"I am very alarming."

in-patient

By far, the most uncomfortable part of my recovery was the 10 hours I spent on a stretcher in the recovery room waiting for a telemetry bed to become available. After a while, when nurses came by to inquire about my pain I would tell them I was indeed in pain, but that pain was in my butt because of the stretcher I was on, the incisions didn't bother me.

I had fun with the PCA pump (patient-controlled anesthesia). I assume it was Morphine, and when I hit the button a few minutes later I could feel the effects of the bolus...nice, but it also made me sleepy.

The nausea wore off after about 4 hours, which was also about the time that my weird internal inhibition from social interaction went away. My main problem was being uncomfortable on the stretcher. They finally came to transport me to the room and I will never forget the sensation when I moved my butt from the stretcher to the bed. That bed was the most comfortable thing I had ever encountered by comparison. I'm pretty sure that was the first time I really relaxed after the procedure.

Then came the battle of the telemetry leads. I wasn't sleeping well on my back at that time, and I knew if I had any sleep apnea I was going to set off alarms and be awakened, so I wanted to sleep on my side. Every time I turned to my side I pulled some electrical lead off and set off the alarms, sending my quiet and attentive nurse to my side to reset them. She was very patient and understanding.

The other thing bothering me was being unable to take anything by mouth. My mouth was dry, I was dehydrated in spite of being attached to an IV infusion, and I was curious what swallowing something would be like. I wasn't allowed to swallow anything until they shot my follow-up GI studies, which weren't scheduled until the morning.

Every time someone in scrubs (i.e., doctors, mostly those in training at this teaching hospital) asked me if they could do anything for me I told them I needed to have the GI series in the morning scheduled as early as possible. I don't think this had much effect, since it was almost noon before they came to get me the next day.

So, that relatively sleepless night was spent wrestling with electrical leads and listening to the man in the next bed make an ass of himself. I don't need to go into his story, but my luck with people in the next bed didn't improve much after surgery. Also, no one told me the TV was free, so I left it off all night.

One pleasant interlude was at about 5 am when the nurse's aide came in to do my morning care. She was a very sweet young woman, obese herself, who obviously derived a lot of personal meaning from her job. She told me about her aborted plans to have a gastric bypass while she helped me bathe and changed my sheets. I really enjoyed that time I spent with her, I wonder how many practically-invisible beings do this kind of good work in the health care system. That was very important to me.

My nurse the next day was a Chinese man, a nice, sort of comically-bumbling guy who did me a great service by telling me the TV was free, regardless of the instructions regarding how to pay across the bottom of the set. I could get caught up on the news and weather, which, since it was wickedly cold outside, was something I was interested in. That made the time pass a lot faster while I waited on my GI studies.

They finally came for me at 11:20, and I went back down to the same place, same room, same technician, who had shot my pre-op studies. A had a different Radiology Resident, a pleasant and attractive woman this time, and I had to drink a different substance, something that is radio-opaque and would not harm me if it leaked into my abdomen. They warned me it tasted bad, but it tastes no worse than cough syrup, and I was happy to drink anything at that point. I was into my 62nd hour of total fasting by mouth.

They got sort of crappy pictures, just like the pre-op studies, and my surgeon was unhappy with the report he got from the pre-op studies (i.e., unhappy with some Radiologist's performance, in other words), but he said there were no leaks, I could start drinking water.

He asked me if there was anything else he could do and I told him to make sure someone knows to take my Foley out. He offered to take it out right then, being a classic surgeon in some ways--he has a almost genetic preference for acting, and he asked for a syringe and took it out.

Ouch. I resolved back when I was in nursing school to never get myself into a situation where I had to have an indwelling urinary catheter, colloquially called a "Foley." Oh well, another resolution down the drain, but I have to credit my surgeon with the awareness and sensitivity to wait until I was under anesthesia to place it. Taking it out hurt, they should tell people to hit their PCA pump before they do that.

Except I didn't have mine. This is a mistake I made in self-management, I have no one to blame but myself for this.

They disconnected my IV before I went down for the imaging. To his credit, my nurse invited me to consider pressing the button before he did so, since I would be without it for a while. I did have incisional pain, not serious, well-managed with what was in the pump, but it would break-through when I changed positions in the way I was going to have to on the table for the imaging.

Then, the transport team let me sit in a staging area for more than an hour, then when I got back to the room, my Foley was out, I put my street clothes back on, and I failed to ask anyone for pain meds, I was single-mindedly interested in discharge. I knew I was sitting in a germ cesspool with fresh incisions, I wanted the hell out of there as quickly as possible.

About that time, I had a very nice surprise, two of my close friends (and two of the best-looking women I know) came to visit. It was great to see them, these were also two of the people I connected with the evening before surgery, and that really took my mind off my anxiety, impatience and growing incisional discomfort. Never underestimate the power of a visit to someone in the hospital, even if it is only breifly. Hospitals are deeply impersonal places, and having loved ones around brings you back to your personhood. It's important.

So, owing to a number of reasons, some good, some mindless, I forgot about my pain management, and by the time I was in a cab going home I was in moderate pain, 6-7 on a scale of 10. I still had to get my discharge meds filled, and I didn't have my wallet, and I didn't have enough cash with me to claim them from the pharmacy. Poor planning on my part, I failed myself as a case manager!

Anyway, I decided to sleep it off until the fixes I put in place for all this came into place. I got meds about 7 that evening. So, from 11AM to 7PM I had no opioid coverage, half-lives being what they are, that means I had a sub-therapeutic level of opioids circulating from about 2pm on, which corresponds to what I was feeling. I hardly would have been able to sleep if I had done that to someone else, but since I had to endure the pain, I felt like I could cut myself some slack and I did sleep most of the time I was uncomfortable.

This was the biggest hitch I had in the entire peri-operative period. It wasn't bad. It was my first time under general anesthesia since I was 3 years old, it was my first major surgical procedure, my first hospitalization since Nixon was President, and as distasteful as it is conceptually to me, the actual experience was remarkably comfortable given what was actually being done to me. I was satisfied, the system mostly worked.

next - 3 weeks