Posts Tagged ‘Surgery’

Anesthesia Recovery Often Stressful

Monday, August 7th, 2017

#anesthesia #oxycodone #overdose

John J. Hohn – Writer, Reviewer and Commentator

Anesthesia for major surgery is awesome stuff. Researchers are not entirely sure how it works, and if they are have trouble with it, consider how difficult it might be for the layman to understand it. Scientific American had the best article I could find. It is worth a read. One thing is sure, after all due consideration, anesthesia for major surgery works. The stuff puts you under in a big way. It’s not like sleep, Hamlet. There is no “perhaps to dream.” Everything is turned off. No subconscious calling your attention to some nagging matter. Stories of patients awakening during surgery must be apocryphal. You go out completely.

Recovery from anesthesia is a battle of sorts. The patient is not aware of what is going on. Those at the bedside know, however. Recovery is a roller coaster affair that the anesthesiologist controls with diligence and care. Once the patient wakes up, he may remember somethings that happened during recovery and not others. My wife, for example, said that I was very feisty. That I trashed around quite a bit. She said the anesthesiologist observed that what I doing was as a good thing. I was not aware of my struggle, however. I was not the least anxious. One thing did happen that I remember very clearly.

Why are you here?

I heard my wife ask, “John, why are you here?

“To know, love, and serve God so that I will be happy with Him forever in the next,” I replied.

Sacred Heart Elementary School, Yankton, SD. (No Longer Standing)

My response was right out of the Baltimore catechism. My wife later said that she did not ask me the question. What is more intriguing is my reply. I thought that I actually spoke it. Not so, according to those at bedside, although they did allow that I was mumbling all kinds of gibberish. For me, the assertion of faith was immediately gratifying. I felt a peaceful feeling come over me, a deep contentment. I was seven years old again, in first grade, and Sister Mary Micheline was smiling  at me. Whatever may have been the reason for my feeling of well-being, it clearly came from my subconscious because walking around wide awake I consider myself an agnostic.

For years, I have not been satisfied with the answers that the Church gave me helped me achieve peace of mind. It hasn’t been a matter so much  that I insist I don’t know, but that I want to know more – if that is possible. There is a huge difference between I don’t know and I’d like to know. I really would like to know. I am open to learning more. The brainwashing of my early years, however, really took. Once you have the answers, nobody ponders the questions any more. At some level, apparently, that early programming cannot be overridden or erased. It’s really powerful stuff, so powerful in fact,  it might be better to wait until a child has reached an age of reason before all this stuff is driven home in classroom drills.

A long-lost loved one . . .

All that aside, the patient recovering from anesthesia should not be surprised if some age old memories surface. Perhaps the name of a long-lost love. Whatever. Not to worry. Whatever the patient utters in recovery will probably come out as garbled nonsense.

I was hustled off to the intensive care unit once I regained consciousness. As it turned out, recovery from the anesthesia was probably more difficult than the surgery. I was asked almost immediately to get on my feet and walk, which I did. Coughing, of course, raised a concern among caretakers. The incision that is made all the way through the sternum to lay open the heart has, on rare occasions has come undone – a real nightmare for the surgeon. The patient is cautioned, therefore, to clutch a pillow to the chest when coughing and not to use his arms to get up out of a chair. I wanted to observe these admonitions diligently. However, at one point I was over taken by a paroxysm that was stronger than others. Clutching my pillow to me as if life itself depended it, I felt a slug of sputum moving up my throat. Blaaack! I spit out this ugly gelatinous ball the size of my fist into my urine flask. It was gray with sooty black deposits in it. I was horrified at it and the realization that it had been in my body.

“Look!” I exclaimed to the nurse when she came in, thinking that I had captured something essential to my recovery or at least would further assist in diagnosing my current state of health.

“Oh, good,” The nurse said calmly. “That has to be all of it. Very good.” Okay, I thought.

Pain is subjective. Nurses use this scale of help patients be more clear.

Pain ebbs and wanes during the first two or three days following surgery. Or perhaps the pain is constant but the pain-killers weaken as the hours pass after taking them. In any case. the nurses always asked, and in order to introduce some quantifying measure, they will call for the patient to give a number between 1 and 10. A chart is provided which helps the patient. It depicts cartoon patient faces with 10 looking as if the subject wants to die rather than endure another minute. Whereas 5 or 6 present the character as displeased but not in a panic. It’s a good system, although it depends on every nurse understanding the gradients of the scale. What is a five to one nurse may be a four to the next and even a six to yet another.

“Any pain tonight,” a nurse asked as she entered the room. I had not seen her before.

“Yes,” I replied. “I’d say about a 4.”

“What can I get for you?” asked. “I have Tylenol, oxycodone, and (a name I didn’t recognize),” as if she was peddling ice cream on the boardwalk

“I don’t know,” I said. “You’re the expert.”

