Google+ Followers

Sunday, October 13, 2013

I Love Propofol

This is the fourth post documenting my experiences, living in Manhattan, after I missed one step on the way to the laundry room and broke a bone in my foot. First post was here: The Fractured Fifth - Manhattan Life with a Broken Foot

I had a horrible time getting all the appointments necessary so I could be approved for surgery.  I was told that I had to get an EKG and a chest X-Ray to my primary doctor so he could give a final thumbs up clearing me for surgery -- especially the general anesthesia.  In my last post, I detailed just how messy it was getting, and let's just say it got worse, although I thought I made the necessary arrangements.

I got a quick taxi ride to a nearby hospital for a chest X-Ray.  Despite my repeated, crystal clear, detailed explanation, they thought I was having surgery in that hospital.  Essentially I ended up waiting unnecessarily, but eventually people who were out to lunch started showing up and they came to their senses.  The fact that I nearly did have surgery at that hospital (see my first post) didn't help, because other X-Rays were already made for that.  They checked the records and told me that they already did the X-Rays and sent them, but then I reiterated for the tenth time that this was a different X-ray, to clear me for surgery at ANOTHER hospital.  You can guess that there were significant language barriers, plus they just weren't paying attention.

Later that Monday, I was going to the cardiologist for my EKG.  I was scheduled to see this very compassionate cardiologist.

A different cardiologist appeared, but the assistant assured me he was compassionate too.  He was a nice guy.  He regretted not being able to give me a stress test, because it'd be difficult for me to hop along on a treadmill until my heart was racing.  He tried to scare me into eating healthier, by saying I had 0.12 cm of cholesterol in my corrodid arteries, as opposed to a normal 0.10cm.  I asked how bad the extra 0.02 was, and he dodged the question.  I eat fairly healthy and will continue to, so I don't think I'm going to worry about it.  He said sans-stress test, he was taking a "risk", but he was going to clear me for surgery anyway

I was under the impression that my primary doctor had to look over the X-Ray and the EKG results, in combination with the blood test he already had, and was supposed to clear me.  But my podiatrist's assistant was already asserting that the cardiologist's clearance was enough.  I asked her why I needed the chest X-Ray then, because no one looked at it yet.  I made the requests to have everything sent to my primary doctor, and to send clearance to my podiatrist.  Eventually the doctor called and assured me that everything was set.  I'm not sure if the chest X-Ray was ignored or not, but I gave up worrying about it.

I had a discussion with my retired parents, now that I knew the surgery was on.  My mom initially suggested sleeping on my couch, helping me to the hospital and taking care of me during the first couple of days afterward, since Aliona had to work.  I didn't like the subpar accommodations for my mom, but couldn't argue that I could absolutely use some help.  I got another call later, then suggesting I instead stay with them in New Jersey.  They even offered to give up their master bedroom, since it was on the first floor, which was important for me.  My mom stressed that the bed had a vibrating feature too.  Although living with parents is not my first choice, how could I say no to being attended to, 24 hours a day by people who cared about me?  They would even bring my knee walker along.

The day before my surgery, I had one more appointment.  The doctor mainly wanted to make sure I was going to start fasting after midnight, including water, which he told me could cause me to drown.  Here's the X-Ray of my foot that, as I mentioned in my previous post, I fractured twice.  You can see the break doesn't look as clean as in the X-Ray I added to my first post.

The doctor drew me a sketch of what his plans were for my broken metatarsal.  He said if he didn't think the titanium plate with screws were enough, he'd wrap the bone in metal coil and pull it tight, like pictured in the lower right.  On the upper right, you can see all the post-surgery instructions I could expect to have to follow.

I asked about possible nerve damage.  One of my favorite things in life is the feeling of bare feet sliding under a cool blanket.  I wanted to feel that again.  Dr. La Puma nodded, saying there is some risk as there's a nerve there, but he'd do his best to avoid it.  He made me a new soft cast out of tight bandages, to wear just until surgery, to reduce inflammation as much as possible., That night, I went home, and made sure I rubbed my toes into my blanket.  It's common knowledge you should try to get good sleep the night before surgery.  I slept maybe 5 hours, which was pretty good considering.

