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.
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