WhiteCoat

Under the Knife – Part 6

I turned around, shuffled backward, and eased myself back onto the clean bedsheets. Mrs. WhiteCoat removed the lines from the IV pole and moved the pole to the other side of the bed so it was on the same side as the arm where the IV was placed. Then she gently hung the Foley catheter bag back on the bed.
I told her “Dang, this thing hurts,” referring to the catheter.
“Then hit the button,” she replied, nodding to the PCA pump.
“It doesn’t help when I do hit the button anyway. Simple physics. Think about it. Look at the IV line. It is about 4 or 5 feet in length. Every time I hit the button, it squirts about 1 mL of medication into the IV line. That amount of fluid takes up about, what, an inch or two of IV line? I would have to push a button a good 40-60 times before the medication from the syringe actually reached my vein.”
“Did you ever think that maybe they primed the line with medication before they attached it to the machine?”
“If they did, then why do they have to lock tube of medicine inside the pump? For aesthetics? All of medication is already in the IV line. Why don’t they just put a syringe of saline there?”
“Then people would either think they were getting saline for pain or they would know that they could get a huge bolus of medication just by cutting the IV line and letting all of the medication run into their veins.”
“Good answer. I guess I won’t publish that on my blog then. Besides, since when is pain from a rubber tube causing a friction ulcer on the tip of my woo hoo an indication for pain medication? The answer is to remove the rubber tube, wouldn’t you think?”
“Don’t make me come over there and wrestle that button from your hand.”
“Fine.” I pressed the button. “You happy?”
“Yes. Now maybe we both can get some sleep.”

Mrs. WhiteCoat and I watched television for an hour or so. Both of us got text messages on our phones. I took pictures of my stomach and sent them to people who texted me. I was getting to be quite the voyeur. In the back of my mind, I was determined not to go to sleep.

My nurse came into the room to see how I was doing.
“So what are the chances I can get this Foley catheter out?” I asked.
“Well, they were planning on taking it out tomorrow morning. We can try to take it out now, but then if you are not able to urinate because of the pain medication and the anesthesia, we would have to put it back in. From what I’ve been told, putting it in is a lot worse than having it already there.”
I gave my wife an evil eye. “So taking pain medication me make me have to keep this catheter in longer, huh?”
“Well, maybe, but that doesn’t mean you should not take the medication if you are having pain,” the nurse said.
“I think we’ll go for a little more pain and a little less catheter.”
She smiled, winked at my wife, and left the room.
What were they planning?

I was woken by someone in a white coat touching my shoulder.
“Hi, I’m Joan. I’m Dr. Smith’s physician assistant. He wanted me to come over and see how you are feeling.”
I wasn’t sleeping. I was just resting my eyes. From being up all last night. It’s not like the pain medication knocked me out or anything.
Dr. Smith was a good guy. He was a gastroenterologist and had taken care of both my wife and me in the past. Up with the gown again to expose my dressing and my distended abdomen. One tends to lose one’s modesty when in the hospital. She listened with her stethoscope and gently pressed around the incision site. Then she tapped lightly on my stomach. Still a lot of air inside. Sounded like a ripe watermelon. She made sure that I didn’t need anything and then left to finish her rounds.

By then, it was dinner time and Mrs. WhiteCoat had to go get dinner for the kids. She gave me a kiss and promised to bring the kids back with her after dinner for a quick visit.
I sat alone for a while in the bed, watching the evening news, wondering why I had to be in the hospital. I could watch the news at home. That’s right, I have to pass gas first. I tried bearing down a little bit. Nothing. Rats.

Out of the corner of my eye, I could see another nurse standing at the doorway. She wasn’t dressed like the nurse taking care of me that day. She had on a cleanly pressed white jacket. She was just standing there facing toward the room with her hands at her sides. I watched her pull the sides of her jacket down and walk tentatively into the room.
“Hi, I’m Kate. I’m a nursing student and you’ve been assigned to me as one of my patients.”
I smiled. “Nice to meet you, Kate.” She seemed hesitant. “What’s wrong?”
“I’m a little nervous. It’s only my second day in the hospital and they gave me a doctor as one of my patients.”
“Don’t worry, we don’t bite — at least most of us don’t.”
“Is it okay if I examine you?”
“Of course.” Up goes the gown again.
She had me lean forward to listen to my lungs for about 2 seconds, then she listened to my heart for about 2 seconds, then she listened to my abdomen for about 2 seconds. She pressed lightly on my stomach once or twice and said “thank you.”
“So what did you hear?”
“Everything sounded OK.”
“Did you hear my heart murmur?”
She hesitated. “Um … no.”
“Good, because I don’t have one.”
That was enough to get her to loosen up a little bit. I helped her do another examination on me and showed her a few things about physical findings, including how the heart rate speeds up when one takes a deep breath and slows down when one breathes out. I showed her how different parts of the body have different sounds when they are percussed, like the flat sound you get when you tap on someone’s thigh versus the hollow sound when tapping on my abdomen, and the dull sound when tapping over my liver. Then I showed her how my legs had a little edema.
She stopped to thank me.
“I got to learn so much today. Before you, I learned all about total parental nutrition on a patient of mine with Crohn’s disease. This is a really great day.”
The patient in Room 1408 came to mind.
We talked a little about our families. Then she had to go.
As she left, I told her that she’ll be a great nurse.
She smiled.

