Saturday, July 9, 2011

Day Two-My kingdom for some ice chips

Much like when you start a new workout regime, day two (and sometimes three) after a surgery are where you feel the worst. Its normal. Your body is adjusting, the anesthesia has mostly left so sleep may not come as easily and you aren't quit as numb. You are likely on less medication so the pain shines through a little more. And in the case of kidney donation, they want you to get up and start moving around.
On day two I was awake at about 6AM. I was getting good at sensing someone about to come in my room about two minutes before it happened so I had woken myself up. I was insanely thirsty but my ice chips had become water and the water I had consumed. I was slightly nauseous-kind of like having a slight hangover and there seemed to be pains in places I had never felt before. Nothing terrible though.
A lab tech came in at little after 6AM and took two vials of blood. I believe that was to measure my creatine and probably something else (hence the two vials). They don't tell you. They don't say much of anything actually.  They then came back at 8AM and took more blood-same two vials...I found out later that this was a mistake and the nurses had put the request into the system twice by accident (and almost a third time!) At least it was just two vials!

During the surgery your breathing slows down a fair bit because of the intubation and also the co2 they pump your belly full of (it puts pressure on the diaphram).  These shallower breaths keep the little air sacs in your lungs from filling with air. These sacs can flatten and their insides stick together like a water balloon after you let the water out. In order to get air back into these sacs, you need to do special breathing exercises using a little contraption every hour for at least five minutes. It helps your lungs fully inflate and prevents things like pneumonia and lung collapse. The deep breathing also helps get the gas in your stomach moving which can be a main source of pain post op. You basically have to blow as hard as you can into a tube and inside the contraption a ball moves up based on your effort. It wasn't the most comfortable activity for my abdomen (pillow brace or not) but the worst part initially that day was that my already dry mouth became unbearably dry (which would also lead me to cough which hurt). It was so dry that when I tried to say something, I just kind of squeaked as well.

I realized to continue the exercising and also just to feel better, I need the ice chips and or some water. I had though around 7AM that I would just wait for shift change and ask for more ice then. But no one seemed to be coming in to check on me. I was  also starting to hurt as I hadn't had any pain medication since 3AM. At about 8:15AM I couldn't take it anymore and I buzzed the nurses station. I asked for some ice chips. They said no problem.  I waited. Half an hour later, still no ice chips. I didn't want to be a pain but I was so uncomfortable. I buzzed again. They seemed annoyed and said I'd get some soon. Shortly thereafter Dr W, the nephrologist came in to check on me. He wanted to see me do the breathing exercises. I attempted but apparently wasnt exhaling deeply enough for him (I was at 1000-1500 output and he wanted 2000). I tried to tell him I wanted to practice more but really needed some water and ice chips as my throat was painfully dry. He said he'd ask someone for some and left. Fifteen minutes later my nurse showed up and I asked her for ice chips. She did my vitals, said she'd get me more pain meds and ice. I think by about 9:30 I had the pain meds but still no ice.  It showed up at 10:15. I never though ice cubes could make me so happy. I teared up a little after I got them.

Friday, July 8, 2011

Surgery Night

By the time I was back in my room post surgery and had contacted Charlie, it was after 4:30. My pain was at about six or seven out of ten. I was not on a morphine pump which I had read many donors get the option of. Instead every few hours I was asked if I wanted more. That first night they were good about asking so I didn't feel like I was ever in a spot where I was in a great deal of pain.  The surgeon gave them a range of dosage they were allowed to give me and I don't think I was ever at the top...I think 2/3 of the maximum dose was where I felt comfortable. They want to make sure you don't really hurt but at the same time aren't too slowed down my the medication. I do remember trying to email a few people and literally falling asleep mid sentence, head down drooling.  I'd jerk awake a few minutes later and continue typing the email (I was still trying to notify people and Charlie was on his way to the hospital). I don't think I said anything silly other than announcing that Righty was now enjoying her role as Chief Operating Kidney (COK).

Because the anaesthesia and the morphine so "slow you down" I had to wear and oxygen mask initially and moved to the tubes that stick in your nose after that. That was uncomfortable because it always felt like I had "junk" in my nose that I couldn't get out and the tubing made my face feel greasier. I did appreciate however that oxygen is important and that they'd let me off of it as soon as I was ready to.  They did attempt once either that first night or the following morning but my levels instantly dropped to 90% which they weren't happy with so back on I went.

