Intensive Care Unit.
I feared this experience almost more than heart surgery itself. At least in surgery you’re unconscious.
I was a broken body hooked to machines, lines, pipes, monitors, drains and tubes. Thanks to the drugs, I couldn’t think or communicate easily. I was in the worst pain.
This blog post is about the nurses and experiences in ICU.
Wake up! It’s the first day of the rest of your life.
My Coronary Artery Bypass Graft (CABG) took place on a Monday morning in mid-April, 2015. It took 3 hours (which was relatively quick). I think I woke up that evening.
If you’ve had an anaesthetic you’ll know that waking up is really annoying. You’re in this amazing deep sleep then somebody goes and wakes you up.
Well, imagine also
- waking up with tubes down your throat
- being unable to breathe or speak
- feeling like you dropped out of the sky and
- landed on a road and
- got run over by a juggernaut
That’s pretty much how I felt on the first day of the rest of my life.
My first memory is panic. I have a hyper-sensitive gag reflex and a fear of choking. The ventilator tube felt as big as a vacuum hose. There were people hovering around watching me wake up. I gesticulated wildly at my throat…
Get this thing out!
I think there was hesitation. I remembered that I had to demonstrate independent breathing before the assisted ventilation could be removed. So, does panicky hyperventilation count?
Eventually, it did. The “vacuum hose” was pulled out. I coughed, spluttered, gagged and made choking noises.
But, yay! First challenge over. The dreaded ventilation tube has gone. One down, how many to go?
In another blog post I told you a nurse gave me a list of what to expect when I woke up in ICU. Well, as horrible as that was, I’m glad she did.
My Fentanyl nightmare
Q: Drugs, drugs on the ward. Who’s the worst one of them all?
A: Fentanyl. No question.
I had access to a PCA pump (Patient Controlled Analgesia) which sounds like a nice idea in theory. You get to dose yourself up with painkillers when you want to. I was encouraged to use it liberally to control pain during sponge baths, repositioning myself, and getting in and out of bed.
Trouble is, I am petite. This fact was frequently exclaimed by the nurses.
Oh wow, look how tiny you are! You are so young and so little!
I bit my tongue. It’s all relative, I thought. They don’t mean to, but it really hurts to hear that. It reminded me how unfair it felt to be in this situation.
I am confident they calculated the maximum dose of Fentanyl for me but I don’t always tolerate drugs well. I got some of the Fentanyl side effects quite badly.
Eventually, I was spaced out, swirling, dizzy, unable to focus. I was seeing double, the world was warping in and out, whirling around in a blur.
I was in a Fentanyl nightmare.
Make it stop!
OK, sure. We’ll give you more drugs.
It was very hard for me to think straight, let alone communicate that I wanted fewer drugs, not more. At one point I had the doctor’s face right up close to mine. He was concerned about my anxiety.
You are too anxious. You need to calm down.
No kidding, Doc! Just stop giving me drugs. I’d rather have the pain.
That was the worst day in ICU.
How to get out of bed with a broken sternum
I soon discovered the sternum is pivotal in movements we take for granted. There is a special technique for getting in and out of bed when your sternum is cut in half.
Try this method for getting out of bed:
- From flat on your back, shimmy your hips rather than your upper body to gently move to the left edge of the bed
As a mad keen dancer, shimmying the hips is my thing!
- Keep your spine as straight as you can. Bend your knees up and roll onto your left side
Notice that your sternum is under pressure in this position and your left arm is underneath you
- Swing both your legs over the side of the bed
- Place your right hand near your left shoulder on the bed
Notice that moving your upper arm involves muscles around your sternum
- Press through your right hand so that you rise vertically through a sideways plane
I have fairly strong triceps and core from years of Pilates, yoga and Barre so for me this step wasn’t difficult.
Mini soapbox rant
Stop thinking that exercise is just for losing weight and looking fab.
Exercise gives you much more than outward changes. It benefits you in ways you cannot start to imagine!
If I had been unfit and unhealthy, then my heart event, surgery and recovery would have happened sooner, been more difficult and taken longer.
Drain, Drain go away.
Over the next 60 hours in ICU, I was gradually released from some of my tethers. The IV drips went, so did the urinary catheter. Many remained to be removed later.
For me in ICU, removing the surgical drains was the worst. It’s not a matter of just pulling them out. It has to be done quickly in a certain way to avoid contamination, air going in, and with minimal pain.
I had 3 drains in my abdomen. Yes, right in the soft fleshy part of the belly where there is nothing bony for the nurses to press against for traction. It took two nurses to pull out each drain. It hurts like hell. Unfortunately, the pain lingers after the drain is gone, thanks to the clever stitches they use.
“Purse string sutures” are nifty stitches placed around the drain tube so when the tube is pulled out, the stitches come together and close the wound.
Things to think about
- How have you felt after waking up from surgery? Relieved, confused, annoyed?
- Did you try the getting out of bed technique? Easy or not?
- Will you change how you think about exercise now?
We have a WINNER!
In the last blog, I asked you to guess the internal diameter of my Lateral Anterior Descending artery (the “Widow Maker”).
Kelly wins with her guess of 0.01 mm. Thanks for your guess, Kelly!
The unobstructed internal diameter is 1.5 mm.
The 98% blockage means that my LAD has an internal diameter of 0.03 mm for blood to squeeze through. Think for a minute, how narrow that is.
You know you are interested when you peruse the references!
If you only read one reference, read this one! It’s short and explains everything about the ICU experience after cardiac surgery. I highly rate this reference!
And this too! It covers things I didn’t talk about – like coughing, eating and drinking.
Techy talk about purse string sutures
Post-surgery recovery – the advantages of being fit
A loyal follower of “The Heart Source” is a fellow WordPress blogger Dr. Jonathan Neal Colter who advocates self-responsibility in health care. This is a philosophy I like too.