Thursday, August 30, 2007

Operation: knee

The anesthesia fully wore off yesterday and I tasted the full-fledged pain for the first time. Now that the pain has settled a bit (or I'm just getting used to it), I can describe what brought me to this state.

SIGNS OF FOREBODING

I was slightly late getting to the hospital due to traffic so I didn't have much time to be nervous. But when the the registration receptionist wished me "Good luck" after she set up my file and payment, it started to sink in. That was nice of her, but it really wasn't very confidence-inspiring for me to hear, as if things could go wrong very easily with my procedure. Then when I was inside, the registration nurse asked me a bunch of questions and asked me if I wanted to sign the form for healthcare proxy (including a question about DNR) -- another non-inspiring moment as I waited nervously for my procedure to begin. I don't think I've ever been so nervous before, not for the SATs, not for interviews, not even when speaking in public.



MY VULNERABLE STATE

I was not dressed to impress in hospital-issued floppy mismatched robes (one with the opening in back and another on top of that with the opening in front) that were about eight sizes too big for me. And since I hadn't eaten or imbibed in over 12 hours I probably had hunger breath and dry mouth. A PA, anesthesiologist, and resident/fellow (is there a difference?) came to talk to me, almost repeating the same thing over and over. None of them seemed to appreciate my sarcasm (or maybe I just wasn't very funny). The PA didn't seem very friendly either but he did draw a crooked arrow pointing to my left knee to prevent future lawsuits (I had to sign a statement that they made a mark). The fellow was helpful though -- I finally understood the entire procedure and he added the doctor's initials above the arrow to make it clearer what the doctor had to do: They would make several small incisions on either side of the knee cap and replace my torn ACL with the graft of a cadaver's achille's tendon. They would then screw it in place with titanium screws, which may or may not set off metal detectors in airports (yes, I asked).

When I finally walked into the OR (the last normal walking I would do in a long while), I had to remove the outer robe, leaving me exposed to the cold air. My inner robe was held up by the fellow as I hopped onto the tall skinny table in the center of the room. The table had two swiveling arms at the side and laying there with my arms outstretched felt like I was about to be crucified in a walk-in freezer. Thankfully a nurse brought me a warm blanket and I tried to convince myself that I was just getting a spa treatment.

Before they would put me under, we had to wait for the doctor to finish up his other procedure and come say hello to me. (The nurses claimed the doctor would talk to me before the procedure; he has a bunch of peons to do his bidding while he just shows up for the main task.) Finally the doctor strutted in, asked me how I was doing, signed something on the door, and walked out. The anesthesiologist had already stuck an IV in my wrist and when the doctor was ready to begin, he injected something into the tube. Within seconds I thought the huge lights overhead looked fuzzy (like when you use the blur filter in Photoshop). I don't remember anything else until slowly waking up in the recovery room and hearing hospitalspeak.

I tried to enunciate my need for my glasses as three female voices bent over me. I heard my doctor say something about it going great as he patted me on the shoulder and asked how I was doing. I managed a "tired." Then someone came and took x-rays of my leg. I remember Dear walking into the room and then leaving shortly after, leaving me to rest.

My mouth and throat were really dry and I asked for apple juice. I downed two cups like they were nothing. (Little did I know that those cups would lead to my doom later.) The nurse then talked me into coherence. Everything was going hunky dory (except for a slight throbbing in my knee) until a doctor (or was it the PA or another resident?) came over with the x-rays. He pulled the nurse aside, said something to her, and then walked over to me. He said that the doctor would have to come back and look at the x-rays because something looked weird to him. He reminded me of a sleazy car salesman who isn't telling you the whole truth and was evasive when I asked him questions. Great! And I thought I was doing really well because everyone around me was getting nauseous and needed extra meds while I was already being rolled to the discharge area.

Apparently peeing is a sign that you can go home and I really needed to go so they wheeled me into the bathroom, picked me up and planted me on the throne. It was a relief! However I would not get to go home. Another patient of my doctor (her procedure was after mine -- I remember seeing her in the admitting area) was also brought over and she relieved herself shortly after me. Unlike me, however, she got ready to go home while I waited. She got her crutches lesson, her belongings from her locker, her street clothes, and she was put into a wheelchair.

An hour after they told me that my doctor was turning back and was in the Lincoln tunnel and would arrive in 15 minutes, he finally showed up. He told the other patient that everything with her procedure went great but since I have such a tiny bone they had to use a shorter screw. This led to instability or something so that things were misaligned, whereas the other woman got a 30mm screw and hers is perfect. So he would have to go back in and insert what I understand to be the medical equivalent of a wall anchor that you use when hanging heavy objects in drywall or plaster. Meanwhile the other patient was saying goodbye, thanking the nurses, and wishing me luck.

What's worse was that I wouldn't be put under since I had those cups of juice (in the event that I would aspirate, whatever that means). Instead I would get an epidural, what I originally wanted but everyone told me the state of coma was better (including the first anesthesiologist). The second anesthesiologist seemed sleazy to me and it irked me to no end when he tried to convince me that the epidural was the better way to go instead of telling me the truth that it was my only option since I had had something to drink. He kept saying they would "take good care of me." If I had known what I know now and if I wasn't in a weakened state, I would have argued because in fact, the epidural is horrible. Besides the thought of a giant needle being inserted into your spine, it was just weird to not be able to feel your lower body. I was also shivering like mad (an effect of the anesthesia the nurse said) despite several blankets being piled on me.