I had a really uncomfortable frog in my throat from the intubation tube in my throat during surgery. The recovery nurse had told me it was normal but I found it to be quite uncomfortable, probably because it seemed to exist through the morphine bubble I was in. I wasn't allowed water (in case it made me sick) so I couldn't drink it away either.  I was however allowed to eat ice chips which did help a little and at least kept my mouth moist. It seemed so dry and when you can't drink to help that, ice chips become your best friend.

I was feeling okay if I didn't have to move. By move I mean any movement of my arms, legs or torso or any kind of bed adjustment. They brought me more warm blankets for my tummy and also gave me an extra pillow to put on top of it...its a good protection thing and also is pretty comforting. They also told me to use the pillow as a brace of sorts if I had to cough. I hoped that wasn't going to happen because i was pretty sure that would be enormously uncomfortable (pillow or no pillow).

Being on a folley catheter was kind of a new experience as well.  It's an odd feeling-well you cant really feel it but you know its there. You feel a need to urinate but then suddenly you don't. And of course you have a tube running into a bag which is hung on your bed or IV pole for anyone to see. I was told I'd have to keep it in until they were satisfied with Righty's performance (which also can be affected by morphine!). To be honest though, if it meant I didn't have to get up  or move, I was happy to have it.

That first evening I was in an out of sleep a fair bit even with Charlie there. I'd be fine then I'd tell him I needed to sleep for a bit (usually 10-15 minutes) then I'd be awake for about the same time and cycle through again.  The nephrologist (Dr. W) was there a couple of times and reminded me to stay hydrated with the ice chips and not to go to fast with them. Before Charlie left I made sure he got me two cups of them :).  My only "homework" from the Doctor was to sit up and dangle my legs once before going to bed which I did.  Getting to a seated position sucked but once I was there is was heaven because i could finally scratch my back which had been driving me nuts for hours. I was too hot in the bed and it was also nice to have the cool air on my skin.

I have to say that first night I was very well attended to by my nurse and the staff on the floor-probably the best care I got that week (I was probably most like the patients they were used to that night). The nurse was friendly, helpful and attentive.  She made sure they washed off the excess iodine on my body so I wouldn't get itchy. They were quite bedazzled by my incisions as they hadn't seen that technique before (I guess there usually is an extra hold they were expecting) so I did have another two nurse come in to see my incisions to learn (Foothills is a teaching hospital).

I don;t know what time it was (my lack of glasses meant I couldn't see the clock above my bed and my phone was charging) but it was getting dark (so 10:00 pm?) and things were quiet in the hospital.  Charlie was gone for the night and the nurse were done most of their check-ins on me.  The curtain started to move and I knew someone was heading in. I was surprised to see Dr. S on his own, scrubs and all. He asked me how I was feeling and sat down in the chair-he looked tired. He told me that my recipient was doing really well and that Leftie was doing great in its new home. Apparently Leftie had kicked in right away and was a "really good looking kidney". I was very pleased to hear that (obviously) and was surprised how emotional and relieved I felt at that moment. After Dr. S left,  I fell asleep quickly, sleeping soundly through most of the night (even with the every four hour vital checks).

Thursday, July 7, 2011

Confidentiality & Communication

Before I get into describing my recovery at the hospital and after I was home, I'm going to take this opportunity to talk about what I think was by far the hardest, most frustrating experience I had throughout this process. I am going to be very clear from the get go that this had nothing to do with the Living Donor program itself as they were completely unaware until it was already a problem that this was going on. The Foothills Medical Centre administration is going to take the blame on this one. I welcome an explanation from them although at this point what is done is done. Please for the sake of other non-directed donors out there, don't do it again.

There was a post I did awhile ago about the fact that there isn't a consensus on what to call donors like me. The names used so interchangeably, non-directed, anonymous and altruistic, all mean something very different depending on who you talk to. I've said before, in my mind, I am non-directed which to me means I don't have a recipient in mind for my kidney-no other expectations or meaning.  Now I totally understand it is standard  procedure to keep the donor and recipient separate prior to the surgery and to that means different wards, maybe even different buildings, keep us apart in the surgical holding pen and in recovery. Make sure sure the surgeons don't share names etc. I do think however they took it a step too far with me.

