Feelin "Groovy"

In the river guiding world, there are numerous references to the port-a-potty or the act of evacuating one's bowels. When you host 26 people on a river trip and fill them full of good healthy food (also called a "float and bloat" trip), all that good food gets processed into the inevitable. To reduce the potentially nasty impact on river canyons and wild places, ALL waste must be packed out and disposed of properly. Nowadays there are fancy systems and products that do this with little "yuck" factor. However, the old days were not so efficient. Therefore reference to all things involved with the port-a-potty deteriorated aggressively over the course of a few days on the river, especially for the rookie who got saddled with rowing that particular containment apparatus on his or her boat. Names for this apparatus were varied and comical. They included, but were not limited to, the "Porta," the "Honey Pot," "Big Windy," "The Pooper," "The Shitter,"and finally, "The Groover". The rest of the names are self-explanatory but the "Groover" was an anomaly. It originated from a c.1970's practice of using military ammunition containers to carry gear down the river. They were watertight and fit nicely into the metal frames of a raft side by side. One of these cans was designated specifically for the removal of human waste. Multiple plastic bags were placed in the can and the can was taken down wind of camp and placed in a location with a view. Patrons would then either "squat" over the can or simply sat on the can and enjoyed a picturesque backdrop of the river, the area surroundings, and even some wildlife. Afterwards, the can would be filled with lye, the bags closed and a strong, watertight lid would be placed over the top. It was then tied into a raft with great care. In fact, it was often the only thing that was never lost in the event of a flip because no one ever wanted the liability of swimming in the river with an open honey pot. However I digress.....the reason the Groover is called the Groover is that depending on one's length of stay while visiting the portable human waste receptable, it was altogether possible to have the marking of a perfect rectangle or a "groove" on one's backside upon standing. Thus, the term "Groover" was coined along with it's associating components in the English language. The verb "to Groove" was the action of having a bowel movement and feeling "groovy" indicated that a movement was imminent. Of course, there are degenerations that developed over time such as groove-a-licious, groove-a-matic, groove-worthy, groovinski, groovanator, etc. Ironically, it is one term that is specific to the river industry that most river people understand and share with a reflective grin.

Just about everyone suffers the side effect of constipation associated with narcotic use. Post-surgical patients get the double whammy because during surgery, the gut is shut down. Nothing passes through until after the parasympathetic nervous system is turned back on and inspires the body to start passing gastric contents through the alimentary canal. This process can take some time. In the old days, it used to be that you could not leave the hospital until you were moving your bowels. To speed up this process, almost all patients got the go-home enema. I was happy to have avoided this experience but now that I was home and still hadn't moved my bowels, I was starting to get a little worried. I sent the hubby to the store for prune juice.

Not my favorite libation, prune juice tastes like liquefied raisins to me. This is odd because a prune is not a dried grape, it is a dried plum. However, the taste of prune juice makes me think of someone putting a bunch of raisins into a Vita-Mix blender and liquefying them until they resemble a dark black liquid which is ugly enough to scare the crap out of you let alone inspire peristalsis. I drank it twice daily. My daughters made all kinds of faces as they watched me drink it. None of their faces matched mine. Picture a blend of grimace, wince and disgust all rolled up into one contorted face. The girls felt hopelessly sorry for me. I tried to take the high road without success.

By this time, my stomach felt "full". My nurse voice started to take over. Ileus? Bowel Obstruction? Soap Suds enema? Fecal disimpaction? My nurse voice could scare the daylights out of the most stalwart of our tribe. I contemplated the worst case scenario and what I was going to do if the Mcmuffin principle held out to be true. I envisioned presenting to our local ER, which is also my place of employment, with the chief complaint of "can't poop." My colleagues would massacre me. Not because of my actual malady but because it meant that potentially, one of them was going to have to glove and gown and manually eliminate the contents of my rectum. This was not a pleasant thought for either of us, having been on the gowning and gloving end of the poop removal process. This would be a huge favor to ask of anyone, let alone a person I had to work with. I decided to go to guns.

Laxatives are tricky. If you are already backed up, the last thing you want to do is send a whole lot of liquid contents to the the site of the blockage because it will only increase that "fullness" and discomfort. It is hopeful that this liquid will soften the offending blockage and break the dam thus releasing the pressure and relieving the discomfort.

Whenever I am faced with complexities of the human body, I try to put things into simple, analagous terms that are helpful. For example, when I worked in the cardiac catheterization lab, I had to learn, very quickly, the anatomical and physiological workings of the human cardiovascular system. If you consider everything that goes into the functioning of the human heart and the network of arteries and veins that compose it, you will be lost in electrical, mechanical and biochemical oblivion. The intricacies of this system are infinite and therefore completely overwhelming. However, it you break it down into the most simplest form, it's really just pumps and pipes. I learned about the mechanical aspects first. How does a pump work? It has to fill and then subsequently eject its contents. How do pipes work? These are simple basics of volume and pressure that you can get in a quick study of fluid dynamics on the internet. Now let's consider the human gastrointestinal system. It's basically a gravity-fed, septic system with a pipe that squeezes to assist gravity's job of moving things through it. Imagine this pipe getting clogged. How would you unclog a clogged bathtub or septic pipe? You would probably start with a declogging agent such as Drano.

Important disclaimer: DO NOT DRINK DRANO, EVER. Drano is an alkali. The Merck Manual, put out by Merck & Co, one of the largest pharmaceutical companies in the world and makers of most medical reference material for physicians and healthcare personnel, says the following about alkalis:

"Alkalis cause rapid liquefaction necrosis; damage continues until the alkali is neutralized or diluted. Alkalis tend to affect the esophagus more than the stomach, but ingestion of large quantities severely affects both."

Taken from The Merck Manual Website

In other words, ingesting Drano would liquefy your bodily contents, cause gastric perforation and stop your heart. It is a very horrible death and one you should seriously avoid. No playing around.

So what do we use instead? Laxatives. There are many on the market, some gentle, some not so gentle and some downright violent. The general idea is to start gently and move in an aggressive direction. Prune juice is a gentle and an appropriate starting point. Adding fiber to your diet is also a very smart "move."(Pun intended). Remember: all drugs have side effects so natural means should be the preferred starting point. From here, the grocery aisle of digestive products gets large and variable. There are groups such as lubricants (i.e. mineral oil & glycerin) that coat the inner lining of the gut to prevent water absorption out of the intestines, leaving stool more opportunity to be loose.

Next are the softeners composed of Docusate Sodium, a.k.a "Colace" or "Phillips Liquigels." They bring water into the stool directly. Some may argue their effectiveness. Smart Money says start these early because by the time you are blocked, they don't do much. They are more of an insurance policy than a declogger. Take them for good karma.

Up next we have the Saline or Osmotic Laxatives which attract fluid into the bowel to soften contents. These are also known as Mira-lax, Milk of Magnesia, and my personal favorite, Magnesium Citrate (Boom!). I have rarely seen Mag Citrate not get the job done. Things get pretty exciting with this one. I consider it "going to guns" in the war on poop.

Finally, we have the stimulants. These are the least comfortable as they stimulate the muscles of the gut to move things through, often given the term "cramping." Stimulants include anything with bisacodyl or castor oil. You may recognize products called Dulco-Lax , Ex-Lax or Senokot. If Osmotics are "going to guns", then Stimulants are "going nuclear." Important safety tip: Do not plan any activities that take you far from a restroom when you take this stuff. You will have little or no warning when it breaks the clog free and you cannot even fathom how much the human gastrointestinal system can actually hold.

Speaking of which, it begs the question. How much can the human intestine hold? The volume of a tube is V=∏r2h.In the interest of time, I took the liberty of doing the calculations on my own and came up with a max volume of 9 liters. 9 liters! That's 2.38 gallons of maximum capacity. Thankfully, we are never at full capacity, although I know plenty of people who are totally full of crap. However, in the interest of making a point, let's say half of your gut is full of poop and you just drank the pharmaceutical equivalent of Drano. You soon will be evacuating a gallon (or more) of a foul, highly odiferous, substance that will not wait unless you have Herculean sphincter strength and a rectum of expansive proportions. Keep the porcelain near.

My particular defecation pickle found me backed up for four days with no success from the prune juice nor the mountain of steamed vegetables, raw spinach salads, bran flakes, or roasted corn that I was eating. It was time to go to guns. I introduced the Mira-lax and mixed it with my prune juice. This worried me because I was not a fast walker with crutches and if things started happening, I was going to need rollerskates to get me to the throne. When minutes turned into hours and hours led to night, I started to panic. I kept wondering who was going to be working triage and the look on their face when I presented my chief complaint. In anticipation of this, I threw out an email to my tribe of nursing buddies to smooth the path and put everyone on alert.

Dear Nursing Posse: No BM X 4 days. Prune juice not working. Pain meds and surgery suspected culprits. Stool softener and Mira-lax on board. Thoughts?

The general consensus was of course, go nuclear. However, a couple of my friends pointed out that 4 days wasn't really that long and perhaps, my morning coffee might be just enough to tip the scales. I had been avoiding coffee, which explained the headache. Coffee was part of my regular routine prior to surgery. Perhaps my body was just waiting for that particular communication that all systems were go. Just to be safe, I cautiously administered half a bottle of mag citrate in my evening spinach smoothie as a precursor for success.

That night, my husband prepared a yummy stir-fry selection of all his favorite gut-movers, carrots, onions, chicken and corn among them. I passed on the rice since this is generally a "binder" and potentially a step in the opposite direction. I was soon full after very little and slightly fearful that each bite was just adding to the blockage notwithstanding the foreboding rumbling sounds now coming from my abdomen, blatantly audible as if an event were looming. Still, there was no result before bedtime and the sounds of liquid rushing through my gut were now beginning to sound ominous. I anticipated a cataclysmic outcome and feared that it would occur sometime during the middle of the night.

