Misery guts in the recovery room
TL:DR Caity whines about a long day in hospital and getting a cardiac monitor.
So on Friday 16th I had my cardiac monitor implanted. It was Not Fun. I mean, you never expect surgery to be FUN, but this was So Very Not Fun.
To start with, I’d been having a major depressive episode, which built up to suicidal ideation. Last Friday the psychiatrist (someone new, very nice, but not my regular Very Helpful Psychiatrist, who was away) wanted to admit me to hospital for my own safety, but I wouldn’t go – lots of reasons, including I hate being on the local ward, they did offer me an an alternative three hours away – but it’s just as well I didn’t take that offer…
Because later that night I got a call saying my cardiac implant surgery had been moved forward a week. Meanwhile we had put safety measures in place, started on an antidepressant that had worked in the past (very few do for me, I get a lot of either adverse or paradoxical reactions) and arranged for me to see my (new but lovely) mental health nurse every day.
Did I mention that I haven’t been able to drive since about March, when I started having weird fainting spells? So poor patient Mr Beloved has to do all the driving, and I have lost my independence. (Public transport here is a joke, and simply doesn’t exist for a lot of our everyday errands). After many investigations, the cardiologist, Dr N, decided that the only way to find out for sure if it’s my heart causing the fainting problem (officially Vasovagal Syncope ) or if it’s purely blood pressure related or a mix of both was to go ahead with the insertion of the cardiac loop monitor. Dr N is one of the better specialists I’ve dealt with, genuinely sympathetic, dedicated, funny.
And as I think I might have mentioned, I had a lumpectomy on July 31. During which the breast surgeon took out a big chunk of benign but very dense, fibrous tissue. And that seemed to be healing well … Except now I have a new lump, bigger than the lump they removed, above the scar of the lumpectomy. When I saw my GP back at the start of September she seemed to think it was lymph that at wasn’t draining properly (she, by the way, is awesome, and actually works in surgery as the assistant to the breast surgeon two days a week.. She’s a smart cookie) because she pointed out “we did take a LOT of tissue out of there, I’d expect it to take time to settle down, but come back if you’re at all worried.”
But then I got depressed, and suddenly the surgery was happening.
UNDER A LOCAL ANAESTHETIC.
So I’m anxious anyway (because the depression is still hanging around) and the weatherbeaten old wardsman wheeling me in is saying “didn’t we just see you the other month, sweetie?” Which is kinda nice but…not, you know? And as usual the theatre nurses are being super reassuring as they struggle to get a canula into my cold veins (there will always be one senior sister who knows the trick to get it done) but instead of my usual “here’s where I go to sleep and wake up in recovery” … I get a horror show.
I still have my glasses on but I keep my eyes scrunched shut. The cardiologist and the company rep specialist start discussing where the incision should be so that the implant ends up in the right place (it has a little plastic pusher thing that inserts it, then gets withdrawn.) I point out (verbally) they might need to take my lump into account. Dr N counts down my ribs, bruisingly, “first intercostal space, second intercostal space, third intercostal space…” I start crying, Dr N says “give her some sedation”. Nurse tells me “it’ll be like half a glass of red wine, won’t that be nice?” And I say I don’t really drink.
More discussion. Another bruising count down my sternum. “Are you going to have more surgery on that breast? We can put off doing this surgery today.” I tell them no, my doc is pretty sure it’s lymph, it was benign fibrous tissue before and if anything is likely to be more of the same, that I’m seeing the breast surgeon for follow up in February .
Somebody puts stickers on my chest, I have no idea why? Maybe to help visualise the incision and placement? Another rib-bruising count of my intercostal spaces. The stickers are taken away but for some reason now they decide to hook up an ECG (more stickers, but not where the surgery will be) and a blood pressure cuff. Maybe I’m looking panicky. You know, given that some of the known causes of vasovagal syncope are needle phobia and stress, wouldn’t this be an operation you’d consider NOT doing under conditions which would expose the patient to those things? Just a thought…
Rep and Dr N have more discussion about the incision. Dr N orders more sedation for me. Finally they warn me “this will be cold” and start swabbing my chest, and setting up a drape (I still haven’t unscrunched my eyes) and Dr N starts injecting locals. I whimper, Dr N orders more sedation. Throughout the theatre nurses start muttering “you’re doing really well…” And I’m not sure if it’s for me or Dr N.
