind of, almost feel normal—but I’m still so tired, which seems ridiculous given how little I’ve been doing, until you think about where the energy is going, the busy exhaustion of the jumpsuited commander spinning between monitors deep in my brain.
Blood and lymph, still monitoring for infection, carrying away waste, working to deliver painkillers and carry away the toxins that come with all the medication.
Bones, perhaps even the large bones far from my face, hastily producing huge quantities of stem cells and new osteoblasts, the cells that create new bone, to finish healing the eye and the sinus, diplomatically ignoring the insult of their original work having been destroyed, and creating a detente with their adoptive siblings, the titanium hardware that is, apparently, here to stay. Other cells continually evaluating and reevaluating the situation with those implants.
The ocular nerve, studying and evaluating the eye’s position and reframing how I see things, again and again and again, so my eyes can team and work better together.
The blood vessels that have been reducing the lump on my chin and the bruised bump on my eyebrow, continuing Project Return to Normal, which has engaged them for five weeks.
And the part I can feel: the infraorbital nerve, which must consist of millions of neurons, all reporting back to the brain rapidly and continuously, on what’s happening in their individual, minuscule territory. The commander, in turn, is jiggling knobs and ordering programmers to try new approaches in an urgent repair mission. The messages zing from nerve to brain and back at up to 275 miles per hour. In contrast with the nerves in my other cheek, which are probably humming along at a low dormant state unless I scratch my cheek or squinch my eye, the left cheek is in a state of constant activity right now, reporting and healing and testing and reporting.
So yeah: I’m tired, even though it looks like I’m just sitting here. It all makes sense now. Time to rest my eyes. Again.