Yet, morning came with the rising of the sun and I remained perturbed and poopless. Day 5 was now underway and my optimism was waning. My splitting headache reminded me of the coffee idea. In light of my present irritable mood and my head feeling like it would soon explode, coffee was probably a good idea on many levels. I made my way to the kitchen. Upon walking into the kitchen, I smelled coffee already made by my doting husband (bless him!). The waft of roasted Arabica Beans present in the air was another reminder that we were in fact home. I was heartened by the sight of my girls drinking Saturday morning smoothies and the fact that mine was sitting there waiting for me. And in this magical moment of being with my family, in our peaceful home, on a sunny, beautiful mid-winter's day, I was truly "feeling groovy," groovy enough to send me scrambling for the Honey pot whereupon I finally grooved............And grooved.............and grooved.

3 magazines later, mission accomplished. Now, I had a new problem.......making it stop. Looks like sushi and pizza were back on the menu!

Home

I am always amazed at how vulnerable I feel every time I leave a hospital. After breaking my body into 10 pieces, a femur repair surgery, a knee repair surgery and two weeks in a hospital, they just let my Mom drive me home. I was 22 years old and the responsibility of taking care of myself in such a state was frightening. I had take XYZ meds at certain times, make sure not to bear ANY weight on my right leg while my left leg was in a brace with my knee constantly bent at 30 degrees. My instructions were to eat right, get lots of rest and do my range of motion exercises. It was a much different life from managing ski gear, travel plans and schoolwork.

After I delivered my first baby, they just let us take her home the next day. We walked out with a new baby daughter and a new life of changing diapers, round the clock feeding, carseats, cribs and colic. Once again, life had changed and the hospital just let us go without a manual, without a clue and without a prayer.

Hospitals change lives, and usually in an unplanned way. My hip replacement surgery was elective, to some extent, but the change in my condition was unforeseeable. What if there had been complications? What if the surgery didn't go well? What if it went perfectly? What does one expect? You can't possibly know until after you are home and can compare what is going on with your everyday life.

St. Vincent's hospital tries to make this transition easier. It's called "Case Management" and they transition a patient from the hospital, a large building full of technology and human resources, to your home, a humble hovel on the side of a hill with the nearest neighbor a half a mile away. Depending on the difference in living situation, this transition can be huge. I do not envy the job of the case management worker, but I am sure glad that hospitals have them.

My husband got us out of Los Angeles just in the nick of time. We were leaving LA at 3pm on a Wednesday which meant that we were right on the cusp of rush hour traffic. I felt exposed sitting the front seat of the Buick Impala with windows to the world. Everything outside of my bubble was happening so fast! Cars were weaving in and out, jockeying for position on LA freeways amidst 18-wheelers, BMW's, Toyota camrys and the occasional Ferrari. After all, this was LA. My husband performed effortlessly and the sharp relief of my condition compared to his was a staunchly apparent. I thought I was such a badass in the hospital because largely, I was comparing myself to other orthopedic patients and was receiving very positive feedback about my recovery. However, being outside the walls of the hospital, I suddenly realized that I was definitely the weak one of the herd. If this were the Serengeti, I would be lion fodder.

I was mostly comfortable, propped up with pillows and taking my pain medication. Once out of Los Angeles and north of the Grapevine, I was overcome with hunger. There's an exit with everything imaginable as you drop in to the Central Valley corridor. I was so excited for non-hospital food. We went to Chipotle, one of my favorite "fast food" stops. When we pulled in to the parking lot, I realized I would have to get out of the car. You forget about the easy things in life like sitting down on toilets, getting in and out of cars, bathtubs, and beds, and walking from point A to point B carrying something in one or both hands. It took me an eternity to get out of the car. I had to keep my foot rotated outward so my poorly supported knee wouldn't dive inward and shred my hip capsule. My stamina was also in the tank, so after first getting both of my legs out of the car, I had to stop and rest. This did nothing for my ego. I grabbed my crutches and headed inside. Again, everything was happening so fast.....

"Hi, Welcome to Chipotle, what can we get started for you today?"

I felt like I was in a time warp. I just looked at the kid in his 20's with the blank stare of a serial killer. My husband stepped in to save me.

"I'll have a carnitas burrito..." and then it was more questions,

"Pinto beans or Black beans? Corn? Rice? Salsa? Lettuce? Tomato? Sour cream? Salsa? "

The word whooshed past my ears like I was in a wind tunnel. Thank goodness I was not operating any heavy machinery. Now it was the Chipotle kid's turn to stare. I was on the spot of indecision.

"Chicken, Black, corn, lots of it, very little rice, no cheese, lettuce, tomato, and salsa, the brown one."

"Flour tortilla okay?"

Not fair, he sabotaged me and went out of order. We were back to the beginning and I felt like I was in a spinning vortex. He was challenging me. Did he not see that I had two crutches that could crack him up side the head at any moment?

"fine," I managed.

The assembly line of my burrito continued faster than I could walk from one end of the counter to the other. My husband was paying for everything before my burrito was even finished

"Anything to drink?"

Seriously? I decided that there were a finite number of questions that people were allowed to ask me my first day in the outside world and this guy's quota was up. My husband, after knowing me for 17 years, sensed that an altercation was on the horizon, that my fuse was short and that I had weapons of mass destruction. He completed our transaction before I could come up with the witty, jolt of sarcasm that was brewing beneath my sharp tongue.

We headed back to the car, which while parked as close as it could be, still seemed like it was in the next state. Upon my arrival, I spent what seemed to be an eternity re-situating myself in a tolerable position that would also lend convenience to eating the massive burrito that we had just provisioned. I dove into it with fervor. It was as if I hadn't eaten anything but gruel for months. It tasted so good, all the flavors just bursting in my mouth. The hidden flavors not on the chipotle choice list, cilantro, lime, chiles, avocado, were all surprising additions to my already perfect meal. I got halfway through and started to feel full, but it was soooooo good! I just had to have one more bite.....and then it was gone. I ate the whole thing. I could feel it just sitting in my gut, which was also about the time I realized that I had not had a bowel movement in three days. I hoped the burrito would push things through. After all, there was little rice and lots of corn. That should do it.

We continued on I-5 north. The I-5 corridor is a vast emptiness of farmland and CAFO's (concentrated animal feeding operations) which have a stench to them that is unique and distinctive. It is also a great precursor to the ejection of a burrito. I wasn't sure if it was the speed at which things were coming at me, the new food, the new smells or the pain medication, but my stomach was sending me a message. "Do that to us again, and I will make you taste it twice."

With my stomach spanking me for my indiscretion, I thought it prudent not to add more pain medication to the mix. However, I-5 was not the smooth, flat pavement I remembered it to be. There were expansion joints, potholes, and a multitude of mini-overpasses that had just enough of a rise to give the contents of the car a slight lift when we hit them. The fluid in my leg responded to this lift and the accompanying discomfort was having a cumulative effect. The novelty of being freed from the hospital had worn off. I closed my eyes and gritted my teeth. 3 more hours of this was going to test my mettle.

I managed to fall asleep to the rhythmic up and down motion despite the pain it was causing. When I woke, my husband asked if I was doing okay. I explained my situation.

"Well, that would explain the groans of agony."

Apparently, I groan in my sleep.

We arrived home around 9pm. My daughters were still awake, of course, because my mother-in-law believes that our established bedtime is really just a "guideline," and I was coming home, so I guess this was a "special" event. They waited so patiently for me to go through my car evacuation ritual and slowly amble into our house. They hugged me gently and welcomed me home with homemade cards and kisses. I was suddenly surrounded in sweetness. I was so happy to see them. Before my surgery, I was so afraid that a complication might change the way we live our lives forever, or that I might not see my children again. Yet here they were, and here I was and aside from a few bruises and some swelling, we were all going to be just fine. It was a comfort and a relief that is impossible to describe other than to say, I exhaled, finally.

Home was comforting. I knew the lay of the land, and which unpredictable obstacles to avoid which included anything associated with the dogs and cats. The peaceful quiet that comes with rural living enveloped me and I realized that this would be the best possible place to heal a new hip. Now, if we could just find that bottle of Coumadin (a derivative of rat poison) that Grandpa seemed to have misplaced........

Bail

"Tori, Tori Tori Tori Tori!"

At 5am, my wake up call was delivered personally by a beautiful woman with a thick, African accent and skin as black as night. She was loud and boisterous and filled my hospital room with personality. She was the first person to call me by my first name on our first meeting and spoke to me like we had been friends for generations. I slowly rustled from my narcotic stupor to embrace today's multicultural experience.

"My name is Shauna and I am please to meet you. Your name, Tori, means 'because' in the language of my country. I am from Ethiopia."

How cool was that?! Suddenly, I wanted her to sit down, have some coffee so we could chat about where she was from, what brought her to Los Angeles and regale me with stories of Africa. I was more alert to my surroundings. She took my blood pressure, checked my vital functions and jump started my day with a happy disposition. Despite my cultural awakening, I was now aware of my recent hip replacement. My right hip felt like it had been the stopping apparatus to a 60-car freight train. It was swollen, stiff and sore. The good news is that it wasn't THAT bad, really. This was the worst it would ever be, and I was tolerating it on oral pain meds. My good mood was undeterred.

Wednesday was discharge day. As long as I passed all my tests with PT and OT and survived another internist evaluation, I was to be released on bail. Hubby had the monumental job of driving us home. It would be seven hours in a car with a wife 3 days out from a hip replacement and a low tolerance for pain. He was about to make good on that "for better or worse" promise he made around 14 years ago. Jacked up on lattes and McMuffins, he looked ready for battle when he came in to my room Wednesday morning. All the preparations for kicking a patient to the curb were underway. Pharmacy delivered my 3 weeks worth of Lovenox, an anti-coagulant that would hopefully keep my blood from developing a clot that could wreak havoc on just about any part of my body. Surgery is the easy part. It's surviving the potentially life-threatening complications of clotting, infection and patient stupidity that make it hard. The pharmacist also included a bottle of Norco, a narcotic pain medication that I will be relying on heavily to keep me from destroying everything in my path. I am quite irritable when I'm uncomfortable, making me very unpleasant to be around. I think Dr. Stefan, my internist, who ordered it, had the best interests of everyone involved in mind when he planned to send me out the door with this stuff. Today, Nurse Mirtha was back. She was very specific about pain control and quite irritated when she found out I didn't receive the Dilaudid that was ordered when I was having trouble the night before. She made sure I was well medicated on her arrival and throughout my last morning at St Vincent's hospital. The pain and swelling had taken hold with the anesthesia now completely worn off. It wasn't unbearable, but it was definitely more consistent with my expectations of having a hip replacement. However, walking was still far better than it was prior to my hip replacement which is a true testament to the fact that I was in a lot more pain than I thought.

