Major Surgery: the gory details edition part two
WARNING: PURE MEDICAL GEEKERY FOLLOWS. As I said before, though my hospital stay wasn’t any fun, it was very interesting. Lots of gadgets, new procedures, ways to not kill patients. This (very long) post will deal with some icky stuff, so you might want to skip it unless you find that kind of thing as interesting as I do.
Second installment: a hospital is no place to get better.
I was plenty scared about the anesthesia among other things. You don’t have to read very many sensational news articles about people being awake but paralyzed during surgery for it to play on your fears. Fortunately (to say the least) that didn’t happen.
Anesthesia has really improved. In the past, waking has been like fighting through a swamp, wandering this way and that to find a way out of a dark maze. But this time I woke up easily in a large room somewhere, my mind pretty clear right away. That’s a neat trick considering what I had just been drugged into ignoring only an hour previously.
Well not entirely clear. Someone said to me; “Welcome back, Mister Wiman.” (all smiles) “You didn’t get a colostomy!” Great. I wondered: where am I, and what’s a colostomy? But only a couple minutes later I had sorted that out and was fully awake and damn glad not to have one. Story continues below the fold, with photos.
Gut-wrenching: the actual operation, what little I understand about it
What is a perforated bowel? It’s a hole in the large intestine that allows bowel material to escape into the abdominal cavity. When this happens you need surgery NOW. My perforation was in the sigmoid colon. I received a twelve-inch vertical abdominal incision, and the operation took three hours, roughly twice as long as expected. The incision was closed with about 45 surgistaples.
I wasn’t able to find any videos of this type of operation being performed, or even any good pictures, but that may be just as well. From what I’ve been able to find out the surgeon has to lift out your guts, rinse them off and lay them alongside, rinse out the abdominal cavity, inspect and repair the guts, and pack them back into the abdominal cavity. Do they practice origami in medical school? (If anyone with medical training can provide a more accurate description, I’d love to improve this post with it).
Post-op killers, considered
Clearly the medical community has made an effort to address some of the big ones. These include infection, drug dispensing errors, blood clots from the legs, and fluid buildup in the lungs.
Respiration: Suck On This
Fluid tends to build up in post-op patients’ lungs, often with fatal results. There are several, painfully simple reasons for this. A person who has just had abdominal surgery doesn’t like to cough OR even to breathe deeply. It’s uncomfortable! Another, when lying in a hospital bed, breathing is shallow because you are at rest.
The solution is for the patient to breathe deeply many times an hour, but telling them to “breathe deeply” is pretty vague. So I was given a simple “incentive spirometer”, which is a little plastic flow-meter invented for asthma patients, that lets me know exactly if I was breathing deeply enough. I was told to use it ten times an hour for every hour I was awake, and given specific volume goals. It’s simple, cheap and effective if you can get the patient to cooperate, which I did. It’s not like I had anything else to do.
Move, dammit! And self-managed pain control.
Patients used to be kept very still following surgery (or even childbirth). They were supposed to “rest”, which made for poor circulation, shallow respiration, and the formation of adhesions between abdominal layers. Now we’re advised to get out of bed as soon as possible after the surgery. Get off that bed and walk! My first walk, with someone helping, was from my room to the exit sign down the hall and back. After five days I’d figured out that the hallway circumference of the recovery wing was about 400 feet, give or take. One day, all told, I racked up nearly a mile over several walks pushing my own IV pole the whole way.
This is where self-managed pain control is crucial. They WANT you to use the morphine. It was very funny how several people took the time for a detailed description of how to operate the morphine pump. (C’mon, folks; I’ve used them before and it only has one button.) Dr. W. said; “We want you to move, we want you to cough. You won’t do either if it hurts.”
To sleep, perchance to dream (forget it, big boy)
This is a non-trivial problem and they didn’t seem to have a very good handle on it. Every one of the six (!) tubes connected to my body was an opportunity to wake me up and do something to them at regular, overlapping intervals. In fact, the IV tube split off to multiple sources, which drained into me in sequence partly by gravity order (clever, that) and partly by computer control.
They were constantly checking my vitals too (and a good thing, because my blood pressure really spiked at one point). Charting involved waking me up to scan my wrist band, and ask me my name and date of birth to make sure they were not about to give me someone else’s drugz. There was too much light and noise, and of course, I was very uncomfortable. I didn’t get more than an hour’s continuous sleep for nine days; between sleep deprivation and drugs I literally could not track the passage of time. I got online a couple times but nothing made sense to me. I’m still coming back but the important thing is; you have a better chance of sleeping at home.
You really do need this kind of oversight after major surgery, so I can’t think of a ready solution.
The nine-day massage
A major cause of post-op deaths and stroke is blood clots from the legs. I woke up to find that a pneumatic device was squeezing my calf muscles at one-minute intervals, essentially pumping blood through my legs. I’m told most people don’t like this machine but I loved it! Because of my chronic pain condition, sitting or lying still for more than a few hours is a terror to me. But this machine prevented the pain and here’s the cool part: if I can find a portable version, I’ll be able to travel by air again. Several helpful people (including my boss) did some research and found that there are indeed portable versions of these machines. Some time this summer I will be acquiring one, and here I didn’t even know they existed. If there is any silver lining to the whole experience, this is it.
The hand grenade and mega-weirdness
There was a tube protruding from the side of my abdomen ending in a little silicone rubber bulb the size of an orange. They called it; “the hand grenade” and its purpose was to collect drainage from my abdominal cavity. The tube was sutured to my abdomen, which was very uncomfortable. Every few hours, they’d come empty the hand grenade into a cup, measuring and inspecting the resulting fluid. Once emptied, they’d sqeeze it concave and then cap it, to maintain negative static pressure relative to the abdomen.
