How to break out of prison. Or at least hospital.
Postop day three. POD 3. Today is the day that I should transition from a full fluid diet to a general diet after my major abdominal surgery.
Except that I already did that. Yesterday morning. And then at lunch my surgeon told me I could go home.
That was almost exactly 48 hours after I was wheeled out of the operating room after Mark removed most of my rectum. But before I could go home I had to have my JP (Jackson Pratt) drain removed, have the dressings changed over that drain site as well as four other laparoscopy sites - one of which was my umbilicus, the medical term for my belly button - and the 10 cm incision site across the bottom of my abdomen. I still had two intravenous catheters in my left hand and arm that needed to be removed as well. I had a discharge prescription for pain killers I didn't think I would need but didn't want to be without just in case, as well as a prescription for 28 days of blood thinner injections that would prevent me getting a DVT that could turn into a pulmonary embolism. The risk of developing this life-threatening complication is increased in all patients having surgery, but for patients having surgery to manage malignancy - like I did - the risk of a clot can be double or even triple that of the risk for patients without cancer. Mark had written my prescriptions but they needed to be faxed to my pharmacy so they could be ready for me when I went home.
It was a lot to do, and I wanted to get out of the hospital as soon as I could.
It's not that the care I received wasn't great. Everyone - and I mean everyone - involved in my care was super. I felt well cared for, I felt like my health was important to them, and I felt like they had the time to talk with me about anything at all that concerned me. I would have thoroughly enjoyed spending more time with them... except that meant being in the hospital.
Nope. Time to go.
"How are you doing after lunch, John?" my nurse asked. She was new to my care but very sweet and insightful. She also works part-time in the colonoscopy screening program that diagnosed my cancer and was coincidentally the nurse who called to schedule my colonoscopy a few months earlier.
"Pretty good. Mark says I can go home!"
I was excited. She was surprised. She had been on lunch when Mark had come to see me and a few people had looked at my chart so it wasn't in the usual spot for processing that it should have been. She went to grab it and before long had a fourth-year nursing student who wanted practice pulling my JP drain as well as a second-year nursing student who had been involved in my care on postop day zero to help. The fourth-year student was confident and professional and had gathered all the supplies she needed to pull my drain; my visitors left, leaving only my wife there to watch and give moral support.
My JP drain emerged from my stomach on the right side of my abdomen not too far above my appendectomy scar. But the business end of the drain - the part that actually drained fluid - was resting on the other side of the inside of my abdomen, down at the lower left of my belly around where my sigmoid colon was now anastomosed to the remnants of my rectum. It had drained an appropriate amount of an appropriate fluid, showing no signs of an anastomotic leak. It had done its job and now it was time for it to come out.
My bedside nurse gave clear, direct instructions to the student nurse who was about to cut the stitch that held the drain in my belly. It took the student nurse a few tries to get the right approach, but a quick snip with a hooked blade released the suture. "Okay. I'm going to pull it out now - one smooth, even movement. Ready?"
"Sure. Go ahead," I told her.
It was probably the weirdest sensation I have ever felt.
We feel things very differently inside our abdomens than we do on the outside. Visceral sensations feel odd and are sometimes difficult to localize compared with when we get a cut or scrape or bruise. I had about 30 cm of tubing inside my belly that had to slide out a tiny hole, disturbing all kinds of visceral sensors along the way. It didn't hurt and I couldn't really feel specific spots that the tubing passed as it left my body, but I felt sort of... squirmy inside as it slid from around my rectum across below my belly button and out the hole smaller than a pen in the right side of my abdomen.
"How was that? Weird?" My bedside nurse asked.
"Very weird!" I said. "I'd rather not do that again."
"One patient I had said that it felt like I was pulling her intestines out of the hole with the JP," she said.
"That's pretty dramatic," I said. I honestly couldn't sense anything as definite as an organ or structure inside me as the tube passed out. It just felt strange - but it was over.
