Inspiration of the Day September 27, 2004

Good morning all! This is now the fourth time that I have started this and it is long....some of you may get two copies because you are on a couple of my distribution lists, but it was easier to use the lists rather than add people one by one.  Sorry for the inconvenience.

As you can see, I started to write this two days ago and {now 2 weeks ago}, thinking that I was well enough to do that, but today, hopefully, I am. That sensation of feeling well enough to do an Inspiration of the Day page quickly passed each time that I tried to write this, so I will start at the beginning and bring you up to date. In the meantime, I apologize for not getting to you any sooner and for any extra worry that that may have caused you.

Thursday, the day of my surgery, started out just fine, and it is hard to believe that it was nearly 2 weeks ago. I arrived at the hospital and got checked in without any hitches. They started an IV without a problem. My surgery was scheduled for 11:15 a.m. and at about 11 a.m., the nurse came to say that the 8 a.m. case that was scheduled before me had not gone to the operating room yet. There had been a large trauma case and my surgeon had been working all morning on that. They stated that the trauma case would probably be another hour, then they would have to do the 8 a.m. case and then it would be my turn. I was ticking off the hours in my head. I was wondering, "What time does my surgeon normally go to bed?" I couldn't eat anything, I couldn't drink anything, I had no clothes on except for the quintessential hospital gown with its lovely, royal blue print on soft, brushed cotton, so I decided to curl up and take a little nap. I had planned enough ahead to bring several magazines, a couple of books, and my daughter's portable CD player. At about 2 p.m., my surgeon walks in and states that the trauma case is going to take another 1 1/2 hours. He is going to send the 8 a.m. case home as well as the case that was after me, but he will be ready to do me at about 4 PM. He tells me that he has had a Coke and a cup of coffee and that he should be fine for surgery on me in a couple of hours. I am very reassured by that. This time, I do lie down and take a nap. The nurses in the holding area had moved me to a room that had a door, so that it would be a little quieter. Of course, I had just fallen asleep, when this loud ringing starts. I have no idea what it is. It is none of the usual "bells and whistles" that I carry around. Just then, I noticed that there is a phone in the back corner of the room. I had been wheeled into the room backwards, so I did not see the phone. I then attempted to get out of my gurney, but both of the side rails were up, I had an IV in my arm and the pole was on the opposite side of my bed. I did manage to just scoot off of the end, pickup the phone, and of course, it stopped ringing. It was one of those old black phones with those loud and very annoying rings. I waited, expecting whoever it was, to call back. They did, and it was the anesthesiologist, who in the interest of time, wanted to ask me all of the questions over the phone that he would normally ask me in person. He tried to do that, but he could not hear a word that I was saying. Even those answers, which I had repeated to several people several times, which were the same answers to several of the same questions that I had been asked that day, because all the questions were the same, except for some minor variations. I began to worry a little bit.

That little worry started because a week before, I had been for the preop anesthesia assessment. The computer system was down and so all of the information was written on a piece of paper and the physician’s assistant said that it would be entered into the computer later. Then, when I had checked in, the holding room nurse, again, put all of my information on a piece of paper and did not refer to the computer that was right there beside the gurney. I asked her why she did not look at what was already entered from the week previous and why she did not enter her information as she spoke with me. She told me that the computer was too slow. Now the anesthesiologist is calling me and is asking me how to spell the names of some of my medications. I really would think that he would want to know what medications I was on so he could plan on what he was going to administer as my anesthetic medications long before the few moments that he wanted to try and save by telephoning me. Anyway, I trust God and I trust my surgeon.

They come to get me and my surgeon walks in and says he is up to it, so I say okay! The next thing I know, I am waking up with all of these blankets wrapped around me, nauseated and in pain. The first question that I remember is whether I am in pain or not, and I replied that I am. They give me some Dilaudid intravenously and I feel pretty good. The nurses in the recovery room were a little worried because my oxygen had dropped quite a bit, so they did want to leave me on oxygen and watch me a little bit longer. I was also still very sleepy and not waking up as much as they wanted me to. I forgot to tell them that I had not slept all the night before or the night before that, because I had planned on sleeping during the operation. They decide to put me in a room so that the outpatient surgery people can go home, especially since it is 9 p.m. and I may be staying overnight. As I am going to the room, the pain becomes terrible again and on a scale of 1 to 10, it was about 100. They gave me some more Dilaudid and in a few moments, the pain was much better. My daughters were waiting at the room, so I received hugs and kisses and I sent them home, since they had school tomorrow morning.

