Thursday, April 28, 2016

Sinus Surgery - Part One - Day Of

Squick warning.  Going to talk about the details of my sinus surgery.

I had sinus surgery on Friday, and not the short easy kind either, where they only drain one or two of your sinuses.  They cleaned out all of my sinuses endoscopically.  In addition to that, my surgeon reduced my inferior turbinates.  As it was explained to me, the turbinates (there are three sets, but it's the lowest set that's most often troublesome) are features of bone and mucus lining that warm and humidify the air coming in through your nose.  Over time, or just naturally in some people, they can become enlarged and create obstructions, even in an otherwise perfectly healthy airway.  Mine were obstructing a perfectly unhealthy nasal passage, so we opted for a reduction.

My surgery was scheduled for noon.  Wendell and I arrived at the hospital twenty minutes early, got all checked in, and were taken back to the first room promptly at ten.  The nurse who took us back was completely uncommunicative, to the point of just handing me the urine sample cup and looking at me expectantly.  When I came back, he basically just grunted and gestured to the pants, gown, and robe I was supposed to change into and then walked away.

After I changed, I had a new nurse, who went over my medical history.  She noted that I had sensitivity to antidepressants, and was pleased that my pre-op appointment nurse had noted down that detail.  She then checked to make sure I hadn't taken any blood-thinners (Asprin, Advil, etc) in the past ten days, had taken two special antibiotic showers, and checked when I'd last eaten.  Funny thing was my answer was always (I got asked this question by literally everyone): I ate at midnight when I got home.  This invariably led me to a conversation about what I do for work that means I get home so late.  I wasn't allowed to have water after 8am either, which I assured them I hadn't.

After she finished her analysis, she took us down several floors and plopped me down in a reclining chair in the corner.  At this point a different nurse came over and gave me a warm blanket.  Yet another nurse came over to get my IV started.  It took me great lengths to convince he to put the IV in my right hand, since I'm left handed.  And all that effort was for naught, because she tried three different times in my right hand and couldn't get it to work any of those times.  I would like to note that I've donated blood quite a few times and had IVs before and never have I had a problem with the nurse not being able to get my vein.  I'm also glad that this nurse used lidocain (which I'm not used to), otherwise the whole process would have been both annoying and unusually painful.  She finally used a heat pack to warm my left hand and got that vein on the first try.  That nurse then went on to mess up several times on two of the other three people in the room (the third person got his IV done by a different nurse, who succeeded first try).

We waited for probably another half hour before another nurse (the one who'd done the other guy's IV) gave me another blanket and told me, without me asking, that she'd check to see how the surgery prior to mine was going.  She came back within a minute and told me that they were out of surgery and my anesthesiologist, operating nurse, and surgeon would all be back to see me shortly.  It was probably about 11:15 at this point.

My anesthesiologist stopped by about 15 minutes later and we had a good chat.  He listened when I said I had family history of sensitivity (my grandpa gets a dose that a normal ten year-old gets).  And I told him last time that I'd have nausea for months afterward.  He nodded and took notes and told me that he'd use a different form of anesthesia and that he'd also give me an anti-nausea patch that is frequently used by sailors.  Then he said he'd be back with the patch and some Tylenol, which would also help him out.

My surgeon came back a few minutes after he left and went over all the details that she'd gone over with me at my last appointment.  She emphasized that I should use nasal irrigation a minimum of 4-6 times a day, but if I wanted to do more, that would only help.    I asked if I should start that day and she said it couldn't hurt if I was feeling up to it, but I could wait until tomorrow.  She said she prescribed me antibiotics to help my body not reject packing if she had to use it to keep my turbinates stiffened and also Tylenol with a bit of Codeine in case I needed it for the pain.  And she reaffirmed that afterward I needed to cough and sneeze with my mouth open and I wouldn't be allowed to blow my nose.

