Thursday, May 22, 2014

Staples and Tape

     I was discharged from the Hospital on April 28th,  five days after my surgery for Colon Cancer.  I would need several more weeks to heal, to regain my strength, and find some measure of my former stamina.  First however I had to endure a week of sleeping with staples in my stomach.  Stretching, reaching, bending -any action that might cause undue stress on my tender tummy would require an element of discretion.    After a week or so of broken sleep and cautious movements, I had my follow-up appointment with the surgeon.     On May 8th I finally got those damn staples removed.  My doctor was pleased with how my incision was healing.    Which meant I could shower, I could walk at my usual cadence and overall, start doing typical Terry things once more.  The real healing would begin.  Yet there was one more annoyance in the aftermath of all my surgery:  tape.  Another sticky situation to deal with.

     Tape used by Hospitals is meant to adhere to your skin no matter what.  When I was released from the Hospital I had a new dressing covering my stapled incision.   I couldn't have a shower yet,  but I could luxuriate in a bathtub.   That's when I discovered I still had tape on my back from the epidural.   Removing it wasn't too bad, hair grows back.  Usually.   The real mess was from the  gummy residue that  clumps up and sticks to skin and hair, resisting all my attempts to remove it.   Soap and water, alcohol, and finally soaking the affected areas in baby oil would be used.   Baby oil would be my go-to choice in future:  just let it sit and it gently and painlessly  washes off.  I'm such a wimp.

    My first walk the day after the staples were removed was a wonderful half-hour romp:  to visit a doctor of course.   I needed to check in with my family doctor to complain about a few issues,  and get prescription refilled.   That Friday morning on a fine sunny spring day, I walked the 30 minutes to his office, happy to simply have that option available to me.  Upon arrival I would go through the usual medical rituals: weight, blood pressure and general health questions with the nurse.  Once these preliminaries were complete, I was ushered into the room to await my family doctor.

   We exchanged pleasantries, discussed my surgery, he seemed impressed that I was doing so well roughly two weeks from my surgery.   The reason for my visit today was to have my Crestor prescription filled (no sense having a heart attack after surviving Cancer!) and to see about some nagging issues.  Seems that I was creaky in some of my joints, specifically my left knee (I had twisted it shoveling snow in February and neglected to have it looked at due to my other priority), and an inability to straighten the ring finger on my left hand.   Cursory examination suggested I might have a fractured my finger.   I could move the finger but not straighten it out,  and it was painful in some cases.  I would need an X-ray.   More walking to the clinic where I would receive my X-ray.  A walk to the drugstore to pick up my prescription.  A walk BACK to the clinic, to retrieve the prescription that I inadvertently left there when dropping off my X-ray forms.  Back to the drugstore.  Finally with my prescription filled I wandered home.  I had walked for the grand total of about an hour and a half, most of that 'at speed'. I was exhausted. 

     Over the next several weeks I would regain some stamina and walking would not be the draining activity it was on that Friday.   I was feeling good.  More importantly, I was happy and some of my confidence that I would   'be OK' was returning.   The next few days saw a steady increase in the walks -few long ones but their frequency increased.  Plus a lot more naps between walks.  Everything seemed to be progressing as it should and I was happy.   Then I received a phone call from the Hospital.  My family doctor wanted me to have a Bone Scan for my hand.   Friday May 16th , one week after having my hand X-rayed I would be getting a Bone Scan.  My adventures continue.

Saturday, May 17, 2014

Going Home starts with Jello

      My journey from Patient to Person made significant gains on Monday, April 28th.   It began with two events:  my first meal in days, and  moving to a new floor.

     Breakfast that Monday would be the first morsel of food I had consumed since the prior Thursday.  As it always is in this type of surgery, breakfast consists of Jello and juices.  The intent is to gently start up the normal processes without undue stress on the colon.  However after four days of nothing but fluids my appetite was slow to return.  Between the Orange Juice and and a few tiny sips of black coffee, and  slurps of Raspberry Jello, I managed to finish the small portion provided.   Clear fluids would be my diet initially,  and slowly progress to fuller fluids.  My lunch had vegetable soup - my first hot meal in days, and I drank it down greedily.   Having achieved the goals of eating without incident, I was now ready to be transfered from P.O.T.U. to another floor.  My Journey was literally continuing.