I don’t know where I was in the hospital or what even the room number was, but there was an elderly lady snoring away in the bed next to me. The nurse comes in and starts asking for the 5th time all of the questions that I have been asked countless times and I very politely and patiently answer her as she makes marks on a piece of paper again. It is now 10:30 pm and the pain is terrible again, so I ask for some more pain medicine. They had inserted a pain pump that was supposed to deliver continuous pain medicine to the joint for 48 hrs after surgery, and I began to wonder if it was working. The pain shot makes things feel a little better and suddenly it occurs to me that I haven’t eaten in over 24 hrs and that I am hungry. I ask the nurse if I can have anything to eat and I just get this blank stare. Again, I ask if I am allowed to have anything to eat and she says she doesn’t know and that she will check. I tell her that I know that the kitchen is closed and that she doesn’t have to fix anything or anything like that, but if I can have something, I would have one of my friends that were there go and get it before everything closed down for the night. I wait 45 min and no response. I send a friend looking for her, but no luck. We turn the nurse light on and someone else comes in and I state that I was just trying to find out if I could have something to eat. She says that she will go and check. I tell her to let the other person checking know that they are both checking. The pain is getting bad again, but I have never had surgery and really did not know what to expect, except I thought our goal was to keep the patient comfortable and I was mighty uncomfortable. I hit the call light again and the nurse comes back. I tell her that I need some more pain medication and I inquire as to whether I can eat or not. She says that she doesn’t have an order for any more pain medicine and she still does not know about the eating part. I tell her that she needs to call the doctor and get an order for some more pain medicine, but I think that he did leave an order for me to have it as needed, and at the same time, she could ask about whether I can eat or not. She leaves and comes back in 20 minutes stating that she did have an order for pain medicine, but still doesn’t know about eating. I am miserable, I am hungry, and I don’t know what I have done to deserve this. The pain gets a little better for a second, I send my friend to get something to eat thinking that if she has an order that I cannot eat, I will give it to her and if I can eat, then I will eat it.

It is now midnight and she says that I can go home if I feel OK and I state that I do, except for being hungry and except for the pain, which is headed back past 10 on the scale of 1:10. I told her that the pain was too bad for me to go right now, but if she could get another shot, I could probably get home and she says OK. I start to get dressed and they have this continuous ice machine/cooler attached to my shoulder. My surgeon had told me that I would go home with that and would use it continuously for the first couple of days. I go to pack it up and she tells me that I can’t take it home. I tell her that my surgeon said I was supposed to. She says no. I say, "Please give me my pain shot and let me go home! Are you sure that this pain pump is working? It doesn’t seem to be doing anything." I am told that it is doing its job. By this time, my patience is running very thin, and I want to scream, but I put my clothes on, crawl into the wheel chair and Steve rolls me out to the car.

On the way, she gives me the discharge instructions, which don’t make sense to me, but I have a ton of Dilaudid on board, so I really don’t expect them to make a lot of sense, but I figure that they will in the morning. We head home and the pain just continues to get worse. I get home and take some Tylenol with codeine (T#3 for short), lie down and wait for it to kick in, but it doesn’t. The pain just keeps getting worse and it has now far exceeded what I told you that I had experienced with the MRI. I keep praying and hoping the T#3 will kick in and do something. It is now 3 am and it is excruciating. The girls are sleeping. Steve was staying the night to keep an eye on me and finally I wake him to tell him that it is horrible. I tell him that even though it has only been 2 hrs since I took the last T#3, I am going to take 2 more tabs now. He asks if I want to call the doctor and I say, "Let’s give this a try and if things aren’t better by 6 am, we will call." I just lay on the couch and ½ moan, ½ pray, but it is hard to pray when it hurts so badly. There is no way that your mind can stay fixed on God. All I can do is work myself into a trance like state and block out the pain a little, but that doesn’t work well either. At 5 am, I take 3 T#3s. I am a doctor so I figure that I know how much I can take before it is toxic to my liver. Nothing is helping and in fact, it is only getting worse. At 6 am, I wake Steve and ask him to call the doctor. It hurts so bad, that I can not talk... I am just sitting with my jaws clamped shut, rocking back and forth, thinking "Lord please take this cup from me, I am not strong enough." Steve talks to the doctor and he asks him to check the tubing for the pain pump to make sure that the clamp was unclamped... Guess what? The clamp was clamped. No pain medicine had been going in at all. He asks us to wait a couple more hours and see if it gets better once the pain pump starts working and he tells me that I can take a couple more T#3, which I do at 7 am. The pain pump was filled to 100cc at 6 am, it was filled to 100cc at 7 am, it was filled to 100cc at 8 am and it was filled to 100cc at 9 am. Nothing had moved and the pain was only worse. All of the anesthesia affects were wearing off and now there were only a couple of T#3 trying to control the pain.

