I Left My Lobe in San Francisco: Liver Resection Hospitalization - Vignette 1&2

I was in the hospital for six days.  Actually, I left the morning of the sixth day, and the first day I had surgery, so being an over-achiever, I am going to say recovery took me four days, with each day getting a bit easier on me.

After a day or two, I settled into a routine.  I felt really good in the morning but at 3:30 I suddenly crumpled.  The pain became intense, and I starting pushing the button for extra meds and watching the clock until I could get my next dose of dilaudid.   I don't know why it happened in late afternoons, but it did.  I was grateful (and surprised) to feel well for half the day though,  and spent my time leafing through magazines, reading the paper, playing with my iPad and chatting with my family. I got out of bed and sat in the chairs for longer and longer periods each day.    I had visits from my stepdaughter, which I much appreciated although she often came after work which was when the pain had hit and I was tired.  It was nice for my husband though, who got to leave the hospital and take her for some food.  Here's what I remember most about the hospital stay.

Hospital Vignettes


The Catheter

I was quite fearful the day they took the catheter out, which was the second day after surgery. The comfort of having a urinary bag cannot be over-estimated; I highly suggest you try it next time you feel like playing Farmville for three days straight.  Style-wise?  Well, they need some work. I'm not even sure Michael Kors could help with that, although wouldn't that be a fantastic challenge on Project Runway? "Make this catheter bag a style feature all women will want."  Those runway models have a hard enough time walking in some of their shoes; let's add a catheter bag dangling down between their legs. Now, that's good TV!    

Once I knew the catheter was coming out, and I'd have to get up to go like a normal person,  the bathroom looked like it was 100 miles away: a trail littered with bones, rocks, sand, and the puddles of those who had come before me.

I knew I wouldn't make it.

The nursing staff put a commode near my bed, "just in case" and told me to call if I needed help.   I was disgusted - me?  A commode?

Peeing near your bed like a dog?  No wait, even dogs don't pee near their beds.  Peeing near your bed like some kind of wild animal, or hoarder who can't get through the newspaper pathways?

Not on your lfe.

I guess I don't value your life much.

It's the middle of the night. (Probably 9:30).  I'm all alone and need to pee seriously bad.  Why doesn't the CIA do this kind of torture?  Hook somebody up to an IV that drips gallons of liquid into them, and then make it impossible to use the restroom?  I'd tell state secrets, wouldn't you?

Anyway,  I still had the epidural so my legs were numb and walking was impossible without help, plus unhooking an IV behind me on the wall was an issue - so the bathroom was out of the question unless I called an aide.    That night, my nurse's aide was a man:  a young, good-looking man.   I'm still old-fashioned enough not to want a hot dude to help me take a pee.

That's for old ladies.  Or fetishists.  

There was nothing to do but use the commode.  On my own.  Without anybody to hold my hand. See, I told you I was a risk-taker.

I maneuvered myself like a snake to the side of the bed and used my bad arm to push myself up to a sitting position.   It was one step to the commode but it was a complicated step - I had to put my hand on it to steady myself, pull my gown open in the back, move all the IV tubing,  then pivot and sit, all with numb legs and a stapled stomach that could spill its contents at the smallest  provocation.

But, I managed.  I struggled, but I did it!  Independence!  I was sitting on a commode!  

When you have an epidural, you can't really feel anything down there, or start or stop your flow properly - it just sort of.....happens.  Numbly.   So, I sat there for a while, hoping things would begin, imagining how it used to feel and hoping that would help, when I suddenly realized my wrinkled nude behind was facing the door, and the curtain covering the area only went to mid-back, and the light was shining under the curtain in my direction.  Anybody who walked in (and in a hospital, everybody walks in) would be greeted by the site of my skinny rear, all lit up, spread out on a commode.  And, given my condition, I would not be able to protect what was left of my dignity by covering myself. 

Now, not only did I have to worry about how to start to pee, I had to worry about somebody coming in, seeing me in that compromising position, worry about protecting my personal privacy, and then getting a lecture on taking this huge risk and peeing alone.

Who could come in?  What if it was a doctor wanting to discuss results?  What if it was the cleaning man?  What if it was a radiology tech?  Do I sit and pee have a normal conversation like nothing was going on?  Do I scream, "Get out!"  Do I just pretend like I wanted to get up and that was the only place to sit, and nothing was happening?

I was trapped.   I wanted to get this over with but while my mind was going a mile a minute, my hoo-haw was apparently in a coma. 

Suddenly......ahh....relief.  The stream started.   I was peeing like a hoarder,  right next to my bed.  And peeing.  And peeing some more.  And urinating.  And whizzing.    And suddenly, I realized that that I possibly had a lot more pee in me than that container could hold.

But I couldn't stop, my bladder was open and there was no way to shut it.

Add overflow to my list of worries.

