Sunday, April 5, 2009

In the Hospital (Part one)

Well, if anyone is wondering why this took so long to post, I'll tell you right now that it is exceptionally hard to compose anything on the computer when the words on your screen spontaneously start jumping around the screen and doing the hamster dance (less music). No, I'm not talking about some new computer virus, but rather the mildly hallucinogenic side effects of hydrocodone on a man five days after surgery. So that kind of slowed me down a bit.

However, I figured after venting my frustrations and anger for most of the kingdom to read, I might as well put a bookend on this story and tell some of the positive parts of my tale.

The rescheduled surgery was for Tuesday, the second of March. This time, however it was for noon, meaning that I didn't have to show up before sunrise for registration. I was there the Monday before for lab work, and this time the lab techs drew about three extra vials of blood from me, just to make sure there was no repeat of the previous week.

So, Tuesday arrives and my whole family loads up and heads down to the hospital for the big event. I arrived early, signed in, and was shown up to the surgery waiting room. The volunteer who greeted us recognized my name and asked me “ weren't you in here last week?” rather bluntly. He wasn't being rude so much as just stunned as seeing a name twice in two weeks. We joked it off, and gave the man the summary statement of the previous week. He didn't say anything else, but I got the impression that he had heard more than he was saying. (Actually, I wont detail any of this beyond this statement, but throughout the previous day and Tuesday morning, I heard several comments that lead me to believe that hospital administration had made their presence felt in spaded after I had had words with a few of them the previous week.)

Anyway, to make a long story short, I was lead back into the surgical prep area and run through the same gambit that I went through before. I put away my things, changed into the drafty hospital gown, and then sat down on the bed to wait for whatever was to come. My mother, wife and son were all there at one point or another. Though after a while I directed them all back to the waiting room. It was taking me all I could muster to maintain my composure, and the stress of having to keep a smile in my face for my three-year-old son was really, really hard.

I would like to point out that a friend of ours from the SCA volunteered to watch our son during the middle of the day. Obviously, naming names here would be inappropriate, but they know who they are, and I extend to them my greatest and deepest thanks for helping my wife out during this time. By all accounts my son had an absolute blast playing with his friends, and for my family, not trying to keep a three year old entertained in a hospital waiting room was a God-send.

So, the hour approached and I got to meet the team once again, including the new anesthesiologist, and the same head surgical nurse. The anesthesiologist and I spoke briefly, and he said he wanted to give me a pain blocker before the surgery, it wouldn't do anything for the procedure, but would probably help me for a while afterwards. I shrugged and agreed, figuring that I had nothing to loose, and I wasn't in any hurry to feel any more pain that I really had to, within reason anyway.

Just about then surgeon came in and went over some last minute details with me. One of which was when he explained where the spleen was, and that mine was enlarged, about twice the size it was supposed to me. Well, I knew where the thing was, I had known that ever since I was told I would need to have it removed. However, the whole part about it being enlarged... that was news.

“Um... Doc, Whats this about it being enlarged?”

“Oh, yeah.” He explained. “We've known that since the ultrasound last month.”

I nodded, and recalled a number of other such proclamations that the man had made in the past. It wasn't that I was upset about the spleen being enlarged, it wasn't going to be a factor in a few hours anyway. However...

“Okay, an when were you going to tell me this?”

Understand that this isn't the first time I have asked the man this exact question. To his credit, he took on a slightly sheepish expression. “Oh... sorry.”

I just rolled my eyes. “You were saying.” Like I said... it wasn't going to be a factor one way or the other in a few hours anyway. And I had made my point (again) about how I wanted to be kept in the loop about my own treatment and condition. So, anyway, after the last minute pow wow, everyone went their separate ways.

A short time later the nurse came and wheeled me out of the prep room and into the operating room. While she was doing that I was relating one of the funnier stories from my time as a volunteer fire fighter, she got a kick out of it and the laugher helped me get past the nearly paralyzing apprehension I was feeling.