Kahra, the super occupational terrorist, dropped in to teach me how to get in and out of bathtubs and vehicles and taught me again how to get my socks on. She was a real gem. I wanted to bring her home with me. Not because I needed an occupational therapist, but because I wanted to invite her over for dinner and lots of red wine so we could regale each other with the exploits of our youth. We had a lot in common. We are boisterous, sarcastic and innocuously rebellious. If we lived in the same locale, I think we would be dangerously good friends.

A different guy from the medical equipment company showed up with my new crutches. He looked at the ones that had been delivered previously, and then looked at me and broke out into a fit of laughter.

"I think these will work much better," he chuckled.

I was so excited. The crutches were another step toward freedom. Forearm crutches have a cuff that surrounds the forearm rather than going all the way up to the armpits. Their use increases upperbody strength because there is no position of rest. For this reason, one must be very careful not to do too much too soon because it's easy to forget that the muscles of the upper body are not used to bearing the load of the lower body. The learning curve is steep in the beginning and it's easy to wear out using these crutches. They were perfect for me as they would limit me from doing too much. Either that, or I was going to have super strong arms and shoulders. It was a win-win situation.

I immediately cruised the nurse's station on delivery. By now, people knew me and figured I was on my own. Family's from other patients talked to me about my surgery and marveled at my current level of mobility. I took another pass down the hall with the view of downtown LA and warm, sunny hallway that reminded me of a world without constant care. While on my morning cruise, we ran into Dr. Schmalzried. He had not gotten any shorter. I told him I was rolling and that this would hopefully be the last he heard of me until my six week checkup. I asked him for an address to send him a Christmas card. He told me to talk to Carol and to make sure I included sports photos for the website. Another mission for the damaged diva was declared. I liked him. For six weeks, I tried to pick him apart, assess his strengths and weaknesses and how those would affect my surgical outcome. Dr. Schmalzried is a very rare form of surgeon. He appears to really care about his patients. He is held in high regard by his staff and colleagues who appear comfortable and confident in his presence. He has remarkably, proficient social skills, including going the extra mile of introducing himself in his own waiting room, the likes of which I have never seen in a professional of his stature. He is an efficient, skilled, orthopedist who lacks arrogance and ostentation. He is pragmatic, realistic and straightforward, and he was one of the few people I considered worthy to perform major surgery on the mother of my children. I was hopelessly grateful for his work and the incredible good fortune I had to find him.

I was ready to leave, but paperwork was holding up my escape. Drugs and crutches delivered, PT and OT checkboxes complete, nursing notes all shored up, it was now up to case management to get my out. Mirtha brought me more Vicodin. At 3pm, I made bail. I tried to sneak out on my crutches but the nurse's aid busted me. It's hospital policy that all patients be assisted to their private vehicles in a wheelchair. I tried to politely refuse but they were having none of it. I said a heartfelt goodbye to Kahra, Raddick and Mirtha who took incredible care of me with their sharp wit and vast experience. The aid then rolled me into an elevator and out the front door where I breathed in some fresh LA smog. It did not matter. It was non-hospital and it was the first step to living on the outside with a bionic hip.

As I got into the car and situated myself in the best possible position of comfort for a 7 hour car ride, I noticed a familiar snack food. What was left of the Salt and Ground Black Pepper Kettle Brand potato chips was on the floor of the front seat and I just so happened to be hungry.

"Let's find a sushi place on the way home honey."

Lessons of Pain

As I neared the end of my first Day, post-op (that's "after surgery" for those of you who have never watched ER, Gray's Anatomy or any other hospital show.....), my experience of pain began to change. Now that my drain was no longer evacuating the fluid from leg and the anesthesia was worn off, I started to feel like someone had hit me in the butt with a baseball bat. Either that, or my surgical team loaded me up with a squat bar and made me squat for 2 hours. I was sore. It was discomfort related to tissue trauma and it was hard to really quantify. Pain is perceptual so there is no way to really convey to another human being what your experience is. The hospital has all kinds of pain tools like verbal and non-verbal indicators. Crying, screaming, vomiting, and threatening to dismember your nurse or nearest healthcare professional are generally pretty telltale signs that one is not comfortable. However, other than this, pain is much harder to determine. Enter the dreaded "pain scale," the bane of everyone's existence. Nurses don't like it because it is too simple and most patients have no idea how to use it despite numerous teaching attempts. Patient's don't like it because trying to quantifying pain is like quantifying love. "Well, I love you more than my favorite TV show but less than chocolate." Yeah, that's effective. I mean, are we talking really good chocolate or the cheap kind you might find at a truck stop? And which episode of your favorite TV show? The one where McDreamy and Meredith finally seal the deal or the one where Izzy can't remember the secret ingredient to her Mom's famous cupcakes? Seriously? It's like that.

The Wong-Baker faces scale is a tool created by Donna Wong, a pediatric nurse and Connie Baker, a child-life specialist back in 1981 to try and evaluate pain in children at a Burn Center in Tulsa, Oklahoma. The primary goal for creating this tool was to assist children in communicating the extent of their pain to parents and clinicians so that they could provide adequate pain relief. The Wong-Baker faces scale is a rendition of 6 faces with corresponding numbers. While this scale is generally used for children, it helps adults to clarify a number in terms of how much pain they are in. All of us experience pain differently and the presence of physical pain might not be as big as, or magnified by, the issue of emotional pain.

It is without fail in my job as an ER nurse that I struggle with this pain scale primarily because it is not measured, but rather, reported by the patient. Take for example the 6'2", 200-pound male that presents after breaking his collarbone while riding his motorcycle. He's manly and proud and spends most of his emergency room visit telling me about how he cut his hand "near off" with a buzzsaw or suffered multiple concussions while playing football in high school. He's tough. He can "take" it. He will tell me his pain is a "3" on a 1-10 scale. "Great!' I'm thinking we'll just get this guy a sling, a referral to an orthopedist, and send him on his way. However, the minute I stand this very large, very proud man on his feet, the color invariably leaves his face, his pupils dilate and he gets all sweaty right before he tries to pass out. Try stopping a Sequoia from toppling over in the forest. The best you can do is change the direction of fall and hope he lands on something soft. However, this makes me, the nurse, question whether or not patients can really give me an adequate representation of their pain.

Now let's look at the other end of the spectrum: A 52 year-old female of average height and weight comes in with severe back pain. She takes all kinds of pain medications including morphine, oxycontin and the muscle relaxant du jour. We load her up with enough pain meds to drop an elephant. 30 minutes later, asleep and drooling all over herself, I wake her up to see if her pain is relieved and if the medication was effective.

"Mrs. Jones your pain was a "10" (worst pain ever) on the 1-10 scale before the pain medicine. What is your pain level now on that scale?"

Mrs. Jones struggles to open her eyes, does a little head bob and manages to slur out the number, "ten," before she drops her head back on her pillow and drifts off into a pleasant, slumber.

Hmmmm. Really? Let me run right back and get you some more pain medication.......

So nurses get to be skeptics and have to rely on other tools other than patient statement regarding pain. The problem with this is pain varies from person to person.

Take a 5 year-old patient who comes in with a broken leg after falling off a trampoline. A "10" on the pain scale is considered the worst pain you have ever had in your whole life. Well, a 5 year old has had little life experience, so this is presumably the worst ever and warrants a "10". Simple enough.

However, take a 9 year-old who has previously fallen off of a trampoline, crashed Dad's ATV, got 22 stitches when he broke Mom's favorite vase and a bloody nose when he ran over the goalie at his soccer game and now presents in your emergency room with a broken arm after falling off of his skateboard. He tells you his pain is "no big deal, maybe a "4" on that same scale( Dad is also watching which may or may not have an effect on the actual number). His answer is slightly incongruent with his age and experience until they tell you the laundry list of emergency department visits they've had. And now you are thinking this kid needs a helmet just to eat his cereal in the morning.

This incongruence can be present in adults as well. I've met plenty of 30- or 40-somethings who spent their entire life in a bubble with their worst injury being a paper cut until they come in screaming and moaning and carrying on because they were in a car accident and they broke a fingernail. This is almost always the case when the 9 year-old is right next door which prompts him to say, out loud, "What is WRONG with that lady Mommy?" Okay, it should also be said that the emotional response to a traumatic event tends to magnify pain and a patient's report of pain, so now I'm giving high doses of Morphine to a 33 year-old female with a broken fingernail while my 9 year old next door is laughing on Motrin with an arm broken in 3 places.

Finally, there are the 70 year olds who come in with a decreased pain sensation anyway, but have lived life to the fullest and now have two new knees, a hip replacement, a pacemaker, a lifetime of smoking, and come in for a "a little chest pain" because their granddaughter said she saw something on TV about how important it is to get something like Chest Pain checked out....... Little do they know they are having the "big one" and I'm running around getting cardiac drugs and defibrillators while this guy tells me about his sciatica and how that hurt much worse than this little old heart attack!

Pain is based on experience. Pain is different for everyone and different with each system and each precipitating event. In my life, I have had 6 knee surgeries. 4 of them were arthroscopic, snipping out unwanted and non-crucial cartilage that broke loose or having synovial fluid evacuated. 1 was due to a subluxed (simultaneously dislocation then relocation of) patella that required a little resurfacing and the other was to fix a total blowout to the lateral side of my left knee after a ski accident where I also broke my Tibial plateau, the top part of my lower leg. In this same accident, I broke my femur in 8 places which warranted a separate surgery called an "open, reduction, internal fixation" of my right femur after I not only broke it, but it shot out the back of my leg and ripped a pretty sizeable hole. I broke my pelvis in 4 places and my lower back which was accompanied by debilitating back spasm for a year. I've had stitches, concussions and pulled muscles and ligaments in just about every major joint in my body. I have been around the proverbial orthopedic block so to speak. And if that's not enough pain experience, let's talk about two pregnancies and two 'almost' natural deliveries.

