Tuesday, March 16, 2010

Adventures with Ankles - Part 4 Surgery and After

For the surgery I had an epidural and so was awake.  I warned the anesthesiologist, as I always do, that I needed a stronger dose than he would expect and, as usual, I assumed he didn’t believe me.  I am unusual, in that I am female and yet have an insanely high pain tolerance and this high tolerance to drugs.  No one ever believes me.  I’d had an epidural once before, when Jesse was born, given to me after 40-odd hours of labour, when it appeared I might need a c-section.  (I didn’t.)  It’s supposed to paralyze you from the entry point on the spine down, but after it was administered I could still feel my legs and move them.  I was nervous about the idea of being paralyzed, though, and so didn’t ask for more of the drug, since I’d had enough to take the edge off the contractions and the eventual use of forceps.

This time, though, I did not want to be able to feel anything.  I’m not usually afraid of pain, probably because it’s usually not very bad, but I was terrified twice during this experience, when I knew the joint had to be put back in place and about the surgery.  Fortunately either the anesthesiologist did listen to me or what he used was more potent than what I received 28 years ago, because sure enough, I was paralyzed.

He chose vertebrae about halfway up my ribs.  I’m not sure what he based his decision on, but he spent some time feeling my spine before choosing.  He used a local anesthetic first

This was very strange.  I could think about my legs, think about moving them, feel the command go to them, but was aware they didn’t move.  This was scary.  And strangest of all, I was convinced that both of my legs were in the following position: right next to each other, knees bent, feet flat on the table, even when I lifted my head and could see my right foot in a totally different place.  And when the epidural wore off, I felt my knees gradually unbend until each leg lay straight, just as it truly did.

The surgery was to reposition two bone fragments, strengthen the ankle with assorted bits of hardware and, as the surgeon said, clean things up a bit.

I couldn’t see much, which is kind of too bad, as I think it would have been interesting, but since I didn’t have my glasses, I wouldn’t have seen much anyway.  From what I heard, it involved a lot of hammering, sawing, and the use of chisels.  I learned later that while the drill was a power tool, the other tools weren’t.  Indian music was playing, and at times I quite got into it, especially when one or more of the doctors was singing along.

I must have dozed or drifted at times, because the surgery took two hours, but it didn’t seem that long.

After all the drama about the bed, I received some pain medication and figured I’d just go to sleep.  The surgery had ended at 10 p.m., and by now it was close to midnight.  Feiz had helped Melissa find a hotel ($35 a night) and so I told her to go get some sleep.  She has been a rock all through this, and dealing with most of the stress of being in a strange place and all the logistics. 

A little while later I had to pee, and told one of the nurses.  There seemed to be only two on for the night, and the ward was still stuffed with patients and assorted visitors.

I’d used the washroom during the day.  There were only two stalls for everyone to use, men and women, patients and visitors.  The floor was always wet, although we later figured out that the people here use water to clean themselves after using the toilet, instead of toilet paper.  Still, it seemed less than sanitary, and made the floor slippery, which was a problem for me.  During the day, Melissa helped me into a wheelchair, wheeled me over to the corner where the washroom door was, get me as close to a stall as possible, and then support me while I hopped to the toilet.

I was told after the surgery that I should use a bedpan and not get out of bed.  I was told several things, though, that were later contradicted by things other people told me, and so I was never sure what to believe.  I tended to just trust whatever the latest person told me.  And while I was told that I should stay flat on my back for 24 hours after the epidural or I’d get a bad headache, I was shortly after told that I could sit up a bit.  And I was never told about the risk of paralysis that can occur if there is stress on the spine after a spinal injection, which is the real reason I was supposed to stay flat.  Anyway, when the nurses showed up with a wheelchair, I was glad not to see a bedpan and figured that they knew that a chair would be ok.

Fortunately, I did not suffer any ill effects after moving about.  What did happen, though, was that the nurses did not know how to support a patient with a mobility problem.  When I stood on one foot to get out of the chair, a nurse held out her arm, so I rested my hand on it.  As soon as I’d put some weight on it, in an effort to balance on my one foot, she dropped her arm, and I fell onto my just-repaired foot.

I didn’t fall to the floor, though, and I hopped over to the stall and did what I needed to.  I then got myself back in the wheelchair and back to the bed.

