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### anatomy lessons

## Hernia Heaven

Thad McIlroy

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There's probably no better place in the world to get a hernia repaired. - Atul Gawande on the Shouldice Hospital, The New Yorker

I checked into the Shouldice Hospital in Thornhill, half an hour from downtown Toronto, on a Sunday at about 1:00 p.m. They took my credit card, my weight, my blood and my EKG, in that order.

Then I was ushered in to Dr. Saunders, one of three doctors on duty, for a pre-admission examination.

“So we’re repairing a hernia on your left side,” he said, checking his notes.

“Sorry?” said I.

“We’re operating tomorrow on the hernia on your left side,” he said.

“No,” I said. “My right side.”

“It says here ‘left’.”

And indeed it did. Two months earlier I had signed a consent with the doctor on duty that day for surgery to be performed on my left side first thing the coming Monday.

“You signed the form,” said Dr. Saunders.

“I didn’t read it,” I protested. “I thought he knew what he was doing.”

For a moment I thought Dr. Saunders was going to hold me to the agreement.

“Let’s take a look,” he said, finally.

He began an extensive examination of my right side, but failed to detect any sign of a hernia. He poked and prodded. I held my breath. I strained.

“Nope, I can’t find any evidence of a hernia,” he said. “No, wait. There’s one inside your belly button. Did you know that?”

“Nope.”

“Does that hurt?” he asked, sticking a couple of fingers deep into my inny.

“Yep.”

“That?”

“Ouch. Yes!”

“Well, it doesn’t matter. If you haven’t noticed it before, we don’t need to fix it,” he said dismissively. But the Chief Surgeon, he said, would examine me first thing in the morning and decide what was to be done.

I offered to go home and come back the next day. Dr. Saunders said I should stay the night.

I got bed number 2, by the window in Room 205. My roommate, an old guy named Fred, had been operated on on Friday and was slated for discharge Monday.

“Don’t worry,” Fred said to me. “It’s not so bad. You’ll be up and about in a couple of days.”

“Oh good,” I said.

I went to the orientation session on the third floor with the other thirty-one patients—middle-aged men and “old guys,” and one who appeared to be in his twenties—admitted that day. Dr. Saunders went over the information in the brochure they had already given each of us, and then Nurse Jane gave us the schedule. Dinner at 5:15 on the main floor. Sleeping pills at 9:30. Nothing to eat or drink after midnight, including water. “Half of you will shower tonight,” she said, “and the other half in the morning.And make it last—you won’t be able to take a shower again for a week after surgery.”

The young man is the only one with a question.

“What happens if I leave before the four days is up?” he said. “Four days is too long to stay here.”

One of the old guys spoke up. “Why? You on the lam?” Another said, “Walk, don’t run.” Everyone laughed, a little uncomfortably.

The nurse said, “If you want to leave early we can’t stop you. Just make sure you let us know. If you go AWOL we call the cops.”

Dinner was a fillet of something that once lived in water. I was at a table with two guys in their sixties who looked like brothers, and with a tall goofy guy, about forty, from Thunder Bay, who wore a San Francisco 49ers baseball cap. On one side of him was a handsome South Asian guy, and on the other side, the kid.

The two guys who looked like brothers were in fact cousins from Windsor. They had finagled to get admitted at the same time and to share a room. They were both having double hernia repairs and were scheduled for six nights. The one sitting next to me, the shorter of the two, said there had been some controversy about his diagnosis. One doctor had said he didn’t have a hernia at all, another said he had one hernia on the left side, another two doctors had agreed that he had two hernias, and yet another doctor said that whether he had a hernia or not, if so many people believed that he did then he probably did have at least one hernia and he should get it or them looked after.

I asked him whether he felt any discomfort.

“Nope.”

“Can you feel either hernia at all?”

“Nope, I can’t. But the doctor’s convinced that I’ll need them looked after eventually. So I’m here.” He shook his head.

Beyond that the stage was pretty much shared between the guy from Thunder Bay and the kid. Thunder Bay was rich with the wisdom of fresh experience and eager to share with us newbies. He’d had one side stitched last Wednesday and the other side on Friday and had just one more night to go. The South Asian guy had had a belly-button job last Friday.

“I’m having mine there too,” said the kid, pulling up his sweatshirt to reveal a small X just north of his belly button.

The kid was the only one in the group who had asked for a full anaesthetic; the preference at Shouldice is for a local anaesthetic only, with lots of Valium. So why the full anaesthetic? The kid said he had tried a local for an operation on one of his hands and he had looked over and saw what he said was “the flesh flapping.” “That was enough,” he said. “Never again.”

I doubted that he would be checking out before me.

After dinner I went out for a walk, but it was already too dark to admire the twenty-six acres of lawns and woods and the putting green, surrounding the hospital. Thornhill had blossomed since I’d last been there. Across the street there was a new mall and a community centre with two skating rinks and a library. The mall hosts a Shoppers Drug Mart, a CIBC branch, a physiotherapy clinic and a Java Burst coffee shop.

A large crowd of slightly dissolute-looking men and women were gathered outside the arena, smoking cigarettes, a couple of them in wheelchairs, puffing heavily.

The foyer was packed with ex-smokers of similar age and disposition, and kids jumping up and down and making too much noise, hoisting duffle bags filled with skating equipment, anxious either to leave or get their turn on the ice. A Zamboni was gliding over the rink to my left. On my right a game was in full swing.

It was league competition, a Home team and an Away team, and the parents were screaming. A slightly less disreputable-looking group filled the bleachers and intermittently screamed at their sons at the tops of their lungs. I stepped in and found myself next to the boys’ change room. Kids were coming and going. The air smelled of sweaty socks.

People seemed to eye me suspiciously. I couldn’t imagine why. Probably everyone knows everyone else around here and they could see that I didn’t have a child on or near the rink. I left after a few uncomfortable minutes, after Home scored a goal.

I bought a Colgate toothbrush for $1.99 at the Shoppers. It featured extra gum-scrubbing action.

Then I took some money out from the bank machine at CIBC. The coffee shop had closed so I went back to Shouldice.

I’m sitting now in the piano lounge downstairs next to the dining room. Water falls gently from the fountain nearby. No one is playing piano; it’s not clear what it’s doing here. But we were told that the wireless signal is strongest down here, and sure enough, it’s good. The loud guy in the bright red jersey sitting on the couch five feet from me can hold his iPad on his lap and talk loudly to his wife, whom he can see on-screen, and who, I assume, can see him on her screen. They’re catching up on what’s happened since she was here in the afternoon, and what might happen between now and nine o’clock tomorrow morning, when she’ll be back again.

A few minutes later the man in the red jersey has found another friend with whom he’s now discussing his Internet data plan. He screwed Bell over because Bell screwed him over, he says. Though sometimes he feels bad for Bell. Shaw, on the other hand, does one thing only, and does it well.

It’s going to be a long night.

First of two parts.

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Thad Mcllroy is an electronic publishing analyst and consultant, author of more than two hundred articles and several books on the subject. For three years he has been named one of Canada's fifty most influential people in graphic communications. He lives in Vancouver and at thefutureofpublishing.com.