I am on comeback number 11 by my count. Hip replacement surgery is just another walk in the park and I really thought that maybe I could skate through it with ease.

However, at the end of my first day, I was beginning to revisit the joys of post-surgical tissue trauma which included pain and swelling and it was time to cry uncle.

My nurse Mirtha came in the room.

"What can I get you darling?" she offered.

"I think I need something for pain, Mirtha."

"What is your pain on the 1-10 scale?" she asked.

The shoe was now on the other foot. After having to analyze pain in hundreds of thousands of patients and determine if their non-verbal cues matched their verbal ones, I was now being asked to provide my own number. It was karma and a hard lesson into the actual difficulty of trying to identify a number that matched my pain. I felt like I was taking the SAT. I gave my answer with clarification.

"Well, I'll give it a 7. It hurts enough to do something about it, but it could still get worse and I would like it to get a whole lot better. Compared to a broken femur, it's probably more like a 5 but that was a long time ago."

Mirtha, unimpressed, went to get me some Vicodin. I felt defeated.

"You just had hip replacement surgery," my husband reminded me.

"Yeah, but I still feel like a sissy. I should have said 6."

The fact is, there is no wrong answer. It is dependent solely on how the patient perceives their pain, which as I have mentioned, can also be affected by a precipitating event inducing a hypersensitive emotional state, a lifetime of experience, or lack thereof to compare their level of pain with. Patients get it wrong sometimes. Not because they are bad people, but because it is hard to quantify pain, especially if you happen to take massive amounts of pain medication and are unable to tell if you really hurt or if your brain is telling you that you hurt so it can get its narcotic fix. The new trend in healthcare to reduce the judgment and skepticism is to consider pain the "fifth vital sign". Phooey. Vital signs are directly measurable. You can't fake or control a blood pressure, a heart rate, oxygen saturation or a temperature. They are what they are. Pain is based on subjective data and too many factors. However, until someone comes up with the pain-o-meter that directly measures impulses and their impact on one's central nervous system, we are all stuck with the patient's perception and report of pain in number form. Nurses and patients will continue to make mistakes, but hopefully, we can treat and be treated with dignity and respect regardless of the pain tool du jour.

Mirtha gave me my first Vicodin at 3pm. However, by 6pm, I still felt like I had been the center of attention at a butt-kicking convention. She gave me another Vicodin. I could see that Mirtha did not care if I could quantify my pain or not. After 30 years of nursing, she just wanted a number to write down because with pain being the "fifth vital sign," it meant she had to record it. I gave her a 6.

After two Vicodin, my pain was under control by shift change. I was much more comfortable at "2" on the pain scale and appropriately "fluffed up" for the new night shift nurse who was a young, Filipino gal named Violet. Violet was not the calm, smooth, nurse of many years of experience. She played by the rules, and was obviously irritated by the use of my call button.

I was always sad to see my husband go when he left the hospital. He provided perspective into my skewed thought processes and when he left, I felt unsure of myself. Should I really get up and go pee without calling my nurse? Seems perfectly logical to me but I always like to bounce the biggies off of my spouse, like what is that big orange glob in the middle of my dinner plate? Now he was gone and I was left to my own devices, again. Perhaps sleeping would bring him back sooner, with lattes in hand. Once again, I could not get to sleep. As I watched the minutes creep by with my iPod and 3 failed TV program attempts, I realized I was uncomfortable. I hit the call button.

Violet appeared shortly. I told her my pain was returning and I might need something a little stronger this time as the Vicodin was not lasting as long as I had hoped. She explained that I could have 2 tablets every six hours. However, because my last one was at 6pm, I would have to wait until 12am to get the second tablet. I asked if that was all there was, and she, very frankly, retorted that those were my "orders."

Hmmm. Dr. Stefan said I had Dilaudid for breakthrough pain. One tablet of Vicodin for a post-surgical hip replacement patient with 2 more hours until her second tablet and my nurse was not budging on either the breakthrough pain med nor the 120 minutes left on the clock. I wanted to get self-righteous, I wanted to start screaming obscenities at miss "holier-than-thou," but the truth is, I have walked a mile in her shoes. I have stood before a patient and told them something similar and the weight of this news was now weighing on me personally. I was learning a lesson and the gift of this lesson was worth retaining my dignity and gutting out the remaining time. However, I did not wish to lay awake for the two hours I had left nor deny my traumatized tissues the rest they so desperately needed. I played my last card.

"I'm pretty sure Dr. Stefan wrote me something for sleep. Can you bring me something to help me sleep through the discomfort of the next couple of hours please?"

Violet returned with Ambien and a defeated look on her face. I would see her once more at around 4am when they came to take my blood pressure. Since I was awake, I took the two Vicodin tablets I could now have according to my "orders", and drifted back into pleasant, chemically-induced slumber. It was the last I saw of Violet......and the formerly, skeptical, self-righteous damaged diva.

The McMuffin Principle

Day-1 Post-op

Usually, the first day after surgery is the worst. This being my 9th orthopedic surgery, I was no stranger to the fact that Day-1 Post-op generally sucks. The anesthesia wears off, the swelling is in full bloom and the pains of being in a weird position during surgery not to mention a leg filling up with fluid (swelling) gets to be a little much. Plus, the post-anesthesia hangover kicks in along with the unrelenting urge to vomit. Having nothing in your stomach means you simply feel like crap and do not feel like eating. I was prepared for this day. I canceled all appointments, turned off my iPhone and was ready to bribe Father Time to speed up the turning of the Earth on its axis. I braced myself for the worst.

Happily, and uncharacteristically, I felt great. I was also wondering when my patient-controlled analgesia (PCA) machine would arrive. I thought for sure that I would get this magical thing where all I would have to do is push a button and a small amount of pain medication would be injected into my IV thereby allowing me to control my pain as needed. They are very handy machines as you can program them to give only an amount that is safe for the patient and regulate the time intervals so that the patient doesn't accidentally overdose. It was ingenious in the 80's, and I wondered why it wasn't already here. I would bring this up with my nurse.

My new nurse for the day walked in and introduced herself. She was a middle-aged woman of Hispanic descent who took good care of herself with long nails and her hair swept up. She was a lovely woman and being a Spanish-speaker, I was comforted that we would communicate together easily in one language or another. She had been a nurse for 30 years, which made her unflappable and possibly very difficult to manipulate. Her name was Mirtha.

And directly behind her was my adorable husband with two quad venti, nonfat lattes in his hands and a characteristic fast food paper bag with golden arches. Today was going to be a perfect day on St. Vincent's sixth floor.

"What do I have for pain control," I inquired, innocently.

"Vicodin, darling," my nurse Mirtha replied. Her speech was smooth and rhythmic. She had a thick Spanish-English accent and rolled her R's distinctively. As soothing as her presence was, I could not help but panic at the sound of the word Vicodin. Vicodin? Seriously? I just had my leg ripped off, the end sawed off and a 6 foot 8, physician, weighing in around 200-plus, bang on it with a very large mallet. Did they really expect my pain to be controlled with Vicodin? I had planned on doing some world class hurting soon, which warrants world class pharmaceuticals. I wanted a morphine drip. I wanted round-the-clock Dilaudid. I wanted my anesthesiologist back. Vicodin? Seriously?

I have made concessions about the fact that I am a nervous person. Anxiety is not a crutch but a strategy. It generally prepares me for the worst possible scenario. I should clarify that my pre-emptive tirade was in anticipation of pain. At the moment, I was not hurting at all thanks to the morning dose of IV Toradol, and I admit that I was a little surprised by this. Having been a damaged diva before, this was very unusual for my 1st day post-op and I was still bracing for misery. I lacked faith.

Then, I was overcome with a wave of inspiration. How cool would it be to not need narcotics? Had medicine really come this far? Was I not going to hurt at all? I was starting to relish the idea of being a total badass, having a hip replacement and no narcotics. I was also feeling faithless and cynical. How is that even possible? Hope made me want to believe that I might make it through this without pain. Previous experience usually beat the crap out of hope.

"Are you having pain, sweetheart?" asked Mirtha.

"Strangely, no, I am not, Mirtha. The Toradol appears to be working perfectly."

She brought me more ice water to drink, a bag of ice for my swelling leg and floated out of the room gracefully and quietly. Before she walked away, she left me one gentle nursing reminder:

(Waving her index finger...)"Remember, don't be a hero," referring to the rule of pain control that it is better treated early and better managed with consistent pain medication and not the rollercoaster of peaks and valleys that so many patients find themselves riding. This was an indicator that hope was about to be pummeled by reality, and my inner desire to be a total badass ("It's just a flesh wound!") was really just a pipe dream. One thing was true: if things were about to get worse, I wasn't taking any chances, and if all I had was Vicodin, then there was no way I was going to tackle it on an empty-stomach.

"I'll be eating those egg McMuffins now." I said to my hubby. He handed me the bag and I reached inside. It was at this time I realized he didn't buy egg McMuffins. He bought SAUSAGE McMuffins. Sausage McMuffins are made with sausage, egg and cheese while egg McMuffins are made with Ham, egg and cheese. How could he screw THAT up? I said "EGG MCMUFFIN" not "SAUSAGE MCMUFFIN!" First, Vicodin, now Sausage McMuffins? My day appeared to be swirling down the industrial drain.

By now you've probably come to realize that I am not a big sausage fan. In addition, I rarely do fast food at all. I was hungry and trying to make it easy on my husband by sending him to a place that had a drive-thru and didn't require a whole lot decisions for him to make. When death is on the line, my husband can multi-task like a supercomputer, but if he doesn't have any investment in the outcome, minor details fail to be important...(Huh? Egg? Sausage? There's a difference?) There are few fast foods that I can live with. One is an egg McMuffin. The other is a chicken soft taco, so when there was no egg McMuffin in the bag, I lost my appetite......and my sense of humor. This was written all over my face apparently after I pulled the first McMuffin out of the bag. It was hard to mask my disappointment.

