After Mother Nature saw to it that my surgery was cancelled on February 8, 2010, by virtue of dumping 4 feet of snow in our region, I was re-posted for Monday, March 1, 2010. Surely we would not have a repeat snow emergency as late as March 1st (we almost did).
My uberfriend and personal nurse, Ruth, flew here from Salt Lake City on the previous Saturday, and we spent Sunday shopping at Whole Foods for the vittles necessary to keep us in the gustatory style to which we have become accustomed for the past 45 years.
On Monday, I drove us to Good Samaritan Hospital on Loch Raven Boulevard in Baltimore. We had to park in a remote lot since all the good parking spaces were already in use by the early-morning shift. I was told to report to the admissions office by 10 a.m. There, the usual paperwork was done swiftly, and we were escorted into the surgical holding area of the hospital, where clothing was removed (Ruth got to keep her clothing), machines were hooked up, IV was started, and vital signs were taken every 5 seconds. Owing to numerous mis- or un-identification leading to the mistaken sawing off of limbs and the erroneous removal of organs, hospitals have finally learned (and it's now the law) to make double-damn sure that the patient is the right patient and the proposed surgery is being done on the right body part. I was asked no less than 10 times to state my name, spell my name, recite my birthdate, and narrate my procedure. By the time I actually went to surgery (where I was asked the above questions twice more), I was fairly confident they knew who I was and what I was there for.
My surgeon and I had previously discussed that this was an operative procedure that could be done using local anesthetic and intravenous sedation, which would allow me to be conscious during the operation. As it turned out and which was quite a shock to my sensibilities, the anesthesiologist in league with the surgeon decided it would be much better if I were placed in a prone (face-down) position instead of a lateral position, and that requires maintenance of an airway and a general anesthetic. I had a momentary fright as I contemplated "going under. " It wasn't what I expected. When that announcement was made by the anesthesiologist in the surgical holding area, I looked at Ruth and said, "Should we do this?" She gave me a quizzical glance for a nanosecond, and then I decided that if I ever had the chance of being pain-free, losing consciousness would have to be part of the process. I said, "OK." Off we went.
Ruth was escorted to the surgical waiting room, and I was rolled on a gurney into the operating room. There I was met by a bunch of masked but friendly OR personnel, including the anesthesiologist. He said, "I am going to give you some Versed now." I asked him if I had to count backward from 100, as is usually the case when a patient undergoes induction. He said, "I don't think that will be necessary." That was the last I knew.
I can't swear to it because I have no conscious memory of it, but apparently the OR personnel managed to get all 292 pounds of me, unconscious, on the operating table, face-down, without dropping me or damaging me in any discernible way. The next thing I was aware of was waking up in the recovery room, trying to talk, pulling the oxygen mask off my face, and saying, "I've been cut." I looked at the clock in the recovery room, and it was 6:20 p.m. My surgery had been delayed because of a heavy OR schedule, and I didn't get into the OR until after 3 p.m. My throat was sore, and my vocal cords were quite irritated from the endotracheal tube that was in there to maintain my airway during surgery. That's the part of a general anesthetic I like the least. It takes a few hours to get your normal voice back, and it takes me that long to stop coughing from the throat irritation. The incision itself is a nothingburger compared to the throat and voice inconvenience. I wanted ice chips, and they were forthcoming immediately.
It wasn't too many minutes later that some kind soul went to the surgical waiting room to fetch Ruth, and she was allowed to stay with me in the recovery room for the two hours they kept me there. My vital signs were excellent at each check. The nurse in charge of me in the recovery room was Julie, and she had a great sense of humor and gave me very good care.
At 8:45 p.m., I was finally taken up to my private room on the orthopedic surgical ward. The first thing I did was get off the gurney under my own steam and go to the bathroom. There is only so much a bladder can hold. Then I got into my bed, and the rituals began. I was hooked up to a PCA pump (patient-controlled analgesia; in my case, IV Dilaudid) and an IV of normal saline. Venodynes were placed on my lower legs (to prevent blood clots while sedentary). I was carefully instructed by the floor nurse how to activate the PCA pump, but I told her I didn't need it and wouldn't use it. She was doubtful about that, but I never did take even one hit off the Dilaudid. I am not a fan of narcotics. I would rather suffer some pain than feel the fuzzy-headed effects of narcotics. Later, the nurse wanted to give me oral OxyContin, but I refused that too. I told her I would take some Motrin if I needed pain relief. They were all surprised, including the surgeon when he learned the next morning that I hadn't had any pain killers after surgery.