My surgery was at Interfaith Hospital.  I've been going with Go Green Ride for car service, rather than taxis, so I don't have to risk trouble hailing cabs on crutches.  They didn't have availability to take me to the hospital at 6am on a Thursday, for whatever reason.  Upon asking them for a recommendation, they managed to squeeze me in.  Dr. La Puma told me to arrive at 7am, but then the surgical coordinator called me and requested I arrive at 6:30am.  I arrived at 6:20am and ended up waiting outside the hospital on crutches for 10 minutes, because I was locked out and no one was around to let me in.  Eventually someone saw my crutches, walked over, and gave me a cold stare.  He opened the door, asking me if I was there for surgery, then finally let me in.  I just wanted to have a good experience leading up to the surgery.  I did not need to be treated like you'd expect in the bad part of Brooklyn that I was in.  But I trusted Dr. La Puma and his staff, and I didn't have much choice at this point.  I needed the surgery.  So I entered the waiting room.  It was after 6:30am, but the one lady at registration told me to wait, and eventually left.  I wanted to get the paperwork started, but there I was, in the waiting room, about to be forced unconscious and hacked into by mostly strangers.

Twenty minutes later, she did return and I was registered, then told to wait in front of the nurse's office.  15 minutes later, she did arrive, and registration began.  There was a bit of a language barrier, but the questions were very standard.  No, I did not have diabetes.  That sort of thing.  The nurse went into explaining what the procedure was exactly.  I was pretty well-informed already, and suggested it was going to be an "open reduction internal fixation", which I learned on the internet means cutting into me and leaving something inside me to hold the bone in place, as opposed to other alternatives.  The nurse replied with a "wow" and decided to move on.

I was then escorted off to another room where I got to meet Dr. La Puma's residents.  They were a fun bunch.  I often like to make jokes in the form of silly situations I'd pretend to be true.  The chief resident  totally got my humor without missing a beat, and I suggested he had a knack for improv comedy.  He admitted he did try that at one point years ago.  My main goal was to make the doctors laugh.  My belief was, if the doctors liked me, they'd be more careful not to kill me.  Each of them had a separate conversation with me, all asking the same questions.  No, didn't have diabetes.  They were just being absolutely sure, which I appreciated.  One resident looked at my record and was suggesting to be careful of my cholesterol level.  I replied, "Oh, you mean the 0.12 cm of cholesteral build-up in my corrodid artery?"  I wasn't trying to impress her, nor the nurse, but she was similarly impressed anyway, and I hoped that would make her even more careful not to kill me.

The anesthesiologist introduced herself.  I ask her up front, "So, how are YOU feeling?"  Bewilderment struck the faces of those around her, and one doctor mentioned that it was a first for me to ask HER that question.  The anesthesiologist, however, completely understood, telling me how she had a great night's sleep and she was feeling really good, with no reservations.  That's exactly what I wanted to hear.  She slept better than I did anyway.

I changed into a hospital gown and robe, putting all my possessions in a plastic bag, including my cell phone.  They let me keep my glasses.  I got back on crutches and followed the staff into the elevator, and into the operating room.

The operating room was not as big as I'm used to seeing in Gray's Anatomy or House.  It also had walls packed with all sorts of medical supplies.  It looked clean enough where it was believably sterile.  My filmmaking side told me that sterile rooms had more of a cold blue color cast.  This was just a normal looking room with lots of medical supplies, and a table in the middle.  The table was long enough for me to lie on.  There was something black with straps lying on the head area, which I imagined with be later strapped around my head, holding a breathing device in place.  Again, general anesthesia (specifically propofol) stops you from breathing on your own, so a machine keeps you alive instead.  There were also skinny little side supports for my arms, one pointing directly to where the anesthesiologist was sitting.

Dr. La Puma and his staff gathered around, and one placed my injured foot on a hard block of some sort.  I imagined it as a butcher's block.  An IV was inserted into my left arm.  I didn't feel very nervous, but you can't fool an anesthesiologist with a stethoscope.  My heart rate was over 100.  Without any warning, I felt a very pleasant cool stream flow into my arm.  It felt very nice, but I wasn't feeling any effects of drugs, so I wasn't sure if it was the anesthesia yet.

