Transitioning Hospital to Home

Saturday involved more physical therapy, now including walking with crutches, as well as in the parallel bars. All of it is still very very tiny amounts of movement -- 3 stairs here, 12 crutch-steps there. Nothing like what I'm going to have to be prepared to do when I go home. They train you "how" to do the motions but they don't work on strengthening you to handle how much your muscles are going to have to be doing by the time you are moving. It is all well and good to practice 3 stairs, but my house has 13 to get from first to second floor. But I suppose form is most important; I'll have plenty of "on the job" training as soon as I get out of here. I was not sent home with any PT "prescription" or any discussion of types of exercises I should focus on at all.

Today (Sunday) I go home around noon, after having spent seven days in the hospital (including the day of surgery). By now my pain is pretty well managed with oxycontin and oxycodone. My PT is progressive in the sense that I can now walk more steps and even handle some stairs, up and down. But the heat rash itching has not gotten any better despite the creams and powders.

Last night I managed to fall asleep on my left (non-operated) side for about an hour, but had to be rescued like a beached whale when it was time to be rolled over onto my back again. Of course when I woke up I had that same strange "where am I" feeling I always have had in the hospital, and the concern that I'd woken up in a dream (rather than FROM a dream), if you know what I mean. That has happened to me more than once while here at the hospital, like there must be some other alternate reality that I am missing just before I wake, and in that other reality I don't wake up every day in a gown on a gurney scratching my back raw. Also -- and this must be the drugs -- every time I wake up I feel like I'm in a different room. Very similar to my other hospital room, but a different room nonetheless.

The doctors came by early this morning on rounds (as usual) and I was completely out of it and falling asleep in the middle of conversations (as usual). That is so very embarrassing. Patients are never nodding off like junkies in the middle of coversations with Dr. Gregory House, for example. Unless it is important for their differential diagnoses.

I am ready to go home. I don't think this hospital bed has much more to offer me (other than the trapeze, which I will sorely miss).

All the paperwork has been done for my release; Dr. Millis himself wheeled me to the door and wished me well (I'll see him in three weeks for follow up anyway) and was very sweet about everything. Some of the nurses seemed genuinely sad to see me go, and say that they have requested me as a patient for next time (which I have to think is a lie, can you even do that?)

My mother and I got on the road about 1pm and stopped for a coffee/restroom break at McDonald's on the way. It was my first time in public on the crutches and it is just a joke how slowly I move on crutches. People must think I'm kidding -- I look healthy and strong enough, and yet I'm heaving like a cast Clydesdale and I'm moving about 6 inches a minute. I couldn't make eye-contact with anyone at the McDonalds because I have to study the ground for each step and think so hard about my muscles, so I don't know if anyone was staring or not, but this one poor kid did have to hold the door for me for like 5 minutes as I snailed my way through. Bet he regretted that one.

The drive home was about three and a half hours; my leg kept jiggling or bouncing with the car's movements, plus I missed a painkiller while I was asleep during the journey, so needless to say I was in a world of hurt and exhaustion when we pulled in the driveway. It was all I could do to make it up the back steps to the den and pass out on the couch. After a while I had mustered enough strength to make it all the way upstairs to my room to sleep again.

Recovery Day 4 -- Exit Wounds

This morning I was up by 7:00am, which is pretty much the earliest I have woken up and stayed up since I got here. I was still furious about the back issue when I woke up, which is never a sign of rationality or an omen for a positive day. My lower back and flanks were still raw and itching terribly, damp and nubbly feeling when I scratched them; I could feel the angry rash forming. This discomfort was keeping me distracted and furious, like a six on my pain scale. I'd never intended the pain scale to apply to more than hip joint pain, I tell you that.

The nurses arrived and got me back in my CPM machine (which itself is not annoying or uncomfortable). I let them know that overnight my back had continued itching as if I'd been sitting sat naked in a poison ivy beach chair for three days. I'd tried shifting position, having sponge baths and salve creams applied but nothing seemed to ameliorate the horror. Only the IV-administered itching drugs could (temporarily) keep me from trying to claw off my own skin.