After about fifteen minutes, my ankle started to hurt, and hurt bad.  It was bad enough that I writhed about on the bed and made enough noise that people visiting areas nearby became concerned.  The pain was as bad as after the original injury before the joint was reduced.  I had to call out for a nurse, as even if one walked past my area to a neighbouring one, they ignored me.  I finally got one to come over and told her I thought my ankle was again dislocated.  She was very skeptical, but agreed after some urging on my part, to get the doctor on call to see if I could have some more pain medication.  The doctor came eventually, but told me that as my ankle had just been repaired with a pin, it couldn’t have become dislocated again.  I should have thought to ask her why, if that was the case, I had a cast on and was told to stay off that foot, but of course we never think of the right things to say at the time.  Anyway, she agreed to give me more pain medication, but it didn’t come for over an hour.

It was now past 3 a.m.  Visiting hours were still going strong, a radio blared, cell phones rang constantly, people talked everywhere, out in the center of the room, in the curtained areas.  The people next to me, in my old bed without the curtains, pushed my partition over to make more room, but I couldn’t find the energy to care.  I was crying by then, something I don’t do often.  I didn’t cry with my gall bladder attack, or when I first hurt my ankle, but I cried for that whole hour waiting for the pain medication.  A young man, in a nearby area became very concerned.  I saw him walk by several times, each time coming a bit closer and looking in at me.  I finally spoke to him, since it was clear he wanted to see if he could help but was shy to speak.  I told him I was waiting for the pain med and he went off, presumably to speak to one of the nurses.  After another fifteen minutes or so, it finally came.

They don’t give me enough pain med here, and I had to fight to be given anything at all, since I had received an injection earlier and so couldn’t possibly be experiencing pain.  This new one, even though it wasn’t strong enough, did take the edge off, and when the young man returned, I was able to smile at him and thank him.  He was there with his very pregnant wife.  I’d heard a fetal heart monitor coming from their area, and I sure hope the delivery went smoothly.  In that whole ward, he was the only one who paid any attention to me or seemed to care.

I must hasten to say that other than this one incident, people here have been wonderful, especially once I was transferred out of the ward and into a private room.  The on call doctor must have written in my chart that I thought my ankle was dislocated again, because when the surgeon came by the next morning, he was furious.  More X-rays showed that sure enough, one of the loose pieces of bone had moved away from where it was supposed to be, and others had shifted.  He didn’t want to subject me to another surgery and decided to try a manual adjustment, which basically involved him pulling down and manipulating the ankle while two nurses wrapped their hands around my calf and pulled the other way.  He filled my foot with local anesthetic but despite the fact it wasn’t very effective, I finally decided to grit my teeth and bear it.  It was not fun.  Melissa later told me she cried, too, but she bullied them into letting her be present and she held my hand the whole time.  We were both so exhausted and overwhelmed and just had no resources left to draw upon.

I’m crying now, just thinking of it.  But writing all this is probably good for me, and as I probably will post it on the blog, I am sorry if it is distressing for you.

After the manipulation, the bone piece was closer to where it should be, but not exactly in place.  The surgeon decided to see how things went, saying that I might recover well enough and then, if I wished, I could see a doctor either later on during the cruise or back in Canada.  I am recovering, and the pain is a little less each day.

Anyway, they took me back to the ward, but I now had the surgeon demanding that I be moved.  The first room available was the Executive Suite, the single most expensive room in the hospital.  I do believe this was true, they weren’t just trying to milk more money out of me.  As I said, the people here have been wonderful, going well out of their way to help us.

Moving here was wonderful.  I decided that no matter what the cost, I needed to be somewhere quiet so I could rest.  During the previous night I’d tried to relax my leg, knowing that tense muscles would only add to the problem, but it was so noisy I just couldn’t.  As soon as I was situated in my bed in this room, and it was a bed, not a gurney, I started to relax.

It’s a nice room, with its own bathroom, and a comfortable couch that Melissa can sleep on.  I know she felt terrible for not being with me during the night, but before I told her what had happened, I told her that it was I who had insisted she go to the hotel to get some rest.

I haven’t been allowed to use the bathroom, of course, as I’m still not supposed to get out of bed, and so have become acquainted with bedpans.  Other than that, though, things have been as pleasant as I could hope for.

The nurses here are much better and the room is cleaned twice a day, the sheets changed every day.  I feel somewhat guilty, the white person who apparently needs only the best, and so gets special treatment.  Most people here can’t afford this room, but there had been someone in it when I first arrived, so it does get used by local people.  And Melissa pointed out that most people in the ward were not all that sick.  I still feel bad, but also very grateful that I am receiving what I need to recover.