She went back to prep for surgery and then my anesthesiologist came back and put the anti-nausea patch behind my ear (which he warned me would give me dry mouth) and gave me Tylenol with a small (much desired) sip of water.  On his heals, my operating nurse came back, it was shortly after noon (my scheduled surgery time), and asked me again about food and water, and chattered away until she was ready to take me back.  She went Wendell upstairs and then we went into the operating room.  I got up on operating table and they had me position myself.  They wrapped some things around my legs to make sure I had good circulation and didn't end up with clotting.  They then put a pure oxygen mask on me and presumably turned on the anesthesia drugs because I was only awake for at most 30 more seconds.

I woke up in recovery feeling shocking sharp compared to the last time I'd woken up after anesthesia. The very first thing I noticed was that it was after 5:00pm.  Wendell had to leave for work at 5:30, which meant I was going to have to drive home with my grandpa, who's a terrible driver.  Panic hit me and I resolved to get out of the hospital as fast as I possibly could.

I closed my mouth on something hard and unyielding, which I promptly spat out.  It was a bloody piece of tooth, which likely chipped off as they were removing the breathing tube.  I know I mumbled something about a "tooth" and the nurses clucking and telling me "everything was normal".  Frustrated, and knowing that a chipped tooth wasn't normal, I gave it up.  A nurse then tried to give me ice chips, which I thought was water.  I spat it out immediately since it made my desert-dry mouth and throat immediately worse.  "Water would be lovely," I remember saying.  I figured if I could form sentences, especially polite ones, then that would help me leave sooner.  She pressed the ice chip spoon to my mouth again and I kept my mouth shut, categorically refusing.  "You need ice chips first.  Otherwise you'll get nauseous."  I fought down my frustration; "I'm not nauseous at all.  Please may I have water?"  She tried to put the ice chip spoon in my mouth while I was speaking, which I wasn't super happy about.  Finally she gave up  and brought back the same cup, this time with some water.  She tried to hold the spoon for me again and I grabbed the cup and drank down the water, finally getting a brief respite from the terrible dry-mouth/throat problem.

From there it was on to the next order of business.  I needed to pee something awful.  I'd meant to ask before I'd gone back to the operating room, but got swept up in the sea of medical professionals.  Once again, I remember being very polite: "May I please use the bathroom?"  "Oh, the bathroom, the bathroom.  She needs to use the bathroom.  Where's that bedpan?"  They all clucked.  As soon as I heard the word bedpan, I resolved to wait until they'd actually let me use a toilet.  They did find the bedpan, and once again, I categorically refused.

This whole time, the nurses were going on and on about where my prescriptions had gone.  They weren't in the chart and where could they possibly have gone (my surgeon was operating on a different campus because some other surgeon had cancelled their surgery days, so neither the nursing staff nor my surgeon were used to working with each other).  I tried to tell them that the pain really wasn't particularly bad and that I could pick them up from my own pharmacy after I got home.  They, unsurprisingly, were having none of it.

As the time marched onward, I got more panicky and started to cry.  My sinuses were ridiculously full and pressing on my eyes, so I found this hardly surprising.  It alarmed the nurses though, who redoubled their efforts to find my prescriptions.  I tried to explain that I just cry at the drop of a hat; it's just how I am and that they shouldn't be concerned.  They didn't believe me, and Wendell points out that he doesn't really blame them for me being concerned about me crying.

Finally (though it was only about 5:15 when I convinced them I was feeling very well indeed, thank you), they took me up to the second phase of recovery.  We passed a bathroom at that point and I pretty much made the nurses pull my bed over then and there. A nurse, quite annoyed, helped me get into the bathroom, hung my IV from a hook, and stood there expectantly.  I waved her out and blessedly went to the bathroom.  Then I washed my hands as best I could with the IV still in, grabbed the IV, and made my way over to the reclining chair they indicated was mine.  The exertion had caused blood and drainage from my nose to pick up and soak the gauze drip pad taped below my nose and the same frustrated nurse went about changing it (including pulling the tape off none-to-gently) without saying a word.  I remember protesting, confused as to what was happening, at which point she explained what she was doing.