As I mentioned when I posted about my admission, I was forced to sign a confidentiality brochure on arrival to my room. It didn't really outline effectively what that would mean specifically in my case nor was it explained. I thought maybe it was kind of like when a celebrity checks into a hotel, they give a code name that people could reach them by. No, not really. It meant that if anyone inquired about me by name, I would not exist in their system.But even that wasn't explained.

Now why was this a bad idea? Here are some of the reasons:

Flowers:  I couldn't get any because I didn't exist and I couldn't tell people I couldn't get any because I didn't know ahead of time that I wouldn't exist. In fact it wasn't clear to me until about 3 days in that not only were people not to send me flowers but it was somehow my fault if they did and I was really causing problems for the hospital. the day after surgery, I was up for my first walk around the floor (sleepy, unstable and hurting a bit).  I walked passed the nurses station. A nurse there said "Brenda!" in my direction. Christian, my walking partner said "Do you mean Lauren?" She waved her hand dismissively and continued "Do you know a Jamie?!?!".  I was confused at best. Christian let her know that was my brother in Texas.  She reached behind her and produced a pretty little flower arrangement with a bear attached. "I have no idea how these got through.  You shouldn't be getting flowers" and thrust them at me. I felt like a 5 year old that had done something wrong. We continued back to my room, perplexed, trying to figure out what I had done wrong. No one asks to have flowers sent? I felt terrible that I was somehow making waves. Over the next few days I received a couple of texts and emails from other people and a flower store trying to confirm my existence and where I was exactly because they were being told I wasn't a patient. I realized my brothers had gotten through because I happened to have told him in passing the night before my surgery when he called, the number and name of my unit. The florist had called him about my non-existence (all the way in Texas!!) and he added that information to see if that would work. Two other arrangements made it through because people managed to text me and find out what ward I was in and that was the secret handshake required (I guess).

Visitors: a couple of days after my surgery I had a surprise visit from another non directed donor who lives in town. I had met her a month before my surgery and she decided to show me some support by coming by for a visit. I was lying in bed and the angry flower nurse came in and asked me if I knew "Cindy". It clicked who she was talking about and I said yes.  She looked more irritated and said she'd go and get her then. After the visit was over my regular nurse came in and informed me (I think this was 3 days post surgery?) that I'm not really supposed to have visitors because of the confidentiality agreement and I would need to provide them with a list of anyone who might visit me (and by the way I had to supply the paper). If they weren't on the list, they wouldn't be allowed in. I'm sorry...did I do something wrong? At that point to for the record, I had had the 3 visitors-Christian, Christian Jr. and Cindy. 

Communication fail & where they got lucky: Because Christian was at work for a portion of surgery day, I had asked several medical professionals along the way if he could be called when I was out of surgery (around 12-1PM MT). "No problem" I was told repeatedly. That has to be fairly common right? I had even asked about this before being admitted so I could put a plan in place for Christian to call my mother in Ontario so that she could relax and also share with other anxious people. He could then also be at the hospital around when I was back in my room. Except for whatever reason, no one called him. I don't think that had anything to do with the confidentiality agreement and everything to do with the trauma ward not wanting me there. By 4PM MT, he hadn't heard anything. He was getting anxious and thought about calling the hospital but opted instead to just start driving there. Had they needed to switch my room or even ward, it may have been an issue for him to find me without jumping through hoops.  My mother, frantic in Ontario, was also in the process of looking for information to call the hospital. Imagine if she had called and was told I didn't exist? They got lucky here because just before several  frantic people were about to call/arrive (and find out I didn't exist) because notification was long overdo, I contacted them. What you ask?  You called them? But you just had a kidney removed?

I got back to my room, barely awake and asked the nurse if Christian had been called, assuming he'd be there any minute. She said no and just kind of shrugged. I panicked. She didn't offer to call and was working to get the chart station set up in my room. Despite the fact I was in pain, groggy and as high as a kite on morphine, I asked her if she could get my iPhone out of my shoe in the closet. I managed to send Christian a text "I am in my room. I am OK. Please call my mother". I think sent an email out (I had a draft saved) to a slew of others here and in Ontario, so that they would know I was alive.