The other thing that bugs me about being so uncomfortably itchy is that I know I am moving my operated hip too much and putting it in non-optimal positions while trying desperately to talc, salve or sandblast my back and flanks. I can feel that I am causing my hip extra pain and I worry that I am delaying its healing because I am unable to focus on protecting the joint in the face of eliminating the raging discomfort on my skin.

Dr. Sankar came to see me at around 7:15am. I am just so so angry today; everything is making me furious. Before I was sad and pathetic and self-pitying, but now I'm just pretty much pissed off. Pissed off at how much I am itching and really pissed off at having to use the bed pan. I'm pretty sure I have already explained properly how f'ing pissed off I am about the bed pan.

At 8:45am the physical therapist came to help me practice getting from the bed to the recliner chair beside my bed. That was an ordeal which involved me supporting myself on the trapeze and swinging my good leg to the ground, followed by the physical therapist supporting my bad leg, following my lead to keep my bad leg in the correct alignment to the good leg all the way to the floor, so that eventually I would be sitting on the edge of the bed with both legs hanging off towards the floor. Or at least that was the idea.

What actually happened was that I swung my good leg to the ground but the the PT-held bad leg lagged behind and so was shifted from its usual angle and caused a painful bursting feeling within the joint. It honestly felt like a small water balloon had burst within my hip joint. I gasped and swore and instantly began crying hysterically. Partially because of the pain and surprise, partially because of the fear, and partially because of the (probably unwarranted amount of) hatred and blame I immediately directed towards the PT-tech who had ruined the whole maneuver (in my opinion). When I finally got settled into the chair, I refused to work further with the PT tech and refused to move from the chair until 11am. Which behavior is probably why I was appropriately sent to a children's hospital to have this surgery.

By 11 my tantrum had run its course and so I moved to a commode chair (basically a chair made of a high toilet seat with arms and legs with wheels), which could be rolled into the bathroom for me to shower in. The commode chair could also be rolled over the toilet to allow me to use the toilet like a normal person without the cursed bedpan scenario.

Taking a shower (even with the unwanted and what I considered unnecessary assistance of a nurse I did not particularly like) was quite a lovely experience. Getting back into bed from the commode chair was quite the opposite. The same logistical problem of launching a good leg onto the bed while balancing body weight on the trapeze and having a bad leg guided by a PT tech made me nervous and irritated. The PT's approach to this maneuver was not making logistical physical engineering sense to me, nor did she seem nearly strong or reliable enough to trust with lifting and guiding my injured leg in sync with my good leg. Again, I was not wrong, and she ruined it (in my opinion) because the approach she was suggesting required superhuman strength and accuracy from me and there is no way any patient could have done it. So that did make me like her any more at ALL.

So I had my horrible exit from the bed, my excellent shower and chair nap, a relatively productive 12 shuffly steps between the parallel bars and a horrible reentry to the bed. Getting into and out of bed were so scary and horrifying that it almost made everything they facilitated, including the shower, the steps, the chair, the non-bedpan urination, and the easy salving of my back, not worth the fear and panic of exiting and reentering the bed.

The whole experience made me ruthlessly dislike the physical therapist and her every appearance. Luckily the next person to arrive in my room was my friend Josh, and then Dr. Millis, who said I should be able to get out of here by Sunday noon.

And the doctor told me to drink my milk of magnesia. All everyone wants me to do here is drink milk of magnesia, drink miraplex, consider suppositories, blah blah blah. I haven't eaten a thing since Sunday night, so whatever is in my intestinal tract is not exactly a Hoover-dam type blockage. But clearly the whole team is freaking about my GI tract so I'm drinking my f'ing magnesia people, relax.

Friday night I got my second blood transfusion along with what turned out to be an accidentally overly high dose of oxycodone, so the entire experience was a end-of-Pinocchio-like a nightmare of blurring memories, alien-invasion-dreams, tubes of blood going into strange machines, stretched out time, slurred words and confusion. The back/flank rash was still horrible and itchy, and I kept waking up in what seemed like a different sci-fi dream. And I don't particularly like sci-fi.