  The same nurse, who was quite finished with me at this point, told me that they didn't want me to stress me out.  I noted that perhaps not being able to see my loved ones, but knowing they were literally twenty feet away would stress me out more.  She either didn't hear me or (more likely, I suspect) pretended she didn't hear me.  That nurse then strapped the blood pressure cuff on my arm.  I figured what that meant, but she didn't really explain that she needed to take my blood pressure.

She started taking my blood pressure without telling me and I remember asking for water.  She told me I could have ice chips in a second and I once again tried my very best to default to polite.  "My throat and mouth are very dry from the anti-nausea patch and the tube.  Water would be lovely."

My grandparents and Wendell were brought back then, but they insisted that only one person was allowed to be with me at a time.  The other people had to wait on the other side of the cloth partition.  I tried to point out how silly it was that they were allowed to be in the room but not see me.  Wendell came over and the nurse asked him once again about the prescriptions.  He told her that the surgeon had brought them out to him, and he'd brought them to the pharmacist.  My grandpa was picking them up at that very moment.  She complained about how normally they stayed with the chart and that's not how things should of been done and he sorta shrugged.  But then he came over to me and kissed me on the forehead and I started to cry again, because I really desperately wanted to go home with him and not my grandparents.  I asked why the surgery had taken so long, and hour and a half longer than the maximum I was scheduled for and he said all they knew was there had been some technical difficulties; nothing had gone wrong with the surgery, but some type of technological problem had slowed them down.  He did tell me that the surgeon had needed to put packing in to keep my turbinates from getting "floppy", and that she'd take them out at the post-op appointment, I then told him how much I wanted to go home with him(it was 5:35 at this point, already past when he needed to leave).  He, being the wonderful person he is (and already knowing the answer), went and asked Nurse Grumpy, who thankfully had gone to go get me water.  The nurse told him no, it was against policy, and that I need to have my vitals taken three times.

He came back and informed me of that and then the nurse gave me the water.  I asked her how many times she had taken my vitals so far and she said just once.  Annoyed, I went to drink and she started taking my blood pressure again and told me I had to hold still and not drink.  I know I responded with frustration at that point, but I don't remember what I said; I think something about actually giving me some warning.  My vitals were more stable at that point though (140s over 70s as opposed to 150s over 70s).  At that point it was 5:40 and Wendell really had to leave.  I started pretty much sobbing at that point and couldn't stop, even though I saw he felt terrible about having to leave.  I was proud of myself for not asking if he could just be a little late to work, because I desperately wanted to.

When Wendell left, my grandma came in.  The first thing I remember her saying was that my surgeon was beautiful (which she is).  I agreed, somewhat confused and non-plussed.  She also rehashed the technical difficulty story.  I'm pretty sure she was at a loss of what to say.  Finally Nurse Grumpy's shift was over and she explained to the new nurse that I really wanted to go home, but I still had one more set of vitals left in five minutes.  The new nurse, fresh and actually sympathetic, bless her responded to my desires with alacrity.  She told me she was going to change my dressing one more time and I asked about my inhaler.  She gave me that while she prepped the dressing and got it all in place.  She then checked the giant mug of water that I'd inhaled and was impressed to find it empty.  She suggested that she refill it and I take it with me.  I declined at first, knowing I'd need to pee soon, but she pointed out it would help with the dry-mouth/throat and I agreed.  My grandma also pointed out how useful the mugs could be, which I agreed to, confused.  The nurse heartily agreed though and said they threw them out anyway.

My grandpa had returned from the pharmacy at this point and the new nurse suggested that he and my grandmother go get the car.  By the time she finished with my last set of vitals, getting the IV out, and me dressed, that they'd probably be ready.  She suggested lots of fluid and cough drops for the dry/sore throat, and then handed them a bag of medical tape and gauze to change the dressing as often as needed.  So off they went and she did exactly as she told me she was going to.  She took my blood pressure, after warning me she was going to.  it was in the 120s over 70s, which is normal for me, and I remarked that it had returned to usual.  She seemed both pleased with the result and pleased that I'd noticed it'd returned to normal.  She then took my IV out and I asked about clothes.  She pointed to the bag in the corner, which I'd over looked and asked me if I needed help.  I emphatically declined and she went to go get me more water and a wheel chair.

