Pain Management

I was deeply overconfident.

I know what to expect, I thought. I was going in for a hysterectomy. I'd had abdominal surgeries before. I've had 3 Cesarean sections and an ectopic pregnancy. I've had bone surgeries, dental surgeries, a three hour surgery to my neck. I understand pain - broken bones, labor, strep throat that hurt so much that I couldn't swallow my own saliva. I've spent 2 1/2 days on a morphine drip. The ectopic pregnancy was the worst pain I've ever had - writhing, thrashing pain that had me wishing that I'd pass out from it.

I've got this, I thought.

I did not have it. I had nothing in my wheelhouse to even prepare me for it.

I'm not a wuss. I actually handle pain quite well. It's not unusual for me to take nothing but Tylenol after a surgery. I tend to wake up in recovery saying, "When can I go home?" I walked through ancient ruins and Disneyland with brand new surgical screws in my feet. I was still unprepared for the first, fierce 24 hours after my hysterectomy.

When I woke up in recovery, I couldn't move or open my eyes. All I knew was that my back hurt, I couldn't breathe, and I wanted my husband. I have a "restricted airway" (read: throat that's smaller than normal), and being intubated creates lots of sticky phlegm, so unless I keep clearing my throat, it closes up and feels as if I can't breathe. (My nose is no help; it's chronically swollen.) I kept clearing my throat and calling for my husband, and someone - I had no idea who, but they seemed to be handling me - kept shushing me and telling me that, "There's no Dan here."

Now, I dislike being the kind of person who tells others how to do their jobs (mostly because I hate being told how to do my job). I'm sure that the recovery nurses have handled more loopy, drugged and irrational patients than I have. But here's how I see it: those who are sick or in pain should be handled the same way that small children and the mentally ill should be. If someone's calling a name, ask who it is. "Is Dan your husband?" If I say "Yes," say, "He'll be here soon." If it turns out that, say, you find out that he's a stalker and I live in fear of him, say, "He can't get in here." The whole point is to comfort, not to panic, the subject. Just telling me that he's not there and I should hush is not comforting.

In fact, it was so panic inducing that I later had trouble with him going to the rest room, because he was out of my sight. This is very uncharacteristic for me, and it is not good. Just a heads up.

Before I could move anything, I became aware of more pains, and things began to make sense. I remembered where I was, and why, and realized that the surgery was over. Someone put something in my mouth - I still don't know if it was just a sip of water or medicine, and I said, "Can't swallow."

"Yes, you can." Well, OK, but not easily.

I tried repeatedly to form coherent thoughts, but full sentences were difficult. "Scoliosis. Back hurts. Need to sit up."

"You can do that later."

"After you get to your room, the bed will be more comfortable."

The back pain is still the worst part of the whole experience. I expected abdominal pain, but it felt like the entire three hour plus surgery had been spent in the worst possible position, and my back screamed.

After they took me to my room - and, thank heaven, my husband was allowed to come with me - the first thing I asked the nurse was, "Can I sit up?" I could. "Can I lean way forward?" Yes, I could. "Can I pull my legs up and lean up like this?"

The best thing my first nurse, Rodger, said to me was, "Well, you're going to just love me, because I'm full of all kinds of 'yes' tonight." Oh, thank heaven.

What I really wanted was to straddle the bed like a horse, or a surfboard, with my legs down either side, then lean all my weight up onto my hands or elbows, but I couldn't quite do that. I was worried about putting my weight on the incision site, but Rodger's "yes" meant that I could. I pitched forward and finally got my back to stop screaming quite so loudly. "Oh, much better. Much better."

Rodger was puzzled. "Your back must have really hurt."

"Scoliosis. Dear heaven. You have no idea."

The problem with hospital beds, beach chairs, recliners - anything made for the comfort of the average person - is that leaning back like that puts pressure on the place in my spine where it kinks to the side, and it makes everything hurt. It also cuts off circulation to my left side. I need to do what causes most people pain, and pitch forward. Sometimes, efforts to make me comfortable will have exactly the opposite effect.