"Not what you wanted?" he asked.

"No thank you, you can have them." I handed the bag back.

"You said McMuffins!" he retorted.

"Yes, EGG McMuffins," I replied calmly

"What's the difference?"

The difference dear husband is that I just had HIP REPLACEMENT SURGERY! AND I WANTED AN EGG MCMUFFIN, DAMMIT! Doesn't he remember the Salt and Fresh Ground Pepper Potato Chip Menagerie? Sensing that this approach would probably not bode well for me when I needed something really important, I decided to make an investment in my future.

"One has sausage the other has ham. I'm not sure my newly awakened stomach is ready for 'mystery' sausage, " I politely explained.

The other issue to the sausage incident is I don't eat RED meat or any beef-containing product. I gave it up years ago and now my stomach cannot tolerate it. I have fits of gut spasm that my husband has witnessed and I am very skiddish about "meat" of unknown origin. Ham is pretty hard to screw up. It looks like ham and most likely comes from a pig, unless it's turkey ham, in which case is not a problem, because turkey I can also tolerate. I've never heard of "cow ham" nor has anyone tried to sneak me "cow ham" in a food product claiming to have ham. Sausage is another story. You never know what kind of meat goes into it and generally we don't ask, but I've had too many bad experiences with sausage to take a chance and this being my 1st day post-op, I wasn't going to risk that brand of agony. Knowing my aversion to fast food and mystery meat, my husband realized his mistake.

"Sorry."

"It's okay."

I felt badly because he had made such a big effort and it was kind of him to bring me anything and I knew it. I took one of the McMuffins out and took out the sausage. The egg-muffin sandwich was a good second choice, and my husband didn't mind having the sausage. Of course, he eats street food in Mexico. Why should this be a concern? We came to an acceptable compromise where I got to eat and he got to be spared my post-hip surgery, wrenching-gut guilt.

Dr. Stefan entered my room.

"Good Morning!"

"Good Morning!"

We all cheerfully exchanged pleasantries and discussed the benefits of Benadryl as a sleeping aid.......not Dr. Stefan's favorite evidently.

He began his lecture.

"Ambien is a good drug. It only lasts four hours and you will not be on it long enough to become addicted or have the nasty hallucinatory side effects that you are obviously misinformed about. Benadryl does not allow the body to cross over into REM sleep and therefore, it's not a deep, restful sleep."

And I was so proud of my inventiveness....

Dr. Stefan was a brilliant internist. I think I mentioned that before. I shared my fear of impending onset of pain. He assured me that Vicodin was a better choice because it lasted longer and saved me the drama of having a sharp needle thrust into the muscles of my butt. Having just had surgery and a fresh incision that wrapped neatly around my swollen derriere, the idea of needles in that region was a little disheartening. And every good medical professional knows that IV medications don't last nearly as long and turn you into a slurry, slobbering cretin. I concurred with his choice of oral pain meds and was immediately grateful now that the logic had been laid out before me. He assured me the nurses would call him if the ordered medicines were not effective, and would write something for "breakthrough" pain. Dilaudid I presumed. It was comforting to simply know that it was there. He did another thorough assessment, listened to my lungs and told me to keep smiling.

He ended with, "Just say yes to drugs," and left as quickly and efficiently as when he came in.

Not long after that, Raddick came for a visit. "Wanna take a walk?" He had crutches in his hand.

"Hell yeah, bro. Bring those on over!" I was presumptuously overly comfortable with my new PT and I was ready to walk. My hip was already starting to stiffen and I felt like it would seize if I didn't move. I put on my robe and slippers, clipped my last remaining Kling-on, the hemovac, to my garments, and we headed out the door. Crutches were like an old friend and I was happy to ditch the geriatric special. I wasn't having much trouble with moving except for getting in and out of bed. My adductors (inner leg muscles) and internal rotators (inner leg turners) were super weak and every time I moved, I felt like my knee wanted to dive inward which was a big "no-no" according to Kahra and Raddick. They told me the trick was to turn my foot outward. It was effective but not automatic and as soon as my knee started to dive inward, I would feel like my leg was going to twist off. My bed had a metal triangle that hung from a chain on a center bar that ran the length of my bed about 3 feet higher than the bed itself. I called it a "trapeze bar." I liked the trapeze bar for my hospital bed. I could do pull-ups and cheat my way in and out of bed without feeling like I was twisting off my leg. However, Raddick had different physical therapy goals for me, like how to get in and out of bed without a trapeze because the trapeze bar was not a take-home option. As you can imagine, my husband made frequent references as to how one of them would be "convenient" to have at home. What a brilliant idea! Because sex was the first thing I wanted to do with a new hip and a gash in my leg from my butt to my knee. Right. I felt compelled to inform him that it was going to take a lot more than Vicodin for that to happen, (despite Kahra's little "safe sexual positions" handout). It would probably take an anesthesiologist, two physical therapists and more highly, technologically advanced equipment than a stupid trapeze bar. Moreover, I was short on alacrity after the "McMuffin Incident."

Raddick took me around the sixth floor. I told him that I had requested forearm crutches ahead of my surgery and that I had a doctor's order for them. He said he would put that play into motion and have them delivered. Forearm crutches are generally not handed out because they require upper body strength and don't allow the user a "rest" position. They were great for mobility and doubled as a handy weapon in case I would be mugged.

Walking was a dream. No pain, no limp no unexpected zinger that would reverberate through my body. It was smooth, painless and solid, but I didn't want to trust it. Raddick would ask me "Why?" to which I had no answer. Each step I took further inspired confidence to the point where Raddick was running out of limiting factors. He wanted to test me so he took me to the stairs. Nailed it.

"Is that all you got?" I chided.

Raddick rolled his eyes and laughed at my bravado. Wait 'til I start taking Vicodin, I thought silently to myself. Hubris aside, I was astounded by this new hip of mine and happy to be on my way to independence.

We returned to my room without event. I could have walked all morning but Raddick had a whole floor of patients, and I was already being cautioned not to "overdo it."My husband had work to do, so he headed off to the 9th floor where they had internet access and a view. I think he was tired of my berations, my overconfidence in my abilities, and lack of gratitude and needed to go accomplish something. I was left to my own devices.

After a short rest, I got back up and headed toward the door. Just as I was walking out, in came Dr. Schmalzried followed by another gentlemen who appeared to be a Doctor, although he could have been a lawyer. As I've explained, my visual impressions are generally not correct. He was a well-dressed hispanic man, of average height which was unfortunately magnified by the towering effect of Dr. Schmalzried. They were surprised to see me standing.

"How are you feeling?"

"Great," I told him.

He responded, "You see? Take a former athlete who has broken her femur and had two kids. I can't hurt her."

I smiled with pride.

He told me to walk, but not too much.....

"Listen to PT and use the ice. My PA, Debbie, will be by later to take out your drain (tether #3) and answer any questions."

That was it. Admittedly, I felt somewhat jilted. I was not impressive enough to warrant more than 5 minutes of his time. This is an interesting phenomenon about hospitals. As an emergency room nurse of 12 years, I can pretty much guarantee that if you are being totally ignored, you are in great shape. The last thing you want in a hospital is doctors and nurses swarming you, asking you questions with a disturbingly intense focus on every minor detail of your physical makeup. While this may feed your innermost desires of needing to be recognized or validated, trust me, this is not the attention you want (i.e. "Why yes, Mrs Robinson you ARE having a huge heart attack, you were right!"). If doctors and nurses are appearing excessively attentive then bad things are probably on the horizon and nobody cares about how you were neglected as a child or that you've had that toe pain for 3 months running. Doctors overly interested in you are either about to save your life or just realized you have two forms of insurance, including medicare. Or, they are Psychiatrists, who get paid by the hour. Take-home message: Be happy when a doctor ignores you.

I wanted to ask Dr. Schmalzried all kinds of earth-shattering questions about the surgery, my new implant, and the science of it all, which is probably more appropriate for an orthopedic seminar than a patient consultation. However, in hindsight, I probably should have been better prepared to demand his attention by bleeding to death, throwing a clot, or in the throes of septic shock with a blood pressure of 60/40. Doctor's usually like to stick around for that stuff. Despite not feeling interesting enough to warrant his attention, I was also glad to see him go. I was doing great and there was no need for him to stay. There could have been a knee replacement or bilateral hip replacement down the hall with one of the aforementioned conditions and suddenly, my need to know the metallurgic makeup of my new implant and details of the surgery seemed slightly selfish. In reality, he was probably late for a Laker's game, but no matter. He showed up on time for my hip surgery and if he needed to go unwind on the court, hey, I was good with it. Either way, my feelings of being dismissed passed quickly. I had an agenda.

"I've got some hallways to cruise." I thought.

I looked forward to seeing PA-DC again, but dreaded the drain removal. Back in the 1980's they used a penrose drain which was a large diameter, piece of collapsible surgical tubing. It drained the affected area of fluid that built up in the site to relieve swelling pressure and reduced the potential for infection. Removal of this drain was a mildly uncomfortable procedure because it came out of a swollen area and basically, just looked like they were ripping the inner parts of your leg out. However, I had a hemo-vac. It was silicone, small diameter and was draining what appeared to be a lot of blood. I imagined it to be deep in my leg. My inner badass was shriveling up. I contemplated my first pain med.

Too late. In strolled Dr. Schmalzried's Physician Assistant, Debbie.

"Let's take out that drain."

"Um...."

While I was stumbling for a stall tactic, Debbie removed the spongie, plastic tape holding the drain in place. She checked out my incision and appeared satisfied that all was right with the world. Then she distracted me with talk of new types of surgical tape and their uses and before I knew it, she had started pulling out my drain. Unimpeded, the deeply situated drain tube came out without a hitch. I felt like a sissy.

"That's it?"

"That's it." She verified.

The final tether was gone. I was free. Nowhere to go but around the nurse's station. Look out world, here I come!

There was some mention of stiffness, ice etc. but I paid no mind. After all, that wasn't going to happen to me because I was going to be walking off this whole hip replacement thing. My mission lay before me and my sense of badass had returned.

