December 24, 2007

Part I of ACL Surgery: Evil Nurses, Underwear and More than you EVER Wanted to Know

I’m back. Did you miss me? When I say "back," you should know that I’m still spending the majority of my life horizontal and that one week post-op, I am still hurting and hating being vertical. Here begins the story of the ACL reconstruction that happened one week ago today. This is part I of III. Hopefully, I’ll have some news of great progress by the end of the week. I have two PT appointments this week and an appointment to have my stitches removed. I had to divide it up into three because otherwise it was just too crazy long.

Monday and Tuesday were easily the worst days of my entire life. I don’t know exactly what I was expecting, but it certainly wasn’t what I experienced.

Monday

I woke up at 3 a.m. and was unable to go back to sleep. I arrived at the hospital at 7:45 a.m. and wasn’t called back to get prepped for surgery until almost 9 a.m. By then, I was an absolute wreck. My hands were shaking and I was super nervous.

I was led back to a little changing room and told to take it all off. I asked about the underwear, but it was a no go. I asked the nurse if she understood that I was indeed having KNEE surgery and she smiled and said she understood. Mr. BBM started joking about going commando and I just wanted to cry.

I was led over to a prep area, given a gurney, and a nurse practitioner came and asked me a bunch of questions. She was super sweet. She asked me if I had any questions and I told her just one. "Why can’t I wear underwear for KNEE surgery?" She rubbed my arm and gave me a sympathetic look. "I know," she said. She asked who my surgeon was and when I told her she smiled and said, "You have a GREAT doctor." That made me feel reassured. We also discussed his good looks for a couple minutes and Mr. BBM was a good sport as usual.

While I was waiting there, someone came in and called my last name. An older man answered just as I was about to respond and I looked at Mr. BBM with wide eyes. "Oh my GOD!" I said. "I hope they don’t confuse our surgeries! What if he’s having prostate surgery or something?" Mr. BBM almost cried he laughed so hard, and then it really was my turn.

I thought they were going to start my IV there like with everyone else, but the next thing I knew, the transport man came to push my gurney down the hallway with Mr. BBM in tow. Because he was a volunteer, he didn’t follow the "No Admittance" signs and allowed Mr. BBM to accompany me to right outside the OR to what they called the "holding area." He made some comment about being a volunteer and how he should have left my husband back behind the double doors, "but what are they going to do? Fire me? I’m a volunteer. What’s the worst thing they could do? Send me home? And how could that be bad?" He was definitely my kind of guy. He had me laughing and for that I was so grateful.

Mr. BBM said goodbye, and the volunteer left me in the holding area. I still didn’t have an IV and started to wonder if they thought I was going in awake or something. After a couple minutes and several people asking me who I was and what they were doing today (I swear 50 people asked me the same questions and looked at the same "yes" written on my left knee), a young male nurse came to get me. He wheeled me over into the PACU (Post Anesthesia Care Unit) to start my IV. There were tons of crying kids in there. There were lots of adults lined up in a row trying to wake up.

I told my nurse I couldn’t wait until I was in there after the surgery. I just wanted it over with. Jamie, my nurse, reached down my gown and put a bunch of leads on me. When I say bunch, I mean it. I thought I got them all off and actually found one right before I came home from the hospital, more than 24 hours after the surgery.

Then he started checking out my veins. I told him I didn’t want an IV in my hand because I had a bad experience with that before. He tried to find a good vein on me in my arm and thought he did; but he wasn’t confident enough so he called an anesthesiologist to come do it for him. Three pokes later, I had a working IV. They all kept apologizing, but I didn’t really care because when an anesthesiologist does your IV, they use local first so I didn’t feel a thing. Plus, I joked that with all the local I was getting, I’d soon be numb head to toe so it would make the surgery easier on me. They all laughed. I was glad that at least they were at ease.

They called another anesthesiologist to come and get my femoral nerve block started. The anesthesiologist Rob, came in and went right to work. Despite being commando, he kept me pretty much covered up for having to do a procedure on my bikini line. He asked me if I wanted a sedative and I asked him if he could please put a mojito or two in my IV. He laughed and ordered versed and fentanyl. The nurse injected the meds into my IV as I asked how long it was going to take to start working. Rob was injecting local into my bikini line as the meds flowed into my vein. As the words were coming out of my mouth, I felt like I was sinking into my pillow. "Now that’s what I’m talking about," I told him. "Yep, good stuff" he said as he smiled. "On the streets you’d go to jail. In here, it’s perfectly legit."

Before he started the business of finding my nerve, one of the nurses painted my leg green as she sang me "O Christmas Tree." I’m glad they found it amusing that I was turning green, so I lifted up my head and saw that it was a pretty amusing shade of green. That could have been the influence of the IV mojito though. Probably was, now that I think about it. The ceiling was also fairly amusing.

Anesthesiologists are a funny breed. They are extremely excited about the drugs they deliver to patients. Rob started telling me about the nerve block. "These are sweet," he said. "We’re going to find the right spot here and then stick a small catheter in there and you’re not going to feel any pain in the front of your leg or knee for the entire time you’re here." Then he started commenting on my body. "Wow! Awesome!" he said. "You are so skinny. You’re not our typical 300 lb. 70-year old getting a knee replacement. This is going to be a piece of cake." I told him I didn’t realize I’d be getting showered with compliments on my surgery day and thanked him.