Then... I felt the propofol.  It was such a wonderful sensation.  I exclaimed out loud how I was very happy and relaxed now, and they didn't have to worry about me.  The anesthesiologist complemented whoever she was overseeing, saying that starting with a test dose was exactly the right way to do it when the patient is nervous.  I saw another guy join the crowd, joking around a little and doing a little dance.  I never met him and probably never will, but I didn't mind some energy in the room.  That was the last thing I remembered before the surgery began.

Upon awakening, I was in the recovery room, and it was about three and a half hours later.  The nurse was there, asking me if I was up for seeing my parents.  Sounds fine.  My mom described how ugly I looked as I was being rolled into the recovery room.  The funny chief-resident stopped by and described how nasty the fracture actually was.  The anesthesiologist visited next, and told me a few things, including emphasis on keeping my foot above heart level when it feels painful.

Dr. La Puma was the next in the procession.  He told me flat out that everything went beautifully.  I asked about the nerves, and he said my nerves are absolutely fine.  So much relief.  He did also say how the break was uglier than the X-ray showed.

There was apparently a section of bone that had "flipped off to the side", and they had to put that back in place as well.  But as planned, they were able to secure all the bones with one "main" screw.  Then the plate plus the smaller screws were additionally installed to further hold everything in place.  In this X-ray, you can see the big screw, along with the long plate and the five additional smaller screws protruding from it.

My hospital wristband, almost matching my blue shirt and jeans, and gauze covering the spot where they stuck the IV.  In the recovery room, I was given my belongings back.  I changed in the bathroom and texted Aliona with my phone, to let her know I was fine.

It was pretty difficult to slide my jeans over my very padded cast, which consisted of a fiberglass splint underneath my calf and foot, plus lots of gauze.  I knew I'd have to switch to sweatpants.  As my parents helped me to the car, the nurse told me how lucky I was.  I was able to comfortably stretch my legs over the back seat.  My next worry was my parents navigating out of Brooklyn successfully.  It wasn't easy, but we made it.

Upon arrival, I settled into bed, with the intent of getting as much sleep as possible.  My mom showed showed me the bed's remote control, and pressed a button.  It vibrated fiercely.  I was waiting for her to leave so I could turn it off.  She realized that it was weird and just turned it off for me.  But it did elevate the head/feet for me, which was really nice, considering I was supposed to keep my foot elevated, and would be spending a lot of time sitting up in bed.

The most important pill pictured below was the small pill, oxycodone.  I was told not to wait for the pain to start.  Just take one pill every 4 hours for the first couple of days.  My foot was sore enough to keep me from sleeping easily.  My mother suggested a system where I would state my level of pain from 0 to 10, where 10 was me screaming horribly.  In general, the pain never got more than a 6, and maybe briefly a 7.  One thing I didn't like about the oxycodone is that it made me feel "blah", and I was very sluggish.

My mom did her best to cater to my iffy appetite.  I pictured the wonderful fruit that Aliona inspires me to eat often, and I realized I was very much in the mood for it.  Mom went shopping and soon I was presented with my first snack. 

A lot of my time was spent watching Netflix episodes of this 2004 sci-fi series called "4400".  It was not very good, but good enough to stay interested.  I watched one episode after another during my moments of awakedness, and slept otherwise.  It helped me avert any boredom, which I was worried about.

Along with my brother, I was visited by some of my friends from New Jersey, Paul, Mike, Leigh, and Scott and Christine Miller with their baby Kathleen.  We had a wonderful time talking and they admired the ingenuity of my knee walker.  Mike brought a few board games, and we played the one that required as little intelligence as possible, at my request, since my brain was still a bit under the influence.  I won one round, so I think it fit that requirement fine.