Recovery Day 3 - My Back is Covered in Magma

Today my linens were changed again, but this time Dr. Millis himself was smart enough to be there for the actual changing -- I think he knew I'd throw a fit (because last time I was so nervous about the moving around and the sea-mammal-lifting scenario) and that my pride would probably cause me to suppress my panic in front of the head of the orthopedics department and therefore allow the deed to be done. Again I question why my linens needed to be changed less than 24 hours since their previous change. But anyway.

There were a lot of people around (male and female nurses); Dr. Millis was distracting me by talking about various unrelated things and giving me various meds while others were messing with the bed around and beneath me. So it all went far less terribly this time than my apprehensions had suggested. It also helped that my left elbow had healed enough that I could lift myself with its help from the trapeze, unlike last time.

My epidural was also taken out today, which was far less painful than I'd anticipated it would be. I suppose the epidural itself inside my back was quite small -- although I will say that it did affect how you could lean back in your seat, it had to be just right or it dug into your spine in quite the wrong way. A bigger coersion to removal was the tape around the epidural site and wires -- it itched crazily (a trend, you will see). But all went well and the epidural came out just fine and left almost no mark, as the hole in my spine had been so tiny. The epidural delivery system itself had been off since the morning anyway (meaning no medicine had been flowing through) as I was transitioning from that delivery system to my new oral meds.

The real, very distressing concern I had with removing the epidural had nothing to do with pain. Without an epidural (the wires for which had kept me in bed since the surgery), I no longer had any need for a urinary catheter, and without a catheter, I'd have get out of bed to use the toilet. (Sorry, I'm going to have to discuss catheter territory here...) So far, I hadn't had to get out of bed for anything, and, because I had a the luxury of a catheter, I'd kept myself very hydrated, drinking tons of water in addition to the IV fluids I was receiving on a 24 hour basis. I happened to be on the phone when the nurse who was sponge-bathing me mentioned something in passing about removing my catheter and began fussing around down in the catheter area. (Red flag just on its own.) Hold the phone, literally. I was not about to fall for that little she's-distracted-by-the-phone diversion trick. So I got off the phone and launched into a little whining parade, asking why I couldn't just keep the catheter until I learned to get out of bed safely. But I guess catheters are often the source of infection and so they should come out as soon as possible. Given the fear I'd already acquired about moving (even just enough to change my linens), and the amount of fluids I'd been drinking (consequence-free due to the catheter), I was actually prepared to accept the risk of a UTI (everyone likes cranberry juice, right?) over a constant (one-legged) Tigger-like bed to bathroom bouncing cycle. Alas, mine was the minority opinion and so the catheter too came out.

This meant that by Thursday afternoon I'd become almost totally wireless -- no leads, no epidural, no catheter, no IV-drips (although the IVs were still in place should they need to be hooked up to something or other).

This would all have been excellent progress except that Thursday also suffered from a timing problem. The day was supposed to have gone like this: get wireless, get a pint of my own blood transfused (for extra pizzazz!), get out of bed with PT's help, learn to use the rolling commode chair to get to the bathroom, rest on laurels. But instead, something got delayed with the blood and the schedule went more like this: get wireless, wait for the pint of own blood, inevitably have to go to the bathroom but no more catheter and no training in how to get out of bed (because PT wouldn't come until after I've gotten my pint of blood, of course, which makes perfect sense in Nonsense Land). For bathroom breaks I was forced instead to choose between pissing myself or using a bedpan, both choices I had planned to put off until at least my mid-80s.

The bedpan required me to hoist myself up on the trapeze, a nurse to position a plastic bowl-type thing beneath me, me to lower myself onto it and try to pee in it without missing and pissing all over my bed (which of course, could have been an option on its own, as you recall). Lots of people have to help set this bedpan scenario up for you and so you are not exactly left with any modesty while performing the task. It is mortifying and disgusting beyond belief, and honestly should be someone's episode of Fear Factor. Personally, I chose to add in the optional pre-bedpan temper tantrum (which does not lessen the bladder's needs) before succumbing to the bedpan option. I did, however, maintain what I thought was a shred of dignity by countenancing a complete, unabated, immature and utterly satisfying fury for the remainder of the day, and going on a water strike. All of which, I'm sure, showed them.

