That’s another one crossed off, not quite so quick this time, but seven days isn’t bad. By the time the anaesthetic had worn off and wires and tubes removed, I was ready to come home. Well in my mind anyway. The first 3 or 4 days were, once again, pretty much a blur to me. Just a couple of days in intensive care this time, less than that, about 36 hours. Such was the intensity of the pain I was kept dosed up throughout my stay in hospital, and in the main they did a good job. I don’t remember anything before waking up in ICU sometime on Tuesday night, with an oxygen mask over my face. I remember asking where I was, even though it was pretty obvious. The nurse reassured me that my stay in ICU was “just precautionary”, although I am now well able to read the monitors to which I was attached, to understand that my blood pressure and oxygen levels were far from normal. Even so it wasn’t long before I was being transferred back to the ward.
The wheelchair I was transferred in was rather overcrowded with equipment as I was wheeled back. Drips, PCA, oxygen and yards of trailing wires and cable that were attached to my body. The veins in my arms were now collapsing faster than a pack of cards , and so all drugs and drips were now using veins in my neck which made movement of my head rather tricky. I was accommodated on the heart ward due to lack of beds on the appropriate lung ward although this didn’t make any difference to my recovery. It was interesting to see the speed of recovery of heart patients who had undergone double/triple by pass operations. They were certainly mobile far quicker than myself. It seemed that they were doing three or four a day, the success of which were clearly visible. The nursing staff were particularly caring and helpful while I was there and did everything they could to ensure that my pain was kept to a minimum. The consultant came to see me the following morning to discuss my operation. Far more difficult than they had anticipated due to the previous collapsed lung and the proximity of the tumour to a major blood vessel in my right lung. The tumour had been removed in it’s entirety although they had not been able to achieve the usual clear margins they would normally hope for because of the position close to the blood vessel. The ‘clear margin’ is an area of tissue surrounding the tumour that is disease free, to ensure no infected cells are left. Obviously we would all have been happier had the margin been achieved, but it demonstrates just how lucky I had been, just a few millimetres more and it would have been deemed inoperable. I’m so glad I didn’t postpone the operation until after the summer, as I had anticipated at one time. I had been in ICU because of difficulty they had re-inflating my lung after surgery, and so it was imperative that I should be up and mobile as soon as possible to avoid and further problems and infection. It was no surprise therefore that the physio was one of the first therapists to visit me, and no surprise that she wanted me out of bed. The pain in doing so was equal to that following my bowel operation. It didn’t really matter how long I was in the chair for, I still had to make the return journey. Both left me gasping for breath and almost screaming in pain, despite the doses of morphine prior to both exercises. In the main my pain levels were kept to a minimum due to the help of an epipleural anaesthetic( the same as an epidural except in the pleural layers of the lungs) and the PCA. PCA stands for Patient Controlled Analgesic, a syringe pump that delivers a dose of morphine at the press of a button. The device limits you to one dose every five minutes to prevent any overdose, but anyone that has had one knows how reliant you become on them, and how effective in pain relief they are. Whilst on morphine your obs (BP,oxygen, heart rate) are monitored every two hours, and in the early hours of day 3 post op, I noticed that my BP and oxygen levels were falling. When the day shift came on I mentioned this to them. My stats were being monitored hourly from then on, still showing consistently low levels. I knew that the third day would involve me walking, and sure enough this was to be the case when the physio arrived. We set off, me with a walking frame, whilst the physio pushed the drip stand alongside me as I made my way along the corridor. We made it halfway down before we turned round for the return leg, at which time I experienced an overwhelming pain in my chest and collapsed on the floor barely able to breath. Within seconds I was surrounded by nursing staff, oxygen face mask back on and helped into a wheelchair, and swiftly taken back to my bed. Obs were taken again, still worryingly low as I sat on the side of my bed, where I was most comfortable, as the nursing staff went off to find the on call doctor. I was anxiously waiting for the green light to come on that would allow the next shot of morphine, pressing the button as soon as it was illuminated. I pressed it, eyes fixed on the pump as it gently pushed the syringe forward. Drip, drip, drip – what ! I looked closely as droplets of the drug slid down the inside of the pump encasement It’s not supposed to do that ! The dripping stopped as the gentle movement of the syringe ceased. Just to make sure I waited again. Pressed the button once the five minutes was up, and drip, drip, drip. I could hardly believe my eyes. I called the nurse over and showed her. She looked horrified. The syringe inside the unit was minutely out of place, and as a result the dose of morphine was dripping inside the unit instead of being pumped into my veins. Good reason for my collapse, low BP and oxygen levels, I had not been receiving any pain relief since the early hours of the morning when the syringe was last changed – under the light of a mobile phone. With a quick key turn, and ‘click’ as the syringe was correctly put in place, the problem was resolved, and the relief from pain almost immediate. Nurse Lauren continued to apologise, even though I tried to re-assure her it wasn’t her fault, the syringe was changed by the night shift some six hours earlier. It could only have been noticed if she had been present at the precise time I had been pressing the green button.
So we were back on track. Pain relief now being delivered successfully. The consultant was having a weekend off, so the last time I saw him was Friday night after he came out of theatre. My lungs were working okay, albeit in a limited capacity, and the only hurdle now was controlling the pain . He agreed I could go home once I was comfortable with pain relief measures. By Sunday evening I’d had enough, I convinced the physio that I could manage stairs at home and so armed with the usual parcel of drugs I left for home.
A week has passed, the district nurse has been and removed the stitches from the hole that was my chest drain. I wish I could reports a massive reduction in pain. I can’t. Hardly surprising considering the mechanics behind the surgery I’ve undergone. I have a lengthy scar across my back almost mirroring the one resulting from liver surgery in December. My shoulder blade is sticking out like a dorsal fin as a result of the parting of my ribs to get access to my lungs. Movement of the scapula (shoulder blade) involves eight different muscles alone, with a further eighteen directly attached to the scapula. The opiates I normally take for background pain have been increased, and I’m still relying on additional drugs to control breakthrough pain. I’m waiting for the Macmillan nurse to call me with regard to this, she’s always come to my rescue before, in managing pain. Opiates are fine, and effective, but not something I want to rely on in such high doses. They affect sleep, digestion, appetite, and more importantly the mind. What little sleep I get is accompanied by disturbing dreams. Not frightening, not scary, just never nice. Oh sweet dreams. A comment made so casually, yet something I would willingly pay for at the moment.
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