On the Third Day

Day 4 post op. Well it is barely day, Two thirty in the morning is day but certainly not daylight and it still feels like night, I am awake and feeling very unwell. I am nauseous, clammy, sweating profusely and I am in pain. I do not know what is wrong with me but I have a pretty good idea. If I were not in so much pain it would be easier to think.

I manoeuvre myself out of bed. The shoulder is sore but my feelings of being unwell are unrelated at least in a direct sense, to my shoulder. My shoulder just adds a complication as it is very hard to get comfortable and move around freely. Even rolling up into a ball is not readily possible. The need to go to the toilet is upon me but when I sit, the feelings of unwellness increase and there is a pain inside me when I push that is what I could imagine would be the sort of feeling I might have if a King Arthur type sword had been inserted into my bum. It is sharp, intense, worrying and the waves of nausea are creeping over me in earnest. What am I to do?

I know intrinsically my unwellness is due to my bodies reaction to itself. There is too much of myself within me and it is making me sick. I need to shit. However the pain when I try is immense so damned if I do and dead if I don't. Oh happy days!

The problem with working in a healthcare environment is you can know too much, or have heard too much. This can really fan the fire of worry and dread. If I go to the hospital what are they going to do?  I can tell you straight up, they are not going to treat it as seriously as I want them to. I will have to wait in the waiitng area and who knows how long that will be for. It is not like I have lost a limb or have an ice pick sticking out of my head. I feel like I am dying and if that is how the cookie crumbles, I would rather have some semblance of dignity by dying at home. I have never felt this bad and in such pain in trying to do something about it,  than I have ever felt before.

I had started to go down hill on Day 3. I had a mild awakening to the problem that was now causing me distress. I had calculated it was three days since I had gone to the toilet which was concerning for a regular as type of guy. However, I had heard stories of much longer and the ones I had witnessed in the operating room, the ones with a genuine bowel blockage, were often well over this time.  Luckily I had found some Movicol in the medicine cabinet. The instructions were vague.

" Take one sachet with water daily increasing to up to 8 satchets if needed."

 Over what sort of time frame please. If I build up at that rate it will be a week or so before I might go naturally! So after an initial sachet, within a few hours I took seven more and hang the consequences. This was going to end badly I knew it.

Mechanical removal. Enemas, Flushing. Operations to look for bowel blockage and the reason. I had heard people speak butm the talk now sounded frightening. It is always okay when it relates to someone else but to me? I had had a hernia operation  a few years back. Maybe coincidentally I did have a blockage from post operative adhesions? Oh, the pain and the shame. I knew these people. And how would I get on having to cope with a stuffed shoulder at the same time.

I wandered around drinking water, trying to sit every now and then but always met with the sharp pain inside me.

My wife woke at five am.. Thankfully I was now not alone.

" You look terrible. I am getting dressed and we are off to the hospital!"

OIC: Opioid Induced Constipation. A phenomenon which is well documented and one which  I could now add  to the list of illnesses, conditions and other medical ailments that I had endured in my life time. It was one that had caught me unawares. Mr Organised, Mr Planning had come a cropper. Mr Think Ahead was now in a right state and the answer required to rid me of the evil was overdue. Action was required now or the consequences were not going to be good.

Through clenched teeth and with  an agonised face I said I would be alright for the time being. I was not being cute or casual or brave. I did not want to endure whatever they might have for me at the hospital and I still had not given up hope of a home birth.

My wife suggested drinking warm water, which I did, in the words of Cyndi Lauper, " Glass after glass."

I had tried to sit on the toilet numerous times but this time I was determined. The complicating factor was Elvis Presley died on the toilet. He had underlying issues for sure but it was the toilet that finally got him. One should not push hard on the toilet. It does terrible things to your blood pressure and bad things to other things in that area. I have had a coronary stent so issues with the heart are near and dear to me.But if this was how I was going to leap off this mortal coil, so be it.

I sat, sweated and tried a little, increasing in intensity progressively until I was trying a lot. And then it happened! Let's just say I am still here and it took a whole day of repeated visits to the loo to clear the log jam but eventually I got there and felt bloody amazing once again!

The opioids given to me to keep the pain at bay for my shoulder gave me wonderful pain relief and really were fantastic. I had been warned about constipation but as a warning, with no practical advice on what to do, I let my guard down. The breakfast menu in the hospital had prunes on it amongst other things. I should have had these perhaps. I should have taken foods into the hospital that might have helped e.g dried fruits, dates, prunes, kiwifruit. I should have had a plan. I should have considered the possible complications. So many shoulds. I let my guard down. It won't happen again!

The breakfast menu has options that might have been better than going for the luxury what I seldom get at home choices!

The medicine cabinet is now complete with things to help including the last ditch suppositories. Once you are in a state of being bunged up, eating a few prunes is not going to help. The pain is unbelievable and at least a suppository beats cutting one's own guts open to remove the offending blockage. Yes I had contemplated that as a last ditch thing.

