The Big Day

Day 2 (Tuesday) – ICU

The medical profession likes to measure pain on a 1-10 scale.  Actually  Zero to 10, where Zero is fairly obvious and Ten is “Holy #&*%$^!  MAKE THIS STOP!!!!”  Let me say right here that I sincerely hope you never have to experience a 10 – or a 12 – or a 15.  It’s not a lot of fun.  But right after surgery, you can be in a pretty serious amount of pain.  And  you’re in the exact right place to have this happen.  They have all the good tools at their disposal to fix it quick.

To set the stage, my surgery was substantial.  Many have been worse, but this was still pretty big.  In several stages.

First, a vascular surgeon sliced me open from about 3″ above my belly button down to 3″ below that same belly button (there go my Speedo days…).  Then this same surgeon retracts all the internal organs that would be in the way of the spinal surgeon’s tools and hardware..

Now Doctor Hostin goes to work with lots of long tools to prepare every section of my spine for straightening, spacing, fusion and ultimately bolting to very long steel rods.

Then they tuck me back together.

And put me on another table designed for the patient to be face-down.

And slice me open from my tailbone all the way up  to past the middle of my back and start making room to insert cages for fusion, rods, bolts and the like.  Then I suppose the whole thing gets closed up and it looks like I’ve got a huge zipper down my back.  Ed Hardy if you’re reading this:  You did my Dragon in 1981 in your little shop on Van Ness.  How’d you like a zipper project sometime next year.  Only you, buddy.  The front is closed with wire staples [Your Mileage May Vary] and looks a lot like a shahny new bob wahr fayunce (for non-Texans that’s “shiny new barbed-wire fence).  Which would be fun to leave exactly the way is is.  Any option for a good Story should be considered…

In the [Your Mileage May Vary] department, not all patients will go to ICU after “procedures” or operations.  This is determined by how much supervision you need, your age, health, other  risk factors, the length of time you were under, the amount of pain relievers you normally take (are you an addict, dependent, or a light user?), etc.

I woke up in ICU fairly uncomfortable, but not too bad.  A 5.  No surprise and not unacceptable, but I found the pain pump button and gave it a push.

Hospital pain control is handled on several levels:

• A full-time IV drip at a dosage determined to be  good baseline, augmented by patient induced bursts
• Directly administered by Nurse via syringe through a Central Line (CL) or IV
• Oral pain killers (once the digestive tract is “awake” enough to process oral input.  This can take ad or 5 days depending on the individual situation.

I was on a Dilaudid drip.  Is it effective? Pretty well for me, but it gives me headaches.  I prefer Morphine.  More on this later.

I’m comfortable enough right up until I want to reposition myself up the bed a few inches. OW! OW! OW! OW! OW! OW! OW! OW! OW! OW!  Dammit!  OMFG that’s painful.  I’m pretty sure that was a 13.

Push the button again.

Now if it should come sneaking into the recesses of your mind that being in fairly high levels of pain will somehow get you out of Physical Therapy {PT) or Occupational Therapy {OT), lemme put your mind at rest.  It most assuredly will NOT – and it Should NOT.  Your whole reason for living now is to Get Healed  and Get Home.  Do you want to live in a hospital the rest of your life?  Well, even if that sounds like the Ritz to yer narcotic-soaked brain, Sparky, your Insurance Company is going to have a few choice words to say about that and they all star with “No”.

So after having all my levels checked and it’s determined I’m healthy enough and actually doing better than most at this time, PT shows up to get me sitting up for the first time.  This was Very painful.  The hardest part was changing position – forcing the filleted  muscles and tendons to actually do some serious lifting in their traumatized condition.  That Really hurts a lot.  Once in position, it’s not bad at all.  Allowed to remain sitting up with my feet dangling off the side of the bed for a few minutes isn’t too bad.

I discover at this time my entire left leg is numb.  Now most people might have a reaction to this.  But not this Little Black Duck.  Nosirree.  I’m positive this is related to the issue that set all this in motion originally.  The numbness from left hip to pubic bone.  My Pain Management Doctor (PMD) of which I’ve had 5 or 6, told me this would happen and I’d lose the use of my leg if I didn’t hop to it and have the surgery.  So I figure this is simply swelling based on bone manipulation in the area of this particular nerve root in my spine and it will go away in a few days.  Plenty of time to worry about it if that doesn’t happen.  So I mention it to my Doctor.  He concurs.  We move on.

Now I’m guided while I get out of the bed and standing with the help of a walker and make my way completely under my own power around the bed to a recliner, where I manage to lower my myself into place (with much grimacing and groaning)  I spend the next hour sitting in the recliner and visiting with a lot of people who think I’m making amazing progress. (didn’t think I had a choice, actually…)

Then rinse and repeat in reverse – equally painful.  A complicating factor is that I have ZERO muscle in my right shoulder after 4 surgeries there.  This makes supporting any amount of my weight laughable at best and excruciating at worst.

The balance of Day 2 is spent trying to stay comfortable, snork up as many ice chips as possible and try and remember to push the Dilaudid button as much as allowed (every 10 minutes).  Dilaudid is fairly effective, but gives me headaches (Swell).  No gut sounds, so no food or oral meds.  Basically nothing is going to change.

No gut sounds so no change..  Basically, if you can’t get your gut working, they aren’t going to put anything else in it.  Makes sense, but you can get pretty hungry…  To that end, I’m on muscle relaxants, Valium, Anti-Spasm meds, laxatives, finally a suppository (remember what I said about no self-respect?) and  another 24 hours later a FART.  It’s like I’m 3 and finally spelled my name right.  I thought  it was gonna be on CNN!

But that ‘s all.  Just a Fart.  A good start.  But just a Fart.  La Dee Da.
Another part of the Not-Wasting-Time approach to medicine is to get you, the patient (and the one trying so hard – and so unsuccessfully to get a little rest) out of wherever you are now – and up the food chain so you’re someone else’s problem, a bed is freed up and you are that much closer to going HOME!  So by around 3:30 or so on Day 2, they have a room for me in PCU – and I’m In It!  Wow!  PCU is the Step-Down area for ICU.  Excellent care, but no the 1-to-1 or 1-to- MAX Nurse to patient ratio, it will be higher.  And there’s a pull-out bed and recliner your mate can sleep in  (we do NOT like to be separated) – so we like this a Lot better.  Except the beds suck.  In fact, I think the only worse night’s sleep I’ve ever had, was sleeping on a gravel road.