     Before I left the P.O.T.U. however I was divested of another of my tubes:  the catheter.   Not always comfortable, you're not even aware you're voiding.  It would be  removed early that Monday morning.     The process was not painful but somewhat disconcerting, as I would be an educational experience for a nurse who had never removed a catheter before.   From my past surgeries,  I recall this process being performed late at night (The "wee" hours of the morning?).  This time it would be mid-morning with me sitting on the side of my bed, gown up to my waist, looking anywhere but at the two nurses huddled in front of me.   I tried not to listen to their conversation regarding the mechanics of what they were about to do, but there was a moment when "oh..."  turned into "OH!...much better thank you...".   My relief was genuine and now under my own control.

    "De-catheterized"  I still needed to prove that I could void without problems.  Being a hospital they're not about to accept my statement, they want proof.  I'm instructed to use the provided plastic container, which also has graduations on it to measure volume.   On my first attempt I did an impressive 500ml.  Success in a hospital is not measured by extraordinary results, it's measured by how you manage normal everyday things.   So far I was walking without problems, I was eating without issue and now, oh joy, I was peeing.  I was deemed fit enough to move out of P.O.T.U.

    My new home for the next day and a half would be room 7105A, one floor below the the P.O.T.U.  For some reason however my impressive feats of filling plastic containers needed to be repeated to the satisfaction of my new nurses.    I obliged with a personal best that finally  allowed me to relegate the "pee bottle" to the shelf for the remainder of my stay.   I was making great progress, but was still tethered to my IV.  If I could get through lunch without incident it would be removed.  I had another goal, one I was confident I could achieve.

    Lunch didn't have Jello, it was a "full fluids" meal:  milk, cream of broccoli soup, and vanilla ice cream for dessert.   Having successfully taken in fluids and food without incident, my IV was disconnected, I was no longer tethered!   My freedom is on the horizon!  However, now that I was eating my nurses were asking me that extremely critical question:  Have I passed gas?

    Colon Cancer surgery  removes tissue from the (empty) colon and splices it back together.  Your body has not sent anything down that passage for days.  It has to learn how to do that again, and it has to be 100% successful to qualify for the 'get out of Hospital free' card.  Passing gas is an absolute prerequisite in the continuing transition from Patient to Person.  Eating starts the normal process, but it simply takes time and can't be forced.   During my stay my doctor and nurses listen intently to my belly sounds with their ever-present stethoscope.  I wouldn't disappoint such an intent audience.  Eventually the few meals I consumed would produce the expected results.   It is my personal belief that Cream of Broccoli soup can make a brick pass gas, such was its effect after lunch.  But there remained  a second prerequisite that would prove the success of my surgery.    Achieving this second prerequisite,  ( Number Two of my goals if you would prefer)  would be the key to my being released from the Hospital.  Before that would happen, I would keep walking to help the process along.

     Exercise after surgery is great. It's one of the few activities I could do to keep boredom away.  My visitors would come to see me, and  we would walk the halls of the hospital.  When they were gone I would walk laps around the floor.  On average, I was able to complete one lap around my floor in 74 steps.  Not bad for a guy in a bathrobe and slippers.   I would do perhaps 15 minutes of walking, then rest and drink water.  A lot of water.  Then walk some more.  Waking up in the morning after my shave and bath, before breakfast, I would do laps.  Before visitors arrived, more laps.  With visitors -laps.  I had two dozen staples in me still, but was cautious to not overdo my efforts and cause that tingling effect of  metal on sensitive skin.   It was only Monday, and I desperately wanted to go home.   My wish would be granted the next day.

