So to have surgery, since I am now fused occiput - c4, I have to be intubated using fiber optics. This is a major thing to go through, but personally I feel informed is the best armor when dealing with something hardcore, thus I am writing about it. Here's what happened to me (since I don't know for sure that EVERY awake intubation is done like this).

The anesthesiologist came in and took a look at my mouth size, how far I can open my mouth, and my ability to extend my head (tilt back.) Based on that visual exam he made a decision on the need for awake (fiber optic) intubation.

They started an IV & started pushing a sedative of some sort.

• Make sure to tell them if you have a major gag reflex! They can give you an extra drug to help minimize your gagging.
• It would be helpful for you to also start using a netipot or other nasal saline clearing regimine. It will help with the one of the next steps.

The anesthesiologist gave me an extra drug to help with my gag reflex after I told him about it. Then he gave me a big blob of gel lidocane to swish around in my mouth. For as long as I could keep it in my mouth and when I couldn't, I was to swallow it. An atomizer comes into play next. Lidocane...more lidocane. I was instructed to inhale and they would spray the atomizer. We did this little dance a bunch of times. When he was satisfied that we'd done that enough times he went for the medical swabs. The big ones. Out came the medical cocaine and one after another the swabs were dipped in & then stuck up my right nostril. 4 in all. Ick. Once they'd left those in for awhile he pulled them & got basically a nose speculum out. It wouldn't go in my nose...cram cram cram. Nope. One of the students or assistants suggested that he warm it in water (the latex ones are softer, but I'm sensitive to latex). That helped. So now the hard plastic bit slides up into my nose. Crack pop crack crack pop. "What's that noise?" I ask. You can hear that? Mmm. Little bits of cartilidge breaking in my nose. Tube is in. Then the fiber optic thang to take a look at my wind pipe. Ok. We see it. Then out comes fiber optic, in goes breathing tube. Then they say they need to make sure it is in the right place. Fiber optic back in to take a final look. That's the last thing I remember.

When I woke up, I was in recovery. No intubation in evidence. Ah. Very Good. Felt pretty alert. Gotta make a note that they got the right anesthetic this time. Yea! I hear a few people talking. Ooh, Eliot's coming in ? We should get her cleaned up so he doesn't freak out. Here Kriss, we're going to clean your face up. Wet cloths on my face, gently swabbing off blood and dried blood. A little sponge on a stick scrubbing the worst of the blood off my teeth. Seemed like quite a bit of blood. Eliot said when he came in it was still pretty messy. So obviously some bleeding went down in relation to the intubation.

And blood lugis. Blood lugi blood lugi blood lugi. Tuesday the 16th was the first time that when I cleared my throat it wasn't a blood lugi. Don't know where it all came from. Some was old blood. Some was new blood. Ick.