[Note: This entry was actually written in Feb 2014. I changed the posting date to keep my blog entries in chronological order.]

by George Taniwaki

The PACU

When I awaken, I am laying in a gurney. Two nurses are helping me into a bed in a private room. The clock on the wall and my wife tell me it is just after 4 pm. I was put under anesthesia at about 9 am, so it has been over seven hours since my last conscious thought.

Why did my surgery take so long? I was expecting to be in the room by 2 pm. And where did the time go? Unlike waking up from sleeping, waking up from anesthesia gives no sensation that any time has passed.

I vaguely recall being wheeled into this room from the post-anesthesia care unit. But maybe I’m just imagining that. From my research, I know patients are taken to the PACU after surgery until the anesthesia and sedation wear off. And I know the PACU nurses won’t let patients be transported unless they are conscious, communicative, and stable. But I have no memory of leaving the operating room, of ever being in the PACU, or talking to anyone before being brought to my room. Apparently, anesthesia also induces a form of amnesia.

Pain control

I feel drowsy, disoriented, and very weak. It hurts to breathe or move. A nurse checks my wrist band, asks for my name and birthdate, and then introduces herself. She asks me to rate my pain on a scale of 1 to 10. I say 7. The pain is throbbing, but it is not unbearable. Is 7 too low a rating? I guess I have a very high tolerance to pain. And I’m not squeamish, either.

The nurse says I can administer morphine using the PCA pump. The pump is calibrated to provide a 0.5 mg dose into my IV catheter when I push the button. There is no background dosage, so if I don’t press the button, I won’t get any pain relief. She tells me to err on the side of pressing the button too often rather than holding back. I can’t OD because the device has a timer set so that the button is locked out for six minutes after each dose (for a maximum dosage of 5 mg/hr or 120 mg/day). A blinking light tells me when pressing the button will cause the pump to switch on.

I press the button. The blinking light goes out. I hear a beep followed by the pump whirr, but don’t feel any better. I can’t wait for the next six minutes to pass. This is going to be a long evening.

PCApump

PCA pump, notice the syringe containing the morphine is in a locked box to prevent tampering or theft. Image from Abbott Laboratories

Vital signs

After a few hours, I feel better. I notice that I have a large number of wires and tubes connected to me. The wires on my chest and arms are connected to a machine that monitors my vital signs including my heart function (pulse rate and electrocardiogram). A cuff on my arm automatically checks my blood pressure every few minutes. Other sensors measure my temperature and breathing. The machine has an LCD screen with readouts and blinking lights and a speaker that makes a soft beeping sound to tell me it is working.

VitalSignsMonitor

LCD panel of a vital signs monitor. Image from General Electric

Kidney function

I have a catheter in my arm connected to a 1-liter IV bag of lactated Ringer’s solution set to a very fast drip rate. It’s running about 1 drop every 1-1/2 seconds, which I estimate to translate to 250ml/hr. That’s a lot of liquid being added to my blood that my kidneys… er, my one remaining kidney has to filter out. But I won’t have to worry about having to get up every few minutes to pee. That’s because I have a Foley catheter attached to my bladder that drains into a graduated jug.

BladderScan

The BladderScan measures bladder volume and urine retention. Photo by Susan Wolcott

Each time the IV bag empties, a nurse comes in to replace it, measures the volume of urine in the jug and empties it. If the amount of urine in the jug is less than 250ml, then I am retaining fluids. That is a sign that my kidney is not able to handle the workload. (It’s my chemical engineering training that makes me think about the complex biological, chemical, and mechanical processes that drive the mass balance equations.)

As an additional check of my urine production, the nurse also uses an ultrasound device called a BladderScan to measure the size of my bladder and the amount of urine that remains in my bladder.

Oxygen

I have a nasal cannula providing supplemental oxygen to me. Since it hurts to breathe, I’m taking shallow breaths and the extra oxygen is welcome.

Food

It is now past 6 pm. I’m not very hungry, even though I haven’t eaten anything since breakfast yesterday. For my first meal in over 36 hours, I can only have clear liquids. Unfortunately, the room service kitchen is now closed, so the only items available are beef broth (which doesn’t have much flavor but too much salt) and for dessert a square piece of red-colored gelatin. Yum.

Sleep

I doze off and suddenly I am awakened by the sound of the monitor alarm beeping. A nurse rushes in to check on me. She adjusts my cannula and leaves. A few minutes later, the alarm sounds again. We decide the problem is apparently sleep apnea and that it is safe to reduce the sensitivity of the monitor so the alarm doesn’t sound unless I stop breathing for more than 30 seconds.

I find that pressing the button on the PCA pump even when it isn’t blinking gives me a sense of satisfaction. I soon realize that since the pump can only be activated manually, sleep will be difficult. Unless I stay awake all night and keep pushing the button, I can’t administer the morphine to ease the pain. My guess is what will happen is that I will eventually get so tired that I will fall asleep. Then the pain will wake me up and I will push the button. I’ll stay awake until the morphine kicks in, then fall asleep and start the cycle over again.

Later that night, that is exactly what happens. I wake up in uncomfortable pain, push the button, and try to go back to sleep. A few minutes later, I wake up again. Couldn’t a safe pain-killer regimen be developed that could be administered automatically so that the patient could avoid the restless sleep?

****

The story of my recovery at the hospital continues in an Oct 2010 blog post.

For more information on becoming a kidney donor, see my Kidney donor guide.

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