    Early Tuesday morning my surgeon came to see me again.  Pleased with my progress so far he asked if I wanted to go home, and seemed satisfied with my immediate YES to his question.   My nurse however was a bit more cautious, as I had not fulfilled the second requirement of my obligatory prerequisites.  But I would pass that test soon: waiting in the wings was breakfast, and this time it was Oatmeal.

      Oatmeal is a high fibre breakfast cereal.   Lots of fluids, lots of exercise, and the effects of fibre were enough to earn my release.   I was happy in a way that I think only patients who have undergone this process might understand.   In a few hours I would be in my street clothes packed up and ready to leave.   As my discharge paperwork progressed my nurse turned to me an  said with some amusement:  "Will you require a wheel chair to bring you out of the Hospital?"  Another nurse chimed in "He'll probably just WALK down the stairs!".   They were quite aware of how mobile I had become, and knew what my answer would be before they asked.  By noon I would be outside, waiting for my ride. 

     The act of leaving my residence of the past five days imperceptibly freed me from the last vestiges of being a Patient.  I was now  a Person.  Once more I was Terry McAlinden.   Rain that had been  routinely falling throughout the morning had ceased.  The sun was shining  and I breathed in that unseasonably chilly air as I stepped out of the Hospital, and into the car that would take me home.

Saturday, May 10, 2014

P.O.T.U.

     On a cold and wet Friday morning April 25, 2014 I had gone into the Hospital for Colon Cancer surgery.   I would wake up in the Post Operative Treatment Unit.  There I would remain until the following Monday afternoon.

      In P.O.T.U. I would be closely monitored.  It meant being woken up every two hours to have my vitals taken.   It mean ice packs would be used to determine the extent and effectiveness of my epidural.  It meant lying in my bed feeling disoriented, dry mouthed, spasms in my belly and nausea that would bring up nothing.   A breathing tube in my nose.  I was catheterized and my left hand was tethered to an IV.  I had no sense of the hour or the day.  For the spasms and nausea there would be medications.  For the constant dry mouth there would only be ice chips.  Sometimes I was chilled, other times uncomfortably warm.  I was unable to turn on my side or stomach.  My transition from Patient to Person had started as it always did:  in a drug-infused haze.

    The Friday I arrived in P.O.T.U. I was still under the anaesthetic's  spell.   I remember being woken up so that the blood pressure cuff could be wrapped around my arm and a thermometer placed in my mouth.   I especially remember the epidural tests:   a bag of ice being applied to various parts of my abdomen and me being asked if it was cold or if I just felt the weight.  By this action they made sure that the my lungs and mobility were not impaired.   I never knew what time it was.  I only way I knew that a new day had begun was  the bustle of activity when the shifts changed.    Mornings also brought the Student nurses and my bath.

     I learned about 'sponge baths' from my very first stay in a Hospital.   They're a poor substitute for a shower.  But I wouldn't be able to see the inside of a shower for some time yet, tethered and bandaged (and rather unsteady) as I was.   The name 'sponge bath' is  misleading:   I never saw a sponge,  just a washcloth and basin.   My nurse would fill the basin with warm soapy water,  and deliver it to me along with clean towels and facecloth.   With pulled curtains I would struggle to sit up and gingerly splash water on various parts of me with the some vague idea of trying to get clean.  I had another goal, also learned through hard experience in a Hospital: don't defer shaving.

     After the morning bath I was asked if I could sit in  a chair.   Big, sturdy and heavy,  these chairs were moderately comfortable and a key step in the transition back to Person from Patient.   It required all my strength and my kind nurse to help me out of my bed and co-ordinate the tangle of tubes attached to me.   No sooner had a I sat down than I decided that I wanted to shave.   My electric razor was in the nightstand an impossible four feet from where I was sitting.  So once again my remarkably patient student nurse retrieved the razor for me.  Of course my chair was nowhere near an electrical outlet which was conveniently located near the bed I just vacated.     We reverse all my previous manouevers to leave the chair and I sit on my bed to shave.  By now I've been vertical long enough to feel confident and I can slowly navigate my way back to the chair on my own.  But I have my sights set on another goal:  wash my hair.

