Today, Wednesday, May 28, 2003, I took my dear wife to the
hospital == to arrive there at 6 AM, as scheduled.
You may be interested? You may not be, but from the messages I've received on this, so far, there are enough who are interested for me to write about this.
First, Jean had to decide whether or not she WANTED this surgery -- we realized that it was NOT up to the doctor to say she was eligible, but up to HER to decide whether she wanted a complete knee replacement.
The many pages of information in these web pages was enough data for her to make that decision, even the process of the doctor "agreeing" with Jean that this was the right action is fully described in these pages.
Once that was done, there was really no further thought or second thought on the matter.
I wonder, then, at my many bold efforts to persuade those who have been scheduled for bypass surgery, by sending them my very critical remarks about bypass. I know that once we had made up our minds we no longer interested in any negative comments. Certainly BEFORE Jean had made up her mind she would have considered other options, but once that decision was made, a friend's worry about a "bad" decision was not at all welcome. We did NOT read many of these "helpful" negative comments -- our minds were made up.
This made me realize that you, too, might get into that
position. I have to conclude that when you write to me and ask about
bypass, your mind is NOT YET made up, and my severe criticism of bypass is
reaching an undecided mind.
So, after the decision we did not concern ourselves with "other" treatments.
The ONLY worry and doubt was BEFORE that decision, not after.
Once she had decided to trust the surgeon, and the process, she had no misgivings and no second thoughts.
So, neither of us "worried" about the outcome of the surgery.
Next, I also harbor very extensive and strong negative feelings about doctors, drugs and hospitals. You see that in my writing. It helped in this case that the surgery was mechanical, not handling some degenerative problem. But we both knew, going in, that the doctor would have his rules, and the hospital have its rules, about traditional practices, including the use of drugs and pain killers.
We did NOT seek to convince the surgeon to "do it our way." That is, once the decision was made to trust in the process, we bought the entire process without disagreement.
The doctor, his staff, and the hospital staff were very
thorough in describing for us what to expect.
Do you recall the news item of the man in Florida who had an amputation -- one was needed -- but the doctors cut off the wrong leg?? What a tragedy.
I tell you that the doctor, nurses went to great lengths to be sure they got the right knee to replace -- including their "asking" Bonnie several times, and noting down her answer on some form, and even writing her initials on THE leg, just a couple hours before surgery -- so that there would not be any mistake.
So, the schedule was to arrive at St. Joseph's Hospital in Burbank, California, at 6 AM, Wednesday, May 28, 2003 -- today. We did.
We understood that surgery would be at about 8 AM. That happened.
The first two hours were very efficient -- in a surgery
preparation area with nurses who really knew what they were doing.
One area we had not asked about, and was a shocker -- about 7:30 AM a nurse inserted an IV in Jean's arm. The conversation was not very specific, but I thought I heard that it was nothing more than a nutrient solution. Well, in fact, it was a beginning of the anesthesia.
The anesthesiologist came in shortly after, fiddled with the IV and Jean started to say she was sleepy -- the anesthesiologist answered my question as to what was in there and said, "Valium, Demerol and morphine." We were both shocked, but once you decide to get some procedure like this it does NOT make sense to argue about pieces of it. We didn't.
She was wheeled away to surgery a short time before 8 AM, and
I waited in the "surgery waiting room." We understood that the surgery
would be about 2 or 2 1/2 hours -- by 10:30 I was ready to hear results.
The surgeon actually came in for me about 10:40 and said the surgery was smooth
and uneventful -- that Jean was in the recovery room, had been there about 20
minutes, and would be "out" for another hour or so -- they wheeled her into her
room when she was awake and I saw her there -- about 1 PM.
She was groggy and in pain -- the pain was less later in the day, but she was still on a pain medication.
I visited twice a couple hours each time, but she really wanted to sleep.
I expect her to be much more cheery Thursday.
I write this at 9 PM, Wednesday, and go back at 9 AM, Thursday to visit -- the doctor has told her that she would be walking at least some on Thursday -- Jean expects that.
That's the story -- we are glad it's done, but not unhappy to have done it -- she will get the other knee done in some months, and I get a hip replacement from the same surgeon in about October.
Thursday, May 29, 2003.
I forgot to write, above, that we had a full description of the rehab procedure well before the surgery. We understood that Jean would be expected to stand up and even walk on the first day after surgery. Then, we understood that there would be about three or four days of rehab at the hospital, that many such patients go home after this amount of rehab, but that if she needed more, she would go to a different part of the hospital -- same hospital -- that did rehab and get as much as another week there.
We were ready to rent a hospital bed and put it downstairs, so she wouldn't have to walk up the stairs to our bedroom.
