7 Feb 2019 Day Zero.
6:45am admission at Calvary Hospital, Wagga. In room 207 in the right-side bed so that I will be able to get out of bed on the left side with a stiff and unmanageable knee for the next few days. Had a shit and then a shower with the special washing liquid. That was the 3rd of 3 showers with that stuff, the other two were yesterday. Into the gown and paper one-size-fits all underpants. Leg washed with Betadine.
8:20am wheeled (on my bed) down to the operating area – with X-rays and, in a big plastic bag, all medication that I take. Leg shaved. Anaesthetist Dr Anthony Gray (who I had requested because he did an excellent job last year for the other knee) meds are checked, questions asked and he told me of side-effects of the anesthetic to be administered (low blood pressure and headache).
8:40am wheeled to anaesthetists prep room. Swapped to the operating ‘bed/trolley’. Given a pre-op ‘whiskey’ via cannula and then the spinal. I have chosen to stay awake throughout the surgery. Wheeled through a single door into the OR. The ‘Blood/Brain Barrier’ set up to keep my head and the anaesthetist separate from the rest of the room. That meant that I could not actually see any part of the surgery. But I could hear and sense being banged on.
Quite a friendly team. I could not sense any dominant hierarchy. On my side of the barrier: my head and anaesthetist Anthony. To the right, a team of three nurses who ran their own work-team. No idle talk or chit chat but a constant stream of questions, answers, what was happening or about to happen, counting things. At least two surgeons (Andrew Redgment and assistant David) who, according to them, talked the whole way through but I could hear little of what they said – except towards the end when technique was reviewed and problems discussed. I did hear their discussion about my patella (knee-cap) that they spent quite a bit time on – deciding to keep it, polishing the underside and adding a ‘button’. Also where my patella had been lowered and attached to my tibia in a different place to normal in that reconstruction back in 1963.
Initially, an electric saw and then hard banging of something being hammered into my femur. This was the surgeon’s ‘trial’ period where they were selecting the size of the upper part of the prosthesis. They began with 11½, next 12 and settled on ‘13’. I have no idea what that meant. I did manage to stay awake – mainly. I did catch myself snoring a few times so maybe not ‘all’. Anthony Gray took a photo for me late in the surgery just before they were closing up. The final bit would have been closing the tissue, closing the skin (with staples), dressing, wrapping and ice pack. Nurses counting things, blood-brain barrier taken down, cleverly moving me from the operating platform back onto my ward bed without any lifting.
I was in the OR for just over two hours. Longer than normal because of difficulties arising from having to work around the reconstruction of 56 years ago. Andrew had already thought through many of the issues, but there were a few unexpected complexities.
Back in recovery just after 11am. As expected, my blood pressure was low 90/40 and I was cold 35ºC. I was wrapped in a heated blanket and hot air pumped under that. I was given a saline intravenous drip. By about noon, my BP was acceptable (105/60) and temp up a bit so I was taken back to my room – for a wash and lunch (sandwiches, black tea).
Settling back into my room is fairly mundane after that. I have a room-mate, Chris, who had his surgery (Total Knee Replacement of Right Knee) this afternoon. Helen has made two visits. For the previous knee, Helen drove just over 1,000 km running backward and forward and running errands for me before I was allowed to drive again. A huge effort – given that in the six months since, between us, we have driven just 5,700 km.
Dr Redgment came to see me twice this afternoon to see how I’m getting on. He is an extremely experienced and capable surgeon. The biggest concern appears to be at the back of my knee (which is a little painful). I’m not to work on straightening it too soon and take considerable care not to straighten it too soon or too much.
Of the hurdles that I have to clear before discharge, I’ve completed the first – I’ve had a piss since surgery – thus avoiding the catheter.
I’ve also had a shit – which is an inconvenience to all as I’m not allowed out of bed yet and so had to use a bed-pan. Alas, that shit does not count as a hurdle because it really should have been pre-surgery. I still have to avoid the enema. Constipation is a serious issue because of a) the surgery itself and b) the painkillers.
