Surgery - Hospital Stay update

It is hard to believe that is has already been over a week (ten days to be exact) since surgery. I am glad to be sitting here, on the other side, looking back, because it was not a good time. The surgery itself went well, although the outcome was a bit different than what was expected. The recovery period in hospital, however, was absolutely horrible. But I will start from the beginning.

I woke up at 4:30; allowed myself to sleep in a bit longer than expected. Mum and I left for the hospital just after 5, and we made it in good time. There was already a bit of a line up at the admission desk (only one person working so early in the morning), so that took some time. Then we were sent to same-day surgery. This is where everyone is sent, regardless of whether or not they are staying the night in hospital. I got to change into a 'lovely' blue gown (that actually somewhat fit. I usually drown in those things!). Vitals were taken. Questions were asked and answers. And an IV was started.

Around 7:30 I was taken upstairs to another waiting area just outside the operating rooms. There were quite a few other people waiting for surgery. It felt like everyone came to talk to me all at once... there was actually a small lineup. Not used to being the popular girl XD There was the surgeon, two anesthesiologists, and two nurses who would be working in the OR. The surgeon came and went over what he would do one last time and asked if I had any questions. He said he would put lots of numbing stuff in my leg itself, so I wouldn't feel much after surgery. He warned me that I might wake up with an external fixator if things went badly. Instead of the regular antibiotics you get during surgery, the nurses hung vancomycin as not to mess with what I have been taking for last seven weeks. I didn't have to put on the silly blue hairnet you have to wear during surgery until I was walking to the operating room. Here I am waiting, maybe 20 minutes before surgery.

I tried to get a good look around the operating room; there is always so much to see in there, and the nursing student in me was really curious. I swear it was the same OR as last time. There were seven people, plus me, in the room. I forgot all of their names instantly, literally the second after they said them. All formalities really. Not very important to me, especially seeing how nervous I was. I had to lie down on a really small bed/table, arms stretched out and strapped down, attached to all sorts of monitors. I had to breathe into a mask, the anesthesiologist told me that he was injecting something into the IV, and before I knew it I was a sleep.

And then I was waking up, being wheeled into the recovery room and surrounded by lots of people. It took me a good ten minutes to come to my senses, and longer to realize that my leg was in a heavy plaster splint (and not a fixator!). My throat was a bit sore for a  few hours, and my mouth felt like a hay bale, but nothing like the last surgery, and I didn't loose my voice. Pain management was a huge issue. I have pretty high pain tolerance, but I was sitting at 8/10. The nurses kept giving me more IV pain meds, but nothing came close to touching the pain. I remember lying on the stretcher groaning in pain for hours. My nurse was horrible. She actually commented "We have given you all we can. You must have really low pain tolerance". And I am thinking "Ya, that's it... not the fact that I just lost a chunk of my tibia and have a piece of cement holding the ends of my leg together". I came out of surgery at 9:15. By 11:15 I was told that I couldn't have any more pain meds until at least 3 pm. My breathing started slowing down around that time. I remember laying on the stretcher thinking about how slowly I was breathing but not really caring about it. I was groggy and in pain and very sleepy. The lack of sleeping seemed insignificant. As a nursing student, I knew something wasn't right, but in that position you don't grasp the seriousness of it. Every few minutes my 02 stats would drop below 90% and the O2 monitor would alarm, which would result in a nurse yelling at me to breathe. After a while that was not working, so I was put on oxygen. I think the lowest my 02 got was 83%. I was in recovery for about 6 hours because there was a shortage of beds on ward I was supposed to be admitted to. In this time, my mum was no allowed to come see me. Neither were other people allowed to visit any of the other patients in revocery who were waiting for a bed. I heard some family members actually snuck in. Finally around 3:30 I was moved to the sixth floor. On the way up, the recovery room nurse pulled out my IV by accident... and I am a hard stick. I was unimpressed. Fortunately everything was done through my PICC line after that.

Here I am just after being moved out of recovery.

Pain control was a massive issue after this surgery. The nurses were reluctant to give me meds more because I had been given so much in the recovery room. My pain remained 8/10 over the night and into the next day. First thing Thursday morning one of mysurgeon's residents came to talk and said I was going home that day. Nope. Not going to happen. I couldn't even lift my leg out of bed. Later in the morning, PT stopped by to try to get me out of bed. I could barely sit with my leg dangling out of bed , even when supported by the physiotherapist, pictured below.

Physio came back later in the day and got me into a wheelchair for about 3 minutes, before I couldn't take the pain anymore and had to get back into bed. Come Friday I was still having lots of issues with pain control. The Percocet and Tylenol were clearly not cutting it. PT came by again at some point. They got me up and sitting in a wheelchair. They wanted me to stay there for about half an hour. Less then 10 minutes in the physiotherapist came to check on me. I must have looked as horrible as I felt, because she immediatly half asked/stated that I needed to go back to bed. It took her and to other people to help me back into bed. Just before the end of her shift, the day nurse came and told me there was a new plan in place with pain meds. I would get one med every four hours and could ask for another every two hours. I was happy to finally get the pain under control (about a 7/10 at that point). But no. The night nurse came just after seven, handed me some meds, and said "This is it, you’re not getting anything else until midnight". Needless to say, it was another rough night. Fortunately the day nurses on Saturday were much better and stuck to the new plan. I was still in considerable pain (6-7/10), but at least the pain was on the way down.

