Friday, 9 May 2014

My left bootie: Adventures in healthcare

I’m home from my unpleasant medical procedure, “taking it easy for a few days” as directed.

Short version of the story: Inferior uvulectomy, because my uvula is (was) long and fleshy and I could feel it on the back of my tongue and it was a huge anxiety trigger and potential contributor to my gagging problem. So I had it yanked out. There has been discussion about preserving part of it so I can continue to make uvular trills for demonstration in class, but I'm not sure to what degree that has been accomplished.

Long story: except for the sleep study, I’ve never spent a night in a hospital, so I’ve been kind of anxious about the whole process. I think I was more anxious about the process than the actual procedure.

So it started months ago with the ENT (that’s Ear-Nose-Throat doctor, or otolaryngologist if you prefer). Followed by the scheduling and the rescheduling, much paperwork (fairly detailed medical history, four pages of consent and indemnification stuff, and so on), and a couple of weeks ago a pre-operative assessment. Basically information at all stages (in both directions) was the same.

The procedure itself should have been relatively minor, an outpatient deal. But because of my general health issues, my gag reflex, and so on, I had to be admitted to the hospital overnight. Which confused absolutely everyone, because all my information had dire warnings about not being alone for 24 hours, having someone around when you sleep, and so on. Which is one of the reasons they kept me in the hospital, as if I were undergoing a much more complicated uvula-pharyngeoplasty.

Okay, so the precise timing of my post-op instructions is a little cloudy, in terms of when exactly I am allowed to be out of someone's sight and to pick my own meds and drive and so forth, but I figure we’ll cope. Tuesday the hospital calls to confirm my surgery, which apparently has been moved from 2:45pm to 7:45am. So the carefully negotiated plans to get me to the hospital around noon go out the window and I have to scramble. Luckily I have many more, better friends, than I sometimes realize.

So Ken gets me to the hospital yesterday morning at 6:20 or so, in plenty of time for my 6:45 check in, which turns out to be when admitting opens anyway, so I sit in the lobby not drinking coffee or anything because I’m not supposed to eat or drink anything before surgery (this starts at midnight for food, actually 9:30 or so for me) and no more than 6 oz of water not less than 3 hours before surgery. So sitting in a waiting room for half an hour being able to smell the coffee and the donuts was a bit of a trial.

So I’m in prep. I change into my gown, put little mesh bootie things on my feet and climb into bed. Doctors come by to reassure me. I managed to do everything else right (shoes in black bag, black bag and everything else except the CPAP machine into the white bag) except that I forgot to put my shirt in the white bag. A nice orderly took care of that for me on the way to surgery. Oh, and I couldn’t work the hairnet thing so he had to do that too.

In the hall outside the surgical suite, I go through everything with nice OR RN Ricardo.  He gets me onto the table, hooks me up to my IV, attaches a bunch of electrode thingies to various parts of my body.

Surgery, I’m told, went perfectly, which from my end isn’t quite how I’d describe it. The actual procedure was fine, I guess, but as they were removing the breathing tube I experienced some kind of spasm (laryngeal, tracheal, possibly esophageal) and couldn’t move any air. Not being able to breathe is another huge anxiety trigger, which is one of the reasons I don’t swim anymore, so naturally I panic. It takes a couple of nurses and the anaesthetist (which they spell with the up here and pronounce with [i]) to hold me down and pump some Ventolin with the oxygen and get me to calm down. A little. I occupy my mostly functional brain trying to remember BSL fingerspelling, which I believe I am successful at, so I am able to convince myself, as I slowly begin to draw breath, that I haven’t had a stroke on the table. Which can totally happen. It’s not particularly likely, but, you know, a little learning….

So I’m in recovery, oxygen sensor, blood pressure and other things attached (as they have been all through the procedure). Mostly uneventful, since I’m awake and breathing, except at one point my blood pressure starts to drop (I heard 80-something/54), so they start me on some saline and things seem to moderate. I get some ice chips. Through all of this, they keep saying that it’s possible they could send me home that afternoon/evening, which would have required a huge scramble. But it wasn’t to be.

They take me upstairs to the Apnea Ward, which is empty except for me (it fills up over the course of the morning). I drift in and out of useful consciousness while nurses hook me up to stuff and monitor my vitals and make sure I don’t die, or whatever they’re there to watch out for. I get more ice chips. Eventually I get my glasses and phone and stuff, take some pills, get some lunch. Lunch consisted primarily of some cream of asparagus soup, which was actually quite good, and some orange juice, which hurt. And some milk and ice cream and some warm tea.

At some point I’m given a new gown and apparently SOP up there is to drape another gown around your shoulders. Mine is blue and I wear it tied around my neck like a Superman cape. I want one of those for wearing around the house.

