Thursday, March 5, 2009

Day 10

While it wasn't a setback, I don't think I made much progress today. The knee is a little sorer than usual. I didn't help myself when I reached awkwardly for my phone while I was walking toward it. I didn't need to hurry, but I did. I stretched my quad muscle and the suture site a little more than I should have. There's no damage, but I caused myself some unnecessary pain. I need to be more careful. Now is not the time to do something stupid.

Here is the remaining stuff about my hospital stay. It's long and full of detail. I hope it will give knee replacement candidates an idea of what they'll experience.

The following takes place between noon, Feb. 24, 2009 and noon, Feb. 27, 2009. (Cue ominous music.)

It did not take a Jack Bauer effort to survive my hospital stay. And at no point did I find myself fending off terrorists with a bedpan and an IV pole. But a knee replacement is an adventure in its own right.

I'll first start with a slight rant. If J.D. Power & Associates called to rate my overall customer satisfaction with the level of nursing care on the ward at OBCH (One of the Big Cleveland Hospitals), I’d be inclined not to give it high marks.

Once the surgery is over, doctors (or someone from their staff) do drive-bys to make sure your leg is still attached and leave the rest of the care to nurses and nurse’s aides. Many of the nurses and aides seemed nice, some seemed competent and others … not so much. I assume there is a written protocol for knee-replacement aftercare. But I’m not certain everyone on the orthopedic ward at OBCH bothered to read it. I'm fine and have made good progress. Perhaps I expected too much.

I was wheeled up to my (single!) room around noon on Tuesday. There still was not much sensation in my right or my left leg at that point, but I could feel the epidural wearing off. That became fully evidenced when pain began to radiate outward from my knee. These were no minor twinges. This was, “Holy crap, that really hurts,” kind of pain.

As mentioned previously, the anesthesiologist had hooked up a pain control device while I was in post-op. These devices allow patients to push a button every six minutes that safely delivers a small dose of high-powered Dilaudid through their IV. I was told numerous times that I should not be afraid to push the button, that it would not turned me into a tweaked-out lab monkey if I kept pushing the button.

Everyone said that there would be pain, but I wasn’t quite prepared initially for just how much pain there would be. I quickly embraced the junkie monkey in me and pushed the damn button whenever I could. I spent the first 24 hours in a gauzy haze, which is not a bad place to be after doctors have slice opened your knee and have spent an hour or two sawing, hammering and stapling your body.

I couldn't get past the first page of the John Irving novel I had brought with me. My wife brought the kids for a short visit and I slurped down a liquid lunch and ate a little of the fruit and yogurt tray I had ordered for supper. The rest of the time was spent sleeping and pushing the button.

The Dilaudid made the pain bearable, but the nerve block was not doing much at all. It was supposed to alleviate pain through the top of the knee. The anesthesiologist resident upped the dosage slightly the next day, which helped immensely.

The hospital bed became a warm cocoon, a good thing given the condition of my knee and the fact I was strung up like Neo in a pod. Attached to me at that point were an IV line, the nerve block, a Foley catheter and a drain that removed blood from the surgical site.

My first physical therapy session came Wednesday morning (Day 2) after a not-so-pleasant breakfast. I felt hungry and decided to give an egg, sausage and cheese sandwich on shot. Wasn't ready for that. Should have stuck with the Jello.

The physical therapist and a therapist in training stopped by and asked me if I could do some jumping jacks. (Not really.) They tested the amount of strength I had in my leg and had me stand up with the aid of a walker. Fail. My leg wasn’t strong enough to support even a portion of its own weight. I got back in bed, slightly discouraged.

The therapist team, two-thirds of a wholesome Charley's Angels team, returned in the afternoon and we tried again. This time I slowly inched out of the room and about 30 feet down the hall before turning around and returning to my room, exhausted. Progress had been made. Day 2 also brought a clearer outlook on the world. I still needed my button, but not quite as much. The pain was not as bad and I found myself able to read. I went with liquids for lunch, but at a nurse's urging, tried solids again for supper. A toasted cheese sandwich and bowl of tomato soup never tasted so good.

By Day 3 (Thursday), I had even grown accustomed to the catheter that had been conveniently emptying my bladder. (There is no other way to get that job done after a knee replacement.) But by Day 3, that puppy needed to come out. That task fell to a young nursing student early in her hospital training. The instructor had a slightly devilish look on her face when she told the surprised student that she’d be pulling out the catheter. She probably got some pleasure from the panicked look on my face. The catheter slipped out without incident. My outlook on life improved immensely at that point.

An orthopedic resident changed my dressing and pulled out the drain. That gave me my first opportunity to view the incision. It looked impressive, about 7 inches long that runs through the center of my knee. The skin was held tightly together by 18 surgical staples. The doctor said it looked good, that there no signs of infection.

Finally, the unhooked all of the IVs, including the pain pump. They'd be giving me Percocet tables from that point on. And when the nerve block went, I became completely untethered of lines and tubes. That meant I could get rid of that ghastly hospital gown and put on some underwear, sweat pants and a golf shirt. Life was good. (And praise be, as if I wasn't already the luckiest guy on the planet, I even had a bowel that morning. Yes, yes. TMI overload. But if you get your knee replaced, you’ll know just how blessed an event that will be.)

My new therapist, Dave, arrived Thursday morning and led me on another spin down the hallway. I cruised past the stopping point for the previous day’s jaunt and made it to the end of the hall, where we practiced getting up and down stairs with a cane. “Up with the good (leg), down with the bad.” My knee buckled on the way up. Thankfully, Dave was there to support me. We took the same walk in the afternoon, only this time, I went up and down eight steps without a hitch.

Day 4 (Friday) involved some breakfast, another round of therapy and some last-minute instructions. I was home by noon, extremely grateful and a little anxious to be there.

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