I got dressed as quickly as possible and felt so good to be in my own, comfortable, warm clothing.  I pulled back the cloth partition, fully intending to walk to the parking lot if she wasn't back with the wheelchair yet.  As Wendell pointed out later, the nurse probably suspected as much and got back with the wheelchair just in time.  I got into it before she could help and she handed me the water.  Then she wheeled me out to the parking lot (I think I genuinely could have walked there, it wasn't far, but taking the wheelchair was probably better) and my grandparents were just showing up with the car.  It was a few minutes after 6:00 when I got in the car.  The whole recovery process had remarkably taken less than an hour.

I got up from the wheelchair and into the car; pretending not to hear the offers of assistance.  I got all buckled into the front seat and we were away almost immediately.  In retrospect, my grandparents had the air blowing in the car on the way home, which caused my throat to dry out immediately, which was extremely painful.  My head also started to ache and I got super dizzy, with my grandpa driving his jerky-stick-shift ways (yes, I realized there are good manual drivers, but I don't think my grandpa is in that category anymore).  We took surface streets a long time before getting on I90 (again, my surgeon was scheduled in Seattle, about 30 minutes west of her normal campus and my home), which only made things worse.  Luckily, my grandpa had Tylenol on him and he gave me two, after asking me extensively if I'd had any pain medication already (I hadn't, the nurses had been clear on that fact).  Frustratingly, they left the bag with the gauze, tape, and, most importantly, my inhaler in the trunk (seriously, who does that?).  My grandpa offer to pull over and I vehemently refused, knowing I wouldn't want to get back in the car with him once he'd stopped.  I also knew I'd hurt his feelings by saying so, so I just said something about wanting to get home as soon as possible.

On the surface streets, my motion sickness, courtesy of my first anesthesia experience, was acting up and I asked them for the motion sickness bag that they must have sent with us.  Turns out, probably in my haste, they didn't send up with a motion sickness bag.  My grandma handed me a clothe bag, which she assured me was washable.  I was aghast and resolved to hold it in, if it got really bad.  Luckily at that point we got on the freeway and the nausea eased up.  And I will say, my anesthesiologist was a wizard.  That was the only time I got nauseous at all.  I was worried when I removed the anti-nausea patch yesterday, but no nausea at all!  Which made recovery a whole hell of a lot better.

The rest of the drive home was a bit of a blur.  I was miserable.  My grandpa merges too close both behind and in front of people and tends to go under the speed limit.  My throat also got progressively more painful was we continued.  I do remember formulating a plan for when I got home: change the dressing (maybe just hold it in place, because the tape was painful), two cough drops, more water, popsicle, sleep.  Finally we pulled into my place and my grandpa did a horrible job parking.  As he went to straighten out, I basically just told him I had to get out.  I then asked my grandma for the key, which she annoyingly, had to look for, which took entirely too long.  I burst in the front door with my water in hand.  I made my way up the first set of stairs and stumbled to the bookshelf and popped in the two cough drops, which immediately soothed my throat.  My grandparents had gotten in the door at this point and as I headed up the second flight of stairs to my bedroom and bathroom, asked if I needed anything.  I told them "Popsicle" as best I could with my ruined throat.  They said "What?"  And I said "Popsicle" to which they repeated "Popsicle", so I know they heard me.

I got up to the bathroom and the two giant mugs of water caught up to me.  I then stumbled back to my bed and sat there for a bit.  Both Wendell's cats  wanted in and I let them.  I waited for my popsicle.  Or my grandparents.  Or really any attention at all.  And it didn't come.  It was probably about 7:00, fifteen minutes after we'd gotten home by the time I stumbled back to the stairs.  "Can I have a popsicle?"  I plaintively called.  I felt pathetic, but I wasn't up to stairs again so soon and my throat really fucking hurt.  Finally my grandma brought one up to me.  I spat out the remnants of the cough drops and ate the popsicle.  I couldn't taste it, but it eased my throat even better than the cough drops.  My grandma then went back downstairs, leaving me alone (and sad again).  She hadn't even brought me my phone so I could text other loved ones to tell them I was doing okay and my throat was too sore to call down.

