Friday, May 13, 2022

Punk Rock and surgery part II (YGTBSM edition)

PBJ and cereal for brekkies. Space tent in the background.

What's a space tent, then?

I promised this a long time ago, clear back on October 11. SMH. Big thanks to John Blackshoe for the reminder, and to all of you kind readers for hanging in there while I've been  wherever the hell I've been...

Before we get to the part two, Let's have some music. When it comes to music, I like what I like but I can't tell you why I like it. I've liked Modern English for 40 years. Can't tell you why. Their lockdown edition of "Melt With You" is awesome.

And now, again from England, my new favorite punk band Not Tonight and the Headaches "Reasons to Smile."

'cause I am
at the end of my rope,
with these things
that wind me up,
but I won't
go givin' up,
'cause you're,
you're the reason I smile through it all...


Let's see, where was I?

In the OR I felt warm and relaxed. There was a bit of conversation but I don't recall the details. The Seahawk Anesthesiologist placed a mask over my face. "Just breathe normally," he said, so I did. I detected the faint odor of anesthesia gas.

Then I woke up in the recovery room.


I was a bit muzzy at first, having just come out of general anesthesia. The first order of business was to check my legs. I'd just had spinal surgery after all, so the question was whether I was paralyzed or otherwise neurologically compromised. So. I could wiggle my toes and bend my ankles. I could feel the sheet on my legs and feel my feet moving against the gurney and the sheet. Perfect. I could also bend my knees, but, oh crap. I had a foley catheter in. Firetruck! It pulled and stung as I moved my legs. Shit!

"Hey, I'm Betty. I'm your recovery room nurse. How are you feeling?" She'd been been quietly sitting on my right side. I hadn't noticed her before she spoke. I glanced at her, then glanced again. Another fetching beauty, brunette this time rather than blond. That I noticed this immediately upon coming out of anesthesia says a lot about me, I think. You can take the sailor out of the navy, but you can't take the sailor out of the sailor.

"Good, actually," I said, "but let's get this catheter out. I can move my legs and I'll be able to get up to pee."

"Okay, let me check your legs first," she said. "What's your pain level?"

It was something I'd been co-assessing as I checked my legs. I was quite surprised to have zero pain at the incisional site, even though I could feel the site and that "something" had been done there. I suspected that the surgeon had injected a local anesthetic to ease the onset of incisional pain and allow me to wake up without a high level of hurt. I'd seen navy surgeons do this during appendectomies and even used the trick myself once upon a time. More importantly -- and more surprisingly -- to me, the grinding radiculopathy pain I'd been living with for two-and-a-half years was gone completely. No numbness-aching-burning-poking-stabbing pain in the left leg and foot. At all. It was, well, amazing.

"it's zero," I said with wonder.

Betty did a double take. She checked my legs carefully, paying close attention to sensation. I passed the test.

"Let me check on the catheter," she said. Rather than scurrying off to find the person with authority to yay or nay the request, she picked up her phone and did some texting magic.

Her phone vibrated with an incoming message. "They're checking with the surgeon. Are you hungry?"

"Ah, not really," I said. Seemed like a strange question for the recovery room.

It was at this point that I realized it was (IIRC) sometime after noon. The surgery had taken a while.

One of the first things Betty did for me was get me my phone. The first thing I did with the phone was snap a post-op selfie to prove to the world I was whole and completely unaffected by the anesthesia.
Sober as a judge. If that's even still a thing.

She also handed me my Alex dog tags. Which was cool.

In a relatively short time we got permission to remove the catheter, which was a major win as far as I was concerned. Betty told me there would be a delay in getting me up to my room because they were having to set it up as an isolation room due to my status as a MRSA carrier. I guess I was the modern equivalent of Typhoid Mary. MRSA Mikey? Something like that.

As I sobered up Betty and I had a long, rambling conversation. I don't remember a lot of it but it seemed nice. I do remember her telling me I was the best post-op patient she'd ever had. The sailor in me was convinced that she was hitting on me. The above-the-brain-stem part of me realized the truth. I was physically fit so I'd weathered the surgery well, I was constitutionally opposed to being whiner, and with my background in medicine the very last thing I wanted to be was "one of those" patients. So I wasn't.