"Lunchtime!"

My lunch tray was delivered but I swear I had just had breakfast....Time was going quickly and I still had milestones to meet. Where were those new crutches?

Lunch consisted of some sort of chicken salad thing, a salad, diet coke, a banana, yogurt and two oatmeal cookies, but I was not hungry. Just then, my best friend Erin showed up. You may have read about her and her fear of spiders. Well, she's not fond of hospitals apparently either. I knew this was a big effort on her part.

"Let's go for a walk," I said.

"Uh, is that responsible? Should you be doing that? Shouldn't we call your nurse first?"

I assured her that that would not be necessary, that I had already walked around the nurse's station and we were going to go check out the view.

Before I gave her a chance to scream or faint, I was up and walking. The "deer in headlights" effect was working as I got up out of bed and started walking across the floor. Erin and I had done far more rebellious things in High School than this , so I knew she could handle a little civil disobedience.

"Come on, this will be fun."

We headed down the hall. Her body language was hysterical. It was a combination of uncertainty between, "should I walk behind her or in front of her in case she falls?" She was desperately searching for someone to intervene. Her face told the story, "Is anyone else seeing this?" and the ever familiar, "Why am I here?"

We walked down the hall and ventured off toward the elevators where you could get a nice view of the LA skyline and the sun streamed in through big windows.

Erin's countenance changed from uncertainty to relief. She was amazed that not 24 hours ago, they ripped my hip out and put a new one in. I admit I shared this amazement but chose not to dwell on it. I was happy to be moving and not requiring massive amounts of pharmaceuticals to keep me doing so. My future was completely different to me than it was a mere 48 hours prior.

Erin left and the Case management representative came in and started asking questions about my home. I was going home tomorrow and orders needed to be put in today. I told her about the special order crutches. She agreed to see it done.

The rest of my afternoon was intermingled with trips around the nurse's station and visits with the occasional passerby, like a guy who had bilateral knees replaced and another guy who was on his second knee replacement. Apparently, the first one was not done by Dr. Schmalzried.....

My husband returned with laptop and crackberry in tow and appeared satisfied to have gotten some work done. Preparations were in place for my discharge and things were starting to happen. For example, a courier arrived with 21 days worth of Lovenox and Norco. For the next 3 weeks, I would be anti-coagulating myself with Lovenox injections. This was to reduce the risk of blood clots in my leg that would seriously hinder my progress. The Norco is a stronger form of Vicodin. Again, I was happy to have it, but planned on not using it. Dr. Stefan had originally discussed Oxycontin, but we both agreed that might be overkill given the fact that I still wasn't eating up the ordered Vicodin. Norco was a healthy compromise and probably wouldn't get me into too much trouble.

Just then, a man from the medical equipment business arrived. He had in his hands a set of brand new, chrome, forearm crutches. He was now, my new best friend. We signed the papers, exchanged small talk, and he was gone. I was excited to take them for a test drive. Upon closer inspection, my husband and I realized that the crutches delivered were a little long. In fact, they were so long, they didn't fit my husband of 6 feet. We called the Case Management lady.

"Can I help you?" She asked politely.

"Yes, they brought my new crutches, but they are too long," I told her.

Smiling, she replied, "But they are adjustable."

She picked up the crutch and began to adjust the length.

"Yes," I said, "They adjust longer."

With a perplexed look on her face she, not only realized that I was right, but that there was probably no person in the world, besides Dr. Schmalzried, that would fit these crutches.

"I will call the company." She turned and left the room.

Minutes later, Raddick came in the room.

"I heard you got your new crutches!"

"Yeah, and they don't fit," my husband and I chided.

Raddick's predictable response was comical. "Yeah, but they're adjustable!"

My husband and I responded in unison, "Yep, they go LONGER!"

Of course, Raddick didn't believe us and had to actually adjust the crutches again, because after all, he WAS the expert. After closer inspection, he resigned and agreed we were in fact correct that these crutches would not be working for a woman of 5'5" or anyone under the height of 6'8".

"We'll make sure you have the right ones before you leave."

I was again, disappointed. My leg was now swelling with fluid since I no longer had the internal drain and my pain was starting to become apparent. Clearly, I was not getting out of this 1st day post-op without effort and today's antics were a gentle reminder that no matter how much badass you got goin' on, or how prepared you think you might be, there is a force in the universe that will school you every time. Some may call it Murphy's Law or some other negatively connotated aphorism approriate for the situation. However I have decided that the McMuffin Principle would be my new maxim for such events, much to the frustration of my husband who will endure this for many years to come.

Untethered

"Good evening, Mrs. Robinson. My name is Roderick and I will be your nurse this evening. Can you state your name and birthdate please?"

"Yes, Tori Robinson. Please call me Tori." I gave him my birthdate and he proceeded to give me my intravenous antibiotic and a magical drug called "Toradol." Toradol is an anti-inflammatory. Much like Ibuprofen, Advil, or Aleve, it is the only available injectable form of an anti-inflammatory. Generally, post-surgical pain is related to swelling so this is a great way to relieve pain without snowing a patient who still has enough anesthesia on board to drop a hippo. It was 9pm on St. Vincent's Ortho floor and I was hurting. I was shivering but not because I was cold. My anesthesia was wearing off. I was more aware of my incision and the fact that I just had my hip replaced about 12 hours ago. I was restless and shaky and knew sleep was not coming anytime soon. I must not have looked very good because Roderick had that "concerned nurse" look.

"Are you okay?"

"Yes, I'm fine."

By now the Toradol was taking effect and I was starting to have some relief of my pain which was also good for my anxiety. However, I knew I wouldn't be falling asleep anytime soon and would need some help.

"Do I have anything for sleep?" I asked.

"Yes, they wrote you an order for Ambien."

Egads, Ambien. I was a little worried about Ambien. There are all kinds of horror stories out there about how Ambien made perfectly sane people kill their entire families without their knowing it. I was a little concerned about taking a sleeping pill that I had no experience with and with the shivering and my vital signs in the tank, I didn't want to be drastic. It was time to be creative.

"Roderick, didn't Dr. Warnicht (my anesthesiologist) order Benadryl?"

"Why? Are you feeling like you are having a reaction?"

This is one of those moments where you don't want to lie to a perfectly good person that you just met. However, Benadryl has a side effect of drowsiness. When a physician writes an order for a medication, they write it on an "as needed" basis and must provide a condition for why it is needed. In this case, the order probably read something like: Benadryl 25mg, IV as needed for itching or urticaria (hives). Parents sometimes use Benadryl for travelling so their kids will sleep during long car rides and airplane trips. Shift workers such as night nurses use it to help them drop off to sleep at odd hours or during daylight. I wanted to use it for this reason but when my nurse got his license to practice, he had taken an oath not to give any drug that would knowingly cause harm or be used for unintended purposes. Roderick seemed like a good guy. I wanted to keep him honest and preserve his plausible deniability.

"Why, hmmmm, come to think of it, yes, Roderick, I am a little itchy on my back."

"Let me take a look." he beckoned.

I sat up and he looked at my back. I already knew it was red because that is where my epidural was. It wasn't a bold-faced lie. It really was a little itchy back there. Epidural morphine tends to cause a reaction which is very common.

"Yes, you do look a little red. Any trouble breathing or swallowing?"

"nope."

"I'll go see if I can get you some Benadryl."

Mission accomplished. I felt very satisfied that I had abused the privilege of my education responsibly.

Roderick was a young, African-American gentlemen who started this evening's shift with a rapid response code in the room next door. There is no better way to start a night shift than with a code because it leaves the rest of the night for paperwork....lots of it. Hopefully, you don't have an annoying patient/nurse who calls you into her room every 5 minutes. I had great potential. However, I liked Roderick from the start. He told me that the word on the floor was that I wasn't one of "those" nurses.

"Those nurses?" I prodded?

He said, "Yeah, the ones that tell you how to do everything, and complain about what you're not doing right. I heard you haven't caused hardly any trouble today!" He smiled.

Clearly, I wasn't trying very hard. Either that, or he was lying up front to send me a message that trouble would not be tolerated.

I made Roderick a deal.

"Roderick, I promise not to code for the next 12 hours, if you promise to bring me a quad venti nonfat latte in the morning."

He thought that was amusing, but couldn't make any promises.

I said, "Okay, Benadryl will do."

"I can keep the aide busy until 5am." he offered.

Now you are speaking my language. I had orders for vital signs every 4 hours, which meant they had to take them at 11pm, 3am and 7am, or put more simply, there will be no sleeping. Pushing my second set to 5am meant he could turf the last set to day shift, and give me 2 more hours. Roderick was a good dude.

The Benadryl hit me quickly. The shaking and shivering was starting to subside and I was starting to relax. Aaaaaaahhhhh, (read Benadryl junkie). The feeling was so calming and I was so happy to be able to control my own movement. My leg still ached a little but the Toradol helped a lot. I put a pillow between my legs and laid back. This not being my first rodeo, I knew that the sounds of a busy hospital floor would wake me up, so I brought my trusty Nano iPod. I put my headphones in and drifted off into peaceful slumber. It was roughly 1130pm.

At 5am sharp, the nurse's aide came in to take vital signs. 70/30, heart rate of 56 and a temp of 101.4. I do not look good on paper. Roderick came in shortly after.

"You have a fever."

"Yeah, cuz I was shivering for 4 hours yesterday. I'm sure it's nothing."

"I"m giving you Tylenol anyway."

Tylenol is prudent nursing practice for fever. He also made me put ice bags in my arm pits and had me do my incentive spirometry. When a body is immobile, it tends to not expand the lung fields. Over time, the small sacs called Alveoli, in the lungs, can collapse and fill with fluid. It's bad news. However, if a patient breathes deeply 3 sets of 10 times per day, this incidence goes down. The deep breathing activates the little sacs to stay open and be available for oxygen exchange with the bloodstream. This little exercise is a handy way to keep someone out of congestive heart failure. The incentive spirometer is a little, plastic, graduated column with a rubber stopper. Every time you breathe in, the stopper floats up to the top which is your goal. It's like taking a really big drag off of a cigarette....

