My HYSTERical HYSTERectomy

To try to lighten this up a bit, here's a story from the Mardy history shelves:  In response to Martine Ehrenclou's wonderful piece about older patients in the hospital needing health advocates/helpers: I must have been "OLDER" five years ago when I had a hysterectomy because I needed an advocate!

I actually had one, a friend who was knowledgeable about hospitals and process and was a manager and could speak up and all the things I think a person ideally needs to have as 'soft skills' to navigate what I affectionately call 'the mangling medicine maze'.  

As 'luck would have it', she won Employee of the Year and the night of my surgery, the 14th of December, a Thursday, was their holiday party where she would receive this prestigious award from a well-known and large company in Grand Junction.  That was the only date and time available (3 pm check in for 4 pm surgery), due to it's being the end of the year and people wanting to get work done before their yearly deductibles went back to $0.  But they had delays in the OR so my surgery didn't happen until about 7 pm.  

I'd had all the preliminary labwork done but it got to be time for the surgery team to start looking at my chart and the anaesthesiologist required a pregnancy test! Not only was I 46-1/2 years old and my hormones weren't anywhere near what it takes to get or stay pregnant, if you'd seen the state of my uterus they were taking out, you'd have a good laugh at THAT -- it was pulled over backwards and laying into my colon.  So that caused a delay.  The nurse came in to put in the IV and despite my very prominent vein, she clearly wasn't very experienced at putting in IVs and dangled my arm over the edge of the bed/gurney and milked my arm and then blood went running down my arm onto the floor.  

By this time, it was within an hour of when my poor friend needed to be on her date to the awards banquet and her eyes were as big as saucers and she just said 'I'm not leaving until you go to surgery'.  (THAT is a loyal friend!)

I breezed through surgery, I was totally coherent after, even changed my outgoing message on my cell so people could call and not disturb me and get the update if they wanted, and the nurse I had seemed to be experienced and competent.  Then change of shift happened and I kid you not, one of the RNs had been an aid years before when I first moved here -- and not one of our better ones!  The other nurse that was in the room was also just graduated from the nursing program THAT WEEK! ... they were collaborating with my older, confused, combative, roommate -- in a room that was used for storage except they were so busy they needed the room for us, so NO television even to listen to, JUST what was going on in the room with the roommate.

Being confused, she loudly/'combatively' accused them of putting a catheter in her without her approval, which had not been the case.  The family would read her the menu over and over -- and she was on a liquid diet so they'd offer the items she could have and she'd say she wanted a hamburger!  This went on ALL DAY and ALL EVENING. Which is annoying enough when you're not nauseous.  

BUT it couldn't just be THAT bad, it had to get worse! That night a new/inexperienced nurse saw that one of the medications keeping my brain from being nauseous in combination with the morphine was expensive so she switched it out for a stomach motility stopper.  So my brain was nauseous but my stomach could do nothing about it.  I couldn't talk as I was so nauseous, and nobody oriented me to the notebook the hospital sets up for all patients that was out of reach over my right shoulder, NOT on the overbed table.  

I'd felt that as much as I knew about this kind of material, I'd be okay for a night and then we had a plan for me to get home the next day.  That did not happen as I was so sick.  I'd told my doctor/surgeon when he came in the next day mid-day that I was SO nausous and didn't know why, and he said 'you'll feel better when you get up and take a shower: do that and have lunch and you can go home."

So I'd gotten up and, with an aid walking with me, gotten to the shower room; the room they were charging me/my insurance a TON for -- the former storage room -- didn't have a shower like modern hospitals typically have.  Just as I got into the central bathroom with the shower, I was overcome by the nausea and ran for the sink.  The aid yelled to the nurses station "she's throwing up in the sink". My initial thought was  WHAT?!!! I can't believe someone was doing this -- and then I felt ( .... but WHO should be embarrassed -- me?  Or the hospital/staff for acting this way? .. (think about it.....).  

Then they left me alone to shower!  I remember thinking "I don't feel safe -- I wonder if I haunt my patients too closely or if they're just not concerned enough about me -- I just know I wouldn't leave me alone if I were them."  I think that perhaps the people helping me were NOT the  (brightest bulbs)....  

But I got dried off, dressed and back to my room and bed.  I did feel better, having accomplished that and also having gotten to throw up and all. I laid down again and for the whole afternoon, I was unable to talk due to nausea -- I just pulled the curtain to surround my bed as the communal sink was literally so close I could pinch the butt of anybody washing their hands, and listened to the nice family read the nice, confused matriarch the menu over and over again.  I'd asked the evening before, when just out of OR and feeling how uncomfortable the bed was, for a mattress overlay and was told "I think that's a PT thing and we don't have any PTs here at this hour (since we were running hours behind)."  The PT came into the room to work with my roommate and I was so nauseous I truly couldn't deal with trying to communicate anything about wanting an eggcrate overlay (which would entail my doctor getting orders for PT for me and a whole bunch of 'stuff', I knew from having worked hospital).  I say this because maybe the narcotics had my brain so swirly along with nauseated that I was quite not able to advocate for myself.  Hence my saying that EVERYONE potentially needs someone checking on them at the hospital, no matter their age.  

