The previous posts in order:
Discharge Day
Although no one has said anything, I’m pretty sure I’m going to get discharged today. The doc, occupational therapy (OT), and physical therapy (PT) all have to sign off before I can go home. So I have a lot to do today and my code is calling to me, I’m close to getting something working that I’ve been working on for weeks.
Hospitals are busy places. The nurses have lots of patients and I’m, somewhat oddly, not on the orthopedic floor, I’m on the medical/surgical (“med/surg”) floor that mainly deals with oncology patients. As a reuslt, they are experts in pain management and that is exactly what I need. In many ways, there are people in my part of the hospital who need a lot mroe attention than I do and I am cognizant of that. The ironic thing is that I’m still on “bed rest” orders which means I can’t sit in a chair. This is ridiculous because a hospital bed is a dangerous place. You can get deep vein thrombosis if you lie in a bed too long, inactive. My high tech bed has these nifty “sequential compression devices” (SCD) which are velcro sleeves that wrap around my legs and gently massage them every 20 seconds or so. I’ve had these on the whole time. This morning the nurse just looks at me and says “we’re getting you out of here today”. She takes me off the IV drip and takes off the SCD’s and I’m not shackled to anything for the first time. But the nurse can’t let me get into the chair because my orders say bed rest. And my attending physician is a surgeon and he is in surgery. :-(
There is also the issue of medication. I get my last Toradol dose mid-morning. It’s a bad idea to just transition to taking oral medications at home after being on IV medication in the hospital. What happens if the oral medication isn’t working? It’s almost the worst case scenario: you end up back in the hospital. Nobody wants “do overs”. I want to get on whatever oral medication follows Toradol (turns out it is just regular ibuprofen in horse pill size, 650mg). To do that, I need an order for that medicine and several hours of observation while I’m on that med. So I’m not getting out until tonight (it’s Tuesday, March 19). But my attending physician is in surgery.
At this point, whle I am discussing these things with the nurse, she says “you must be frustrated”. Actually I’m not. But she is plenty frustrated for me and I really appreciate that. :-) She goes off to get things all straightened out. Doctors do great work in hosptials and help people in myriad ways. But hospitals don’t run without the RN’s and Overlake has really good nurses. I was very impressed throughout my stay. Even the relatively new nurses knew what to do and are very well trained. A nursing supervisor told me that they get 12 weeks of orientation and it shows in the quality of care that even the newer nurses provide.
I guess my nurse for today knows how to crack the whip because in short order they release the bed rest order (yea! I can get in a chair and work) and my doctor’s physician assistant comes in, fully dressed in scrubs, looking like he just got out of surgery. He doesn’t seem like a PA to me, he has the mien, knowledge, and authority of an actual doctor. He discusses my case knowledgeably (he obviously read my records), repeats that I don’t have to wear the brace (“just for comfort”), and says they are going to put me on oral ibuprofen. It’s clear now that I’m going home today. My nurse assures me that having several hours of oral ibuprofen under our belt for the afternoon is plenty to assess its appropriateness as a follow-on medication for my pain, swelling, etc.
Sometime during the day occupational therapy (OT) shows up. These are the “activities of daily living” (ADL) specialists. They go over how to get in and out of bed, showering, and re-emphasizing BLT: no Bending, Lifting, or Twisting. Keep centered, back straight, don’t reach outside of a narrow range, etc. I need a grabber because I can’t pick up anything off the ground (I’ve become adept at using my feet, though :-)) since that requires bending over. Later we order a transfer shower chair that straddles the edge of the tub allowing you to scoot inside the shower. That’s going to make a big mess on the bathroom floor. But I just can’t wait to take a shower, it’s been four days and I feel like a grubby rag. I got to shave yesterday, though, that was an almost transformational experience as I just hate beard stubble.
The last thing is to have PT go over navigating stairs. This goes surprisingly well and easy, despite my fears. She is quite satisfied and we agree that it is appropriate and safe for me to go home.
The discharge paperwork doesn’t show up until the new shift nurse comes on at 3:00. She goes over it and there’s surprisingly not much of it. I don’t, though, have any of my medical records so she fills out a form so my primary care physician doesn’t have to go through a bunch of rigmarole to get them.
Getting my street clothes back on presents the first taste of my new recovery life. Try sitting up straight and put on a pair of pants without twisting or bending over. It’s pretty difficult. :-) People who know me know that I always wear shorts and these are way easier to put on without violating the BLT strictures than regular long pants. The paperwork is signed off, the medical records request is faxed (faxed? really?) to the records department and it is time for me to get out of there. Just as we are about to leave, a huge bouquet of flowers shows up from work. They were almost too late! (Thanks Mary! :-)). I didn’t even tell them what hospital I was in, but she figured it out anyway. The wheelchair shows up, I transfer in and we make the trip down to the Overlake main entrance. We hit some of the same bumps I hit on the way from ER to my room and, this time, it doesn’t hurt at all. What a difference 2 or 3 days makes.
We pick up my meds (tylenol and ibuprofen!! :-) ) at the hospital pharmacy and get onto the streets of Bellevue at rush hour. Murphy’s law at its best. It’s a slow drive home along Bellevue Way / Lake Washington Blvd. And nearing downtown Kirkland it’s stop and go and the stop part causes some pretty good pain spears to run through me. This is really stressing out my wife because she thinks everything she is doing is causing me pain. I’m trying to make this as easy on her as possible but the truth is I’m totally dependent on her for the most basic things and this is new territory for me. I suppose we will adapt to this new norm but I know this is hard on her. I just want her to get on with the rest of her life and have me be the least burden as possible. But right now that just seems impossible.
It is, like the Saturday of The Fall, one of the nicest days this year so far. It’s about 70 degrees, sunny, and everyone is out walking along the lake front in Kirkland. I don’t know how to feel about this. I’m so grateful to be alive, not crippled, and it really is a nice day, but I’m filled with fear and uncertainty and I don’t even know if I’m going to fall getting into the house and have to go back to the hospital.
We finally arrive home and I have to face the rough concrete walkway leading to the two steps to the front door (no railing). I have a belt wrapped around my brace so my wife can hold on, I face the wall so I can fall into it instead of falling down and it’s a piece of cake, I’m in the house, safe and sound. I don’t whether to laugh or cry or what. I guess all of them are appropriate. It was a long trip to The Land, it took 4 days to get there and back.
Facing me now, however, is my first night without the support of nurses. No on-call help, no IV medicine, no “techs” to help me with anything I want. Just us. It feels both great and terrifying. We prop up the flowers that work sent in the bedroom and I do the careful rotation “log roll” into bed. It hurts in all the expected places but at least I’m home. Tomorrow is the first day of my recovery life.