normofthenorth
Well-known member
OK, I've been meaning to start this for days now, and here goes at last!
It's Monday, almost exactly 5 days after they wheeled me out of the OR last Wednesday. I was supposed to be home now, but I got "stuck" here overnight by a little SNAFU from different teams manipulating my INR in different directions.
Since I ended up with a Dacron "simplicity ring" on my MV, I need to have ACT for 3 months, while the patch and the stitches and the corners smooth out, to present a smaller target for clotting. The pro's forgot to mention the 3 months of ACT from the patch, and apologized to me post-op. What can you do? (Thank God I never make "misteaks", eh?)
Well, they'd been maintaining my INR in the 2.5-ish range, where they want me to keep it at home, too. The last measurement before they were going to yank out my pacemaker wires showed 2.3. Many people don't think that's a problem, but the 2nd-banana CSurgeon thought it was too high, and should be lowered before the yank. So I got some Vit. K in OJ, and THEN the wires were yanked a few hours after. Whatever.
Today, I was all dressed up in street clothes, all hoses and lines and wires removed, saying my goodbyes and doing some "work work" on the laptop, expecting to hear any minute that I could leave. Everything was done, and all the results were in, EXCEPT my last blood test. When it came in, at 2-ish, it showed an INR of 1.40 (leftover from the Vit. K), and they decided I should NOT go!
They say they can keep me safe from clotting in a number of ways (like with LMW Heparin), but those other ways don't raise INR, only Coumadin/Warfarin does that. And they don't want to cut me loose until I'm in my therapeutic INR range and stabilized there. The feedback on (oral) Coumadin is so slow, that even with a rush blood test, they can't prove that I'm "good" until tomorrow, so I'm stuck overnight.
The place and staff are tops in so many ways -- unfortunately the menu selection is the pits, and I've had WAY too much trouble sleeping in the fancy hospital bed!! And if I don't NEED to be in a hospital, I'd SO much rather be home. But no.
My overwhelming surprises, as I've posted elsewhere, are
(1) PAIN: that the whole thing didn't hurt a LOT more, or need a LOT more painkillers, and (2) I've been "ME" throughout, and cogently so, whenever I wasn't knocked out! I never (OK, maybe "hardly ever") felt mentally, psychologically, emotionally, or spiritually changed. Many, maybe most, people experience both of those things differently, and some WAY differently.
And here's a third: I feel like I've already picked up where I left things last Wednesday! My work has certainly continued right where it left off (at the computer), with a few days off in-between. Of course, I won't be driving, or bicycling, or walking fast or very far, the way I did a week or two ago. Of course, there's a long gradual sternum "heal" and a long gradual slide toward, and through, cardiac rehab. But it doesn't feel like the first day of the rest of my life in any profound way, and it's different from last week in a few obvious ways, but not in kind.
So the story thus far is a surprisingly happy one for me and mine -- touch wood!
I posted a LOT more detail on the pain stuff already, at www.valvereplacement.org/forums/showthread.php?36941-on-the-other-side&p=479995#post479995:
Basically, since coming out of the OR, I've had a total of ONE dose of any narcotic (2cc of Morphine), and a few Extra Strength Tylenols, maybe 5 total! Not trying to be a hero here, just not taking them unless they seem needed, and trying to keep my mind clear.
Other than my sternum, which hurts a bunch when I stress it in any way, my "second-place" "silver-medalist" pains are puny things. Some of the tubes and things hurt coming out. (I was asleep when most of them went in.) Every time I get stuck for a new IV or a blood test, etc., I look the other way or close my eyes! I'm a real wimp about needles -- it's one of the reasons I've pushed my pain threshold at the dentist!
I HATE the way the hairy-but-shaved parts of my body feel!
I'm generally surprised how good my old "holes" look and feel. E.g., I didn't think I'd be able to walk almost straight into a nice hot shower right after my IV line was pulled out!
I had maybe 20 "connections" -- yee-yikes. Good news is they soon started slowly being removed. When I got to my first shower, I was surprised that nobody had warned me that the hole from my "trip-alum" feed into my Jugular vein was VERY heat-sensitive!?! When the shower's hot water hit it, it BURNED! Two days later, it was bac to normal.
