Pain

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Where was I? Did I abandon you?

In my last show, I promised that you’d get another episode in the following week, and that while you were listening to it, I’d be in the hospital recovering from my bilateral total knee replacements.

Obviously, that didn’t happen. And the reason it didn’t work are actually a good lesson that I needed to learn. Maybe you will be able to learn from it, too.

This episode will be about my surgery, and I will go into a fair amount of detail, partly to explain why I was absent, and partly to remind myself of exactly what I went through.

I made a mistake. Yes, I know. Shocker, but I’m not perfect.

See, I’m a registered nurse with 19 years of experience. I teach at a local college, and I have groups of clinical students at a local hospital every semester. Knee replacements are a common procedure that we see. Consequently, I am familiar with their treatment course. I have been unofficially working with a physical therapist who gave me a number of exercises to speed my progress and I actually did practice those prior to surgery.

I’m also a guy, and as such, I can be blinded by my ego and assumptions. I know how all those patients do after their knee surgeries, and since I am only 51 and in generally good health, not only will I naturally recover faster, but my knowledge of what to expect will give me an added edge. That will allow me to quickly advance through the inpatient recovery period with maximum functionality. I’ll probably be the one patient who is ambulating up and down the halls all day, just exercising my legs and preparing for discharge. And I know how to stay on top of the pain, yet not use too much pain medicine that could fog my brain a little.

Um. Do you have the sense of some foreshadowing in that paragraph? Do you see possibly where my plans might fall apart?

It all started before the surgery, which was Wednesday, May 20 at 7:15am. In anticipation of my convalescence period, I spent the preceding weeks doing as many household tasks as possible, because I knew that I would be very limited for a few weeks. And as the surgery approached, I realized that I didn’t have time to record an episode for Thursday, May 21. With everything I needed to accomplish, I needed to complete items that had a higher priority than the MYST episode. (As much as I need all of you, and appreciate your listenership, I live with my wife and her needs must be met first.)

But that’s okay. I had a plan, and I thought it a pretty good one indeed! My surgery was early in the morning on Wednesday. I knew that I wouldn’t be doing any physical therapy that first day, so my only activity will be resting and keeping up with pain control. I’d be out of surgery by noon, and in my room by 1pm. A few hours napping off the anesthetic, and then I’d be relatively awake and alert. As evening rolled around, my wife would go home (she had to teach the next day) so I’d be alone in my room. A room with wifi. And so in addition to my computer, I also brought my portable microphone, because I was going to record a show “on the road”! Yes, I would record a show from my hospital bed, and get it loaded and ready to publish for all my awesome listeners.

Plan #1: Record on the night of surgery for an interesting point of view. Dead on Arrival.

About the only part of that plan to be accurate was “my wife would go home”. I was never fully awake and alert. I think I have good pain control. I know I was getting pills every 4 hours, and occasional IV morphine (probably relates to me not being awake and alert.)

But I had other issues that night.

For surgery, I chose to have a spinal block. That is where the anesthesiologist injects the anesthetic into my spinal canal, and that deadens everything from about the navel down to the toes. I chose that because it actually provides about 2-6 hours of relief after the surgery, allowing he long acting anesthetic that my surgeon injects into my knees to begin working. I also wanted to avoid a general anesthesia (breathing tube, gas) because there is more nausea and vomiting from that, and that just isn’t fun.

So I went into the surgical suite and the doc injected my spine and I laid down waiting for it to work. Eventually, everything went numb, much like when the dentist numbs your teeth before drilling. You know, he/she will inject some novacaine in just the right spots so you feel almost nothing, just those little bits of pain once in a while. Right?

The surgeon start checking my body parts. I couldn’t feel anything. So he started the first incision. And I can tell you that he begins the incision above my right knee moving down, because I felt that! The anesthesiologist said, “Whoa, we don’t allow you to feel anything!” and he knocked me out hard.