We call back to tell him the pump has not moved and does not appear to be working. He asks if I am using the ice machine. I tell him that they wouldn’t let me bring it home and he states that they were supposed to send it home, I had paid for it. I ask if there is anything that can be done to fix the pump and he says no, but that we should leave it in because sometimes they do start to work. He is going to order some Oxycontin for me and have his nurse get me an ice pump. I have been ready for hours to go back to the hospital, but I did not want to face what I just left. I didn’t know how he was going to get the pain under control with just pills, until he says that he wants me to start taking 80 mg of Oxycontin and if that does not do it to go up to 120 mg of Oxycontin. Just to clarify for you, 10 mg is the popular strength that our druggies use on the street and that is enough to kill them. My patients with cancer pain who have been taking Vicodin or T#3 around the clock, I usually start on 10 or 20 mg every 12 hrs and he was telling me to take 80 mg and I hadn’t used any narcotics prior to the last 12 hrs and my system wasn’t geared up to that kind of dose. I was way too uncomfortable to argue and it was still going to take an hour or two to get the prescription and then get the medicine from the pharmacy. All I could do was pray that my insurance company would not require prior authorization that would result in even longer delays.

It is noon and my babysitter walks in with the Oxycontin and the ice machine. I take the 80 mg of Oxycontin and take another 2 T#3 because Oxycontin is a long acting pain medication and it takes 2-4 hrs for it to get to a therapeutic level in your blood stream. I look at the pain pump and it still says 100cc. We put the ice machine on and the cold does make it feel a little better but the pain is still 1000 on a scale of 1 to 10. I just lay on the couch, curled up into a ball, begging God to take it all away... and wondering whose job it was to unclamp the clamp. There was a tech support # on the pump, so I asked Steve to call and see what they had to say. They said that because it had been clamped so long without any flow through the catheter, that either some tissue swelling or some bleeding or some clot had probably occluded the opening. They said that they couldn’t suggest this but that sometimes, if you pulled the tubing back a little, that would remove the occlusion and the pump would start flowing. But only the doctor’s office could make a suggestion like that. I figured it was worth a try. I wasn’t going to lose anything. We undressed part of the dressing and found where the catheter was going in. There were about 6 circles of tubing taped down to my shoulder. We pulled back on the part that entered the skin a little, but it slipped right back into place. We then put a piece of toothpick under it to keep it out a little bit and that worked but now it was just wait and see. Steve then prays over my shoulder. I looked a like a whipped puppy. At 4 pm, the Oxycontin is starting to kick in and I can open my mouth and unclench my jaws. My surgeon calls back and I state that things are getting a little better but I tell him that the pump is still not working.

Now the nausea starts, which is another side effect of narcotics. I can’t imagine retching or vomiting with my shoulder hurting as much as it is. I do have a nausea pill, so I take that and some more T#3 and at about 7 pm, the pain is down to 100 and I am thinking that I might be able to sleep. At 8 or 9, the pain is almost gone and I look at the pump and it is down to 95cc, so it has started to work, but I am on another planet. The confusion that can occur with narcotics as a side effect has now started and I don’t know what is going on. I can’t remember what pills I have taken and what I haven’t, what day it is or anything. It didn’t make me confused enough to forget the nausea or pain though. I took my midnight dose of Oxycontin and went to bed... and I slept. I woke at 5 am with terrible pain in my right heel, both of my hips and my right shoulder. I couldn’t figure out why but Steve said I was sleeping with my heel ground into the bed and rocking my hips so that I kept my shoulder moving some. It felt like I had a pressure sore on my heel and I couldn’t move my legs. Of course, I had to go to the bathroom and I had the ice machine contraption on. Now, even walking was agony, but I made it to the bathroom. And... all the way, all I could do was thank God for hip and heel pain, and for being able to walk, and for being able to go to the bathroom, and for being able to feel, because the shoulder pain was gone and I realized that I hadn’t thanked Him for that and whatever good He was going to make of it..

You don’t realize how important your right arm is, until you do something simple like go to the bathroom, reach for toilet paper, or try to get your pants up, even ones with just an elastic waist. Eating was an adventure on the few occasions that I felt like eating. Trying to dress yourself when you are used to wearing T-shirts all of the time, was an exercise in torture. They don’t make women’s shirts that button up the front and that are also comfortable. If it zips, it zips about 1/3 of the way down but not all of the way. Saturday went pretty well. A good friend came and spent Saturday evening with me since the girls were with their dad and Steve spends Saturday and most of Sunday with his son. I watched "The Passion of Christ" Saturday night with my friend, who had never seen it. I had watched it three times before and each time, the pain and suffering during the scourging and the crucifixion became more painful and seemingly more unendurable. That Saturday night though, I didn’t feel the horrendous pain that I had felt inside previously and I kept trying to figure out what that meant. At first I thought, maybe what I had just gone through was similar and now I "knew" what His suffering was like, but I knew that wasn’t the answer. There was no way that I could make any suffering that I did "equal" what Christ did for us before the cross and on the cross. So, I just kept pondering it... My friend made Saturday wonderful and made me forget what discomfort I was still having and made me again appreciate how good friends are to have.

