I was asked again about my pain level, which was still around a 4. The nurse showed me how to use the morphine pain pump as well as the call button, and explained about my "moon boots" (can't remember the real name). These were similar to an automatic blood pressure cuff that ran the length of each ankle-to-knee and alternated legs between inflating and deflating, the purpose being to promote circulation and decrease the likelihood of blood clots. She then checked my incisions and drain site. At some point I asked for my chapstick and some water. One was permitted, the other was not. I wasn't allowed to drink anything until the next day, after successfully completing a barium swallow leak test. Instead, I was given a cup of ice water with a tiny sponge on a stick in it. This was to be my new best friend for the next several hours. My mouth and lips got very dry very quickly, or so it seemed - it could have been a couple hours, but since the anesthesia was still wearing off I probably wouldn't have known the difference. Nonetheless, my bedside table was constant host to my sponge stick, chapstick, cell phone, and incentive spirometer.
What's an incentive spirometer? See below for a picture! I already knew that I would have one of these, and how to use it. You seal your mouth around the end of the tube, then breathe in slowly and steadily, keeping the small blue bead on the right between the two blue arrows. I was told not to worry about how high I could move the blue disc in the numbered section. Clearly, these people had not met me or any Haydon before. We are competitive. I was required to use it 10 times an hour, every hour that I was awake, in order to help my lungs stay inflated properly and prevent pneumonia. I started off getting up to around 2000 and, over the next couple days, maxed out at an average of 3000. The one time that I achieved 3500 was a victory that I celebrated by...swabbing my mouth with the sponge stick!
Incentive Spirometer. Picture from www.dreamstime.com
Around my 3rd hour of being awake, I realized how grateful I was for the foley catheter that had been placed at the beginning of surgery. I had been watching the IV bag of fluids slowly dwindle and knew that what goes in must somehow come out, and since I wasn't sweating, that meant pee. However, as I was not yet up and about, the catheter took care of everything! I had originally thought that I would somehow have to summon the will to void into the tube, so was especially excited to see that the attached bag had already collected an impressive volume! There was never a feeling of bladder fullness or urgency - the pee just dribbled out as soon as it was made. I couldn't help thinking how much more I could get done in the day if I had one of these permanently. A bit awkward to sling in one's purse, though...
In the late afternoon, a nurse came to get me up for my first walk. I was very ready for this, as I had some discomfort from what I guessed was residual gas in my abdominal cavity, and knew from reading RNY forums that walking frequently would help greatly in resolving this. I was excited to get moving, and started to sit up. Bad plan. No matter how much you try to use only the arms to go from reclining to sitting up, the fact is that the abs get involved. The same abs that had recently been sliced open in 5 small locations. The nurse gave me a lesson that would prove invaluable: roll onto my side in bed, then push myself up into a sitting position, while using my legs as a counter-weight as they swung over the side of the bed. I went slowly, but it worked like a charm. After tying the back of my gown, removing my moon boots, arranging my IV/pain pump pole and attached tubes, catheter bag with thigh garter (ooh sexy), and drain ball, I was ready to go. I shuffled out the door and into the maze of hallways. I went past several rooms and down to the nurse's station, around the bend and back again. It wasn't far, but the nurse was very impressed; she told me that many people only make it as far as their room door the first couple times. I mentally chalked up another point in my Hospital Games (spirometer 0, Rachel 1; other people walking 0, Rachel walking 1). Clearly, I was going to emerge victorious.
I continued to get periodic visits from various nurses, always checking my temperature, blood pressure, oxygen level, heart rate, incisions and drain site, and pain level. For the remainder of the time in hospital I hovered around a 1 or 2 - very mild and nothing to write home about. Mostly, I felt pressure where I assumed there was air lurking, and a "jumbled up" feeling in general. I continued to take regular walks, farther each time, and found that it did indeed help to expel the air - mostly from the lower of the 2 conventional exits.
Upon request, my mother stayed the night with me. I added my CPAP mask to the collection of tubes and wires connected to me for a truly spectacular look. The night was uneventful, with the exception of a few more visits from a nurse for the routine stats updates. By this point I was allowed to walk without a member of staff, as long as one of my family members accompanied me. My mother was a good sport about going for a walk around 6 AM the next morning. A few hours later, I was asked to transfer into a different bed that was waiting in the hallway in order to visit the radiology department for the barium swallow leak test. As part of my pre-op clearance, I'd had one of these before, so I knew what to expect. It was similar to the previous time, except that I was blessedly not required to lie on my front this time and was given a much thinner suspension to drink. Two things were surprising to me: I was instructed to drink through a straw and take big gulps, both of which I had been told numerous times in my pre-op education not to do this early out. I mentioned this to the doctor, who replied that they always do it this way and it doesn't cause a problem. Later when I asked the nurse on the bariatric floor about this practice, she said that her department has been trying to get this changed for ages, as it in fact does have the potential to cause issues. During the study I was asked to change position several times, rolling onto my back and either side at different angles. The tech who stayed in the room with me had obviously dealt with people on pain meds trying to do this before, as she held my hands above my head and provided physical direction to assist me in achieving the proper position. It only took a couple minutes, which I assumed either meant there was nothing wrong, or an obvious leak. I was doubtful about the latter, since I thought I would have probably felt that. Shortly after I returned to my room, my assumption was confirmed when a cup of water was brought in for me to drink.