The nurses have been very respectful and careful.  Only once has someone brought up what happened.  A woman, a nursing supervisor I assumed, came to tell me that her nurses wouldn’t have done anything wrong.  At first she said that I had been told not to get out of bed, but Melissa, who is much more diplomatic than I am, pointed out that I had no reason to mistrust them when they brought the wheelchair. She then wavered, clearly hoping that I would say it was fine, no harm done, but I didn’t.  I did say that it appeared they hadn’t bothered to read my chart and so didn’t know I wasn’t supposed to get out of bed, and she seemed to accept that.

In reality, my problem wasn’t caused by my getting out of bed but by these nurses not knowing how to properly support a patient with mobility problems.  But with the language problem making all communication difficult, because while most people working here know some English, most can’t seem to understand things that they don’t normally discuss in that language, I decided to let it go.  The fact is, though, that this incident caused me an enormous amount of pain and greatly reduced any chance I might have had of being able to put weight on that foot and so move to a walking cast in anything less than a month to six weeks.

My guilt in moving to this room, though, isn’t helped by my realization that the people who are in the ward clearly receive care that is of a lower standard than that received by those who can afford to pay more.  Those of you in the US probably find nothing unusual in this, although I’m curious to hear what you think, as I have no experience with health care in the States, other than an occasional visit to a doctor for one of the kids’ ear infections or something small like that.  In Canada, I’ve noticed no difference at all in the quality of care based on the type of room one is in.  The only difference there I have noticed is between hospitals in Saskatoon, when Jesse was in for issues relating to his Crohn’s.  RUH, which is the teaching hospital and has a good reputation, had too many patients and too few staff on its pediatric ward, while City Hospital was relaxed and fabulous, but he was old enough then to be on an adult ward.  I don’t know if this was a timing issue or what, as Jesse’s other visits to RUH, when he was first diagnosed and during his early years with the disease, were good.

The surgeon talked to us about what we should do when we leave here.  He thought I should return to Canada, but I realized, even before leaving the ship to come here, that there is no better place to convalesce than a cruise ship.  Since most guests are elderly, there are always some in wheelchairs, and the whole ship is designed for easy movement from one area to another.  As I told the surgeon, at home there are a lot of stairs and no room service. On the ship, I can get into the cabin washroom with my walker, as I did before, and use the wheelchair to get to my favorite places, such as the promenade deck and the library.  I can rent movies to watch in the cabin, or I can go to the move theatre when it’s playing something I want to see, as it has areas for wheelchairs. And room service runs 24 hours a day.

Plus, I can continue to teach my writing classes and run the book club.  After the outpouring of love and support I got from so many guests, I feel a need to give back to them.  I know they don’t all take my programs, and would be horrified at the thought that I would risk anything at all for them, but I do know that many of them love the programs and what I can offer.  And there is no reason why I can’t teach a class or run a book discussion from my wheelchair.  Plus, there are those wonderful doctors and nurses on board, and if anything should happen, I can be looked after and return home if necessary.  Frankly, I think the long trip home to Saskatchewan from here would be a far greater danger to me than the relatively shorter flights to India where I can meet the ship.

I assured both surgeon and ship that I would not return unless the surgeon felt it would be all right, and he has agreed.  Melissa will not permit me, at least for the first few days, to get into or out of the wheelchair or move about in it without her being there, and I have agreed to this.  On occasion I can be sensible.  We can order room service for supper and watch a video in our cabin.  Sometimes she can deposit me in one of the very comfortable library chairs, leather with footrests, that I discovered before were perfect for someone with an ankle injury.  I hope that soon she will feel safe to leave me, because I want her to do the things she did before, spend time with friends, go swimming, dance.  She’s been coming to my programs all along, and has been a big help, and so she’ll continue doing that, writing on the flipchart or passing things out, but really, my programs are not very strenuous physically.  My main regret is that I had been going to the gym and now won’t be able to.  I’ll miss those endorphins, but I started thinking about all those fit wheelchair athletes, and Melissa thought that maybe I can start pushing myself around the promenade deck.  Once she decides I’m ready, of course.


  1. It's really a shame that you injured your ankle after the surgery. I sure hope it heals well. It does sound as if you got excellent care and I agree that being on the ship is probably going to be a lot more comfortable for you than being at home. I hope you're able to enjoy at least part of the rest of the cruise!

  2. wow, that is just too much, I admire your strength of character. Hugs.

  3. Judy,

    I have only just read about your ankle trials. Pain and vulnerability are always ultimate tests. I would say you survived both brilliantly. You certainly have lots of writing material from this experience. Linda