So late that afternoon, I am trying to work off both anesthetics. Very slowly. I wasn’t clear of the after-effect, but I was certainly losing the numbing effects. I got a thirsty (I love ice chips.) Got a little hungry (mmm, orange jello.) Oh, yippee! Passing gas! These are all signs that everything is waking up. And at this point, I was still thinking “Maybe I can still record tonight.” I even stood at the bedside, for about a minute before I almost fainted.

Except one organ refused to wake from its slumber. I won’t go into too many details, but after surgery, a patient needs to prove that they have good kidney function. And they have 8 hours to meet that challenge.

And I failed. And I begged for a one hour extension and was granted it. I pounded water like it was a forbidden food.

And I still failed. And so, I experienced another lesson: straight cath. Yes, where the catheter is inserted into the bladder to drain it. Now, over my 19 years, I’ve done this many times, and each time I told the patient, that this will be uncomfortable but over quickly.

Oh. My. God. What a lie!!!!

I have never had such pain in my life! Now, the good thing is once it reaches the bladder, the pain is instantly gone. Until it is removed. But I will never gain use the words “little uncomfortable” again. Never!

And of course, the eight hour time limit starts all over.  Kept chugging water, and discovered that when you need to use the bathroom, a call light is never answered fast enough. However, my urinal was in reach and, well, let’s just say, I passed that test with flying colors.

By now it is nearing midnight. And I realize that there is no way on earth I was recording anything tonight. I decided to take that off my to-do list and replace it with one thought: “Survive until morning.”

Wednesday arrived and I was feeling pretty good. I had received meds every four hours, and that was working. The lab tech came in and drew some blood. I ate breakfast. Hmm. Maybe I can record today. It will be a day late, but still…

And then physical therapy showed up. And after a few exercises, I was wringing from sweat and fell asleep. Missed my scheduled pain pills. Lunch, with a few walks to the bathroom, and another PT session. More almost uncontrolled slumber. Dinner. Got pain pills, forgot to ask for the IV anti-inflammatory. Walked in the hall after supper, about 200 feet. Felt good, like I accomplished something.

Fell asleep. Until 1am. And the realization that I hadn’t received two doses of the anti-inflammatory (which is only given if I request it) and one missed pain pill schedule put me way behind the pain curve. I was in horrible pain. More pills, IV anti-inflammatory medication, and IV morphine finally brought it under control. Big lesson: take charge of yourself. If you don’t speak up and ask for something, no one will know you need it.

But that pretty much set the tone for the remaining days in the hospital. PT, pain pills, sleep. Over and over. I don’t remember big chunks of my time there. I do remember the times the pain was bad. But mostly, I was always tired.

And there was a good reason for that feeling of tiredness. I donate platelets through the American Red Cross. And for each donation, they always check my hemoglobin level, or the amount of oxygen-carrying iron in my red blood cells. I am always on the high end of normal 15-16g. I found out later on Thursday that when my CBC was checked, my hemoglobin was 9.9! That is way anemic! Now, it was to be expected after having two knees replaced but that explained why I was so exhausted while in the hospital and continue to this day. I’m doing what I can to help it. I am taking iron pills, and eating meals of liver (good thing I like liver) but it will still take a while for my body to replace all those red blood cells. So my profound tiredness will continue for a while.

Plan #2: Record as soon as I get home, because I’ll get back to normal quickly.

Well, that plan was doomed to failure for a few reasons. First, I really had a hard time getting a good level of pain control. It’s hard to focus on anything—creative or passive—when everything hurts. Not the sharp, stabbing pain of the initial incision or catheter placement, but the dull, deep throbbing ache that never went away. I would move from icing my knees, to elevating my legs to reduce the swelling (which was considerable), to gentle walking, to trying to sleep, to taking maximum amounts of pain pills, trying to find a pattern that would give some relief.

And I was still exhausted. Getting cleaned up, dressed and walking to the living room was tiring. When physical therapy started, I was a dripping puddle of sweat, looking for a place to sleep.