Pain. The advice here at Calvary Hospital is to ask for pain relief early at the first hint that there might be pain. Don’t be a hero and try to tough it out because that just makes everything harder. I remember that last time, pain management was fairly easy and that although I had a little pain, it was easily contained. This time, there is a wee bit more. I think Anthony Gray is extremely good at pain management. I am on 2 Endone every 4 hours plus two other slow release opiates Targin and Pelexia 12 hourly. Plus Panadol and Tramadol six hourly alternating. Let us see how we go.
Nursing shifts at Calvary are 8 hours. Morning 7am-3pm, afternoon 3pm-11pm, night 11pm to 7am. Mornings and afternoon I have Jay, Caitlin, Charlie and Bianca; nights Heidi.
8 Feb 2019 Day 1. Sleep was very strange last night. I’m certain that I slept but just as certain that I was awake all night. I had my Bose headset on listening to music. They began to get us up from about 6am. Two physios from Synergy came in at about 7:30am to get me out of bed – painful – and go for a little walk – even more painful. What Andrew Redgment said about not straightening it is very true. My recovery this time will take longer. Quite wonky and light-headed. BP very low (94 on 60) so I did not take my morning BP reduction pills. Charlie gave me a wash. Then back to my chair to wait for breakfast that did not come until about 9am. In the middle of all this Andrew Redgment arrived for look see. He is very concerned about not straightening. Back to bed. Very spaced out. Helen came for a visit at about 9:40am and brought a vest and a power board. A good sleep until 11:30am then out of bed for lunch – which I had sitting in my chair – quite cold and I put my vest on. My BP is up again, I’ve taken the two BP pills I skipped in the morning. Lunch at 12:20am. While in bed, I have to drape my left leg over a pillow – much more comfortable and it keeps my knee bent. This afternoon, my wound sprang a leak and filled the dressing with blood. That dressing needed to be changed and the wound washed, I was very narcoleptic all afternoon – going to sleep in the middle of sentences. Wheeled off to get x-rays of the left knee. Sitting in my chair is getting a little easier each time. My left thigh is swollen so we’ve elevated my feet a bit – the bed has a setting. Pain is decreasing – I think. My appetite is way off, I’m unable to finish off the small hospital meals. I did manage to get out of and back into bed for dinner without assistance – a remarkable achievement.
9 February 2019. Day 2. Slept much better – I managed to sleep on my left side – kind of. I’m still a bit narcoleptic. Once again, I had my headset on all night. My classical playlists are not bad to sleep to. Some of those playlist have 20 hours of listening. Now that I have been through all of them, I will have to make up a few more playlists. Up and into the chair for breakfast. I think that communication between doctors and nurses can be improved. This is my example. My surgeon, Andrew Redgment, wants my knee kept bent and personally put a pillow under my knee to keep it bent. All of the nurses see the pillow and immediately try to remove it (“you must not have a pillow under your knee. It is bad for you.”) Then follows a short argument between the nurse and me. Redgment has dragged in the ward supervisor and told her. But, the other ward supervisors do not know. It is similar with the physios, who see one of their key targets is to get me to straighten my leg fully. Me, I’ve very glad of a slightly bent knee – less pain and I can sleep. My physio came at about noon. I’d been waiting in that chair since 7:30 and had given up. Five walks with my walking frame. Not far just about 10m each time. Four good shits, so I have that hurdle off my back.
10 February 2019. Day 3. Slept quite well – mainly on my back with my head quite elevated and ditto the feet – like a vee shape. Played music through my headphones all night. The physio was here at 7:30am today. I’m on crutches now and allowed to walk 10m further. There is no chance I can do their exercises – way too early. Feeling much better and not as spaced out. Pain levels – close to zero – with the three sets of opiates and two sets of Panadol meds that I’m taking. I was about to write not so narcoleptic, but I went to sleep writing it.
My roommate, Chris from Tumut, is going through a tough time. He is in considerable pain and is often crying out with it, yet, when the nurses ask ‘How is your pain?’ He always answers ‘Not too bad.’ This means they cannot give him the medication that he needs. He intends to tough it out.
Two minor scares this afternoon evening: my temp was up (38) as was my blood sugar (10.4). Both came down after an hour. They ran out of my slow release pain drugs – ie they did not manage to get sufficient from the pharmacy to get through the weekend. Just as well I am pain free. It would appear that some of the nurses here decided what medication patients should get regardless of what the doctors prescribe.