Meanwhile, when PT wasn't trying to get her to get up and 'do' PT (which they can bill insurance for and is good for the patient), which was another 'battle' since the woman was confused and tended to be combative and had all her family there tending to her every whim and making her LESS inclined to get up with a stranger/PT, their reading the liquid diet menu selections to her went on and on with her saying "I WANT A HAMBURGER" in response. They stayed for the whole evening and left about 11 pm.  Super nice people, ideal family -- just literally the 'all American family' having what a LOT of families are going through.   It was that night that she was having trouble voiding and agreed to a catheter then forgot and was very upset and .... it was a VERY long night while the patient 'sundowned' and then she finally went to sleep.  While she was awake, if I moved in the slightest, or made any sort of noise, she'd call out as if I might be her husband or family.  So naturally I tried to move and be totally quiet. We finally got some sleep. Her family came back in about 6 am waking us all up again.   

By mid-morning, I had drifted into some sort of quasi-sleep, I'd maybe call 'drugged resting' when my doctor came in mid-morning and said 'why are you still here!?' ... I said "I'm just so nausous" and he said that morphine could do that.  I'd told them all I didn't want narcotics to start with but nobody wanted to go that route, so at this point he granted my wish and left to go talk with the nurses.  And out the door he went -- a man who delivers babies, takes out women's 'stuff' in surgery, and sees people at the office -- a very busy man.  THEN I remembered the question I had for him -- you see, I'd not had anything to write ON to make notes to refer to when my doctor came in, and he was moving at a speed a person moves when they are NOT on narcotics and with a very foggy brain AND no sleep due to a cognitively impaired, confused, combative roommate. 

But GOOD NEWS! The experienced nurse was back, as shifts had changed again, and figured out the medication 'switch' and we came up with a plan that since morphine caused the nausea to switch me to ibuprofen, give me one last blast of the anti nausea medicine, have me eat something and then go home.  I had to remind them to order my food and tea.  I had to remind them to bring me my 'pain meds' and when she came into the room, she popped out of pill packs ..... narcotics! Unfortunately for her, the anti-nausea medicine had worked and so now I could talk.  

And I was TICKED!!!  I'd not told her what I did for a living, nor that I'd worked in hospitals and skilled nursing and knew how the nurses had to do paperwork and a whole process to destroy narcotics that were erroneously dispenses.  BUT she tried telling me that I had to take the narcotics since she had taken them out of the packaging!!!  I told her how she could dispose of them if she didn't like the formal, required process for narcotics that are not taken by a patient.  She left and came back with ibuprofen.  I ate my custard, drank my tea and was ready to roll.  

I got up out of bed, got dressed, pulled my hair back, put on mascara, packed up my things and set them on the only place you could, which was the bed and I had no chair to sit in as my roommate was combative and restless and so they had the team approach, so I went to the nurses station and asked them to get discharge orders from my doctor.  "You've not been out of bed in a day, he's not going to do that", and I said 'If he hears I'm standing here asking for discharge orders, I bet you he WILL'.  

Then they offered me another room when I told them I'd be in the lobby since I didn't have anywhere to sit.  You can only imagine my response to giving them one more dollar or minute of my time.  The nurse who had previously tried to get me to take the narcotic ended up coming up to the front lobby and pulling my IV up there and going over my discharge orders.  And just then my ride came, and off we went!  

Here's the happy ending to the story --  Three days later I was already showered, dressed and out the door to the Holiday party for Chris and Cheryl Young's clinic; I believe that part of the reason I was so 'boosted up' was I had been so concerned about infection and had an IV of vitamins and minerals the day before the surgery and had done so routinely (every month) for a while; it's part of the alternative things I did to steer the fibromyalgia that had plagued me around to being 'manageable'.  

Since I'd never been pregnant, this had to be an abdominal hysterectomy, and my doctor had insisted I stay out of work for six weeks.  He made me his FIRST patient after his Christmas/New Years break.  His FIRST words to me were "So when did you go back to work?" -- And I'd been faxing bare necessities after five days but was very dizzy as I had TMJ/vertigo problems.  I saw my first new patient a week after the surgery, but my assistant was doing all the hands on and I was doing the computer evaluation portion.

The next thing he said was that he apologized for the problems; he was so used to that hospital being really effortless that he should have been more aware when he saw a lot of unfamiliar faces.  Keep in mind, I was once a new graduate and I understand the learning curve, but when the budget problems lead for massive layoffs and leavoffs by the experiences staff that have the ability to quit and who feel they can't be involved in risky business, problems occur.  

With that particular hospital there have been cycles, and I've seen it in skilled nursing facilities where a facility that was 'really good' can turn really NOT good very rapidly.  So don't just go on 'reputation'; take into account how recently those people's experiences are.  Be prepared -- look at Martine's piece/list about what to do, purchase the book if you're so inclined to do more thorough learning on the subject, and then KEEP YOUR SENSE OF HUMOR!   I hope the HUMOR in this has helped, as well as the , leading you to have  and not .  Remember to help your friends and loved ones by  this to them if it applies.  

Live and Learn. Learn and Live Better!!  ~~ Mardy

Link to Martine's topic about hospital advocacy/list of suggestions: www.lumigrate.com/forum/older-patients-are-risk-hospital-how-advocate-0