Keep me separate from the recipient-fine.  But only people who know me know my name and they would be the only ones asking about me.  The confidentiality agreement made things stressful for me. I was pretty forcefully made to sign it with no explanation. I was treated inappropriately by select hospital staff for "undermining" it. I worried that people were sending me flowers and were worrying when they learned I didn't exist. I felt bad. I felt even worse when I got flowers-guilty. I worried about potential visitors to the point I emailed a few good friends and told them not to bother coming if they were thinking of coming. Did I need to worry about that? No. Did I need to feel like some kind of dirty secret? Absolutely not. It was not necessary and was not fair. Patients need support and sometimes that support isn't planned or on a list.

It's funny but the admitting instructions said not to bring cellular devices. However the living donor coordinator told me its fine if used responsibly. Had I not had my iPhone, the lack of hospital contact post surgery compounded by the confidentiality agreement would have been a lot worse. Which mean that unless the right people in charge learn from this, it could be pretty tough on the next donor in my shoes if they leave their smartphone at home.

Wednesday, July 6, 2011

The Surgery

A rough idea of the table
Obviously I was asleep for this part of the story (and I recall having some really good dreams-it didnt seem like I was asleep that long). I'm about to get a little nerdy and borrow heavily from the internet as to what occurred when I was asleep. It's too bad I don't have access to the fancy doctor site Dr. S showed me because it was clear and concise in its explanations. I'll try to simplify some of the surgery highlights. There is also a video here "not-so faint of heart". I haven't watched it yet but I am sure its interesting. It's important to remember that the steps involved in the surgery are plus or minus what is done, but that at various stages every surgeon would do things a little differently. Even the incision points can vary.

The Surgery

A warming blanket is placed on the patient to maintain core body temperature. The patient is positioned carefully for optimal surgical exposure (in this case on my right side and the bed itself curves-see photo), and IV antibiotics are given prior to surgical incision. IV hydration is critical to optimize blood flow to the remaining kidney; so normal saline is administered to maintain adequate hydration. A cathedar is inserted and urine output  is carefully monitored.

In my case, two small ports were used-oner in the upper abdomen and the other in the lower abdomen, closer to hip level. A third, longer incision about 6-7cm long was made about 1cm to the left of my navel. They pump your abdomen full of CO2 to create more working space (pciture your belly growing to about the size of a 5-6 month pregnant woman).

The left-sided approach avoids the need for liver retraction and often provides a longer renal artery and vein (so its easier-they have more to work with). They basically get the kidney to a point where it is easily accessible. And then they pause. Using the laproscopic equipment, they move the other surrounding organs "out of the way" tying them back somewhat (the spleen, the colon and any other nearby friends).

Dr. S told me that at that point they put me on hold for a bit-upwards of an hour. The recipient would be in a likely adjoining room. Their surgeon(s) begin the process of getting their patient ready to receive the kidney. Truthfully I am not sure what is involved there. The reason for the pause for the donor at this point is that they need to make sure while doing the preparations on the recipient , no other medical/surgical issues arise that would put the transplant in jeopardy. For example if the patient is reacting badly to the anaesthesia or is having heart issues, they don't want to take my kidney out and then not have the ability to complete the transplant. So they get me ready, then get that person ready, assess everyone is doing okay and then take the donor kidney.

Once the go ahead is given, the donor surgeon works to detach the kidney from things like the adrenal gland, the bladder and eventually the renal vein and artery (in my case I just had one of each so it was easy-peasy and "unremarkable" according to Dr. Y). A special vascular stapler is used, freeing the kidney for removal.

It basically sounds like they then insert a bag using the scope into the larger incision at my navel-the bag springs open, they scoop up the kidney and pop it out, all contained in the bag. I assume at that point they put it in some kind of container and take it over to the recipients operating room where the rest of the magic happens.

At that point they check for bleeding and using dissolving sutures/stitches close up the small ports and the larger incision. On the surface they use steri-strips (aka butterfly stitches) which are essentially little pieces of tape that hold small wounds/incisions together as they heal.