She dropped a tablet or two (I can’t remember) into a paper cup, handed me my water glass, and I downed it all in one big gulp. Thus began the wildest, most terrifying night of my entire life. Instead of the gentle easing into a serene feeling of well-being that usually followed after taking Oxycodone, I had the sensation that the room was beginning to spin. Shadowy figures were coming and going. Some seemed menacing. I didn’t know whether that were hospital staff or not. I didn’t know why they were in the room. Some felt like a menacing presence. But the worst was yet to happen.

I began to lose a sense of myself. I lost touch with my core self. I became like one of Dante‘s characters from the Inferno being blown wildly about by the wind.I had slipped my mooring and was being tossed about in a fearful emotional storm.

A sense of the self . . .

All of my life, whether consciously or not, my perceptions of the world around me registered against the base of my essential self, as if my sensations were the wine and my essential self the goblet keeping all in order. Now the goblet was gone. Only the wine, flowing out of control remained, assaulting my senses like a beleaguered swimmer trying to escape a tsunami. The only thing that was left of the I who I knew myself to be was the fear and the panic that my mind was utterly beyond my control.

I was on a trip. I have heard about trips since college. I have never taken hard drugs. I am very respecting of them and do not feel that, given everything I have been told by those who indulge. they will add anything to the fullness of my life or the joy of living it. “Just think,” my wife observed, “there are people out there who want that experience.” I can’t imagine why.

One friend explained that most of my panic resulted because I did not know what to expect. Could be. He went on to observe that I was among strangers in a unfamiliar setting. Nobody was there to reassure me. Again, could be. Nothing, however, would prompt me to repeat the experience regardless of the conditions. I like who I am. I don’t want to abandon my sense of myself for any reason. Friends know me as a loosey-goosey guy, uninhibited and fun-loving. If anything, one of my biggest problems is weak impulse control. I wish at times I were more uptight. I can think of scores of embarrassing moments that would not have happened if I were. So, if what happened to me is what others are going for in using drugs, I am dismayed. Too bad they can find life itself awesome and marvelous just as it is presented unenhanced to all.

Thanks for dropping in on my web site. While you are here, please take a few minutes to look at some of the other pages. Your comments are also welcome.

Coronary Bypass Surgery Commonplace and Life Extending for Many.

Wednesday, August 5th, 2015
John J. Hohn, Writer

John J. Hohn, Writer

Coronary bypass surgery has been around for more than 50 years. Yet to the patient, most of whom experience the procedure only once, undergoing the operation can give rise to anxiety. The survival rate is actually very high. Less than 5 percent mortality in the first thirty days and less than 8 percent in the twelve months following. Survival rates increase slightly with age and depend in large part upon the general health of the patient going into the operation.

I can’t say that I was anxious at first. Astonished would be more to the point. I thought that with my diet and aerobic workouts, I was invulnerable. As reality settled in, my feelings changed. If I was anxious at all, I feared pain. I’ve never liked pain. I’ve avoided it all of my life. I hoped that the repairs to my ticker could be performed using the newer less invasive techniques. The thought of sawing through my sternum and spreading rib cage to access to the chest bordered on terrifying for me.

I had been on a been on a blood thinner (clopidogrel) since I had three stents inserted into my coronary arteries almost five years earlier. Consequently, I was hospitalized on a monitor (my left descending artery was 90% blocked) for four days before the operation. During that time, my blood was checked every four hours to see if the effects of the blood thinner had worn off and it was safe to operate. The frequent blood tests were a serious annoyance. My guess is even the janitor on the floor knew that it would take at least 48 hours for the effect of the blood thinner to wear off in a six-foot-two-inch male weighing 210 pounds. But no! Every hour hours, beginning right after admission. Forget what would be reasonable. It helps run up the lab bill, after all. The markup on lab procedures is probably several hundred times. But the wait gave me plenty of time to stew about my chances and my future.

When it came to not surviving, I knew only that I did not want to leave. That sounds a bit silly, but dying didn’t really bother me. I embraced my mortality years ago. Most writers do. It’s all but forced upon them. I didn’t want to leave my wife and children. I wanted to hang around and enjoy loving them and time with them. I didn’t want them to grieve. As a consolation to myself, I decided quite calmly that I had lived a good life. It was certainly exciting, perhaps more at times than I would have wished. But I was completely comfortable with the realization that I was not an evil man. A fool, yes! But evil, no. I never deliberated set out to hurt anyone or deprive anyone of anything he or she needed. I made a few mistakes. Some of them quite serious. (Don’t ask.) But mistakes are not as important as how one recovers from them. I felt, all in all, if I was on the threshold of departure from this life, I could make my good-byes with a degree of satisfaction that my life was a successful one, especially given then last 35 years, or roughly half.

