Well, here I am. Back from the hospital after a 2 night stay, with 85% of my stomach missing. I'll try and describe what it was like day by day...
Day 1 (Surgery Day):
Let me preface this by saying that I did not sleep a wink the night before surgery. Not. A. Wink. So, upon arriving to the hospital for my 7am appointment, I had already been awake for 24+ hours. So that probably added to the dream-like quality that everything had to it that day. But still, that's the only way I could possibly describe everything that happened that day. It was surreal.
Since I couldn't sleep, I decided that my husband shouldn't either, so I got him up at 4:30, and we set out from our hotel for the hospital at 5:30, even though it was only a 30 minute drive, and we didn't have to be there until 7am. At this point, I was convinced that I was probably going to die on the operating table, so I was giving my husband instructions, such as
"My wedding ring is in the change pocket of my purse. I'll want to be buried with it on."
Stuff like that. I'm sure he was amused by it all, but looking back, I can't believe I did that to my husband! (who already has some anxiety issues BTW)
So we arrived at the hospital super-early, and I tried, yet again to catch a 15 minute nap in the car. When it became apparent that even that wasn't going to happen, we went into the hospital to register at 6:30. They brought me back pretty quickly, but left my hubby in the waiting room. They weighed me (219.4) and brought me into a room with a stretcher in it, and told me to change into the gown and socks that were on the stretcher. Now, I don't know if they just see that someone is having bariatric surgery, and automatically put the XXL gown on the stretcher, or what, but that gown was huge. You could have put three of me in it. The socks were also ridiculous, they could have fit on my feet over a pair of winter boots! But I did as I was told, and proceeded to spend the next hour and a half trying not to flash everyone in the pre-op area... Then a nurse came in, took my vital signs, and did an admission questionnaire and had me sign paperwork. Then three separate anesthesiologists came in and talked to me, looked in my mouth, and asked me several of the same questions the nurse had just asked. Then another nurse put an IV in my left hand. Then, finally they allowed my husband to come back in.
We sat there and talked for awhile, and then my surgeon came in... now I know many of us bariatric surgery patients have had multiple appointments with their surgeon prior to the actual surgery day, but for me that was not the case. I'd only met Dr. Shillingford once for about 5 minutes, in January. But meeting him for the second time on surgery day, I was again reassured by his confident demeanor, and his relaxed bedside manner. Plus it helped that every other medical staff person I'd met so far that day had referred to him as an excellent surgeon. Once he arrived, that really seemed to get the ball rolling. Just about 10 minutes later, they were giving my pre-op "cocktail" (I asked, it was Versed). Then we rolled into the OR. I remember them asking me to scootch from the stretcher I was on, to the operating table, which I was able to do, and then....nothing.
Next thing I knew, I was lying on a different stretcher, in a different room, with a different gown on and someone was taking an oxygen mask off of me, and putting me on a nasal cannula (the little prong things that go in your nose). I was in a lot of pain, which I guess they anticipated, because someone handed me a little button, and said I could push it as much as I wanted for pain medication. Now, being a nurse, I know there is a lockout period, so you can't overdose yourself, so I must have asked that. They said it was set to dispense medication every 8 minutes. There was a blood pressure cuff on my right arm that kept squeezing every few minutes, so I decided to push the button every-other time the BP cuff went off. After three or four pushes, the pain had faded into the background, but by then I was becoming nauseated. Like clockwork, they asked me if I wanted medication for nausea. Yes, please! Once I had those nausea medications in, I was feeling pretty good. Good enough in fact, that when they got me up to my room, I was able to stand up and waddle over to my new bed almost all by myself... At this point, I was hooked up to two IV's, I had a foley catheter in, and I didn't know it yet, but there was a drain hanging off of the right side of my abdomen. But the only thing that was sore (and still is) was the incision on the left side of my abdomen. I later found out that's where my stomach was taken out.
The rest of that day went by in a little bit of a blur. I wasn't allowed any water, or anything else by mouth, but they did give me some swabs, and some ice chips, which were a godsend. I remember going for a walk, up and down the hallway with my hubby later in the evening, but other than that, I pretty much slept in between being asked, like 10 times, by 10 different people if I was diabetic, and/or did I need to have a CPAP machine (no, and no). And that was pretty much Day 1. And since I'm pretty wiped out, I think I'll save Days 2 and 3 for another post...