Of course, there are MANY parts of this experience that are weird, unprecedented, and HUGE! Like those connections! One of the tests they ran on me in CVICU, maybe twice, was a direct test of my hear't output, like pressure times volume. They took two of the connections that were already going into me, but capped, and connected them directly to each other, through a fluid-flow gauge! For a while, all the blood coming out of my heart was going straight outside my body, through this gauge, then straight back into my heart! SKIP the BODY!!
Sure, that's no weirder than the heart-lung-machine "pump", but I didn't get to experience that directly! I was wide awake and totally aware and cogent when all my blood was bypassed like that! Yee-yikes!
I had a few frustrations, one or two of which almost drove me nuts. I've probably already written TOO much about my experience "coming to", before I ditched the breathing tube. NOT my fave, 'nuff said.
Probably my biggest frustration happened shortly before the surgery, and got me way into the stress zone for a while. Two med. pro's (surg. nurses?) were in charge of fitting me up with the "connections" that patients get while they're still awake. That was mostly an IV line (back of a hand or back of a wrist -- I forget which, having had both since the surgery!) AND an "art" line, a line into a forearm artery.
The "art" line looked a lot like another IV, but it's different, and maybe always trickier. The nice young "couple" (1M, 1F) who were in charge couldn't make it work AT ALL for what seemed like FOREVER! They stuck it into an artery on the back of my right arm, then they tested it (I forget how) to make sure the artery was open and flowing all the way to the needle and not blocked. NOPE! It's not working. So they checked out the other arm. Then they came back to the FIRST arm! Then they had to go back to the OTHER arm again!! And each time took a while, and wasn't fun, either! (Did I mention I really don't like needles?)
Anyhoo, the combination of stressors was almost too much at the time:
Eventually, it worked, and I started breathing normally again. Soon enough to have a nice chat with Dr. Feindel, my world-class rock-star surgeon. Our chat was so friendly, light, and charming, that I even decided to confront him with the fact that he'd "fibbed" to me about the study that shows that the Perimount COW valve seems to have better hemodynamic performance than the Hancock II PIG valve that I was getting (and got). (What kind of idiot confronts his heart surgeon with something like this 10-15 minutes before his own open-heart surgery?? You're listening to him!!
)
"Really? What'd I say?" he asked So I told him. (It's on here somewhere, if you search.) AND I told him he was a co-author of the study whose approach he'd misrepresented, and whose validity he'd besmirched! He kind of winked, and started walking away toward the OR, then turned back with a smile and said "I still don't believe that study!"
BTW, I have a hypothesis (based on NOTHING!) for how it turned out that way: the main author from Leipzig and the 3 Torontonians all started chit-chatting about valve hemodynamics at a big conference somewhere. The Toronto crowd (Munk Centre, Univ. of Toronto) were close to publishing their "Gold Standard" article proving for once and for all (or so it seems!) that the Hancock II PIG valve lasts longer than any valve has ever been demonstrated to last, including longer than the Perimount COW valve. The German challenges them to a "shoot-out" on hemodynamics. He will provide a small but random sample of cow data, and they will have their computer randomly search their large database of pig patients, to find the most perfectly matched "case-controlled" pairs, ideally differing in virtually NOTHING except the animal the valve came from! And they'd sum up (average) the hemodynamic data, and publish the results under all four names. (The order of names would presumably begin with the winner(s) of the bet.)
When the data came in, the Canadians got smoked, lost the bet, and apparently helped prove that their fave Gold-Standard most-durable Aortic tissue valve ever, has maybe 10-ish% WORSE hemodynamics than its arch-rival! Ouch!
Anyhoo, I'm totally speculating above, but it's definitely a weird and rare glimpse into that world of jet-set heart-surgery research, no matter what the truth really is.
My heart is weird! My heart didn't seem QUITE as weird today as it did yesterday, though I think the remote-monitoring board showed it was doing a bunch of PVCs today, maybe even more than yesterday. Not often >10/minute, but almost never 0/min, even for the past minute. It's also been beating unusually fast -- 90s resting, and over 100 when I do stuff (walking, getting up, sitting up -- BIG stuff!)
Neither the rate nor the PVC frequency concerns my team. But I seem to notice my heart "beating out of my chest" at least as much as pre-op, maybe more. Maybe more yesterday and less today.