Because the PCA pump was hooked up to my IV, the nurses had to come every 2 hours throughout the night to check my vital signs. This is the protocol when a patient has access to a PCA pump, regardless of whether or not the PCA is used. Ruth stayed overnight with me, trying to get a little sleep in the recliner chair in my room. Every time we would doze off, they would come in and turn on the bright overhead lights (interrogation-style lights) and wake us up. One thing that's hard to come by in a hospital is uninterrupted sleep. You have to go home for that.
At 6 a.m., another surgical resident came to make rounds on me. That also woke us up, of course. He didn't contribute much to the process except to look at my incision and to test my motor and sensory parameters. Both were fine. Mercifully, my surgeon rounded early and was there by 8:30 a.m. I was sitting up in bed, and he came into the room and said, "Look at you!" I don't know what he was expecting, but he was surprised to learn that I hadn't had any IV or oral pain medication at all. I told him that I was ready to rock and roll, and he very happily discharged me to home right then and there. In a few minutes, the nurse came in and discontinued my IV, pulled the line out of my arm, and I dressed in my street clothes, Ruth brought the car around, and we were home (with a sigh of relief) by 10 a.m. on Tuesday, March 2, exactly 24 hours after I presented for admission. Nothing could have been better. They gave us a week's worth of surgical dressings so Ruth could change the dressings every day.
And now the food: I had to fast for 16 hours before surgery. On the day of surgery, I was put on a clear-liquid diet after the operation was over. That's the norm. In the recovery room after surgery, I had diet ginger ale and cranberry juice (juice drink, full of sugar and hardly a cranberry). This elevated my blood sugar to 153, so the protocol kicked in where a patient has to get insulin if the blood sugar is over 150. I am glad my floor nurse decided to belay that, and I never got the insulin. A few hours later, my blood sugar was back to 101. On the morning after surgery, I was advanced to a liquid diet, so they brought me chicken broth, Jell-O, Lipton tea, and apple juice. Since I'm a vegetarian, I wasn't going to drink the chicken broth or eat the Jell-O. I don't do caffeine, so the Lipton tea was a nonstarter. I knew the apple juice would elevate my blood sugar, so I didn't drink that either, fearing that would start another discussion about giving me insulin. Sigh. My day nurse decided I should eat something, however, so she advanced my diet to soft. Right before we left the hospital, the dietitian brought me sauted apple slices, apple juice, and two white-flour fake-blueberry muffins. Ruth and I just looked at each other and decided we would eat when we got home. It's a wonder that hospitals still think this stuff passes for nutrition, but short of bringing your own food, which they wouldn't let you eat anyway, they will never 'get it.' Proper nutrition is mandatory for proper healing, but dietitians don't seem to understand that connection.
When we got home on Tuesday morning, we had organic eggs and toasted Ezekiel bread (organic, sprouted, whole-grain bread bought at Whole Foods---good stuff) and real brewed decaf coffee. It was the best meal of my life.
The rest of the week was uneventful. Everything healed up wonderfully. The incision remained clean, dry, and intact. I was walking around the house without a cane. We went to see Alice in Wonderland in 3D. It was marvelous. Ruth did all the driving since I was told not to drive until my skin clips were removed (26 of them in an incision about 8 inches long). Of course, I cheated and drove 3 days before my followup appointment with the surgeon. Nothing bad happened. I drove Ruth to the airport on Thursday morning, March 11, and I drove myself to the doctor appointment on Friday, the next morning. The skin clips were removed, and I was told I could now drive. I smiled. I was asked to come back for a final followup appointment on April 6. No bending, twisting, or lifting in the meantime. I think they mean I should not be throwing 100-pound alfalfa bales around the barn, which is what I did when I was a kid on the farm and which probably contributed to the lumbar spinal stenosis and herniated disks from which I sought some relief with this very operation. Instead of having spinal fusion and laminectomy, I opted for a titanium device called X-STOP. You can watch a video to learn more about X-STOP. It is now covered by Medicare, for which I am grateful. Instead of recuperating for 6 months after spinal fusion, X-STOP recovery is about 6 weeks (or less). It's a great invention. I only hope it works long-term.
That's all for now. I've got to go sling some hay bales and get ready for a dance at Spring Hill.
