††††††††††† I had my hip surgery on Thursday, October 4th.† As planned Marc had brought jello and bouillon, so I wouldnít be quite so hungry by Friday morning.† I was on the same floor of the hospital, but at the other end, so all the nurses were different, but some of the aides were the same and remembered me.† Friday was generally unremarkable, I think, but my memory is hazy.† I canít remember if I had an indwelling catheter, but I think I did and they took it out either Friday evening or Saturday morning.† Saturday started unremarkably also, except that I had the urge to urinate large amounts about every hour, till about 11:00 am.† I remember looking at the clock and thinking it was going to be a long day if it kept up like that.† But then, I didnít have to urinate again.† A doctor on the pain management staff came in to tell me they were going to put me on a protocol such that I would be given liquid morphine by mouth every few hours without having to wait until I was in pain or asking for pain medication.† (The stuff is very bitter.)† I was impressed by this enlightened approach.† Marc came in to see me, and brought Fred, who brought comic books and candy, a traditional get well gift from Marcís childhood.† By the time he was leaving, I was having some trouble tracking conversation.† He asked me what was the problem so I told him the morphine was making me spacy.† After he had gone, I think, I told the nurse I hadnít urinated since morning.† Apparently she spoke to the doctor about it, because shortly she came back and catheterized me.† The thought that this was a re-catheterization is why I think I had had one earlier.† I remember watching her process, mentally† being very critical of her sterile technique.† She had some difficulty and I was surprised by that, again being critical of her expertise, but now I think she must have had trouble because there was no urine in my bladder.† (Ah, as I write about it more becomes clear....Marc had gone to walk Fred out of the hospital, because the nurse had asked everyone to leave while she cathed me.† Then he came back and we had the conversation about spaciness.† Later he told me he had told the nurse about the spaciness and she had said, ďOK, no more morphineĒ)† I went to sleep Saturday evening.† When I woke up it was Tuesday, and I was in the Special Care Unit.
††††††††††† I have an elusive recollection of being called away twice from an important RPG (role-playing game) that I was involved in.† I vaguely recall one of those times being a conversation with a doctor about treatment for ATN (acute tubular necrosis) and hospitals I had worked at.† Thatís the sum total of my memories for those 2-3 days.† It is both frightening and hard to think about...there is no content to think about:† I seem to be feeling afraid of nothing, because there is nothing there but this huge gap.† I keep coming back to it with a sense of amazement.† ďDid that really happen to me?† What happened to me?Ē† I can piece together the exchanges about ATN and hospitals I had worked at as part of the questions medical people ask patients when the patient is disoriented, but they do not fill in much of the picture.† What was I like?† What did I do?† Days later,† I heard an X-ray technician telling a co-worker how much better I seemed than when he had seen me last.† Now I wish I had thought to ask him some of these questions, but then there was a space I couldnít get across to connect that person who was me to myself.† In some ways that space is still there.
††††††††††† They apparently did a number of tests and such to decide what was happening to me.† The end-result is that I had ATN because of the combination of medications and blood loss.† ATN is a condition in the kidneys where the tubules which do the filtering of the blood, die.† It is reversible if treatment is undertaken quickly.† If treatment fails, the patient needs dialysis for the rest of their life.† The build up of waste products that the kidneys are no longer removing causes the delirium.† It was not completely clear if that was the only factor, since they had given me morphine, an overdose of which can also cause delirium.† They apparently treated me with a lot of Narcan (an opiate antagonist drug) ruling that out...one of those vague recollections includes the doctor telling me how he had used so much of it on me.† Another factor which confused the picture I presented is that there can be clot development following hip surgery.† So one of the tests they ran was a brain scan to see if I had thrown a clot to the brain.† They decided I had not, but they did discover that I had a ďlacunaĒ in my brain.† Thatís the terminology for a hole or space which does not belong where it is.† They mentioned it in passing, though I canít remember the details of the conversation.† When I asked about it later, they told me I could follow-up on it once I was out of the hospital if I was concerned, but they did not seem very concerned about it themselves, since it wasnít related to my delirium.
††††††††††† After a day or so in the Special Care Unit, they sent me to a step-down unit, and then back to my original floor.† I was there for a couple more days and then they admitted me to the rehab unit.† This was a gamble since my insurance does not approve the expense of hospital rehab, and would prefer me to have gone to a nursing home.† However, I was there for a week before Oxford started insisting I be discharged either to a nursing home or home.† In that time I had gotten an idea of what rehab would entail and what was even going to be possible, given the state of the rest of the joints in my body.† It was an exhausting week, as I had not been walking since January, at least, so my muscle strength had deteriorated significantly.† Even in the absence of pain from my hip, my endurance was next to nil because of the pain in my knees.† I finally decided that even though I could get more active rehab in a nursing home, I just didnít have the heart for it.† The doctor in charge of the rehab unit astutely observed that I had had enough of hospitals and hospital-like environments.† The last day I was there the physical therapists rather frantically made sure I knew how to use my walker, do bathroom transfers, and use a crutch to get up and down the stairs. This time they didnít send me home with a set of exercises to do, though I think they would have if I had thought to ask for them.† Instead, there is a list of prohibitions; donít cross my legs, donít bend more than 90 degrees at the waist, donít pivot on my operated leg, and so on. (They had already taught me how to do things like putting on my socks without bending over.† There are a couple of rather neat devices which they have for sale there to assist the process.)† As it was, I had enjoyed about as much of that as I could stand, and wanted nothing more than my own familiar bed and pillows and commode.
††††††††††† Now I am home.† I go to physical therapy three times a week except for when we are waiting for Oxford to OK another round of therapy.† I am using crutches to get around except for when I have to go any distance; then I use a wheelchair.† Itís just past 3 months,† so they should soon be stopping the blood thinning drug that is given prophylactically to prevent clots.† Iím told the prohibitions on movement will last another three months.† The leg orthopedic surgeon is ready to operate on one of my knees (the one that has been the most problem in getting mobile again) but my unoperated shoulder is also getting pretty loose and painful, probably from using the crutches, and my knees and unoperated hip are also painful, probably because I am walking more.† So I have to decide which will be next.† But Iím having trouble thinking about any of it because of those lost days.† Iím wondering which joint is the most problem, and then Iím wondering if I should instead be thinking of which joint will make the most improvement.† Iím wondering if Iím at risk for having another lost time episode.† Iím wondering if I should follow up on that ďhole in my headĒ.† Iím basically floundering around thinking about all this and not thinking about it at the same time.† I guess the thing to do would be to make an appointment with my primary care doctor and talk it over with him.† I think that might give me more concrete information to think about.† Another thought arises from a talk, a couple of days ago, with a friend of mine who had had a similar experience when he was a child.† Since it helped to talk with him, I also think I should be talking more with my friends and family about my current state of mind, which is what prompted me to write this all out for this collation.† Thanks in advance for letting me bend your ears/eyes with all this.
†This has been Becoming
a work in progress of Donna Camp
1088 East 40th St
Brooklyn† NY† 11210
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