[T+1wk] Around the corner?

Its been exactly a week since we woke up dark in the night to drive to Stanford. We packed all the things needed in the hospital a small white board (very useful) and an iTouch with "Speakit" app on it (not useful, never had the energy to write on it), a personal pillow, medications, mirror (didn't use), camera (useful).

I was bleary eyed, when the admissions clerk at Stanford asked "Do you have a living trust in place?". I was taken aback but replied in the affirmative. He then asked "Yes, but does it cover terminal conditions?". I mumbled something and I was easy pickings then. He followed it by which religious priest preference I wanted. After that the paperwork ended.

Operating Room and ICU

The docs showed up all ahead of time. They looked real sharp, introduced me to a new doc Dr. JC. He was visiting from Canada and pursuing a one year fellowship under Dr.RP. He had finished 10 months of it already. He was going to be an observer. I felt good that there were an extra pair of eyes on me. JC is going to start at the Univ of Manitoba in a couple of months.

Dr. Richard Novak showed up for anesthesiology instead of Dr. Atkinson. He has been working since about 20 years with Dr.RP on this kind of surgery. I was worried about any complications due to anesthesia because it was a 3 hour procedure, phase 1 was only 45 minutes in comparison. He was a seasoned hand, he made me feel secure. Dr. Robert Riley did a classy thing. He dispatched a nurse half way through the surgery to reassure my wife that everything was going okay.

The next I know was trying to be waken up at ICU. I won't lie, it was miserable. Pain control in the ICU was real hit and run. Each time they gave morphine, I would feel a warm flush. Morphine was not working out too well. They started giving out Diloudid, a stronger painkiller. The problem with this was that it was making me nauseated and made me throw up. Every time, I went to sleep, I could feel the familiar feeling of OSA, throat collapsing. The docs assured me that they had advanced me by 12mm, the collapse was due to all the swollen tissue.

They started to give anti-nauseating medicines (Zafran) to prevent me from throwing up. Dr. Riley came by, cut my bandages which was a welcome relief. He then proceeded to peek down my mouth and proceeded to say that it was a disgusting site half jokingly because it had all kinds of food and blood. Apparently the Chow Mein I stole from my daughter's plate the previous night was all there. He asked the ICU staff to clean it up ... he was worried about secondary infection. The ICU nurse was fantastic, given the fact that I could barely open my mouth, he water-pik'd and really cleaned my mouth out. ICU was a bit noisy all night, they were trying to attend to a couple of serious patients all night. Lots of doctor's and medical personnel would come down and run an entire protocol, it was a quite interesting except for the state I was in.

Anyway moral of the story, think twice before eating greasy chinese food the night before a big surgery.

Move to Hospital

Next day I was wheeled out of the ICU into the general hospital. I was real happy to see that they had allocated a personal room. Last time for Phase 1, I had to share a room with a 80 year old man whose kidney was just removed. He was completely out of it. He swore and shouted almost continuously and loudly for the entire two nights and days I was there. Normally my heart would go out for him, but I was in no state to dole out sympathy myself. The hospital was full and they could not move me anywhere else.

This time, I was glad to have the room for myself. Dreamette was next door. Several people from the MMA meet group showed up to greet us. It was SO nice to see them and talk to them. They were so supportive. I still had a billion questions and still going through fairly aggressive pain management. In the hospital, they cannot give morphine, but they started giving Oxycodone which is also a narcotic. It was not doing the trick, the had to supplant it with intra-muscular Demerol as well.

The pain-meds would simply "zonk" me out. I used to sleep constantly. It was in stacatto bursts of an hour. On the Saturday, all the doctors had left town. They sent Dr. Jason who was a visiting doctor training for a fellowship under Dr. Riley and Powell to handle the dispatch paperwork. We were really nervous in having to make the decision to leave Stanford. One thing they won't tell you, but Stanford will put pressure on the doctors to get their patients out as soon as possible. The doctors will simply tell you that you have more of a chance of infection if you stay longer at hospital.

One thing I noticed about Stanford nursing is that it had become so much better since my phase 1, 2 years ago. When I came in for phase 1, a lot of care was handled by assistant RN's who are barely trained for 2 months. Many of them don't even know the proper bed etiquette or a simple act of testing for blood sugar. This time I noticed that the care was almost entirely done by full fledged RN's. They were outstanding, every one of them, of course some more than the other. I was real happy with Stanford care this time.

Weekend was real quiet in the hospital, many rooms became empty. I had taken a peek of my hugely swollen face and positively got depressed over it. The food at Stanford is terrible, the thing which they give you as health shake is loaded with sugar and junk. My sugar levels were crzay because they had given Steroid to control the inflammation. Insulin shots were not doing the trick. We decided to leave.

HOME AGAIN


The 20 minute drive home from Stanford was a real killer. You don't pay attention to the quality of CA freeways till you had an MMA! The micro-jolts on the freeway drove up the pain. One important thing we learnt from Phase 1 was to fill Oxycodone for home before the surgery. It can be in short supply and be real hard to find. You don't want to be managing pain without it. We also had to supplant it with Oral Demerol as well, which we had not filled earlier. My lovely wife was running around crazy to get a new order written and filled which was available at only one Walgreens at El-Camino and Grant.

My 13-yr old son thought I looked like a monkey. My 18 yr old nephew agreed. I was really beating myself up on taking the decision to undergo a crazy surgery like this. I was really depressed. This was easily the lowest point. Susan, a friend of Julie came to us like an angel. Even though we had been adviced to stay on top of the pain medications, we were hesitant in using all of them. She called us, reviewed all the medicines, told us not to worry about taking Demerol, get control of the pain and stay ahead of the pain. She asked us to take all the medicines on time, pain or no pain. This was a hard lesson to learn.

Next day Roger told me that I was not getting enough calories. He told me the importance of not losing weight and eating right. He narrated some personal examples with himself as well. This was a turning point, I had a big banana-milk shake with protein powder and immediately began to feel better. After that there has been no turning back.

That's watermelon juice, not Tylenol!



My swelling had come 80%, I could see my features now. Dr. Sesso (his post-surgical skills are outstanding, every time I meet him I am so happy that he is my doc for post-surgery care), got me to the hospital, flushed my nose and got me going.

The magic recipe, pain-medications every 4 hours, rain or shine. Milk shakes, cream of wheat, cream of soups etc. Not great but okay enough calories. Nasal flushes with salt-water and Afrin every 6 hours. Showers 2 times a day (the steam works wonders). Salt water rinses at least 6 times a day. Occasionally ice using gel-packs for 20 minutes on the face. Sleep only sitting up, amongst my "pillow cloud" (this is real hard to do for the entire night). I shaved and learnt to use the tooth water pik (shown in the pic).

The humidifier is great. This one is a cold-water atomizer with no filters, minimizing the chance of infection. Stanford has a mask which constantly blows moisture out. It is very important to use it so as not to get the mouth dry. This one substitutes as an okay substitute at home.

Its been a week since I had surgery. I am relearning the meaning of the word patience. My son looked at my pre-op pictures and thought I was almost there. Finally God is showing me a way around the corner.