So, post-op day one for me could be summed up with one word: Nausea. Starting around 10pm the night of surgery, I began feeling like I was going to vomit, and unfortunately it never really went away... despite receiving the anti-nausea medication (Zofran) every four hours. That whole night, and into the morning was sort of a nightmare for multiple reasons.
First and foremost was the nausea, it would hit me in waves, and I would sit straight up in bed, holding my "puke bucket" under my chin, even though I knew there was nothing in my stomach to throw up. And then I would spit, burp, spit, burp, for about 10 minutes before the wave passed. Then I would put my bed back into the recline position, and fall back asleep until the next wave hit me...
Secondary to giving that whole long night a nightmarish quality was the fact that when I was between waves of nausea, and able to sleep, I would inevitably be woken up for something. Literally every hour, for the entire night, I was woken up for something or other. Now, if you've read my other entries, you may be aware that I am a nurse, and I work nights. And let me tell you, I make it my mission when working a night shift to let my patients get as much sleep as possible. Not the case here.
In her defense, my night nurse was brand new. If I'd been feeling better, I may have tried to teach her a little bit about grouping activities together. For instance, if I had medications scheduled at 12am, and 1am, it's perfectly acceptable to give both at 12:30! Vital signs due at 4am? Why not come in and do them when phlebotomy comes in to draw blood at 3am? That was just a little irritating for me. I was woken at midnight for vital signs and IV fluids, at that time, I asked if I was getting my heparin shot, and she said "No, that's due at 1am." So at 1:30am, she was back for that. At 3am, phlebotomy. At 4am, vital signs. At 5am more nausea meds. At 6am, she came and took my foley catheter out. And then at 7am, day shift comes in, so they all came in to say good morning! Aaargh!
So post-op day 2 has already started off on a sort of bad leg. My surgeon did come in and talked to me at about 7:30, and at that time, I begged him for something stronger for nausea. He agreed, and went out to order me some Phenergan. Now in this instance, it was probably good that I'm a nurse, so I know how things work. Otherwise I probably would have sat there and expected the medication to be given to me in the next 10 or 15 minutes. But no. When the doctor says he's going to order a medication, there is a process that it has to go through. He types the order into a computer. The order goes to pharmacy. The pharmacist looks at the order, and verifies that the medication, dose, frequency, and route of administration are appropriate, and also that it won't interact negatively with any of the other medications the patient is receiving. If they have a question regarding any of those things, they don't call the doctor. They call the nurse. Then the nurse calls the doctor, clarifies the order, and calls the pharmacy back. Then, and only then does the medication get verified by the pharmacy so that the nurse is allowed to administer it. Needless to say, it was nearly two hours before I received the Phenergan.
In the meantime, I had stopped using my pain button at 3am, aware that the dilaudid my very well be contributing to my nausea. So my pain was back in full force too. Regardless of that, I knew I had to walk, so I got myself out of bed, walked to the bathroom, and peed on my own for the first time. I also emptied my drain, which was alarmingly full, compared to yesterday. Then I brushed my teeth, and sat in the chair. That was how my husband found me when he came in to visit. Shortly after he arrived, they gave me my Phenergan, which does have the side effect of making you sleepy. So when they came to get me for my leak test, I was literally falling asleep while sitting up in the chair. But I wanted that leak test done, so I could get some oral pain medication, since I was refusing to use the Dilaudid anymore.
So we went down to Radiology for that.
Let me tell you, that test was by far the worst part of the entire experience for me. Everyone in radiology was super-nice, but the stuff they have you drink tastes like lemon dish soap (if your parents ever washed your mouth out with soap, you know the taste). They have you take small sips of it while standing in front of an x-ray machine, and a radiologist watches it flow through your esophagus, into your stomach, and into your small intestine. But you have to drink enough that they can see all that, and be sure none is leaking out, and also that there is no obstruction in your small intestine. I never would have been able to do it if I hadn't gotten the Phenergan prior to going. Even with it, I had to hold a puke basin in front of me, and dry heave into it every few sips. But, finally the radiologist said I had drank enough, and she hadn't seen any leaks, so I was allowed to drink water when I got back upstairs!
