We’ve discussed two phases of watching over our own medical care – catching a problem early through vigilance and gate-keeping its diagnosis and treatment. The recovery phase, at least in a surgical recovery ward, is sufficiently complicated and hazardous that it warrants a third discussion.
We’re not overlooking any required surgical phase. You took care of that by watching over your diagnosis and selecting a surgeon and a facility, and you’re 100% in their hands until you’re awake again, usually in a recovery ward. That’s where we pick up the story this month, on the murky trail between the O.R. and home. The recovery ward experience might require more assistance and assertiveness than any other phase between your first suspicion of an illness and full recovery, because in this phase you’re more incapacitated and vulnerable than you realize and at the mercy of more people.
You’re on narcotics, with significantly impaired memory and judgment. You sound and feel lucid, but you’re really an idiot. Just as you did not swim the English Channel last night as you vaguely think you did, you won’t remember half of what you discuss clearly with your providers. You’re overwhelmed with inconvenience and disruption while changing from a surgical invalid to a functional person as fast as possible. Doctors and nurses are sandblasting your drugged brain with instructions, and swamped nurses are too busy to provide the personalized care they’d like to offer. They have time to meet your minimal needs, ease your serious pain and suffering, and save your life in an emergency until the doctors get there, and but most of them don’t have time to listen to your intermediate problems. Wrong pills? Prove it. Back’s killing you after knee surgery or arm’s trapped under you because you’re too drugged to roll over? No, sir -- you’re comfortable; now hush and go to sleep. Sweating? That’s your problem, sir; I like the ward at 80 degrees.
Your doctor says the best things you can do to hasten your recovery are sleeping (best healing time) and walking, but there’s no way in hell you’re getting much sleep in those boiler factories and nurses are sometimes too busy to help you back on your feet. I’d just had two major abdominal surgeries in one day, and six different people woke me up six times in one hour to perform six different routine checks on me. Another nurse awoke me at 6:AM -- once -- after less than two hours of sleep to offer me a warm, wet facial towelette -- in a room that felt like a steam bath despite the cold weather.
Deliberate awakenings and the incredible, incessant racket will cost you a great deal of curative sleep. Good earplugs, one deaf ear, my own sound-deadening memory-foam pillow, and a white noise source helped dull the roar, and my own fan helped ease the oppressive heat. Don’t like my sleeping under nothing but a sheet corner over my loins, nurse? Then turn down the freaking heat!
You need a clear pair of ears and brain in the room with you to help you intercept and avert wrong medications, remember how to clean your incision, and figure out how to roll over in bed if really laid up. Few of your doctors and nurses recognize your fog because your empty head bobbles quite cooperatively as they blitz you with information.
Five different nurses over four days tried to give me harsh chemical laxatives my bowel surgeon told me I should avoid (I questioned each new med all week). It seems the prostate and bowel surgeons had coordinated their surgeries well, but had not coordinated the recovery phase as well. (Where else have we seen that recently?) The surgeons were giving contradictory instructions and the nurses were logging neither why nor when I refused the laxatives, so the pills kept coming day after day. Who finally resolved the prescription conflicts? Their whacked-out patient . . . the same person who realized his sedative was dangerously strong, demanded they cut it way back, and discovered after returning home that it was dangerous with narcotics because both suppressed the central nervous system – the system that tells our heart and lungs to keep functioning as we sleep. No wonder it left me literally unable to figure out how to move my pillow.
Then there were the endless instructions and dialogues. How to clean my incision. That the shower room and water are too cold to take a shower. How to operate the TV remote they refused to believe was broken until I changed channels by touching its cord (my brain and eyes were too foggy to read on morphine). How to change my drug regimen. How to use the catheter bag. How my surgery came out. Whether I may live for five years, or 20. That I didn’t really have to pee because I was on a catheter – until the line jumped out of their hands when it shifted and released the flood I insisted was causing pain. How to avoid bending my arm day and night because the nurse didn’t want to replace my failing IV line because her shift was nearly over. That I should not care that my face was crammed into the bed rail because they knew what was and wasn’t comfortable. Where to find new sheet and blankets after mine disappeared. Why they had time for a Halloween party but no time to follow my doctor’s instructions to get me out of bed to walk. To angrily demand I decide whether they should give me an injection for nausea I wasn’t yet having.
Protection from drug-influenced confusion includes taking notes real time on anything important, having a friend present to listen and record, convincing the staff that your memory is unreliable, and providing evidence of your claims. Personal examples of the latter include producing the quick bag-full of urine, asking my doctor to tell nurses personally that a med is wrong, asking other ward mates to verify that one patient took cell phone calls before dawn, listing the procedures performed in six awakenings in one hour and proving it with the written charts, and identifying the nurse who awoke me before dawn to offer me a towelette.
Understand that each awakening costs us more than its own five minutes of sleep. It restarts our sleep-cycle clock, denying us the deep sleep vital to mental and physical recovery. Six hours of uninterrupted sleep is far more healing than six individual one-hour naps, and light, even through closed eyelids, cumulatively wakes us up. One way to promote good, restorative sleep is to demand they leave us the hell alone by doing the necessary checks all at once rather than in 10-12 blinding separate invasions. Before I complained: at least 10 invasions every night plus countless awakenings from banging equipment and loud conversations inside my open ward and then outside my open private door. After I complained: One invasion per night for about four items, done only when I pressed the call button when my IV tower beeper woke me up, with little noise through my now-closed private room door. Funny how non-vital the other half-dozen “mandatory” blasts of light and sound became after I demanded relief. I actually got enough sleep after three days of this that I awoke spontaneously one morning – the way all of us should awaken every morning in our normal lives. My wife and I both still slept like the dead for 12 hours our first night home and I still sleep for nearly 10 hours daily-- something we normally shouldn’t be able to do and I absolutely could not do in the hospital.
The hospital recovery phase message is manifold:
- Have a companion who cares, who realizes that you are under the influence of narcotics, and who will speak up assertively when required to ensure your needs are being met.
- Distinguish, with your companion’s help, between your real needs and basic comforts and unreasonable demands on the staff’s limited time.
- Balance your extra demands on the staff by looking for ways to save them some time. With your friend’s help if necessary, get your own juice, make your own bed (I don’t like my sheet feets tucked in tightly anyway), pick up the wrapper someone left on the floor, turn on/off your own optional gadgets, raise/lower your own bed rail, etc. The more self-sufficient you get, the more confident you get about going home and the more likely you may get a gold star rather than a Whiner! icon on your hypothetical unofficial chart.
- Learn enough about your medical problem and real needs to recognize errors worthy of correction. I let them slide on meds of convenience, but flatly refused to accept two incorrect and potentially harmful meds.
- Get the heck out of there as fast as is safely possible. Doctors, nurses, books, and infection and recovery statistics strongly advise this, and personal experiences in several hospitals reinforce it. Your doctors should explain specific discharge criteria (e.g., number of days, bowel awakening, physical capability, your self-confidence and home environment) and urge you out the door the minute their criteria are met.