He stuck the needle thing in my groin and my leg started twitching uncontrollably. He spent a couple minutes moving the needle around and with each move a different part of my leg would go crazy twitching. It felt weird, but it was kind of funny. That was probably the versed/fentanyl too. After a couple moves, he found the right spot and put it in. He hooked the catheter up to the pump and I was on my way to having a super numb leg.

My surgeon walked in with a big grin on his face and asked how I was feeling. I told him I was nervous, but that the mojito in my IV helped. He patted my leg, told me not to worry, and said "you’re not going to have much pain. It’s really not that bad." He asked me if I had any questions and I told him he answered my 4000 questions the week before. He laughed and went to the OR.

After he walked away I said, "Crap! I did have a question." The nurse asked me what I wanted to ask and said she could go grab him quick. I said, "I wanted to ask him why I can’t wear my underwear!"

Everyone got a nice last laugh, and it was time to go to the OR.

They wheeled me into a icy cold OR and the nurses were buzzing around preparing things. They helped me move over onto the operating table and it was like sliding my bare butt onto a slab of ice. I left out a yell because it was so cold. They strapped my arms gently down and I kept telling them I could still feel my leg. I needed them to know, but they didn’t seem very concerned. They then put this nice inflatable thing around my shoulders and across my chest that they inflated with warm air. They also covered me up with a warmed blanket.

A nice nurse introduced herself and assured me she’d keep me covered up. The anesthesiologist came in and asked me if I felt like going to sleep. He held up my IV with a syringe in his hand. It was all happening so fast now. I heard him say, "I’m putting you to sleep n. . ." and that was that.

I woke up in the OR to a nurse calling my name. I was instantly wide awake.

People were buzzing around the OR much like they had when I first entered. "Honey, why are you crying? Are you in pain?" a nurse asked me nicely.

I reached my hands up to my face and wiped away a tear that was rolling down my face. "No," I mumbled. I didn’t even know I was crying." I blinked a couple times to make sure this was real and then I asked, "So, did you guys all have a nice peek at my ass?" The buzzing OR seemed to stop for an instant and EVERYONE laughed. The nice nurse from the beginning leaned in close to my face and said, "We didn’t see even a peek.

Back in the PACU, I was asked about my level of pain. I felt pain in the back of my calf and the back of my knee, but nothing in the front of my leg. I reached down and felt the top of my thigh. It felt squishy and funny, numb from the nerve block. I had a huge immobilizer brace on my leg (not the one I brought to the hospital and to the OR) and was wrapped in an ace bandage from my thigh to my toes underneath. I also had a drain tube coming out of the bandaging which was attached to a device and bag that collected all the blood.

I said my pain level was a 2. She asked me if I wanted an injection of morphine. "Yes please." It wasn’t horrible, but I had a feeling it would get worse. I was right. Before they gave me the injection, I was easily a 3-4. They gave me the injection. They asked me a few minutes later where I was on the pain scale. I was now a 4. The back of my knee felt tender and my calf felt awful, like a super cramped up muscle, and it was getting worse. The nurse sort of rolled her eyes at me and said that I couldn’t expect not to have any pain. I looked her in the eye, told her I wasn’t stupid and realized I’d have some pain, and that I was told by everyone to stay ahead of the pain.

Another nurse was checking my blood pressure at the time and she sort of pushed the evil nurse away and took over. I later learned that the takeover nurse had undergone an ACL reconstruction herself. She told me that it was killer for the first couple days and that I was right to keep requesting pain medicine.

They kept taking my blood pressure, and watching a monitor above my head. Every once in a while a nurse would stop in front of me, watch my monitor, and tell me to take a deep breath. I didn’t realize that I wasn’t taking deep breaths at regular intervals.

During the time I was in the PACU, I received five shots of morphine. The pain seemed to keep a bit ahead of the injections and I was getting nervous about how bad it was going to get. Eventually they hooked up my morphine pain pump, handed me the magic button, and I was transported to my room.

Once in my room, the nurses used a slide board to transfer me to bed. My leg was so numb and I was hurting, but only on the back of my leg. I didn’t want to even try it myself. I had a roommate who had undergone a spinal fusion. I had a huge window and a view of the helicopter pad. That was pretty cool, right up until Big I waved at the pilot on the night I was being released. He waved back, and I realized that they had probably seen a lot of BBM butt during the night.

My first nurse initially seemed nice. She asked me how I had been injured and seemed like she would be helpful. She told me to stay ahead of my pain, and to let her know if I needed anything. After about an hour of hitting the button, I felt I had sufficiently knocked my pain down enough to deal. Mr. BBM and my parents were visiting, and about an hour later is when things started to get bad.

My pain pump started making funny sounds and I was not getting relief. The pain was ramping up quickly and I was getting more and more uncomfortable. I was trying to breathe through the pain, but unlike contractions, the pain didn’t stop. My nurse eventually came in to check it. It seemed like it took her forever to respond. She then told me that I had maxed it out. I was in so much pain at this point that I was about to lose it. "What do you mean I maxed it out"" I asked her.