When you think of fury, you imagine, perhaps, Yosemite Sam's ruddy, seething face beginning to shake, or the way Acme characters' faces fill up red from the bottom until the very pate is reached and "TILT" begins to flash in their eyes. I am not going to say that in a similar manner my bedpan humiliation fury was physically manifested by the pulsing, hot, Habanero-like heat rash I was to suffer for the remainder of my hospital stay, but I'm not going to deny the metaphoric coincidence either.

As you may recall, during my feverish period described yesterday, my back would pour sweat and feel like an inferno, and I would stuff as many ice packs as possible back there to try to alleviate the situation. All that heat and pressure (despite the ice packs) eventually lead directly to a horrible, spreading, angry heat rash that inspired absolute insanity in me, removing my concern for hip pain, consideration of others, desire for food, drink, life, liberty and the pursuit of happiness and replacing it with a frantic desire to rip the skin off my back with any available shredding and/or rending type object(s). This frantic heat rash condition could be controlled slightly with various anti-itch medications, but would become a background tenet of my mood for the remainder of my stay.

So needless to say, Thursday was an angry day. Not only were my linens changed again in some sort of spasm of sadistic cleanliness, my back began to boil like a hot, itchy pool of magma, my catheter was removed before I knew how to get out of bed, and my dignity was stolen and beaten and ridiculed and tossed into a bedpan in front of male nurses.

On the plus side, I did get to have a shower.

Recovery Day 2 -- Fail Whale

After a good night's sleep last night, I continued the Sleeping Beauty trend through most of the morning, confounding many of the various medical team visitors that came by in the morning intending to work with/on me and finding some sort of hibernating, mumbling creature in my bed.

My lucky epidural/Valium/nubain combination certainly did treat me well through the night and this morning, but when I finally woke up midday I had two problems. One was that my shoulder muscles, having been kept in the same position for two days and nights straight (because of IV lines and injury), were stiff and very sore. The second was that Phlebotomy had not been deterred and was waiting for me to wake up. Seriously? Are they playing some sort of sick darts game with me? Didn't I just give them blood samples yesterday? I was unable to feign sleep well enough to discourage them, so they stuck me again and again and again until they they finally found a vein that could give them what they wanted.

By now all the evil forces amassed against me had noticed that I'd awakened and so I was cheerfully told it was time for my bed linens to be changed. Last time I had checked, I had been lying quite immobilized on my bed linens, tangled up to several types of wires, hooked to a CPM machine, and basically inextricably attached to my bed and, therefore, its linens. I also did not particularly care that my linens were at this point a day-and-a-half old. I don't even change my sheets at home every day and a half. But the hospital cared, and so I was -- strongly against my will, I note for the record -- forced to have my linens changed.

The linen change operation can best be pictured if one imagines how one moves a large sea mammal -- an orca, say, or a manatee -- from one tank to another at Sea World. A big sling is positioned under the enormous beast and then is hoisted; the animal is lifted, fins flopping out to the side, pulleys straining, as the tank is hurriedly changed or cleaned beneath the teetering mass of blubber. Finally, thankfully, the hovering sense of disaster is abated as the humiliated and panting celaphopod is lowered back down to its bed -- I mean, tank.

My CPM machine was not replaced after the linen change, since I'd had the machine on and constantly running since immediately post-surgery. This meant that my operated leg was in a new position and that a pressure sore that had, gradually and, at the time painlessly, been created by the support bar of the CPM machine against the underside of my thigh, had begun to make itself known as the sedation masking it wore off. Quickly and excruciatingly.

Physical therapy came and did some mild exercises with my legs and feet; I ate some broth. All the while the pain from my new positioning increased, the pressure sore began to liken a red-hot poker pressing into my thigh, and, somehow, the epidural began to decrease in effectiveness (despite being raised from 8 to 10 by Dr. Millis last night.)