11 February 2019. Day 4. Slept very well till 5:30. I will catch up later. My physio from Synergy was here at 7:30am this morning – again just as I was completing a short walk. Up and down the stairs. (Up: good leg, bad leg, crutches. Down: reverse = crutches, bad leg, good leg.) My walks will be longer today – still on the even hours. I can do a few of the exercises and I’m still pain free (which is more than I can say for my roommate).
I’ve been playing around with playlists on my phone and listening pretty well full-time to very good music through my Bose headphones.
My roommate is so determined to leave today that he lied about having a shit – the one remaining hurdle to have him discharged. I am in for another two days. I have to be able to lift my leg before I am allowed out. After the news that I must be able to do a full leg raise before discharge, I began to seriously work on my leg raise. During the rest of the day, I completed 5 of them. They each hurt a lot – with a pain level shooting up to 8-9. The problem appears to be my patella (knee cap) which needed considerable attention during surgery needed a bit of a reminder of what to do.
12 February 2019. Day 5. I slept very well overnight – although that patella spasmed a few times and that sudden whack of pain certainly woke me up. At 7am, I went for a walk and then did two leg raises – patella not so bad this morning. Now, the pain has shifted to back of knee and is bearable.
The Synergy physio (the third) turned up at 10am and had nothad any transfer of info from the previous fellow. My impression of the Synergy physios has plunged. Constant pressure to use their services – chasing the work and little interest in their patient. For the two who were here today, I had a constant string of criticism – I think I did not do a single thing right. The message was clear “You are doing so much wrong that you will have to use much more of our services and you are mad for not using our wonderful rehab centre. Why were you silly enough not to do both knees at the same time?” I never react well to that approach. Individually, each of those three physios might be ok, but with the constant changes (3 different people in 5 days) and no interchange between people, the process does not work. That, plus the constant putdowns, criticism and sales pressure make it impossible to recommend Synergy.
A bit of a change of pace. Just after 2pm, I went down for an ultrasound to look for blood clots. And found two: one about 5cm long and the other 4cm. I’m back on my ward now. Waiting. It turned out that there were no notification processes. Until I talked to one of the nurses, they knew nothing. However, little change in getting me discharged. My surgeon, Andrew Redgment, says that the clots are not big and I will continue with a blood thinner to dissolve them. Helen was volunteered to do the injections.
During the afternoon and evening both Andrew Redgment and anaesthetist, Anthony Gray, dropped in to talk about my discharge tomorrow. We really liked Anthony’s summary ‘Anyone would think you have had major surgery where someone sawed through a couple of your bones.’ Anthony will keep me on the same medication as last time. I hope that the progress will be as before in that I took the slow release opiate (Palexia or tapentadol) for a few weeks but not take any more Endone after my discharge. Most pain management will be through a rigid regime of Panadol. Yes, just over-the-counter Panadol.
The final thing for the day was distressing. Nurses here take regular measurements of patients’ blood pressure, pulse and temperature. When nurse, Julie, arrived to take the final set of ‘obs’ I was about to get up and have an urgent piss. My piss was not allowed. When the obs were taken I was trying not to piss and the bp readings were consequently high. I asked for them to be taken again. Refusal. Julie ran down the corridor yelling ‘I’m going to tell the doctor’. Other nurses subsequently took more readings and the readings are normal. What crap. That particular nurse does like a bit of drama. I understand that abnormal reading should be confirmed with other readings. A bitter end to a stay in this hospital.
13 February 2019. Day 6. Departure day. The main tasks to be completed were: half the staples have to be taken out; all meds to be taken; blood pressure observations; breakfast; review of medication and writing of scripts by pharmacy; dressing removed, wound cleaned partially of blood and half the staples removed; given X-rays to take home; review by surgeon Redgment; various paperwork dropped on my bed by the nurse who could explain only a few of them; final visit by yet another physio (Tom) from Synergy – who is the only one who talked sense; walked to nurses station where put in a wheelchair and wheeled out. No good bye. Very odd. Felt like being chucked out. Such a different experience from last year. I know the remaining staples are to be taken out on Monday but don’t know where. I think the discharge process is now woeful.
All of that took 4 hours and we left at 11am. Helen drove me home. A bit of an effort getting into and out of the car. Slept for much of the day and then all night.