After that, the patient is moved from the table back to their hospital bed (this is where I woke up-I remember it pretty clearly) and off they go to the recovery room. There a nurse monitors the patients vitals, administers pain medicine if needed (it was but not terribly). In my case, she reminded me to keep breathing a few times, but not the "special fancy yoga breathing people do these days". At first I didnt really like her-she seemed kind of gruff but after awhile I realized it was more that she was trying to make sure I was okay and that you have to sound gruff when you are reminding people to keep breathing.

The pain, as I mentioned, was definitely there but not horrific. It was more discomfort-an achy pull on my left side. The upper small incision hurt the mist. My stomach felt bloated and looked large. I wasn't in a ton of pain unless I had to move. Case in point, my favourite part of the recovery room was when they needed to do a portable chest x-ray which involved sitting up straight so they could get a panel behind me while I was half asleep. Even with one or two people helping get me up, it really sucked. My abs raged at me. It was thankfully over in no time and once I was back lying down the pain subsided. I am not sure if the x-ray is standard or if they had a particular concern with me. I know they want to be sure your lungs don't collapse because of pressure on your diaphram from the gas they pump in. Anyway one thing I did find very helpful with the pain were warm blankets they put on my stomach-a definite must have for anyone getting abdominal surgery.

Overtime I became more alert although I was still struggling to stay awake. Every time I'd glance at my recovery nurse she'd ask what I needed. I told her I was just looking at her and she told me she is there to watch me not the other way around. I think I called her a lurker. She at least laughed at that. Soon thereafter she made a comment that I was ready to go back to my room and that they needed to make room as there were a "lot of kidney flying around today). They moved me to a different part of the room to wait for purple porters. The nurse did one last check to see if I needed anything. I said I didn't. She smiled, adjusted my pillow a bit, leaned over and whispered "You did a really wonderful thing you know". 

 I thanked her and fell asleep.

Tuesday, July 5, 2011

Surgery Day-Time to Go Under

I waited in the "holding pen" outside the operating rooms for awhile before anything new happened.  It was pretty quiet excpet for the occasional murmur of a patient to their family member or when my IV would start to beep. I figured out quickly if I put my arm on my stomach vs flat on my side it would do that and the whole room of blurry faces would look at me. About 10 minutes after my purple porters left, another pair of purple porters brought in a patient (in a bed!), maybe a bit younger than me who was sobbing and quite distraught. I assume because of her emotional state, she had two family members with her. It definitely changed the mood of the room as people around them struggled to not look. Everyone got a lot more quiet. I realized in looking around that aside from the man who questioned my bed arrival, everyone else in the room had a spouse, a mother or a daughter with them. It made me feel lonely and I was kind of mad at myself for not insisting Christian be there or asking my Mom to find a way to fly out for the week.

It seemed like 7:30 was the magic time as suddenly it stopped being a room full of patients waiting and became a frenzy of surgeons, anesthesiologists and nurses rotating in and out. It was a little weird to me that I could listen in and know exactly what everyone else in the room was having done, from gall bladder removal to tendinitis repair. I knew peoples' names, dates of birth and in most cases, the names of the people with them - not something you are used to in this day of privacy sensitivity. I guess they assume whatever drugs you'll get will make you forget what you heard?

My anesthesiologist came along first. She had a series of routine questions-some pertaining to the anesthesia and some of the standard health ones I've been asked a trillion times. She at least had a sense of humour to acknowledge that. She asked me what I was having done. I kind of giggled because I knew I probably wasn't supposed to say out loud what it was and that she wasn't supposed to ask. It actually felt good to say it out loud instead of being the dirty secret it had been for the last 24 hours. No sooner did she go than I saw a vaguely familiar blurred face. It was Dr Y. He just came over, patted my hand and said hello. Thankfully no more questions. He asked if I had any - of course I didn't so he patted my arm again and told me he'd see me in there. A  little while later an OR nurse came to introduce herself. She apparently knew the top-secret-drill so she pointed to a document on a clip board and said "is this what you are having done" and raised a finger to her lips as though to remind me it was a secret. I laughed and said "I guess so but I have no idea what you are holding up". She pointed again at one line-the document somewhat resembled the consent form I signed the day before but I still couldn't tell what she was pointing to. I explained I was as blind as a bat without my glasses or contacts. She got a little was kind of like watching an odd game of charades - I could tell she wanted to blurt it out but couldn't. She thrust the clipboard right in my face and I said yes, that's what I'm doing. She sighed with relief. Who knew my crappy vision could almost wreck the whole anonymity scheme!