After a bit longer just sitting there, I stumbled back to the bathroom and tried my tea-pot style Netti-Pot (for sinus irrigation).  It did very little.  The saline solution and drainage are supposed to come back out the other nostril, but I was too congested/inflamed/fulling of gauze packing for it to do so.  Still, I did it to both nostrils and then got myself back to bed, which Wendell had thoughtfully set up for me with a back pillow (so I could remain sitting up) and a favorite blanket.  I know I dozed off for a bit and then woke up, again wondering why no one had even checked on me.  I could hear sounds of them banging around in the kitchen, but no one actually talking to me.

This time I did brave the stairs and got all the way to the dining room table.  My grandmother asked if I was hungry, and I informed her I was starving.  She asked if I wanted soup and I said no, it sounded terrible.  She told me that my first meal was supposed to be liquid, because of the nausea.  I once again told her I wasn't nauseous and hadn't been nauseous at all except for the motion sickness.  She sounded surprised, but started warming up soup all the same (she did at least listen when I told her that I didn't want the canned stuff that they had very genuinely thoughtfully brough; I wanted the stuff in the fridge).  I went to the freezer and got myself my own fucking popsicle, which again helped.  I also took the potato salad out of the fridge and took it with me to the dining room table.  Then my grandmother presented me with the soup that I didn't want and she spied the potato salad.  "You're not supposed to have potato salad yet, miss."  She warned me.  I'm pretty sure I just ignored her.  She gave me some chicken soup broth, not even with meat or noodles.  She told me I could have meat and noodles after I finished that.  I took one sip and burned my mouth at which point I pushed it away, saying "hot" and dug into my potato salad.  It had be twenty hours since I eaten and I was utterly ravenous.  My grandmother gave up protesting when I made it clear I was going to eat the potato salad regardless of what she said.  I did go back to the broth when it was cooler and then she did bring me another, less hot, bowl.  In retrospect, the soup would have been fine if it hadn't been warmed at all.

I asked my grandparents if my surgeon had said anything about taking a shower, because I'd forgotten to ask.  I felt desperately dirty and suspected the steam would make my throat hurt less.  She told me she hadn't said anything and that'd I'd need to wait until Monday to call and ask.  I told her that wouldn't be happening and went back upstairs (with my phone this time), fairly safe in my assumption that they wouldn't follow me.  I texted both my sisters, dad (who took my mom to Hawaii for her 50th birthday and they're both feeling very guilty about leaving me with less help), and Wendell.  Carl was brief, but sympathetic; similarly with my dad.  Shea I texted at length, since she wants to go into nursing, and told her I should have had her drive me home from the hospital.  We both realized this would have been a preferable answer, especially since she had been free.

Wendell was glad I was feeling as well as I was and somewhat surprised at it (as I was myself).  He got increasingly frustrated by my descriptions of my grandparent's actions, which I felt vindicated about.  And I think I must have expressed entirely too many times, that I wanted him to be home.

I called my mom then and chatted briefly.  Told her I was feeling actually much better than anticipated; not any worse than my worst sinus infection, at any rate.  She was glad for me.  I did go into length about feeling ignored and completely unhelped by my grandparents, which she was surprised and sympathetic about.  She also told Shea, who was babysitting me the next day to actually pay attention to me.  She, Shea, and Wendell all figured that it was probably alright to take a shower that day.

I dozed badly for another hour, took more Tylenol around 9 and went to the office to check on my dogs and cat, who had been extremely good and quiet all day (Wendell had taken them out before work, because he's the best).  They were super happy to see me, but also very calm, and knew something was up.  I let them out and followed them downstairs, where one of Wendell's cats had made himself at home in the living room with my grandparents.  I don't remember talking much with my grandparents this time, though I got another popsicle.  They expressed surprise that I'd let my dogs out and I know I was defense, pointing out that they were being very good actually (thankfully my grandparents did agree on that subject).  I sat down at the dining room table and my little dog jumped onto my lap and my grandmother went to push him out.  I think I actually did push down my annoyance successfully that time.  He was being a little wriggly, but very good, and more importantly, I had invited him into my lap.