By late afternoon I was probably at a seven or an eight on my pain scale, moaning and crying and repeatedly pressing the nurse call button to beg hysterically for help or a shotgun. Unluckily, my mother was out taking a walk at this point, so I was literally alone, sobbing into the abyss and the nurse call walkie-talkie.

The pain began above my hip, probably where the screws entered my iliac crest just below my waist on the right side. The pain widened and deepened at the hip joint itself, illuminating all the different moving parts aching inside the joint and around it, including the muscle along the outside of the hip joint. The pain then shot down the right side of my thigh and flared out again near the lateral tibial head, narrowing and dissipating down the lateral side of my right calf. This pain was steady and totally consuming, and I couldn't figure out why it would radiate out so far from the hip itself.

I cried and moaned and hit the call button again and again. Finally, FINALLY, a nurse came and brought Pain Services, who discussed my pain and did some sensory tests to determine the coverage area of my epidural. The Pain Services team eventually decided to raise my baseline epidural to 12 and to give me a jump start on pain relief by injecting a small dose of lidocaine directly into my epidural line. Although it was not instantaneous, the lidocanine did the trick and provided me with possibly my first (and only) pain free 90 minutes while in the hospital.

Once the lidocaine kicked in and my biggest crisis was resolved, some of my smaller irritations could be addressed. I'd been feverish all day, so my body temperature had been fluctuating between chills and hot flashes. When I was hot, I was dripping sweat and had to be packed around with ice packs all over me; when I was cold, I was swathed in blankets and chattering my teeth. When I was hot, my back would itch and drip and feel like an inferno pressed against the pillows and the bed, and I would stuff as many ice packs as I could between myself and the bedding. My fever hit 102 at its highest. My back itched and overheated horribly, only worsened by the enormous ace bandage dressing wrapped around my incision as well as my entire abdomen.

Needless to say, this was an incredibly uncomfortable day. I was in pain and/or discomfort almost constantly, as well as woozy for long portions when I was on Valium to help me relax and Nubain to help relieve the itching.

At 6:30pm Dr Millis came by to remove the large ace bandage dressing and replace it with much smaller dressing over the incision alone, which relieved some of the abdominal discomfort, but not the horrible itching and damp heat on my back. I saw my incision through the stitches and steri-strips -- it looks about five inches long and not horribly disgusting. Dr. Millis said my fever was normal. He looked at the pressure sore from CPM machine but declared it didn't look that bad, which was annoying since it certainly continued to *feel* that bad.

I ate my first food (some bites of scrambled eggs and a few crackers) so I'd be able to start switching to oral medicines in the next day or two.

I would have to say that today, Wednesday, was one of the very worst days so far, and that I am surprised and disappointed that I was so very uncomfortable and painful several days after the surgery. I didn't expect the recovery to be pain free, but I certainly did not expect the seemingly increasing level of durable, multivalent misery that I would be still be experiencing several days following the surgery.

Recovery Day 1

Last night -- the night after my surgery day -- was rougher than I thought it would be. Despite being exhausted after the surgery, I kept being snatched from the edge of sleep by various distractions, both human and electronic. Nurses came often to check my vitals, and oversensitive monitors periodically became convinced that I was no longer breathing, which of course sounded an emergency alarm that brought people running to my unnecessary rescue. My sleep was fitful from all the interruptions, and uncomfortable because of the itchiness brought on by the epidural medications and the all the contraptions stuck to and moving on me.

In my bed, I was sleeping with two IV lines, three monitor leads, a pulse oximetry meter, rhythmically inflating compression leg wraps on both lower legs and my entire right leg in a continuous passive motion (CPM) machine cycling my hip constantly between 30 and 70 degrees. Cozy.

The 11pm nurse shift change brought relief in the form of a wonderful nurse who gave me Nubain (for itch) and Valium (for muscle relaxation and sleep) among other delights. I slept much more comfortably after that but I wouldn't call it cozy.

