Thursday, May 19, 2016

Worse The 2nd Time Around

There are two levels here. The first may simply be a forgetting of the pain from last time. It is thus all subjective, yet none the less real. As this is now day 4, and walking is much more tolerable already, plus I am not fighting against taking the full dose recommended of pain meds for all those reasons I posted about earlier, I am much more willing to go with the subjective part of the evaluation.

Except for one very big thing. This time, coming out of the anesthetic, was the very worst experience I have ever had. And I've had plenty. I like to joke that all the spare parts have now been removed.
When I hit a new doctor's office and need to list previous surgeries, it's almost too long a list to remember, and definitely too long a list to keep track of the scientific names for. Tonsillectomy I can pronounce. Spell even. But there's a fancy term for what's more easily understood as gall bladder surgery. That's so far down my list that I've given up on trying to even remember how many syllables it has, much less what they are and how they are spelled.

All of that is in favor of establishing my street creds for being able to judge what is my worst time of it. So if you can accept my background for judging, let's scoot right on over to the details.

From the very first second of renewed awareness, it was bad. I've never gotten the "shakes" from anesthesia before. Just in case you cannot logically extrapolate from the expression, tensed up muscles increase pain exponentially. Relaxing is a wonderful gift, heretofore underappreciated. All that tissue severed and pulling against the stitches and staples trying to hold it back together so you don't spill out all over the floor... can we just settle for a unconditional statement of never wanting to go there again? Please?

 I'm not sure just why it was different this time. Did they use a different dose? Different drug? Stop it at a slightly different time? I caught some background chatter about doing something different with the anesthesia once I was able to both feel the pain and recognize I needed to shake - like that was a choice? - and finally capable to move the right muscles to vocalize what was happening. I'm not sure if that background comment was actually about me, but people started moving around and dosing me with whatever, and after about 5 minutes it eased.

Five minutes is a very long time, unless you're eating very good chocolate ice cream. I wasn't.

I went back under for a bit after that, not remembering the actual lift and transfer into my room bed. That is a good thing, though it had an unintended consequence. I was not there to keep track of what was being done for me out of the list of things which were supposed to be getting done for me. Some of you will instantly recognize the phrase "it was shift change" and understand. I heard at least three different people tell me that ______ would take care of that for me as soon as he/she got in. I was trusting enough to accept that, or at least groggy enough not to fight against it.

Big mistake. There was an increasingly full bladder demanding attention as I would cycle around to consciousness again. There were pain meds that I was actually argued out of taking. Reasons I was given included it being too close to getting my next dose and not being as desirable a pain medication so maybe I really wanted to wait?

Seriously? My nurse is suggesting to me that despite my post-surgical pain (scale of 1 to 10, score 13)  that maybe I really wanted to wait to get pain medication? Are you freaking insane? My reaction at that point is every twitch of my body screaming "Fix it! Fix it! Give me the strongest stuff you've got and if it makes me unconscious, so much the better right now!" Plus I know I'm going to have to get up to pee, as in walking to the toilet, and that's going to hurt even more if I'm not properly medicated.

One of the ways I react to anesthesia, and probably one they deliberately go for, is losing not just the ability to move myself around but the will to do anything. Think lobotomy. I'm simply not assertive. I may be screaming on the inside but it never reaches the throat. It's being conscious without there being a "there" there.

It lasts a while. I was awake enough to read the clock but not capable of doing anything to follow up on taking care of my needs for two whole hours. Yep: two hours!

When my nurse finally poked her head inside the door enough to give me her attention, and I was able to say something to her, I had a list!

Unfortunately, she got defensive. Now intellectually I can understand the chaos of shift change. I didn't need it to all crash down on me, however. I'm sure I wasn't all cheery, friendly, or smiley as I listed my issues, but then neither was I blaming, swearing, yelling, or bitchy - unless just the process of enumerating a list of issues comes across as bitchy. But I didn't either want or need excuses. I needed specific attention. And I finally got it.

Of course, the pain levels  had been allowed to climb in the meantime, and it's much more effective to keep on top of them rather than have to play catch-up. Takes lower doses that way as well. But my much needed hike to the toilet was excruciating, so bad in fact that I wasn't sure I was even able to support myself without a fall. My escort just sort of rambled along next to me rather than observing that I was nearing the wrong side of coping. He also assumed aloud that I was capable of not only standing again but doing it steadily enough that I could safely wipe my own behind afterwards. You know, because that was when I should ring the bell pull for him to come back. Umm, did not do that so well. Scary. That experience encouraged me to delay the next few potty trips as well, exactly the opposite of what I should have been doing.

Contrast that with a pair of nurses that first night  after doing the first knee who made sure I felt neither reluctance nor embarrassment about needing to be wiped those first times, and in fact offered should I need an assist. Oh, and made sure for the first two trips I was wearing a safety belt for additional support and they were on the other end.

I should note that by mid morning of day 2 I was just fine with coping, and by day 3 steady as a rock and impatient at needing to wait for my escort back to bed. But this was immediately post surgery. (Well, plus those two hours of delay.) My first hike. I really needed him for what he was supposed to be there for, that first time.

And apparently I was still not so good at being assertive.