I watched more television during what was dinnertime at the WhiteCoat household. Right about now, the kids were probably arguing over who wasn’t helping clean up from dinner. Strange that I hadn’t eaten in more than three days and I still wasn’t hungry. I chewed cinnamon gum every once in a while to get the bad taste out of my mouth, but at that point, I didn’t miss food.

It wasn’t too long afterwards that I heard kids footsteps trotting down the hallway. My spirits immediately perked up. I saw long curls of blonde hair peek around the edge of the doorway. I expected them to all run in and jump on the bed, but instead, they walked in slowly, looking all around the room as they entered. Each came up very slowly and gave me a hug around the neck, being careful to avoid touching my stomach. They had been debriefed well by Mrs. WhiteCoat prior to their arrival.
I pulled up my gown again (I was getting used to this) to show them that I was OK. They all seemed a little more comfortable. I pulled the two younger kids up on the bed with me. The older ones sat in chairs with my wife and we all watched television for a little while – something we rarely do at home. My youngest daughter discovered the incentive spirometer at the side of my bed. She asked me what it was and I showed her how it works. I was hitting about the 1500 range by now. She got about 700. Then the other kids tried using it. Even in my postoperative distended abdomen Foley catheter pulling state, I still had the best score.
A little more time watching TV, then the younger two started falling asleep and the older two were obviously getting bored. I got another round of kisses, felt the warm touch of my wife’s hand one last time for the day, and then everyone left to go home.

As soon as they had gone, I put in my earphones, turned on my MP3 player, put my bed back and tried to rest. Based on my experiences from the night before, this time I was getting a head start on sleep.

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Here are links to the other parts in case you get lost:
Part 1, Part 2, Part 3, Part 4, Part 5, Part 6

15 Responses to “Under the Knife – Part 6”

  1. Jen says:

    Back in the dark ages we primed the PCA tubing with the drug. It was micro tubing so it didn’t take a lot to fill the tubing.

  2. Connie says:

    We prime PCA tubing as well, but we also connect another line of normal saline at the y-site, and run that at about 25 ml’s/hour to deliver it as well. But your were still NPO – why didn’t you have fluids running?

  3. Christine says:

    Another vote here for priming the PCA tubing with the drug. Some of our patients wouldn’t get drug for hours or even days if we didn’t.

  4. Mad Dog, RN says:

    Teaching the student nurse how to do an assessment – very cool of you.

  5. ER Murse says:

    I thought it was standard procedure to prime the tube, connect it to the bottom Y site, and have fluids running at at least a KVO rate to flush it in. I suppose that varies by facility? The PCA tubing we use is really small bore too, so it doesn’t take much to prime.

    • ScrubNinja says:

      ER Murse, you’re correct. Only the leg of the Y that goes to the PCA should be primed with the drug, and the rest with NS. That way, when it’s hooked to the patient and the fluids start running, you don’t get a sudden narcotic bolus.

      Since there’s a mnemonic rhyme for everything in medicine: “Prime to the Y and your patient won’t die.

  6. girlvet says:

    woo woo? hahahahahahaha

  7. WhiteCoat says:

    This was regular tubing that was attached to a “Y-adapter” on my forearm.
    Definitely not microtubing.

    • Tarl says:

      Was the regular tubing a screw-up, or are you alleging that morphine push-buttons are all a scam?

      Certainly I’ve visited friends who have gotten relief from their drug trees – not immediate, but within a few minutes. Enough delay to be pretty sure it wasn’t a placebo effect. Presumably there is a standard for how much volume lies between the “Y” connector and the vein, and how much saline travels through that tube to produce a predictable delay.

      On the other hand, it does seem that pain killers are an inappropriate treatment for an ongoing injury – if you are getting a friction ulcer, the last thing you want to do is take pain meds allowing you to make it worse.

  8. ER Jedi says:

    Man, getting foley’d is probably my worst fear in life. Glad to to hears its actually worse than I am imagining it.

    • Ed says:

      Much, much worse.

      Somewhere in a hospital near me there is a nurse with a size 12 foot imprint on his chest. Not my proudest moment, but he should have known better.

  9. SeaSpray says:

    I guess the foley catheter is worse for men. I don’t recall feeling that in Bajingoland. Maybe you had yours in longer?

    Woo hoo? Ha ha!

    I love that you took the time to teach her. She’ll probably always remember your kindness and your joke. :)

    Looking forward to #7.

  10. horsetech says:

    I can’t say I’ve encountered the medical term woo hoo as used for male genitalia (which rhymes with Australia, BTW) yet in veterinary land. Depending on the context and the company, jingaling, peeper, kickstand, and some cruder colloquialisms are more common in my circles. “After we sedated the horse with acepromazine, he put down his kickstand.” I guess woo hoo sounds too similar to hooha, a female term.

    Eagerly awaiting the next installment.

  11. Adan R Atriham says:

    I am sure that young nurse student will remember you for the rest of her nursing years. Great to touch a young life like that. Nice job !

    • Future says:

      Perhaps the nursing student should switch to medical school. We need more physicians who enjoy learning.

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