This morning Dr. Sankar came to see me as I awoke, and he said I looked very well for someone the morning after surgery. Phlebotomy followed Dr. Sankar, which caused me to mar my fine looks with a considerable scowl, as they pincushioned me for some blood tests. The scowl deepened when I found out these would be daily blood tests.

Then the physical therapist arrived, which I honestly thought was a joke. Seriously, how much physicality did they think they were going to be able to get out of me in this state? A toe wiggle? Well, that was pretty much the answer. Wiggle your toes, move your ankles, etc. They did ask me to isometrically tighten the quadriceps muscle in my right (operated) leg as much as I could. It was a strange sensation to be sending my leg muscles signals that simply did not seem to be received. The therapist laid her hand on my thigh and said she could feel my muscle contracting, so my efforts were not unheeded, but I was still numb to any response at all and the non-feeling was quite bizarre.

I spent most of today sleeping, probably making up for my poor night's sleep last night. In the evening the anaesthesiologist checked on my left elbow injury -- I still couldn't use it to help lift myself using the trapeze (the pole above my bed that can be used to lift and adjust the body using the arms) and I still did not have full extension or flexion. The pain was tolerable if I kept the elbow relatively still, but it was obviously a concern for the surgery team.

Dr. Sankar also came by in the evening to remove my "drain," a pair of tubes that had been left in the wound and led out to a collection pouch outside the body to drain away blood and fluid from inside the surgery site. The drain reduces swelling and aids in healing, and had been emptied several times since I'd gotten to my room on Monday night.

When Dr. Millis came up at 7:45pm, my last visitor of the night, he asked what my pain level was in my hip. I told him honestly that it felt like I had a machete driven through my groin. He thought this a sufficient enough reason to increase my baseline epidural from 8 to 10. The machete became a steak knife and the night passed relatively peacefully.

The Surgery Itself

My mother and I made the chilly, five minute, pre-dawn walk to the hospital. Right on time at 6:00am I made a point of bounding up the hospital stairs towards the Admitting department, ticking off my last "last" before surgery. In the Admitting area there were three other patients with their families checking in for surgery. All of them were kids, except for me, which I guess is to be expected at a children's hospital. They were, alternatively, sniffling and clutching a teddy bear, silent and affectless, and moderately cheerful. I was actually a bit jocular and excited, which seems an utterly inappropriate mood with which to approach major surgery.

By 7:00am we were all in the pre-op holding area, a room lined with curtained off alcoves, like stalls in a barn. In my "stall" I changed into my surgical "johnny" gown and met with the anaesthesia team. They reiterated everything that had been discussed about anaesthesia during the pre-op meeting in February.* In some PAO blogs I'd read that some patients had experienced problems with their epidurals where the wrong leg was numbed, or the epidural did not work at all. When I mentioned this to the anaesthesiologist, his answer seemed to be something like: "yes, that happens sometimes; it is tough to pinpoint the right spot; we are actually working blind in there because we are not going to bring in a fluoroscopy for a simple epidural, but we do these all the time so it should be fine." Oh, OK, now I feel better.

Dr. "Woody" Sankar came to sign my hip and Dr. Millis, sporting a green St. Patrick's Day bow tie, stopped by to answer last minute questions. He estimated he would be done with the surgery by 1:00pm. After the doctors left, the anaesthesiologist gave me "something to relax" through my IV -- I don't know what it was but it hit me almost instantaneously.

Quickly thereafter, at 7:45am, I was wheeled into the operating room and my mother was taken into the family waiting room. I didn't have my glasses on anymore, but through the fuzz I saw that the OR was full of a lot of people, a lot of tables and a lot of stuff on the tables, everything in the blue/steel/white color palette that looks so good with my complexion. I also remember thinking Dr. Millis' surgical cap was not at all like the caps the surgeons wear on Greys Anatomy.

My gurney was wheeled close to another bed, which had been piled with pillows or cushions of some kind, and I was told to swing my legs around so I was sitting on the side of my bed resting my shoulders, forearms and head on the cushions. "Try to make your back into a 'C' shape," the anaesthesiologist said.

