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.
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