I developed a nice simple plausible mechanism to explain it, or part of it, but I haven't heard anybody sign onto it, so maybe it's not so plausible. They just say "You're only X days after open heart surgery!" and "It'll smooth out," and stuff like that. Hope so.
Funny exchange today! I was always scheduled for an EchoCG today, and needed one as part of my checking-out. (Hah!) When the guy arrived with the wheelchair it was the absolutely worst timing. I'd just spent maybe 25 minutes turning their breakfast and a bunch of my good solid high-fiber food into a remarkable bowl of porridge -- steel-cut oats, good yoghurt, packaged "mixed-fruit" (like fruit cup), raisins, and enough of their skim milk to make it semi-liquid -- and I was about to sit down to start eating it. But NO!! I ended up taking it, and my coffee, on the wheelchair, and doing some breakfast in the halls and on the elevators.
When I arrived in the ECG exam room, the lovely full-grown Russian immigrant technician put my breakfast up on a safe high shelf, and I got on the table and rolled away and breathed as she requested. After maybe 10 minutes, I thought we were substantially finished, so I made a probing joke (hoping to get a report on my scans): "So, what do you think, should I buy green bananas, or not?" She didn't stay up with me first time, so I explained that a person should only buy green bananas, if they think they're still going to be around for a few weeks, until they ripen. She thought for a minute and then said earnestly "A person should always have some hope!"
About three times, I lost the struggle to stay still for the remainder of the exam, because I couldn't stop thinking of that response, and laughing!
The ECG seems to be fine, no regurg, no leakage or seepage at the sutures. She was going to tell me the exact size Hancock II I got, out of my file, but it didn't happen. Maybe I'll ask one of my nurse pals.
NURSES!! Nurses in general, and Hospital workers in more general, tend to be a good group. A few of my repeat nurses have been absolute delights, professionally and "socially" while we're chit-chatting (as I do, can you tell?) At least in THIS part of THIS hospital, all the staff seem to be happy to be working here, with this group, and for this organization. That makes life much better for a patient. My Dad stayed in several greater-Boston-area CC Hospitals and ES Hospitals, and they ran the gamut, from absolute Hell-holes (some of them with big bills and well-known names), to some of the best-run organizations of ANY kind I've ever seen. The Munk Center for Cardiac Care at UHN/TGH seems to rank with the best I've seen -- DESPITE their repeated failure to get my "art line" set up last Wednesday, and their failure to get me home today!
How to recognize the ~20% of Hospital Staff who found the RIGHT job!
During my first few days, when I was having trouble doing simple things like sitting up in bed, or getting out of bed (even with the motors), I found that there are about 20% of staff "who get it". I don't think I'd "get it", I think I'd be in the other 80%, so this DEFINITELY isn't about them not being as "good" as I am.
Here's what I have in mind:
Whenever any hospital staff enter your room, they usually have a problem: You're lying down and have to sit up, your pillow is in the wrong place, the table or the waste-basket is in the way of their machines, whatever. All 100% of them do a fine and quick job of solving that problem of theirs. Then they do their job, generally just fine.
THEN, if they're in the same "bottom" 80% as I am, they've solved all their problems, and they leave and probably close the door. If it's "Day 1", I can no longer throw things in the waste basket or reach all the stuff on my table, and my pillow's in the wrong place. The "top 20%" take the next step, do their best to put the things back where they were, and double check with the patient that they're in the right place.
I doubt that anybody is trained for that; I think it's just obviously important, to certain personality types -- the types that should be disproportionately hired in hospitals but maybe aren't!
Here's an example: When I first moved to the Cardiac Ward on Thursday, I was introduced to a nursing student, who would be responsible for me. She immediately distinguished herself as a member of "the top 20%", with flying colors. I decided to tell her teaching supervisor. When I did, she treated it is as if I'd given her evidence that the student was wasting time doing frivolous jobs, instead of getting straight onto the next patient who may need something IMPORTANT! Sure, I've done a lot of idle chit-chatting with the staff, so I'm not innocent on that one, but that's NOT what was happening here! I disagree!
I did have ONE weird neurological episode: Around midnight Friday night, soon after taking my first metoprolol (s-p?) beta-blocker, I found myself mentally handicapped. Not amused. I decided that I'd press the nurse-call button, but I hesitated, because I didn't think I could verbalize my problem. I lay there for a while, searching for words, feeling dysphasic (but I never could have found THAT fancy word!). Eventually, I pressed the button, and explained my problem, quite slowly, with the "script" I'd worked out -- first to the first nurse, then a second, and then a doctor or two. I'd done two medication things for the first time -- the metoprolol and some Vit. C -- and I suspected the metoprolol had cost me 40-50 IQ points.
