5 Things to do that start with P

After heart surgery, I was in the Intensive Care Unit (ICU) for two and a half days then I went to the Cardiac Care Unit (CCU) for four and a half days. It felt like a series of school graduations – from nursery school (preparing for surgery) to primary (ICU) to secondary (CCU) then to university (home!)

This post is about what happened in the Critical Care Unit.

Room 118

Welcome to CCU where you are constantly monitored by heart telemetry and nurses (are supposed to) attend to you faster than a regular ward.

I couldn’t believe it. I was in the same room my mother stayed when she had her pacemaker implanted two years previously. Freaky or what?

hospital tributes

Room 118. The beautiful flowers and cards cheered me up.

The orderly parked me next to the bed and left me there. I waited. Nobody came. I wanted to get onto the bed and lie down. Perhaps a sign of my stupidity or my determination – I’m not sure which – I struggled up and manoeuvred myself onto the bed. I swear I could feel the edges of my sternum grinding together. Moving in any way was extremely painful, never mind getting out of a wheelchair and onto a bed unsupervised.

Needless to say, I didn’t try that again.

For the first couple of days, I was too tired to read and too awake to doze; I was in a persistent twilight zone. My husband and family visited. Emails and texts kept me entertained, I could only smile loudly (too painful to laugh) at jokes people sent me. I even had the rare fortune of being able to exchange texts with my uni mentor in the middle of the night. Thank God for insomniacs.

The “P” Parade

My hours were punctuated with things starting with “P”.

Pills

Ah yes, the inescapable, endless medication. I needed so many tablets! Here’s what I was given:

  • Metoprolol (am & pm) – beta blocker to reduce blood pressure and ease heart effort
  • Pregabalin (pm) – painkiller for nerve pain
  • Rosuvastatin (am) – lowers blood cholesterol
  • Aspirin (am & pm) – “thins” the blood and reduces risk of clot formation; helpful after CABG
  • Magnesium (am & pm) – helps prevent irregular heartbeats after heart surgery
  • Paracetamol (am & pm) – painkiller, said to be helpful with bone pain
  • Heparin injection (am & pm) – another blood “thinner” and to prevent clots
  • If I needed them, I could ask for anti-nausea and extra strength painkillers

Much of the time I had to take these with food. I had zero appetite and breakfast was very hard to face (I mean, just look at the photo – that sludge is meant to be porridge). It took a mammoth effort to force anything down. Those magnesium pills were humungous.

Hospital food

Breakfast. Not yum.

Pills

Take your heart pills, love.

Pillow hugging

Before my operation, I met a female 20-something patient on the ward who’d had an operation on her thymus. She’d had her chest cavity opened and stayed in ICU. It was great to talk to her and get the insider’s perspective. She introduced me to pillow hugging.

Um, what is this? Some kind of new age cult?

There is no need to explain that a cut sternum hurts like hell. Nor is there any need to mention that breathing, coughing and sneezing is totally excruciating. But there’s a morsel of non-medicated relief that comes in the form of a small square pillow wrapped in a towel. Your huggie pillow.

You hold it tightly to your chest to stabilise the broken sternum. It was was handy when I got the hiccups (several times). I think my lungs and diaphragm wanted to kill me.

Physiotherapy

A vital part of recovery from surgery is physiotherapy. These days, patients are encouraged to get out of bed as soon as possible. It’s tempting to think they want to free the bed for someone else, but actually, it’s for your own good and studies prove it.

At any time of the day or evening, the CCU corridor was full of patients hobbling up and down, doing their walking quota for the day. We must have been a sight. Clutching our huggie pillows, wearing pajamas and thick white pressure stockings…

Almost immediately, I had to walk six circuits of the ward at intervals throughout the day. It was nice.

  • It gave me something to do
  • I met people
  • I felt a sense of accomplishment and progress
  • I like ticking things off a list

Four days after the operation, I started a series of exercises for mobilising my upper body.  My poor, sore, battered, bruised and aching upper body. The routine went for six weeks, twice a day and the number of reps increased each week.

The purpose of these was to improve and maintain:

  • Joint flexibility
  • Muscle lengthen and tone
  • Lung function
  • Circulation
  • Heart fitness

When you think about it, it’s not at all natural to saw open a sternum and prise it apart. Ribs get jammed together at the back and weird stuff happens to the collar bones. After you get put back together, the body complains. I don’t blame it. The complaining areas got attention with simple exercises.

