Friday, October 01, 2004

Out, damned tubes ... out, I say!

Knee-plus-two (Friday 1-Oct-2004):
I started today again with real coffee from home. Yummm.

Morning PT was pretty much like Thursday’s (k+1). However, tubes and drains began to be removed after lunch. The Foley came out (hurray!); the IV was shut down (although the port remained for IV administration purposes); and the epidural was removed. Pain killer was switched to ketorolac (that’s the generic name), syringed into the IV port; percocet and oxycontin for pain control began by mouth.

Once I was “free” --- except for the wound drain --- I put on a polo shirt, and began to feel normal. PT was great --- I was able to walk the halls as I chose, and could do so even when back on the floor. At the end of the day, I was walking the halls by myself when my wife and daughter came to see me.

Removal of the epidural was excruciatingly painful, not because of the catheter but because I have a hairy back, which was not shaved pre-op. The epidural catheter was secured to my back with a large adhesive pad (ca. 9 in x 13 in) covering most of my back. Removal of the epidural was as simple --- and as painful --- as freeing one edge of the large pad, and slowly ripping it off of my back, from top to bottom. I did not feel the actual catheter leave my body, only the adhesive being torn off.

My family physician tracked me down in PT, so I had him check the epidural site. I could not believe that the epi cath was removed by yanking the adhesive pad from my back. There was no bleeding --- the doc could hardly find the insert location). He also cut out the Fe supplement.

I was interested to learn that a Foley catheter is “held in place” by inflating a small balloon (with sterile water, not air) within the bladder. The catheter is actually a tube-in-tube with the urine flow occurring in the inner tube, and inflation/deflation of the balloon occurring through the outer tube. The nurse simply used a syringe at the collection bag end of the catheter to completely deflate the balloon, and then --- tug --- and out it came. A little pressure, uncomfortable but no pain, as it slid out of the ureter.

Removal of the Foley meant that I had to demonstrate that I could urinate without the catheter. I rapidly filled a bottle for the nurse [I was drinking a LOT of fluids]. However, there was a small friction sore at the opening to the ureter which had been caused by the catheter rubbing on my clothing. The nurse said that this was common and should go away overnight (which it did).

Preparing for a Saturday departure also meant that I had to have a bowel movement --- or else. The threat was “BM by 8 PM, natural, suppository, or enema.” Whew. I came through but it was painful. The opiate-derived pain killers suppress normal peristalsis, and “bind you up.” I had almost never in my life been constipated, but had become quite constipated following surgery, even with all of the fluids I was consuming and 2X daily doses of a stool softener.

At the end of their evening rounds, the surgeon’s PA (and the weekend on-call partner) visited. They confirmed that I could go home on Saturday (they’d come in for the discharge early in the AM), and removed both the Ace bandage and the blood drain. Blood volume in the drain during Friday was ca.125 mL --- the desired threshold was 100 mL or less. This put the “pull the drain” decision in the hands of the physicians, not the nurses. But they did pull it.

My wife and daughter went home, and took with them everything that I didn’t need for Saturday. I had horribly over-packed clothing. Until the catheters came out, I wore a hospital gown. I wore long boxer shorts with no additional underwear (catheters, remember, until Friday afternoon). And as much as I expected to be able to read, I could not. The pain killers kept me from being able to focus much at all. I would read and re-read the same sentence repeatedly.

And then ...
My entire hospital experience changed with the beginning of the weekend staffing schedule. Until Friday evening, I had only positive things to say about the service in the hospital. Friday night certainly changed those perceptions.

I was given my PM meds, and “put to bed” by 10 PM. By 11 PM, the hallways appeared to be empty. The night shift nurse (and apparently, only one, rather than the two or more who had been assigned to our wing the previous two nights), came in, got distracted by my roommate’s demands for sleeping pills, and neglected to take my temp and BP. Then he disappeared. A puls-ox alarm went off down the hall, and continued to shriek for more than an hour. No response from the nursing staff. This continued to occur during throughout t entire night, Friday. If I had been in the room with that patient, it would have completely freaked me out. I “listened” to CNN Headline News all night long to block out the alarms from the hallway.