There was talk of discharge, even though I hadn't even been up on crutched yet. One of the nurses asked me if I was excited to come, to which I replied yes, not realizing they would interpret that as "She wants to go home today". Fortunately everything got sorted, and I was not discharged. My mum did a lot of talking with the nurses, I cried a bit, and it was determined that I would stay.

My IV pole.

Despite the new pain medication (dilauded every four hours, and Tylenol), pain was still an issue. Things were switched again (on Saturday I think), this time to long acting dilauded twice a day, morphine for breakthrough pain, and Tylenol for anything else. This finally did the trick.

By the time I was discharged on Monday, pain was 5/10. Not fantastic, but much better than 8/10.

This next bit might be a bit TMI, so you can skip this paragraph if you are a bit squeamish. One of the issues that patients face post-op is constipation caused by a combination of narcotics and immobility. Basically, everything just stops moving (being put to sleep for surgery makes this worse). On Friday, my nurse asked me if I had a number two. I replied no. Patients are not allowed to be sent home until everything is working as usual. On Saturday, however, they were more than willing to send me home without this (quite crucial in my opinion) function working properly. It is good I wasn't discharged because I didn't end up going until Monday afternoon. Between Friday and Monday, I had 3 suppositories, lactulose syrup three times, an entire bottle of citro-mag, and an enema. Plus stool softeners twice a day. I usually wouldn't talk about this stuff so openly, but a week in hospital and talking about bowel movements with various people kind of messes with your sense of dignity and embarrassment. The lactulose syrup is horribly sweet. My nurse on Sunday told me to chug it like a shooter. I obediently did, activating my gag reflex as it hit the back of my throat, and retching half of it onto the floor (fortunately I was smart enough to lean over the side bar on the bed). The next step (Monday morning) was the Citro-mag. My nurse said most people can't even get through a quarter bottle before they really really have to go. I drank the whole thing... and nothing. Not result. So the dreaded enema...which actually wasn't nearly as bad as I thought it would be. Don't get me wrong. I wouldn't want to have one again. But definitely not as bad I expected. Finally results! Yay! I never thought I would talk so openly about poop, but here we are.

Here is the citro-mag, and me drinking it. It has a strong lemonly taste. I didn't mind it.



Because of the confusion of whether or not I was being discharged on Saturday, my bed had already been assigned to another patient. If people are being discharged in the morning, they are moved to the physio therapy room. On Thursday, a man in the ward I was on was moved to that room because he was being discharged in a few hours, and the space was needed for someone else. He was really upset about it. I was moved to the new room on Sunday morning. I didn't mind at all though. At that point, I was sick of the other patients in the room. One woman was in lots of pain, groaning and talking in her sleep every night. One of the other women would mumble to herself "Oh god, please just stop talking. Go to bed already". I didn't mind moving rooms, even if surrounded by physio equipment. At leat is was quiet. Plus the view out the window was amazing.

The lovely new room.

The night before discharge. Exhausted but starting to feel much better. And my big bulky plaster cast. By Sunday the swelling in my leg had gone down a lot and it was obvious that the cast was too big. It felt like things were grinding around inside of it. The plan was to get a new cast on Monday, but it turned out that the fracture clinic was closed because the surgeon who works in the clinic on Mondays was away.

Jsut before discharge. Brought my own blanket from home. A little comfort in hospital goes a long way.

 

 

I struglled a lot with nausea, vomiting, and dizziness throughout this hospital stay. In the end, we narrowed it down to the pain medication I was on. The nausea continues once I was discharged and talking morphine every four hours at home. Once I stopped that, the nausea went away. I am still on the long acting dilaudid, but feel much clearer in my head. I was having some really odd dreams for a while, due to the pain medication. One was about a bunch of giant yellow monkeys all smiling and laughing at me. I am not sure if that is funny or horrifying XD

 





I was sent home with a perscription for stool softeners, lactulose syrup, morphine, and long acting diluadid. I was given an appionemnt for last Thurday to see a orthopedic surgeon (couldn't go this Friday because my surgeron was off for the long weekend), and told to make an appointment with my own surgeon for the 9th for my post op appointment, and to call infectious disease to make an appointment for 2-3 weeks from then.

The ride home was a bit bumpy, but not too bad. Mum and I took the senic route to avoid rush hour.

Home, trying not to throw up into my lovely blue bowl.

Sicne surgery, there has been a lot os sleeping and watching tv or movies. Just comfortably relaxing. Everyday I feel better and my leg hurts less.

 

I will update on the appointment with the orthopedic surgeron later. Lots to write about that.