Anyway, that pain blocker I mentioned, its administered by injection directly into the spinal column, kind of like an epidural, but without the hose and all that. The nurse mentioned that she had gotten one before and that they didn't hurt too bad. I had to sit up while the anesthesiologist numbed the injection site on my back, in general terms it was about halfway between my waist and the bottom of my shoulder blades as I remember, but even then I was just guessing. The truth be told, the numbing injections weren't bad at all, I think a bee sting would be too strong a comparison. And I didn't even feel the needle that went into the spine itself (Thank God!).

However, when the anesthesiologist was done, he grabbed the sterile sheet that was taped to my back and yanked it clear in one swipe, taking about a square foot of hair with it. I nearly came off the table I jumped so hard.

“Hay!” I shouted over my shoulder. “ How about some warning next time!”

“Sorry” the man replied through some considerable laughter. “Forgot that that part wasn't numbed.”

The irony, and the humor of that hit us all about the same time and for a few moments all of us were laughing pretty hard at my expense, and I honestly was enjoying it.

So, they laid me back down, and a moment later the anesthesiologist told me he was about to administer the first round of drugs. I waited for what was probably a solid minute (I was counting the flashes on the digital clock on the wall, so I know I wasn't too far off) and then said.

“Are you going to hit me or not, doc?”

“Actually, I just did... about three seconds ago.” he replied.

That thought took about a second and a half to register with me. This was the moment that I had been terrified of for the months leading up to this. The fact that I was going to be rendered unconscious by an outside force was just terrifying for me, and here I was, all of a sudden face to face with that exact sector.

I only had one response, “Oh...”

The next thing I know, I'm looking at the ceiling of the ICU as I am transferred from one bed to another. There wasn't even any time perception in between the two images. As far as I am concerned, it was like having someone flip the channel on a TV screen. One second I am looking at the OR ceiling, the next I was looking at the ICU. Just like that, and in less (perceived) time that it probably took you to read the first sentence in this paragraph.

Now, while I was not conscious for any of it, I do know that I was hit with the first round of anesthetics just after noon I don't know what time I woke up, but I know it was late, probably after seven or eight PM. So, call it eight hours. I was so stunned by the suddenness of the anesthetic that I remember asking one of the people who was standing by me “am I done?” In retrospect, I don't think that their would be any other reason to put me in the ICU if I wasn't done with surgery, and I even remember thinking at the time that I probably was done, but still...

“Don't worry buddy.” a male voice replied. “You're all done, you did fine.”

To give you an idea of how lucid I was at that point I remember saying “Cool, I think I'll go back to sleep now.”

The truth of the mater is that I didn't sleep. My situation was too out of the realm of normal for my body to go back to sleep. My abdomen was numb, well most of it anyway. And what wasn't numb was tender, and sore. I was in a different type of hospital gown than I had been wearing when I went into the OR, and there were bandages across the left half of my belly. I had an IV in the back of my hand, and arterial line into my forearm, and a huge line into one of the veins in my neck. Oh, almost forgot, I had a clear plastic drain pipe running out of one of my incisions, and a pain pump and delivery line leading into another.

Add onto all of this a naso-gastric line. Don't know what those are? Well pull out your Latin books and cringe alone with me. Naso means Nose, Specifically its the same root as Nasal, and Gastric comes from the same root as Gastrointestinal... So yes, its a plastic hose than runs into your sinus cavity, down your throat and into your stomach. Its used to keep the stomach from producing too much acid while your under. I'll be the first to tell you, that of all the lines and wires they had me hooked up to, that goofy NG tube quickly earned its way to the top of my “get rid of” list. Just it by itself made breathing and swallowing tricky, and the latter became mildly painful when my sinuses realized their was something in there and started dumping mucus in response. Imagine a major head cold with ugly drainage, and you have a quarter inch diameter hose running down your throat.

Well, it was a long night. Best as I can figure, I was awake most of it, from eight PM on. I found the controls for the bed and raised myself up into a sitting position, almost fully upright. From there, I just sat still and looked at my surroundings for most of the night. I don't know why, but I didn't watch TV, even though there was a remote right next to me. Every half an hour or so, the blood pressure cuff on my left arm would automatically inflate, and the computer it was hooked up to would take all my vitals at the same time and transmit them to the nurses station.