While we chatted and my brain cleared I snapped a few more pics. I had a bunch of those patient identification bracelets. They checked my ID with each patient encounter, which was comforting. For certain values of comforting (I know how the sausage is made). They scanned the barcodes with each encounter as well; part accounting and part charting. And the red one is a bright warning to one and all that I'm allergic to Bextra, an old-school non-steroidal anti-inflammatory drug which is no longer on the market because a lot of people had serious side effects and adverse reactions while taking it. Bextra is an interesting case, as it's one of those Cox-2 inhibiting NSAID's, like Vioxx, which caused statistically significant increase in heart attack and stroke. It also caused a lot of serious skin reactions, which is the adverse effect I had when after taking a single dose. The FDA pulled drug approval on Bextra and Vioxx despite Pfizer's loud complaints.

I still had an IV in my left wrist.

In addition to waking up with a foley in place, I also woke up with and A-line in my right radial artery, clear down at the wrist. I was a bit surprised at this, because in my experience arterial lines -- used to monitor blood gasses and finely monitor blood pressure -- are serious business and generally employed only on very ill people or very fragile patients. I suppose that by virtue of being a boomer I fell into the fragile category, if not the very ill category. 
Sigh. I couldn't get a pic of the A-line because my post-anesthesia dexterity wasn't up to doing left-handed smartphone snaps. Boomers be like that.

I also had a surgical drain tube running from the place that still didn't hurt and around to my left side, where it was pinned to my sexy hospital attire.

The business end of the tube was buried in the surgery site and held in place by the pressure of the stapled skin closure. It's job was to provide an exit path for any blood and fluid which would otherwise build up in the area. You really don't want that stuff to stay in there. In a perfect world the body would reabsorb it over time, but excess fluid (swelling) is incompressible, being a water-based liquid, and it can interfere with circulation, press on nerves causing pain, and press on newly repaired tissue, slowing healing and even causing misalignment of the repairs. Potentially even worse, a big puddle of bloody fluid at the surgical site is a perfect place for bacteria to grow, and hospitals are where they store all the bad bacteria.

On the distal end of the drain tube was a suction/collection bulb.

Gentle suction helps evacuate fluid, and the clear bulb makes it easy to measure the stuff that comes out and assess how much leaking and/or fluid accumulation is happening and how quickly it's slowing down.

After a while, perhaps 90 minutes or so after I woke up, I began having a bit of pain from the surgical site. It wasn't bad, but it was irritating, particularly as I moved around. Betty directed me to the blue button of bliss which was connected to a machine which would administer micro doses of fentanyl into my IV. I hoped the machine was stocked with pharmaceutical grade fentanyl, rather than the ultra potent chineseium street stuff. I crossed my fingers and pressed the button. The pain eased but my level of chemical impairment increased. I resolved not to use the auto-martini button very often.

The transfer from recovery to room happened in late afternoon. As you might imagine, it involved being wheeled through passageways and up elevators. When we got to my room, the door was emblazoned with "MRSA ISOLATION" signs and stickers. The nurse who received me was masked, gloved, and gowned. The nurse who had delivered me was not. What we were dealing with was administrative isolation, rather than real isolation. Which was fine, because I judged that the risk I presented to staff and patients was far less than the risk they presented to me. In one sense my isolation was no more than a bit of theater. On the upside, I got a room to myself. On the downside, well, there was no downside. I would have to wear a mask outside the room, but everyone had to wear anti-wuhandromeda masks anyway, sooo...

The nurses paused for a moment to discuss whether I needed to be lifted from gurney to bed. I interrupted the discussion by sitting up and declaring that I was fit enough to do it myself and that I was highly motivated to be up and around. They were willing to let me try (try? yeah right!) and would only convene a lifting team if I failed. Fair enough.

The hardest part of shifting from gurney to bed was sorting out all the lines, wires, and tubes. Once that was done I had zero difficulty getting up, walking over to the bed, and getting into it. There was only a very small bit of pain involved, but compared to the pain I'd been living with for so long it was less than a trifle.

As I got into the bed I launched my "get the firetruck out of this place" plan.

"I need to pee," I said, "so can I get up and go?"

After a quick huddle the answer was yes.

I got up and peed without difficulty. Well, with only a little difficulty. Lines, wires, tubes. An IV stand to be pushed into the bathroom. Mere encumbrances. Of course I had to pee in a duck (hand held urinal) so they could measure the output, compare it with input, and determine whether my kidneys were functioning properly, which they were.

Back in bed, I asked them to leave the rail down so I could get up and go as needed. When you have an IV running fluid in, you have to pee more often, and I really didn't want to be pushing the call button and waiting around with a full bladder for the nurse to arrive. I also asked if I could get up and walk the halls. I really didn't want to lay in bed, I wanted to get up and move around. As part of my devious escape plan, I understood that demonstrating mobility is one of the keys to getting sprung from medical incarceration.