The drape touching my face is a comforting presence and I almost ask them to put it back when the nurses notice and tie it away. I don’t feel the incision but I do feel the pressure as Dr N, coached by the Rep, pushes the loop monitor and it’s inserter into my chest, and although I try to block out their conversation about moving it into the right place I am still wide awake and scared. And then the pain starts. Tearing pain.
“I’m about to say a very bad word,” I tell the room, I hope reasonably calmly, then I scream, long and loud, “THAAAAAAT FUUUUUUCCCKKKIIING HHUUUUUURRRRRTTTTS!!!!!!”
I have a bit of a blank after that. The nurses go into their “you’re doing really well” flutter. Dr N and the company rep go into a discussion about the best way to close (“steri strips and some dissolvable stitches, but you should probably have…”) Dr N tells me he’ll see me in his rooms in a week to get the stitches out. I cry at him at nod and he squeezes my hand, and as I’m wheeled into the corner of the room I can hear Dr N and the Rep talking about what an unexpectedly long time my surgery took, and something about “her anatomy…”
“All done, sweetie?” It’s the same wardsman again, with his skin cancer-pink face beaming down from under his sky blue scrub cap. “Last one for a while, I hope?” I tell him I hope so as he wheels me around to recovery.
The nurses in recovery look familiar from last time. L, who’s looking after me, is in her mid twenties but has an air of authority I’ll never achieve. She calls me “darlin'” and bounces around on her pink and blue sneakers, Getting Things Done. Dr N comes out between surgeries and writes up a prescription for an antibiotic and says I can have Panadol for pain, orders an X-ray, and says I need to stay until six o’clock. I apologise for swearing during the operation and he laughs it off, but I am hugely embarrassed. I don’t swear at authority figures, I am a Good Girl. I will apologise to Dr N each of the three times I see him while I’m on the recovery ward.
L bounds off to organise the X-ray and pills, her brunette ponytail swinging. When she gets back, I mention my arm hurts. Ummm, it’s hurting quite a lot. Where the canula is, in my elbow? I point, with my clumsy right hand, middle finger trapped in the oximeter, bicep suddenly being squished in the death grip of the auto blood pressure cuff, to the mass of tape the theatre nurses used to stick the drip line to my left arm. L checks the beeping alarms on the drip machine and feels my arm above my elbow. “Okay, we need to flush your line”, she says, and I feel the cool saline flow into my vein as she fixes the problem.
Recovery ward is a noisy place, a symphony of beeping machines; nurses with raised voices “the operation’s over, Edgar, I need you to open your eyes for me, Edgar, squeeze my hand, Edgar, can you wiggle your toes, Edgar?”; visiting doctors “well, everything went very well, I’ll see you in my rooms in…”; and, down the other non-bed end of the ward, the non-stop squawk of commercial tv. Even with all this I manage a small snooze- I hadn’t slept well the night before, had to be up at five for my last small drink and take my medications, and present at the hospital at seven thirty. I found out later I got to the recovery ward at ten thirty- and I wasn’t waiting more than twenty minutes on the trolley ready to go after the admissions nurse was done with me and I was gowned up. Time does not conform to usual patterns in a hospital.
The portable X-ray machine is here. (This is still a thing of wonder to me, that in my lifetime technology has changed so fast that a single skinny bloke can bring the X-ray machine to the hospital bed, instead of waiting for a wardsman to take your bed on a long bumpy ride down the dark corridors, usually to the very bottom of the hospital or even an outbuilding to the X-ray department and all the way back again.) I sit forward, he puts the plate behind me, I sit back, he calls “X-ray on bed… Thirteen!” And it’s done.
Time to get dressed. I sit up on the bed slowly , L disconnects me from the oximeter and blood pressure cuff, and I strip operation Caity off (those paper undies!) and start putting ordinary Caity back on, slowly and with a bit of a wobble and taking great care not to bump the canula.