The nurse started to push my tank of a bed towards the hallway leading to the OR. I think the bed and I weighed about 4 times what she did.  She got some help from another worker and pushed me the last 10 ft to the outside of the OR. We quickly all realized (at about the same moment) the new beds from McCaig are too wide to negotiate the sharp turn from the hallway into the OR door. Bump bump bump we went against the door frame. The anesthesiologist looked on curiously from the room. "You know..." I started. The nurse finished my thought "You could maybe get out of the bed and walk into the OR?". The anesthesiologist laughed and said "she's the healthiest patient in the hospital right now - I think she can". So that's exactly what we did. Bum hanging out and all with the IV in tow, I jumped off the bed, walked 8 ft and climbed onto the operating table.

I settled in an looked around.  I was surprised how small the room was and how much "stuff" was in it. Carts of supplies, a ton of just seemed cluttered. I watched people buzz around me, checking wires, hooking me up to machines. They had to start an new IV as the other one had failed so they set to work on that. They seemed anxious to have Dr. Y come back and do some kind of protocol briefing speech about what we were all doing there. Suddenly he appeared, did the speech, pulled my gown over a bit and drew a mark on the left side of the abdomen-either a smiley or a Y, they weren't sure.

The anesthesiologist let me know she'd be giving me stuff to make me relax in a couple of minutes. And that is when I panicked. A little part of me wanted to stand up and run out of there. What the hell was I doing? What was I thinking? I was scared, I was worried and suddenly very uncertain of my choice. I took a few deep breaths and tried to remind myself that this was a good thing and that I would be fine. And that whatever was going to happen, would. I had to trust these people. She put the mask over my face and told me to breath normally. I waited a few minutes for the part where I was supposed to count to 100 - it didn't come.

I don't even remember falling asleep.

Surgery Day-Ready, Steady-GO!

One of my porters...ok not really.
6:30 AM. The sun was up (it was still overcast but definitely light out).  My teeth were brushed, my face was clean. I had been told I'd get about a 10 minute warning that the porters were on their way for me, likely around 7AM. I was thirsty and pretty hungry. I was still in my pj bottoms with my shirt from yesterday and my bra half on. I was feeling a little tired which I think was helping with my numbed calm feeling.
I was considering calling my Mom or Charlie when the curtain by the door of my room started twitching. Two ladies came in. I recognized them as being nursing assistant or something. The told me someone would be coming to get me soon and and asked if I needed to use the washroom or anything before they locked me up in the bed. I said I did and started to get out of bed.  it was at that point that one of them noticed what I was wearing.

"Why don't you have a gown on?" one of them asked. "because no one has given me one yet". They seemed concerned with this and one hurried out of the room to get a gown. She came back and handed it to me. I gestured towards the IV tubing and asked her how I was supposed to get the shirt off with that on.  She seemed more irritated and said she would go get a nurse (they are not allowed to unhook IVs I guess-makes sense). Within moments the nurse rushed in, quickly unhooked my IV and I scooted into the washroom to suit up. I forgot how complicated hospital gowns can be! Its amazing how quickly you can feel inept trying to get one on. I was amused to see that the "designers" of gowns have still not figured out how to adequately cover the butt region.  One day they will get it I'm sure!

No sooner was my half covered butt in bed when the porters showed up. At Foothills they are all dressed in the bright purple that made me envision two Barney the dinosaurs pushing me down the hall (remember I was a little tired). I giggled outloud but I don't think anyone noticed. There was some commotion as to where my chart was, who had it and who was going to get it.