It didn’t make sense. If the morphine was set to run in four hour cycles and I was only allowed to hit the button every six minutes, and if the medicine would not be delivered before those six minutes were up, then it makes no sense that I could "max out." The evil nurse started lecturing me that I needed to "just relax" and "calm down" and "control my pain with positive thinking" and "with your karate training you should be able to handle this." If she had been close enough, I think I would have taken a swing at her. I have never in my life, experienced such terrible pain.

With tears streaming down my face from the pain, I calmly and coldly told her that I had been through two lengthy natural child births, and that I do not have a problem tolerating pain. This however, was intolerable and I needed something NOW. She left the room and a nurse’s assistant told me that I was allowed to have up to two additional injections of morphine. I hadn’t had a single one.

My dinner sat on my tray getting cold, because it was impossible for me to do anything but sit there very still and try to will myself to not hurt so much. My entire body was tensing up and anything that took attention away from me trying to mentally control my pain was unthinkable. I could hardly speak; I could hardly breathe.

After what seemed like an eternity, she came into my room with the morphine injection and attitude. Later I was told by the assistants that she was being read the riot act in the hallway by both of my nurse assistants. She was being a total jerk and I am so thankful that those assistants said something, which resulted in her doing something. Needless to say, I was very happy when that first nurse left.

I’ll spare you most of the details on the other "issue," but I was unable to get out of bed at all the first night which meant I had to use a bedpan. I can’t use bedpans. When I was in a car accident years ago, they tried to make me use one and I couldn’t. When I was in labor with Big I, they tried to make me use one, and I couldn’t. I just can’t do it. I did, however, have to pee really badly. I sat there on that bedpan for almost an hour. I tried relaxing, visualizing, concentrating, putting my hand in a cup of warm water. Mr. BBM ran water for me; he left the room; he came back in the room, and still nothing. It’s very hard to go when you have a roommate and her husband is visiting too. I turned my TV up louder and still couldn’t go.

Mr. BBM was feeling really sorry for me at this point. I had survived surgery, a brawl with an evil nurse, and was still in pain and now my bladder was threatening to burst. He sat on the side of my bed and massaged my hand. I poured some water down there and the combination of the two worked. It felt fabulous to finally go. I thought I had broken the seal but my night was going to get much worse.

After Mr. BBM and my parents had gone, I tried to rest. One of the nurse’s assistants was such a doll. She brought me a washcloth and a basin so I could wash up a bit. She also brought me some cookies and kept an icy drink on my tray within reach at all times. She also helped me brush my teeth. We trash talked the nurse a bit, which made me feel better. The assistant assured me that I wasn’t being whiny; "evil incarnate"(the evil nurse) had just been ridiculous and that it was her standard modus operandi.

After a couple hours, I had to pee again and couldn’t go. I tried the previous routine, but it wouldn’t work. Nothing would. The nurse’s assistants even brought me a portable potty that looked like it was a bucket on a walker. They set it right beside my bed and helped me get over there. I was in excruciating pain. My leg was just throbbing and I couldn’t even begin to imagine how awful it would feel if I didn’t have the nerve block. Despite being upright, I still couldn’t go.

I’ll spare you the details but the nurse’s assistant talked me into being straight cathed. At this point, I had enough pain in my leg. I didn’t need to be dealing with any in my abdomen so I let them just do it. It wasn’t really that awful. After you have kids, I guess you just don’t care who sees and is in your business. My night nurse was fabulous. Before her shift was over, I would need to be straight cathed one more time. I just couldn’t go and at this point, I just didn’t care anymore who saw my business. What was more humiliating? A couple minutes of straight cathing with 100% relief or sitting on an uncomfortable bedpan for an hour. I’ll take the former.

Every time I went they used an ultrasound machine to scan my bladder. When I was able to go on my own, I still wasn’t emptying completely. The anesthesia/morphine combo had really done a number on my bladder. My bladder was very sleepy and just didn’t want to wake up.

For the entire night, I was strapped into a CPM (Continuous Passive Motion) machine that bent my knee to 30 degrees and back. It was slow and actually comforting. It was like a fuzzy hammock for my leg and felt great compared to the rigid immobilizer they had me strapped into.

I was beginning to think that I was just going to have to get used to having pain. It seemed endless. I would follow the nurses instructions by hitting the button several times so that I would get a blast of it and would be able to sleep. I fell asleep for almost three hours, but woke up to a horrible firey pain. The nurses thought that my continuous nerve block must have moved inside so it wasn’t providing relief like it should. I was given another bolus of morphine, followed by a bump up in the amount I was getting through my pain pump and an increase in how often I could hit the magic button. Despite a significant bump up in the amount of morphine I was getting, it was still barely taking the edge off of the pain. I was officially "behind" my pain and that is a very bad place to be. It was excruciating, but I was increasingly feeling more out of it. I felt like this day would never end.

If I had only known how much worse Tuesday would get. . .

This is the first of a three part series which will be posted over the next three consecutive days.