BECOMING
Donna Camp
I
had my hip surgery on Thursday, October 4th.
As planned Marc had brought jello and bouillon, so I wouldn’t 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 can’t 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 didn’t 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 Marc’s 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 hadn’t 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, “OK, no more
morphine”) 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. That’s 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. “Did that really happen to
me? What
happened to me?” 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 couldn’t 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 “lacuna” in my brain. That’s the terminology for a hole or space
which does not belong where it is. They
mentioned it in passing, though I can’t 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 wasn’t 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 didn’t 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 didn’t 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;
don’t cross my legs, don’t bend more than 90 degrees at the waist, don’t 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. It’s just past 3
months, so they should soon be stopping
the blood thinning drug that is given prophylactically to prevent clots. I’m 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 I’m having trouble thinking about any of
it because of those lost days. I’m
wondering which joint is the most problem, and then I’m wondering if I should
instead be thinking of which joint will make the most improvement. I’m wondering if I’m at risk for having
another lost time episode. I’m wondering
if I should follow up on that “hole in my head”. I’m 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
(718)
692-2373 aka (718) NY CADRE
e-mail:
campground@acedsl.com