The first nurse asked me the standard battery of "do you know where you are?" type questions. What's the date, what's this place, etc., etc. I knew all the answers, though I produced them quite slowly. Then the second, more experienced nurse came in and very soon asked me to spell the word "WORLD" backwards. I tried! GOD I tried. After about 5 tries, I might have finally hit it, maybe.
So we had a consult with the doctor or two, and I went back to sleep around 12:15 AM, and they went off to make plans for a brain CT for me in the morning. At about 1:15 AM (an hour later), I woke up, and felt 100% again. When the experienced nurse came in, she heard my story, and she let me spell "WORLD" backwards. Then she joked "And now we should let you spell 'Mississauga' backwards!" (It's the Native name for a Western suburb of Toronto.) I promptly spelled it backwards, while she wrote it down on my little white-board, to make sure she didn't miss a letter. I got it right -- YAY!!
The local post-op cardiologist and I still wonder if it was a drug effect, but all other eyes are on a TIA. The CT came up pretty clean -- one general faint "shadow" on my left side, but nothing defined. One of the nurses thought I was weaker pushing on my left side (which would implicate the RIGHT side of the brain), which I certainly never thought I was. (Maybe she was noticing the strength deficit in my left calf muscle after my recent Achilles tear?)
So far, that's the closest thing to a migraine or other cloudiness or fuzziness, and I don't need any more!
I think I mentioned in my Pre-op post that I told the anesthesiologists to try to avoid the drugs that cause amnesia and those that cause migraines. They agreed with the migraines (and thought the IV anesthetics would be safer than the inhaled vapors). They initially agreed on the amnesia, too, then suggested that I should change my mind, at least for a low dose of the implicated benzodiazepines, which I did. That was an interesting negotiation, which I'll slip in tomorrow. Getting tired now.
It's Monday, almost exactly 5 days after they wheeled me out of the OR last Wednesday. I was supposed to be home now, but I got "stuck" here overnight by a little SNAFU from different teams manipulating my INR in different directions.
Since I ended up with a Dacron "simplicity ring" on my MV, I need to have ACT for 3 months, while the patch and the stitches and the corners smooth out, to present a smaller target for clotting. The pro's forgot to mention the 3 months of ACT from the patch, and apologized to me post-op. What can you do? (Thank God I never make "misteaks", eh?)
Well, they'd been maintaining my INR in the 2.5-ish range, where they want me to keep it at home, too. The last measurement before they were going to yank out my pacemaker wires showed 2.3. Many people don't think that's a problem, but the 2nd-banana CSurgeon thought it was too high, and should be lowered before the yank. So I got some Vit. K in OJ, and THEN the wires were yanked a few hours after. Whatever.
Today, I was all dressed up in street clothes, all hoses and lines and wires removed, saying my goodbyes and doing some "work work" on the laptop, expecting to hear any minute that I could leave. Everything was done, and all the results were in, EXCEPT my last blood test. When it came in, at 2-ish, it showed an INR of 1.40 (leftover from the Vit. K), and they decided I should NOT go!
They say they can keep me safe from clotting in a number of ways (like with LMW Heparin), but those other ways don't raise INR, only Coumadin/Warfarin does that. And they don't want to cut me loose until I'm in my therapeutic INR range and stabilized there. The feedback on (oral) Coumadin is so slow, that even with a rush blood test, they can't prove that I'm "good" until tomorrow, so I'm stuck overnight.
The place and staff are tops in so many ways -- unfortunately the menu selection is the pits, and I've had WAY too much trouble sleeping in the fancy hospital bed!! And if I don't NEED to be in a hospital, I'd SO much rather be home. But no.
My overwhelming surprises, as I've posted elsewhere, are
(1) PAIN: that the whole thing didn't hurt a LOT more, or need a LOT more painkillers, and (2) I've been "ME" throughout, and cogently so, whenever I wasn't knocked out! I never (OK, maybe "hardly ever") felt mentally, psychologically, emotionally, or spiritually changed. Many, maybe most, people experience both of those things differently, and some WAY differently.