Somewhere between pre-op and the ward, my left bootie has worked itself off my foot and the aide goes looking for it in the bedclothes while I try to lever myself to my feet, and take myself to the washroom without falling over or getting dizzy or anything. (Over the course of the afternoon, I figure out that I’m one of only two remotely ambulatory patient in this ward.) I figure out how to work the bed, and the table, and the IV stand. I read a comic book on the phone and doze.

More pills, then dinner is some really mediocre cream of carrot soup (didn’t care for the texture, and could really have done with some pepper or something. But since I’m supposed to avoid anything spicy for a while it’s probably just as well), warm tea, chocolate pudding and pineapple juice. I decide to skip the pineapple juice, having learned my lesson with the orange juice earlier. I do try some milk. I really don't like milk.

I make it to the bathroom again a couple of times over the course of the evening, and every time I end up looking around for my left bootie. It just won’t stay on. Around 9:30, I’m given two Tylenol 3 with codeines and told I can go to sleep. Per doctor’s orders, I’m on oxygen overnight, no CPAP. I haven’t really slept without my CPAP machine since September 2009. And I still haven’t really. Dozed some, didn’t really sleep all night.

I’ve come to the conclusion that whatever codeine is supposed to do to you doesn’t happen for me. Morphine either. I had codeine in high school for a really bad skin rash on my legs. A friend of mine got a chemical burn in her eye, and they gave it to her too. She got so dopey on it that they sent her home from school. I drove her on the same dosage of codeine. Now granted, I was fat in high school, but still. Just after grad school I had a back spasm, ended up in the emergency room was given, among other things quite a bit of morphine. I think, over the course of the morning, a whole grain. At least half. On M*A*S*H, when they amputated your leg, you got a quarter grain. And it didn’t really get me to the point where I could move or stand.

So one of the things that kept me occupied all night was the constant struggle to keep my left bootie on. The soreness, the breathing panic, the orange juice will probably fade. The memory of that stupid left bootie will linger.

Anyway, so this morning, I met my LPN student, Sam, who was going to take care of my discharge. There are vitals, pills, instructions, discussion of when and who is someone going to pick me up. Breakfast consists of a tray of food I couldn’t eat owing to the injunction against foods that need to be chewed or crunched. I had some scrambled eggs, which turn out to be the same texture as what’s left of my uvula so that was an adventure. It came with a mini-bagel (no chewing), cereal (no crunchy food), some coffee, and more milk. At some point another tray appears, this one with more or less the same stuff, but I snag the yogurt cup, which turns out to be key lime. I make it through about a third before the acidity of the yogurt, or the lime, starts to get to me, so there you go.

Good news is that this morning at 7am, my blood sugar was 7.0. It was 10.1 and 11.something all day yesterday. 7.0 is an almost normal human fasting blood sugar, and is certainly the lowest non-hypo-feeling blood sugar I’ve seen in a while. So maybe portion control really is the key.

So there’s a walk around the floor, discharge orders, post-op orders, calls to the doctor for follow up stuff, and Sam walks me through everything well. My buddy Heather from work comes about 10am to pick me up, and she takes me home. The clock radio is still on, so apparently I didn’t put it on sleep yesterday at 5:30 when I got up.

Anyway, before I settle into taking it easy, I had to dash to the store to fill a couple prescriptions and pick up some liquid Tylenol (which I've been advised to try before resortin to the prbably useless Tyl3w/codeine). Liquid Tylenol only comes in children’s varieties and flavors, so I got grape. Also an antibiotic, we believe as protection from potential infection. I've also checked the proportion of peroxide (in the form of a rinse called Peroxyl) relative to what you get in a bottle of peroxide. So Peroxyl is 1.5% H2O2, where hydrogen peroxide is 3%. So my tablespoons of peroxide in a cup of water becomse a tablespoon of Peroxyl in a half cup of water.  With which I will rinse twice a day until told to stop. Or something like that.

So two things: 1) Since I woke up yesterday I've noticed that I have a funny numb spot on my lower lip. Like most of the left side, not quite to the corner. Sam says it happens when you've been anesthetized that sometimes some small patch of somewhere stays numb, sometimes for weeks. So we'll just see. 2) I'm enjoying and iced coffee from Starbucks that I picked up while waiting for my prescriptions. While there I discovered that the thing that I thought was a knot or something in my hospital gown that I couldn't move from my left side back was one of those electrodes Ricardo put on me. I have vague memory of them being removed, but not by who or when.

So the plan now is to take it easy for the weekend. There's coconut-ice-milk-sicles and cups of vanilla Haagen-Dasz in the freezer, some vanilla pudding and apple sauce in the fridge, and some rice to make okai, or okayu, which is basically rice gruel that requires no chewing and can be eaten luke warm and is a staple of Japanese-American sickbed food.  And for when I feel like I need an actual meal with protein and fiber in it, there's some Glucerna. So here I go taking it easy.