Thursday, July 30, 2015

The Day I Almost Died

When we go into the hospital for elective surgery, we sign a whole bunch of forms. In the recesses of one of those forms is listed the risks of the surgery. The majority of the time, none of those risk factors play out in the course of surgery, or subsequent recovery. The majority of the time... but what about the times when the small risks becomes reality?

Well, I can only speak for myself, and, from my point of view, it is surreal and not a little unsettling.

I went in for what is called a 360ยบ lumbar fusion back surgery on July 8, 2015.  The procedure is two operations in one, really, a five + hour procedure that leaves the patient (me) with 5"-7" incision in the abdomen, as well as one running parallel to that in the back.

Inquiring minds can click on the link above to find out what exactly takes place, medically speaking, in the five hours of a 360° lumbar fusion back surgery.  The rest of you will have to trust me when I say it is a multi-step process carried out by only the most highly trained surgeons.  I was happy to have found one of the best, in my area, to operate on me.

Back to the day of surgery.  I went in to the operating room that morning, and emerged that afternoon, with all the rods, screws and bone graft cages in place.  The surgery itself, mechanically speaking, had gone well.  All was in order and my back repair was complete. *big sigh of relief*

My blood pressure, however, did not get the memo that all was going well, and decided to act up, or down, as the case may be.  In the recovery room (as well as in the operating room, I would later learn), my usually high blood pressure was low, especially when narcotics where introduced.

 I spent some extra time with the lovely nurses in the recovery room who, stayed past their shift change, to make sure I was okay, and delivered me to my (ICU) room in stable condition.

I was told I was in the ICU room only because of a lack of beds on the rest of the floor, but not long into that non-ICU stay in the ICU room, I became a full-on ICU patient, as my blood pressure dropped dangerously low at around 4:00 am.

What happened next was/is a blur in my mind.  The kind of thing you see on TV when a (fictional) patient becomes critically ill - medical personnel of all sorts running to and fro, yelling orders.  I heard - lower the head of the bed!  No, lower! Make sure the feet are well above head-level, we need as much blood/oxygen as possible going to her brain and heart!  Push those IVs wide open!  Someone come and start another line on the left side, she needs two IVs going! Push that saline and the [vassopressors] and turn off all narcotic pain medications! We need a chest x-ray in here, now! I can't get another line started, we may have to get a central line! Where is that chest x-ray...?

I recall little besides the flurry of activity and the searing pain, as they shoved an x-ray board under my back (recall previously they had turned off all pain relief) and log-rolled me this way and that way, all the while my feet up in the air and the blood rushing to my head.  Uncomfortable is an understatement to what I felt in the next 12-24 hours, as they tried to stabilize my vital signs and keep me from going into shock, organ failure, or death.

I tried to focus on something, anything, besides the pain, but it was difficult, after being cut from stem to stern, and being unable to receive any narcotic pain relief.  Liquid, IV Tylenol, which works about as well as it sounds like it might; I don't care what any healthcare professional says, was the extent of my pain relief.  I wasn't allowed to take my usual daily medication for depression and anxiety and migraine (which had developed with a vengeance sometime during the night), either, since they are narcotic adjacent, and likely to pull my blood pressure down.

I continued on the vassopressors (still not sure exactly which ones I had, but no matter) and I also received two units of donor blood.  Over the next 12 hours I stabilized, and just as I thought all was starting to going well, and I was able to get one dose of dilaudid pain reliever on board, both of my IVs, they had started the previous day, blew out.  No IV access means no IV pain medication.

Some discussion transpired between the ICU doctor, the internal medicine doctor and my surgeon's partner, who was on call that day, about what to do with me (no one ever said it was easy to be my doctor, haha), since no medical personnel were able to gain access to any of my poor dehydrated veins.

I ended up having to wait a while longer for more pain relief, as they called in a specialist who could start a midline IV (which I really didn't want because of a blood-clot complication I had from a previous insertion of one of these harpoon-like IV catheters) into my upper arm, guided by an ultrasound machine. I was assured that this one would be different than the aforementioned one, however, and lacking any other real alternative, I agreed to have it inserted.  It turned out to be a much better experience than the previous one.

Things picked up briskly for my health after that.  I was able to get some pain medication into my system, and I even walked my happy ass (happy being relative, and with the aid of a back-brace, a nurse, and a walker) out of ICU that evening, and into a regular room down the hall.  I was so happy to be out of ICU. In the ICU is it day time 24/7, with flurries of activity that are to be expected in that kind of environment.

My new room was quiet and dark by comparison.  This allowed me to get some much needed rest and I progressed so well, I was able to go home the next day. I thought this remarkably fantastic, considering I was quite literally at death's door a day and a half earlier.

The body is a remarkable entity that endeavors to protect itself against shutting down, and can turn itself around on a dime and begin to thrive again. as quickly as it began to shut down.

Since I've been home, these past couple of weeks, I have continued to steadily recovery from my surgical wounds, and also from the emotional wounds that were foisted on me, as I contemplated all of the negative outcomes that COULD have come from a low blood pressure crisis like the one I had.

 I recall while the medical staff frenzied around me, praying and singing a hymn over and over again in my head, on that horrible day my body thought it might shut itself down.

I remember thinking/praying - this can't be it Lord?  I am really not done living yet.  Luckily, He responded with - you're right, you are not done yet, so go and do what you were put here on this earth to do.

I'm trying to do just that.  I am not wasting my second chance and I thank God that I have no lasting side effects from the low blood pressure crisis.  It's uphill from here, man.

~Psalm 111:1-2Living Bible (TLB)
Hallelujah! I want to express publicly before his people my heartfelt thanks to God for his mighty miracles. All who are thankful should ponder them with me.