The rules are that the next stage involves the patient being wheeled in a recliner by a nurse to the other end of the ward. The recliner’s brakes are set, and if you’re lucky you get to eat and drink at long last. L unhooked the drip line from my canula ( “these five wheel bases are really unstable, I’ll just pop this up the other end first”) and I sat in the chair until we reached the loos… Escorted in and out, but I was finally free to have a wee. More of a dehydrated trickle, but my bladder was grateful. Back in the chair for the final destination… Parked in front of … Shit. A tv. Some people in front of me but still… Daytime tv. My idea of hell. L tells me she has to look after someone else down the other end now but she’s handing me over to L2, who I remember from last time. L2 asks “can I get you anything?” Oh yes, please, I’d love a cup of tea, white, no sugar. L2 is also in her mid twenties but seems less confident than L. But she’s very pleasant. She’s brought me tea and sandwiches. Oops. I’m sorry, I say, sandwiches upset my tummy, could I have custard instead? She sets down the tea in the blue plastic mug on the table attached to my recliner and says “I’ll get you some! No problem!” (Do nurses self select for cheerful, or is it a job requirement, like cold hands? Or do they work super hard at it for the poor patients? If so, they deserve way more money.)
I’m not yet reattached to the drip, L2 hasn’t come back yet. I haven’t had anything to eat since two small slices of cheese at midnight. I sip my tea. Even hospital tea is tasting like my favourite brew when… I feel it coming. My arm is hurting again, but that’s not it. I carefully put the tea down. It’s that hot, rushy feeling. I push the blankets to the floor. Still too hot. Close my eyes, try to wiggle my toes, clench and unclench my calf muscles. Hot. Hot. Going. I’m going to faint, I call out, I don’t know if anyone can hear me.
I still have my eyes shut as my chair is wheeled away from the tv and multiple voices start “get that tea outta the way for me ;” get that oxygen mask on her”; “Caity, Caity, you still with us?” ;”restart that line, try flushing it, it might have tissued”;”Dr N? Yes, vasovagal syncope just now. Conscious. Oxygen. Increase to…” ;”Caity, can you hear me? Give me a wave if you can hear me”. I feel a cold wet cloth on my forehead and think “how very Florence Nightingale”, which is unfair to a great woman, but there it is.
I open my eyes. I’m in the middle of the recovery ward, between the beds and tv area. It’s quiet. Well, the symphony of beeps and nurses goes on, but the tv hell is in the distance. Sometimes the beeps almost sync up, then they move apart again. I am woozy, I am always woozy after one of these events. And I am embarrassed, even though L assures me they often see vasovagal syncope in the recovery ward.”happens aalllll the time, darlin. It’s the stress. Don’t worry about it.”
I am also supremely pissed off. I’ve just had painful surgery to try to determine the cause of my fainting and then had an episode where once the nurses got the blood pressure cuff on me they could pretty definitely say “that time? Blood pressure.” I’m also hooked back up to the oximeter, have oxygen prongs up my nose, and the auto blood pressure cuff is bruising my arm every ten minutes. I listen to the beeps some more. I try very hard not to move my left arm, in case the canula messes up again.
I still haven’t had anything to eat or drink, until L bounces up with my antibiotic and Panadol and a plastic cup of water. She warns me the antibiotic smells horrible (it does) but says “the IV one is awful, if you get that on your hands it stinks for a week!” I sniffle and then cry and she says “oh darlin, what’s up? Something wrong or has it just been a day?” I nod at the last one and she gives my back a rub as she kneels beside me, then says “have you had anything to eat yet?” She organises L2 to bring me white tea and cold curdled custard and a box of tissues and springs back off to her other patients. This time I get to drink my tea, and it’s still hospital tea, but magically tasting as good as my favourite brew, even though it’s probably no name tea dust in a teabag, even though it’s served in a a thick plastic mug. Tea.
