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
