Wednesday, 2 April 2008

On The Post Operative Surgical Unit

The operation for the filleting of my right thigh ( to remove infected bone and soft tissue along with the metal implants that had contributed to the 4 years of post operative sepsis) took a little longer than planned.

I was given an epidural ( for the second time in my patient experience) for which I was glad. Because of the past history of Crohn's disease my previous experience of General Anaesthetic followed by days of lying flat in bed has been that I would be sick for many days and then bloated.

I now know that these conditions contribute to pseudo obstruction of the bowel - for me at least. The treatment for this has in the past involved the insertion of a tube into my stomach through my nose with a small bag attached to collect stomach secretions until the pseudo obstruction resolves itself. The devise is called a nasal gastric tube. Not only is this process painful but to my mind moves me significantly, toward the alien end of the human/alien life form axis!

The other contraption that has a similar effect is the insertion of a "central line" into the side of my neck. This contraption consists of a plastic tube from which a number of other plastic tubes split off to be connected to monitoring devises and/or therapeutic equipment like kidney dialysis machines. I have had a central line inserted three times ( in fact during each of the last 3 operations) fortunately all done while under the influence of an anaesthetic.

I have never had to endure both nasal gastric tube AND a central line at the same time and think If I did I might never re-emerge as human but would remain completely alien - in my mind at least!

Because of my history of renal impairment I was due to be nursed after recovery on a recently opened Post Operative Surgical Unit. This is less invasive then intensive care and is separate from an associated High Dependency Unit. Its purpose is to provide a facility to enable constant observation, monitoring and specialised treatment after an operation.

I went down to theatre around 1:00 p.m and recall 3 occasions when the general anaesthetic must have worn off sufficiently for me to hear the sound of hammering ( to remove the old implanted hip joint) and feel the effect of the hammering moving me up ( or down) the table. I mentioned this afterwards to the Senior Registrar who commented that yes I had tried to "assist at times". I asked if this meant was I talking and giving advise? To which he replied "no you just decided to flail about a bit!"

Around 8:00 p.m I regained consciousness. I noticed my wife was sitting at the end of the bed. I think I acknowledged her but was unable to converse much at the time. I gathered however from the discussion she was having with the young doctor attending to me that the operation had not gone altogether as smoothly as planned and that I was in a state of shock. All I can remember is that Martha - the nurse assigned to me - was asking questions and I that I felt very cold.

I could see that to my left was a computer screen split into about 8 displays of what I assumed were traces of heart rhythm, blood pressure, respiration among others.

I was aware that in response to saying that I felt cold Martha reached behind my head to the right and I felt warmer. I noticed that in place of a sheet and blanket I was under a series of plastic / paper tubes about 3 inches across. There must have been sealed double layer around each tube and it was into this space that warm air was circulating to warm me up.

I next looked under this arrangement and saw my right leg, which I could not feel. The word "akimbo" came to mind as did the image of Meryl Streep in "Death Becomes Her" after tumbling down stone stairs shortly after becoming to all intents and purposes immortal. It was not a pretty site. My right foot was turned completely out. The outside of my right knee ( slightly bent) was lying flat against the bed. I also noticed how swollen my right thigh was. I am used to the swelling involved in normal hip replacement but this seemed more excessive than normal. All in all I had no feeling of my right leg belonging to me and what sensation I did have was analysed by my brain as a lumpy mattress on the right side of the bed!

I was vaguely aware of saying goodbye to my wife as she left. Richard the young doctor returned from time to time - on one occasion he had to re site an arterial cannula. This, along with the central line inserted in my neck allowed very accurate monitoring of various vital signs. I could see the small contact that was reattached after the cannula was successfully inserted and remember thinking about "nano technology"

At this time I therefor had a venous cannula through which I was receiving fluids, an arterial cannula for monitoring purposes, a catheter, an epidural line into my back, a central line on the right side of my neck. In time each would be removed as I would revert to being increasingly human again. Fortunately there was no nasal gastric tube to achieve a full house!

Around 2:00 a.m. I think I had recovered sufficiently to be conscious and to my surprise was asked by Martha if I wanted anything to drink. I assumed this would mean, as I had experienced before with a very dry mouth, sucking on a sponge lollipop followed by sips of water at 15 minute intervals. To my surprise Martha was offering to bring me a beaker of coffee complete with spout to aid drinking. What is more I was even brought some toast and marmalade!

About 6:00 a.m I became aware of staff coming and going and handing over. Richard introduced me to Amy who would be taking over from him and would ensure I was fit to return to the ward later that morning.

A few hours later Amy returned and ensured I had some more food - in this case some vegetable soup which as she said would do me "more good than all these fluids and drugs were putting inside you."

I was shown a red silky half sheet that was in fact a roll of smooth cloth. Amy said that this should accompany me to the ward and be used to assist in moving me around the bed when required. It was never used for this purpose and was in fact discarded. I did however make sure it was taken home with me ( it was labelled "for single patient use only" so I assumed it was disposable) as I thought it would help me get into and out of bed with my swollen unco-operative right leg.

I will reflect on the potential benefit of this patient handling "device" in later postings as I recount my experience of differences among the ward nursing staff in their understanding of the importance of patient handling techniques generally but particularly for those with no hip joint.

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