THE SECOND TIME AROUND

I was told to sit up and hug a pillow so that the anesthesiologist could inject his torture. The needle didn't feel like much but as he injected, I felt a sharp twinge in my leg traveling through all the branches of the nerves in my leg and then total numbness. Soon after my legs felt like they were floating and then like they were disembodied. As uncomfortable as I was, at least I got to witness part of the procedure.

My doctor came in, talked some jive about the anesthesiologist being the best out there (yeah right, I think he pumped way too much crap into me) and told someone to get him the scrub nurse. (Yes, there is actually a nurse whose job is to put the outer scrubs on the doctor.) He also tried to butter me up by saying that I have good bones (no idea what that means). The table was raised and the doctor had some weird mitt-like paper object which he held my foot with. I had no idea he was even holding my foot until I saw my foot raised in the air. I appreciated that he was narrating his steps: he was painting iodine all over my toes and then down my foot and leg to prevent infection, just as he had done before, he said. The other two doctors that were there came over to help. Then the two helper doctors attached a sheet to these poles on either side of me to block my view. The doctor said I wouldn't want to watch anyway but I said I wouldn't mind. He ignored me and went on. :(

I heard him tell one of the other doctors to remove this stitch and that stitch. He asked me if I felt anything and thankfully the answer was no. The anesthesiologist came over and said he'd talk to me to keep me distracted or something. Of all things to talk about he asked if I was married and when I was going to have kids because "you have to have kids shortly after getting married." My favorite topic of all! Oh another reason to be put under!!

When he finally left me alone, I heard the doctor ask for a certain drill (I would be really interested in what kind of drills and drill bits he uses) and I heard the familiar whirring sound. Some other inaudible tasks later and then I heard him ask someone to wash up the area and close me up so that "we can all go home." He popped behind the sheet and said he'd go find Dear and tell him everything was done. Minutes later he came back, told me Dear must've stepped out, and then he was gone. When the other doctor was done closing me up, three people lifted me by the sheet under me and put me on a stretcher. I saw a giant blood-like stain where my hip had been and deduced that it was just iodine. Then the unbelievable discomfort began.

I was shivering; I moved my hand to my side and found a nice warm spot. It turned out to be my leg but I couldn't feel it at all! Nurses asked if I could wiggle my toes. I told my feet to move but couldn't tell if they were moving. Then I felt really warm and thirsty. I asked if I could have something to drink but since I had no lower body sensation, I could only have ice chips. The ice didn't help my thirst much and instead upset my stomach. It got progressively worse and started to feel like menstrual cramps times 100. I wanted to roll myself into a ball but couldn't move my legs. The nurse told me to take deep breaths and breathe out slowly. I also started to feel pain in my lower back. The nurse propped some pillows under me so that I was sorta laying on my side but it didn't help. I bent my good leg up and it felt better, but not completely. No matter what I did, I couldn't find a comfortable position and the pain in my stomach was only getting worse. The deep breathing helped a little but not enough. I asked for ginger ale in the hopes that I would burp out the gas (what everyone thought was the cause of my stomach pain) but the more I drank, the more it hurt. I thought the coldness was irritating my stomach so I asked for tea. It also made it worse and I thought it was the caffeine causing irritation. So I asked for room temperature ginger ale. I also got some saltines but they were so dry that I had to drink something in order to not choke, leading to more pain. I got Maalox and some anti-nausea medication. Finally, they convinced me to move to the chair and they wheeled me over to the other side of the room. In transporting me, they jiggled some burps out of me, but as soon as I was laying down again, the pain started.


Hours later, I still couldn't feel my lower body and since I had to pee in order to leave, I knew I would be in for the long haul since I couldn't even feel my bladder. With my cramps I was irritable to the nurses and I had a vision of what I would be like when I'm old and in a nursing home. I slowly started to get feeling in my feet and could push back on the nurse's hand so I got my crutches lesson. When I stood up and took a few steps, I felt wetness down my leg and I realized that my bladder was working on its own. Good thing the whole floor was empty and only the nurses witnessed my incontinence (I was too grouchy to be embarassed at the time). I lost balance and they wheeled the blasted chair (I think the deep recline of the chair contributed to my discomfort) over to me to transport me to the porcelain throne again but by then I was done. I insisted on sitting there for a while though, because sitting upright felt so much better. Hours later, I started to feel urges to pee. That, coupled with some practice on the crutches, led me to release more gas (both orally and anally, haha!). Finally, around three o'clock in the morning (only one nurse remained and she turned off most of the lights on the floor already), I drank some tea to wet my mouth and had some bites of a muffin since I hadn't really eaten in over 24 hours. I struggled to change into my street clothes, got put into a wheelchair, and finally left the hospital. I was put into the back seat of the car so that I could keep my leg elevated. When we got close to home, I felt a similar cramping as before in my lower abdomen but now realized that it was my full bladder talking to me. (Even if I had realized this earlier, I don't think I would have been able to control my bladder to release the liquid.) Dear went upstairs to get his rolling office chair so that I wouldn't have to struggle with the crutches while still partially numb and we made it just in time for me to pee for 5 minutes straight. Each time I thought I was done, the liquid would continue to accumulate, and I kept going. This also happened several times throughout the night.

LESSONS TO LEARN

Petite people are built differently! The anesthesiologist shouldn't have given me such a high dosage because it really shouldn't take me more than 24 hours to fully regain feeling in my lower body (I continued to have labored peeing throughout the following day). And the doctor, I guess, never really worked with people of my size because I wouldn't have had to go in twice if he got it right the first time (I'm still debating whether or not he's a good enough doctor for me to recommend him). Now on to recovery....

2 comments:

Anonymous said...

You've been through a lot! Hope you have a speedy recovery.

Sam said...

would a diaper have helped??