Thursday, April 22, 2010

Recovery room ordeal, such as it was

Advance warning: this is a singularly whiny post that describes what I regard as the worst part of my post-surgical experience. Read the following posts in this blog, ideally before this one, to avoid pre-programming troublesome biases.

Recovery from surgery is something that I have experienced and not enjoyed before. Those initial few hours of casual observation to ensure that an alien won't explode from your chest on their direct watch don't sound like a bad idea, but your comfort is either not a priority, or hard to achieve.

This time, after (I believe) 6 to 8 hours of surgery, I awoke slowly, and feeling very hot. I later found out that it was late enough that the building's climate control had been turned off due to the lateness of the hour. I was still under the heated blanket that had been placed over me in the ferociously cold OR, and had enormous trouble communicating due to facial swelling, residual anaesthetic, and muscular disobedience.

I ultimately managed to ask the nurse in attendance (I don't know who, since I had iced gauze over my eyes to reduce swelling) to turn off the blanket, and mostly remove it (although it was still seat-belted onto me). I was wearing open-toed compression stockings against DVT, which were also warm, but I eventually convinced the nurse to roll them up to at least allow my feet to chill, and managed to ruck my own pajama pants up around my thighs. Once she understood the dire straits I was in, she also found a small fan and pointed it at my feet. At this point, I believe I may have fallen in love with this woman, whoever she was.

I had an automatic blood-pressure cuff on my right arm, and a pulse/blood-oximeter sensor on my right hand, and I discovered a really neat trick that I proceeded to show off to anyone who would stand still for long enough. My heart rate was higher than normal, I think, but by stilling my mind and switching to long, slow breaths, I could drop my heart rate so fast that it sounded like it simply missed a beat or two. One moment I was running 60-70bpm; the next there was a full two seconds of silence from the machine. It was awesome.
After some time, there was a change of shift. I think Lisa (my paid 72-hour carer) took over, but I'm not sure. The first thing she did was pull down the stockings over my feet and cover me with a blanket again, which elicited immediate tearful but imperfectly coherent requests from me to stop. She answered sharply, which I expect is probably the best thing to do with patients recovering from anaesthesia, but it took her a while to understand my thermal problems, and partly reverse those changes. From that point on, the suffering continued until we left. I discovered, much later, that that fan of angels had been repointed at the ceiling at some point during this process.

Dr Zukowski, on one of his semi-random checkins, seemed to have a better grasp of the issue, and wiped down my exposed skin surfaces with wet gauze. This caused an immediate shivering reaction, which makes me suspect that my internal thermal regulation was completely shot anyway. He identified a major heat-rash on my chest and ordered Benadryl added to the IV, but after the various other measures tried, it went away anyway - I don't know if that happened after the Benadryl, or if that was skipped due to the obvious symptoms being alleviated.

My major remaining problem was that I had very thick and bloody mucus adhering to my teeth and palate. I could neither swallow it nor spit it out - it was stuck too firmly to the inside of my mouth - but while lying prone, it had a tendency to slowly drift backward to occlude my airway. Since my nose was stuffed with packing, every breath came with the fear that I was about to draw in a lungful of mucus and launch into a monstrous coughing spasm. I was allowed sips of water in an attempt to break it up, and the nurse reached into my mouth with gauze to try to wipe away what I could collect onto my tongue, but it was a largely ineffectual exercise, and complicated by our seeming inability to synchronize my breathing with the gauze intruding into my mouth and blocking my next critical intake of air. This was a very, very unpleasant experience.

Whilst suffering, and having given up trying to explain and secure assistance, I was entertained by any number of overheard conversations. There was a wife of a doctor friend who was being slotted in for some work at short notice. There were nurses throwing back and forth 'marvellous', 'fabulous' and other such superlatives in mock British accents - I doubt this was mockery, since I wasn't capable of speaking so many coherent syllables for them to mimic. This was the sound of a normal office environment functioning in that end-of-day mode that presages cheerful departures to family and friends. Sadly, I was still there.

After some more time, only Lisa and I were left, and she was working on paperwork. I had a call button in one hand that I'd used repeatedly to try to get help with lowering my temperature earlier on, but had since largely given up on it. A coughing spasm shook me strongly enough to trigger the call button. Judging by the sound of the pager approaching, she had been working in another room. I apologized for accidentally triggering the call. Since she was already preparing for my release, she just took away the call button from me altogether and returned to whatever it was she was doing, which did absolutely nothing positive for my stress levels over the next 10-20 minutes. I just hoped I'd have the energy to make enough of a racket against walls and equipment in the event of respiratory failure to summon her attention again.

Finally, she was done, lifted my bed into a sitting position, transferred me to a wheelchair, and began cleaning the bed and area. This was my first hint that she was not an independent care provider. Somehow, I'd assumed that hospital transfer and domestic care was her full-time occupation, but it turns out that she is in fact an assistant nurse at the Zukowski Center who takes time off from that job when patients need her for post-op care. Somehow I missed this in all the documentation that I had received; perhaps it was not mentioned. It probably shouldn't matter, but was nonetheless another surprise.

Moving out to the car was less of an adventure. As soon as we'd left the office, the temperature dropped precipitously, and I was much happier to be parked in the foyer while she closed up. She was very patient with loading me into her giant SUV for transport back to the hotel (in the front seat, from where I spent the whole time looking at the 'SRS' airbag symbol before me and imagining the worst), and then equally slowly transferred me to my room via wheelchair.

At my request, she ground up my first two vicodins into a few teaspoons of yoghurt, since swallowing was very painful. I was a little way through this when I remembered that yoghurt increases mucus production. Not bright, Mikolaj, particularly for a night with a single airway. But from that point onwards, things were pretty much on a consistently uphill trajectory.

Although I would not have wanted to have friends with me in the hotel for the first day - there's simply no way to clear blood and mucus from the mouth other than blowing as hard as possible and letting it drool, fall and fly as it may - having a hand to hold on to, a shoulder to cry on, and an ear to whisper into during recovery may have made those first hours much easier.

Consider yourselves warned.

(You may wonder how I can remember these things from post-anaesthesia fugue so clearly a week after the fact. Two things - firstly, much to my amazement and for the first time in my life, I've had no amnesiac effect from anaesthesia whatsoever. Secondly, that first night, I didn't want to speak much and communicated with Lisa by note. Since I had paper and pen, I took notes of the high points of the preceding few hours and photographed them with my phone. I faintly regret not having any pictures of the first 24-48 hours, but not all that much - there's enough documentation of these intervals out there already).

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