"The Horror..."
Open-heart surgery should be scary enough. I've found that people empathize rather quickly, promising to keep me in their thoughts and prayers. My experience with it was probably as good as it could be, with minimal time on the pump, everything going as good as could be expected, and so on. They say that early in ICU afterward, I sat bolt upright and pointed at the tubes in my mouth, such that they had to sedate me even more. Of course I have no memory of that part. There is no accounting for what people might do when only a few parts of their brain have started working again. I do recall having some discomfort with it, feeling a bit choked a couple of times and being reassured to just relax and breathe. For the most part, I was on enough Fentanyl to just enjoy that sleepy ride. Even being extubated only made a slight impression, now quickly fading among the hodge-podge of confused memories.
Overall, drugs saved the day. There is no telling how horrible the whole ordeal might have been if I had not been adequately "under". For most of the next day, I was in ICU, being carefully tended by a very experienced and excellent male nurse. Between hourly checks and occasional turns, "sit ups", and what-not, I was quite content to sleep through it all. Eventually I was moved out of ICU to a normal recovery room, where I experienced a constant turnover of new nurses, charge nurses, nurse aides, exercise therapists, and volunteers. Soon the remaining tubes came out and I retained only an IV line of Toradol. I quickly gained strength and was declared "independent" after just a few days. 4 days after surgery, I was released to go home. Leaving the hospital meant giving up some of the drugs that had helped me through it -- particularly the IV Toradol, an NSAID anti-inflammatory. I would retain round-the-clock therapeutic levels of Oxycontin (10mg twice a day, controlled release) and use hydrocodone (in the acetaminophen-laced varieties of either NorCo or Vicodin) as needed for break-through pain relief. In general, I had some itching from tape used with various dressings, some mild pain, and I got tired relatively easy, but otherwise I felt fine.
Everything was going well, until recovery day 8, when suddenly my pain increased to levels I had not experienced previously. Why? I wish I knew. Perhaps playing the guitar was just "too much". Perhaps I finally metabolized all of the residual Toridol. Whatever the cause, I had to take twice as much Vicodin during the night in order to sleep through. The next day, about the same time my home-care nurse was supposed to show up to check on me, I had what most would call a "psychotic episode".
...of Losing Your Mind
While my family members were busy with something in the dining area, I reclined in the family room and tried to take yet another nap. After sleeping just a bit, I finally decided to force myself up with the intent to relocate to a quieter location in the house. But then I was distracted by a CyberGuys catalog and decided to flip through it while I sat there. I was still sleepy, not completely awake, and reading through the catalog took my mind to other places. In the midst of it all, a dark cloud occluded my memory. I lost all sense of context. I began to feel as if part of brain were not functioning, and it alarmed me. I called out to my family members, saying something like this:"
- Did I just spend a few days in the hospital? They thought I was joking. In my panic, I got up to walk to another part of the house, to do anything that might clear my head. My wife replied "Yes, honey, you just came home a few days ago". I was visibly upset, so she came to me and tried to calm me down.
- But why was I in the hospital? I honestly had no memory of it. My wife gently explained, "You had open-heart surgery."
- No way! That can't be, that's serious. I was crying. I could not remember anything. Why did I have to have open heart surgery? Again my wife tried to explain, "Remember? You had an aortic aneurysm."
- Oh yeah, we found it last December. This news had a ring of familiarity to it, finally, but it still seemed out of my reach. About this time, my home-care nurse came in and joined the party. Yes, she was familiar. I began to pour out a series of questions. My wife answered them, and also checked for signs of any motor or sensory dysfunction, and ruled out "stroke".
And that's how it went for a while, with me crying in terror at not being able to remember how I got to this present situation, while at the same time having it all refreshed, bit by bit, by her reminders. "I don't want to lose my mind. I can't afford to lose my mind;" I said. But she assured me that I was not losing my mind; rather, it was just a side-effect of too much narcotics building up. My pupils were tiny, etc. I eventually felt better, saying I felt I had 85% of my mental integrity back. But it wasn't until later that day, after I had finished a short nap, that I could honestly say I was fully back to normal in my cogitation.
This was the worst part of my recovery experience so far. Worse than waking up intubated. Worse than having the catheter removed (yes, that caused burning and bleeding that took a day to clear up). Worse than not being able to roll over in bed due to pain. Losing your ability to access memories and to use them in thinking is a terrifying loss. I was quite shaken by this, and have since had to find alternatives to simply taking more hydrocodone. In fact, I needed to wait quite a while for the levels of that drug to go down somewhat before taking it again.
Interestingly, my home-care nurse said it was good for her to be able to see my episode, because she cannot take Vicodin at all for the very same reason -- it makes her crazy. She said that at one point she was over her husband's face one night in bed saying, quite angrily, "Who are you?" So she cannot take it at all. But it was insightful for her to see it from the outside.
I would have preferred using oxycodone (like Percocet) for break-through pain instead of the inferior hydrocodone, but it is much more of a hassle to deal with outside of the hospital due to FDA regulations. Still, I'm on Oxycontin timed-release already, and we manage that just fine. I wonder if I would tolerate Percocet better. But in any case, I need to do whatever I can to avoid losing context like that again, because it is quite terrifying to lose your mind.
Posts
