Monday, December 07, 2009
TW IS NOT A GOOD PATIENT.
Did you remember that? I'm just saying, is all.
We are still at the Specialist's office, working out the pre-op details for TW's hand surgery. Specialist's Nurse hands me a shopping list of supplies I am going to need for TW's "home care" after the surgery. I look at Specialist, Nurse, and TW. "What if I can't do this?" I asked. "What if I throw up when I see his hand? What if I pass out? What if I. Just. Can't. Do. This?" Nurse laughs, and rather airily remarks that it's never as bad as you think it will be.
Nurse is a fool. I am NOT one of those people who can cope with broken limbs, stitches, drains, or other medical trauma/paraphenalia. I spend the first three years of Twinks life in a perpetual state of nausea, just from the casts, the surgery (I still get queasy whenever I see her scars) and everything that happened. I am a sympathetic barfer - if you throw up, you won't be throwing up alone for long, because, well, that's what I do. In short, I am a wimp. A weenie. A chicken. I can handle a lot of stuff, but this kind of surgical stuff? No way. And I am afraid that I won't be able to cope with all of the post-surgical care required for TW's hand.
We walk in the door, and the phone is ringing. It's Dee - calling because she knew about the appointment at the Specialist's office. I blurt out my fears about the post-surgical care, and the shopping list, and everything. Dee promises to come and stay with my Mom and Twinks during the surgery so that I don't have to worry about them. She also promises to come back and help me through the first few bandage changes after the surgery. I relax a bit for the first time.
We arrive at the Hospital for TW's pre-op appointment. Everything goes smoothly, although it does take longer than we anticipated. Twinks is with my Mom at home, and I am grateful that they don't have to just sit around and wait with us; there is so much H1N1 around here now, and I don't want any of us exposed any more than we have to be. We meet the anesthesiologist, and he tells us that TW won't have to have the heavy, general anesthesia that we expected. They will "block" his arm, and give him a sedative that will induce a "twilight sleep" similar to what pregnant, laboring women used to get. TW will come out of that quicker, and (hopefully) have fewer side effects. He will also get to go home sooner - this will be an outpatient procedure, although that same silly, queasy part of me wishes he could stay in the hospital at least overnight, in case there is any problem afterward. I am woefully unprepared for even the tiniest problem, should one occur. I have but two comforting thoughts - first, that Dee will be there, should I need her, and second that the hospital is only 5 minutes away; we live nearly in it's shadow, and while it is small - only 50 beds - it is a first-class, state-of-the-art facility that has attracted some of the best doctors in a four-state area. It is also almost brand new - it is barely three years old.
TW is given his orders: No food after 6 am the day of surgery, and nothing but clear liquids after 10 am. His surgery is scheduled for 3 pm, and we are to arrive at the hospital no later than 2 pm.
Surgery day, and the pre-op nurse calls my cell phone at noon. Dr. Specialist is running late - he had an emergancy surgery, and the whole schedule has been shifted backwards at least 2 hours. Because we live so close by, pre-op nurse tells us to stay home until she calls and says it's time to come. We will be more comfortable at home, and we will help minimzie our exposure to any H1N1 that is lurking about. TW is beginning to regret not eating a hearty breakfast at 6 am; he goes back to bed, to try and sleep away the time.