I was given a 1 oz (2T) medicine cup of water and told that if I could drink it over 15 minutes, and then repeat 3 more times, that I would be cleared to drink at my own pace. I passed this next test with no problem, and was soon brought some chicken broth and a protein gel. It felt like the best meal I had ever "eaten". At this point I was also switched from IV pain meds to oral liquid meds. It wasn't until after the morphine was discontinued in favor of liquid percocet that I realized that a good amount of the "jumbled up" feeling I had been experiencing was, in fact, a mild reaction to the morphine. The liquid percocet had a slightly cough syrupy taste, but it worked wonders as it washed over me within 15 minutes of administration, so I didn't care.
Shortly after, my favorite nurse, Kristen, came in to remove my catheter. By this point I had been poked, prodded, and had various body parts checked and therefore exposed so many times that I had lost all sense of modesty. I was seated in a chair and asked if I should "spread 'em" for her to have better access for the task; like a seasoned pro, she replied that it wasn't necessary, and just pulled it out! After the quick and odd sensation of having a tube exit my bladder and urethra, I was pleased to realize that the recent updates to my care meant that I was that much closer to getting discharged. The first few visits to the bathroom were very "hesitant", which I was told is normal after having a catheter in for over 24 hours, as the urethra gets swollen and it is therefore more difficult for anything to pass through. This difficulty passed over the next couple days.
The only real issue I had during my stay was with the dining staff. Even though the meal receipt on my tray specified a "bariatric clear" diet, I was surprised to find that I was given a lemon water ice (2nd ingredient sugar, not allowed), broth with "bits" in it (not allowed), apple juice without the instruction to cut it with water (not allowed), and regular coffee (not allowed)! The server did not have much knowledge of what was and was not appropriate with this diet, and suggested I call the extension for the dining office listed on the receipt. No one answered. Ever. When replacement broth was brought quite some time later, it too had "bits" in it. Luckily the third time was indeed a charm, and I was able to drink my dinner. Upon discussing it later with Kristen, she told me that she had once witnessed a bariatric patient fresh from surgery eating the chicken nuggets that he had been served. I had thought that I might have been getting a bit obsessive before surgery about research and making sure I knew what had to be done, but I was certainly glad for the knowledge when all this inappropriate options were served; the potential results of consuming these prohibited items, especially that early after surgery, are numerous and extremely unsavory (google "dumping syndrome" if you want a gross mental picture).
I continued taking frequent walks and sipping water. My mother stayed over again the second night. The final morning my surgeon visited with his team, and asked if I was ready to go home. Despite somewhat enjoying being taken care of so completely, I was ready. The process to leave wasn't immediate, but the various tasks kept me busy (read as: not overly annoying). I received instructions about taking medications at home, what to do in case of questions or an emergency, and got the remaining tubes and wires disconnected. In anticipation of having my JP drain removed, I requested another dose of pain meds. This had been strongly advised during the pre-op class, and I'm glad that I listened. Having the drain taken out was as quick as the catheter removal, but a good deal more uncomfortable. It didn't hurt, but was by far the strangest sensation I have ever experienced, as the other end was intertwined with my recently reconfigured insides. I believe I shouted "wooOOOAAAHHH" very loudly as it happened - a result of the mental confusion at the strangeness more than an expression of pain. My father took care of picking up my medications while my sister helped me pack my things. Before much longer, we were on our way home.
On the ride home I was glad for 3 things. First, that I had taken the advice to leave a small pillow in the car. It really helped with the bumps in the road, as I was able to manually compress my abdomen to reduce movement to the area. Second, that my parents had taken a friend's advice to rent an SUV. I took such care getting in and out of the seat that riding in a regular car that was much lower to the ground would have been a good deal more difficult. Third, that I had blown through every milestone at the hospital without any trouble, and could actually see myself succeeding at post-op life.
For those who are wondering what to bring to the hospital for their own surgery, below is my packing list. Those with an asterisk (*) next to them were not needed or used.
To Wear to Hospital
Hard soled slippers
Cami shirt w/shelf bra
Loose PJ pants
To Bring to Hospital
*Sleep eye mask
*Meds/vitamins in weekly holder
Leave in Car
Small pillow (to hold on stomach during ride home)