The machines go beep. In time with each other. Out of time. Alarm beeps. I’ve moved my arm, the drip machine is cranky. I’ve brought my iPad, loaded with podcasts to listen to, but I’m not in the mood, and I’ll have to wait for one of the nurses to get it for me anyway. The warmth from the tea is gone now and I’m freezing. Shivering. All the nurses are busy. I try to catch the eye of a blonde nurse as she rushes past. “Oh my gosh, you’re freezing!” Yes, thanks, I really feel the cold, so silly…a blanket for my shoulders? Thank you very much… And she’s gone again. I go back to the beeps.
Dr N stops by after checking on another patient. I apologise again for swearing during the surgery. He laughs again. “Can I check your wound?” ‘Wound’, I think, the language of hospitals is freaky. You didn’t wound me, you deliberately made an incision and shoved a medical device in my chest. I pull down my t-shirt, he pokes at the dressing gingerly, he nods. He mentions something about the drip rate to L2, and starts to leave. He turns, Colombo-like, one more thing: “When you had the episode before, did you lose consciousness?” He seems disappointed when I answer that the nurses’ intervention stopped me from passing out completely. “Okay, I’ll be back to check on you later.”
I ask L2 what the time is. “Quarter to one.” Oh. “Did you want your iPad?” Yeah, thanks, that would be great. I hold it on my lap, staring out the windows with their encased Venetian blinds striping the rooftops and sky. The machines beep, in time, out of time. The nurse’s sneakers sometimes squeak as they hurry past, blue uniforms, hair neatly out of the way. Mr Beloved has an appointment and is busy until at least one o’clock, so I can’t even ask the nurses to call him yet.
L stops mid-bustle, noticing I’m just staring, I guess. “Is there someone we can call for you darlin?” I ask what time it is. “One ten. You want me to call? Your husband?” Yes please, I say, but I’m stuck here til six… “Oh he can just come and sit with you for a while, I’ll go give him a call.” She hurries off to find my file and calls Mr B, who says he’ll come as soon after one thirty as he can. I thank her. “No problem, darlin” and she’s off again.
Mr B arrives. His appointment had gone well, he laughs at me swearing at Dr N during the surgery, but there are no proper chairs for him to sit on and his back is bad and of course he’d got up at the same time I did, so we cut the visit short and he very sensibly goes home for a few hours sleep.
The machines beep. In time, out of time. Chasing each other, almost catching up, crossing over. I work out how to make the back of my recliner move so I don’t have to sit upright. I feel like I’ve accomplished something for the day. Yay for me. I enjoy just lying there for maybe half an hour when my bladder decides that the tea I had earlier needs to leave my body NOW. RIGHT NOW, please and thank you. Oh shit. No nurses in sight, I start to struggle with the chair, remembering that there’s a lever on the right hand side to make the footrest go down, but just then the auto blood pressure cuff starts to pump up and I am trapped in its awesome grip. Let go of my arm! I mutter just as a nurse happens to be passing, and she sees my struggles and asks “need to go to the loo, hon?” Yes, please, I just can’t get up! She disconnects me from the cuff and oximeter and helps me out of the chair, warns me about the unstable drip machine base, holds my elbow, and we’re off.
Back in the chair, connected up again. Beep BEEP beep beep beep BEEP beep. L2 is back. I don’t know how much time has passed, I don’t have my iPad, and there are no clocks visible. “Can I get you anything?” This time I ask for tea, custard, and what the hell, ice cream. The tea comes in a china mug this time, I feel like I’ve been upgraded to business class. The custard is still cold and looks like it has cellulite, and the little tub of gluten free low fat ice cream is half melted, but it’s all nectar, ambrosia. I scrape my spoon around the bowl, greedily.
I lie back in my chair. The machines beep. Eventually, the alarm beeping is my drip machine, and L2 rushes over to check on the problem. I tell her I’m probably being a sook, but my arm is hurting again… She calls over a colleague. “And doctor wanted her to have the whole bag?” “Yes but we’ve had to flush three times already..” “Look, she’s had half, let’s disconnect her and give her a break for a while then restart. And she’s been stable so let’s take off the oximeter and cuff too.” I am overjoyed. They fiddle around with the line and get rid of the bruising cuff. The local has started to wear off so I ask for an ice pack, which I hold to my chest until my fingers are numb. Then I hold it with a blanket.