Click on the hot link below for more information about X-STOP.
http://www.spine-health.com/video/x-stop-interactive-video
My uberfriend and personal nurse, Ruth, flew here from Salt Lake City on the previous Saturday, and we spent Sunday shopping at Whole Foods for the vittles necessary to keep us in the gustatory style to which we have become accustomed for the past 45 years.
On Monday, I drove us to Good Samaritan Hospital on Loch Raven Boulevard in Baltimore. We had to park in a remote lot since all the good parking spaces were already in use by the early-morning shift. I was told to report to the admissions office by 10 a.m. There, the usual paperwork was done swiftly, and we were escorted into the surgical holding area of the hospital, where clothing was removed (Ruth got to keep her clothing), machines were hooked up, IV was started, and vital signs were taken every 5 seconds. Owing to numerous mis- or un-identification leading to the mistaken sawing off of limbs and the erroneous removal of organs, hospitals have finally learned (and it's now the law) to make double-damn sure that the patient is the right patient and the proposed surgery is being done on the right body part. I was asked no less than 10 times to state my name, spell my name, recite my birthdate, and narrate my procedure. By the time I actually went to surgery (where I was asked the above questions twice more), I was fairly confident they knew who I was and what I was there for.
My surgeon and I had previously discussed that this was an operative procedure that could be done using local anesthetic and intravenous sedation, which would allow me to be conscious during the operation. As it turned out and which was quite a shock to my sensibilities, the anesthesiologist in league with the surgeon decided it would be much better if I were placed in a prone (face-down) position instead of a lateral position, and that requires maintenance of an airway and a general anesthetic. I had a momentary fright as I contemplated "going under. " It wasn't what I expected. When that announcement was made by the anesthesiologist in the surgical holding area, I looked at Ruth and said, "Should we do this?" She gave me a quizzical glance for a nanosecond, and then I decided that if I ever had the chance of being pain-free, losing consciousness would have to be part of the process. I said, "OK." Off we went.
Ruth was escorted to the surgical waiting room, and I was rolled on a gurney into the operating room. There I was met by a bunch of masked but friendly OR personnel, including the anesthesiologist. He said, "I am going to give you some Versed now." I asked him if I had to count backward from 100, as is usually the case when a patient undergoes induction. He said, "I don't think that will be necessary." That was the last I knew.
I can't swear to it because I have no conscious memory of it, but apparently the OR personnel managed to get all 292 pounds of me, unconscious, on the operating table, face-down, without dropping me or damaging me in any discernible way. The next thing I was aware of was waking up in the recovery room, trying to talk, pulling the oxygen mask off my face, and saying, "I've been cut." I looked at the clock in the recovery room, and it was 6:20 p.m. My surgery had been delayed because of a heavy OR schedule, and I didn't get into the OR until after 3 p.m. My throat was sore, and my vocal cords were quite irritated from the endotracheal tube that was in there to maintain my airway during surgery. That's the part of a general anesthetic I like the least. It takes a few hours to get your normal voice back, and it takes me that long to stop coughing from the throat irritation. The incision itself is a nothingburger compared to the throat and voice inconvenience. I wanted ice chips, and they were forthcoming immediately.
It wasn't too many minutes later that some kind soul went to the surgical waiting room to fetch Ruth, and she was allowed to stay with me in the recovery room for the two hours they kept me there. My vital signs were excellent at each check. The nurse in charge of me in the recovery room was Julie, and she had a great sense of humor and gave me very good care.
At 8:45 p.m., I was finally taken up to my private room on the orthopedic surgical ward. The first thing I did was get off the gurney under my own steam and go to the bathroom. There is only so much a bladder can hold. Then I got into my bed, and the rituals began. I was hooked up to a PCA pump (patient-controlled analgesia; in my case, IV Dilaudid) and an IV of normal saline. Venodynes were placed on my lower legs (to prevent blood clots while sedentary). I was carefully instructed by the floor nurse how to activate the PCA pump, but I told her I didn't need it and wouldn't use it. She was doubtful about that, but I never did take even one hit off the Dilaudid. I am not a fan of narcotics. I would rather suffer some pain than feel the fuzzy-headed effects of narcotics. Later, the nurse wanted to give me oral OxyContin, but I refused that too. I told her I would take some Motrin if I needed pain relief. They were all surprised, including the surgeon when he learned the next morning that I hadn't had any pain killers after surgery.