It is almost 5 pm before the pre-op nurse calls. We zip up to the hospital, and things begin to happen quickly. As she works on getting TW ready, she tells us about the Specialist's day, and how glad the entire staff is that TW's case "such an easy one!" will be the last one of the day! TW is put into a special gown that has ports in it, and then the nurse hooks up a hose to one of the ports. She hands TW a cord that is attached to the hose; there is a temperature control, so that if he gets too cold or too hot, he can adjust the air blowing out of the hose, through the port, and around his body. He exchanges his socks for hospital booties that have little rubber treads on the bottom, and he reluctantly takes off his wedding ring, and slips it onto my index finger. It is far too big, and slips around, but I will wear it for him until his hand heals enough - and the swelling from the surgery is gone. The anesthesiologist comes in again, and administers the first of the sedatives through the IV that nurse has put in TW's left arm. The IV line in his right arm is established as well. The Specialist walks in briskly - you would never know that he has been operating nearly non-stop for more than 12 hours now. TW jokingly (maybe only half-jokingly) tells him that he would be glad to go home, and come back another day if Specialist is too tired. Specialist says "No way - not now that we have you trussed up like a Thanksgiving turkey!" He goes through a detailed pre-op checklist, including asking TW three separate times during the course of this 10-minute "interview" to identify the finger they are supposed to operate on. The Specialist writes "OK" on the finger and he initials it, the nurse initials it, and TW. Then, he marks out where he will open the finger. I am glad I am sitting down; just the though of what those lines represent makes me feel sick. The pre-op nurse must have noticed my discomfort, she comes and stands by me, and places a comforting hand on my shoulder. TW is fine, however; he is talking with the doctors, and nurses, joking around, and asking detailed questions about the procedure. The Specialist tells him that if, for some reason, they can't use his existing tendon for the repair, they will "harvest" a very specific bit of tendon from his left wrist to utilize in the repair. He makes a few more swift marks on TW's wrist. Again, there is an "OK" written, and three sets of initials. I try to console myself with the thought that this won't be needed; the Specialist is just being extra-careful to tell us about the "worst-case" scenario. More sedatives are pushed through the IV, and TW continues to joke with the staff; since he is the last case of the day, it seems as though *everyone* has crowded into the room. There is lots of laughter, and everyone seems to be quite relaxed. Except for me.
Suddenly, it's time for TW to go. They disconnect his air hose that had been feeding warm air into the port in his surgical gown, and blankets are brought out from a warming cabinet, and tucked around him. The wheels of his gurney are moving, and I lean over to kiss him goodbye, and tell him that I'll be waiting. He whispers that he is *starving hungry*, and to please have a Big Mac and a Dr. Pepper waiting for him. And then he grins at me, squeezes my hand, and says "I love you too - I'll see you soon!". With that, they turn a corner into the surgical area, and I am left standing in the hallway. Suddenly, I am crying without even realizing it. Pre-op nurse hands me a tissue, puts an arm around my shoulder, and shows me to the waiting room. She hesitates for a moment, then she gently says "It will be a while, you know. Let me show you around here a bit". With that, we walk out into the central corridor, and she proceeds to show me where the vending machines are, the bathrooms, and the tiny little chapel is. She worries because I will be waiting alone. I assure her that I will be fine - and that I have spent too many hours in surgical waiting rooms to come without something to keep me busy and occupied. She walks with me back to the waiting room, and then leaves.
This is the hardest part for me. The part where I have no control over what happens to my loved one; where I must just sit and wait helplessly for the surgeon to reappear with news of how things went. My cell phone rang once during the surgery - the OR nurse called to tell me that things were going fine, and that Dr Specialist would be out once TW was safely into Recovery to talk with me. I started to ask her how much longer, but she hung up before I could get the words formed.
The hospital was quiet, it was dark outside the windows, and the lights were dimmed in the waiting room; there were only puddles of yellow-gold light from the lamps that sat on each side table scattered throughout the room. I remember thinking that under different circumstances, one could describe the lighting as "romantic". A TV at the far end of the room was on, but I paid no attention to it. I tried to focus on anything but what was happening beyond the double doors at the other end of the room. I finally gave up, and simply closed my eyes, hoping and praying that someone would come out soon. It was well after 8 pm when Specialist's nurse appeared, and told me that Specialist would be out soon to talk with me.
About 15 minutes later, Specialist came out, and apologized for the late hour. He sat next to me, and told me that things were "much worse" than he had hoped for, and he had indeed had to harvest that tendon - meaning that TW will have to have both hand rehab and PT for his wrist, to regain full function. He described the procedure in detail, and told me that the original tendon was completely "frayed out" and not at all usable, so he had no choice but to go get that tendon out of TW's wrist. He told me everything - right down to the number of stitches in TW's finger and wrist, what the "button" looked like that holds the tendon in place, where he drilled through the finger bone to lace the tendon through - and attach it to the button with a long bit of suture - and then he took my hand in his, and said "Don't worry - he's fine, you know. And this will all work out OK. And, boy, do I hope you have a Big Mac ready for this guy - he's HUNGRY!". With that, he stood, and laughing, told me how all the way through the operation, TW had talked of nothing but going to McDonald's for his Big Mac and fries! He stayed and talked for several more minutes, mostly about TW's post-operative care. He told me that he had found out that I was "sqeamish" about changing the bandages, and he told me exactly what it would look like the first time we took the bandages off, at home, on Sunday night. His nurse re-appeared, and told me that TW was almost ready to go home (already!) and went over several pages of post-op instructions, most of which I had just discussed with Specialist. We had just finished those pages, and I had just gotten my last question answered when the Recovery nurse appeared to take me to TW.
