Another day, another surgery. So what else is new this year, right? This time the aneurysm on my internal carotid artery, found incidentally prior to my brain surgery two months ago, was to meet its doom via the Pipeline Embolization Device!
I was indeed first case Monday morning, which meant I had to be at the hospital at 6:30 am. This time I reported directly to radiology, since that’s where my procedure was going to be done. We helped along an Amish couple who were going to the same place who seemed to be a bit lost. We only had to wait 15 minutes or so before I was called back by my prep nurse. David was able to come back with me right away, which was a first. Probably because the prep time ended up being so short. Nothing atypical in the prep; got my IV placed in my left forearm and peed in a cup because anesthesia was whining that I needed another pregnancy test (since they didn’t trust the negative one from five days prior.) Once it came back negative, they were immediately ready for me in the angio suite. In total, I only spent about 45 minutes in pre-op, a new record!
My “advocate nurse” as she called herself, transported me to the procedure room, telling me what to expect when we went in, and how much she loved watching Dr. Bain work because the things he can do are so amazing. No disagreement there.
Once I was on the table (once again aiming my head for the donut pillow), Dr. Bain performed the time out while everyone present reviewed the procedure. Then everyone got me set up. I was so proud of myself that I had tied the gown correctly without instructions, but as soon as the nurses saw what gown I was wearing (meant for radiology procedures), they said, “Oh no, you can’t wear that gown. It’ll get stuff all over it underneath you.” So two nurses managed to discretely change my gown into a traditional opens-in-the-back hospital gown while maintaining my modesty. Impressive. Once that was settled and I was all set to go, the anesthesiologist put a mask over my face, told me to take four deep breaths, and I was out with the exhale on number four.
For the first time in any surgery or procedure I’ve had, I regained awareness (there is a difference between consciousness and awareness) while still in the procedure room. I was pleasantly surprised to notice that I had no pain at all anywhere. Also another first. I was transported to PACU where a lovely nurse named Nora took care of me. Same as last time, I woke up with more IV lines than I fell asleep with; this time the huge 16 gauge needle was in my left hand and the arterial line was in my right wrist. Had a foley again, which was glorious since I was on bed rest lying flat until at least noon. All I did was pretty much just lay there and stare at the ceiling, since I wasn’t in any pain. I think I might be the first patient in surgical history to not require any pain meds in PACU.
Nora and the charge nurse were frequently checking the dressing on my right groin, where they had accessed the femoral artery, and kept saying it was very weepy. Since it was oozing more than it should have been (keeping in mind I was on aspirin, Plavix, and they had infused me with heparinized solution during the procedure), they busted out the pressure tape and went to town. I think I could have rapeled down a building with the amount of tape they used. Then, for good measure, they shoved about a softball-sized mound of gauze underneath the pressure tape. Whatever it takes, I guess? But Nora also noticed I was covered in dye and blood, so she got some warm wipes and cleaned me up (I think you can use your imagination to determine where…) I thought I would be embarrassed, but I actually felt more grateful than anything. Once you have enough surgeries, you no longer have any shame or care as to who sees what. Guess I’m all set for whenever I have a baby.
The next thing that sort of went against the plan was when Nora removed my arterial line. Even though she was holding really intense pressure, a huge hematoma immediately appeared that was apparently so concerning that they paged Dr. Bain to make him aware and had the PACU physician come examine it. He said it was probably just because enough pressure hadn’t been held when the line was removed, but he ultrasounded my wrist to make sure there wasn’t a large enough collection of blood that he’d have to aspirate it. But he was satisfied that it would regress, so on went more pressure tape, just for good measure.
(Left is 11/22 after dressing removal. Right is 11/27.)
David was able to come back and see me for a little while. I was unbelievably thirsty, so he fed me ice chips. He said he’d spoken with Dr. Bain. No other aneurysms were found and deployment of the Pipeline embolization device only took ten minutes (the whole procedure itself lasted an hour.) I know a resident at least deployed the nickel/titanium alloy clip to close my femoral artery because her name is on the paperwork I was given after the fact. But I recognized her name going back several years, so I know she’s an experienced resident. At least everything went well!
I was ready to go up to my room, but then my nurse got really busy with another admission, so I just lay there in PACU for almost three more hours. It was very entertaining listening to the goings-on of the patients around me. (“Excuse me, nurse, I feel like I have to go number 2…”, “Mr. Patient, we need to ultrasound your scrotum.”) Finally, around 2:15 pm, I was transported up to the same neuro step down unit I had been on after my brain surgery, but four beds down.
The rest of the evening was pretty chill. I was allowed to sit up to 30 degrees when my dinner arrived. And I was thrilled at shift change when in walked the same night nurse who took care of me two months ago! It was a happy reunion, and I was happy knowing I’d be in excellent hands for the night.
Things took a bit of a downturn around 11 pm. I think that’s about when the local anesthetic at the catheter site wore off because I was suddenly in a tremendous amount of pain, likely from the pressure of the pressure dressing. But no one wanted to take it off yet. After two doses of fentanyl helped, but then wore off in 20 minutes, and after the PA told my nurse to give me Tylenol for the 8/10 pain I was experiencing, I decided I had had it and politely told my nurse to please page the PA and switch to morphine, since it lasts longer and I know that’s what works for me in these high pain situations. Thankfully, the PA had no problem with that (the nurse saying “The patient is a pharmacist” didn’t hurt either) so I finally got about 2 hours of relief before needing another dose.
Despite the relative relief of my pain, I still didn’t sleep all night; all I got was a deep doze after the first dose of morphine. The frequent neuro checks didn’t help (“What’s your name? Where are we? What’s the month and year? Who’s the president?”) So I was definitely a little bit grumpy throughout the night. I just spent my times of low pain getting caught up on Facebook and the like. I was also getting my blood sugar checked every four hours because they were giving me Decadron. Those were some pretty annoying bruises on my poor little fingers.
(ET phone home and the 4 am grumpies)
Before I knew it, it was morning and time to remove my Foley so I could finally get out of bed after being on bed rest for 22 hours instead of the traditional 3 hours. And when the pressure dressing finally came off…no bleeding! I was having some pain in my right calf so they ultrasounded my leg to ensure no DVTs had cropped up overnight, but once that came back clear, I was out the door by 11:30 am! Same PA as last time, and she remembered me, so she got me out as soon as she could.
So, another success. My third surgery of the year and my sixth in the past 3 1/2 years. I’m so done now. But even though David is the one who listens to metal, I’m now the true metal head in the house!