About a hour or so after I woke up... give or take, I guess, my wife came in. By then it was late enough that she really only had time to say hello and tell me she was leaving. I learned that my son had already been taken home by my mother, and my wife had to follow relatively soon. We said out goodbyes, and I reassured her that I was awake, so the worse was behind us.

The rest of the night was a long, lonely one, but not unpleasant, considering the situation. I sat still, and just took in my situation little by little as time progressed. I probably dosed here and there, but I have a mostly coherent memory of the majority of the night, so I was probably awake more than not. The ICU had a strict policy against even activating cell phones or laptop computers, and there were no land lines in the rooms, so I was completely cut off from the outside world. Though I have to admit, I was so worn out at that point that holding a phone to my ear would probably have exhausted me in a hurry.

Dawn brought the next shift of nurses, as well as the ICU turning up their lighting. I hadn't noticed it before, but the ICU wing turned down most of the hallway and room lights during the night shift, kind of like on a submarine, where the overhead lighting is dimmed so that the crew has some sense of “day” and “night”.

It was at this point that I met Chris and Sheela, the two nurses who would be looking over me for the day shift. Chris kind of reminded me of a more modern B.J. Hunnicutt, not so much in appearance, but in attitude, and comedic timing. Not only was Chris a consummate professional in his work, he also went the extra distance to lighten my spirits, and try and keep a smile in my face when he could. When I had questions, he never hesitated to answer them, and when I didn't understand the answers, he never seemed bothered by having to explain himself a second time. Sheela was slightly less involved in my care than Chris was, though I think that was happenstance more than anything else. The two of them were responsible for three or four ICU rooms from what I remember, and all four of us had out own set of demands during the day. That being said, I did get to speak with and interact with Sheela a good deal as well, and she too was an excellent nurse, and also had a pleasant and uplifting sense of humor.

Some time during the morning, I think it was probably eight or none, Chris explained to me the pain scale that the hospital used. It worked on a one to ten spread, with one being no pain at all, and ten being the worse pain I have ever felt in my life. I explained that I was “aware” of the incision in my abdomen more than anything else. I wasn't in any real pain or discomfort at the moment, but it was there, and any movement or shifting on my part did cause some discomfort. We talked about it for a bit and kind of came to the mutual agreement that I was probably at a two.

About half an hour later, that number very (and I to mean VERY) clearly went from two to three. Chris had said that I needed to let them know when or before the pain reached four because the pain killers I was on would take about thirty to forty five minutes to take effect and I didn't want to wait too long and have to deal with a five or a six. I called him in and told him that I was at a three, and really didn't want to see what four felt like. Chris nodded with a smile and said “Okay, I think we can work with that.” He left and came back in about ten minutes later with my pain killers, and I can honestly say that I the pain never got to four.

My mother arrived later on that morning. I was thrilled to see her, largely because she was my only contact with the outside world at that point. I had no other way to check in on my wife and son, or find out what was going on outside the hospital in general. For someone who liked to be able to check on things in the news, and check in with people via e-mail and IM every little but, being isolated in a hospital room was a real shock to my system on a bunch of levels.

Keeping in mind that my mother was no stranger to hospitals (my grandmother and aunt were both long time nurses, I and both of my siblings were born via C-section, my father had gone through open heart surgery a few years before, and all of us had taken our share of trips to the emergency room for everything from fever to stitches), it was good to be able to sit there and talk with her about stuff I had noticed, questions I had that I didn't want to bother the nurses with, and just general chatter. It wasn't all about medical stuff either, one of the major advantages with my mother was that she was not unnerved or bothered in any major way by hospitals, which meant she could sit in the ICU with me and not be preoccupied by the setting.

Probably around ten or eleven, The respiratory therapist came in gave me a spirometer that was supposed to make me work my lungs and help dissipate the anesthesia that was still in my lungs. I was told that I needed to use the think every two hours. I was actually fascinated by how it worked. It had a mouthpiece on a hose, and what you do is inhale. Each of the two chambers on either side of the hose attachment are ported (have holes cut into it) at the bottom, and each chamber has a small piston in it. When you inhale, the pistons rise up, but they aren't an air tight fit, so you really have to huff if you want to raise them up any distance. The right cylinder was marked our in thousands of milliliters, and the left chamber was simple marked from “bad” to “good”.