Wait just a minute, I thought. This is the procedure for getting an epidural. I am not supposed to be conscious while getting an epidural. I am not supposed to remember this part. I am way too conscious for this. Meanwhile people behind me are telling me what a great spine I have and what a wonderful "C" shape I've made with it, and Dr. Millis and his strange surgical cap are right in front of my face talking about things completely unrelated to how overconscious I am during this epidural placement. Dr. Millis is holding my hand and the man behind me is saying "this is some local anaesthetic, just a small pinch," and I recoil from the not-small pinch and am told to hold still. At which point I think, oh God, this epidural thing really going to blow and I am far too conscious!!, but then it just a bit of pressure and it is done. The man behind me asks me if it tingles on the right side or the left side of my spine and I tell him it is the right side and I am conscious enough to know and be relieved that the right is the correct side for this epidural to work.

So then many hands help put me on my back on an operating table, and Dr. Millis puts this fleshy plastic face mask over my nose and mouth and I remember he was talking to me and holding my hand and I was frustrated because I wanted to answer but I couldn't because of the windy face mask. And then I was gone.

Since seeing me off by the operating room door, my mother had been waiting in the family area. At 9:30 she was told that all was going well and that my surgery had begun at 8:45. By 11:00am the doctor had begun making cuts into the bone but had not inserted any screws yet. By 12:30pm the doctor had discovered the superhuman bone density of my skeleton and was still cutting bone and was now estimating two more hours of surgery. By 3:20pm the doctor was almost finished and was closing the incision, but the nurse said he would not come out to talk to my mother until I was awake and moved into my bed in the Post-Anaesthetic Recovery Unit (PACU).

Meanwhile, I was coming to in the PACU in what should have been relatively pain-free awakening from general anaesthesia. Unfortunately, during the surgery my left arm had been placed in a position that normally would have been comfortable but in my case was not. The left arm had two IV lines, an arterial line and a blood pressure cuff on it, and was stretched out straight across a table, supported with pads and gel packs. Despite all those protections, my left elbow somehow hyperextended, causing straining or microtearing of the tendon attaching my biceps muscle to my radius.**

I can't even remember if I had any hip pain at all when I woke up because all I remember is excruciating pain in my left elbow. My cries utterly confounded the PACU staff who were (understandably) under the impression my hip was my most likely pain locus. All I recall from this period in the PACU is whimpering and moaning and leaking tears as people tried to figure out what was wrong with me. No conclusion was ever really reached, but I was given morphine anyway, which helped a little.

At 4:10pm Dr. Millis came out to the family waiting area to speak to my mother. He said the surgery had gone well, and that I was out and awake and feeling no pain in the hip, but that I was feeling pain in my elbow. He also mentioned that I had very strong bones, which was why the surgery took longer than expected. Dr. Millis showed my mother films taken during the surgery as the bone was cut, moved and after the five screws had been inserted. The doctor showed a comparison of my pre- and post-surgery hip socket angles -- my pre-surgery angle was 90 degrees and the goal for the surgery had been to increase the angle to at least 110 degrees. The post-surgery angle was actually 114 degrees, so Dr. Millis was obviously quite pleased with that outcome.

You can see the increased coverage of the femoral head ("ball" of the joint) in the image to the left. Compare my left and right hip socket coverage and it is obvious how much more of my right femoral head is in the socket compared to the left femoral head. Obviously all my new hardware is quite visible as well.

The doctor also mentioned that he had not used all of the pints I'd autologously donated prior to surgery, since most of my blood replenishment during surgery came from the cell saver system. But he would probably be using some of my donated pints to ease my recovery in the next few days.

At 5:30pm my mother came to see me in the PACU. I was already on morphine for the elbow pain, so my hysteria had lessened slightly at this point. She fed me ice chips while I kept trying to clear my throat of the breathing tube feeling. While she was there Dr. Millis and Dr. Sankar were adjusting my CPM machine, which I would use for the next few days.

At 7:00pm, twelve hours since I'd first hit a gurney, I was wheeled into my room on the 10th floor. Luckily, I had a private room with a lovely view. I didn't spend much time enjoying the view, though, as I was exhausted -- from the surgery, the sedation, the pain, the morphine, everything. I think I was asleep by 8:00pm.

