The Surgery and the Hospital Recovery part 1

 

————– The Surgery —————

I arrived to the University of Michigan Pediatric Surgery Department on the morning of Thursday March 28th. My surgery was scheduled for 8am. My wife, mother, sisters, and step dad accompanied me(our son who was six at the time went to school). I was warned beforehand that the surgery could take up to 12 hours. To me the surgery was the easy part- I would not be awake during the surgery. I would awaken after the procedure finished. What boggled my mind is that a surgeon could operate for that long.

After I checked in, I was escorted to the surgical preoperative room by the surgery nurse. “Are you comfortable?” she asked. Interesting question I thought, here I was about to get my skull opened to remove a tumor in my brain, and I was being questioned about my comfort level; although I knew she had to ask me this, “yes I am. No complaints,” I replied.

Then two Nurse Anesthetists walked in. “Dr. Chiou? We’re here to start your [intravenous line]. One of us, along with the Anesthesiologist, will be there during your entire surgery. Do you have any questions?”

“Yes,” my mother chimed in, “how long after the surgery will he be extubated?”[1]

“We hope to have him extubated before he goes to the Intensive Care Unit.”

“After the surgery he is going to be placed in the Pediatric Intensive Care Unit(PICU) right? Who will manage him in the PICU? Are there Intensivists that will be in charge of his care during his stay there?” She went on.[2]

“Yes, after the surgery he will be placed in the PICU. There he will be managed by our PICU team which includes a Pediatric Intensivist.”[3]

They then proceeded to put an IV in my arm along with some medication(Versed to be exact). Because I was medicated and essentially unconscious I do not remember anything after that. The next memory I can conjure is waking up in the Surgical Recovery Unit(SRU). However according to my family, I was not in the SRU until 1 am. The surgeon said that the surgery took over 16 hours!

Apparently during the surgery my family thought that getting some food for the surgeons was a good idea. The idea of ordering some pizzas came about. I only tell you this because it gives some insight into the personality of my little sister Alice. This was her telephone conversation with the Pizzeria:

“Hello? We’d like 3 large pizzas delivered to Mott Childrens’ Hospital-a cheese, a sausage, and a pepperoni please,” my sister said.

“Ok, that’ll be $49.75”

“How long does it take you to deliver?”

“Usually between 20-30 minutes.”

“Ok, can you guarantee 20?”

“Uhm…no?”

I’ve always pictured offspring to inherit traits from their parents. People who know my family say that I’m more like my father, my little sister is more like our mother, and my older sister, Amy, is a mix of the two (my parents are divorced, with my mother retired currently living in Chicago, and my father, practicing Urology in Oregon). My mother’s genes came out during that exchange.

Page 1/2 of the operative report.
Page 1/2 of the operative report.
Page 2/2
Page 2/2

————————– PICU ————————-

My next memory is waking up in agony. Simply saying that I was in an incredible amount of pain does not do the feeling justice. I will describe it as a mixture of several sensations: extreme discomfort, enormous pain, nausea and dizziness all bundled into one. The next two days I stayed in the Pediatric Intensive Care Unit on a steady dose of IV pain killers and anti-nausea medication. I had never taken any pain medication before (with the exception of some Tylenol).

I do not remember most of my PICU stay. The only aspects of the PICU that I remember are the kind nurses(although there was one nurse that insisted that I needed to be moved constantly. I remember that with each attempt I would get so painful that I would vomit). I seemed in such discomfort to my family that the Intensivist was called for an explanation. My family never left my side. In the few moments in each day that I was able to open my eyes and be lucid I vividly remember seeing my wife, sisters, and mother. I also remember extreme discomfort with any movement due to my urinary catheter. According to my sisters I did not react to the pain-killing medication well, claiming to them that I was seeing ‘ghosts and dragons’. I do not recall any of this. I was seen frequently by Dr. Maher and his Nurse Practitioner Tara with both asking how I was doing. I slowly improved until it was deemed that I no longer needed to stay in the PICU.

This is the pathology report from my tumor.  I blacked out the names of some physicians.
This is the pathology report from my tumor. I blacked out the names of some physicians.