It was kind of a frightening little device, and when Dr. W. finally snipped the suture and pulled out the tube (which was about two feet in length) I could feel it sliding past my innards as it came out. Ugh!
Stomach pump and why I’m grateful for something I hated so much
I woke with a tube in my nose that ended in my stomach, connected to a stomach pump. I’d munch an ice chip, and a few moments later the little bit of water would hop the u-turn at my nostril and head for the pump. This was in place because the intestines wake up at different rates, and at first anything in the stomach would result in vomiting. As this is the first surgery I’ve ever had where I didn’t vomit (thank doG!), it was a very good thing.
But also a bad thing. I can hardly describe how unpleasant it is to have a tube down the back of your throat from your nose. It’s like (and is) having a giant glob of snot back there which you cannot expel in any way whatever. When after 40 hours the tube was finally removed – like all tubes a long steady pull with weird feelings as it slid past internal parts – it was nearly three feet long. Apparently they want it to coil and lay at rest in the stomach, rather than poking the lining. I stacked up five tissues, reared back and blew my nose, an action which has never felt so wonderful before. Context is everything, I suppose.
Foley Catheter and mega-weirdness
This is the third time I’ve been ‘cathed’ and it isn’t my favorite thing in the universe to say the least. Several years ago following a hernia operation, my urethra or prostate clamped down and I couldn’t pee. The nurse said helpfully; “If you don’t pee, I’m going to have to cathe you!” They waited a very long time until I was excruciatingly uncomfortable (your bladder can literally rupture) before inserting the tube into my penis up into the bladder to relieve the pressure.
This time and one of the other times, the Foley was inserted while I was unconscious, which is worth asking for, if circumstances allow. On a previous occasion (kidney stone requiring surgery) I had a Foley for six days, and it permanently damaged my urethra. Like the cartoon character Hank Hill, “I have a narrow urethra!” This one stayed in for five days, but seems to have left no ill effects. Very, very weird when pulled out-and like all the other tubes, disturbingly long.
Farts and surreality
Sometimes it felt like I’d awakened in a Salvador Dali painting. Beautiful, young professional women would enter my room and ask; “Hello Mister Wiman! Have you passed any gas today?” We joked about what it would be like if other businesses inquired of their customers about this bit of information. “Hello, welcome to Sears! Have you passed gas today?”
But it’s a really important, even crucial question. After all that rough handling, the intestines shut down and there’s no peristalsis. Until every section from stomach to anus starts functioning, you can have nothing by mouth – it would back up and you’d vomit. The OK signal is repeated farting.
“What part of ‘nothing by mouth’ did you not understand?”
Recently I’d been thinking about experimenting with fasting. I’d read an abstract of a study that found fasting one day every two weeks improved insulin response in overweight individuals. Well I got my experiment: for seven days I had no food or drink by mouth at all. My IV tube provided only electrolytes and glucose. I’d question Dr. W. (who really didn’t mind using sarcasm, which I appreciated) about this and she’d say; “No, really, it’s OK! You can just not eat for a week and it won’t hurt you.” Or at least, hurt you less than the alternative. She said; “We’ve had people who are very hungry lie about passing gas, then vomit and aspirate, and end up in ICU on a ventilator. It’s an unfamiliar circumstance to them so they need to understand what it means.” I told her I was only irrational, not stupid. Jury still out, perhaps.
Staples; not just for the office anymore
What can I say about staple stitches? They certainly worked well but I was industrial-strength curious what it would feel like to have them removed. “Oh, it doesn’t hurt at all – it just pinches a bit,” said the nurses. That should have been my first warning.
My skin is super-sensitive to pain. When possible, I take my own stitches out, chilling the area with an ice cube first. I couldn’t reach these so the nurse cooled them with an ice pack and took them out with a clever little pair of special pliers. As it happened, these hurt like crazy. I basically screamed like a nine-year-old girl. Sorry, but ice packs aren’t cold enough, so if there’s ever a next time (perish the thought) I’m insisting on direct ice cube preparation. Apparently for many people, it’s no big deal.
Full incision image available by request. Trust me, you don’t want it.
“Oh, it doesn’t hurt at all – it just pinches a bit,”
Always a bad intro. :cheese: Ditto Leguru. Many things medical make we wince and scream too. I don’t handle pain and needles well. I hate when docs and nurses say, oh it doesn’t hurt… just tell me it’s terrible and get it over with. I would rather it hurt less in my mind cause you told me it would suck than have it hurt more cause you gave me a false sense of hope. Glad you’re on the mend, George. This is a terrific narrative, so while it sucks that you had to go through all this, there’s been an extra positive result. Agree with webs05 on pain imagination management – tell me it’s going to be awful, and then if it’s a bit less awful I’ll feel better. Tell me it won’t hurt when it actually does, and I’ll wonder what’s wrong. Good post. Let me just reiterate how important moving is postop. It doesn’t have to be any major movement a simple turning to your sides when your lying on bed will also be helpful. You see, moving can help facilitate peristalsis, which means your GI system is working again. It can prevent other respiratory problems because it loosens secretions which means water won’t accumulate in your lung and in the same way it prevents infection. Another point I’d like to share is that you will feel pain after surgery and certain measures can help you tolerate the pain. These measures include simple diversionary activities and a back rub or a massage.
By the way, my daughter is a nurse anesthetist. Yes, there is something to be feared, but the newer techniques are much more user-friendly. When she got her Master’s at Columbia I recommended she not charge for putting patients to sleep – if they want to wake up, there’s a charge. Good advise, no?