This was the moment in my hospital stay where I think I ceased to be Lauren, the person, and suddenly became a nameless patient. The purple porters looked right through me. They conversed over me like I wasn't there. Just as we were about to leave the room,  the louder, more flamboyant one of the two noticed I had my glasses on still. She said to the other porter "Wait - I have to take the patient's glasses of so they won't get lost". Once she had done that, off we went. The bed was pretty large and I can only imagine it was heavy...they struggled to steer it around a few initial corners.  I felt a little strange having two women push me in this giant bed, especially knowing we had a fair distance to go. The OR area I was heading to was on the 7th floor of the main building. I was a little surprised to see there wasn't a patient tunnel or something between the buildings and that patients were transported through that same bridge walkway I had navigated the day before.

The purple porters got better with the steering as time went on. I hated not being able to really see what we were passing, the faces of people we passed or where we were going.  I think there should be a way patients can wear their glasses to the OR. Anyway we eventually made it to our destination.  I was wheeled through a large set of doors into a holding type area where there were about 12 chairs, sporadically filled with patients and loved ones. There was room for two beds. They parked my bed (of course not saying anything to me) and a nearby patient in the chairs asked me why I was so special that I didn't have to walk in like they did. I just smiled and shrugged.

I saw the the purple porters had headed over to a sort of office area with a window.  it looked like some kind of coordination office for the operating area. The louder porter told the lady behind the window that I was there (referring to me by ward and room I believe) and that she was going to get other patients that were next on the list, identifying them in the same way. The lady behind the window quickly told her she couldn't do that yet, not for about another 30 minutes. I thought I heard her say something to the effect of me needing to be gone. I figured they must be talking about my recipient. In a donation like mine we need to be separate ahead of time lest someone change their mind and because of course they want things to be anonymous. If I wasn't sure they were talking about me I certainly was once they all looked over at me at once-hello!! I can see you staring (sort of...blurry but still)! It was a weird feeling being talked about like I wasn't there or I couldn't hear. They nailed down their patient logistics, wrapped up the conversation and off they went.  I tried to get comfortable and waited to see what would happen next.

Sunday, July 3, 2011

Surgery Day-Morning Pep Talk

I had a very solid sleep for half of the night before surgery. I was sleeping deeply enough that I really didn't care when the night nurse came in to check vitals. I let her do her thing-very unlike me as I am usually a light sleeper who doesn't go back to sleep easily. After about 2AM thought I started waking up about every 30-45 minutes because I thought I had to use the washroom. I think it was more nerves than anything.

By 4AM I was just awake.  It doesn't help when there is a clock across from your bed starting you in the face. I stared at it for about an hour (and checked Facebook on the iPhone) and finally got up at 5AM. I washed my face and brushed my teeth (and wondered to myself when my dangling bra and day old t-shirt was going to come off). I went back and lay in bed, looking out at my great view. The sun was starting to come up. It was still pretty quiet on the floor-not much of any hustle and bustle yet. I took advantage of the calm and quiet to have a chat with Leftie (as goofy as that might sound). I read a blog, posted by the Kidney Foundation of Canada in my research of a girl whose second transplant was slow to work. After weeks of waiting someone suggested to her that she name it and talk to it, encouraging it to work. After she did that, things started working. I get that there isn't any science behind that, and the lack of logic in the scenario conflicts me but I figured I had nothing to lose and two hours to kill till they came and got me. 

I apologized to Leftie for letting him go (I kind of felt bad for some reason) but I asked him to try to work really hard in his new home, for a long time, that he needed to be strong.  I also encouraged Righty to get ready to get ready to step up and take over for him-I told her she could do it. Somewhere, the doctor who did my psych evaluation is cringing, I bet- "OMG she was talking to her organs...I asked her if she heard voices but I never asked her if she speaks to body parts!! Add that to the checklist for next time!". 

I think obviously it was more of a pep take for me anyway and another form of visualization. I've done a lot of that actually in preparation for this final leg of the journey.  I've tried to imagine what the pain will be like and have come up with coping mechanisms to get through it. For example, recently, when it was my "time of the month, I had my usual brutal cramps. The can last up to a day and I've learned how to coax myself through them. Last month, as they occurred, I made myself consider what if the pain was worse than the cramps and lasted two days instead of one. How would you handle it? By thinking ahead and picturing myself going through the recovery process, I hope it will make me more prepared for whats to come. 