And here's a third: I feel like I've already picked up where I left things last Wednesday! My work has certainly continued right where it left off (at the computer), with a few days off in-between. Of course, I won't be driving, or bicycling, or walking fast or very far, the way I did a week or two ago. Of course, there's a long gradual sternum "heal" and a long gradual slide toward, and through, cardiac rehab. But it doesn't feel like the first day of the rest of my life in any profound way, and it's different from last week in a few obvious ways, but not in kind.
So the story thus far is a surprisingly happy one for me and mine -- touch wood!
I posted a LOT more detail on the pain stuff already, at www.valvereplacement.org/forums/showthread.php?36941-on-the-other-side&p=479995#post479995:
Basically, since coming out of the OR, I've had a total of ONE dose of any narcotic (2cc of Morphine), and a few Extra Strength Tylenols, maybe 5 total! Not trying to be a hero here, just not taking them unless they seem needed, and trying to keep my mind clear.
Other than my sternum, which hurts a bunch when I stress it in any way, my "second-place" "silver-medalist" pains are puny things. Some of the tubes and things hurt coming out. (I was asleep when most of them went in.) Every time I get stuck for a new IV or a blood test, etc., I look the other way or close my eyes! I'm a real wimp about needles -- it's one of the reasons I've pushed my pain threshold at the dentist!
I HATE the way the hairy-but-shaved parts of my body feel!
I'm generally surprised how good my old "holes" look and feel. E.g., I didn't think I'd be able to walk almost straight into a nice hot shower right after my IV line was pulled out!
I had maybe 20 "connections" -- yee-yikes. Good news is they soon started slowly being removed. When I got to my first shower, I was surprised that nobody had warned me that the hole from my "trip-alum" feed into my Jugular vein was VERY heat-sensitive!?! When the shower's hot water hit it, it BURNED! Two days later, it was bac to normal.
Of course, there are MANY parts of this experience that are weird, unprecedented, and HUGE! Like those connections! One of the tests they ran on me in CVICU, maybe twice, was a direct test of my hear't output, like pressure times volume. They took two of the connections that were already going into me, but capped, and connected them directly to each other, through a fluid-flow gauge! For a while, all the blood coming out of my heart was going straight outside my body, through this gauge, then straight back into my heart! SKIP the BODY!!
Sure, that's no weirder than the heart-lung-machine "pump", but I didn't get to experience that directly! I was wide awake and totally aware and cogent when all my blood was bypassed like that! Yee-yikes!
I had a few frustrations, one or two of which almost drove me nuts. I've probably already written TOO much about my experience "coming to", before I ditched the breathing tube. NOT my fave, 'nuff said.
Probably my biggest frustration happened shortly before the surgery, and got me way into the stress zone for a while. Two med. pro's (surg. nurses?) were in charge of fitting me up with the "connections" that patients get while they're still awake. That was mostly an IV line (back of a hand or back of a wrist -- I forget which, having had both since the surgery!) AND an "art" line, a line into a forearm artery.
The "art" line looked a lot like another IV, but it's different, and maybe always trickier. The nice young "couple" (1M, 1F) who were in charge couldn't make it work AT ALL for what seemed like FOREVER! They stuck it into an artery on the back of my right arm, then they tested it (I forget how) to make sure the artery was open and flowing all the way to the needle and not blocked. NOPE! It's not working. So they checked out the other arm. Then they came back to the FIRST arm! Then they had to go back to the OTHER arm again!! And each time took a while, and wasn't fun, either! (Did I mention I really don't like needles?)
Anyhoo, the combination of stressors was almost too much at the time:
- I'm like 20-odd minutes from the scheduled start of my surgery;
- This seems SO much simpler and easier than replacing a valve -- why am I so confident again, exactly?
- Oh, no, here they come again, to stab me again!?!
- Yeee-yikes!!!
Eventually, it worked, and I started breathing normally again. Soon enough to have a nice chat with Dr. Feindel, my world-class rock-star surgeon. Our chat was so friendly, light, and charming, that I even decided to confront him with the fact that he'd "fibbed" to me about the study that shows that the Perimount COW valve seems to have better hemodynamic performance than the Hancock II PIG valve that I was getting (and got). (What kind of idiot confronts his heart surgeon with something like this 10-15 minutes before his own open-heart surgery?? You're listening to him!!