I took a few huffs on the device, and managed a meager 2000ml. A lot of that was the NG line still in place, it made it hard to breath, hard to talk, painful to swallow, and all of the mucus building on the back of my throat meant that I really had a time just trying to get a good breath in without coughing.

I called Chris in at that point and plead my case to him. Promising him that if he got rid of the NG line I would be able to do much, much better on the spirometer, and I would probably feel a lot better too. He pointed out that the doctor had not authorized him to remove it, and that they still hadn't confirmed that my digestive tract was fully awake yet. However, he said he was willing to buck the Dr's orders (or lack there of) in an hour if he could sounds indicating that my upper intensional track was indeed moving fluid okay.

In short he was on my side, and that was good enough for me. I agreed to the term and quietly waited the hour, coughing and hacking the whole time as my sinuses tried to decide what to do about the NG tube now that they were fully aware of its presence.

Let me tell you, the check for an NG tube is just creepy. What they do is unhook the tube from the vacuum line, put on a syringe full of water, and then put a stethoscope over your stomach. The point is to hear fluid moving through your stomach when they push the water through. It dosn't sound nearly as unnerving as it feels, and when they did it I thought I was going to get sick just from knowing that the damn tube ran from my stomach, up my throat, and out my nose.

Anyway, the noise I made was evidently good, because a moment later Sheela came in with a towel and just pulled the whole thing (about three feet worth of pipe) out. Instantly, my breathing got a lot easier and I could feel my energy levels go up by half in a mater of minutes.

Not long after that Chriss came in and told me that they wanted to try and get me to sit up and walk over to the chair in the room. Partly so they could change the sheets on my bet, but mostly because getting up and moving around (within reason) was the best way for my body to begin its recovery. Chris and Sheela were bother there to help me, and with good reason. While Chris was not a small man in any respect, if I went over, it would take two of them to hold me up, and even then it might not be any more than just directing me into a controlled crash. Chris told me that I would get light headed the moment I sat up. He was right, as my head left the pillow I got hit with a very distinct case of vertigo.

“Well,” I commented as I sat up unsupported for the first time in about twenty hours, “the bad news is that your standing on the ceiling.” I pointed at Chris, whom my mind was very clearly showing me as standing upside down, along with the rest of the room (contents and all). “However, the good news is that you are still in focus.” This was significant for me because over the past few weeks, the side effects of my prednisone had gotten bad enough that every time I stood up, the world would stand on its head and go out of focus for a few moments. As far as I was concerned, this was an improvement.

Both I and the nurses were pretty shocked at how stable I was on my feet. I wasn't going to be climbing any mountains, or even stairs at that point, but I wasn't wobbly, and I wasn't getting tired seconds after standing, and those were both good things for a number of reasons.

I was able to stand up and walk the distance without too much held, and it felt good to sit down in the chair for a while. About half an hour later I went back to the bed. Right about then was when I picked up the spirometer again and decided to see how I did on it without the NG line. It was measured out on the right side up to 5000ml. I was told that I needed to get the piston up to the 3500 mark at least ten times every two hours. Well I put the mouth piece between my teeth and let out a long slow breath. I wont say that it was easy, but I put my mind to it, and a minute later I had pegged the piston at the 5000ml mark eight times, and hit the 4500ml mark the other two. Chris had said that as long as I hit the 3500 mark, the Doctor would be happy, so I figured that hitting the 5000 mark would make him ecstatic.

Somewhere in there Chris came in to check my incision. Up until, that point the whole thing had be covered by bandages. Before he pulled the tape up, he asked me if I was squeamish at all. I said that I wasn't; I had seen enough stuff in my life that I was confident I could at the very minimum keep my cool at the sigh of whatever was under the dressings. Well, he pulled the tape and gauze back... and I looked down at what was beneath it.

