Saturday, March 20, 2010

Pain In Perspective

Being home from the hospital less than 48 hours after having facial surgery involving two incisions, two titanium plates, and two or more screws (I didn't inquire about the quantity of screws), it just doesn't seem right that I hurt everywhere except where I had surgery!

This additional pain started to kick in Friday afternoon when I awoke from my 2nd nap around 4:00 PM. It increased throughout the evening and into this morning. The worst of it was this morning when I was trying to get myself out of bed. It was dark outside and I had no idea what time it was. It hurt so much just trying to raise my head and turn it in the direction of the clock that I decided it just wasn't that important. I needed to urinate but not "like a horse" as the saying goes.

It seems like I spent a good 20 minutes just devising a strategy about how best to pull myself out of bed. Getting one leg out from under the covers was a nice start. Then the other. Then getting my right leg off the side of the bed and slightly turning my body so I could put one hand on the dresser to use as leverage. This was not easy.

I remember the surgeon telling me to not be a "couch potato." He wanted me to be active and to practice getting my mouth open nice and wide. What is odd is that I don't remember anyone telling me about the possible side effects of general anesthesia, particularly when these side effects are far worse than anything I have experienced since being hit by a car while riding a bicycle in the late 80s -- an experience that sent me head over heels onto a street, flat on my back, and subsequently left me bed-ridden for about 2 or 3 days, despite the fact that I walked away from the accident feeling fine. Apparently, the quickest method of recovering from this anesthesia hangover is to drink lots of water and flush out all the nasty residue.

I have a very clear memory of the pre-op meetings with various nurses on Thursday evening. The guy who was setting up my IV drip might have given me something to lay the foundation for the general anesthesia. I only suspect this because he said something along the lines of "welcome to Margaritaville" as he was injecting it.

Things started to get a little funny after that. I remember my surgeon showing up and asking me if I was ready. I remember a nurse saying that I wasn't going to remember or feel anything, and they were going to give me something else to make damn sure I didn't even remember getting the anesthesia -- some kind of memory eraser which would backtrack for extra insurance. But then again, at this point I could have been hallucinating the whole damn experience.

I remember being wheeled on my bed cart to the surgery room. Someone said I'd need to be transferred from that bed onto the surgery platform thingey, and if I was involved in that transfer, I sure as hell don't remember it. I remember someone slapping those monitors on my skin and that may have been the last of my memories while my body was comprised of the same parts as it was when I was born into it.

I always thought anesthesia would be like being awake and having a memory and then it just stops at a certain point. In fact, there was a big fuzzy area that may or may not have been reality. There were conversations that I'm pretty sure were not reality. And then, as if no time had elapsed at all, I was being awakened and it reminded me of waking up about an hour before landing after a long 9-hour flight to Europe in which I slept maybe 3 hours after two glasses of wine.

The surgeon was speaking to me. Probably said something about the surgery being a success. I may (or may not) have asked him if he had to do the bone graft. He may (or may not) have answered me. I may (or may not) have asked to look in a mirror. And then I have absolutely no recollection whatsoever about being transferred back to my room. I have no idea how I got into a standard open-butt hospital gown vs. the warm and cozy Bair Paws gown filled with warm air and wind speed of my choosing.

I do remember the doctor telling me I would be staying overnight, that txrad had shown up, and was told the surgery was successful, but that he could come fetch me in the morning. Prior to the surgery, I had been adamant about being sent home the same day, and that was a possibility, but I also knew that with my surgery being moved from early morning on Friday to Thursday evening, it increased my chances of having to be in the hospital for a night. But honestly, at this point do you think I cared? I was quite happy to not be going anywhere.

The nurse was hooking me up to a blood pressure monitor and an IV drip, as well as that thingamabob they clamp on your index finger to measure something... pulse? She turned out the light and left me to rest. The beeping of devices continued throughout the night with the occasional boa constrictor on my arm checking my blood pressure. I'm guessing that happened every hour.

Around 11:00 the nurse came and refueled my drug stash. She came back around 2:00 or 3:00 to deliver another round, and to remove the blood pressure & pulse monitor.