)"Really? What'd I say?" he asked So I told him. (It's on here somewhere, if you search.) AND I told him he was a co-author of the study whose approach he'd misrepresented, and whose validity he'd besmirched! He kind of winked, and started walking away toward the OR, then turned back with a smile and said "I still don't believe that study!"
BTW, I have a hypothesis (based on NOTHING!) for how it turned out that way: the main author from Leipzig and the 3 Torontonians all started chit-chatting about valve hemodynamics at a big conference somewhere. The Toronto crowd (Munk Centre, Univ. of Toronto) were close to publishing their "Gold Standard" article proving for once and for all (or so it seems!) that the Hancock II PIG valve lasts longer than any valve has ever been demonstrated to last, including longer than the Perimount COW valve. The German challenges them to a "shoot-out" on hemodynamics. He will provide a small but random sample of cow data, and they will have their computer randomly search their large database of pig patients, to find the most perfectly matched "case-controlled" pairs, ideally differing in virtually NOTHING except the animal the valve came from! And they'd sum up (average) the hemodynamic data, and publish the results under all four names. (The order of names would presumably begin with the winner(s) of the bet.)
When the data came in, the Canadians got smoked, lost the bet, and apparently helped prove that their fave Gold-Standard most-durable Aortic tissue valve ever, has maybe 10-ish% WORSE hemodynamics than its arch-rival! Ouch!
Anyhoo, I'm totally speculating above, but it's definitely a weird and rare glimpse into that world of jet-set heart-surgery research, no matter what the truth really is.
My heart is weird! My heart didn't seem QUITE as weird today as it did yesterday, though I think the remote-monitoring board showed it was doing a bunch of PVCs today, maybe even more than yesterday. Not often >10/minute, but almost never 0/min, even for the past minute. It's also been beating unusually fast -- 90s resting, and over 100 when I do stuff (walking, getting up, sitting up -- BIG stuff!
)Neither the rate nor the PVC frequency concerns my team. But I seem to notice my heart "beating out of my chest" at least as much as pre-op, maybe more. Maybe more yesterday and less today.
I developed a nice simple plausible mechanism to explain it, or part of it, but I haven't heard anybody sign onto it, so maybe it's not so plausible. They just say "You're only X days after open heart surgery!" and "It'll smooth out," and stuff like that. Hope so.
Funny exchange today! I was always scheduled for an EchoCG today, and needed one as part of my checking-out. (Hah!
) When the guy arrived with the wheelchair it was the absolutely worst timing. I'd just spent maybe 25 minutes turning their breakfast and a bunch of my good solid high-fiber food into a remarkable bowl of porridge -- steel-cut oats, good yoghurt, packaged "mixed-fruit" (like fruit cup), raisins, and enough of their skim milk to make it semi-liquid -- and I was about to sit down to start eating it. But NO!! I ended up taking it, and my coffee, on the wheelchair, and doing some breakfast in the halls and on the elevators.When I arrived in the ECG exam room, the lovely full-grown Russian immigrant technician put my breakfast up on a safe high shelf, and I got on the table and rolled away and breathed as she requested. After maybe 10 minutes, I thought we were substantially finished, so I made a probing joke (hoping to get a report on my scans): "So, what do you think, should I buy green bananas, or not?" She didn't stay up with me first time, so I explained that a person should only buy green bananas, if they think they're still going to be around for a few weeks, until they ripen. She thought for a minute and then said earnestly "A person should always have some hope!"
About three times, I lost the struggle to stay still for the remainder of the exam, because I couldn't stop thinking of that response, and laughing!
The ECG seems to be fine, no regurg, no leakage or seepage at the sutures. She was going to tell me the exact size Hancock II I got, out of my file, but it didn't happen. Maybe I'll ask one of my nurse pals.
NURSES!! Nurses in general, and Hospital workers in more general, tend to be a good group. A few of my repeat nurses have been absolute delights, professionally and "socially" while we're chit-chatting (as I do, can you tell?) At least in THIS part of THIS hospital, all the staff seem to be happy to be working here, with this group, and for this organization. That makes life much better for a patient. My Dad stayed in several greater-Boston-area CC Hospitals and ES Hospitals, and they ran the gamut, from absolute Hell-holes (some of them with big bills and well-known names), to some of the best-run organizations of ANY kind I've ever seen. The Munk Center for Cardiac Care at UHN/TGH seems to rank with the best I've seen -- DESPITE their repeated failure to get my "art line" set up last Wednesday, and their failure to get me home today!