The next three days were all about moving just enough to ease the pain in one part of the body in order to experience some slight relief, but it just transferred the pain to another body part, so soon I'd have to move again. The next 24 hours were a fog of frustration and pain. Every time I started to fall asleep those first few hours, the pulse oxygen monitor - the little clip with the red light that went over my index finger - set off an alarm. Apparently, my breathing slows when I sleep, and the machine shrieked if I dropped below 90% oxygen saturation. (I thought it was overreacting. I never got below 82%.) It also went off if the clip got bumped the tiniest bit off center. More than once, I found myself beating the pulse ox clip against the bed rails, wailing, "Shutupshutupshutupshutup!"

For a while, life condensed down to the 10 minutes between times that I could hit the morphine button. Keeping my eyes open was hard. Sometimes, especially if I already feel bad, any sensory input - sight, sound - will result in an overload similar to motion sickness. You can tell if I'm not feeling well when my communication becomes very staccato. My youngest two kids came to see me, and my youngest daughter kept sharing things that happened that night at youth group, and I'd find myself saying, "Sounds like fun. Now sshh. Too many words." Watching my husband walk across the room caused me to throw up.

Morphine, of course, is notorious for causing nausea and headaches, but I couldn't have oral painkillers until my digestive system started working again. My sinuses felt refrigerated from the oxygen tubes, but removing them made the oxygen monitor shriek.

In general, I hate to be touched when I'm in pain. This is hard for loved ones who try to rub my back or my arm. I tend to bark, "Don't touch me!" I can't stand to have collars ride against my throat, so I left the back of my gown untied and unsnapped. It bothered my husband that it sometimes hung, a la Flashdance, off my shoulders. He'd try to "fix" it, and I'd wrestle the fabric away from him. I'd rather wander topless down the hall than have it ride on my throat. Yeah, good times for everyone.

I try not to be, as my sister calls me, "a curmudgeon." I would hear her voice in my head as I cursed the machinery or the drugs. She'd talked to me just before I went in for surgery. "Remember, they're just trying to keep you alive!" I'm actually a usually reasonable and cooperative patient, and when I know that I won't be, I try to apologize. Having to receive shots in my stomach, I warned the nurse, "I hate to have my tummy touched even when I feel good. I will make weird noises. It's not you, and it doesn't hurt."

Asked if the urine in the catch basin in my bathroom was a normal color, I said, "I'm a woman. I normally see it mixed with water. How the heck would I know what shade it normally is?" By day three, I had a bit of a sense of humor back. My nurse made sure my gown was closed over my rear end, and my response was, "Yeah, everybody'll want one if they see mine." Waiting for me to pass gas - one of those post op milestones that every patient has to hit - I said, "I've spoken to my digestive tract about this. It just isn't listening to me right now." Luckily, my nurse found me amusing.

My nurses and aides were pretty uniformly outstanding. God bless them. My husband offered to take a photo of my last nurse, Sam, and send it to my sister "so she'll be jealous." Young, dark haired and good looking, he was also funny and efficient.

Five days later, I'm home, showering, wearing real clothes and feeling more like a human being. Life is much more pleasant and manageable. I'm stiff, slow and in pain. I'm bruised. Sometimes the abdominal gas feels like a weasel loose inside me. Still, all this is doable. Now I've got this.

After I had my youngest daughter (sixteen years ago) I said to my mother, "I tell myself that I'll never again have to be a patient in a hospital. I know that I'm lying, but it makes me feel better." She humored me. Now I just hope against hope that this was the worst it will ever get.

Because I do NOT want to have to readjust, again, what a 10 on the pain scale feels like. (I use now my friend Steven's swear phrase: "Sweet fancy Moses.")

I won't have to go back to a hospital again, right? I mean, I'm done now, aren't I?

I think I speak for many of us when I say, "I hope so."