Bumpy Postoperative Course: Physical

I did well throughout the lengthy, complex surgery.

So it must have come as a surprise upon my being wheeled out of surgery into ICU that my blood pressure immediately plummeted. My kidneys were unhappy but my heart was really upset and showed its distress by leaking troponin, a cardiac protein. 

That was the beginning of an extremely complicated postoperative course where it seemed that nothing went smoothly. 

My heart’s troponin leak led to monitoring by a cardiac team as well as several cardiac testing procedures.

Since the hypotension was both volume and anemia driven, I was immediately given even more IV fluids than had been given during surgery plus two units of blood to counter the anemia. Later two additional units were infused to stabilize my red blood cell and hemoglobin counts. 

So much fluid is given during surgery, especially an extensive surgery, and with the additional amounts given to me soon afterwards to bring up my blood pressure, I had an enormous amount of fluid onboard. By my sixth postoperative day I had eliminated 25 pounds of water weight. If only that much body fat weight could be shed in six days!

Within hours of admission to the surgical ICU I developed a fever of 102 degrees. Not surprising since the three “dirtiest” fluids were all in the surgical field: urine (bladder removal), bile (gallbladder removal) and fecal fluid (bowel cutting). The source of the infection was apparently my kidneys. More antibiotic troops were sent in.

Pain was expected to be an issue given how extensive the surgery would be, so an epidural catheter had been inserted into my lower spine before the surgery. But my pain management team also placed me under conscious sedation for several days after surgery given at the least the extensive adhesiolysis (cutting of the scar tissue). Even the pain of being turned in bed, a necessity for healing and preventing bedsore development, was excruciating. I was in a fog during such prolonged conscious sedation, and it was weaned by the fourth postop day in favor of IV pain medication.

I remained intubated and connected to a respirator for a week. When they first tried weaning me off the respirator my own breathing was too labored because of the fluid overload and continuing low blood pressure and high heart rate.

Hand restraints are protocol when one is on a respirator because it is believed that a person’s innate instinct is to try to pull the tube out. I don’t ever remember feeling like pulling out the tube, but my hands were restrained for seven days. I have no conscious memory of this. I do know that one nursing aide always removed the restraints when she was in the room. She also gave me memorable foot massages when she and a nurse gave me a luxurious bed bath.

One cannot talk when on a respirator. Communication was almost as challenging as pain relief. I asked with hand signals for something to write on and got a clipboard with paper and pen. This helped a lot except for how small my writing was. I don’t know why I couldn’t make it bigger although as I made physical progress I could.

When a lab tech came in to prick my finger for a blood glucose level check, I motioned for the clipboard. On it I drew a giant “Y” because I am not diabetic. It turns out it is now recognized that the glucose-insulin balance is often disturbed after major surgery. Thus this is standard protocol as is the subsequent injection of the appropriate amount of insulin. And I did receive a plethora of insulin shots in my thighs during my 21-day hospitalization.

What was terribly disappointing to me is that John could never figure out where I was going with something I was writing on the clipboard until I’d written it out completely which was often exhausting. Anne, the nurses, perfect strangers got it before he did. I wondered how someone so close to me couldn’t see where I was going with a thought or request. But it taught me how differently his mind and my mind work, which I am sure attorneys figured out long before I.

I remember the day they removed my endotracheal tube. The respiratory therapists had been increasing the amount of room air I was breathing in on my own until it was 100%. Just after a woman told me it might immediately need to be reinserted, the tube was withdrawn only to be immediately reinserted. It was only momentarily disappointing, though, because it was withdrawn a second time minutes later and this time it worked. I could whisper but my voice got stronger almost as fast as my smile got bigger.

I asked for water. Only ice chips, but I had a child’s glee in crunching those as loudly as I could. Then sips of water. Heavenly.

My nursing administration friend had copied and enlarged my self description and a photo and taped it to the ICU whiteboard and the door so when I was able to talk again, people knew who I was other than a foggy ICU patient. A precious gift.

I spent three more days in ICU (for a total of ten). These were transition days when, for example, I was observed and tested for my ability to handle solid food post endotracheal tube. This meant that a beautiful young woman came with several cold treats (e.g., finely pureed applesauce) and fed me spoonful by spoonful. She gently felt under my chin to see if I was processing the food properly. It was a much appreciated sensory experience for someone who hadn’t eaten since January 5 (11 days).

I was transferred to a surgical postop unit under sedation so I didn’t experience the transfer. Despite two different antibiotics, my white blood cell (WBC) count increased and I was confused so my medical team embarked on a full infectious workup to discover the source of the infection. They discovered an abdominal fluid collection and placed an abdominal wall drain. This gradually resolved the WBC problem. They also discovered a urine leak, but fortunately this was self healing.

When the epidural catheter for pain medicine was discontinued, I experienced three days of uncontrolled pain, drowsiness and irritable behavior toward physical therapy (PT) and occupational therapy (OT) folks. Some of the pain meds I was given were not ones that work on me and actually have an adverse effect on me, so that contributed to the roller coaster ride.

I stayed in the step-down unit for 11 days. There was a window in my room but the view was forgettable. Despite my resistance, PT and OT worked daily with me to help me learn to “launch” up from a chair to a standing position and to walk with a walker. And they supervised me on my discharge date as I dragged myself by the handrail up and down a staircase. Being able to do this was a condition of my discharge.

As much as my mouth wanted to eat food, my bowels just weren’t good at processing it, so I suffered too-many-to-count episodes of diarrhea while in a chair or in bed. It is humbling to be cleaned up by nursing staff but they were whizzes at it and I remain grateful for their practicality, their tricks for minimizing the soiling and their consistently positive, nonjudgmental attitude.

On the day before what became my discharge date, I underwent a cardiac catheterization because of the troponin leak. I cannot remember when I have prayed a “Hail Mary” as earnestly as I did on the way to the Cath Lab. The team who did the test was wonderful and so were the results: no ischemic damage, no abnormality of any kind.  

One of my anesthesiologists happened to see me dressed and waiting to go home. He stopped in his tracks and came into my room to tell me how wonderful it was to see me alert and bright-eyed. I told him it had been a difficult few weeks. “There are so many ways to be sick,” he said. Indeed.

© Jean DiMotto, 2012    Website: www.jeandimotto.com