by Christopher Graham
One of the places on earth where you least want to find yourself, is in the surgical intensive care unit of a major academic medical center. You can be sure that something has gone very wrong in your life indeed, when you wake up in one of those. People in any kind of ICU are sick. People in the surgical ICUs are usually really sick, and people in the surgical ICUs of major academic medical centers are usually really, really sick.
I sure felt pretty sick when I woke up. The first thing I remember from the ICU is opening my eyes on the first night after surgery. I had apparently been somewhat lucid before this, able to answer things like my name and where I was, but I don’t really remember any of that. I remember things slowly dawning on me. I actually thought I was dreaming at first. But, as awareness returned and my brain started forming long-term memories again, I realized I wasn’t asleep in a dream. No, I was instead living in a proverbial nightmare.
Every breath hurt. My sides were killing me, but I couldn’t figure out why they seemed to hurt more than the incision. In retrospect, I think it was because, when you’re getting an exploratory laparotomy, they put a big oval ring around your belly that stretches and holds everything open, kind of like putting something heavy down on top of an open book to keep it from closing up on you. Whatever the reason, I was pretty sure I was in for a rough night.
And in that assessment, I was correct. The first night was by far the worst in terms of “pain.” I have never been able to sleep on my back. It feels like my tongue falls back in my throat. Since I’ve been a kid, I’ve slept on my sides. I made the foolish mistake of trying to turn on my side the first night. Every nerve ending in my abdomen screamed bloody murder at me, and I fumbled around for the button for the pain pump. I pressed the button, and almost instantaneously, the pain subsided. I was going to be sleeping on my back whether I liked it or not. My mom started crying watching me roll around on the bed in pain like that. I hadn’t seen her look that upset in a long time. My dad shoved a pillow under my knees and set the bed into the sitting position, and that helped a lot. It still felt pretty weird to sleep basically sitting up. It just doesn’t feel like the right way to sleep through the night. Maybe that’s just me.
The other thing that helped was a ton of heavy duty pain-killing drugs. The anesthesiologists had set up a pain pump – what we call in the medical world a “patient controlled anesthesia device” or PCA. The PCA was loaded with a syringe of Dilaudid, a drug which is very similar to morphine and heroin, and which is one of the strongest pain killers we have available. If you have any friends who are nurses or doctors, ask them about Dilaudid. I guarantee they’ve heard of it. It’s what all the drug-seekers in the ER are after. I finally knew why, too. Let’s explain it like doctors: Dilaudid provides excellent analgesia for the treatment of severe post-operative pain, and some of the side effects include significant euphoria and somnolence. Let’s translate to normal talk: Dilaudid relieves really bad pain like after a surgery, and makes you feel so good it’s like you’re high, and it also makes you sleepy.
Opiate medications also depress your respiratory drive if you have too much. That’s how people overdose on heroin (or, more commonly these days, from heroin laced with fentanyl). So they set the PCA with a dose control and a timing lockout so you can’t accidentally kill yourself by hitting it too often. The first night I spent in the ICU was experienced, largely, in 10 or 15 minute intervals. I would hit the PCA because it hurt. The drugs would make me feel much better, but also very tired. I would fall asleep for what, to me, seemed like a significant amount of time (though according to Nicole, these were only perhaps 10 or 15 minute intervals), only to be awoken by the pain rearing its head again, at which point the cycle started all over again. Nicole stayed with me the first night, and after a few hours of watching me do this, she decided to stay up and hit the button for me when the pump was ready so I could actually sleep through the night.
Continue reading in the next installment by Christopher Graham here: Chapter 3 | Part 2: Admitting You Need Help