Fortunately, I finished right in time.  The urine level was so high up that the person who later had to dump it not only commented but had to be very careful taking it to the toilet. "Wow, you must have really had to go."

Hospital personnel are masters of understatement.

Anyway, after I was done, feeling quite successful (and proud that I'd remembered to grab a tissue), I gathered myself, weakly got back up, and somehow got back into bed.  And slept, quite well, right next to a full bucket of pee.

No, this isn't me, but doesn't she look happy?

Pain Control

The first day post-surgery was a blur of pain.  Again, I have to mention how grateful I am to my family, who helped in so many ways, big and small;  from handing me things I couldn't get on my own, to talking to medical professionals, to keeping me company.  I highly recommend that if you have an upcoming hospital stay, you find one person willing to spend time with you, even if you have to pay them.  It makes things so much easier.

One big help came when my sister took charge of one of the nurses. The majority of my experience with the nursing staff was outstanding, for which I am grateful after my last experience.   This time, I was given appropriate care - with one exception.

First, let me explain: I have a theory about pain and pain medication which developed after my mastectomy/reconstruction, when I had to spend an extra day in the hospital due to poor pain management (and poor nursing care).I believe that pain control is key to recovery. The more relief you have, the more sleep you get, the more you can cooperate with the nurses when they ask you to get up, the more you can relax and let your body do the hard work of healing. When you are in pain, your muscles are tight, you can't sleep, your breathing is abnormal and it is much harder to recover.  You don't get addicted to pain medicine during in the time you are in the hospital, at least not during a normal stay, so there is no reason at all not to take pain meds.

If you wanna be a tough guy, have at it.  Me?  I'm taking all they give me.

I discovered that is not only my theory.  I was given brochures saying exactly this with my registration paperwork, and UCSF as a whole believes strongly in pain management.  Still, traumatized by my experience at Mercy General, I mentioned pain control to all of my doctors, from SuperSurgeon, to Anesthesiologist,  to Exhausted Med Student, and all agreed with me wholeheartedly, in both theory and prescribing.

The doctors prescribed IV pain meds, and told me I would transition to oral pain pills when I could eat, which would also signal to them that I was getting ready to go home.  I was not expected to eat for a few days, which is normal after somebody has rearranged and removed part of your digestive system.  I had an epidural with a button I could push for extra pain control every 15 minutes, and I was allowed a shot of dilaudid every two hours.  They said I might be in pain a little between shots and they couldn't control it entirely, but would do the best they could and not to be afraid to call the nurses and get what I needed.

That sounded fair to me.

So, my one and only male nurse came in on Day One post-surgery.  He introduced himself, and then stood at the foot of my bed and began his pain medicine lecture.  He told me that he wanted me to take oral pain medicine since it would last longer in my body, and he would not be bringing me IV meds.  I asked him what kind, and he said percocet.

As an aside, I know that percocet was not going to touch the pain that I had right then -  24 hours ago I'd been cut from between my breasts down to my waist, a major organ half removed and burned, and then sewed and stapled together. Percocet is what people take for headaches.

I was quite alarmed at his pronouncement. It was not a suggestion - he was telling me what he was going to do.  He wasn't going to come in to give me shots.  I knew I'd be under his care for at least 12 hours.  I had flashbacks to my last hospitalization and became afraid.

I weakly argued with him, telling him that not only had I spoken to my doctors about what I should get - that very morning, in fact -  and they wanted me on IV meds to be transitioned to oral when I could eat.  I also told him my philosophy about pain relief, and I didn't believe a 5 mg percocet would give me relief for the kind of pain I was in - I'd taken it before and I knew.  He didn't care about my thoughts,  and stood there arguing with me. Literally arguing with a woman in my condition, despite my becoming visibly upset.  Unfortunately,  I didn't have breath or strength to become assertive about what I needed, which is where family comes in.

He left the room, and shortly after, my sister also left.   I don't know what happened in that hallway except she spoke to the nurse.  But I got my pain meds every two hours with no argument, and after that one day, he was not my nurse at all.  For which I was extremely grateful.

I've come to believe he just didn't want to come in every two hours to give me pain relief.  If he did think that oral pain meds were the better course for me, than he has missed his calling and should have gone to med school so he could prescribe what he wanted.  My sister, after talking to him, also believes he just didn't want to be bothered every two hours.

The rest of the nurses gave me my ordered pain meds every time I asked for them, and each and every one of them were wonderful, even if I was annoying, which I'm sure every patient can be.  I can't remember any of their names and I wish I'd written them down, because they deserve a paragraph about their kindness and understanding, rather than the one person who was only concerned about his own time.

I am especially grateful to the nurses aides (they have a fancy title that I forget).  They were the ones who gave me a sponge bath, who helped me to the restroom, and who generally took care of all the icky things that have to be done.  I dislike very much being dependent on anybody, and I'm sure I always will, but I'm grateful that these people were so kind.

Of course, once time, more than kindness brought them to my room..








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