Another extended absence

A little while ago I explained that comps a move to Wolfville had been keeping me away from the blog. My most recent absence was for a completely different reason. This time I have a medical excuse.

On Thursday of last week I had a Percutaneous nephrolithotomy to surgically remove a few kidney stones from my right kidney. The procedure resulted in a two-night hospital stay and then some post-hospital downtime. (Now that a few days have passed and I am not losing as much blood I am getting a little energy back).

Anyway, it seems that this procedure, like other surgical procedures that I have had, is a little more involved I imagined it would be when I agreed to it. Instead of just removing the stones surgically, the process is really three somewhat distinct process that all involve some form of anesthesia or sedation.

The first step, which is conducted while under a general anesthetic, involves the places of stents in the urinary tract. And, surprise, surprise, I also woke up with a catheter (one of the aspects of the whole thing that I don't recall being mentioned explicitly much in advance of the surgery). Once the procedure was complete I was sent to the recovery room where I pretty soon regained consciousness and had a nice talk to the nurse about the fact that all three of my names are last names (this fact is commonly noted in Nova Scotia).

After a relatively brief wait in the recovery room, where I foolishly declined pain medication, I was sent along for the second step of the procedure - the introduction of a tube from my back to my kidney. Much to my surprise, this procedure didn't involve a general anesthetic. That this was to be the case was a little disconcerting at first as the last time that I had surgery to my back I was quite awake and could feel the whole thing. Fortunately in this case I managed to sleep/pass out for most of the procedure. As far as I recall I don't even really remember very much of them placing the tube or how I got from the operating table back to my bed, something for which I was likely at least partially responsive.

The third and final step of the procedure, though it involves no new holes or incisions, is really the most significant part of the whole process. Through various means the stones are broken up and/or removed (an exclusive 'or' is used in this case). All in all, these processes can seeming be quite aggressive and really lead to fair bit of internal bleeding and disruption. And apparently in my case at least of one batch of stones was located in a particularly hard to reach area that required some particularly aggressive maneuvering of a scope (the miming of this process that the doctor did for Neil, Rebecca, and I really made it clear why my procedure was particularly sanguineous).

After this third procedure I was finally sent to my hospital room. Soon after I arrived one of the nurses offered me something for pain - this time I gladly accepted the drugs and began to feel less bad almost immediately.

As I was slowly coming to my senses in the room I started to become aware of the fact that my three roommates were all quite a bit older than I and also, arguably, in much worse overall health. This fact fact was pretty quickly driven home when the patient to my right lost control of his bowels all over the floor next to his bed (and then there was some talk of c. diff). Discussions that doctors and nurses had with the other two guys also made it clear that they too were not in the best health.

That evening Neil and Rebecca came to visit, which was a very nice distraction from the general madness of the room. The visit also allowed Neil and Rebecca a chance to soak up some of the atmosphere of the room and meet my doctor. My sense is that they were somewhat shocked by the 'atmosphere' and impressed by my doctor and his general demeanor.

Not too long after Neil and Rebecca's departure things appeared as though they were starting to calm down and patients were washed and lights were turned off. Of course it didn't take me long to realize that the night wasn't going to be particularly restful.

One of the first problem I noticed was that the IV machines that we all had were really quite noisy and produced a special sucking noise every few seconds. The gauze that the nurse gave helped to some extent but really didn't do all that much to muffle much sound.

Pain and general discomfort were another set of issues that made it somewhat hard to sleep. Even though I was taking pain medication regularly almost any movement or muscle contraction would wake me. It felt as though I had to stay awake just to concentrate on not moving.

Finally, and this was maybe the biggest impediment to sleep, the incontinent patient to my right continued to make noise and lose control of his bodily functions all night long. If I recall correctly, at one point he might have urinated on the floor while at a later point he did something to necessitate a middle-of-the-night sheet change. Several times throughout the night while changing his own diaper he thought that he had messed up his IV drip. While in most cases his IV was fine and he hadn't really needed to buzz for a nurse, though in at least one instance he did manage to completely disconnect his IV from his body (amazingly, in this case he had called the nurse for a completely unrelated reason).

By about 5:00 AM all pretense of trying to sleep by any of the four patients in the room was lost. We were up for the day (or at least until our first nap). Fortunately breakfast soon arrived and I was once again pleasantly surprised by the quality of the hospital's food. I was particularly taken with the pumpkin bran muffin I was served.

Fortunately patient drama decreased dramatically on this second day, and the decrease was basically noticeable from breakfast onwards. Perhaps not surprisingly, at least three of the four of us were clearly getting better.

Shortly after breakfast the doctors came through on their morning rounds. It was at this point I learned that I would soon be losing both my IV and my catheter and that the tube that was still directly connected to my kidney would be stoppered and disconnected from the bag that had been collecting run-off directly from the kidney.

The upside of these changes were that I was no longer bed-ridden and I didn't have to have a loud IV machine constantly making noise next to me. The downside of these changes were that I was now expected to start moving around and I was cut-off from real pain medication (real pain would have been a sign of problems/infection so they didn't want to risk masking it). Fortunately I was eventually given an ibuprofen-acetaminophen cocktail that did a little to dull the pain.

Almost before I knew it I was walking around and pounding water to clear my kidney and bladder of stones, stone fragments, and clots. Relatively early on in this process it became clear that there were a few obstructions that were likely going to force me to stay an extra night in the hospital.

Fortunately, after maybe only an hour or two of aggressive water drinking and shuffling up and down the hall I managed to clear the worst of the obstructions and demonstrate that I was generally in pretty fine health. Of course, I had to deal with the consequences of all of the water drinking for the rest of the day.

Later in the day I had the pleasure of having visits from Jeannette, Neil, and Rebecca. Though at times I might like to put on a face of stoicism, it really is nice to have at least a few hospital visitors for a few minutes a day otherwise the days have a way of passing very slowly.

My second night in the hospital went much more smoothly than the first. Though I didn't wake up much I have the sense that the nurses were called to the room much less frequently and that there were fewer big problems for them to deal with.

During my second morning of rounds I learned that I would be heading home that day and that I would be losing the drainage tube that was then leading to my kidney. Much to my surprise one of the residents told me she would be removing the tube right away. Even more surprising was that the tube removal only took a few minutes and didn't hurt. That this could be painless and so fast and easy still surprises.

Of course the big downside of the removal of the drainage tube was that the drainage was no longer limited to the tube but soon began to flow directly from my side (a development that was expected). Of course, even though this drainage was normal at times it came a bit more quickly than I expected. At one or two points before I was released the drainage was abundant that it overwhelmed the dressings that had been taped to my back.

Not surprisingly, since being released from the hospital I have been trying to take it easy and limit my level of physical activity. Of course this sentiment has been reinforced after my one attempt at dishwashing/floor sweeping seemed to reinvigorate the drainage from the relatively small incision in my back.

Now that I am a few days removed from the surgery I am finally starting to feel a little bit less like I have been hit by a truck and a little more as though I am just at about 75% power. Hopefully with a few more days I will feel more like 90% or 100% power.