On Friday, April 3rd, I had surgery to correct a prolapse of the bladder and rectum, a hysterectomy, and various other repairs in the area. In Part One of this blog post, I related the lamentable experience in Mt. Sinai Hospital right after the surgery. This is part two — a snapshot of the aftercare and recovery, and some advice and suggestions for others undergoing similar surgery.
Saturday was as bedeviled as the day of the surgery, beginning with an aide who gave me a toothbrush loaded with toothpaste, and then a washcloth loaded with soap, without any means of rinsing afterwards. I couldn’t stand, so leaned on the sink with one hand and cupped water to my mouth and face with the other. The aide watched me, apparently confused.
Morphine had finally tamed the intractable pain and I had a calm night. I was expected to go home on Saturday, so all IVs, including hydration and morphine, were dismantled. The nurse explained that we had to be sure we had a regimen of oral medications that would work back home, since you can’t take morphine with you.
The oral meds did not work, and a miscommunication between the covering doctor and my nurse resulted in another contentious delay in getting me reasonably comfortable. It wasn’t until the late afternoon, when Dr. K (the surgeon) granted me an extra day in the hospital and thus another night with morphine, that the pain was controlled again.
The main project for the day was to see if I could void the bladder. Dr. K had said 85% of women can, so I wasn’t too worried. I was in robust good health, had been doing yoga every morning for many years, and would fit nicely within the eighty-five percent. For this test the bladder is filled through the Foley catheter with 500 millileters of sterile solution. Then the patient sits for 15 minutes over a plastic “hat” (in the shape of an inverted hat) which is placed under the toilet seat so as to measure how much is voided. With a full bladder pressing on the sutured surgical area, the process was painful. The nurse did not come back after 15 minutes and I was getting dizzy from the pain, so I waited a little longer and then pulled the emergency cord next to the toilet. I thought this would be considered urgent – I might have fallen, hemorrhaged, or passed out — but it was another ten minutes before she arrived. When I complained about the slow response she snapped, “I was with another patient.” I had thought the cord alerted a central area where more than one person would be available for emergencies.
I couldn’t void a drop, and asked first the covering doctor, then the surgeon, why. The first said, “You have a lazy bladder,” and the second, “You have to relax. Female urination can’t happen when you’re tight.” This failure was apparently my fault.
After she walked me back to my bed, the nurse inserted a new Foley catheter – twice. The first was defective, the second was too small in diameter. (This was, after all, the Orthopedic ward not the Gynecology ward.) The covering doctor inserted a third catheter.
With the pain under control and a catheter in place, I slept and healed, and by the time the morphine was removed the next morning, my pain was only a 6 or so, rising only when I moved.
Sunday began with a visit from the covering doctor. I wasn’t happy about going home with a catheter attached to my thigh, so asked if we could try the void test again. She looked annoyed. “Oh no!! You only get one chance in the hospital. If you can’t do it then, you have to wait for your next doctor’s visit.” The surgeon countermanded the covering doctor and I was given the test again, and failed. I wondered what percentage of patients failed the void test twice. I was worried that something had gone wrong, but Dr. K reassured me, “You can never tell. Some women are stitched up and down and pee like a racehorse the next day, and some don’t. Don’t worry about it.”
By the time I left the hospital late Sunday afternoon I had eaten a couple of spoonfuls of mashed potatoes, a tablespoon of potato soup, and a few bites of toast since the Thursday night before the surgery. I couldn’t reach the water on the bedside table and when someone passed me the cup I had to drink sideways, spilling water on the sheet and floor. I was unable to reach the food trays because I could not sit up. The constant hassles and persistent pain, the worry about the stress being put on my husband, and the concern that something had gone wrong in the surgery diverted my attention from a subject I have studied for 40 years – nutrition. This fasting and dehydration weakened me and affected the serious struggles I would have with constipation after I got home.
I arrived in our 18th floor Hoboken apartment late Sunday afternoon with mixed feelings. I was no longer at the mercy of overstressed, disorganized, sometimes nasty, and often incompetent hospital staff…on the other hand, I was on my own. Thank goodness I had a loving and patient husband to take care of me.
Dr. K, had office hours on Wednesday, three days after I went home. On the first Wednesday, I again failed the void test. On the second Wednesday, I partially voided, so Dr. K suggested disconnecting the catheter. He gave my husband a few minutes of training so he could insert a manual catheter and drain the bladder manually if I couldn’t void. (I wonder how many husbands would undertake to do this.)
Back home, I could not void, and we could not thread the manual catheter, so we rushed to the emergency room at Palisades Hospital, where they installed a Foley catheter. They were efficient, pleasant, and timely enough.
Two Fridays after the first surgery, we trekked back to Mt. Sinai for a second surgery. This time, things went smoothly, and I was home that night with no complaints. My failure to void had not been the result of a “lazy bladder” or my inability to relax – there was a large blood clot restricting urine flow, and the sling holding my bladder in place needed to be loosened. Once these obstructions were removed, I passed the void test, and the healing phase began.
The pelvis is a 24/7 factory which cannot be stilled. In yoga, it is the First Chakra, the grounding chakra which connects us to the basic facts of life – sex and reproduction, elimination of wastes, and turning and walking. In such an active environment, stitches and incisions are constantly disturbed, causing pain until the healing is well advanced. Of course, it depends on the kind of surgery — the anterior wall of the vagina has little sensation, but posterior recovery is slower and more painful. The healing process can take weeks or months, and happens in stages.