"I'm going to miss that thing," I said, referring to the blood pressure device. Then the real drama kicked in. I woke up a short time later, and this time I was relatively awake for the first time since surgery, and I needed to pee. Immediately. I'd been getting IV liquids all night and I'd been sipping water frequently.

I got up and started trying to figure out how to get in the bathroom. My IV was attached and because it was hooked to a machine regulating the delivery which was plugged into the wall, I couldn't just wheel it into the bathroom. I started trying to figure out how to call a nurse. I grabbed the phone and dialed zero. It rang and rang. At this point I was seriously about to break out in a cold sweat when I noticed a cord on the floor. It had the red call button for the nurse on it. I don't remember what I said he she answered. I think I just said "help."

I swear I think I had to get up to pee about 6 or 7 more times before morning, but at least after the 2nd time, I had become a pro at pulling the IV tube out and going to the bathroom without needing to wait on a nurse, even though they were quick to respond. I think 15 seconds was about the longest I ever waited, but it was nice to get up and do it myself without having to rely on anyone, even though I was paying for the full-service.

The red button did come in handy a bit later when I called to have some more drugs delivered. Now I may have been totally out of it, but I swear my mind was like a Swiss watch when it came to establishing the drug schedule, and by the end of the night I was giving them a 20 minute heads up that it was almost time! I think I had 3 different nurses on duty during the course of the evening and I sure as hell wasn't going to let any of them get lax on me when it was time to put the party favors in my IV drip!

It was around 7:40 Friday morning when breakfast arrived. I had been sleeping like a baby on a water bed when it was delivered. I saw a cup of yogurt, a big glass of milk, a small glass of apple juice (at first I thought it was a urine sample which had been put there by mistake), and finally, a mysterious entree on a plate under a stainless steel cover. Visions of scrambled eggs and pancakes were dancing through my delusional head as I lifted the cover to find a bowl of oatmeal. Ahh, yes. Silly boy, you're still on a liquid diet, remember?

This was the first food I'd had in 23.5 hours. I put some of the brown sugar in the oatmeal and sucked that bowl dry through a straw. Then the apple juice. Then the yogurt, and finally I leaned back on the bed, clutching the glass of milk, savoring each sip. Just as I finished, the next nurse on duty arrived at promptly 8:00 to inquire if I needed anything for pain. I let her know that last dose had been brought in around 3:00 and that yes indeed, I did think it was time for another round, on the house.

Unfortunately, I wouldn't really get to enjoy sailing away on that round. From that point until the time I left, it was like a non-stop visitation experience. My surgeon popped in to see me and removed the fat wad of gauze he had stuffed between my cheek and gum which was now soaked in blood and breakfast.

His assistant stopped in to see me right after he left, and then the nurse from my ER visit on Tuesday night popped in to see how I was doing. Another nurse came in with some souvenirs for me to take home, and then txrad walked in just as I was thinking I might get a few minutes more of sleep.

The nurse returned to unhook everything and I said, "I hope I got the bulk of the drugs that were in that IV." Probably not terribly original, especially since this is Austin, Texas, but she grinned ear to ear nonetheless.

My surgeon's assistant had some prescriptions for me which she called in to the supermarket pharmacy close to our house. One is an antibiotic horse pill I'm to take twice a day for a week, and the other is a pain pill. I think it might be the pill form of the liquid pain med I was getting through the IV. Or close enough. It goes by the name of Lortab 7.5 but it's basically like a turbo-charged Vicodin.

Yeah, baby. Yeah!

I took one of those puppies last night about 8:00 and was ready to hit the sack by 8:30. I had some pretty elaborate dreams about being at a flea market. Sounds mundane, but imagine a flea market being run by David Lynch and Dennis Hopper. Also my silver neckchains were turning into metal snakes.

Anyway, I think I have digressed. I was talking about pain. I've never thought I had pain tolerance. I have managed to get through 49 years of life without any surgery other than wisdom teeth removal, never had to deal with a lot of pain, and certainly never broke any bones. I have looked around me at people going through surgeries, some multiple, some life-threatening, and I wonder how they do it. I have always been in awe of such people and never imagined I'd ever be in that group.