I've also calculated how long and when certain symptoms will present themselves (gas, nausea, fatigue) and what I'll do to mitigate them.I've cataloged and committed to memory a list of why I am doing this and how important it is, so in those moments of discomfort or fear, I'll hopefully remember the positives and be able to keep on going. I've accepted certain truths-its going to hurt, I'm going to have to depend on other people, I'm going to look and feel gross and I've going to be put into some embarrassing situations (like being naked in front of strangers, needed bathroom help, saying something dumb whilst on morphine-needing other people in general). I think its important to think things through and imagine as many scenarios as possible so you'll be more mentally prepared for things. I'll keep you posted on that. Again, much like the conversations with the kidneys, I am not sure if it will have any impact at all but what do I really have to lose?

Surgery Eve

With visiting hours essentially over and the evening winding down, it was time for the nurses to do a few things to get me ready for the adventures of the next day. The first step was to get me hooked up to an IV to give me some extra fluids to prepare me for the surgery. My nurse came in with some warm blankets to wrap my arms in.  Apparently this makes the whole IV process a bit easier.

I've only ever had IVs for day surgery and those have always gone into my hand because of the short duration they are in. However for more substantial surgeries or length IV time, they don't like to use the hands, I think because they hurt more and the sites don't stay viable as long.Two nurses came in the room about 10 minutes after the blankets has been wrapped around my arms. After a few false starts due to missing IV parts (that they had to source from other units in the hospital) we were ready to get the job done.

Now whenever I have given blood, had blood drawn or have had the aforementioned hand IVs, I've always been told I have beautiful veins that make it easy to get the job done. The nurse on Surgery Eve made the same comment. Until she tried to find a vein in my forearm vs. in my hand or at the crook of my elbow. Basically I found out that in my wrist area, my veins weave and go deep into my arm, away from the surface making it difficult to find a good spot. They need enough of a straight portion of vein that the needle will go in before the vein curves again. We had an epic fail with one on my right arm (resulting in my hospital bracelet looking like it had been present at a massacre). She tried with the left. I have to say that I have never seen a nurse more focused and confident that she would get the job done.  She really knew what she was doing. She finally found a spot and with great determination, ripping packages open with her teeth as to not lose the vein by letting go, she got the IV in painlessly. Just as she was about to hook the tubing up to the bag of basic saline solution, the EKG man finally showed up. Apparently there were a lot of emergency patient issues throughout the hospital that had kept him busy. He did his thing (in under 3 minutes) and off he went.  The nurse finished hooking everything up and I  was officially tied to a portable IV pump stand.  I know I named the stand at one point but for the life of me I can't remember what I named it-I think it may have been Walter.

A little while later the nurse came by with the best gift ever - an enema kit. By that point she had decided for me that I would just do it myself.  She gave me the instructions, unplugged Walter and told me I could get to it whenever I was ready. I don't really feel like explaining how it works, so if you are really interested, there is more information here. The purpose of this is to make sure your insides are as cleaned out as possible so that there are no accidents while you are in surgery and also because they will be operating near the bowels it's a safety thing (in case something gets nicked). Again, I don't want to get into details but it is a very weird sensation both during and after. I wonder a little bit about the sanity about the person who came up with the concept of enemas. It doesn't hurt and isn't overly uncomfortable-just strange.

With all of that done it was getting late.  I was actually feeling pretty tired.  I did my best to wash my face and brush my teeth. Doing anything in the bathroom attached to my room with Walter in tow was kind of amusing.  The room has a walk in shower, slightly sloped downwards from where the toilet and sink were. Walter, unlike everything else in the hospital with wheels, didn't come with brakes so he was almost always rolling away from me-there wasn't enough IV tubing to stretch the distance so I had to keep pulling him back and using my foot to prevent his travel. It was funny that first night but I wondered how it would be when I wasn't feeling fine and a lot weaker in the days to come.

I was still in my t-shirt and yoga pants I had arrived to the hospital in. I couldn't get anything off the top of me because of the IV (bra included.  I put p.j bottoms on and did my best to unhook my bra and push it aside (very classy). Not ideal but I didn't realize at the time that there was anything I could do about it (I found out later the IV could easily be unhooked by a nurse). I tucked myself in, found a good position for the bed and surprisingly fell asleep fast.