Because the PCA pump was hooked up to my IV, the nurses had to come every 2 hours throughout the night to check my vital signs. This is the protocol when a patient has access to a PCA pump, regardless of whether or not the PCA is used. Ruth stayed overnight with me, trying to get a little sleep in the recliner chair in my room. Every time we would doze off, they would come in and turn on the bright overhead lights (interrogation-style lights) and wake us up. One thing that's hard to come by in a hospital is uninterrupted sleep. You have to go home for that.
At 6 a.m., another surgical resident came to make rounds on me. That also woke us up, of course. He didn't contribute much to the process except to look at my incision and to test my motor and sensory parameters. Both were fine. Mercifully, my surgeon rounded early and was there by 8:30 a.m. I was sitting up in bed, and he came into the room and said, "Look at you!" I don't know what he was expecting, but he was surprised to learn that I hadn't had any IV or oral pain medication at all. I told him that I was ready to rock and roll, and he very happily discharged me to home right then and there. In a few minutes, the nurse came in and discontinued my IV, pulled the line out of my arm, and I dressed in my street clothes, Ruth brought the car around, and we were home (with a sigh of relief) by 10 a.m. on Tuesday, March 2, exactly 24 hours after I presented for admission. Nothing could have been better. They gave us a week's worth of surgical dressings so Ruth could change the dressings every day.
And now the food: I had to fast for 16 hours before surgery. On the day of surgery, I was put on a clear-liquid diet after the operation was over. That's the norm. In the recovery room after surgery, I had diet ginger ale and cranberry juice (juice drink, full of sugar and hardly a cranberry). This elevated my blood sugar to 153, so the protocol kicked in where a patient has to get insulin if the blood sugar is over 150. I am glad my floor nurse decided to belay that, and I never got the insulin. A few hours later, my blood sugar was back to 101. On the morning after surgery, I was advanced to a liquid diet, so they brought me chicken broth, Jell-O, Lipton tea, and apple juice. Since I'm a vegetarian, I wasn't going to drink the chicken broth or eat the Jell-O. I don't do caffeine, so the Lipton tea was a nonstarter. I knew the apple juice would elevate my blood sugar, so I didn't drink that either, fearing that would start another discussion about giving me insulin. Sigh. My day nurse decided I should eat something, however, so she advanced my diet to soft. Right before we left the hospital, the dietitian brought me sauted apple slices, apple juice, and two white-flour fake-blueberry muffins. Ruth and I just looked at each other and decided we would eat when we got home. It's a wonder that hospitals still think this stuff passes for nutrition, but short of bringing your own food, which they wouldn't let you eat anyway, they will never 'get it.' Proper nutrition is mandatory for proper healing, but dietitians don't seem to understand that connection.
When we got home on Tuesday morning, we had organic eggs and toasted Ezekiel bread (organic, sprouted, whole-grain bread bought at Whole Foods---good stuff) and real brewed decaf coffee. It was the best meal of my life.
The rest of the week was uneventful. Everything healed up wonderfully. The incision remained clean, dry, and intact. I was walking around the house without a cane. We went to see Alice in Wonderland in 3D. It was marvelous. Ruth did all the driving since I was told not to drive until my skin clips were removed (26 of them in an incision about 8 inches long). Of course, I cheated and drove 3 days before my followup appointment with the surgeon. Nothing bad happened. I drove Ruth to the airport on Thursday morning, March 11, and I drove myself to the doctor appointment on Friday, the next morning. The skin clips were removed, and I was told I could now drive. I smiled. I was asked to come back for a final followup appointment on April 6. No bending, twisting, or lifting in the meantime. I think they mean I should not be throwing 100-pound alfalfa bales around the barn, which is what I did when I was a kid on the farm and which probably contributed to the lumbar spinal stenosis and herniated disks from which I sought some relief with this very operation. Instead of having spinal fusion and laminectomy, I opted for a titanium device called X-STOP. You can watch a video to learn more about X-STOP. It is now covered by Medicare, for which I am grateful. Instead of recuperating for 6 months after spinal fusion, X-STOP recovery is about 6 weeks (or less). It's a great invention. I only hope it works long-term.
That's all for now. I've got to go sling some hay bales and get ready for a dance at Spring Hill.
Click on the hot link below for more information about X-STOP.
http://www.spine-health.com/video/x-stop-interactive-video
Nice post!
ReplyDeleteSee ya in Spring Hill. Your admiring nephew David.
Love You