  • Neck flexion and extension (looking up and down)
  • Neck side bending (tilting ears to shoulders)
  • Neck rotation (looking side to side)
  • Shoulder circles (rotating shoulders up, around and down)
  • Shoulder rotation (holding hands behind head and rotating elbows in a circle)
  • *Arm swings (moving arms forward and back, like you are marching in North Korea)
  • Trunk rotation (holding arms up at shoulder height then rotating to look behind each side)
  • *Arm cross (with arms long and at shoulder height, crossing them in front of you)
  • *Side stretch (standing straight and bending to each side)

* For some reason, these hurt me the most.

I’ve added a reference at the end of this blog post which illustrates a few of these exercises.

Pulmonary re-inflation

My lungs were fully deflated during the operation. I don’t remember being warned about the after-effects.

It was so hard to breathe! Talking was a challenge. My voice sounded weird. I didn’t realise how many words we normally fit into a single breath.

The physio gave me this gadget to improve and strengthen my lung capacity.

triflow balls

Tri-flow balls. Oh loathsome gadget!

You have to expel your breath then suck as hard as you can on the pipe to raise all three balls to the top. The third (darkest) ball being the biggest challenge. I wanted to cry. I did cry. Would I EVER manage this? I hated this gadget. HATED.

I got my husband to show me if it was easy for healthy people. Yep, a cinch. I felt sorry for myself.

This was my least favourite exercise, so I was relieved when the physio said don’t worry too much about it. Walking and taking regular deep breaths were helping my lung function anyway.

Pain management

It’s easy to forget that I’d also had surgery on my leg. The surgeon removed part of the saphenous vein to use as part of the bypass graft. At night, my leg and big toe were on fire. Such is the joy of nerve pain.

I wore a sexy thick white pressure stocking on each leg. They were difficult to put on and take off because they were very tight and I had to bend to reach them.

Heat packs helped ease muscle pain in my neck and feet. I was taking “heart pills”. Suddenly I wondered if I’d time-travelled to the 2040s and become an octogenarian. Those were the moments that upset me the most.

Preparing to go home

Once I was safely mobile, with lungs inflated, when I could shower standing up unattended, my incisions were uninfected and the chest x-ray showed the sternum clips were stable, I was ready to go home. Well, nearly ready. There were a few leashes left.

I had one last IV infusion of magnesium, iron and potassium.

The incisions in my sternum and leg were taped up with mega-strong surgical tape. The nurses had to peel these off. Meh, just like getting a leg wax? Possibly. I don’t recall it being bad.

Let me tell you what was bad.

Removal of the heart pacing coils. That’s what.

For some reason, I suspected that this was going to be awful. Imagine wires in your heart. Imagine them being quickly pulled out through the fleshy part of your abdomen. It was quick but not quick enough. I am so glad I had my sister’s hand to hold for that procedure.

After that, the central line in my neck was taken away. I didn’t feel that. Is pain relative?

Then the purse-string sutures that had held the surgical drains in place were unpicked. They were in the tickly soft part of my tummy. I can assure you I was not laughing. The nurse had to get another nurse to distract me because I was too tense and making her job difficult.

Last to go, my heart telemetry monitor.

Unleashed. Vulnerable. Unhindered. Nervous. Reborn.

Physically, all that remained were

  • Bruises
  • Incisions
  • Bandages
  • Puncture wounds
  • My madly protruding sternum

Mentally, I gained the “cardiac blues” but dropped other baggage. Let’s talk about this topic another time.

I left the safety of CCU on a bright Sunday in late April 2015. We needed a trolley to carry all the flowers, cards and niece art tributes to the car. I was at once happy, relieved, excited – and absolutely terrified.

This was definitely my re-birthday.

Questions, because that’s what I like:

  • I only had family come to visit. I couldn’t face friends in person or even speak on the phone. If you’ve been in a similar situation, why did you feel this way?
  • Is pain relative?
  • What are the odds of getting the same hospital room as your mother?
  • Why do most of the CCU nurses at The Mount Hospital come from Kerala, India?

References for people who want to know more

  • Management of coagulation during cardiopulmonary bypass (use of heparin)

http://ceaccp.oxfordjournals.org/content/7/6/195.full

  • I think huggie pillows are great, but here’s an article that disagrees

https://www.qualiteam.com/blogs/thequaliteamblog/10601805-pillows-part-of-the-problem-not-the-solution

  • A booklet with the exercises for recovering from a sternotomy

http://vch.eduhealth.ca/PDFs/FD/FD.127.H752.pdf

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