The weekend was ending, and my mother wanted me to stay, but I knew I had to get back to work.  I would have an appointment in a couple of days, and wasn't about to want to go in from New Jersey.  Plus, I missed Aliona and my cat.  I was already reducing my use of oxycodone.  The pain was mostly gone, which amazed me.  Early Sunday, we left, and I was back on the bed, with Luna by my side by early afternoon.

My boss stopped by the morning of my appointment and we talked a bit about upcoming work.  I was back in the swing of things.  My boss told me about how he neglected rehab after his arm injury, until he almost needed to have surgery again.  I had no intention of slacking off when I got to start rehab, however.  I made it to my doctor's appointment later that day, and the massive padding was taken off my foot.  The first thing I noticed was that the skin on my ankle was in bad shape.

 Dr. La Puma applied an ointment to it, which hopefully is helping as I type.  The gauze around the wound was of course flooded with dried blood.  There was this one piece of gauze that was stuck to my wound.  I imagined the nasty stitches that lied in wait behind it.  I didn't worry too much about me being squeamish, but I hoped it wouldn't look too horrible.

Dr. La Puma poured fluid over the gauze, allowing it to be cleanly pulled off.  Needless to say, the wound did look pretty ugly, but I can imagine it easily being worse.  Dr. La Puma was happy, saying how I'd have such a nicely thin scar.

He made me a new cast using the same fiberglass splint, and I worried about it being too tight again.  It felt a bit tight but okay at the moment, but I worried about having to pay for another round trip to the doctor if I needed it adjusted.  One thing I liked was the doctor cut on the lower part of the splint, allowing me to use the bone stimulator again, which hopefully should help me heal faster.  Dr. La Puma also told me that although I'd still need to come in for regular appointments, I would do my rehab at home, which suits me just fine.  If anything, my apartment building has a very nice gym that I'd get to make better use of.  I'd prefer just walking around New York for fun though.  I miss that.

Sure enough, that night, I had a severe burning sensation in my heel.  The doctor told me to come in the next day, and for now, just reapply the bandage making up the cast a bit looser.  I continued to work, with my clumsy bandaging staying intact.

The next day, I went back to the podiatrist, after 4:30pm, and his impression was that the job I did reapplying the bandage was fine, since it was holding well.  I regretted making another trip out there to hear that, but he did apply a new layer of bandaging over my foot, and gave me plenty of spare bandaging in case I needed to adjust it myself.  I felt pretty confident I could do so again if need be, so that helped.

The problem was getting home.  I don't know how long my appointments would last, so Go Green Ride told me to request a "ride now" after my appointment was done, and they'd be there in 10 minutes, or 20 if it was rush hour.  Well, I tried that, and they had no availability for at least as long as the doctor's office was staying open.  I knew I had no chance of hailing a cab, and there was no way I was going to try going into the subway.  I was left high and dry, and made a mental note to replace my favorable Yelp review of that car service with an angry one.

I tried out "Uber", having previously created an account with them and having the app on my phone.  They have a cheaper service where, I believe, non-professionals can give rides requested through the app.  During rush hour, they'd charge 50% more.  I didn't have much choice, so I went for it.  Albert in a Toyota Avalon was supposedly on his way, and I could see on a map that he was already pretty close.  Pretty impressive.

I saw he was approaching, and went to the street.  No one was there.  I got a call from him, saying he was one block away, and was asking me to go to him.  I told him I was on crutches and I'd rather not, but I'd wait until he arrived.  20 minutes later, I see a Toyota go by and wave at it.  The driver nods and pulls up.  Finally I'm going home.

But on the way home, I get a call from Albert saying he just arrived.  I realized I got into a car that illegally accepted a street hail.  The driver, in his very sparse English, reassured me that he was a good Christian, and he was usually a normal car service.  He showed me his driver's license.  He showed me a cane next to him, saying how he had quite the experience himself recovering from an injury, and how he only recently was able to drive again.  He gave me another "hang in there" story, half in Spanish.  I shrug and just decide he's a good dude.  I did my best to navigate him to my home, and it worked out fine, and I paid him around what Go Green Ride would normally have charged me.

I made it to the weekend and finished watching 4400.  In 10 days, I'll have my stitches taken out, and hopefully a month after that, I'll be able to walk again.