That answer was yes as well.

A detailed description of the remainder of my stay would be pretty boring. The food was surprisingly good and was more like restaurant fare than hospital slop. I did a lot of walking and no whining. I expected to go home the next morning but had to stay a second night because the drain was still collecting fluid. I was disappointed, but it was just one of those things.

On Sunday morning I was released and Uncle D and the littles took me home. The littles presented me with get well art!

The art production continues, and I have very colorful refrigerators these days.

Just for fun, here's an image of the stapled incision. The little round spot above the incision is where the drain went in. The tape is just a piece which wasn't ready to come off yet.

I didn't just lay around when I got home. I rested, sure, but I also walked a great deal, at least five miles a day. I knew that my body would tell me if I needed to slow down.

At six days post-op I was prairie hiking. I wasn't lifting (other than the three year old), my legs and heart/lungs were working great, I had almost no surgical pain, and I had ZERO nerve pain!

At 11 days post-op I had the staples out. Ahhhh! It was a beautiful day.

Between then and now I've recovered completely. The winter sucked for various reasons, but winter can be like that. Spring has arrived and I'm quite busy with ranch chores. It feels so good to be outside and moving around without nerve pain.

In addition to ranch chores I'm getting my garden put in in town, and I have a garden art project in the works. I have some olden tires which need to be cleaned and kid-painted so they can become beautiful planters. What can I say? Go Hillbilly early or stay the firetruck in bed!

Also have a public prairie walk scheduled for June 11 on the ranch, part of Nebraska's annual Wildflower Week celebration.

I'd better pull the trigger on this before another seven months go by. It's Friday the Firteenf after all! (had to fix the formatting on that post because, well, you know).

Be well and embrace the blessings of liberty.

Sunday, May 8, 2022

After the wind, snow

Chokecherry snow

A thunderstorm grumbled into being about 11 p.m. last Sunday evening, spitting a bit of light rain and a few tired bolts of lightning. Night rain drumming on the roof was a welcome, peaceful sound. A joyful sound as well, considering two dry years and an April which delivered scarcely a third of the average precipitation we expect to see during the month of "showers."

Despite the fact that I could sleep late if I so chose, I rose Monday morning at 3 a.m. It's a curious fact that when I must rise early I don't want to, and when I can slothfully sleep late I do not. As it turns out, rising early is a good deal for me. Those quiet pre-dawn hours tend to be the most writing-productive hours of the day.

As I puttered around with writing the rain morphed to snow. Big, fluffy, springtime snowflakes, falling straight down with nearly the velocity of raindrops. Two smiles there -- no wind, and lots of lovely water in each and every flake. The view revealed through my east-facing office window was spectacular. Nature makes the best jewels!

The rain/snow combination we received on Monday was ideal. The initial rain was slow and gentle enough to soak in without running off, and the follow-on wet snow provided something like a "slow release" irrigation, allowing the moisture to soak in over time and preventing the runoff which would have happened with heavy rain. It's hard to imagine a better way to break -- even if only temporarily -- the present dry spell.

This time of the year the snow doesn't last very long. By Wednesday there was barely enough left to make little snowmen.

On Thursday it was sunny and quite warm, a beautiful springtime day. Just after 9 a.m. (IIRC) I was preparing to mow the back yard when the fire-tornado-nuke attack siren went off. That last bit is an interesting concept. Until Russia invaded Ukraine in February I hadn't thought about the siren in the sir raid context for a very long time. Anyway, an up-down-up siren tone means a fire department call out while a steady tone means tornado. The steady tone also means air raid, though I might be the only one who remembers that fact. So far as the tornado alert goes, the city schedule for testing the tornado warning calls for a weekly test at 10 a.m. each Thursday. I guess 9:08 a.m. is pretty close. All of this is to introduce a video of Tommy's reaction to the siren. Possibly because I was right there he did not react as he usually does.

That evening, however, he did.

It's been a very busy week since the snow but I'm starting to get my spring chores organized. Today, which is Mothers' Day, we're going to have a little Ocho de Mayo party featuring traditional Americanized Mexican food and a piñata. Cinco de Mayo was too busy for a party. I think Ocho is close enough. I'll try to get some images to share with you kind readers.

But now the littles are stirring and they're gonna need fuel! 

Be well and embrace the blessings of liberty.