Wednesday, July 8, 2009

ON MINISTRY (Part 1--Background)

You might want to read Part 2 first...this is the "deep background" for it and might not be worth reading at all...

This seems to be my toughest-ever writing assignment.......self-imposed as it is. Been thinking about it two weeks and just can't get here we go:

June 22 Carolyn had knee-replacement surgery. I spent 4 days and 3 nights at her bedside in hospital and have been her 24-hour per day "nurse" since her return to the house.

The Monday evening after the surgery, all day Tuesday, and Wednesday morning were rough! She came out of surgery about 2:30 Monday afternoon. Surgeon called me and reported that all went well and she would be in Recovery for a while. About 4:00, they let me go back into the Recovery Room and visit her. At that point she was in excruciating pain and the staff was baffled and in a well-controlled frenzy trying to figure out what the problem was. During the surgery she had had a spinal block (short lived but highly effective) plus an epidural anaesthetic (longer term). At the end of the surgical procedure the anaesthesia team did a block of one branch of the femoral nerve which was intended to control the pain as the spinal block wore off and when the epidural catheter was removed, ending that relief.

Bottom line is the femoral nerve block she had no anaesthetic benefit at that point only 90 minutes after the incision was closed. She was in agony and the staff was doing a major running analysis there at her bedside, so they ran me out, promising to call me back when they had overcome the problem.

At 5:30 they called me again, saying that Carolyn was fine and ready to go to her own room. We didn't get the information immediately but the short form of the story is that there are 3 branches to that femoral nerve and they either missed the first attempt (my guess) or it was necessary to do a second block on another branch (their spin). This is not intended to be critical....that stuff happens and I'm impressed at the concentration of brain power and intense effort the whole staff put into resolving the situation as quickly as possible.

An attendant rolled her bed down endless corridors and through a couple of elevator banks to another building which must be a quarter mile away. We ended up in the old Vanderbilt Hospital building, 6th floor, in a huge (by hospital standards) room. From her arrival there, Carolyn was pitifully nauseated off and on for the next 24 hours. She has always suffered from this post-surgery misery and though this was not the worst-ever, it was pretty bad at times. As time went on, we figured out is was a reaction to the high-powered pain killer they were giving her by IV (oxycontin). After 3 doses at 12-hour intervals, she told them...."Don't do that again; I'd rather hurt!" They switched her over to some oral stuff of lesser magnitude and the nausea was greatly abated.

Tuesday morning, they announced that her blood level was low and they were going to give her a transfusion. We were prepared in advance for this possibility and she had given a pint earlier which they had on she would be transfused with her own blood. This is about a six-hour procedure and would delay her physical therapy for just about the entire day. At this point it looked like we were losing a whole day in the scheduled process geared to her being sent home on Thursday.

Three hours into the transfusion, she was racked by more excruciating pain. Worse, she says, that the undiminished post-surgical pain when the nerve block failed. Once again, the staff was baffled! We had this tremendous charge nurse, a young woman originally from Colombia, and she was doing the transfusion.....but she fell victim to the same sort of thing which happened in the Recovery Room.....something outside the "way it ought to be" Severe back pain is a side effect of blood transfusion. They know that. isn't (according to The Book) supposed to happen when you are being given your own blood. The nurse was smart enough to see no other proximate cause and turned off the blood flow. Within minutes, the pain eased, and Carolyn went to sleep. Watchfully, the nurse turned the drip on again, and the transfusion was completed without further incident.

Wednesday was really the beginning of physical therapy, the progress in which is a determining factor in when and whether one goes home on schedule. It did not go well. Carolyn was still nauseated off and on, more or less a day behind, acting like someone whose surgery had been Tuesday not Monday. It was discouraging to hear talk of going to a Rehabilitation facility for 7-10 days rather than going home on Thursday as we had planned. At the same time I forced myself to face that possibility, I also resolved to do all I could to get her home.....and that "what" was to beseech God to do a work regarding her condition.

Thursday morning a new day dawned but I was so exhausted from the 3 days of stress and sleeplessness, I wasn't too cognizant of the change until mid-morning. Carolyn was simply "much improved" The physical therapist could hardly believe she was the same person who could barely do anything 18 hours earlier. Carolyn was up, taking steps with her walker, sitting in a chair, getting up, etc. By noon or one p.m. the charge nurse was saying things like: I think you'll be going home. When I, still a bit stupified, said "When?".......she floored me with "this afternoon"......and sure enough, at 3:05 Thursday, she was in the car and we were merging into the traffic outside the hospital driveway.

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