Friday, July 25, 2014

17488--Avoid Waking Up with a Crowd Around You

"Shattered" was the word they kept using. 
Left: Fragmented and askew / Right: Steel pins added

The toes I thought I'd dislocated and probably broken, X-ray images showed to be shattered.  They still didn't hurt.  Straighten them out, splint them, and I'd be on my way.  That was my plan.  It had a simplicity I liked and I trusted my body, as usual, to heal the damage I'd done to it.  The doctors had something more complicated in mind.

Their plan involved pins.  They wanted to insert long, steel pins into my toes.  My smiling orthopedist apparently had a secondary specialty in witch doctoring.

"Oh, you need surgery," they said.  "We need to set the bones properly and insert pins to hold the toes straight.  Plus, you've broken the skin, so we need to open that wound and disinfect it."

Twelve hours and suddenly somebody's concerned that I had been bleeding.  At this point, my priorities were pushing food and water back to the top spot and toe yanking was starting to sound pretty good again.

"Oh, no, you were right not to yank them," the orthopedist said.  "That would've been bad."

That from the medical professional whose first impulse had been to grab my toes and start trying to move them.  That part was something I knew would happen and that, when it did, it would be an orthopedist doing it.  When I called him on it, he laughed like he'd been caught in the cookie jar.

"We're going to get you scheduled for surgery right away," he said.

"Well, can we just do a local anesthetic?" I asked.  "Numb it, fix it, and I can be out of here?"

"We'll probably do a general anesthesia and just put you out."

"I don't mind being awake," I said.  "Just do a local and we can be done that much faster and I can be on my way."

"Well, you'll have to talk with the anesthesiologist about that," the orthopedist said.  "Have you had problems with anesthesia or surgery before?"

"No, I just think it would speed things along to not have to put me under and wake me up," I explained.  "One less complication."

"You'll see the anesthesia team before surgery," the doctor said.  "Talk with them about it during prep."

"Oh, I will."

From the emergency department examining room, I was taken to a patient room to await my turn on the day's surgical schedule.  It was becoming late afternoon and nurses would bring up food and water a few more times, then tell me it was good that I hadn't had anything.  My stomach remained unconvinced, but stomachs are like that.  In lieu of sustenance, I continued a steady regimen of vital sign checks and the quiz about my name and birthday.  Yes, I only have one name.  No, it wasn't the day for cake.  Mmmmm...cake.

Appropriately gowned and finally transported to OR prep, I had a chance to talk with an anesthesiologist about staying awake.  Now, they're all about keeping you alive while you're asleep.  My desire to remain conscious was taken as an odd choice to be stubborn about.

I suppose as a resident, her response of "I'll need to get my attending," didn't come as much of a surprise.  When both doctors came in, we did our dance again, but the attending was much more insistent that general anesthesia was the only viable path because of the very involved procedure I was about to undergo.  For my part, I just needed to stay still.  Honestly, with just a local, the comfy bed, and nothing else to do, I'd probably have dozed off on my own.

They wheeled me into the OR and the ortho guys decided that my heavyweight status made me a great candidate for doing surgery right on the transport bed rather than having to move me before and after.  Like I said, comfy bed, so no argument from me.  The logic seemed sound and we engaged in witty banter and trivia quizzing until...Well, until whatever the anesthesia team did to put me to sleep.  Apparently, it also interfered with short-term to long-term memory transfer.  I have no recollection of the anesthesia being started.

My first recollection of new memories began the next morning through the cloying fog of half-sleep.  I'd been lashed to the bed.  The railings felt different.  I couldn't really open my eyes, but it was a different bed.  I had a hazy memory of a prior dream about being a superhero doing the man dance with a gang of villains.  There was a tube in my mouth and throat.  It was irritating so I tried to bite through it while working on breaking my restraints.  When I felt somebody come near enough, I grabbed his wrist.  The communication process had begun.

There was some blather about asking me if I knew where I was and remaining calm as becoming agitated again might result in keeping the breathing tube in longer.  I guess I'd been strapped to the bed for a reason.  I was also told I had to stop trying to chew through the tube.  So many rules that would've been unnecessary if they'd just removed the tube.  I let the first nurse go and got the next pair to understand that I wanted something with which to write.  That bit of communication seemed a lot harder than it should've been.  They weren't impressing me.

Going unheeded once more, I was told that they were waiting for doctors to arrive on rounds to make the decision to remove the breathing tube.  That was as irritating as the tube itself.  The story I was given was that I was uncooperative with the nose mask, so I was intubated (a breathing tube was stuck down my throat).  While the orthopedic surgery went well (the fix I came for), extubating (removing the damned tube) and reawakening did not.  Bloody phlegm came out with the tube and my oxygen saturation level was dropping.  They said they also tried to wake me during this, but whether that was before or after removing the tube wasn't made clear.  Whatever the sequence, in my sleep, I fought whoever was around me.  Ultimately, this became eight guys struggling to hold me down while I was re-sedated and re-intubated.  At least that made the vague memory of my superhero dream make sense.  And why I'd been strapped to the bed.

Waking up in ICU wasn't part of the plan.  Awake, though, I was able to convince the docs to remove the tube.  Then, I was able to get back to answering the endless cycle of tedious questions and finding my way back to taking deep breaths again.  Still, the question of what had gone wrong lingered.  I wasn't supposed to feel worse than when I'd arrived and more than a day had gone by without food, water or writing.  All that needed correction.  Priorities.

NEXT: Guesswork and Bloodletting

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