The rest of the day was a blur, because I was so tired from the phenergan, and then the subsequent oral pain medication (Lortab). I did walk in the hallway with my hubby after I got back from radiology, then I was told to start sipping water, approximately 2 ounces per hour. I managed to do that when I was awake, but the problem was I kept falling asleep. But I probably managed to drink a good 20 ounces of water that day. And later in the night, I noticed that my left hand where I had my IV was getting really puffy. So I when I saw that my IV bag was empty, I stopped it, and didn't tell my nurse. When she came in, I showed her my hand, and told her I didn't want anymore fluids by IV, and promised I would drink enough. Since it was scheduled to come out in the morning anyway, she said that was okay. The nausea went away almost completely after the phenergan, although I did get a small wave of it each time I took the Lortab, it was nothing compared to prior, so I never took any more nausea medication after that.
And that pretty much sums up post-op day 1 for me. I really, really slept that night, fortunately had a different night nurse who definitely is of the same philosophy as me, and lets her patient sleep, which I greatly appreciated. Woke up at 7am feeling like a brand new person!
Post-op Day 2 was also discharge day, so with that in mind, I got right up at 7, brushed my teeth and my hair (which I hadn't done since I'd been there). I got a morning "breakfast" tray consisting of orange SF jello, broth of some sort, plain decaf tea, and a Crystal Light lemonade. I ate the Jello, but have had bad experiences in the past with plain tea causing nausea, so didn't go there. And lukewarm broth just wasn't appealing. I saved the Crystal light for later.
I got lots of visits from all kinds of new people that day. The bariatric coordinator, Sandy came in and told me she was going to be there later to answer all of my questions, so I started trying to think some up. But I didn't have a pen to write anything down. Then another nurse navigator named Robert came in, and told me he was going to make my follow up appointment for me, which I thought was sort of overkill, since I am perfectly capable of dialing a phone. But I know it's his job and everything, so I told hime when my husband got there and we could look at his schedule, I'd call him. At this point, I realized everything was kind of stuck on my hubby coming to get me, and he'd spent the night with a friend in Miami the night before, which was at least an hour away. Knowing that this friend has a tendency to keep late hours, and party, I decided to call and find out an ETA. When I got ahold of him at 10am, he was just eating breakfast. I told him to hurry it up, since I thought they were preparing to kick me out.
But in reality, I still had my drain in, and was still wearing a hospital gown. So I may have been lying a little to get him in gear. But shortly after, my nurse did come in, and said it was time to pull the drain. Now this drain is something I've mentioned in passing, but haven't really described yet. If you're easily grossed out, skip the next paragraph.
It's called a JP drain, and it's like the little bulb shaped suction thingies that they use to clear out baby's nostrils, except attached to a long hose that goes inside of you (gross, I know). It's attached to your skin with a couple of sutures, and fluid collects in it. When I was first out of surgery, there wasn't much fluid, but it was all bloody. Now on day 2, it was full of more serous fluid, kind of yellow tinged. It had drained about 400-500ml of fluid out of my abdomen since I'd left surgery, so it's probably a useful thing to have, but I was sure psyched to get rid of it. So the nurse snipped off the sutures using sterile scissors, which hurt a little. Then she just pulled on the thing, and it was absolutely the most bizarre feeling I've ever experienced. It didn't hurt at all, but it was an extremely strange sensation of something moving inside of my abdomen. Maybe if you've ever been pregnant and felt the baby move, it might compare to that, but I haven't, so I had nothing to compare it to. It was just weird.
But anyway, with the drain out, I thought maybe I could take a shower. Nope... that would require a doctor's order. Okay, I played along, and just washed up as best I could in the sink, and changed into my loosest shorts and t-shirt that I had brought with me.
Around that time, my surgeon came back in with the Bariatric coordinator, Sandy, and told me he was ready to discharge me. I guess this is when I was supposed to ask the questions that I had come up with, but I didn't know that, and I hadn't written them down anyway, so I kind of blanked. So he just told me what meds he was going to send me home on (Vicodin and pepcid) and then said he would go write it up, and see me in his office in a few weeks. In retrospect, I would have liked to ask when I can start exercising, and when I can go swimming. But I am a smart girl, I can figure stuff out on my own.
Finally, around noontime, my husband showed up, and probably not a moment too soon either, because they were definitely ready to be rid of me. Almost as soon as he walked into the room the discharge nurse came in behind him, and handed me my paperwork. She definitely wasn't answering any questions. So I signed, hopped in the provided wheelchair, and was wheeled out to my hubby's car in record time. Hospital stay over! I am completely without medical supervision until my follow up appointment on the 21st! I guess I'll end this entry here, and talk about being at home, and starting purees in a later post. Goodnight!