Shoulder operations involve pain. I had been assured of this fact and luckily the team looking after my well being had provided me with enough chemical means to combat pain to a very good extent. The positives out weighed the negatives but if anyone is steered away from the abyss by being forewarned and therefore prepared, the bullet you have dodged is indeed silver.

One armed and dangerous

The operation got under way at two o'clock. My last memories were from shortly before.

My anaesthetist had given me a block whereby local anaesthetic is injected in and around the area where  the nerves that control the arm.are located. This ensures the arm is numb for at least twelve hours. If it works that means little or no pain in the immediate post op period.. Yahoo!

I woke in my room with a dead cold ham on my chest. Aargh! I had not felt I needed to stand out from the crowd by advising them I was pretty much vegetarian but was this some kind of sick joke?Could my family or workmates have planned such a prank?
Well the cold ham turned out to be my own "dead"arm.  Quite disconcerting in some ways but the lack of pain was great. I too felt great. The arm slowly melted after twelve hours but was still pretty dead at the eighteen hour stage. Wow!

I rearranged the bed slightly to get into the recommended half sitting beach chair position and arranged a pillow to support my injured arm at the elbow. Next of course I texted my wife to let her know all was well. I had "banned" her from hanging around for the operation and then being there afterwards, Dozy patients after surgery are hardly the life of the party and we live an hour out of town and have animals to care for. She would come the next morning to collect me.

There is no point recalling in a "My Diary" sort of way the events of the night or of the morning. However I will note a few points I think are of interest;

• A nurse came to see me regularly with pain relief even though my arm was good. This was to help my body get on top of the pain before the block had worn off.  They were important to have even though the need for additional pain relief at that time was not there. " Drink plenty of water. These medications can cause constipation". So I did refilling my drink bottle from the tap throughout the night. I had a reasonably fitful night but hey, who cares? I had time off to recouperate afterwards, I had my MP3 player loaded with music to listen to and good headphones, I had TV and the sport was on, I had a pen and paper and the desire to learn to write left handed legibly. What more could I want? I got up regularly for more water and to go for a walk around the ward. Exercise gets the blood flowing and helps reduce any chance of developing a clot. It also meant I could make myself a few cups of tea. Luxury!
• Unfortunately hospital food fills a hole but I would hardly say it is overly nutritious. Frozen vegetables boiled to death, they always seem to do that.. But we are in a hospital not a hotel. This is always to be remembered. If there is a next time, I would have packed some fruit and a few snacks. The importance of this will be revisited at a later time, and I was totally unprepared for the consequences!
• Always check  or ask what treatments you are being given. It keeps you involved, it is another check the medications are correct and seriously, you need to have some responsibility for your own care. The medications I was given this time were all correct and in line with exactly what I had been told to expect. However,when my last nurse of my total visit mentioned something in passing, it had never been noted on the notes for my admission that I had a coronary stent in place. She was gobsmacked and as I said, have some responsibility for yourself. It might really pay off.

• Pain

• Importance of Controlling Pain

  Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families. Continuous, unrelieved pain activates the pituitary-adrenal axis, which can suppress the immune system and result in postsurgical infection and poor wound healing. Sympathetic activation can have negative effects on the cardiovascular, gastrointestinal, and renal systems, predisposing patients to adverse events such as cardiac ischemia and ileus. Of particular importance to nursing care, unrelieved pain reduces patient mobility, resulting in complications such as deep vein thrombosis, pulmonary embolus, and pneumonia. Post surgical complications related to inadequate pain management negatively affect the patient’s welfare and the hospital performance because of extended lengths of stay and readmissions, both of which increase the cost of care.
  Reference: Chapter 17Improving the Quality of Care Through Pain Assessment and Management
  by Nancy Wells; Chris Pasero; Margo McCaffery.from the book:Patient Safety and Quality: An Evidence-Based Handbook for Nurses
• Pain needs to be assessed. There is no pain-o-meter or something that can be placed under the tongue to determine the amount of pain someone is experiencing. Patients can assess their own pain as they are often asked to do." Given that unbelievable pain is 10 and no pain is 0, what number woudd you give your pain?" However people perceptions of pain vary widely as do the perception of the nurse taking the information. It is not hard to see when someone is in real and severe pain but after that it comes down to a personal analysis which gives rise to error. There have been a multitude of studies into pain relief. These studies and others suggested that when patients had moderate to severe pain, they had only about a 50 percent chance of obtaining adequate pain relief.
• So back to me. Remember this is all about me. I had been warned shoulder surgery is painful. My clinicians were aware of the fact and I had the block just prior to surgery to give me a good amount of post surgical pain relief. They started oral medication when I was yet to be sore to ensure they were on top of the pain before any chance of breakthrough pain raised its ugly painful head. I was provided with a script for some reasonably powerful pain medication to last me through my first days at home. To be honest, there was pain but it was manageable. I have had back surgery previously and compared to back pain this was a walk in the park! Don't worry your body lets you know pretty quickly when it doesn't like something but change what or how you are doing something, obey instructions, do as you are told with post op exercises and take your medication as advised and you will be fine.
• However, nothing could have prepared me for what happened next. I thought I was going to and I wished almost that I could, have died.