As I write this, I am five weeks into recovery and still find it difficult to sit or walk for long and the pelvic functions don’t yet work comfortably, but in a week or two I’m expecting to be back to my normal schedule and habits. Friends have told me that they still felt small tweaks of pain or discomfort six months later, but these did not impede their activities.
I’ve gathered some information and advice that I wish I had known before I had this operation. My own anxiety and pain would have been reduced, and it would also have been easier on my husband, who has been patient, innovative, and as helpful a caretaker as I could have hoped for.
PATIENT CHECKLIST: A few days before your operation, your brain begins to prepare for the upcoming trauma. The intake nurse told me that people become forgetful and unreliable. That was true for me. (I even forgot my health care proxy! I had trouble tying the knot of the hospital gown.). It is best to gather your things ahead of time. Some of the items you should remember are:
- An index card listing your medications and dosages, existing conditions and previous operations, allergies, and other pertinent information. Though you fill out similar forms several times before entering the hospital, they’ll keep asking you the same questions again and again.
- Your Health Proxy form.
- Your cell phone AND the charging cord. Be sure your doctor’s direct phone is installed in your Contacts list and that all other relevant phone numbers are at hand.
- Copies of your pre-op tests and the permission letter from your primary care physician. (They can get lost – the hospital did not have my EKG and had to take another one.)
- Discuss the pain management protocols before you become helpless. If I understand Mt. Sinai’s written report correctly, they started me on Percocet; when that didn’t work, they doubled the Percocet. When that didn’t lower the pain level, they tried an anti-cramping medicine; after that, there were no further instructions. Waiting for the doctor to get out of the Operating Room and approve morphine took over an hour, and it took still another hour for the pharmacy to fulfill the order. Given the sophisticated pain management methods in place today, there is no excuse for leaving a patient in level 10 pain for 3-4 hours, but once you are at the mercy of the system, there is nothing you can do about it. Clarify the post-op pain regimen BEFOREHAND.
- Check your upcoming schedule. Recovery times vary, and if you can, you should not plan any professional appearances or other demanding activities for six weeks. If you recover more quickly, you can reinvigorate your schedule; that is preferable to canceling scheduled meetings or appearances, as I had to do.
- Scout out a wheelchair, or rent one. The hospital delivers you to your car in a wheelchair, but you will have to get from the car into your house or apartment, and for the next couple of weeks you might need it to go to doctors’ appointments, or, in my case, the Emergency Room. (We were fortunate. There was an abandoned wheelchair in the storage room of our apartment building.)
- Have some supplies ready for when you get home. These might include sanitary pads (bleeding lasts about two weeks), a bolster for the bed (you can’t raise and lower your bed at home), analgesic wipes (Tucks, Preparation H female wipes), enema supplies and/or laxatives (you won’t know beforehand which will work best), a water bottle that a supine patient can easily drink out of, and stock of soups or light foods. Have recommended pain relievers (in my case, Motrin) on hand.
- Consult your resources outside the allopathic medical community, as they may help you recover more quickly. Dr. K was readily available by phone, but his answer to all problems was yet another medicine. A holistic doctor, nutritionist, acupuncturist, homeopathic doctor, or naturopath may have suggestions and treatments that don’t have side effects, as medicines do, or the risk of unfavorable interactions, increased constipation, or allergies. Acupuncture, homeopathic formulations, and laser treatments speeded my healing.
- Dr. K repeatedly advised frequent soaks in a mineral bath. He said Epsom salts (magnesium sulfate), but my holistic doctor recommended magnesium chloride (I order it online), which was more effective for me. Dr. K said to take three baths a day in the beginning. I still take one such bath a day. It helps calm inflammation, swelling, and pain, and relaxes the whole body.
A final note: If I ever have to undergo another operation, I will free up some of my fortune for a private nurse in the hospital (if possible), and a visiting nurse at home. Besides smoothing my recovery, this would relieve the stress on my caretaker. My husband had enough to do shopping for and cooking food, getting prescriptions, ferrying me to doctors’ appointments, gathering information, fetching things for me, and doing all of the household chores that we usually share.
An experienced nurse would know which symptoms were normal and which needed attention, and could help me get up and about. A nurse could change the bed, maintain a high level of hygiene, and assist as I got all the pelvic systems working again. She would, for example, know how to thread a manual catheter. I went to visit my aunt in her assisted living facility before I could easily sit, and her aide not only brought me a pillow to sit on, but also brought me a little table to lean forward on, thus taking even more pressure off of the healing stitches I was sitting on. I would never have thought of that, or, if I had, would not have walked to the other side of the room to get the little table. Trained aides have tricks and skills that ordinary people wouldn’t think of.
I have healed without a professional nurse, but it would have eased the process to have some help.
If you are interested in learning more about prolapse, this article from Obstetrics and Gynecology International gives some history – this is an ancient affliction. This article from Acupuncture Today gives the acupuncturist’s view of prolapse. You might also search for some patient conversations online. That is where I was forewarned that my recovery would be protracted, not the couple-of-days-then-Motrin recovery my surgeon and primary care physician foresaw.
It’s been a long haul, but on the morning of Sunday, May 10th, five weeks and two days after the surgery, I took my first walk along the river in Hoboken. It was short, only about ten minutes, and left me a bit sore, but I was relieved. There have been moments when I regretted choosing surgery, and I won’t know for a while how my body finally settles in to the changes, but every day I am more comfortable. Now I have to start building up my neglected muscles, and to gain back at least some of the 10 pounds I lost. By next week at this time, my memory will begin to erase the extreme pain and helplessness, and I hope to start enjoying the benefits of the pelvic repairs.