TW was sitting up, happily sipping on a 7-Up, and with a twinkle in his eye, listening to the gossip from the two nurses who were left. He was the last outpatient patient of the day, and they were talking freely in front of us about other patients and doctors. I knew he was still pretty heavily doped up, and so I simply kissed his forehead, and with my stomach clenched, admired his bandages. He asked me where his Big Mac was, and I had to tell him that I was waiting on him - I didn't want his hamburger to get cold, so now we could go get one together. It took a few more minutes for the two nurses to take out his IV lines, one working on each side. We got him dressed again, and he began to realize - about the time he tried to put on his socks with one hand - that things might be a bit more, um, *difficult* to do with only one hand. This, Gentle Reader, is the point at which I should have paid attention to the alarm bells going off in my head. But, I was so focused on just getting us *home* before 10 pm that I shrugged off any uneasyness that I felt. He confessed that he remembered nothing at all of the surgery, and was surprised when one of the surgical nurses appeared, and asked him if he had gotten that Big Mac yet. She told us that he had talked almost the whole way through about how much he looooooved his Big Macs, and that he would marry one right now if he had to just to get one! TW was fascinated with the idea of this whole conversation that he did not remember at all - but not so fascinated that he forgot he wanted the damn Big Mac!
Reluctantly, I drove him through McDonald's and we headed home. I knew that the full effects of the pain medication they had given him during surgery wouldn't wear off until somewhere around 2 am, and so I followed Dr.'s orders, and gave him his first Lortab. Thank G-d for Lortab. TW never really had much pain through the whole post-surgical time, and by the third day, he was completely weaned off of the pain meds. There was some discomfort, to be sure, but because the Specialist used such good pain management techniques (by getting ahead of the pain, and keeping ahead of it with the Lortab) TW never had any significant issues. I was (and still am) really impressed with the Specialist.
Sunday came, and with it, we had to take off the surgical dressings, and begin the process of cleaning the surgical sites, and then bandaging them. Despite my overwhelming fear of this, I did OK - and even found myself admiring the beautiful, tiny, perfect stitches that the Specialist had made. Dee (as promised) and Twinks were there, too - and they (along with TW) all seemed to have this clinical *detachment* about the whole thing that I truly envy. But, I cleaned, and swabbed, and swaddled his hand, and for the next two weeks, every day, twice a day, did the same thing.
TW had been told - not once, or twice, but MANY TIMES that he has RESTRICTIONS on this hand. Primarily, he can't lift anything heavier than 5 pounds for the next six weeks, and he is going to have to go to PT to regain the strength and flexiblity in both his hand and wrist. Despite that, he has continued to try and use that hand.
Remember, I told you that TW IS NOT A GOOD PATIENT. I love TW - I truly do, but those two weeks until he got his stitches out... nearly did me in. I thought that, on several occasions, he really would go ahead and take out his own stitches - not to mention that he was (trying to) lift things he shouldn't have and do things he wasn't supposed to. I really did believe that by the time we got to his first post-op appointment that he would have undone all the work that the Specialist had done.
Oh. My. Gosh.
But, finally, last Thursday arrived, and with it, the first of two appointments to take off all of the surgical stitches and hardware that the Specialist left behind. New instructions for care are required at this phase, and for me, at least, a new wave of nausea as the stitches come out, and new frustrations for TW as the admonitions are renewed regarding the care, feeding, and functionality of his left hand.
In just FOUR DAYS we go back to get that "button" removed.
I'm taking along smelling salts for that one...
Ready to finish this up? Read Part 4 here...
Published by Thimbelle - Monday, December 07, 2009