Surgery #4

Tibial Osteotomy

We went to San Francisco on Monday to meet with anesthesia and the orthopedic surgeon one last time and sign consent. There was a child life specialist who met with Evan and went through a whole role play of what to expect on Friday. They had little doctor dolls with masks and hair nets, and they had a little doll with a hospital gown. They had a miniature operating table, a tiny IV and a little mouthpiece for anesthesia. She let Evan control the scene and told him everything that would happen. Then she gave Evan his actual breathing mouthpiece and let him choose a scent to put in it for comfort. He chose chocolate.

We had a check-in time of 5:30 am for a 7:30 start on Friday. We were SO blessed to get a room in the Ronald McDonald House on the 1st floor of the hospital. We were able to stay there Thursday night to avoid such an early drive on Friday. A miracle happened Thursday night. We all got into our room, laid down in bed, turned off the lights, and... SILENCE. Seth--who typically jumps in bed, cries, plays with toys, leaves his room a million times, and takes two hours to fall asleep--was SILENT, and went right to bed. I was amazed.

In the morning, Evan and I went up to the 2nd floor at 5:30. We watched the Minion movie in the waiting room. The child life lady was there with Evan's mask. She brought him into a room to decorate it with stickers and rub the chocolate scent in it. Isaiah and Seth came and joined us. Then we went back to the pre-op room. There was a tablet where Evan played a donut game. Seth did lap after lap around the floor in the wagon and cozy coupe taxi. We pointed out all the animal decals on the walls. I kept waiting for the point where Evan would get scared. Maybe once we were in pre-op? Maybe once he had his hospital gown on? Maybe once they started wheeling him to the OR? Maybe when they started anesthesia? It never happened. He was so calm. His only crying that morning was prior to going up to the waiting room when he was so eager to leave that he wouldn't let Isaiah give him a blessing.

I went back to the OR with Evan. One of the doctors said she has a 20-year old son with spina bifida, and another said that Evan already had a special place in all of their hearts for that reason. They scooted him onto the operating table, he breathed through his chocolate mask for about a minute while we talked about chocolate brownies and chocolate syrup, and then his eyes fluttered closed. I gave him a kiss, (cried a little), and left. The doctors told me they'd take good care of him.

We received text updates about every hour letting us know, "The procedure is in progress.", "The patient is doing well.", "The procedure is going well." We took a walk outside, played on the grass hill, and bought Evan a "Get Whale Soon" balloon. I was again so grateful to have a room in the Ronald McDonald House so we could relax and Seth could nap. About 1 or 2 o'clock we got the message to go to the waiting room. Isaiah went up and got the report from the doctor that things went well. After a little while he was able to go back and see Evan, whose first request was to play the donut game again.

The thing I was most nervous about with the surgery was him waking up afterwards (or rather, not waking up). This is a fairly basic surgery with limited risks, but it was almost exactly 3 years ago when Evan had his shunt surgery (also pretty standard) and didn't wake up when he should have, leaving us wondering if he was brain dead. Even though I was receiving positive texts about this osteotomy, I was not relieved until I knew Evan was awake and responding afterwards. Thankfully that happened much, much faster this time around.

About the osteotomy: Evan's feet pointed in. In looking at his legs, you could see he had some turn in from the hip to the knee, but the majority of rotation was from the knee to the ankle. From what she described (obviously I can't see it yet), the surgeon made a two inch vertical incision at each ankle. They opened things up, put protection around the bone to avoid injuring the soft tissue, and then cut both the tibia and fibula. At that point they rotate the foot and basically eyeball his foot to line it up with his knee. Then they put in a plate and screws which holds everything in place until the bone can heal. They cut at the bottom of the tibia because it's a good place for healing. They cut the fibula also to avoid straining the ankle after the rotation. I still don't entirely understand how it works, but I know his legs are now straight for the first time in his life.

Prior to surgery we thought he would be put in casts up to his mid-thigh. The surgeon said she had never performed this surgery on someone as young as Evan so she wasn't sure if there was a plate that would fit him. She said they would try to use a plate and screws because it is the most secure, but if it was looking too big and awkward then they would do pins. The pins are not as secure so they would have needed to cast higher up for stability. We were super relieved that the plate worked and his casts go to just below the knee. I'm glad Evan was okay with the length. I'd only told him a thousand times exactly where his casts would go up to on his legs. He also had memorized the spiel, "I'm going to have surgery and then I'm going to be in a wheelchair." After surgery he kept repeating that. I told him he already had surgery...that's why he had casts on. He was extremely confused why he wasn't in a wheelchair yet. "Where's the wheelchair?" "When am I going to be in a wheelchair?"