"Here," I said as I passed the spirometer to my imaginary friend, mimicking a certain practice one might do at Snoop Dogg parties.

Roderick, the perpetual nursing professional stifled a laugh. I was glad to catch a glimpse of the human hiding beneath his professional facade.

Roderick left the room which I saw as a perfect opportunity and implied consent for me to go for my morning walk. I got my walker, hung my bulging foley bag off of one side and connected by blood-filled hemovac to my underwear and got up out of bed. I was stiff and sore like I had been hit by a truck, but my hip was working beautifully. I walked across the room, using my walker and pushing my IV pole out in front of me with every step.

Roderick came back with my Toradol and my antibiotic, and he started to scold me.

"You are supposed to call before you get up."

"I knew you would be back."

"How do you feel?"

"Dizzy, like I could fall any minute," testing his gullibility

"Really?" (okay, now I felt guilty)

"No. I feel great."

Roderick helped me back in bed. He gave me my medicine and said I probably didn't need my foley anymore. So he proceeded to take it out. I think he did this on purpose because I was really enjoying not having to get up and go to the bathroom to pee, not because I didn't want an excuse to get out of bed and walk. But rather, because sitting on a toilet was still uncharted territory. Questions of, would I have the use of one of my hands or did I have to hold the rails with both hands, remained unanswered along with how long does it actually take to drip dry?

Foleys are held in your bladder by an inflated balloon. You don't want to just rip these babies out, although I've seen it done a time or two usually by an Alzheimer's patient or someone with way too many substances on board. It looked quite painful. Imagine a golf ball being yanked through a garden hose. Yeah, it's like that. I was willing to wait for Roderick to deflate the balloon, and on the count of 3, he pulled it out. I was bracing for some sort of balloon-deflation failure, stinging sensation or plastic tube friction, but there was none. It slipped out painlessly and I was free. One tether down, two to go. I was less fettered. I couldn't wait to go walking. Just then breakfast arrived.

My "clear liquid diet" had been revised. I had graduated to soft foods. I was served eggs, coffee, something that resembled oatmeal although I couldn't be sure and more grape juice. I called my husband.

"Honey, I need two egg McMuffins and a Large nonfat latte. Can you swing it?"

"Sure, I'll be there in 3 hours."

"3 hours? What? You are only 20 minutes down the road!"

"It's 7am and it's Los Angeles Sweetie."

"Right.... Drive safely."

Roderick returned to take out one of my IV's. He was going off shift so he was "fluffing me up" for the next nurse. The look of resignation on his face was a telltale sign that he had a long and difficult shift. Probably mountains of paperwork and lots of annoying interruptions, albeit not by me, thankfully, but clearly by someone. He rechecked my temperature.

"99.6" he reported.

"Almost textbook." I retorted. "Since I've been such a good, thermodynamically-responsive, patient, can I make one request?

"What's that?"

"Can you take out the right side IV and leave the left one in please?"

I had two IV's. The one in my right arm was in my antecubital space which is right at the bend of the elbow. The one in the left was in my forearm, just down from my elbow. It was easier to bend, and was not in my dominant arm. However, it also had a surgical extension loop, which meant Roderick would have to get me a new loop, take off all the tape, disengage the surgical extension at the hub and change it to the new one. There was a risk of pulling it out or bleeding all over the bed and it was clearly more effort than Roderick was willing to put forth. The thing is, he knew that this would make a difference, that this was the right IV to leave in (because it was also bigger) and would probably mean more convenience for his patient. I offered to do it myself.

"Just leave me a loop, a flush and a tegaderm and I'll have this done in a minute."

He was neither amused nor convinced of my one-handed prowess. He was a man of dignity and integrity and a nurse who gave a damn about the little things. At the end of his long shift, Roderick went the extra mile and agreed to honor my request. By the time he returned with supplies, I had the tape removed, the IV pump turned off and was occluding the vein. All he had to do was disconnect the old, connect the new and tape it down. It was a very successful joint venture, of which I was very grateful. He then proceeded to take the IV out of my right arm. I was now free of my intravenous leash. Another tether removed. 2 down, 1 to go.

It was at this time that I would say goodbye to Roderick. I thanked him for his excellent care and wished him well. My impression was that he hadn't been doing this job a long time. He was a "by the book" kind of guy and really cared about his patients. He still had a new nurse's shyness about touching people or giving patients instructions and he worked the night shift which is usually where new nurses start. He was kind, unpretentious and worked hard, uncharacteristic of a nurse who has been working for more than 10 years, such as myself for example, nurse of 12 years with all the compassion bled out of her one whining drug addict at a time. Thank goodness Roderick was bringing nurses like me to a new level. I hoped I would see him again before my sentence at St. Vincent's was over. And I hoped he would be bringing a quad venti nonfat latte......

Euphoria & Impending Doom

St Vincent's sixth floor was the ortho floor. It was also a melting pot of cultural harmony. Upon arrival to my room, my nurse introduced herself. Her name escapes me because the anesthesia had not yet worn off and I was forgetting things as fast as I was learning them. I swore to myself that I would not forget a single person who took care of me out of my gratitude for that very sizeable responsibility. And I haven't. I still picture all of their different faces and their mannerisms. However, their names have been filed away somewhere in my brain that the Versed has made difficult to retrieve. What I do remember about my nurse is that she was Korean and either she had a very thick Korean accent or my language filter was still pretty fuzzy. I had a private room, which made me feel safe and comfortable on so many levels, I can't even describe it.

Hospitals are very dichotomous places. The perception of hospitals by people who don't work in them tend to be that hospitals are places of refuge, illuminated with a bathing light from above, where people take care of you, tend your wounds, treat your pain, and for all intents and purposes, placate your drama. However, for people that actually work in hospitals, hospitals are dark, terrifying places, teeming with bacteria and viruses of every kind, silently mutating on horizontal surfaces as they wait for the opportunity to attack the weakened portion of your body. Hospitals are also operated by vile and wretched people who don't enable your drama but rather call you out on your manipulations and inspire you to perform your own activities of daily living, like for instance, brushing your teeth. They are evil people who refuse to allow you to leach off of them or your loved ones...and there is no stopping them. By the time you are discharged, you will be a fully functioning member of society, dependent on no one. Damn them.

Hospital workers, such as myself, know what it's like to be a hospital worker so they don't want to bother staff with petty requests like bedpans or warm blankets. They know what it's like when patients request things every time you enter the room, so instead of having individual needs addressed on an as-needed basis, they put their needs in "batches" or "wish lists".

"Do you need anything Mrs. Robinson?"

"Yes, please don't call me Mrs. Robinson. May I have one warm blanket, one pain pill, an extra pillow, a jug of ice water with a straw, a bag of ice for my leg, my TV volume turned down and my call button on the bedrail please?"

"Of course."

"Thank you.... see you in 12 hours."

The last impression healthcare personnel want as a consumer of healthcare is the "junkie in room 600" or "drug seeker down the hall" so they delay requests for pain medication until the last tolerable moment. Of course, no professional worth their salt has these thoughts about their patients because they are intelligent academics that understand how pain and stress affect the ability of tissues to heal and how important it is to manage pain and meet a patient's needs. These very basic considerations about caring for people separate the new nurses from the seasoned ones. It also separates the ones who are gorked out on anesthesia from the people who are actually working. Healthcare workers are the worst kind of patient and I was no exception. I was determined to be an active participant in my nursing care in my slightly compromised state, with one leg to stand on, and a burning desire to be accepted by my new co-workers, whom, by the way, were not having any of it.

I violated the rule of being a good patient right out of the starting gate. About an hour after my arrival to the Ortho floor, and presumably all of my initial needs met, I became ravenously hungry. It had been 19 hours since I had gorged myself with LA's finest Sushi. Now that I was awake, alive, and on the other side of fear stimulus (a.k.a. surgery), it was clear that my sympathetic nervous system was finished with running my life and needed nourishment to be ready for the next bout. It therefore turned my parasympathic nervous system back on, which in turn, stimulated the gastrointestinal tract to go into overtime. I thought it better to test my hurlability reflex first. I sucked down a liter of water so quickly it would have impressed even the most stout of the beer-bong, fraternity set and I soon realized that hurling was no longer an issue. However, in anticipation that my physician wrote orders for a "Clear Liquid Diet Only," I knew pizza was out of the question and formulated a reasonable request that would be simple and acceptable. I called my Korean nurse.

"Yes?"

"I was wondering if I could get some broth?" I politely asked.

"You have a clear liquids diet ordered. Broth is not a 'clear' liquid." she replied.

My husband glanced at me for guidance.

"What, then, would be an acceptable alternative?" I inquired respectfully.

"Water.....or 7-Up." she answered. (Of course! Because what better post-surgical, nutrient-rich replacement is there than the 'UN-COLA'?)

"When is dinner?" I asked. (It was now almost 3pm)

"Dinner 5:30. You want grape juice?" (Because grape juice is obviously more "clear" than broth.....)

"Yes, that would be fine, thank you."

The look on my husband's face was priceless and the anesthesia drugs still surging through my brain made it almost impossible for me not to laugh hysterically and bring tears to my eyes. The continued comments made by husband (Perhaps some wine with that Mrs. Robinson? Shot of Jagermeister? but no I'm sorry broth is absolutely out of the question......) were not helping me gain control of my laughing fit. It's not that grape juice was not acceptable. It was. But the idea that broth was not seemed, well, so unbelievably funny at the time. When the nurse returned with a carton of dark, purple, grape juice, of which, I could not see through, it produced more fits of drug-induced laughter and tears rolling down my face. I was beyond the limits of socially respectable.

"You okay?" checked my nurse.

"Fine." I managed, with my eyes two, narcotic-generated slits, grinning from ear to ear, and on the verge of hysterics.

For those of you seasoned nurses out there, chuckling to yourselves, I hope you are enjoying a little nursing humor. For those of you who are not familiar with the "Clear Liquid Diet", I turn your attention to the Mayo Clinic's version of the Clear Liquid diet.