I stare out the stripey windows again. Not thinking about much. Time floats past me.
Beep. Beep. BEEP BEEP beep beep beep. The nurses who finish at four o’clock start calling out their weekend goodbyes. L2 comes back to restart my line, but the machine tells her there’s a fault, and she has to flush the line again to get it going. I tell her I feel the cool liquid start, and she makes a note in my chart before heading back to the central desk.
Not so many beeps on the ward now. One of the senior nurses is reminding the others to get discharge charts written up so there won’t be a rush at end of shift. “Well, call doctor and remind him he’s got patients down here!”
I think it’s about quarter to five when Dr N arrives. My t-shirt is damp where I’ve been holding the ice pack and the ‘wound’ is really starting to hurt now. “Oh good,” he says, ” you’re using an ice pack. Keep doing that. Can I check your wound?” I nod and pull my shirt down again, he pokes and says “good, good. Now, I have some instructions for you, okay?” And he goes through a double sided list “some of these won’t apply to you, they’re for pacemakers” as he crosses those off “but it’s very important that you keep super hydrated and take the antibiotic for five days, and I’ll see you in my rooms next Friday, okay?” I apologise again for the swearing and he says “you surprised me, just like you did on the treadmill! See you next week, OK?” And he’s gone.
L2 comes over, “good to go? Have you got your phone in your bag? You can call your husband to come get you.” She hands me my bag, and I call Mr B, but his phone goes straight to text. Huh. Wait five minutes, try again. Same thing. Odd. Try the home number instead (which we hardly ever use, since it’s not a reliable line.) Aha! He had done the right thing and turned his phone off when he visited me before, and forgotten to turn it back on. But he’s coming to get me soon.
L2 decides to leave me on the drip for as long as possible. Mr B arrives, and L2 comes over and goes over the discharge papers with us, and has him sign the file to say he’s taking me. She disconnects the drip and takes out the canula and I am sure my poor vein would say thank you if it could (two days later it’s still tender.)
A quick wee on the way out and I’m on my way home. Any lateral movement to my chest is agonising but I’m ok if I stay straight, sort of. I’m looking forward to decent painkillers and ice packs and lying down flat and lots and lots of fizzy mineral water. So that’s what I do. Friday night involves a lot of whimpering, and calling Dr N very bad names. I listen to podcasts until my brain shuts off, and wake up with a sore ear and a sweaty chest.
I spend most of Saturday writing this, getting up to change ice packs frequently, drinking a lot of mineral water. The ice packs don’t have enough time to freeze again between shifts, so they’re more like cold packs, but they help.
And now it’s Sunday afternoon. I’m counting down to when I can next have some pain management. I have a cold pack on my chest, and I cannot twist my upper body at all or bend forward or all the pain alarms in my head go off. I can’t lift anything heavier than 2.5 kg (no picking up poor Connie, who is only 4.5kg) and I have a whole new set of rules to remember about things that emit electromagnetic radiation and how close they can be to my chest (short answer: iPad, phones etc, at least 15 cm away or it messes with the device’s recording.)
I also have a new best friend to go everywhere with me.
New best friend… Has to come with me everywhere
This is the other part of the monitor. If I have an “event” where I lose consciousness, when I come to I have to find this, press it to my chest over where I think my implant is, and press the button until the lights light and the thing goes beep. This then makes an additional recording of some minutes before and after the event, which the cardiologist can look at more closely.
In addition, I now go to the cardiologist every six months where they will wave a magic wand over my chest to download the data from my implant. The battery in my implant should last three years. And I get a card that says please don’t make me go through your airport security cos it will mess with my data recorder, thanks.
As for uni? I’m about to write to my lecturer, letting him now I’ll be applying for a ‘W’ grade this semester, which means that if it’s approved it’s like I didn’t enrol in the subject, no harm, no foul. Has to have good medical reasons but I think I can prove my case, and my psychiatrist is going to back me up.
So that’s where I’m at. Congratulations if you’ve made it this far, you’re a star. Next post, wanna see my scars?!