I’ve been in a lot of hospitals in the last 10 years because I’ve helped elderly relatives (mostly parents unfortunately) with their illnesses, some of them final. So I’m not completely unfamiliar with how they generally operate. But I’ve never myself been in the hospital. I’m really healthy and I’ve had no accidents so far that would have landed me there. So this is a totally new experience, to be the patient.
It’s a bizarre feeling to go from being active and highly independent to completely dependent in a few hours. And it’s very worrisome not to know what the future holds and how long it might take for things to be normal again. Or if they will ever be normal again. It’s true what they say that your life can change in an instant. This is all circling in my mind as I am lying there getting an IV drip put into me and the nurse asking me, once again, “how much pain do have?”. I’m starting to have a lot of spasms at this point. Or cramps, not sure which. I tell the nurse “5 to 6?” and then a spasm hits and she looks at me and says “that grimace doesn’t look like a 5”. So she basically doesn’t believe me. We have a discussion about pain levels and I keep fixating on how much worse the pain could be and I bring up the example of a burn victim. Anyway, I still can’t answer this question adequately.
Just about every movement causes pain in the lower left back area. It’s spasming horribly. It feels like a super strong battering ram hitting me and a cramp at the same time. And it radiates all over that side of my body. I audibly groan whenever it hits, which is often if I move in almost any conceivable direction. What’s really interesting is that I don’t feel any rib pain. When they told me I had three broken ribs (9, 10, and 11) in the ER, I couldn’t believe it. Nothing remotely like rib pain was presenting itself to me.
The main thought that was going through my mind was, “will this lead to chronic pain and eventual back surgery?”. I know several people who have had failed back operations so I was very, very worried.
Given the level of pain I was experiencing, and after a long discussion with my attending nurse, I decided to go with the minimum Dilaudid dose, which is twice what I got in the ER. So at 11:15 pm I get 0.5mg dose of Dilaudid. Dilaudid, if you don’t know, is stronger than its more famous (due to marketing) cousin oxycodone (oxycontin). So I am plenty scared of this given the severity of the opiate problem in the U.S. But I don’t want to be stupid about pain management either so I think the minimum dose is going to be something I can deal with. The strange thing is, it doesn’t feel like I got anything. The pain is not any less and I don’t feel loopy, high, or anything else. It’s like there is no positive or negative to it. It’s now currently hard for me to understand why it is addictive and what it is good for because it’s not relieving any of my pain. Maybe all of my receptors are defective. I skip the 2:00 a.m. dose and accept the 5:00 a.m. dose, again the minimum dose of .5 mg.
It’s quite disconcerting to be “paralyzed in bed”. I can’t really move sideways, up, down, get on my side, anything. Any potential movement is a brilliant stab of pain in my back/hip area. It’s at this point I realize how incredibly ridiculous it was that anyone was discussing the possibility of my going home. I was in the state they call “uncontrolled pain” and I had had no PT (physical therapy) or OT (occupational therapy) to teach me how to deal with my new reality.
Let me explain about an IV pump. In order for you to remain hydrated they give you a saline drip through the IV they put into your arm. There’s a big bag hanging on an IV stand, it goes through an IV pump and into the IV inserted into your arm. The pump is a mechanical/electronic device that monitors the flow rate. It is sensitive to the incoming flow being consistent (which it regulates) and the outgoing flow being the proper rate. If you block the outgoing flow, it beeps at you loudly. The display says something like “downstream occlusion”. The thin tubing running from the bag, through the pump, and into you is long. So it gets all over the place in the hospital bed. So I keep thinking that it’s kinked somewhere and I’m fussing with it all night trying to keep it from beeping at me. So it was a fitful night because of that. The next morning a nurse finally tells me that bending your arm stops the flow in your vein and that causes a downstream blockage. So it wasn’t the tubing it all, it was me bending my arm. Think of holding your phone in your left hand and swiping it with your right hand. That crook in your arm arrests the IV flow. Oops.
At night, as during the day, there is the inevitable “take your vital signs”, pulse rate, oxygen saturation, temperature, and blood pressure. So you get woken up during the night. It was a fitful night but I got some rest because I am Really Good at Sleeping. In the morning, I felt like crap. A combination of the medicine and the aftermath of the injury. They warned me in the ER that the second and third day post-injury are the worst. Everything stiffens up. They were so, so right. I felt even worse on Sunday morning. The entirety of my lower back was stiff as hell and the left side was painful as hell. Bad combination. I think it was PT that got me up Sunday morning to see if I could walk. I stood up, my entire body was stiff and I had no coordination or strength. I couldn’t take any steps, and I couldn’t turn around. The goal was a bedside commode one step away but I just couldn’t make it there. I could walk the night before but I couldn’t walk at all the next morning. I got back into bed, utterly defeated. Oh and I spasmed terribly getting back in.
Eventually around 11:00 p.m. my attending doctor shows up. It is interesting (and disconcerting) that my attending doctor is a surgeon. This is different than I expected, I thought the norm these days is to be attended to by someone called a “hospitalist”. He is a generalist whose job is do patient rounds in the hospital. But I am not assigned a hospitalist but rather a surgeon. I immediately worry that I won’t see him because he’ll be in surgery, something more important than seeing me. But he does show up and does a short neurological assessment and confirms what the ER doctor wrote up. He had already seen my CT scan and medical records. He tells me how lucky I am and, surprise, discusses my pain. I tell him I am at zero pain until I move and then I get this intense spasming. He explains to me that the opiates won’t help with this at all. What I need is anti-inflammatories, specifically Toradol in combination with Tylenol. “Multi-modal analgesia is most effective”. Toradol is like ibuprofen only stronger and is only available in IV form. It works to reduce the inflammation from an injury like mine. Literally two hours after I get the Toradol, I go from excruciating pain to very noticeable soreness. The intense spasms subside almost completely. It felt like a miracle. Later that day I get up, I’m stiff and sore as can be but I make it all the way to the real bathroom, trailing my IV stand. No spasms. What a difference between that afternoon and the morning. No more dilaudid for me. Or so I thought.
By the way, I ordered food from the cafeteria for breakfast, lunch, and dinner. My wife brought some outside food in (I had no dietary restrictions at all) but I mostly ate the hospital food which I must say wasn’t bad at all. Their flat bread pizza was actually really tasty. Way better than I expected.
I went to sleep the second night feeling way better than the first night. I thought maybe I could go home the next day (Monday). But I was definitely wrong about that. The next day I discovered what rib pain is all about.