* All quotes and dialogue attributed to medical staff at Childrens' Hospital are taken from the memories of my mother and my(drugged)self, and should not be considered direct quotations or perfectly correct paraphrasing.

**This is my diagnosis, not a doctor's. But I still think it is right.

Surgery Day - Morning

My surgery time is 7:30 this morning; I have to be at the hospital at 6:00am.

Yesterday my mother and I drove up to Boston; we stayed in a hotel last night. My mother will be staying there for the week. (For others having Boston surgeries, it is the Best Western Longwood, a block or two away from most of the Longwood Medical Area hospitals, including Childrens', Brigham & Women's, Beth Israel Deaconess, etc. There is a special rate for relatives of hospitalized patients.)

I did eat a smallish dinner last night. The pre-surgery eating guidelines allow you to eat up until midnight the night before the surgery, but they recommend having only a light meal. Post-midnight I can drink water until three hours before the surgery, i.e. until 4:30 this morning. Which is basically when I woke up from a night of pretty fitful sleep and could not fall back asleep. So I did get about a liter of water in me just under the wire.

I did not bring very much with me for this hospital stay -- I can't imagine I will need much that won't be provided by the hospital or available on site. (There is a CVS/pharmacy in the lobby of the hospital, and since Longwood is a neighborhood of hospitals and medical facilities, anything I could need is probably available within a 5-block radius.) My packing list included:

- glasses, contacts & solution
- my favorite sheepskin slippers
- cardigan sweater
- reading material
- laptop
- gym shorts
- pyjama pants
- bathrobe
- crutches (which I had leftover from a sports injury a couple of years ago)

Even that seems like a lot given that I'm not going to be able to get out of the bed for several days, much less change out of the hospital-issue gown I'll be in through and after surgery. The shorts/pants, bathrobe and slippers are really for later in the week when I'll be out of bed taking my first steps with the walker and then crutches.

This morning my first stop will be Pre-op Admitting to finalize my admission to the hospital (most of the admitting paperwork was done in February at my Pre-op visit). The nurse there will take my vitals, confirm that I have complied with all the appropriate medication/food/liquid restrictions required in the weeks and days before surgery, and get me changed into my surgery attire.

Next I will go up to the surgery floor, where I will meet with Dr. Millis and the anaesthesiologist. Dr. Millis will sign my hip to indicate which surgeon I belong to and which hip he is to operate on. (I suppose all patients look alike when supine with surgical bathing-caps, breathing tubes and billowing pastel gowns, so one must take more basic measures for identifying one's patients -- like writing on them with Magic Marker. You know there must be a lawsuit or two behind that rule.) Next the anaesthesiologist will start the IV, and hopefully that is the last thing I shall remember.

So now it is time to head over to the hospital. I feel tired and hungry and cold, and everything else you feel at 5:45am on a March morning. I have a bit of a headache; my right hip is at about a 1 on my pain scale. My left hip is at a zero today.

I am not nervous per se. Mostly I sense the culmination of an odd feeling I've been having all week, ticking off my "lasts" before the long period of recovery I will have ahead of me. Last tennis match, last day in the office, last subway journey, last night in my own bed in NYC, last walk with the dogs at my parents', last time driving a car (although the 3.5 hour drive up to Boston may have lessened the blow of that particular "last"). Today I will walk into that hospital feeling healthy and strong, carrying my own things, pushing through the revolving door myself, and bounding up the stairs to admitting in what will be my last "bounding" for a long while. It is quite a juxtaposition with how I'll be in half a day's time.

But my hips are built the way they are built; this surgery is a necessity. People have more complicated, emergent, painful, dangerous, experimental surgeries every day; some come out with outstanding results, some come out with complications, some don't come out at all. I have done what I could to prepare for this, I have chosen a fantastic surgeon and an excellent hospital; there is nothing more for me to do now other than trust the experts. The ball (of my hip)* is in Dr. Millis' court now.

*(Sorry, I just couldn't resist.)