Speed...

Day 1: Settling in and moving forward

After having to leave the ICU so quickly I guess I either got lucky or the staff took some pity on me (probably both) because I was wheeled from the ICU to a single bed room! It was such a relief to go from the ICU which I found to be quiet and somewhat restful (which is absolutely not what I know ICUs to be like – a difference probably explained by the fact that the only time I was really awake in the ICU was the middle of the night) to a room that was equally so. After getting into my new bed (no small effort) once again requiring some serious sweating, I managed to drift off and get some sleep all the way until 6:30am.

Now since, I got evicted from the ICU so early in the morning nobody had the chance to call girlfriend to let her know that I had left. So she arrived at the ICU right at the beginning of visiting hours which was unfortunately right in the middle of getting the new patient whom took my slot settled in. So she had to wait awhile before she was allowed back into the room I was assigned only to find that I was not there anymore. Minor SNAFU that was quickly remedied. 

Eventually girlfriend got directions to where I was. It was good to see her smiling face that morning for lots of reasons but, honestly, one of them was that she had my iPhone. (A really good thing as the withdrawal was starting to get bad.) So along with getting to see girlfriend, and get my phone back, the rest of the morning of the first day was spent with the usual hospital things: rounds, shift changes, morning work-ups, meds, etc… 

In fact the entirety of the rest of the day was equally predictable. I got out of bed for a wheelchair ride down to x-ray. Had more visitors – Dr. Schnittger, Dad, plus a bunch of friends. Sat in a "real" chair for a little while (which was supposed be a pretty big deal but was pretty anticlimactic since I had gotten myself into a chair twice already by that point). And, of course, finally got to eat again which was great. The food (despite a poor appetite) helped energy levels quite a bit.

Pain on this first day was certainly there but was pretty well managed between the block and some occasional narcotics. I guess the best summary of this first day was that it was about celebrating the successful surgery, visitors, and starting down recovery road.

Day 2: Pain and Unplugging

If the first day was about getting on recovery road the second was about disconnecting and dealing with pain.

Although no-where near the misery of the first night post-op the second night was still pretty rough. As day one became day two the pain at the surgery site just started increasing. I soon ran out of comfortable positions, spots, or anything I could find to get some relief. Everything just hurt. 

First post surgery selfie.

The pain management team was good about checking in and doing what they could. Their strategy was to give me regular boluses of meds on an interval. The goal was that the pain would just be starting to come back when it was time for the next bolus. Unfortunately, for me, this was not working as it was coming back well before the next bolus could be given. So I sort of found myself "losing ground" near the end of the cycle. All this meant that by morning of the second day I was not a very happy camper.

Narcotics would help with the pain before the next bolus but the block was far more effective. Clearly a new approach was called for. So the pain team, after talking with my caregivers, decided to switch from boluses to a constant drip which would keep the medication level consistent at the block site.

The switch took most of the day. The decision was made in the morning and it took about 10 hours plus one more smaller bolus (sorta to give it a final kick) to get everything to a good place. But, once I was over that hill the rest of the time with the blocks went perfectly. No real pain in my chest at all and no more pain cycles.

There were other major milestones that I managed to clear on that second day too. After open heart surgery they leave some tubes inside the chest cavity to drain fluids away from the surgery site. I had two of them and in the afternoon it was time for them to come out. Many of the blogs I have read talked about how the tubes "felt weird" or were uncomfortable. I don't know if it was because of the nerve block or some other reason but I was never really even aware of mine. I knew they were in there, because they were supposed to be, but I was not really "feeling" their presence.

Removal was straight forward and certainly felt strange but was not really all that painful. Sort of a burning sensation, with a quick sting, that went away in a few seconds. Once they were out it was much easier to take a deeper breath. I think the chest tubes being out gave me another 500cc worth of lung capacity before my chest would hurt.

The other "big" removal of the day was the dressing on my incision. I could see the surgical site for the first time. It actually was not as bad as I was prepared for. Five inches long with no staples or external sutures. In many ways it just looked like a big cut and it was a cut that was healing nicely to boot.

The rest of the second day was filled with the same events and happenings as the first; plus, some other stuff. Lots of great friends visiting, tests, meds, and just generally monitoring my condition. But, I also was able to get out of bed and walk around the floor a bit. And, both Dr. Schnittger and Dr. Boyd dropped in to check on me and gave me a chance to ask questions again. (Which was great since I was not as drugged and had a much easier time remembering their answers).

On the whole day two was another day of solid progress. And, just as I was sort of reflecting on all this the nursing shift changed and my new night nurse, after introducing himself, mentioned that I might be going home tomorrow…

Day 3: Done

I know there is a big concern that hospitals in the US are pushing patients out the door too quickly. Rushing them home before they are ready and thus adding some risk to their recovery or their health. And, honestly, the first time I heard that I might be discharged only three days after undergoing open heart surgery that was where my head went. It made no sense: I was supposed to be in the hospital for five to seven days not three.

I thought about it that night. On the plus side I basically was not really hooked up to anything anymore. I had an IV that was not being used, two catheters for the blocks, and heart telemetry. I could get into and out of bed, get into and out of a chair, and walk around. (200 - 400 feet anyway). From a functional perspective I had to agree I could go home. 

But, I was really concerned about pain management. Up to this point I was relying pretty much entirely on my blocks for management of the pain. Early on the morning of the third day the pain team had been by and had removed the catheters for the blocks. I was pretty nervous about this since I was basically relying 100% on them for management of the chest pain. And, after my experiences the first night in the ICU I knew how badly it could hurt and really did not want to go through that again. But, the catheters can't stay in very long because of infection concerns and it was time for them to come out. So with the block lines gone (a completely painless event) I was both able to have my back scratched again (the tape used to secure the catheters really itched) plus I started taking pain pills for the first time.

That morning of the third day was the first time I had even tried any pain pills. The first pills were strong stuff and worked pretty well for the most part but they still were not quite "enough" for lack of a better phrase. With pain levels of ≤ 3 I could relax and sleep. With just the initial pills the pain was usually in a range of 3 to 6 averaging around 5. Too much to really be able to relax.

So later in the morning, after consulting with girlfriend, I pushed back and said that I was just not comfortable going home until we had a better pain management strategy. I really wanted to go home (very much) but was just not comfortable that it would work out yet. 

The doctors were great and listened to my concerns and agreed that going home would wait until we had a better, and proven, pain strategy. Plus, they also wanted me to have successfully climbed some stairs (I live in a 3 story townhouse so negotiating stairs was a must for me).

With new, and clearly defined goals, it was pretty easy to develop solutions. My morning nurse suggested another drug to "stack" on with the original pain pills. This worked really well. By 11am it took the pain that was ranging from 3 - 6 down to a 1 - 4 with the majority of the time hovering around 2. Certainly something I could sleep and rest with. 

And, around 2:00pm physical therapy showed up and gave me techniques and the "do's and don'ts" of climbing stairs with a broken sternum. A practice session later and the last hurdle was cleared. 

By 3:00pm it was clear I was going home!

The rest of the day was discharge instructions, prescriptions (almost 10 of them), and a heroic level of effort by girlfriend to secure all of the medications before the only pharmacy my insurance would cover closed. (Weekend hours as it was Saturday).

So at 5:00pm on Saturday February 20th, 75 hours after being wheeled out of surgery, I was being
wheeled out of the hospital to go home!

That car ride home, holding tightly to my "sternal precaution pillow", was one of the best car rides I have had in a long long time.