In frustration, I went back upstairs with my dogs and Wendell's big tom cat, intending to sleep until Wendell got home.  The dogs settled down very nicely, again being very gentle with me.  Wendell's cats both settled down and I felt asleep with four animals in the bed with me.  I woke up several times: to both my grandparents using the other bathroom and then to my kitty crying for dinner (thankfully my grandparents did find her cat food).

I woke up for good to some type of loud noise from the kitchen, this set off my dogs, which was frustrating, but not unexpected the way my night had been going.  It was about 10:45 (Wendell was off at 11 and about 15 minutes away from home).  I stalled and puttered about, looking at my phone and using the Netti-Pot again with a similar amount of success. Finally at about 10:55 I went downstairs and thankfully my grandparents were packing up to go.  We chatted about nothing for awhile and Wendell finally got home at which point they practically ran away.

Now, I'm not being entirely fair.  I'm sure they were trying to be helpful.  It had been a stressful day for them too and it was long past their bed times.  I know I wasn't particularly grateful, and I did feel guilty about it.  But I also ask, how fair is it to put the burden of playing host on the person who had five hour long surgery that day?  They were treating me like a recalcitrant child, not like a convalescing adult.  In our texts Wendell's phrasing was: "You're disabled, not regressed.  And not even that disabled it seems like.  They're treating you like you're five."  And this was my exact problem with Nurse Grumpy and my grandparents.

Unlike I expect, I was perfectly cognizant and shocking functional, essentially from the moment I got into recovery.  I couldn't always make my throat express what I needed articulately, but there were people who could understand me perfectly, so I couldn't have been doing that bad of a job communicating.  The whole time I felt like I was being treated like someone completely incompetent.  I felt like a child again, which is pretty much exactly how I felt.  If I say I'm not nauseous, then take my word for it.  I know my own body.  I know my own limits.  Other people do not get to tell me what is best for me.  If I want water, even if I am nauseous, then give me water.  At worst, I throw up, which admittedly is not great, but hey, at least you respected my autonomy.  There's so many attitudes in our culture that lead to: know, I know better about your own body than you.  And I admit, nurses and doctors have extensive medical training.  But if I tell you I can handle drinking water because I'm not nauseous, then believe me.  If I tell you the pain in my shoulder feels mechanical and not muscular, then perhaps at least pursue that course of action.  Don't blow me off.

Sigh.  Now I'm all worked up.  The end of the night was lovely however.  Wendell came home and took my dogs out and kissed me on the forehead and gave me some spaghetti.  And then because I was still starving, made me a tuna fish sandwhich, and even went back and cut it into smaller bites so I could eat it easier (where my upper right wisdom tooth (mine are still in-tact and useable) was chipped was hurting me (still is some; I need to look into that more thoroughly)).  And he told me about the show, which he'd made it too alright.  And my sub did really well.  And a bunch of stuff happened and people asked about me, but I was pretty exhausted and not all of the information penetrated.  Then we went up to the bedroom and I asked if I could sterilize and use his squeeze bottle sinus rinse instead, since mine wasn't working, and he said yes.

And I finally got to take my shower (I'd held off because I knew my grandparents would lecture me about it (which Wendell was seriously unhappy about)).  As I suspected, the steam helped a lot.  The sinus rinse bottle also was more effective.  I then got into bed and chatted with Wendell about all the things that had happened since he'd left.  I took more Tylenol and eventually fell asleep, sitting up, just like I was supposed to.  I got to sleep quickly because I hadn't taken the anti-inflammatory steroids that day, but couldn't stay asleep.  I woke up every three hours, when the Tylenol first started to wear off and I would take more, take another shower, and rinse my sinuses.  All in all, aside from the frustrating treatment of my recovery, my first night after my surgery went much better than expected.

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