————————— The General Medical Floor ———————

Upon transfer to The Floor I was greeted by the floor nurse that was assigned to me. “Welcome to the floor Dr. Chiou, my name’s Laura I’ll be taking care of you until my shift ends tonight at 7. Let me have a look at your file,” she tells me as she looks at her computer (or C.O.W.S. as we call them, an acronym for computer on wheels), “it looks like here, you have IV pain medication per your request, along with some anti-nausea medication, and some anti-clot shots, twice a day. It says here that you still have an IV in place. How would you rate your pain now on a scale from 1-10?”[4]

This is a question I would be asked the most in the hospital during this whole ordeal. In medicine we are very poor at measuring pain. There is no machine, like for blood pressure, where a number appears that tells us what the level is. My answer was always, “no pain, 1.” There is one school of thought that hates the rating scale, citing that it is too subjective: one person’s perception of pain might be different from another’s. The other opinion is that because there is no way to objectively quantify pain, that the Pain Scale is the best way to accomplish this. Before this whole ordeal I found myself agreeing more with the former group, picturing what we call in medicine as ‘pain-seekers’.[5] However, now, after going through this, I find myself more in the middle; still weary of the subjectiveness of the current system, yet agreeing that there is no better way, currently, to measure pain.

My days on the floor were very regimented. The Neurosurgical team would see me in the morning, the resident or Tara, followed by Dr. Maher. I would then be seen by the day nurse assigned to me who would check my vital signs and administer medication. Hospitals, especially teaching hospitals are extremely regimented. The day typically starts very early, with the resident physician or mid-level provider(MLP)[6] seeing the patient (which includes asking how the night was, how they’re feeling, and completing an examination). The resident or MLP then writes the progress note, and waits for the attending (or supervising) physician to come. During this time typically the day nurse comes in to check the vital signs and administer any needed medications. After this, breakfast, is served. Usually as breakfast is nearly finished, the attending physician comes to the hospital and is ‘de-briefed’ on the patient by either the resident physician or mid-level provider. The attending physician then sees the patient to perform their own assessment. The rest of the day, at least for the patients, consists of lunch and dinner, and more nurse’s visits. My days in the hospital were no different, with the only break to this pattern being either being seen by a consulting physician[7] or conversations with my family.

Because of my persistent double vision and large influx of calls and texts, I decided to not look at my phone. Before the surgery I was glued to my phone, awaiting random text, calls, or emails (I have since begun to revert back to this habit). However, because my wife had a phone and everyone that knew me knew her as well, many people would try to keep tabs on me through her. One of my friends from Lansing, Kyle Snell (also a Family Medicine resident physician) came to visit me in Ann Arbor. I remember this well, mostly because a. I knew it was a long drive for him and he hated driving[8] and b. he was the first (of many) visitors. He was accompanied by his wife, Addy, a nurse on a cardiac floor. A physician and a nurse, who better suited to see me, a recovering surgical patient, I thought. But right from the start of the visit I noticed their discomfort in seeing me in my state. Their uneasiness was subtle, but I like to think that I am quite adept at reading body language and countenance. I imagined the thoughts racing through their heads: He looks terrible. Why is he speaking like that? How can anyone recover from this? These thoughts made me anxious, and this was one of my closest friends. I was set to become chief resident of the Family Medicine Department next year, which meant meeting new people all the time. I had never before felt anxious in meeting people, now apparently after my surgery talking in front of people made me very nervous. Even with these thoughts the visit was a welcome change to my monotonous day. Seeing Kyle made me realize that being closer to my family and friends was important. I then told my wife I wanted to return to my base hospital.

Addy and Kyle Snell
Addy and Kyle Snell

[1] During longer surgeries patients get put on a breathing machine to help control their airway. This involves putting a plastic tube down the patient’s throat. This process is called intubation.

[2] Because my surgery was to be completed by a pediatric surgeon, who was used to operating in a pediatric operating room, my surgery was to be completed in Mott Hospital, the University of Michigan Pediatric Hospital. I was there that I would also receive my care.

[3] There is now a branch of medicine solely devoted to care of patients in the Intensive Care setting, these physicians are called Intensivists.

[4] This way of rating pain is based on the Verbal Numerical Rating Scale (VRNS).

[5] I mentioned earlier that I trained in the Emergency Department many of the patients we saw we labeled as ‘pain-seekers’. Patients who we thought came to the Emergency Department only for pain medications.

[6] Mid-level providers are either Nurse Practitioners or Physician’s Assistants, essentially somewhere between a physician and a nurse.

[7] In my case, because of my double vision the Ophthalmologist was consulted. And due to the anticipated long recovery process, the Physical Medicine and Rehabilitation team was also consulted.

[8] He is obsessed with a phenomenon called Crossfit, a workout fad. Thus if he can bicycle somewhere, he does

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