In a nutshell there are a handful of items generally acceptable. They are, in fact, water, gelatin, tea, popsicles, and.....broth. These foods leave no residue in the GI tract and are pleasant 'waker-uppers" for a sleeping stomach. They also provide potassium and sodium that may have been depleted from the body during surgery. As a bonus, if one's stomach is not yet ready to accept food upon waking, these liquids are gentle (and colorless) on their way back up and provide for easy cleanup, unlike grape juice which might have a slightly less desireable effect of staining when spewed all over a nice clean hospital room. Fortunately, my nurse would not learn this lesson the hard way.

I met my new Physical Therapist (PT) (which also stands for "pain & torture") when he came into my room at 3pm. He was clearly of asian descent and looked like he was maybe 14 years old. I was skeptical that he had actually graduated from PT school. However, he brought me the tool to freedom, a walker, and cheerfully queried, "Ready to go for a walk?"

At this point, I didn't care if he had gone to traffic school. He was my ticket out of here, and like any drunk, impaired person with too much liquid courage surging through their veins, I pragmatically exclaimed, "Of course!" because what could be more sensible then taking a brand new hip joint for a test-drive only 5 hours after its installment with a handsome teenager?

My husband looked down and shook his head. He'd seen this girl before, once upon a time, 17 years ago. It was the same girl who wanted to go rafting at midnight during a full moon or the one that got up on stage in front of his entire, billion dollar company, including its President, with two Brazillian company members and lead everyone in a line-dance she had no idea how to do. It was the girl who followed him down every class V river she could paddle, up trails to Mt. Everest and Macchu Picchu with an almost equivalently weighted backpack and the girl who was still willing to kayak the local river at 60,000 cubic feet per second during the 100-year flood despite his concerns after watching propane tanks and remnants of houses float by. He knew this girl of brash bravado and little applied intelligence and he was not entirely sure how to convey his obvious concerns. Luckily, our new PT, Raddick, was excellent at reading my husband's non-verbal cues and saw reason to be on alert. He pulled out the gait belt.

"That won't be necessary," I said.

"Tori, your last blood pressure was 80/40," my husband reminded.

"Whatever," I mumbled. I stood up and started walking with every intention of ditching both of them.

With foley bag, a hemo-vac drainage collection bag clipped to my gown and my butt hanging out the back, I got out of bed and stood up on my new hip. Admittedly, I expected excruciating pain and paralyzing weakness, but there was none of it. After all, I was still doped up on my anesthesia meds. In fact, there was NO PAIN AT ALL! Imagine the euphoria of standing up without pain, for it had been approximately 5 years since the last time that happened. This only fueled my fire and I started out the door with my walker, my new hip, and enough bodily fluids in bags that would instigate a Hazardous Materials incident if they spilled on the hospital floor. I was MOBILE! I was FREE! I WAS COMPLETELY STONED OUT OF MY GOURD! WOO HOO!

"Maybe we should head back towards your room, Mrs. Robinson...."

Raddick, if you call me Mrs. Robinson, I am going to have to molest you," knowing full well he was not old enough to remember "The Graduate" with Ann Bancroft and Dustin Hoffman.

"Huh?"

"Exactly. Call me Tori."

I was returned to my prison cell, er, hospital bed safely and securely. Now that I knew what was possible, I was pleased as punch. My night nurse would not know what hit him/her/it.

PT (pain and torture) was followed by OT (Occupational Terrorist). Actually, OT stands for Occupational Therapist but generally, it's all about terrorizing more than therapizing. Kahra was a refreshing alternative. She was lovely. She had a mischievous streak in her that could rival my own and I knew right away that we would be fast friends. I, the impish rascal that would test the limits she set for me, and she would be the grinning, voice of experience, allowing me to safely push my envelope and reprimand me with an occasional 'I told you so,' that didn't cross the line of professionalism nor compromise the safety of my new hip. She emphasized cost vs. benefit and used evidence based medicine to back up her arguments. She had me stymied. She discussed the importance of managing pain and the goals of therapy over the next six weeks. She saw my mischief and raise me a pearl of wisdom. She taught me the basics without condescension, like how to move, how to prevent my weakened hip from rotating inward, how to put on my pants and my socks, how to sleep, how to sit on a toilet, how to get in and out of a bathtub and finally, how to advance to driving a car. She even gave me a sheet of potential sexual positions that would not compromise my new hip joint. My husband elevated her to deity. And later, she and I would surreptitiously devise a plan that would make Raddick blush. After all, she was at least 20, but she was wise beyond her years......I hoped I would see Kahra the next morning and that this would not be my last opportunity to make a positive impression. I even offered to make her pancakes. She promised to return regardless.

Most of a nurse's job comes at the beginning of a shift and at the end of it. At the beginning, vital signs are taken, assessments are performed, needs are determined, and interventions such as medicine administration, the emptying of a foley bag, the change of an IV bag and the delivery of dinner and a warm blanket are achieved. At the end of the shift, this process is repeated and is a "fluffing up" of sorts so that when the nurse hands the patient off to the next nurse, the work is minimal and the patient's needs are met. It is without fail that a patient will choose to decompensate at a change of shift, so if 4 patients are "fluffed up" and one goes down, the other three can hold their own.

At 5:30, as promised, my "dinner" arrived. It consisted of all sorts of villainous deviations from the clear liquid diet protocol such as Broth, tea, apple juice and strawberry gelatin. I probably should have sent it back given the danger I was putting myself in. Instead, I slurped it all down ardently and resisted the urge to point out to my nurse, the "clear" liquid selections deemed appropriate by dietary staff based on the physician's order. Certainly, the Mayo Clinic had nothing on THEM. And yet, I felt a kinship to my nurse, this poor woman who drew the short straw and was forced to care for the impossible patient in room 30, of which she had nothing in common with culturally. We were unlikely sisters of the same profession and there's little worse than a know-it-all patient telling you how to do your job.......Besides, shift change was right around the corner and I wanted to start off on the right foot with a good report and low security index.

On my wall was a big sign that said, "STOP! Call your nurse before standing up!"

Hmmm, I pondered. My leg was starting to stiffen and I felt a need to stretch or walk. I didn't want to bother anyone but I also didn't want to be stupid. I hit my call button. A Filipino woman came into my room.

"What you want?!" she demanded.

"I want to get up and walk." I replied.

"You have BM today?" she inquired.

"No, I have surgery today." I responded.

"Okay. You have BM tomorrow then," and she turned around and walked out.

Technically, I called someone, so I wasn't breaking any rules, and by this time, I was sitting at the side of my bed. I was obviously getting ready to "ambulate". There appeared to be no objection other than the BM qualifier, which appeared to be more of a guideline than a rule, so I proceeded to go for a walk. As it turns out, this was an exciting event for many working the sixth floor who hurriedly jumped out of their seats and came over to my hospital room door. There was a big, red and yellow sign on it that said "FALL RISK PATIENT". I wish I had a camera. A photo of me in my gown, with my bags of fluid, and my walker standing in front of it would have been a fun rendition to add to my Facebook page. Alas, no one agreed to take that picture. Raddick came to my rescue.

Raddick (PT): "Where ya headed?"

Me: "Around the nurse's station."

Raddick (PT): "You shouldn't get up without help."

Me: "Help came and went."

Raddick (PT): "You are trouble."

Me: "Nope, just motivated and starting to get stiff."

Raddick (PT): "Alright, let's go."

Raddick accompanied me around the nurse's station for a lap and returned me safely to my bed. He gave me the safety lecture about no "do-overs" and encouraged me to not push myself too far. I agreed to listen to reason but reiterated that movement was good for the swelling, and I could feel my tissues swelling and stiffening already. He knew I was right but he was also sensible. I was not.

"Call me next time. I'll take you around," he said.

"Deal." So much for my security index.

As 7pm rolled by, and then 8pm, I began to realize that perhaps I wasn't as bulletproof as I thought I was. The anesthesia was really starting to wear off and I was now starting to shake, uncontrollably, the way I usually do when anesthesia wears off. I was restless and my anxiety was increasing. Some call this a "feeling of impending doom" and is considered an actual symptom of bad things to come. My husband had gone for the day after watching me successfully navigate my afternoon, babbling endlessly between drug-induced bouts of giggles and tears, and talking smack about my over-exaggerated capabilities. He'd seen all this before and it usually ended up with me being naked. He was confident that my window for decompensation had probably passed, and headed to the home of his Aunt and Uncle for some much-earned rest. However, I was still evolving as a post-surgical patient, unbeknownst to both of us.

The new nurse's aide, Leticia, came in and checked my vital signs all the while explaining that my nurse was busy with another patient. "Roderick" would be with me shortly. I was glad to have a male nurse as I was certain that his level of tolerance was probably much higher. I was excited to meet him.

Upon taking my vital signs, my blood pressure was 76/34 and my heart rate was 88. Too low. However, my heart rate was still in normal range despite being slightly elevated for me. I feigned ignorance.

"I'm going to lower the head of your bed," the aide said.

"No, I'm fine. I have naturally low blood pressure and I'm drinking a lot of fluids. If you could fill my water jug with ice and water, get me an ice bag for my leg, tell my nurse I need something for sleep when he has a chance, and get me a warm blanket, I will be fine."

"Okay Mrs. Robinson."

"It's Tori."

Leticia left the room on her mission. I downed the last of my water and reached over to my IV pump. I increased my rate and gave myself an extra 250ml's in the form of a "bolus" which is like drinking an 8oz glass of water in about 3 seconds. When Leticia returned, I requested she recheck my blood pressure.

"90/58." (HA! Stealth!)

"See? It just runs low. No problem."

There was a lot of noise coming from the room next door. I heard familiar sounds of IV supplies being ripped open, "get the EKG!" and "Call the Doctor!" Never a good sign. This was to be the shift-change "code." While I felt sorry for the patient next door, (and my nurse), there was a selfish part of me that was relieved. I was not to be tonight's shift-change code. I had skirted the odds, for now, despite feeling shaky and anxious, with questionable vital signs, and now very aware of the pain and stiffness developing in my right leg. The bad news was, I also would not be meeting my new nurse anytime soon, and I knew I had a rough night ahead.