Let me tell you, an incision thats less than a day old and being held together by 22 staples just is a completely new experience when its your skin that the whole scene is displayed on.

“Um, Chriss...” I choked out. “can I revise my last answer?” God Bless him, the man understood my situation and put some fresh dressings over it after the check so I wouldn't have to look at it.

The next highlight of the day was the visit by the physical and occupational therapists. The two of them came in together, and at that stage they both needed the same thing, to try and get me to walk around. There was some preparation, mostly me trying to choreograph how I was going to move around when I was under strict orders not to stress or strain the left side of my abdomen at all. Anyway, once the planning was all done, I managed to get up under my own power, and start walking. One of the ladies was next to me, the other behind me. We had all agreed that if I went over, the best either (or both, to be honest) of them could even hope to do was get out of the way and make sure I didn't crush some by standard; neither one of them had a snowball's chance in hell of keeping me upright if my legs folded.

We stared towards the nurse's station (about twenty feet out of my door), and one of the women said “ we'll go that far and then come back and see how you feel.” Well, we got to the station, and not only did I feel fine, but my legs were really enjoying the chance to move around some. So I asked if we could do a lap around the ICU wing (I'm just guessing, but I think the distance was about a hundred feet, give or take. The both women seemed surprised at my willingness to walk further, but quickly agreed.

About halfway around the ICU, I feel my right leg start to tingle, something I long ago figured out meant a cram was about to form. I was standing with a wall on my right side, and my hand was free, so I knew that if I fell over, I would hit the wall, and probably stay upright. So, without saying a thing, and without warning either of the two women, I stopped and started streaking my right leg to prevent the cramp. As my foot left the floor, I heard an audible gasp from behind me. I turned and saw the occupational therapist with terrified expression and a sheet white complexion. “My god, I thought you were going to fall on top of me for a second.”

Have you seen the Geico “trust” comercial? (if not, click on the link and enjoy). Remember the very end, when the poor gecko is about to get flattened, thats almost exactly the expression (bug-eyed shock and all) that the poor woman had on her face.

Anyway, I apologized for the scare, and then continued on. As I passed the nurses station the second time (I intimately did two full laps around the ICU, much to the astonishment of the two therapists), one of the ladies behind the counter took one look at me in my hospital gown (which covers down to my mid thigh) and promptly declares “Strut those sexy legs, honey!” at a respectable volume.

By the way, did I mention that laughing with twenty two staples holding your abdomen together is an extremely painful experience.

By mid afternoon it was time for my mother to head back to Stillwater, so I gave her a message for my wife and bid her goodbye.

Just before six or so, the surgeon showed up to check on me. He asked how the respiratory therapy was going. I pointed at the spirometer and said “Its going fine, I've been maxing it out the machine.”

The man looked at me with an openly skeptical expression. Rather than argue with him, I picked up the spirometer and put the mouthpiece between my teeth. When I inhaled the first time, the piston went rocketing up the chamber like it had been shot out of a cannon. With that being my warm up breath, the following nine were a little easier, and each time the piston was sent slamming into the top of the chamber like a bullet. After ten reps I put the thing down and looked back at the doctor. He was standing there with a slack-jawed expression. Without another word he walked out of the ICU room and I heard him go over to the Nurses station. “Can you believe that? Fifteen years I've been doing this and I've never had a patient do that twenty hours out of surgery!”

With the evening came an open room in the general recovery wing. Chris and Sheela both helped me get my small accumulation of things together and loaded me up into a wheel chair for the trip over.

After I got there, I had trouble finding my cell phone, and I found out that a collect call dialed out from the hospital would cost my wife $15.00, though she could call me for free if she knew the number. Sheela, God bless her, loaned me her personal Cell phone and I was able to call my wife and tell her the the number to reach my room with.

That was, more or less, the last time I saw either of those two, and the last I saw of the ICU during my stay.

I'll eventually sit down and write about the next three days, but I think this is enough for one entry, don't you think?

Lord Ivo Blackhawk
Protege to Master Robert Fitzmorgan
Kingdom of Ansteorra
"God Save the King!"

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