The student nurses put clean dressings on my incision site and over each of the now five holes in my tummy. Mark had already explained that the dressings were not there to protect my wounds, they were there to keep my clothes clean in case the wounds leaked. The only laparoscopy site that had oozed was my umbilicus and my incision had not oozed at all, but the JP exit site had been leaking quite a bit the day earlier requiring two dressing changes. There was a bit of reddish liquid that came out with the JP drain but the student nurse held a wad of gauze over the hole for a few minutes before taking a cautious look.
"All good," she said with a smile as she put a folded piece of gauze on a clean dressing and applied it over the now-vacant JP site, then put dressings over my incision, my belly button, and the three other laparoscopy sites. I thanked her and the other student nurse for their help, smiling at each of them as they cleaned up.
One of my favourite aspects to my job is participating in the training of student pharmacists. Learning how to provide care to patients is a very important part of training that can only be done by doing, not by having someone lecture at you for hours on end. I felt like I was helping these two prospective nurses along their path to their profession by being a good patient, and honestly they did provide very good care for me.
"Okay; let's talk about why you would come back into the hospital," my bedside nurse said as she pulled one IV catheter from the back of my left hand and then turned her attention to the one in my left forearm. Long story short, if any of the following things should happen I was to go directly to the ER;
Except that I already did that. Yesterday morning. And then at lunch my surgeon told me I could go home.
That was almost exactly 48 hours after I was wheeled out of the operating room after Mark removed most of my rectum. But before I could go home I had to have my JP (Jackson Pratt) drain removed, have the dressings changed over that drain site as well as four other laparoscopy sites - one of which was my umbilicus, the medical term for my belly button - and the 10 cm incision site across the bottom of my abdomen. I still had two intravenous catheters in my left hand and arm that needed to be removed as well. I had a discharge prescription for pain killers I didn't think I would need but didn't want to be without just in case, as well as a prescription for 28 days of blood thinner injections that would prevent me getting a DVT that could turn into a pulmonary embolism. The risk of developing this life-threatening complication is increased in all patients having surgery, but for patients having surgery to manage malignancy - like I did - the risk of a clot can be double or even triple that of the risk for patients without cancer. Mark had written my prescriptions but they needed to be faxed to my pharmacy so they could be ready for me when I went home.
It was a lot to do, and I wanted to get out of the hospital as soon as I could.
It's not that the care I received wasn't great. Everyone - and I mean everyone - involved in my care was super. I felt well cared for, I felt like my health was important to them, and I felt like they had the time to talk with me about anything at all that concerned me. I would have thoroughly enjoyed spending more time with them... except that meant being in the hospital.
Nope. Time to go.
"How are you doing after lunch, John?" my nurse asked. She was new to my care but very sweet and insightful. She also works part-time in the colonoscopy screening program that diagnosed my cancer and was coincidentally the nurse who called to schedule my colonoscopy a few months earlier.
"Pretty good. Mark says I can go home!"
I was excited. She was surprised. She had been on lunch when Mark had come to see me and a few people had looked at my chart so it wasn't in the usual spot for processing that it should have been. She went to grab it and before long had a fourth-year nursing student who wanted practice pulling my JP drain as well as a second-year nursing student who had been involved in my care on postop day zero to help. The fourth-year student was confident and professional and had gathered all the supplies she needed to pull my drain; my visitors left, leaving only my wife there to watch and give moral support.
My JP drain emerged from my stomach on the right side of my abdomen not too far above my appendectomy scar. But the business end of the drain - the part that actually drained fluid - was resting on the other side of the inside of my abdomen, down at the lower left of my belly around where my sigmoid colon was now anastomosed to the remnants of my rectum. It had drained an appropriate amount of an appropriate fluid, showing no signs of an anastomotic leak. It had done its job and now it was time for it to come out.
My bedside nurse gave clear, direct instructions to the student nurse who was about to cut the stitch that held the drain in my belly. It took the student nurse a few tries to get the right approach, but a quick snip with a hooked blade released the suture. "Okay. I'm going to pull it out now - one smooth, even movement. Ready?"