     Hospital bath-in-a-bowl do not accommodate washing your hair. I wasn't looking for shampoo and blow-dry, my goal was simple:  rinse my head.  To do this I would need to bend my head under the faucet of a sink,  a moderately difficult  thing to do after abdominal surgery.   At my suggestion my nurse places one of the visitor chairs in front of the sink.    By kneeling  on this chair I can support myself without undue stress on my recent incision.  I hoped.   For a few minutes I know the feeling of cool, then warm water running over my head.   With eyes closed, water dripping over my face I feel fleetingly like my old self.  Towel-dry, then a return back to my  chair.   By first leaving the bed and sitting, then leaving the chair and walking I had accomplished two of my goals.  Each goal is a tiny achievement to my recovery.   It makes a profound difference being actively involved with the recovery, rather than lying passively back, waiting to be asked if I needed anything.   Now that I was cleaned up and back in my comfortable chair, I asked for help plugging in my computer.

     Everything I did that first morning was a struggle.  Cords and tubes seemed to intertwine in uncomprehending ways.   My student nurse would go through complex 'un knotting' procedures with my IV before one of the veterans showed her how to temporarily disconnect and reconnect the tubes, just to avoid that issue.  Finally with laptop plugged in and once more back in my chair I fired up my trusty netbook.   Which promptly failed to boot.   This is an unacceptable situation for an IT professional, so I applied all my 30 years of IT experience and tried it again, with the same results.   Instead I simply sat and observed the activity in my ward.  By now  I had been up for hours and was fatigued by all the morning's activity.   Unassisted this time, I returned to bed.   I wasn't independent yet, but I was far from helpless.  I was satisfied with my progress so far.    My computer would eventually work, but my glassy eyes simply didn't focus well enough to read, no matter how large the font.   I was too tired and just wanted to sleep.  But in a Hospital, you never really rest.

     I drift in and out of sleep throughout the recovery process.  There's  never a sense of being refreshed.  I cannot find a comfortable position. Whenever I try to  sleep, dark, disturbing images  emerge and I feel helpless.  The longer my eyes are closed, the worse it gets.  Eyes open, the images vanish, only to return after I close them again.  My pain-killing medication is responsible, the effects  progressively worsen the longer I am on it.   Throughout my weekend stay in P.O.T.U. I hope for two things:  to sleep, and to taste something that isn't an ice chip.

     Sunday afternoon the epidural is removed.  I know that my recovery is proceeding and I will get better.  I also know that pain is moving in to fill the void left by the morphine.   The heat in my belly is kept at bay by ice-cold drinks of water now.  I crunch ice chips, imagining them cooling the fires within.   I ask for a Popsicle.  It's a clear liquid, so nothing medically prevents me from consuming one at this time.    My evening nurse cannot find any  in the P.O.T.U. but asks other floors if they have any.   One is found and I find that a Banana Popsicle never tasted so good.   I eat slowly,  simply because I have no appetite.  The coolness seems to galvanize my determination to drink more ice water as well.  I would not experience the fiery pain as I had in my prior surgeries.   I still don't sleep well, but maybe I rested better.   With the removal of the epidural,  I felt I was rising up through hazy depths to clarity once more.   And I was able to walk.

      My initial walk in P.O.T.U. were unsteady steps, simply to a sink a dozen feet away and back.   Each day I strove to walk a little more.  By that Sunday two days after my surgery I was gently pushing my IV pole, catheter bag secured and wearing my own bathrobe and slippers,  to amble  around the P.O.T.U. floor proper.  These little jaunts did not last long, I had learned from experience that I needed to build my endurance in small increments.  Marathons were not being attempted at this time.   As the weekend drew to a close I was mobile, managing my pain but still not sleeping well.  My IV had been changed, now on my  dominant right hand, it hampered me slightly.    Sunday would be my final night in P.O.T.U., the critical aspect of my post surgery was over and the next day I would be moved to another room on another floor.   My journey from Patient to Person continues:  I was getting better.