How to recognize the ~20% of Hospital Staff who found the RIGHT job!
During my first few days, when I was having trouble doing simple things like sitting up in bed, or getting out of bed (even with the motors), I found that there are about 20% of staff "who get it". I don't think I'd "get it", I think I'd be in the other 80%, so this DEFINITELY isn't about them not being as "good" as I am.
Here's what I have in mind:
Whenever any hospital staff enter your room, they usually have a problem: You're lying down and have to sit up, your pillow is in the wrong place, the table or the waste-basket is in the way of their machines, whatever. All 100% of them do a fine and quick job of solving that problem of theirs. Then they do their job, generally just fine.
THEN, if they're in the same "bottom" 80% as I am, they've solved all their problems, and they leave and probably close the door. If it's "Day 1", I can no longer throw things in the waste basket or reach all the stuff on my table, and my pillow's in the wrong place. The "top 20%" take the next step, do their best to put the things back where they were, and double check with the patient that they're in the right place.
I doubt that anybody is trained for that; I think it's just obviously important, to certain personality types -- the types that should be disproportionately hired in hospitals but maybe aren't!
Here's an example: When I first moved to the Cardiac Ward on Thursday, I was introduced to a nursing student, who would be responsible for me. She immediately distinguished herself as a member of "the top 20%", with flying colors. I decided to tell her teaching supervisor. When I did, she treated it is as if I'd given her evidence that the student was wasting time doing frivolous jobs, instead of getting straight onto the next patient who may need something IMPORTANT! Sure, I've done a lot of idle chit-chatting with the staff, so I'm not innocent on that one, but that's NOT what was happening here! I disagree!
I did have ONE weird neurological episode: Around midnight Friday night, soon after taking my first metoprolol (s-p?) beta-blocker, I found myself mentally handicapped. Not amused. I decided that I'd press the nurse-call button, but I hesitated, because I didn't think I could verbalize my problem. I lay there for a while, searching for words, feeling dysphasic (but I never could have found THAT fancy word!). Eventually, I pressed the button, and explained my problem, quite slowly, with the "script" I'd worked out -- first to the first nurse, then a second, and then a doctor or two. I'd done two medication things for the first time -- the metoprolol and some Vit. C -- and I suspected the metoprolol had cost me 40-50 IQ points.
The first nurse asked me the standard battery of "do you know where you are?" type questions. What's the date, what's this place, etc., etc. I knew all the answers, though I produced them quite slowly. Then the second, more experienced nurse came in and very soon asked me to spell the word "WORLD" backwards. I tried! GOD I tried. After about 5 tries, I might have finally hit it, maybe.
So we had a consult with the doctor or two, and I went back to sleep around 12:15 AM, and they went off to make plans for a brain CT for me in the morning. At about 1:15 AM (an hour later), I woke up, and felt 100% again. When the experienced nurse came in, she heard my story, and she let me spell "WORLD" backwards. Then she joked "And now we should let you spell 'Mississauga' backwards!" (It's the Native name for a Western suburb of Toronto.) I promptly spelled it backwards, while she wrote it down on my little white-board, to make sure she didn't miss a letter. I got it right -- YAY!!
The local post-op cardiologist and I still wonder if it was a drug effect, but all other eyes are on a TIA. The CT came up pretty clean -- one general faint "shadow" on my left side, but nothing defined. One of the nurses thought I was weaker pushing on my left side (which would implicate the RIGHT side of the brain), which I certainly never thought I was. (Maybe she was noticing the strength deficit in my left calf muscle after my recent Achilles tear?)
So far, that's the closest thing to a migraine or other cloudiness or fuzziness, and I don't need any more!
I think I mentioned in my Pre-op post that I told the anesthesiologists to try to avoid the drugs that cause amnesia and those that cause migraines. They agreed with the migraines (and thought the IV anesthetics would be safer than the inhaled vapors). They initially agreed on the amnesia, too, then suggested that I should change my mind, at least for a low dose of the implicated benzodiazepines, which I did. That was an interesting negotiation, which I'll slip in tomorrow. Getting tired now.