Sunday started out pretty good but at about noon, the pain pump ran out of juice. The pain started back, but I was still taking 80mg of Oxycontin, so it was tolerable. I wouldn’t say that I was comfortable, but it was tolerable. I could talk and I could move around slowly. We were supposed to pull the pain pump out, so I gave Steve that job. We took all of the dressing off and my entire shoulder down to my elbow and across my chest to my breast bone was one big bruise. He got all of the tubing loose and asked me how much I thought was inside and I said maybe an inch or so. He pulled and nothing happened. He really pulled and nothing happened. I am thinking that someone stitched or stapled it down inside somewhere and they were going to have to open the joint up to get it out. He pulls again and nothing... the sweat starts rolling. I say, "Lord, please let it come out..." He pulls hard and I have to brace myself so that he doesn’t pull me off of the couch. I hear a pop and then nearly a foot of tubing comes out of the joint. We realize that the ¼ in or so that we moved it on Friday had nothing to do with making the pain pump work... that was all the Lord’s doing. Again, I say thank you and it really didn’t even hurt coming out.

Now, besides confusion, nausea, sedation, dry mouth, and blurred vision, the next side effect of narcotics sets in. Constipation. I had been taking stool softeners all along in anticipation of problems and had doubled them on Saturday and Sunday but nothing had moved. The cramping and bloating and just general belly ache set in and kept me up all Sunday night. I took extra stuff Monday and then spent the rest of Monday on the toilet. That was when I thought I was well enough to write this. But the narcotics made it impossible to concentrate, the blurred vision made it impossible to read, and I couldn’t get my hand to the keyboard in a comfortable position no matter how I tried. That is pretty much how the last week has been. Monday, I was able to cut down to 40 mg of Oxycontin, but that is still a big dose and still causes a lot of problems. I am either staring off into space in a "narcotic fog" or I am asleep or I am in the bathroom trying to move the bowels. You would think I was 82 yrs old or something. But that is why nothing has been written and every time that I tried to do email, it only made my nausea worse and each time I checked my inbox there were another 100 messages or so in it, so I gave up. It would take me an hour or two to answer one message, so I never got very far.

I am feeling better. I am still requiring 40 mg Oxycontin twice a day and lots of Ibuprofen. I am still icing it overnight and during the day a couple of times. I have started PT and went to my first one this past Wednesday. I am to do nothing active with my shoulder for a month and active means just lifting it. All I can do it let it dangle at my side and let it swing back and forth a little. I am getting a few hours of sleep before the pain wakes me up, which is a major improvement. I am still nauseated and actually have lost 12# in the last 2 wks because of no appetite and some muscle atrophy. I am still taking bucketfuls of stool softeners and will be glad when I can get off of the narcotics but they think it will be another couple of weeks yet. I have tried to hold out and not take them, but I only last about 2 hrs. I have not read all of the jokes and stories that you all have sent me over the last 2 wks, but I have enough to entertain me for weeks to come and I thank you all. I also thank you all for all of the prayers and well wishes, and thought and flowers, and helping with patients and phone calls and call and for whatever I may have forgotten to mention.

As I was writing a couple of thank you cards yesterday, it came to me why watching the "Passion" felt different this time. For the first time, I truly knew that HE is the only One that can save us from anything... from pain, from death, from suffering, from ourselves. He is the only One who can lift us above and beyond it. He is the only One who can wipe it all away as if it never happened. I will never forget the experience, but I can’t remember what it felt like now or how bad it felt. All I can remember was that I thought it was a horrible thing. I do remember the joy I felt when it was gone on Friday night. I do know that a person having the same surgery as I did on Friday did not have a malfunctioning pump placed in his shoulder, because of my experience, they checked to make sure it was working and they couldn’t get it to work. They found one that did, so whatever I went through helped someone else and will probably help others until we forget to check again. Of course, we want to ask why it had to happen, especially when simple little things like undoing a clamp could have made huge differences... but those where human errors. Someone didn’t do their job. Discharge plans went awry because someone didn’t do their job and either orders weren’t clear or orders weren’t written or things were not followed up on as they should have been. Those mistakes all take forgiveness on my part and I do forgive whoever, even though I don’t know who was responsible and I don’t want to know. I did write about all of the problems on the patient satisfaction survey that they send you home with only because I do not want anyone else to suffer the same and what if they were 70 or 80 yrs old or less fit or less knowledgeable?

I will thank God for all of you, for my surgeon who responded to my discomfort, for my family and special friends who have put up with my cranky, whiny, irascible self the last couple of weeks and who have been the best nurses without an RN, and my patients for being patient in my absence and for all of those who are caring for them in my absence.

Thank You! And God Bless!!