The previous posts in order:
Day Two
Monday morning. Work day. I am going to get some actual work done today and not just sit in my hospital room spasming. And get out of the hospital! Or at least that was the plan. I totally didn’t anticipate what really was going to happen.
I actually did get some work done. I am especially good at working remote, having done it very regularly for the past 20 years working at Microsoft. So I have the routine of working remote down pat. But just try to do that in a hospital bed, while you can’t move because every time you move in any direction It Hurts Bad. I tried putting my Surface Book on top of the nifty bedside stand. The keyboard is hard to use and the screen is hard to read. I finally end up with my laptop on top of a pillow while I am sitting up in the bed. Not ideal but I can actually debug the code I am writing and get some real work done. It definitely felt like a small victory.
An orthotist shows up in the morning with a brace. I immediately think, “they must think my back is not stable”, but this is more about not re-aggravating the muscles in my back by keeping them in the proper position. After I fit the brace (it’s actually quite comfortable and comforting), I walk around. It’s at this point that someone gets the bright idea that it would be far safer if I used the walker, which is inside every hospital room. It immediately feels much more stable to use the walker (duh) and I wonder why anyone was letting me walk around without it. The previous day, walking with the IV stand seems particularly precarious in retrospect.
I never see my attending physician on the second day. In the early afternoon I am exhausted after working for several hours and I crash out heavily. I am woken up by a consulting orthopedist coming in my room. I’m groggy as hell but he immediately starts giving me his opinion. (Um, can I have a cup of coffee and 10 minutes first, please? No?). It’s basically all good news. He tells me I don’t really need the brace, it’s just for comfort. There is no need for surgery, and it wouldn’t help any of my conditions. He explains what “transverse process” fractures are. What I basically glean from this is my spinal column performed one of its main functions, which was to protect the spinal cord and the nerves radiating from it. I had no discernible damage to this life critical component at all. He says he is going to change the opiate order to a “PCA”, which I think stands for patient controlled activation. He leaves and I am left feeling like I am the luckiest person in the world at that moment.
Now that I had my brace, the physical therapist showed up and took me for a walk. I made it about halfway down a long hallway where I waved to my nurse. I looped back around and made it back to my room without incident. It was the longest I had walked since I walked out of the studio after falling the previous Saturday. She also tells me about how to deal with the back injury I had sustained. BLT: no Bending, Lifting, or Twisting.
I also find out that I am supposed to be on Toradol for 48 hours so there was no way I was going home that day.
So I’m feeling good, I got a good amount of work done, I had a positive visit with the orthopedist (who I will see again in a couple of weeks), the PT took me for a successful walk, and my pain was in relatively good shape. I was eating the salad (organic greens! gotta love the Pacific Northwest) with my favorite salad dressing that my wife brought in and something went down the wrong pipe. In a very serious way. I had to cough and it was going to be a strong cough. I remember the ER doc saying to avoid suppressing the cough and let it all out. This is to prevent food in the airway which can contribute to pneumonia. First cough. Man that hurt. Second cough. That hurt, too. Third cough was the strongest of all and all of a sudden it felt like a rib exploded and punctured something inside. The pain was absolutely searing. I was doubled up on my side just moaning. This wasn’t like all the other pain episodes which had a fast ramp, a sharp peak, and a fast decay. This one just kept going and going and going. It eventually subsided, but not to zero. I definitely knew then that at least one of my ribs was going to present itself as a pain point.
I was in a lot of pain for the rest of the afternoon. The nurse had an order for another muscle relaxant, Flexeril, which she though might help with my pain. So I took a dose of that and it just knocked me flat. Between 3 and 5:00 PM on Monday does not exist for me. It just knocked me out. I woke up at 5:00 as groggy as I had been during the whole episode. I caught up on some work email as I tried to come back to life. And the rib pain was still there, angry and present as ever. So it didn’t help with the rib pain and the other back pain was about the same as before (still spasms, but generally quite manageable).
At this point I was feeling a bit desperate. Before the coughing episode, I felt like I was getting a lot better. After the coughing episode I was miserable. So at 7:00 PM I had the nurse administer another 0.5 mg of Dilaudid. You will remember that I had had this dose before. But I still had Flexeril inside of me. As soon as the medicine went in, it hit me like a freight train. The room started spinning and I was loopy or high or I don’t know what. It was just terrible. I just laid back and tried to ride it out. The worst of it only lasted maybe half an hour but at that point I was just done. The Dilaudid did not help with my rib pain at all. I was just not going to take that medicine again. And that was the last dose I had.
I was really out of it Monday night/Tuesday morning. Early Tuesday morning the IV pump malfunctioned with “upstream occlusion” and wouldn’t stop beeping. The nurse finally had to change out the pump and it stayed quiet the rest of the night. It was the deepest, strongest sleep I had had, but I think it was fueled by the medicines and I did not like what it did to me at all.
In summary, my experience with opiates is they didn’t help with my pain at the doses I was willing to take and, in combination with some medicines, they can have some very severe side effects. I am sure there are conditions where the pain is much more severe (cancer, burns, etc) and where high dosages for significant pain relief is called for, but in my situation, it was not of any assistance at all. To prescribe high doses in a situation like mine would have been a dubious practice at best.
Tomorrow: Discharge Day