"Sure. Go ahead," I told her.
It was probably the weirdest sensation I have ever felt.
We feel things very differently inside our abdomens than we do on the outside. Visceral sensations feel odd and are sometimes difficult to localize compared with when we get a cut or scrape or bruise. I had about 30 cm of tubing inside my belly that had to slide out a tiny hole, disturbing all kinds of visceral sensors along the way. It didn't hurt and I couldn't really feel specific spots that the tubing passed as it left my body, but I felt sort of... squirmy inside as it slid from around my rectum across below my belly button and out the hole smaller than a pen in the right side of my abdomen.
"How was that? Weird?" My bedside nurse asked.
"Very weird!" I said. "I'd rather not do that again."
"One patient I had said that it felt like I was pulling her intestines out of the hole with the JP," she said.
"That's pretty dramatic," I said. I honestly couldn't sense anything as definite as an organ or structure inside me as the tube passed out. It just felt strange - but it was over.
The student nurses put clean dressings on my incision site and over each of the now five holes in my tummy. Mark had already explained that the dressings were not there to protect my wounds, they were there to keep my clothes clean in case the wounds leaked. The only laparoscopy site that had oozed was my umbilicus and my incision had not oozed at all, but the JP exit site had been leaking quite a bit the day earlier requiring two dressing changes. There was a bit of reddish liquid that came out with the JP drain but the student nurse held a wad of gauze over the hole for a few minutes before taking a cautious look.
"All good," she said with a smile as she put a folded piece of gauze on a clean dressing and applied it over the now-vacant JP site, then put dressings over my incision, my belly button, and the three other laparoscopy sites. I thanked her and the other student nurse for their help, smiling at each of them as they cleaned up.
One of my favourite aspects to my job is participating in the training of student pharmacists. Learning how to provide care to patients is a very important part of training that can only be done by doing, not by having someone lecture at you for hours on end. I felt like I was helping these two prospective nurses along their path to their profession by being a good patient, and honestly they did provide very good care for me.
"Okay; let's talk about why you would come back into the hospital," my bedside nurse said as she pulled one IV catheter from the back of my left hand and then turned her attention to the one in my left forearm. Long story short, if any of the following things should happen I was to go directly to the ER;
- Severe or rapidly increasing pain.
- Vomiting more than once
- Inability to pee
- Significant blood with a bowel movement (more than the 1 cup allowable with a colonoscopy)
- Any signs of uncontrolled bleeding because of my blood thinners; change in vision, a headache that doesn't respond to Tylenol, nosebleeds that won't stop with normal treatment, frank blood or black tarry stools when I have a bowel movement, or coffee ground emesis.
- A temperature that lasts more than six hours, chills, or rigors.
I could shower any time I wanted but I am not allowed to spray water in to the incisions, just let it run over them. I am not allowed to sit in a bath or hot tub or go in a pool for 4-6 weeks or until the incisions are completely healed. All of my incisions have SteriStrips instead of sutures or staples, so they will automatically come off in 7-10 days at which point my skin should be relatively healed. I can't tug them off, but if they are coming off at the edges I can trim them and then pull them towards the incision if it's been more than a week (as long as I don't pull ACROSS the incision, of course).
All of my discharge instructions were also given to me in written form before my nurse smiled and thanked me for being a good patient. She closed the door behind her as she left the room and my wife helped me get the clothes I had just worn 48 hours earlier and put them on.
I walked out of the hospital and across to the parking structure, calling people to let them know I had been discharged as my wife drove me home.
And that's it. That's how you escape the hospital. You just have to follow instructions and you'll be home in no time, sleeping in your own bed and wearing your own clothes. Although admittedly, I think my surgical stay was unusually short and I did unusually well postop. Not everyone facing the same surgery I did would be able to go home as quickly as I did; I think I was just really luck to get home so fast!
Such a great ending to a scary story! It’s always better to be home!
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