Let me insert here that I should have asked for someone to be there with me when I woke up. Knowing I would be something less than company, I turned down offers. Turn back the clock to when I was 40 and had nobody to wait in the hospital with me. Kids in school or working, no boyfriend, etc. A good friend insisted that I really needed somebody to be there with and for me, and took a day off work to be that person for me. At the time I thought it was loving and very sweet of her to do. I never connected it to "necessary", not until now. So once I regained some semblance of my mind back, I called her up and let her know very belatedly how much that meant to me even though I hadn't a clue at the time. She would never have let two hours pass before somebody tended to a stated need of mine.

Thank you again, Joan.

Once my most pressing needs were taken care of, I was clear enough to hold an actual conversation with my nurse. I do respect nurses, and more, recognize how vital they are to what happens during my hospital stay. Together we could plan my meds schedule, basing it around not only the clock on the wall but the needs of PT so I could stand to do the exercises. We could schedule cleaning up and dressing, keep information flowing both ways. I wanted to be sure we two could work successfully and amicably as a team.

My cardiac meds unexpectedly became involved in a disagreement on the last day, as well. My BP was a bit low. They plan on your not taking BP meds on the day of surgery. That was fine. It can bottom out under anesthesia. They also delayed the timing of my metoprolol, but they'd done that with the first knee,  explaining that morning meds just happened at 9AM for everybody, not 6 as in my home schedule. So I expected that as well. But then they were going to withhold, not just delay, the metoprolol, as well as the amiodarone, both of which I take to maintain cardiac rhythms. New-to-me nurse here, by the way.

I kept shaking my head and saying "no" as she listed each thing she wasn't giving me. I was also getting this look that told me she was finding me a difficult patient. It was not a look that indicated in any way that I would be getting my meds. Not even when I told her the two in my case were not just for BP but to maintain rhythm properly.

I suddenly had an epiphany. I had just set my kindle down as she'd walked in, and I keep two very important little strips of paper in its cover. So I switched the conversation around to having her acknowledge she knows how to read an EKG. Yes, she does. So I pulled the strips out so she could read for herself exactly what happened when I was not getting proper meds. They were the EKG strips taken in the ambulance on my ride to the hospital last summer. It impressed her enough that she let me know she no longer just thought I was being "anal" about my meds. Then after a quick check with the hospital doc who'd given the original order to withhold meds, I got the amiodarone back. Good enough compromise. I let her know I appreciated her following through on the matter for me.

There were other unsettling things about my first night. Obviously my brain wasn't working well, but I do recall that the list I had for my nurse had three things on it. I've no clue what the 3rd was. But the response I got was that it was something that I was supposed to have set up ahead of time, with time somehow defined as immediately after surgery but before now when I was functional. I still fail to understand just how whatever-it-was was supposed to be my responsibility when I was incapable of doing anything except feel a filling bladder and a knee that felt like a dozen knives had just sliced holes in it, nor did I recognize either name or function of the person I was to have set this up with.

It is remotely possible that item 3 on my list was a query about supper. It it was, I still don't see how I was supposed to have arranged it ahead of time. I did actually get my menu choices made in time for breakfast, and all following meals. I also thought I had not eaten the night before. However, while perusing the menu I read the details about one entry and could not only picture exactly how it looked on the plate, despite no picture in the menu, but knew how it tasted and felt in my mouth. I even recalled how much of it I had left on my plate!

Speaking of epiphanies, I have trouble fully communicating another one I had. There are two orthopedic wings in that hospital. One caters to "Joint Club" patients as first priority, the other to both the joint club overflow and to other  post-surgical ortho patients. In theory, they should be identical. Either can take the overflow from the other as necessary, both combine into one when patient levels drop, same floor plan,  both interchange staff.

However....

Having had two mirror surgeries in 10 weeks, one recovering in each wing, to me they were different. Possibly it is due to the two opposite kinds of wake-ups. But I found just enough difference in primary function, that despite their attempts to keep them the same there were differences. When you specialize in the exact precise thing that I need, and do that precise thing for and with everybody, you do it better and my needs are better met. It may be as little as 1/10th of a percent of difference, but it's there.

Normally when they shut down one wing, it's the joint club side they keep open. This time it was the medical-surgical side. Same staff for PT, exactly. Many of the same supporting faces from last time. I would just hope, because the differences are so subtle, that they continue to keep joint club open when they cut back. Make the open wing "joint club plus" rather than "orthopedic including joint club". Maybe it's as subtle as how the first trip to the bathroom gets handled. Or which clock takes priority over distributing meds due to PT scheduling. Or knowing whether and just how high to raise the bed before I get out or in, and which leg needs how much assist to change position, chair or bed. None of those things are huge. The difference they make is.


For all who were wondering, I am home, reasonably sane, partially capable. I still have a schedule that alternates about an hour of sleep with  two awake, but sometimes it's the opposite. I can actually hear most of a question that's asked and process what's meant, and if it's a really good time, come up with an answer. I can almost watch a whole TV program without finding myself waking up to either commercials or a "Delete this?" box in the corner. Reading lasts about  three pages. In short, I'm recovering. Call me in a day or two.

1 comment:

Susan schnatz said...

Sorry your experience on that first night was so different from what you remember from your previous visit. You should always be catered to the night of surgery as it is evident to most that the patient is in no condition to take care of themself.
Please continue to rest and heal so that you can enjoy the new matching set of knees you now sport.

Oh, and by the way, it's cholecystectomy! :)