And I could not think of anything to talk about. I had no motivational spark inside me.  I thought it was gone. It was like when they opened my knees, something more than blood leaked out. I was just here. I couldn’t imagine beyond myself.

Oh, speaking of blood leaking out, a couple days after leaving the hospital, my legs started to display incredible bruises. From hip to ankle, inside and out, I as bruised. Big, ugly red-black bruises. (Ah, that explains some of my low hemoglobin!) If you go to the show notes at MYST.com/knees you will see some of the pictures. The bruises didn’t hurt, but they were scary-looking!

I wrote this script on Wednesday, June 10, exactly 21 days since surgery. That was the first day where I feel as though I can concentrate on something like this. And I still don’t know what to write about, but maybe this will be entertaining and informative enough for you.

This entire experience has been a major growth opportunity. While I really wish that I had never needed the surgery, part of me is glad because now I have a better understanding of my patients, and how they feel about things that seem so minor—to the nurses—but to the patient are very important.

An example was in my first room on the fourth floor, I had an over-bed table and a night stand. And I kept my computer on the nightstand, and other items like my water, and some snacks, on the over-bed table. Both tables were within easy reach. (I wasn’t able to record on my computer, but I was alert enough to put in a movie and watch it, at least for a little while until I fell asleep.) One night, the nurse was “organizing” and she move the nightstand out of my reach. Well, in addition to my computer, that is also where I kept my glasses and my phone and when I woke up in the middle of the night, nothing was where it was supposed to be. It was frustrating. And all because the nurse wanted the room more “organized.” This will help teach my students that patients have such little control over their situation, making arbitrary changes to their room is a bad thing.

On day three, I was moved to the eighth floor, because they were closing the fourth floor due to low census. Okay, that was fine. Except the staff forgot my shaving kit. And they forgot to bring my elevated toilet seat (such a wonderful invention!) I actually had to ask three different people before finally someone brought it up for me. Frustrating. Also on the eighth floor, I had an arrangement with my nurses that I wanted my pain pills every four hours, and they were to wake me if I was sleeping (which I never was—I generally only slept two to three hours at a time while in the hospital.) So, that Friday night, they were due at 9pm.  A half hour or so early, I called the nurse, reminding her that my pain was climbing and that I wanted them as scheduled. She agreed and said she would be in my room at 9pm. Except that when she finally arrived, it turned out to be 9:30. “Oh, I got tied up with another nurse, and it slipped my mind.” Pain control is important. And when you commit to providing a service—pain pills, or anything else—you need to honor that commitment. She didn’t. That bothered me.

So what have I learned?

Even when a person is educated—maybe especially when—that is not the same as experienced.

Education can act as a hindrance to positive performance.

Making plans off of assumptions based on education and not experience is a very bad idea.

And when you make a promise, no one really cares what the excuse is when you don’t meet your obligation.

How does this apply to you?

Let’s say you want to start your own podcast. And you decide to use my mentor’s course (Meron Bareket’s Podcast Starter Kit.) You sign up, watch all the videos, do all the prep work, and everything is running smoothly. You are now educated in podcasting.

But you won’t know what podcasting really is until you record your first shows, submit to iTunes and start getting reviews. That is when you start becoming experienced. (And that form of education never ends.)

Some links (but not all) within these show notes may be Affiliate Links, meaning that I may receive a small commission when readers click on them and then purchase something. This does not increase your cost at all, but it does help me cover some of the cost associated with this podcast. Thanks!

Music composed and performed by Jason Shaw, courtesy of Audionautix.com

Voiceover courtesy of Matt Young. Matt is a professional voiceover artist. If you have any need of voiceover work, for your podcast, radio spot, or whatever, you can reach Matt by a variety of methods. He is on LinkedIn. On Twitter. And Google+. And you can read his really nice, contemplative blog. Matt was also my guest on MYST 54. Give his story a listen!