Lights  out . . .

For a man who lives by his imagination, I had no idea what I was going to experience. My last hospitalization for surgery was minor when I had the stents implanted as I mention earlier. This time, I was rolled into the operating room, a huge, overwhelming gray and white space. Several humans were milling about in light green surgical suits. I had to scrunch a little to get onto the operating table.

Coronary Bypass Surgery  Illustration

Coronary Bypass Surgery Illustration

Then. blam! Lights out. I am guessing that the anesthesia for coronary bypass surgery takes the patient about as far under as one dare go. I jokingly said that the anesthesiologist has a “death meter” that must be watched as the needle hovers precariously above zero. After all, my heart was going to be stopped. A machine was going to breathe for me. So. I ceased to exist as I know myself. I would like to write that it was pleasant, but it wasn’t! It wasn’t anything. I continued to exist with no awareness of myself and life around me. If death is like that, I’m thinking it’s not to be feared.

Waking up, however, is another matter. My wife and stepson were at my bedside side with the anesthesiologist and a nurse. Apparently, I struggled and thrashed around for a couple of hours or more. I’d give thumbs up and nodded when asked, but I do not remember anything. At one point, in the darkness, I heard my wife’s dear voice, “John? Why are you here?”

“To know, to love and to serve God,” I responded with great pride that the answer felt so right and came to me so readily. (Never underestimate the power of early catechism lessons.) It was a response that I respect to this day and one that I still question because I really want the answer to be an honest one. As it stands, it may be something learned and recited by rote. On the other hand, I felt an innocence flow through me in making the reply. I felt like a babe being lifted dripping naked from the bath. My response was mumbled. Nobody understood what I tried to say. The borderline between consciousness and stupor bends and sways at this point in overcoming the anesthesia. Taking it seriously, I do love God. I intend to serve God in all that I do. (I can’t imagine deliberately undertaking to not serve God.) The heart of the matter for me is knowing or striving to know God. Lots of pretend, sometimes ludicrous knowledge clutters the path.

Suddenly, I am aware. Alive! The people in the room appear as silhouettes. “I love you guys,” I proclaimed in my joy at being awake. The fact that I only knew two people present concerned me not in the least. I was in a recovery room in the intensive care unit (ICU). I was comfortable but groggy, drifting in and out of consciousness, so much so that I remember very little of the day.

Extremely Depleting . . .

When the next day rolled around, I was more myself. I was immediately challenged to stand up which was a struggle. I began to realize how much the body gives up enduring major surgery. It is extremely depleting. The nurse was impressed with my leg strength, given my age. Why not? I had been working out regularly for 40 years, but I felt horribly weak. Later, when I was asked to walk,

Interveneous Insert = I Needed Two.

Intravenous Insert = I Needed Two.

every step required effort. I tired very quickly. The heck with my heart – what had been done to the rest of my body? Apparently, experience proves that patients who get back on their feet immediately, recover much faster, and thus the effort to get one out of bed and strolling about even if it requires assistance.

All of my systems were coming back onto line. I could not get to the bathroom on my own, but I had a bottle. I hacked up a lifetime-best slug of sputum from my lungs. “Oh good!” my nurse exclaimed when I told her about it. “Everything’s working.” My appetite returned. I had not eaten for two days. I ordered lunch, but before it arrived, I was told that I was doing so well that I was going to be moved out of ICU into a coronary care area. The lunch was directed to my new room The nurses in ICU, however, did not want me to be transferred until they had two working intravenous inserts (IV’s) established.

My arms looked like the no-man’s land of a World War I battlefield. Blood had been taken from the back of my hands up to my elbow on both arms. My fatty arms. I don’t have rope veins on the surface al a gym rats everywhere. They could not find a place to insert the new IV. I kept telling them to try above my elbow. But no, they’d rather not. Finally a doctor was called and she found a place using a sonogram locator. Guess where. Above my elbow. Lunch hour was long gone. It was 4:00 pm.

Locating the right place for the IV took so long that my lunch was returned to the kitchen. I was starving. I told the nurse on the floor to which I was transferred that I needed something eat. She insisted on completing a questionnaire on a monitor in the room that repeated all the questions I had been asked every day for six days. What good, I thought, was a system if it didn’t retain the answers from one day to the next? When the nurse left saying nothing about my lunch, I called my wife and asked her to bring me a peanut butter-and-jelly sandwich from home. We live five minutes from the hospital. It seemed the only way.  I really did not, as I feared, experience much physical pain. The only pain I experienced during for my entire stay was hunger in the face of indifference toward it and multiple attempts at inserting an IV. But there is more to my story . . .

To be Continued . . .

Thanks for visiting my website. While you are here, I invite you to look through the other pages and enter a comment in the area provided on the last page. Please come again.