When I arrived "today," Thursday, May 29th, at 9 AM, Jean was obviously in better spirits than the day before. The day before a nurse asked her for a "pain measure." She asked, "On a scale of zero to ten, what is your pain level?" Jean answered 7!
Today, the answer was 3.
This visit? She was busy. But, the
highlight of the hour I was there was the rehab nurse and that was fascinating
to watch.
This nurse, Kathy, was very skilled at her job. She explained in great detail what Jean would be doing with what part of her body -- even to where Jean should put her hand, and how she would push herself up -- to stand inside the "walker" they had ready for her.
She had this machine contraption bending her knee on a slow gentle pattern, and I learned that the blood that was "moving" into or out of her body was her own blood -- some sort of a put it in and take it out action that I still don't understand. She has a tube gadget putting a very low amount of pressure of oxygen into her nose, she had a catheter for urine, and I swear there were other tubes, wires, gadgets.
This is a very high-tech activity.
She did get up, standing on the floor, and took a couple steps with the walker. What a triumph.
I'll be going back at 2 PM today for the second round of rehab. Jean does NOT want a picture of her in this process!!
This experience has been important for me -- I have much more respect and admiration for this hospital, and its staff, than I had generally for "generic" hospitals.
I did quiz Kathy about "MSM," and as I expected she did not know what that is, nor several of the other "alternative health" words I mentioned. These people have a very high degree of education in a field that probably excludes where I have been concentrating for the past 20 years.
It is good to get this good view of that world. I won't be abandoning my own world, but I respect the fact that they do very well with the data that is true for them.
Friday, May 30, 2003
I arrived to visit today at 11 AM, just as Kathy was ready to start one of the two rehab procedures of the day.
My daughter, Maia, has learned that insurance pays for one hour per day of "rehab" but will pay for two hours per day of "occupational therapy." What a kernel of value!
The rehab nurse is highly skilled. The occupational therapy is often done by a volunteer.
Kathy is obviously very highly trained. She knows all about the many tubes and wires, now to move the bed, how to position herself, all.
I can see that the logical progression would be that you start with a rehab nurse until you can get out of bed by yourself -- then an occupational therapist can take over for the simple exercises.
Maia was advised to suggest to Jean that she is ready for it, to request the occupational therapist and get two hours of therapy per day. Jean has recognized that she needs this therapy to recover quickly.
Jean could almost get out of bed by herself -- but not completely. Today, after she got into the walker, she was able to walk a few steps, turn around and get back to the bed. But, she would not have done this without help.
Another thing I've learned. The hospital wants to keep costs down, so they are anxious to move you out as soon as possible. They generally want to kick you out in three or four days. The HMOs may differ, but ours will pay for 7 more days in a "convalescent hospital" where they give similar rehab to people. After that it gets expensive.
So, the trick of keeping your costs down is to do the exercises which the rehab nurse advises and do them often -- to try hard to get out of bed -- avoid the pain killers.
Jean found the walker action so strenuous today that she was sweating from the effort. She is still happy she got the knee replacement, but it hasn't been the easy walk-in-the-park we both hoped.
So many nurses! I've seen a large number of pleasant nurses, all doing their thing. As she was doing her little walk, someone came into "check vital signs" and found that her pulse was up to 150! That is rather high!
So, they immediately ordered an EKG. They don't take risks here. "Don't die on my watch!"
By the time she was back in bed the pulse dropped to 137, and at the same time as the KEG, about 20 minutes later, they did another BP and pulse -- her pulse was 111. So, the drop in pulse was very good. The BP was very good. I couldn't read the results of the EKG, but I'm sure there was nothing alarming there.
So, Jean will be getting another rehab action this afternoon. I visit her in another hour or so, then once more in the evening.
She is obviously in much better spirits today than yesterday.
One doctor I talked to suggested she would be moved to the convalescent hospital on Saturday. I objected (gently) and he indicated he would talk this over in his "noon conference" and probably recommend that she stay until Monday, then be moved to the "transient rehab" section for two or three days, then home.
She is willing to go to the convalescent hospital, and the advice we have is to stall going there as long as possible because you only get those 7 days there -- under the insurance.
Jean has had a few visitors, but isn't all that anxious for many. She has flowers too, but there is hardly much room in that space for more.
Food? She hasn't been hungry much, but the hospital is willing to make anything, practically, that you want.
She has a phone there, but hasn't been very interested in calling people.
She is using our CalmCream to reduce some skin irritation from lying in bed so much.
She is satisfied with her recovery -- I admire her determination to move through this.
K
Karl Loren
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