I'm not sure how I was able to come back in the house on the night of March 1st, after I fell and busted all this shit up, wipe my face off, and go to bed. And SLEEP!

The next morning when my doctor referred me to a surgeon and told me I was probably going to need an operation, I was mortified. On March 5th when I saw the surgeon for the first time, he suggested that we wait a week for the swelling to go down, and then re-evaluate. He thought it might not be necessary, or if it was, it might only involve an incision through my mouth, and a worst-case scenario might involve multiple incisions. I chose to focus on the "no surgery" possibility because I'm a wimp.

A week passed and as I went for my follow-up, I had come to terms with the inevitability of surgery, but was still hopeful I could get by with just one incision in my mouth, but the doctor seemed to be thinking this would be two incisions minimum. And if my lower eye socket was severely fractured, it could involve a bone graft! I was just shocked by all this since I'd been relatively pain-free thus far. Sure, there was some discomfort, but constant throbbing pain had been dealt with effectively by taking ibuprofen.

Then the following Tuesday night during dinner when my jaw locked up on me, I was entering the proverbial World of Pain. Aside from feeling like a rod had been jammed into my jaw bone preventing me from closing my mouth, I had throbbing pain like fire shooting down my throat when trying to swallow. It was bad enough that for the first time in my life, it was ME who initiated the call to my doctor, and it was ME who told txrad I needed to go to ER.

And then things would get even scarier. While in ER, my surgeon asked them to go ahead and do another CT scan. Apparently the one I'd had done two weeks earlier hadn't been great quality. He viewed the scans on Wednesday and called me. My injury was worse than he thought.

When I went in on Thursday afternoon for my pre-surgery consultation, he told me this was one of the most complex breaks he'd ever seen in his 20 years of experience. It was not going to be an easy fix and there was a possibility he wasn't going to be successful. In that case, he told me he'd send me to Dallas to the surgeon who trained him two decades ago.

I feel the same about mistakes as I do about pain. I try to avoid both. But when I make a mistake, it might as well be a whopper. I was starting to wonder if my little excess tequila incident and falling on my face hadn't turned into the biggest fuck up of my entire life. How did one little drunken incident at home on the privacy of one's own patio turn into a rare injury not seen by a specialist with 20 years of experience?

My surgeon was reassuring though. He said, "If I didn't think I could fix this, I'd just send you to Dallas right now. But I want you to know it's going to be a challenge."

He then had me initial several pages of forms which outlined potential issues caused by this surgery, including blindness, if the surgeon happened to get a little too jittery with the knife around certain nerves. How I maintained my composure during that meeting, without passing the fuck out, is beyond my comprehension. This was escalating into all my worst fears being rolled into one tight little package.

But I hadn't come this far just to change course. It was now at the point where I had to continue with him and invest just a little more faith, and roll all my dice that night, or start over with a new face in a new city, a few days later.

I had a level of comfort with my surgeon, a bond which allowed me to understand what he was saying even if he didn't say it. When he said, "I know you can't open your mouth wide, but when you're under the anesthesia, I will get your mouth open wide," I was hearing this: "I am going to pry your pie hole open so wide it's going to make the corners of your lips crack and bleed, and you better know this is true." And I was OK with it. I needed to get fixed and this was the guy I trusted to do it.

Now the ball is mostly back in my court. That cheek bone, even with the plate, is going to have a tendency to go back where it was unnaturally if I don't work on stretching my mouth open in the coming days. It is my responsibility to get it moving again, to get it flexible, so it will heal normally as desired. That may be a bit more pain, but I have to do it.

Now is not the time to sit back and tell myself the worst is over. It is over as long as I do my part and with a bit of luck I guess. Just a little more pain isn't too much to ask when the alternative is an overnight trip to Dallas.

And for a replay of surgery no less.

[Note to my friends in Dallas: just kidding! Dallas isn't THAT bad.]

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